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1 2 3 4 | Addendum Antennas | Users Manual | 88.98 KiB | June 03 2009 |
M3002-66480 IEEE802.11 a/b/g Dual Band Wireless LAN Module Addendum The operation of the M3002-66480 WLAN Module is permitted only with one of the following antennas:
M3002-66494 _ Manufacturer: Philips Medizin Systeme Bblingen GmbH Type: Dual Band PCB Antenna Stand-alone Antenna Performance:
Maximum Gain 2400MHz-2483.5MHz: 1.42dBi Maximum Gain 5150MHz-5850MHz: 5.86dBi _ _ M8100-66490 Manufacturer: Philips Medizin Systeme Bblingen GmbH Type: Tri-band PCB Antenna Stand-alone Antenna Performance:
Maximum Gain 2400MHz-2483.5MHz: 3.43dBi Maximum Gain 5150MHz-5850MHz: 4.40dBi WTS2450-RPSMA _ _ _ Manufacturer: Centurion Wireless Technologies, Inc. Type: Tri-Band Rod Antenna Stand-alone Antenna Performance:
Maximum Gain 2400MHz-2483.5MHz: 4.66dBi Maximum Gain 5150MHz-5850MHz: 4.36dBi Philips Medizin Systeme Bblingen GmbH Hewlett-Packard-Str. 2, 71034 Bblingen, Germany Telefon +49 (0) 7031 463-0 Telefax +49 (0) 7031 463-2202 Geschftsfhrer: Michael Dreher (Sprecher), Dr. Werner Haas Registergericht Stuttgart Reg.-Nr. HRB 245187, Sitz der Gesellschaft: Bblingen www.philips.com/healthcare
1 2 3 4 | Addendum to User Manual | Users Manual | 66.74 KiB | June 03 2009 |
Addendum to the Instructions for Use 1English Addendum to the Instructions for Use This addendum provides additional or corrected information for the following IntelliVue Instructions for Use (software revision G.01.xx):
MP20-MP90 Patient Monitor (M8000-9001K)
MP5 Patient Monitor (M8105-9001C)
MP2 Patient Monitor (M8102-9001B)
X2 Multi-Measurement Module (M3002-9001B) If your Instructions for Use has a different part number, you may discard this addendum, otherwise please store it with your monitor documentation. CO2 Alarm Specifications For Microstream CO2 in the MP5 and for the M3015A, the CO2 alarm specifications are as follows:
CO2 Alarm Specifications etCO2 High etCO2 Low imCO2 High Delay less than 21 seconds. less than 21 seconds. Adjustment Range 20 to 95 mmHg (2 to 13 kPa) 1 mmHg (0.1 kPa) 10 to 90 mmHg (1 to 12 kPa) 2 to 20 mmHg
(0.3 to 3.0 kPa) Adult/pedi: 10 to 100 rpm Neo: 30 to 150 rpm Adult/pedi: 0 to 95 rpm Neo: 0 to 145 rpm 10 to 40 seconds steps of 1 mmHg
(0.1 kPa) under 20 rpm: 1 rpm steps over 20 rpm:5 rpm steps 5 second steps awRR High awRR Low Apnea delay less than 21 seconds. settings <20 rpm: less than 8 seconds
>20 rpm: less than 21 seconds set apnea delay time + 8 seconds (with 2 m sample lines) or 11 seconds (with 4 m sample lines). IntelliVue Telemetry Transceiver User Information For complete user information, including accessory listings and specifications, for the M4841A/
M4851A TRx/TRx+ IntelliVue Telemetry Transceiver, please refer to the Instructions for Use provided with the device. MP2/X2 Radiofrequency Radiation Exposure Information This equipment complies with FCC radiation exposure limits set forth for an uncontrolled environment. This equipment should be installed and operated with a minimum distance of 20cm between the radiator and the patient or user. The transmitter must not be co-located or operating in conjunction with any other antenna or transmitter. 3 Addendum to the Instructions for Use MP5/MP5T - Intended Use The monitor is intended to be used for monitoring and recording of, and to generate alarms for, multiple physiological parameters of adults, pediatrics, and neonates in a hospital environment. The MP5 and MP5T monitors are also intended for use during patient transport inside the hospital environment; only the MP5 monitor for use during patient transport outside of the hospital environment. The MP5 and MP5T when used with TRx 4841A/4851A IntelliVue Telemetry System Transceiver are intended for use in a hospital environment and during patient transport inside the hospital environment. Measurement Modules You can plug in and unplug modules during monitoring. Insert the module until the lever on the module clicks into place. Remove a module by pressing the lever upwards and pulling the module out. A measurement automatically switches on when you plug the module in, and switches off when you unplug it. Reconnecting a module to the same monitor restores its label and measurement settings, such as alarms limits. If you connect it to a different monitor, the module remembers only its label. 4 2Addendum to the Instructions for Use 2Language 2 2Addendum to the Instructions for Use 3Language 3 3Addendum to the Instructions for Use 4Language 4 4Addendum to the Instructions for Use 5Language 5 5Addendum to the Instructions for Use 6Language 6 6Addendum to the Instructions for Use 7Language 7 7Addendum to the Instructions for Use 8Language 8 8Addendum to the Instructions for Use 9Language 9 9Addendum to the Instructions for Use 10Language 10 10Addendum to the Instructions for Use 11Language 11 11Addendum to the Instructions for Use 12Language 12 12Addendum to the Instructions for Use 13Language 13 13Addendum to the Instructions for Use 14Language 14 14Addendum to the Instructions for Use 5 15Language 15 15Addendum to the Instructions for Use 15Addendum to the Instructions for Use 16Language 16 16Addendum to the Instructions for Use 17Language 17 17Addendum to the Instructions for Use 18Language 18 18Addendum to the Instructions for Use 19Language 19 19Addendum to the Instructions for Use 20Language 20 20Addendum to the Instructions for Use 21Language 21 21Addendum to the Instructions for Use 22Language 22 22Addendum to the Instructions for Use 23Language 23 23Addendum to the Instructions for Use 24Language 24 24Addendum to the Instructions for Use 6
1 2 3 4 | User Manual | Users Manual | 2.74 MiB |
INSTRUCTIONS FOR USE IntelliVue MP2 Patient Monitor Release G.0 with Software Revision G.0x.xx P a t i e n t M o n i t o r i n g Printed in Germany 09/08
*M8102-9001B*
Part Number M8102-9001B 4512 610 28821 S M8102-9001B 1Table Of Contents 1 Installation Installation Checklist Unpacking and Checking the Shipment Mounting the Monitor Mounting the External Power Supply (M8023A) Connecting the Monitor to AC Mains Checking Out the Monitor Operating the Monitor Setting the Date and Time Checking Country-Specific Default Settings Handing Over the Monitor 2 Basic Operation Introducing the IntelliVue MP2 Controls, Indicators and Connectors Extending Measurements Operating and Navigating Operating Modes Understanding Screens Using the XDS Remote Display Using the Visitor Screen Understanding Profiles Understanding Settings Changing Measurement Settings Switching a Measurement On and Off Adjusting a Measurement Wave Using Labels Changing Monitor Settings Checking Your Monitor Revision Getting Started Disconnecting from AC Mains Power Monitoring After a Power Failure Networked Monitoring Capturing Alarm Reports and Printing 3 Whats New?
Whats New in Release G.0?
Whats New in Release F.0?
4 Alarms Visual Alarm Indicators Audible Alarm Indicators Acknowledging Alarms 1 2 3 3 3 5 6 7 7 7 10 10 13 16 22 23 24 24 25 26 27 27 27 28 30 30 31 32 32 32 33 35 36 40 41 42 1 9 35 39 i Pausing or Switching Off Alarms Alarm Limits Reviewing Alarms Latching Alarms Testing Alarms Alarm Behavior at On/Off Alarm Recordings 5 Patient Alarms and INOPs Patient Alarm Messages Technical Alarm Messages (INOPs) 6 Managing Patients Admitting a Patient Quick Admitting a Patient Editing Patient Information Discharging a Patient Transferring Patients 7 ECG, Arrhythmia, ST and QT Monitoring Skin Preparation for Electrode Placement Connecting ECG Cables Selecting the Primary and Secondary ECG Leads Checking Paced Status Understanding the ECG Display Monitoring Paced Patients Changing the Size of the ECG Wave Changing the Volume of the QRS Tone Changing the ECG Filter Settings Selecting Positions of Va and Vb Chest Leads (for 6-lead placement) Choosing EASI or Standard Lead Placement About ECG Leads ECG Lead Fallback ECG Lead Placements Capture 12-Lead EASI ECG Lead Placement ECG and Arrhythmia Alarm Overview Using ECG Alarms ECG Safety Information About Arrhythmia Monitoring Switching Arrhythmia Analysis On and Off Choosing an ECG Lead for Arrhythmia Monitoring Understanding the Arrhythmia Display Arrhythmia Relearning Arrhythmia Alarms About ST Monitoring ii 53 83 89 43 45 49 50 51 51 51 53 59 83 85 85 85 86 89 89 90 90 91 92 93 94 94 95 95 95 96 96 100 101 102 103 104 105 106 106 107 110 111 117 Switching ST On and Off Understanding the ST Display and Windows Updating ST Baseline Snippets About the ST Measurement Points ST Alarms Viewing ST Maps About QT/QTc Interval Monitoring QT Alarms Switching QT Monitoring On and Off 8 Monitoring Pulse Rate Entering the Setup Pulse Menu System Pulse Source Switching Pulse On and Off Using Pulse Alarms 9 Monitoring Respiration Rate (Resp) Lead Placement for Monitoring Resp Understanding the Resp Display Changing Resp Detection Modes Changing the Size of the Respiration Wave Changing the Speed of the Respiration Wave Using Resp Alarms Changing the Apnea Alarm Delay Resp Safety Information 10 Monitoring SpO2 SpO2 Sensors Applying the Sensor Connecting SpO2 Cables Measuring SpO2 SpO2 Signal Quality Indicator (Fast SpO2 only) Assessing a Suspicious SpO2 Reading Changing the Averaging Time Setting the Measurement Mode Understanding SpO2 Alarms Pleth Wave Perfusion Numeric Perfusion Change Indicator Setting SpO2/Pleth as Pulse Source Setting Up Tone Modulation Setting the QRS Volume 11 Monitoring NBP Introducing the Oscillometric NBP Measurement Preparing to Measure NBP 117 118 119 120 122 122 127 130 131 133 133 134 134 137 138 138 139 140 140 140 140 143 143 144 144 145 145 146 146 146 147 148 148 148 148 149 151 152 133 137 143 151 iii Starting and Stopping Measurements Enabling Automatic Mode and Setting Repetition Time Enabling Sequence Mode and Setting Up The Sequence Choosing the NBP Alarm Source Switching Pulse from NBP On/Off Assisting Venous Puncture Calibrating NBP 12 Monitoring Temperature Making a Temp Measurement Calculating Temp Difference 13 Monitoring Invasive Pressure Setting up the Pressure Measurement Zeroing the Pressure Transducer Adjusting the Calibration Factor Displaying a Mean Pressure Value Only Changing the Pressure Wave Scale Optimizing the Waveform Non-Physiological Artifact Suppression Choosing the Pressure Alarm Source Calibrating Reusable Transducer CPJ840J6 Calculating Cerebral Perfusion 14 Monitoring Carbon Dioxide Measuring CO2 using the CO2 Option or M3014A Measuring Mainstream CO2 using M3016A Measuring Microstream CO2 using M3015A Setting up all CO2 Measurements 15 Assigning Two Devices to One Patient How Can You Combine Devices?
Functions Available When the Telemetry Data Window is Displayed Functions Available For Devices Connected Via SRR General Telemetry-related Functions 16 Enhancing Telemetry Monitoring with the Monitor 17 Trends Viewing Trends Setting Up Trends Documenting Trends Trends Databases Screen Trends iv 154 154 154 154 155 155 156 157 158 159 161 162 162 163 163 163 163 165 166 168 171 173 174 177 181 182 182 187 189 192 192 193 157 159 167 177 185 187 18 Recording Starting and Stopping Recordings Overview of Recording Types Creating and Changing Recordings Templates Recorder Status Messages 19 Printing Patient Reports Starting Report Printouts Stopping Reports Printouts Setting Up Reports Setting Up Individual Print Jobs Checking Printer Settings Printing a Test Report Switching Printers On Or Off for Reports Dashed Lines on Reports Unavailable Printer: Re-routing Reports Checking Report Status and Printing Manually Printer Status Messages Sample Report Printouts 20 Care and Cleaning General Points Cleaning the Monitor Disinfecting the Monitor Sterilizing the Monitor Cleaning, Sterilizing and Disinfecting Monitoring Accessories Cleaning Batteries and the Battery Compartment 21 Using Batteries Battery Power Indicators Checking Battery Charge Replacing a Battery Optimizing Battery Performance Battery Safety Information 22 Maintenance and Troubleshooting Inspecting the Equipment and Accessories Inspecting the Cables and Cords Maintenance Task and Test Schedule Troubleshooting Disposing of the Monitor Disposing of Empty Calibration Gas Cylinders 23 Accessories ECG/Resp Accessories NBP Accessories 199 200 200 201 203 204 204 205 206 206 206 207 207 207 208 209 213 214 214 214 215 215 218 220 220 221 222 225 225 226 227 227 227 229 233 199 203 213 217 225 229 v 243 271 234 235 239 239 240 240 240 241 243 244 244 246 246 246 247 248 251 254 255 267 271 277 277 278 281 281 282 283 283 283 286 Invasive Pressure Accessories SpO2 Accessories Temperature Accessories Mainstream CO2 Accessories Sidestream CO2 Accessories Mainstream CO2 Accessories (for M3016A) Microstream CO2 Accessories Battery Accessories 24 Specifications Intended Use Manufacturers Information Symbols Installation Safety Information Altitude Setting Monitor Safety Specifications EMC And Radio Regulatory Compliance Out-Of-Hospital Transport - Standards Compliance Monitor Performance Specifications M4607A Battery Specifications Measurement Specifications Safety and Performance Tests 25 Default Settings Appendix Country-Specific Default Settings Alarm and Measurement Default Settings Alarm Default Settings ECG, Arrhythmia, ST and QT Default Settings Pulse Default Settings Respiration Default Settings SpO2 Default Settings NBP Default Settings Temperature Default Settings Invasive Pressure Default Settings CO2 Default Settings vi 1 1Installation Installation should be carried out by qualified service personnel, either by the hospitals biomedical department, or by Philips Support. If you have purchased a customer-installable bundle, it is assumed that your own hospital personnel will install and, if necessary, configure the monitor. You can contact Philips Support for assistance if required; any assistance will be associated with additional costs. For mechanical and electrical installation, you need technically qualified personnel with a knowledge of english. Additionally, for monitor configuration, you need clinically qualified personnel with a knowledge of the use environment. For further information on Installation, refer to the Service Guide. WARNING Monitor configuration settings must be specified by authorized hospital personnel. For installation of the device as part of a system, always refer to the Service Guide. As the first step in preparing the monitor for use, follow the installation instructions given in this chapter. Installation Checklist Use this checklist to document your installation. Step Task 1 2 3 4 5 Perform initial inspection of delivery, unpack and check the shipment (see Unpacking and Checking the Shipment on page 2). Mount the monitor as appropriate for your installation (see Mounting the Monitor on page 3). Insert the battery into the battery compartment (the battery must always be in the battery compartment during use). Connect the monitor to AC mains via the external power supply using the supplied power cord (see Connecting the Monitor to AC Mains on page 3). Perform Visual, Power On and Functional test blocks (see Checking Out the Monitor on page 5). Perform Safety Tests, if required by local laws and regulations (see Checking Out the Monitor on page 5). Check Box when Task Done 1 1 Installation Unpacking and Checking the Shipment Step Task 6 7 8 Check/set the time and date (see Setting the Date and Time on page 7). Check that the country-specific default settings are appropriate (see Checking Country-Specific Default Settings on page 7) Perform System Test as necessary (see the Service Guide) Check Box when Task Done Unpacking and Checking the Shipment The monitor and any supporting options ordered are supplied packed in protective shipping cartons. Initial Inspection Before unpacking, check the packaging and ensure that there are no signs of mishandling or damage. Open the package carefully and remove the monitor and accessories. Check that the contents are complete and that the correct options and accessories have been delivered. System Components, Accessories and Supplies Comments Monitor with options as ordered ECG accessories NBP accessories SpO2 accessories Pressure accessories Temperature accessories CO2 Accessories External Power Supply including AC power cord and MSL cable Rechargeable battery Instructions for Use Quick Guide Documentation CD-ROM (includes Service Guide and Instructions for Use) 1 optional optional optional optional optional optional 1 1 1 1 1 Claims for Damage If the shipping cartons are damaged, contact the carrier. If any of the equipment is damaged, contact both the carrier and your local Philips service organization for repair or replacement arrangements. Repacking Retain the original packing carton and material, in case you need to return equipment to Philips for service. If you no longer have the original packing materials, Philips can advise you on alternatives. 2 Mounting the Monitor 1 Installation Mounting the Monitor The monitor can be rested on a flat, level surface, hung on the bed rail, or mounted on a wall or on a rollstand. See the Service Guide for details. Mounting the External Power Supply (M8023A) The external power supply (M8023A) can be rested on its rubber feet on a flat, level surface, or mounted as described in the Service Guide. The following pictures show examples of correct (
power supply.
) and incorrect (
) ways to mount the Connecting the Monitor to AC Mains The monitor is an electrical Class II device in which the protection against electric shock does not rely on basic insulation and a protective earth conductor but on double and/or reinforced insulation. 3 1 Installation Connecting the Monitor to AC Mains The monitor has a wide-range external power supply (M8023A) that allows you to operate the monitor from an AC (alternating current) power source of 100 V to 240 V ( 10%) and 50/60 Hz ( 5%). The external power supply also charges the monitors battery. MSL Cable connects to power supply (M8023A) 1 1 2 3 4 4 2 3 AC power cord. Connect to AC mains socket. Connect LAN cable here. For connection to a PC or Information Center. Measurement Link (MSL) cable. Supplies AC input power to the monitor for AC operation and for battery charging. When there is a LAN connection to a PC or Information Center, the MSL cable also carries this data to and from the monitor. Power-on LED. The green light is on when the external power supply is connected to AC mains. WARNING Always use the supplied power cord with the earthed mains plug to connect the external power supply (M8023A) to an earthed AC mains socket. Never adapt the mains plug from the power supply to fit an unearthed AC mains socket. 4 Checking Out the Monitor 1 Installation Do not use AC mains extension cords or multiple portable socket-outlets. If a multiple portable socket-outlet without an approved isolation transformer is used, the interruption of its protective earthing may result in enclosure leakage currents equal to the sum of the individual earth leakage currents, so exceeding allowable limits. Do not connect any devices that are not supported as part of a system. Any non-medical device placed and operated in the patients vicinity must be powered via an approved isolation transformer that ensures mechanical fixing of the power cords and covering of any unused power outlets. Checking Out the Monitor The following table defines which tests and inspections need to be performed, and when they are required. Test Test or Inspection to be Performed Visual Inspect the monitor, measurement accessories and cables for any damage. Power On Functionality Test Safety Tests (1) to (4) System Are they free of damage?
Power on the monitor. Does it start up successfully without errors? Do all alarm lamps light up during power up?
After start up, the monitor sounds a tone, and you can see the monitoring main screen (normally with measurement wave channels and numeric positions). After power up, touch the battery status indicator in the bottom right of the screen. The battery status window should open. Press the blue Main Screen key to close the window and return to the main screen. Perform safety tests (1) to (4), as described in the Service Guide, for standalone devices if required by local laws and regulations, and each time you combine equipment to form a system, or exchange system components. Details of the safety tests and procedures are described in the Service Guide. These safety tests are derived from international standards but may not always be sufficient to meet local requirements. Perform the system test according to IEC 60601-1-1, if applicable, after combining equipment to form a system (see the Service Guide). For test and inspection information regarding repairs, upgrades and all other service events, refer to the Service Guide. 5 1 Installation Operating the Monitor Operating the Monitor To complete installation you will need to operate the monitor to check basic functionality. Here is a quick introduction to the monitor. 1 Switch on the monitor. After start-up the monitor display will become active. You operate the monitor using the touch screen. 2 Touch something on the screen (numerics, waves, other screen items) to enter the corresponding menu. Touching the NBP numeric, for example, brings you to the Setup NBP menu. 3 Touch again to select an item on the menu and work through the menu activities. 4 To access SmartKeys, press the SmartKeys key. Main Setup is one of the SmartKeys. 5 If you cannot find a menu by touching the screen you can always use the Main Setup SmartKey which will get you to all menus on the monitor. 6 Press the Main Screen key to close all open menus/windows and return to the main screen. Press again to enter the Change Screen window, where you can choose from a number of pre-configured screens. 6 Setting the Date and Time 1 Installation Setting the Date and Time To set the date and time:
1 2 3 4 5 Press the SmartKeys key to enter the SmartKeys window. Select the Main Setup SmartKey to enter the Main Setup menu. Select the Date, Time screen element from the monitors info line to enter the Date, Time menu. Select, in turn, the Year, Month, Day, Hour (in 24 hour format, only) and Minute as necessary. Select the correct values from the pop-up list. Select Store Date, Time to change the date and time. If your monitor is connected to an Information Center, the date and time are automatically taken from this. Once it is set, the internal clock retains the setting even when you switch off the monitor. Checking Country-Specific Default Settings Some settings are made in the factory to match the typical requirements in a specific country. Line frequency, units for weight and height, and ECG cable colors (AAMI or IEC) have been set to appropriate values. If you suspect that these settings may not match your institutions requirements, check the settings and change them if necessary as described in the Configuration Guide. WARNING Before starting monitoring, check that the current configuration meets your requirements, especially patient category, alarm limits and paced setting. If you need to enter configuration mode:
1 2 In the Main Setup menu, select Operating Modes. Select Config and enter the passcode. The passcode for configuration mode is given in the monitors service documentation. The monitor displays Config at the right hand side of the status line and in the center of the Screen while you are in configuration mode. Before you leave configuration mode, always be sure to store any changes you made. You must store changes made to each Settings Block and to each Profile, individually. As it may be difficult to remember whether the settings you changed belong to a Monitor Settings block or a Measurement Settings block, we recommend that you store each block before you leave configuration mode. To leave configuration mode:
In the Main Setup menu, select Operating Modes and then select Monitoring. Handing Over the Monitor If you are handing over the monitor to the end-users directly after configuration, make sure that it is in Monitoring mode. 7 1 Installation Handing Over the Monitor Users must be adequately trained to use the monitor before monitoring a patient. To achieve this, they should have access to, and read, the following documentation delivered with the monitor:
Instructions for Use (this book) - for full operating instructions Quick Guide - for quick reminders during use Additionally, we recommend working through the Training Guide for self-training on the monitor before use (not available in all languages). The part number is M8102-944XB, where X is a digit dependent on the language. The English training guide is M8102-9441B. 8 2 2Basic Operation These Instructions for Use are for clinical professionals using the IntelliVue MP2 (M8102A) patient monitor. This basic operation section gives you an overview of the device and its functions. It tells you how to perform tasks that are common to all measurements (such as entering data, switching a measurement on and off, setting up and adjusting wave speeds, working with profiles). The alarms section gives an overview of alarms. The remaining sections tell you how to perform individual measurements, and how to care for and maintain the equipment. Familiarize yourself with all instructions including warnings and cautions before starting to monitor patients. Read and keep the Instructions for Use that come with any accessories, as these contain important information about care and cleaning that is not repeated here. This guide describes all features and options. Your monitor may not have all of them; they are not all available in all geographies. Your monitor is highly configurable. What you see on the screen, how the menus appear and so forth, depends on the way it has been tailored for your hospital and may not be exactly as shown here. In this guide:
A warning alerts you to a potential serious outcome, adverse event or safety hazard. Failure to observe a warning may result in death or serious injury to the user or patient. A caution alerts you to where special care is necessary for the safe and effective use of the product. Failure to observe a caution may result in minor or moderate personal injury or damage to the product or other property, and possibly in a remote risk of more serious injury. Monitor refers to the entire patient monitor. Display refers to the physical display unit. Display Screen and Screen refer to everything you see on monitors display, such as measurements, alarms, patient data and so forth. 9 2 Basic Operation Introducing the IntelliVue MP2 Introducing the IntelliVue MP2 The Philips IntelliVue MP2 monitor provides a comprehensive set of basic physiological measurements: ECG (including ST analysis and optional 10-lead ECG), NBP, SpO2, and optionally invasive blood pressure, temperature and CO2. Through networking it provides information integration, documentation and information access. The MP2 can be used with adult, pediatric and neonatal patients in a hospital environment and during patient transport both inside and outside hospitals. The monitor stores data in trend databases. You can see tabular trends (vital signs) and document them on a central printer. You can view measurement trend graphs, including horizon trends, to help you identify changes in the patients physiological condition. The monitor can be powered by a rechargeable battery, or from AC mains using the external power supply (M8023A). For battery charging, care and status information, refer to the chapter Using Batteries on page 217. Controls, Indicators and Connectors MP2 Overview 4 3 4 2 1 8 5 6 7 6 5 9 1 2 3 4 5 6 7 8 9 On/Standby Switch Power and battery indicators (see MP2 Controls and Indicators on page 11) 3.5-inch TFT LCD touchscreen QVGA display Alarm lamps (see MP2 Controls and Indicators on page 11) Built-in carrying handle Battery eject button Keys (see MP2 Controls and Indicators on page 11) Measurement connectors (see MP2 Patient Connectors, Right Side on page 12) Battery 10 Controls, Indicators and Connectors 2 Basic Operation MP2 Controls and Indicators 6 7 5 4 3 2 8 9 10 11 1 1 On/Standby switch 2 On/Standby LED. Green when 3 4 5 6 7 8 9 monitor is on. Red indicates an error. Battery status LED. Yellow when charging. Flashing red when battery is empty, or a battery malfunction is detected. External power LED. Green when monitor is powered from an external power source. Alarms off indicator. When alarms are suspended, the lamp is red, and the ALARMS OFF message appears on the screen. Active INOP alarm lamp in light blue. Stays lit until active INOP is acknowledged. Active alarm lamp. Red or yellow, depending on alarm level. Stays lit until active alarm is acknowledged. Silence key Alarms key: turns alarms On/Off, or pauses them 10 SmartKeys key: brings up SmartKeys on the screen 11 Main Screen key: closes all open menus/windows and returns to the main screen, or selects current screen. 11 2 Basic Operation Controls, Indicators and Connectors MP2 Patient Connectors, Right Side Symbols (International) Text (English versions only) 1 2 7 4 3 6 5 1 2 3 4 5 6 MP2 Left Side 1 2 3 4 5 6 1 2 3 4 5 6 7 1 2 Pressure (option) Temperature (option) Noninvasive blood pressure SpO2 ECG sync pulse output
(See page 252 for specifications) ECG/Respiration CO2 (option) Loudspeaker MSL Connector. Connects to the external power supply via the MSL cable for AC mains operation, battery charging, and communication with a network. 1 2 12 Extending Measurements 2 Basic Operation Extending Measurements Your monitor is compatible with Philips measurement extensions for use with other IntelliVue patient monitoring devices. These allow you to add specific measurements to those already integrated into your monitor. These measurement extensions are referred to as MMS extensions. MMS Extension M3014A attached to the MP2 The MMS extensions connect to the monitor and use the monitors settings and power. Trend data and measurement settings from the measurements in the extensions are stored in the monitor. WARNING Measurements from a MMS extension are only available when the extension is connected to the monitor, and the monitor is running on AC mains via the external power supply (M8023A). Measurements from a MMS extension connected to the monitor are not available when the monitor is running on battery power. Any measurements on a MMS extension that conflict with those in the monitor cannot be used. For example, only one CO2 measurement is supported. To separate an extension from the monitor, press the release lever and push the extension forward. 13 2 Basic Operation Extending Measurements M3014A, M3015A and M3016A Measurement Extensions The optional M3014A Capnography extension adds mainstream capnography, and optionally one pressure plus either a pressure or a temperature to the monitor. Cardiac Output and Continuous Cardiac Output are not available when used with the MP2. The optional M3015A Microstream CO2 extension adds microstream capnography and optionally either pressure or temperature to the monitor. The optional M3016A Mainstream CO2 extension adds mainstream capnography and optionally either pressure or temperature to the monitor. Only one CO2 measurement at a time is supported. M3014A Capnography M3015A Microstream 1 2 5 7 6 1 3 M3016A Mainstream 2 1 2 4 3 1 2 3 4 Pressure connectors (red) Temperature connector (brown) Mainstream/sidestream connector CO2
(optional) Cardiac Output connector 5 6 7 Inlet Microstream connector CO2 Gas sample outlet 14 Extending Measurements 2 Basic Operation M3012A Hemodynamic MMS Extension MSL Connector to MP2 Pressure connectors
(red) Cardiac Output (orange; optional) Temperature connectors (brown) When attached to the MP2 connected to the external power supply, the optional M3012A Hemodynamic extension adds temperature, pressure, and an additional pressure or a temperature to the monitor. Cardiac Output and Continuous Cardiac Output are not available when used with the MP2. 15 2 Basic Operation Operating and Navigating Operating and Navigating The principle method of operating your monitor is via the touchscreen. Almost every element on the screen is interactive. Screen elements include measurement numerics, information fields, alarms fields, waveforms and menus. There are also four keys to the right of the screen (see also MP2 Controls and Indicators on page 11). These let you:
Key with symbol
(international) Text replaces symbol (English versions only) Silence alarms: the Silence key acknowledges all active alarms by switching off audible alarm indicators and lamps. Switch alarms on or off, or pause alarms. Call up SmartKeys on the screen (see below). Close all open menus/windows and return to the main screen. If you are already in the main screen (no additional menus/
windows are open), then pressing this key opens the Change Screen window, where you can choose from a number of pre-configured screens. To temporarily disable the touchscreen operation, press and hold this key for 2 seconds. Press the key again to re-enable the touchscreen operation. 16 Operating and Navigating 2 Basic Operation A typical main screen looks like this:
4 5 6 7 8 9 3 2 Bed9 Adult Doe, John SpO2 Sinus Rhythm 1mV HR M NBP Sys. All Sett. reset Profile Adult 10 1 11 MP2 Screen Elements Item Description Comments 1 2 3 4 5 6 Alarm volume off indicator Patient name / alarm message field Patient category and bed label / INOP message field is displayed when the alarm volume is set to zero (0). Patient name can be covered by alarm messages or alarms On/Off/Paused message. SpO2 LOW Adult Bed4 HR SpO2 ST-I ST-V6 If red and yellow alarms are active at the same time, they rotate in the alarm field. Bed4 HR Adult ST-I ST-V6 APNEA SpO2 Patient category and bed label can be covered by INOP messages. If there are multiple red/
yellow/cyan INOPs active at the same time, they rotate in the INOP field. APNEA SpO2 ALL ECG ALARMS OFF HR ST-I ST-V6 Network connection indicator Measurement label Paced status Documented in Information Center Instructions for Use. Touch the measurement to enter the measurement setup menu. Displayed below the HR label. 17 2 Basic Operation Operating and Navigating MP2 Screen Elements Item Description 7 8 9 Measurement numeric/values Measurement wave Status line 10 Battery status indicator Comments Touch the numeric to enter the measurement setup menu. Touch the wave to enter the measurement setup menu. Shows information and messages prompting you for action. Gives information about remaining battery charge, estimated operating time, maintenance requirements and malfunctions. See the chapter Using Batteries on page 217. Using the Touchscreen Touch a screen element to get to the actions linked to that element. For example, touch a measurement numeric and the setup menu for that measurement opens. Touch a wave to enter the setup menu for that wave. Measurement Setup Menus Each measurement has a setup menu where you can perform operations or change settings. Typically, the setup menu window covers the whole screen, with the exception of the INOP and alarm message fields, which are always displayed at the top. The following picture is for illustration purposes, and may not exactly represent what you see on the screen. We are using non invasive blood pressure as an example, but all measurement setup windows are similar and share the same basic layout and components. Touch the measurement numeric on the screen to enter the setup menu. Measurement setup menu No Central Monit. NBP Pulse 60
Setup NBP Auto NBPs HIGH 08:28 NBP meas. + autom. cycle started Sys. Alarms :
On Al. from :
Sys Start/
Stop Mode :
Auto Stop All Repeat:
15 min NBP STAT 1 2 3 4 5 Main screen Bed4 Adult Doe, John HR SpO2 Pulse 60 Auto 15 min 18 Operating and Navigating 2 Basic Operation Key to measurement setup menu:
Item Description Comment 1 2 3 4 5 INOP and alarm message field. Wave/numerics window. Status/prompt message. Next page arrows. Measurement menu buttons. These are always displayed at the top of the screen. The main measurement numeric and wave (if applicable) are shown in this window so that you do not lose sight of the current measurement while making changes in the menu. Status/prompt messages related to the measurement menu are displayed below the wave/numerics. General status/prompt messages on the main screen are covered by the measurement setup menu. The menu may have more than one page, as shown here. Move to another page by touching these arrows. Each button has two lines of text. To perform an operation on a measurement, press one of the buttons. Some buttons lead directly to a task. For example, pressing the Start/Stop button for noninvasive blood pressure starts a measurement. Other buttons open a pop-up window, which can have more than one page, from which you make a selection. Again, using noninvasive blood pressure as an example, pressing the Repeat Time button for setting the repetition time opens a pop-
up window from which you pick a time, scrolling if necessary. Main Setup Menu There is usually more than one way to enter a setup menu for a measurement, to change a setting or to execute a task. Some routes are more direct than others. You can use whichever method you find most convenient. Which routes are available to you, however, can vary depending on your monitors configuration. For this reason, this book generally describes entry to a measurements setup menu via the Main Setup menu, as this route is always available and is not subject to configuration dependencies. You can get to all setup windows from the Main Setup menu. You enter the Main Setup menu by pressing the SmartKeys key, then selecting the Main Setup SmartKey. Main Setup menu From here you can get to all setup menus SmartKeys A SmartKey is a configurable graphical key on the screen allowing fast access to frequently used functions. Press the SmartKeys hard key to call up a set of SmartKeys on the screen. Although the selection of SmartKeys available on your monitor depends on the monitor configuration and on the options purchased, the SmartKeys window generally looks like this:
19 2 Basic Operation Operating and Navigating No Central Monit.
SmartKeys NBPs HIGH Start/
Stop Measmt. Select. Admit/
Dischrge Alarm Limits Vitals Trend Profiles Alarm Volume QRS Volume Monitor Standby Touch to view more SmartKeys Main Setup is one of the SmartKeys. enter Main Setup menu - you can get to all setup windows using this key enter standby mode - suspends patient monitoring. All waves and numerics disappear from the display. All settings and patient data information are retained. enter profile menu, or revert to default profile previous Screen change Screen, or revert to default screen quick admit a patient enter patient identification menu to admit/discharge/transfer end case to discharge a patient lock touchscreen operation set alarm limits change alarm volume change screen brightness (not for independent displays) change QRS volume change amplitude (size) of ECG wave review beat labels (annotate arrhythmia wave)
- start/stop manual NBP measurement
- start auto series
- stop current automatic measurement within series re-learn arrhythmia start NBP STAT measurement stop automatic or STAT NBP measurement and measurement series start NBP measurement and measurement series 20 Operating and Navigating 2 Basic Operation start veni puncture (inflate cuff to subdiastolic pressure) stop current NBP measurement set the NBP repeat time access patient reports switch CO2 pump off zero invasive pressure transducer new lead setup set standard or EASI lead placement review vital signs trend review graph trend unpair equipment and continue central monitoring with the monitor unpair equipment and continue central monitoring with the telemetry device start 12-Lead Capture (only available if Information Center is connected) access ST Map application select measurement device Pop-Up Keys Pop-up keys are task-related graphical keys that appear automatically on the monitor screen when required. For example, the confirm pop-up key appears only when you need to confirm a change. Using the On-Screen Keyboard Use this as you would a conventional keyboard. Enter the information by selecting one character after another. Use the Shift key to access uppercase letters. Use the Back key to delete single characters, or use the Clr key to delete entire entries. Select Enter to confirm what you have entered and close the on-screen keyboard. Bed10 Adult Not Admitted Last Name
Q W E
R
T
Y
U
I
) PO A S D F G H J K L
Z X C V B MN
Shift Alt
Back Clr Enter 21 2 Basic Operation Operating Modes Operating Modes 2 1 When you switch the monitor on, it starts up in monitoring mode. To change to a different mode:
Select the Main Setup menu. Select Operating Modes and choose the mode you require. Your monitor has four operating modes. Some are passcode protected. Monitoring Mode: This is the normal, every day working mode that you use for monitoring patients. You can change elements such as alarm limits, patient category and so forth. When you discharge the patient, these elements return to their default values. Changes can be stored permanently only in Configuration Mode. You may see items, such as some menu options or the altitude setting, that are visible but grayed out so that you can neither select nor change them. These are for your information and can be changed only in Configuration Mode. Demonstration Mode: Passcode protected, this is for demonstration purposes only. You must not change into Demonstration Mode during monitoring. In Demonstration Mode, all stored trend information is deleted from the monitors memory. Configuration Mode: Passcode protected, this mode is for personnel trained in configuration tasks. These tasks are described in the Configuration Guide. During installation the monitor is configured for use in your environment. This configuration defines the default settings you work with when you switch on, the number of waves you see and so forth. Service Mode: Passcode protected, this is for trained service personnel. When the monitor is in Demonstration Mode, Configuration Mode, or Service Mode, this is indicated by a box with the mode name in the center of the Screen and a symbol in the bottom right-hand corner. Select this field to change to a different mode. Config Standby Mode Standby mode can be used when you want to temporarily interrupt monitoring. To enter Standby mode, 1 2 Press the SmartKeys key Either select the Monitor Standby SmartKey Or select the Main Setup SmartKey, then select Monitor Standby. The Standby screen looks like this:
22 Understanding Screens 2 Basic Operation STANDBY Press any key or select any field on the screen to resume monitoring The monitor enters Standby mode automatically after the End Case function is used to discharge a patient. Standby suspends patient monitoring. All waves and numerics disappear from the display but all settings and patient data information are retained. A special Standby screen is displayed. If a patient location is entered at the Information Center, this will also be displayed on the Standby screen (availability depends on Information Center revision). To resume monitoring, Select anything on the screen or press any key. Understanding Screens Your monitor comes with a set of pre-configured Screens, optimized for common monitoring scenarios. A Screen defines the overall selection, size and position of waves and numerics on the monitor screen when you switch on. You can easily switch between different Screens during monitoring. Screens do NOT affect alarm settings, patient category and so forth. Switching to a Different Screen To switch to a different Screen:
1 After closing any open menus or windows, press the Main Screen key to access the Change 2 Choose the new Screen from the Change Screens menu. Screens menu. Changing a Screens Content If you do not want to change the entire Screen content, but only some parts of it, you can substitute individual waves, numerics, or trends. Be aware that these changes cannot be stored permanently in Monitoring Mode. To change the selection of elements on a Screen, 1 2 Select the element you want to change. For example, touch the wave to enter the wave setup menu, or touch the numeric to enter the numeric setup menu. From the menu that appears, select Change Wave or Change Numeric, and then select the wave or numeric you want. 23 2 Basic Operation Using the XDS Remote Display 1 Wave B 1 Big Wave Change Screen In the Change Screen menu, the changed Screen is shown linked to the original Screen and marked with an asterisk. Up to three modified Screens can be accessed via the Change Screen menu. To recall Screens, select the name of the Screen in the Change Screen menu After a patient discharge, the monitors default Screen is shown. Modified Screens are still available in the Change Screen menu. If the monitor is switched off and then on again, modified Screens are erased from the monitors memory and cannot be recalled. If a modified Screen was the last active Screen when the monitor was switched off, it is retained (unless Automat. Default is set to Yes in Configuration Mode). Vital Signs B 2 Waves A 2 Waves B Using the XDS Remote Display Using the IntelliVue XDS solution it is possible to view an independent monitor screen on an external display. The XDS solution consists of a medical grade PC-based hardware platform, XDS application software and the XDS connectivity option on the monitor. Depending on the configuration you can also operate the monitor from the external display. The XDS must be connected to the same Local Area Network (LAN) as the monitor. It is also possible to use an existing PC, connected to the same LAN, to host the XDS Application software. For more details, including limitations and restrictions, refer to the Instructions for Use for the XDS Application. Using the Visitor Screen If a visitor Screen is configured for your monitor, you can use it to clear the screen of all waves and numerics but continue to monitor the patient with active alarms and trend storage at the bedside and Information Center. You can change the name of the visitor Screen in Configuration Mode. To activate this Screen, Press the Main Screen key to open the Change Screen menu. Select the name of the visitor Screen configured for your monitor from the list of available Screens. 1 2 To select a Screen with waves and numerics again, Touch the gray rectangle in the center of the screen showing the visitor Screens name, or press the Main Screen key, to open the Change Screen menu and then select a Screen from the list. 24 Understanding Profiles 2 Basic Operation Understanding Profiles Profiles are predefined monitor configurations. They let you change the configuration of the whole monitor so you can adapt it to different monitoring situations. The changes that occur when you change a complete profile are more far reaching than those made when you change a Screen. Screens affect only what is shown on the display. Profiles affect all monitor and measurement settings. The settings that are defined by Profiles are grouped into three categories. Each category offers a choice of settings blocks customized for specific monitoring situations. These categories are:
Display (screens) Each profile can have a choice of many different predefined screens. When you change the profile, the screen selection configured for the new profile becomes active. Measurement Settings Each profile can have a choice of different predefined measurement settings. These relate directly to individual measurements, for example, measurement on/off, measurement color, alarms limits, NBP alarm source, NBP repeat time, temperature unit (oF or oC) pressure unit (mmHg or kPa). Monitor Settings Each profile can have a choice of different predefined monitor settings. These relate to the monitor as a whole; for example, display brightness, alarms off/paused, alarm volume, QRS tone volume, tone modulation, prompt tone volume, wave speed, resp wave speed, pulse source. PAP ZERO+CHECK CAL Doe, John PAP ZERO+CHECK CAL Doe, John Profiles Profile
: Profile Adult Patient Category
: Adult Paced Display
: No
: Vital Signs Profile Measmnt. Adult Patient Measmnt. Pedi Please Confirm To activate the highlighted settings block select Confirm Measmnt.Settings
: Measmt. Adult Please Confirm Confirm Cancel Profiles Menu, showing current settings Available choices in measurement menu. Confirm your choice when prompted. You can change from one complete profile to another or swap individual settings blocks (display screen/monitor settings/measurement settings) to change a subset of a profile. Changes you make to any element within the settings blocks are not saved when you discharge the patient, unless you save them in Configuration Mode. Depending on your monitor configuration, when you switch on or discharge a patient the monitor either continues with the previous profile, or resets to the default profile configured for that monitor. 25 2 Basic Operation Understanding Settings WARNING If you switch to a different profile, the patient category and paced status normally change to the setting specified in the new profile. However some profiles may be setup to leave the patient category and paced status unchanged. Always check the patient category, paced status, and all alarms and settings, when you change profiles. When you leave Demonstration Mode, the monitor uses the default profile. 1 Swapping a Complete Profile Press the SmartKeys key and Either select Main Setup and then Profiles in the Setup menu. Or select the Profiles SmartKey In the Profiles menu, select Profile. 2 3 Chose a profile from the pop-up list. 4 Confirm your selection. Swapping a Settings Block 1 2 Select the Main Setup SmartKey and then Profiles in the Main Setup menu, or select the Profiles SmartKey. In the Profiles menu, select Display or Measmnt. Settings or Monitor Settings to call up a list of the settings blocks in each category. 3 Choose a settings block from the pop-up list. 4 Confirm your selection. Default Profile Your monitor has a default profile that it uses when you leave Demonstration, or Service modes, or when you discharge a patient. This profile is indicated by a diamond
. Locked Profiles Some profiles are locked, so that you cannot change them, even in Configuration Mode. These are indicated by this lock symbol. Understanding Settings Each aspect of how the monitor works and looks is defined by a setting. There are a number of different categories of settings, including, Screen Settings, to define the selection and appearance of elements on each individual Screen Measurement settings, to define settings unique to each measurement, for example, high and low alarm limits 26 Changing Measurement Settings 2 Basic Operation Monitor settings, including settings that affect more than one measurement or Screen and define general aspects of how the monitor works, for example, alarm volume, reports and recordings, and display brightness. You must be aware that, although many settings can be changed in Monitoring Mode, permanent changes to settings can only be done in the monitors Configuration Mode. All settings are reset to the stored defaults:
when you discharge a patient when you load a Profile when the monitor is switched off for more than one minute (if Automat. Default is set to Yes). Changing Measurement Settings Each measurement has a setup menu in which you can adjust all of its settings. You can enter a setup menu:
via the measurement numeric - select the measurement numeric to enter its setup menu. For example, to enter the Setup ECG menu, select the HR (heart rate) numeric. via the Main Setup SmartKey - if you want to setup a measurement when the measurement is switched off, use the Main Setup SmartKey and select Measurements. Then select the measurement name from the popup list. With this permanent key you can access any setup menu in the monitor. via the Measurement Selection key. Switching a Measurement On and Off When a measurement is off, its waves and numerics are removed from the monitors screen. The monitor stops data acquisition and alarming for this measurement. 1 Enter the measurements setup menu and select the measurement. 2 Select the measurement name to toggle between on and off. The screen display indicates the active setting. Adjusting a Measurement Wave To quickly adjust wave-related measurement settings (such as speed or size), select the measurement wave itself. This displays the measurement Wave menu, which has only wave-related measurement settings. Changing Wave Speeds Lowering the wave speed compresses the wave and lets you view a longer time period. Increasing the speed expands the waveform, giving you a more detailed view. The monitor distinguishes two groups of wave speed settings, RespiratorySpeed, for CO2 waves. Global Speed, for all waves not included in the other group. 27 2 Basic Operation Using Labels Changing the Wave Group Speed 1 The wave speed group setting defines the speed of all the waves in the group. To change the wave speed of a wave speed group, Select Main Setup -> User Interface Select Global Speed or RespiratorySpeed, as required Select a value from the list of available speeds. 2 3 Changing Wave Speed for a Channel Select Change Speed. To change the wave speed of an individual wave channel, 1 Enter the Wave menu for a measurement by selecting its wave. 2 3 To set the speed to the wave group speed, select RespiratorySpeed or Global Speed. To set an individual channel speed, select a numeric value from the list of available speeds. This overrides the wave group speed setting and sets the speed for the individual wave channel on the monitor Screen. The wave channel speed is independent of the wave (label) depicted in the channel, if you change the wave, the new wave will retain the set channel speed. Using Labels You can measure up to three invasive pressures and temperatures simultaneously. The monitor uses labels to distinguish between them. The default settings defined in the profile (such as measurement color, wave scale, and alarm settings) are stored within each label. When you assign a label to a measurement, the monitor automatically applies these default settings to the measurement. The labels assigned are used throughout the monitor, in reports, recordings, and in trends. Changing Measurement Labels (e.g. Pressure) To change a measurement label of a measurement with multiple labels (invasive pressure or temperature), 1 Enter the Wave menu of the measurement. 2 Select Label. 3 Choose a label from the list. The monitor automatically applies the scale, color, etc. settings stored in the Profile for the label you select. You can change scale settings in Monitoring Mode, but color can only be changed in the monitors Configuration Mode. Any labels already being used in the monitor are shown grayed-out in the list and cannot be selected. Resolving Label Conflicts Each label must be unique, that is, it can only be assigned once. If you have a MMS Extension equipped with a pressure measurement connected to the monitor, there is a potential conflict with, for example, the ABP label. If you manually enter measurement values these may also conflict with existing labels on the monitor. Depending on your configuration, the monitor will either 28 Using Labels 2 Basic Operation display the Measurement Selection window automatically for you to resolve the conflict take no action, you must enter the Measurement Selection window and resolve the conflict measurement selection key All the currently available measurements are depicted in the Measurement Selection window. Any measurement labels causing a label conflict are shown in red. If a measurement is connected but currently unavailable, for example, because it was deactivated due to a label conflict, that measurement is shown grayed-out. If a MMS Extension is not available, for example if monitor is running on battery power and not an external power source, the MMS Extension is not displayed. Unavailable measurements are grayed-out PAP ZERO+CHECK CAL
*** APNEA Measurement Selection ABP Tcore NBP SpO2 ECG Resp Temp PAP CO2 CPP Temp Change Label De-
Activate Setup SpO2 More A MMS Extension is only shown in the Measurement Selection window when the monitor is connected to the external power supply (M8023A) and running on AC mains power, and not when running on battery power. To resolve a label conflict:
Press the SmartKeys key and Either select Main Setup and then Meas. Selection Or select the Meas. Select. SmartKey to display the Measurement Selection window. Select the label to be corrected. 1 2 3 Use the measurement selection keys to resolve the conflict. Select either:
Change Label: to assign a different label to the conflicting label. De-activate: to disable the conflicting measurement. It retains its label for future use but Setup <Measurement label>: to enter the Setup menu for the measurement and change becomes invisible to the monitor, as though it had been unplugged. the conflicting devices label to a different label. Select the De-activate pop-up key to disable the conflicting measurement. 4 29 2 Basic Operation Changing Monitor Settings Label Compatibility When a new measurement is introduced, or new labels for an existing measurement, these labels will not be shown on older Information Centers, and consequently not on the Overview screen sourced from the Information Center. When a patient is transferred from a monitor with these new labels to one with an older software revision, the labels will be replaced with a generic label for that measurement. The settings for that generic label will then be used. If it is critical that the measurement labels are available at the Information Center and after transfers, the older monitors and the Information Center must be upgraded to the appropriate software revision. Changing Monitor Settings To change monitor settings such as brightness, or QRS tone volume:
1 2
. Press the SmartKeys key Either Enter the Main Setup menu by selecting the SmartKey want to change, or select User Interface to enter a submenu where you can change user interface settings. Or Select the appropriate SmartKey for the setting you want to change. Select the setting you Adjusting the Screen Brightness Select the Brightness SmartKey. Select the appropriate setting for the screen brightness. 10 is the brightest, 1 is the least bright. Optimum is suitable for most monitoring locations and optimizes power usage for battery powered monitors. 1 2 Your monitor may be configured with a lower brightness for Standby mode and also for transport to conserve battery power. These settings can only be changed in the monitors Configuration Mode. Setting the Date and Time If your monitor is connected to an Information Center, the date and time are automatically taken from this. Once it is set, the internal clock retains the setting even when you switch off the monitor. In the Main Setup menu, select Date, Time. Select, in turn, the Year, Month, Day, Hour (in 24 hour format, only) and Minute as necessary. Select the correct values from the pop-up list. Select Store Date, Time to change the date and time. 1 2 3 Checking Your Monitor Revision Select Main Setup -> Revision to open the Monitor Revision menu. Select the correct device from the device pop-up keys. 1 2 30 Getting Started 2 Basic Operation 3 From the Monitor Revision menu, select the monitor component for which you need revision information. Getting Started Once you understand the basic operation principles, you can get ready for monitoring. Inspecting the Monitor WARNING If the monitor is mechanically damaged, or if it is not working properly, do not use it for any monitoring procedure on a patient. Contact your service personnel. 1 Before you start to make measurements, carry out the following checks on the monitor. Check for any mechanical damage. Check all the external cables, plug-ins and accessories. 2 Always ensure that the battery is loaded in the battery compartment when monitoring a patient, even when the monitor is running on external power. 3 If you are using battery power, ensure that the battery has sufficient power for monitoring. Before using a battery for the first time, you must charge it, following the instructions given in the section on Charging Batteries. 4 Measurements from measurement extensions attached to the monitor are only available when the monitor is operating from AC mains power. The measurement extensions are not active when the monitor is operating from battery power. 5 Check all the functions of the instrument that you need to monitor the patient, and ensure that the instrument is in good working order. Switching On Press the on/off switch on the monitor for one second. The monitor performs a self test and is then ready to use. If you see a message such as CO2 SENSOR WARMUP wait until it disappears before starting to monitor that measurement. Power On/Power Off Behavior The general rules determining the behavior of the monitor when connected to, or disconnected from power are as follows:
A monitor that was switched on prior to a temporary power loss switches on again when power is restored. A monitor that was switched off prior to a temporary power loss remains off when power is restored. When AC mains power is lost, a battery powered monitor continues to run without interruption on battery power. Setting up the Measurements 1 Decide which measurements you want to make. 31 2 Basic Operation Disconnecting from AC Mains Power 2 Connect the required patient cables and sensors. The connectors are color-coded to the patient cables and sensors for easy identification. WARNING When connecting devices for acquiring measurements, always position cables and tubing carefully to avoid entanglement or potential strangulation. Starting Monitoring After you switch on the monitor, 1 Admit your patient to the monitor. 2 Check that the profile, alarm limits, alarm and QRS volumes, patient category and paced status and so forth are appropriate for your patient. Change them if necessary. 3 Refer to the appropriate measurement section for details of how to perform the measurements you require. Disconnecting from AC Mains Power To disconnect the monitor from AC mains power, unplug the power cord for the external power supply (M8023A) from the mains socket. Monitoring After a Power Failure If external power is disconnected or there is a power failure, the monitor continues to run on its rechargeable battery. If the monitor is without any power (no external power or the battery is empty) for less than one minute, monitoring will resume with all active settings unchanged. If the monitor is without power for more than one minute, the behavior depends on your configuration. If Automat. Default is set to Yes, the default profile will be loaded when power is restored. If Automat. Default is set to No, all active settings are retained, if power is restored within 48 hours. The Automat. Default setting is made in Configuration Mode. Networked Monitoring You can connect your monitor to an Information Center on a network, using one of the optional interfaces:
Standard wired LAN Wireless LAN IntelliVue Instrument Telemetry System (IIT) WARNING Do not connect patient monitors to the standard hospital network. 32 Capturing Alarm Reports and Printing 2 Basic Operation If your monitor is connected to a network, a network symbol is displayed in the upper left corner next to the bed label. To see details about the monitoring equipment and technical information about the network, select the Main Setup SmartKey to enter the Setup menu, then select Bed Information. Be aware that some network-based functions may be limited for monitors on wireless networks in comparison to those on wired networks. Capturing Alarm Reports and Printing You can print out standard reports, alarm reports and trends with the IntelliVue PC Printing Solution. This is a software package which allows you to print to a standard, off-the-shelf printer or to an electronic file such as PDF. You can download the IntelliVue PC Printing Solution free-of-charge from the Internet and install it on an existing PC. Capturing Alarm Reports The monitor can be set up to automatically capture alarm reports, triggered by selected alarms. The necessary settings must be made in Configuration mode. When one of the selected alarms occurs, the monitor automatically captures the alarm and creates a report which is stored in the database. As soon as the monitor is connected to a PC or network with the IntelliVue PC Printing Solution software, it will automatically print the reports, or send them to a patient-specific folder as an electronic file. 33 2 Basic Operation Capturing Alarm Reports and Printing 34 3 3Whats New?
This section lists the most important new features and improvements to the monitor and its user interface introduced with each release. Further information is provided in other sections of this book. You may not have all of these features, depending on the monitor configuration purchased by your hospital. Whats New in Release G.0?
Short Range Radio Interface for MP2 A short range radio interface is now available for the MP2 monitor. This allows a telemetry transceiver with a short range radio adapter to be assigned to the monitor, resulting in a direct connection. The measurement data from the telemetry transceiver appear directly on the monitor screen with a minimal delay and are combined with the monitor data in one sector at the Information Center. IntelliVue XDS Solution Using the IntelliVue XDS solution it is possible to view an independent monitor screen on an external display. The XDS solution consists of a medical grade PC-based hardware platform, XDS application software and the XDS connectivity option on the monitor. Depending on the configuration you can also operate the monitor from the external display. The XDS must be connected to the same Local Area Network (LAN) as the monitor. It is also possible to use an existing PC, connected to the same LAN, to host the XDS Application software. New Fields in the Admission Form A Middle Name field is now available in the admission form - whether it appears is configurable. Two additional ID fields, Lifetime Id and Encounter Id, can also be configured to appear and their names can be customized to fit hospital requirements. SpO2 Enhancements Additional SpO2 Labels - SpO2pr and SpO2po labels have been added. New manual measurement mode when telemetry devices are connected via a short range radio link. Signal Quality Indicator displayed with the SpO2 numerics. ECG Enhancements New */**Afib yellow alarm when an atrial fibrillation waveform is detected. QT View window - shows current wave and baseline wave with Q and T points marked so that you can verify that the QT algorithm detects correct Q and T points. 35 3 Whats New?
Whats New in Release F.0?
Whats New in Release F.0?
QT/QTc Interval Monitoring QT interval monitoring is used to assist in the detection of prolonged QT interval syndrome. The QT interval is measured and the heart-rate corrected QT value, QTc, is calculated. The monitor also provides a 'QTc value which tracks variation in the QT interval in relation to a baseline value. High alarm limits can be set for QTc and 'QTc enabling alarm notification. Manual Data Entry Measurement values (for example lab data or manually measured temperatures) can be entered manually into the monitor and stored in the database. They can then be used for trends, reports and also be displayed as a numeric on screen, if required. Horizon Trend Enhancements The trend indicator arrow indicates how the patient trend has developed in a set time period. This period is now configurable and can be set to 10 minutes, 5 minutes or 2 minutes. The horizon (or baseline) can now be set to a range or to a specific value. Connecting an MP5 to a Monitor (Companion Mode is indicated) The MP5 monitor can be connected to one of the MP20 to MP90 monitors (then called the host monitor) and used like an MMS. This provides monitoring continuity in transport situations allowing measurement data and patient demographics from the MP5 to be transferred to another monitor. When the MP5 is connected to a host monitor, no alarms will be announced on the MP5. NBP - Programmable Measurement Sequence Up to four measurement cycles can be set up which will run consecutively. For each cycle you can set the number of measurements and the interval between them. By setting the last cycle to run continuously you can have regular measurements continue after the sequence has run. New Printing Options For Reports Reports can now also be printed via an external PC-based print server or to an internal print database, when no printer is available (for example, during transport). As soon as a printer becomes available, the reports stored in the database will print automatically. Manual Pairing At Monitor Previously, devices could only be manually paired at the Information Center. You can now pair devices at the monitor as long as the monitor is already connected to the Information Center. Moving Windows And Menus Windows and menus can now be moved on the monitor screen. Using touch or a mouse you can select the title of a window and then drag it across the screen. Some positions on the screen are not allowed, such as ones overlapping the alarm field or the monitor info line. Invasive Pressure Changes Wave cursor - A cursor is now available on the realtime pressure wave to allow you to define a position and store the corresponding value. Reduced alarm limit steps in lower ranges - The alarm limits setting in 2 mmHg steps is now possible in ranges up to 50 mmHg (previously up to 30 mmHg). 36 Whats New in Release F.0?
3 Whats New?
New Patient Check The monitor can be configured to ask you in certain situations: after a specified power-off period, after a specified standby period and when no basic vitals (HR, RR, Pulse, SpO2, NBP) have been measured for a specified period, whether a new patient is now being monitored. By selecting the Yes pop-up key you can discharge the previous patient and reset settings. New Smart Keys A SmartKey is available for New Lead Setup when a new ECG lead set with fewer leads than previously is being used. Better Visibility Of Gridlines The brightness of the gridlines on the realtime waves has been increased for better visibility. 37 3 Whats New?
Whats New in Release F.0?
38 4 4Alarms The alarm information here applies to all measurements. Measurement-specific alarm information is discussed in the sections on individual measurements. The monitor has two different types of alarm: patient alarms and INOPs. Patient Alarms are red and yellow alarms. A red alarm indicates a high priority patient alarm such as a potentially life threatening situation (for example, asystole). A yellow alarm indicates a lower priority patient alarm (for example, a respiration alarm limit violation). Additionally there are short yellow alarms, most of which are specific to arrhythmia-related patient conditions (for example, ventricular bigeminy). INOPs are technical alarms, they indicate that the monitor cannot measure or detect alarm conditions reliably. If an INOP interrupts monitoring and alarm detection (for example, LEADS OFF), the monitor places a question mark in place of the measurement numeric and an audible indicator tone will be sounded. INOPs without this audible indicator indicate that there may a problem with the reliability of the data, but that monitoring is not interrupted. Most INOPs are light blue, however there are a small number of INOPS which are always yellow or red to indicate a severity corresponding to red and yellow alarms. The following INOPs can also be configured as red or yellow INOPs to provide a severity indication:
ECG LEADS OFF ECG/ARRH ALARM OFF (yellow only, no red INOP) CUFF OVERPRESS CUFF NOT DEFLATED OCCLUSION TELE DISCONNECT. Replace TeleBatt All monitors in a unit should have the same severity configured for these INOPs. Alarms are indicated after the alarm delay time. This is made up of the system delay time plus the trigger delay time for the individual measurement. See the specifications section for details. If more than one alarm is active, the alarm messages are shown in the alarm status area in succession. An arrow symbol next to the alarm message informs you that more than one message is active. n** HR HIGH 39 4 Alarms Visual Alarm Indicators The monitor sounds an audible indicator for the highest priority alarm. If more than one alarm condition is active in the same measurement, the monitor announces the most severe. Your monitor may be configured to increase alarm indicator volume automatically during the time when the alarm is not acknowledged. Visual Alarm Indicators Alarm message: An alarm message text appears in the alarm status area at the top of the screen indicating the source of the alarm. There is a field for INOPs (light blue, red or yellow) and a field for patient alarms, which is shared for red and yellow alarms. If more than one measurement is in an alarm condition, the message changes every two seconds, and has an arrow (
yellow alarm conditions are active simultaneously, they alternate every two seconds in the patient alarms field. The background color of the alarm message matches the alarm priority: red for red alarms, yellow for yellow alarms, light blue for standard INOPs, red for red INOPs and yellow for yellow INOPs. The asterisk symbols (*) beside the alarm message match the alarm priority: *** for red alarms,
** for yellow alarms, * for short yellow alarms. Standard INOPs do not have a symbol, red and yellow INOPs have exclamation marks beside the alarm message: !!! for red INOPs and !! for yellow INOPs. Depending on how your monitor is configured, it may display alarm limit violation messages in text form, for example **SpO2 LOW or in numeric form, for example **SpO2 94<96, where the first number shows the maximum
) at the side. If both red and deviation from the alarm limit, and the second number shows the currently set limit. Flashing numeric: The numeric of the measurement in alarm flashes. Bright alarm limits: If the alarm was triggered by an alarm limit violation, the corresponding alarm limit on the monitor screen is shown more brightly if Show AlarmLimits is enabled and there is sufficient room on the screen. Alarm lamp: A lamp on the monitors front panel flashes. The alarm lamp is divided into two sections. The right one flashes for a patient alarm, except for short yellow alarms where the lamp will light for approximately six seconds. The color is yellow or red corresponding to the highest priority patient alarm currently present. The left one lights continuously for a light blue INOP and flashes for yellow or red INOPs as follows:
INOP Lamp Color Yellow Red Modulation (how long the lamp is on or off while flashing) On 1.0 seconds 0.25 seconds Off 1.0 seconds 0.25 seconds If only patient alarms are present, and no INOPs, the patient alarms will use both left and right sections to flash (for red and yellow alarms) or light for approximately six seconds (for short yellow alarms). If only INOPs are present, and no patient alarms, red and yellow INOPs will use both left and right sections to flash but light blue INOPs will always light continuously in the left section only. 40 Audible Alarm Indicators 4 Alarms Audible Alarm Indicators The audible alarm indicators configured for your monitor depend on which alarm standard applies in your hospital. Audible alarm indicator patterns are repeated until you acknowledge the alarm by switching it off or pausing it, or until the alarm condition ceases (if audible alarm indication is set to non-latching). WARNING Do not rely exclusively on the audible alarm system for patient monitoring. Adjustment of alarm volume to a low level or off during patient monitoring may result in patient danger. Remember that the most reliable method of patient monitoring combines close personal surveillance with correct operation of monitoring equipment. Alarm Tone Configuration The audible alarm indicators of your monitor are configurable. In the monitors Configuration Mode, you can:
increase the alarm volume of unacknowledged alarms at regular intervals change the interval between alarm sounds (ISO/IEC Standard alarms only) change the base volume of the red and yellow alarm tones and the INOP tones change the alarm sound to suit the different alarm standards valid in different countries. Traditional Audible Alarms (HP/Agilent/Philips/Carenet) Red alarms and red INOPs: A high pitched sound is repeated once a second. Two-star yellow alarms and yellow INOPs: A lower pitched sound is repeated every two seconds. One-star yellow alarms (short yellow alarms): The audible indicator is the same as for yellow alarms, but of shorter duration. Standard INOPs: an INOP tone is repeated every two seconds. ISO/IEC Standard Audible Alarms Red alarms and red INOPs: A high pitched tone is repeated five times, followed by a configurable pause. Two-star yellow alarms and yellow INOPs: A lower pitched tone is repeated three times, followed by a configurable pause. One-star yellow alarms (short yellow alarms): The audible indicator is the same as for yellow alarms, but of shorter duration. Standard INOPs: a lower pitched tone is repeated twice, followed by a pause. Changing the Alarm Tone Volume 41 4 Alarms Acknowledging Alarms If you want to see a numerical indication of the current alarm volume on a scale from zero to 10, or change the setting, select the Alarm Volume SmartKey. The volume scale pops up. The current setting is indented. To change the setting, select the required number on the scale. Any settings that are inactive (grayed out) have been disabled in the monitors Configuration Mode. Alarm Volume When the alarm volume is set to zero (off), the alarm volume symbol reflects this. If you switch the alarm volume off, you will not get any audible indication of alarm conditions. Minimum Volume for No Central Monitoring INOP If your monitor is connected to an Information Center, and the connection is interrupted, the INOP message No Central Monit. will appear within 30 seconds, accompanied by an INOP tone. To help ensure that this INOP, and any other active alarm, is not overlooked, the INOP and alarm tones may be configured to have a minimum volume. In this case, INOP and alarm tones will sound even if the monitor alarm volume is set to zero. Minimum Volume for Severe Yellow or Red INOPs Severe yellow or red INOPs require action to ensure the well-being of the patient. Therefore the minimum volume for the INOP tone is set to at least alarm volume 8, irrespective of the current alarm volume setting. The INOP tone will sound even if the monitor alarm volume is set to zero. The severe INOPs for which this applies are:
Cuff Not Deflated (configurable to yellow or red) NBP Cuff Overpress (configurable to yellow or red) Insert Battery (yellow) Acknowledging Alarms To acknowledge all active alarms and INOPs, press the Silence key. This switches off the audible alarm indicators and alarm lamps. A check mark beside the alarm message indicates that the alarm has been acknowledged. If the monitor is configured to re-alarm, a dashed check mark will be shown. If the condition that triggered the alarm is still present after the alarm has been acknowledged, the alarm message stays on the screen with a check mark symbol beside it, except for NBP alarms. When an NBP alarm is acknowledged the alarm message disappears. If the alarm condition is no longer present, all alarm indicators stop and the alarm is reset. Switching off the alarms for the measurement in alarm, or switching off the measurement itself, also stops alarm indication. APNEA 42 Pausing or Switching Off Alarms 4 Alarms Acknowledging Disconnect INOPs Acknowledging an INOP that results from a disconnected transducer switches off the associated measurement. The only exception is ECG/Resp: acknowledging a disconnect INOP for ECG leads does not switch off the ECG and Resp measurements. Acknowledging a disconnect INOP at the Information Center switches off the audible INOP indicator but does not switch off the measurement. Alarm Reminder (ReAlarm) If Alarm Reminder is configured on for your monitor, you will get an audible reminder of alarm conditions that remain active after you have acknowledged the alarm. This reminder may take the form of a repetition of the alarm tone for a limited time, or an unlimited repetition of the alarm tone (this is the same as a new alarm). Alarm reminder is not available for standard, light blue INOPs but for yellow and red INOPs. In Configuration Mode, you can set the interval between silencing the alarm and sounding the reminder tone to one, two, or three minutes. The alarm reminder behavior at the Information Center is different to that at the monitor. Refer to the Information Center Instructions for Use for further information. Pausing or Switching Off Alarms If you want to temporarily prevent alarms from sounding, for example while you are moving a patient, you can pause alarms. Depending on your monitor configuration, alarms are paused for one, two, or three minutes, or infinitely. To view the alarm pause setting chosen for your unit, Select Main Setup -> Alarms -> Alarm Settings 1 2 Check the Alarms Off setting. This setting can only be changed in Configuration Mode. To Pause All Alarms Press the Alarms key. If your monitor is configured to infinite pause time, the lamp next to the alarms off symbol is red, and pressing this key switches alarms off. Depending on the configuration, you may need to select Confirm to complete the change. To Switch All Alarms Off You can only switch alarms off permanently if your monitor is configured to allow infinite alarms pause. Alarms Off 43 4 Alarms Pausing or Switching Off Alarms Press the Alarms key. Pausing alarms infinitely is the same as switching them off. To Switch Individual Measurement Alarms On or Off 1 2 Select the measurement numeric to enter its setup menu. Select Alarms to toggle between On and Off. The alarms off symbol is shown beside the measurement numeric. While Alarms are Paused or Off The red Alarms Paused lamp on the monitor front panel is lit. In the alarm field, the monitor displays the message ALARMS PAUSED or ALARMS OFF, together with the alarms paused symbol and the remaining pause time in minutes and seconds, or alarms off symbol. No alarms are sounded and no alarm messages are shown. INOP messages are shown but no INOP tones are ALARMS PAUSED 1:28 ALARMS OFF sounded. The only exceptions are the INOPs CUFF NOT DEFLATED, CUFF OVERPRESS and INOPs relating to empty, missing and malfunctioning batteries. These INOPs switch the alarms on, and the INOP tones are sounded, even if alarms are paused or off. You need to remove the INOP condition first before you can switch the alarm tones off again. If a NO SENSOR or NO TRANSDUCER INOP is present and alarms are paused or switched off, the measurement in question is switched off. Restarting Paused Alarms To manually switch on alarm indication again after a pause, press the Alarms key again. Alarm indication starts again automatically after the pause period expires. If the monitor is configured to stay paused infinitely, you must select ALARMS OFF again to restart alarm indication. Resetting Arrhythmia Alarm Timeouts To reset the arrhythmia alarm timeout period, press the Alarms key and then press it again. Extending the Alarm Pause Time If your monitor has extended alarm pause enabled, you can extend the alarm pause time. Use this to prevent alarms being indicated, for example, while you are washing a patient or carrying out a procedure. Only extend the alarm pause time when you are sure that clinical personnel are available to monitor the patients condition closely. To extend the alarm pause time to five or 10 minutes, 44 Alarm Limits 4 Alarms 1 2 Select one of the alarm fields. This calls up the Review Alarms window. Select either the pop-up key Pause Al. 5 min or the pop-up key Pause Al. 10 min. Each time you select one of these pop-up keys, the Alarm Pause Time is reset to five (or 10) minutes. Alarm Limits The alarm limits you set determine the conditions that trigger yellow and red limit alarms. For some measurements (for example, SpO2), where the value ranges from 100 to 0, setting the high alarm limit to 100 switches the high alarm off. In these cases, the alarms off symbol is not displayed. WARNING Be aware that the monitors in your care area may each have different alarm settings, to suit different patients. Always check that the alarm settings are appropriate for your patient before you start monitoring. Viewing Individual Alarm Limits 85120 HR 50 Alarm limits You can usually see the alarm limits set for each measurement next to the measurement numeric on the main screen. If your monitor is not configured to show the alarm limits next to the numeric, you can see them in the appropriate measurement setup menu. Select the measurement numeric to enter the menu and check the limits. Viewing All Alarm Limits The Alarm Limits overview window lists the currently set alarm limits for all measurements. If an Apnea alarm delay time is set, this is also shown. The ALARMS OFF symbol is shown beside the measurement label of any measurement whose alarm switched off. To open the Alarm Limits window, either select one of the alarm fields then select the Alarm Limits pop-up key, or select the Alarm Limits SmartKey, if configured. 45 4 Alarms Alarm Limits 1 Alarm Limits Off 2
'QTc SpO2 NBPs ABPs All Lim. Narrow 3 All Lim. Wide 1 Graphic view of current yellow and red alarm limits and currently monitored measurement value Off indicates the measurement is switched off Measurement labels, with alarms off symbol where appropriate 2 3 Select Show ST Limits to expand the list of ST leads and view the currently set alarm limits. Set narrow or wide alarm AutoLimits for all measurements Selecting Hide ST Limits hides the list again. You can use the pop-up keys that open with the Alarm Limits window to perform common tasks:
All Lim. Narrow/All Lim. Wide to set narrow or wide alarm AutoLimits for all measurements. These pop-up keys are not available in the window for changing individual alarm limits which you access by selecting the measurement label in the Alarm Limits window. Changing Alarm Limits To change individual measurement alarm limits using the measurements Setup Menu, 1 2 In the measurements setup menu, select the alarm limit you want to change. This calls up a list of available values for the alarm limit. Select a value from the list to adjust the alarm limit. For example, to change the alarm limits for SpO2:
Touch the high limit on the alarm limits menu button. Choose the high alarm limit from the pop-up list that opens. Touch the low limit on the alarm limits menu button. Choose the low alarm limit from the pop-up list that opens. 46 Alarm Limits 4 Alarms Alternatively, you can use the keys in the measurement Change Limits window, which you access by selecting the measurement label in the Alarm Limits window. 1 ABPs 2 Alarms On/Off 3 4 5 6 7 8 10 9 1 2 3 4 5 6 7 8 9 10 Parameter label High red alarm (view only) High yellow alarm field Select to open a pop-up list of high alarm limits Alarms On/Off key - select to toggle between alarms on or off Preview Alarm AutoLimits for a measurement before applying Select to apply wide AutoLimits Select to apply narrow AutoLimits Low yellow alarm field Select to open a pop-up list of low alarm limits Low red alarm (view only) Graphic view of alarm limits with currently measured value To change alarm limits, 1 Enter the Alarm Limits window. 2 To set the high alarm limit, select the high yellow alarm field to open a pop-up list of high alarm limits. Select a limit from the list. Repeat to set the low yellow alarm field. If you set the yellow alarm limit outside the red alarm limit, the monitor will automatically set the red alarm to the yellow alarm limit. 47 4 Alarms Alarm Limits When an ST measurement is in the Change Limits window there are also two pop-up keys available labeled All ST Narrow/All ST Wide. With these keys you can set Auto Limits for all ST Leads. About Automatic Alarm Limits (AutoLimits) The monitor can automatically set alarm limits suited to your individual patient, using the Automatic Alarm Limits function. This tells the monitor to adapt the alarm limits of selected measurements to the measured vital signs within a defined safe limit. The monitor calculates safe AutoLimits for each patient based on the measured values from the last 12 seconds. The wide and narrow limits have a fixed relationship to the measured value within the non-
pathological range. Outside of this range, no auto limits are calculated. To set values outside of the non-pathological range, limits must be changed manually, based on the clinicians judgement about the specific patient. 3 1 2 2 1 4 Wide alarm limits Narrow alarm limits Alarm Limits Measurement value 1 2 3 4 Limits Narrow sets limits close to the currently measured values for situations where it is critical for you to be informed about small changes in your patients vital signs. Limits Wide sets limits further away from the currently measured values for situations where small changes are not so critical. Use the keys in the Change Limits window to apply AutoLimits for individual measurements. These keys are not available if AutoLimits have been disabled for the measurement in the monitors Configuration Mode. AutoLimits are not available for all measurements. The list of measurements for which AutoLimits can be used is defined in the monitors Configuration mode. Use the Change Limits window to check AutoLimits before you apply them to ensure that they are appropriate for your individual patient and their clinical condition. Once applied, AutoLimits are shown on the monitor screen just like manually-set alarm limits. If the AutoLimits are not appropriate for your patient, you must set alarm limits manually. The limits remain unchanged until you set them again or change them manually. 48 Reviewing Alarms 4 Alarms Documenting Alarm Limits To print a list of all current alarm limit settings on an available printer:
Select the Main Setup SmartKey. Select Reports from the Main Setup menu. Select Alarm Limits. 1 2 3 Reviewing Alarms You can see which alarms and INOPs are currently active in the respective alarms and INOPs fields at the top of the screen. To review the history of alarms and INOPs, select the alarms or INOPs field to open the Review Alarms window. All alarms and INOPs are erased from the Review Alarms window when you discharge a patient, or if you change to Demonstration Mode. Review Alarms Window The Review Alarms window contains a list of the most recent alarms and INOPs with date and time information. Review Alarms 23 Apr 14:08:30 23 Apr 14:08:30 23 Apr 14:08:19 23 Apr 14:42:55
***Apnea Alarms Silenced
**AwRR LOW (14<15)
**SpO2 NON-PULSAT. Alarm Limits PauseAl. 5 MIn PauseAl. 10 MIn If configured to do so, each alarm is shown with the alarm limit active when the alarm was triggered and the maximum value measured beyond this limit. The Review Alarms window also shows when the monitor was switched on (after being switched off for longer than 1 minute) and any changes made to the Alarms On/Off, Standby, Silence or ECG source. When you select an item from the list, you can get additional information about that item. If you select a high or low limit alarm in the list, the Graphical Trends window will open to provide further data. If you select an alert other than a high or low alarm, a help text window opens with more information. Some items in the list are simply log items not related to a patient alert as such (for example, Alarms On or Alarms Off). You cannot see any further information if you select one of these items. When you close these windows you will return to the Review Alarms window. The information in the Review Alarms window is deleted when a patient is discharged, and when you leave Demonstration Mode. 49 4 Alarms Latching Alarms The Review Alarms window pop-up keys appear when the window is opened. If alarm pause extension is disabled, the pause pop-up keys are inactive. Alarm Limits Pause Al. 5 Min. Pause Al. 10 Min. Latching Alarms The alarm latching setting for your monitor defines how the alarm indicators behave when you do not acknowledge them. When alarms are set to non-latching, their indicators end when the alarm condition ends. Switching alarm latching on means that visual and/or audible alarm indications are still displayed or announced by the monitor after the alarm condition ends. The indication lasts until you acknowledge the alarm. Viewing the Alarm Latching Settings To see the alarm latching setting for your monitor 1 2 In the monitors Main Setup menu, select Alarms. Select Alarm Settings, and see the Visual Latching and Audible Latching settings. This setting can only be changed in Configuration Mode. You should be aware of the settings chosen for your unit. There are three possible choices each for visual and audible latching, Red, Red and Yellow, and Off. These choices can be combined to give the following settings:
Visual Latching Audible latching R&Y R R&Y Off R&Y R&Y Off Off R Off R R R = red alarms, Y = yellow alarms Alarm Latching Behavior Red and Yellow Measurement Alarms Non-latching alarms Visual and audible latching Visual latching, audible non-latching Alarm has not been acknowledged. Alarm has been acknowledged. Alarm condition still present. Alarm condition no longer present. Alarm condition still present. Alarm condition no longer present. Alarm tone on. Alarm lamp on. Alarm message. Flashing numerics. All audible and visual alarm indicators automatically stop. Alarm tone on. Alarm lamp on. Alarm message. Flashing numerics. Alarm message. Flashing numerics. Audible alarm indicators automatically stop. Alarm tone off. Alarm lamp off. Alarm message. Flashing numerics. Audible alarm reminder (if configured). Audible and visual alarm indicators automatically stop. All INOPs are non-latching. See Yellow Arrhythmia Alarms on page 112 for information on one-star yellow alarms latching behavior. 50 Testing Alarms Testing Alarms 4 Alarms When you switch the monitor on, a selftest is started. You must check that the alarms lamps light, one after the other, and that you hear a single tone. This indicates that the visible and audible alarm indicators are functioning correctly. For further testing of individual measurement alarms, perform the measurement on yourself (for example SpO2 or CO2) or use a simulator. Adjust alarm limits and check that appropriate alarm behavior is observed. Alarm Behavior at On/Off When you switch alarms on, the settings defined in the currently active Profile are used. If the monitor is switched off for longer than one minute and then switched on again, or after a loss of power lasting longer than one minute, or when a patient is discharged, the monitor can be configured to restore either the alarm settings from the monitor's configured default Profile, or the most recently used alarm settings. After any of these situations, you should check that the alarm settings are appropriate for your patient, and if necessary, select the correct Profile and patient category. If power is lost for less than one minute, the alarm settings prior to the power loss are restored. Alarm Recordings 1 2 3 4 5 You can set up your monitor so that it automatically triggers alarm recordings at the Information Center, or if configured, to a printer as a realtime report. Press the Main Setup SmartKey. Select Alarms from the Main Setup menu. Select Alarm Recording from the Alarms menu to open the Alarm Recordings menu. Select a measurement from those listed for which you want to change the alarm condition that triggers an alarm recording. This opens a pop-up list. For the desired measurement(s), choose the alarm condition to trigger an alarm recording:
Red Only: an alarm recording will automatically be triggered when the measurement enters a red alarm condition. Red&Yell: both yellow and red alarms will trigger an alarm recording. Off: disables automatic alarm recording. Refer to the chapter Recording for details of how to set up a recording. 51 4 Alarms Alarm Recordings 52 5 5Patient Alarms and INOPs This chapter lists patient alarms and technical alarms (INOPs) alphabetically, irrespective of their priority. INOPs start on page 59. All alarms and INOPs are listed here; the ones which can appear on your monitor will depend on the model and the individual options. Patient Alarm Messages The measurement labels and abbreviations for pressure, temperature, SpO2, and anesthetic agent alarms are explained in the individual chapters. Some alarms may be shown at the Information Center in shortened form, when transferred through IntelliVue Instrument Telemetry. These shortened alarm texts are included in the list and identified with the note at Information Center. Note that yellow arrhythmia alarms may be shown with one or with two stars, depending on your monitor configuration and the Information Center revision you are using. Refer to your IntelliBridge Device Driver Instructions for Use for patient alarms from connected external devices. Alarm Message
*/**AFIB
***APNEA or
***APNEA mm:ss sec or
***APNEA >10min
***ASYSTOLE
**awRR HIGH
**awRR LOW
**BIS HIGH From Condition Indication ECG/
Arrhythmia CO2, Resp, Spirometry Atrial fibrillation waveform detected Respiration has stopped for longer than the preset apnea time. mm:ss denotes the Apnea duration in minutes and seconds. ECG CO2, Resp, AGM No QRS detected for a period greater than the asystole threshold (in the absence of Vfib or chaotic ECG). The airway respiration rate has exceeded the high alarm limit. CO2, Resp, AGM The airway respiration rate has dropped below the low alarm limit. BIS The Bispectral Index value has exceeded the high alarm limit. yellow alarm lamp, short yellow audible alarm. numeric flashes, red alarm lamp, alarm tone. numeric flashes, red alarm lamp, alarm tone. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. 53 5 Patient Alarms and INOPs Patient Alarm Messages Alarm Message
**BIS LOW From BIS Condition Indication The Bispectral Index value has dropped below the low alarm limit.
***BRADY/P xxx<yyy or
***BRADY xxx<yyy
**CCO/CCI HIGH
**CCO/CCI LOW
**CPP HIGH
**CPP LOW
***DESAT or
***DESAT xxx<yyy
**etCO2 HIGH
**etCO2 LOW
**etO2 HIGH
**etO2 LOW Press, SpO2 The heart rate from the Pulse signal has fallen below the bradycardia limit. xxx denotes the lowest measured value; yyy is the bradycardia limit. Continuous Cardiac Output or CC Index is above the high alarm limit. CCO CCO CPP CPP SpO2 CO2, Resp, AGM Continuous Cardiac Output or CC Index is below the low alarm limit. The CPP value has exceeded the high alarm limit. The CPP value has fallen below the low alarm limit. The SpO2 value has fallen below the desaturation alarm limit. xxx denotes the lowest measured value, and yyy is the desaturation limit. The end tidal CO2 high alarm limit has been exceeded. CO2, Resp, AGM The end tidal CO2 value has fallen below the low alarm limit. O2, AGM The end tidal O2 high alarm limit has been exceeded. O2, AGM The end tidal O2 value has fallen below the low alarm limit.
EVENT:<GRP>
*/**/*** EVENT at Information center Event surveillance Event surveillance
***EXTREME BRADY
***EXTREME TACHY ECG ECG An event has occurred and the event notification is configured to alarm.
<GRP> is the event group An event has occurred and the event notification is configured to alarm. Check on the monitor for more details on event group. The bradycardia limit has been exceeded. The tachycardia limit has been exceeded. 54 numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone. numeric flashes and high alarm limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and low alarm limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, red alarm lamp, alarm tone. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, and low limit is highlighted, yellow alarm lamp, alarm tone. event group name flashes, yellow or red alarm lamp and alarm tone
(on monitor) event group name flashes, yellow or red alarm lamp and alarm tone numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone. numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone. Patient Alarm Messages 5 Patient Alarms and INOPs Alarm Message
**HR HIGH From ECG Condition Indication The heart rate high alarm limit has been exceeded.
**HR LOW ECG The heart rate has fallen below the low alarm limit.
*/**IRREGULAR HR
*/**MISSED BEAT
*/**MULTIFORM PVCs ECG/
Arrhythmia ECG/
Arrhythmia ECG/
Arrhythmia
**NBP HIGH
**NBP LOW NBP NBP
*/**NON-SUSTAIN VT ECG/
Arrhythmia
*/**PACER NOT CAPT ECG/
Arrhythmia
(paced patients only)
*/**PACER NT PACING ECG/
*/**PAIR PVCs
*/**PAUSE Arrhythmia
(paced patients only) ECG/
Arrhythmia ECG/
Arrhythmia Consistently irregular heart rhythm. No beat detected for 1.75*R-R interval, or if HR>120bpm no beat detected for one second (non-paced patients only). Two differently shaped Vs detected, each occurring at least twice within the last 300 beats and at least once within the last 60 beats. The measured NBP value is above the high alarm limit. s, d, or m after the label indicates whether the systolic, diastolic or mean pressure has crossed the limit. The measured NBP value is below the low alarm limit. s, d, or m after the label indicates whether the systolic, diastolic or mean pressure has crossed the limit. A run of Vs having a ventricular HR>V-Tach HR limit, but lasting for less than the V-Tach Run limit has been detected. A missed beat with a pace pulse was detected. A missed beat without a pace pulse was detected. A non-ventricular contraction, followed by two ventricular contractions, followed by a non-ventricular contraction has been detected. No beat detected for a period greater than the pause threshold. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. If configured to short yellow, the sound switches off after 5 seconds if Arrhythmia is On. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. If configured to short yellow, the sound switches off after 5 seconds if Arrhythmia is On. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, yellow alarm lamp, short yellow audible alarm. 55 5 Patient Alarms and INOPs Patient Alarm Messages Alarm Message
***<Pressure>
DISCONNECT From PRESS
***<Pressure> HIGH PRESS
**<Pressure> HIGH PRESS
***<Pressure> LOW PRESS
**<Pressure> LOW PRESS
**Pulse HIGH
**Pulse LOW
*/**PVCs/min HIGH
**QTc HIGH
**'QTc HIGH
*/**R-ON-T PVCs PRESS SpO2 PRESS SpO2 ECG/
Arrhythmia ECG/QT ECG/QT ECG/
Arrhythmia
**RR HIGH RESP Condition Indication The pressure is non-pulsatile and the mean pressure is continuously less than 10mmHg (1.3kPa). This alarm occurs only with arterial pressures (P, ABP, ART, Ao, BAP, FAP, PAP, UAP, P1, P2, P3, P4). The measured pressure value is above the extreme high alarm limit. s, d, or m after the label indicates whether the systolic, diastolic or mean pressure has crossed the limit. The measured pressure value is above the high alarm limit. s, d, or m after the label indicates whether the systolic, diastolic or mean pressure has crossed the limit. The measured pressure value is below the extreme low alarm limit. s, d, or m after the label indicates whether the systolic, diastolic or mean pressure has crossed the limit. The measured pressure value is below the low alarm limit. s, d, or m after the label indicates whether the systolic, diastolic or mean pressure has crossed the limit. The pulse rate has exceeded the high alarm limit. The pulse rate has dropped below the low alarm limit. More premature ventricular contractions have been detected in a minute than the limit. QTc value has exceeded the QTc high limit for more than 5 minutes
'QTc value has exceeded the 'QTc high limit for more than 5 minutes For HR <100, a PVC with R-R interval
< 1/3 the average interval followed by a compensatory pause of 1.25 x average R-R interval or two such Vs without compensatory pause occurring within 5 minutes of each other. (When HR
>100, 1/3 R-R interval is too short for detection.). The respiration rate has exceeded the high alarm limit. numeric flashes, red alarm lamp, alarm tone. numeric flashes, high limit is highlighted, red alarm lamp, alarm tone. numeric flashes, high limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and low limit is highlighted, red alarm lamp, alarm tone. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, yellow alarm lamp, alarm tone. numeric flashes, yellow alarm lamp, alarm tone. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. 56 Patient Alarm Messages 5 Patient Alarms and INOPs Alarm Message
**RR LOW From RESP Condition Indication The respiration rate has dropped below the low alarm limit.
*/**RUN PVCs HIGH ECG/
Arrhythmia A run of PVCs greater than 2 was detected.
**<SO2 label> HIGH SvO2/SO2
**<SO2 label> LOW SvO2/SO2
**<SpO2 label> HIGH SpO2
**<SpO2 label> LOW SpO2 The the measured intravascular oxygen saturation has exceeded the high limit. The measured intravascular oxygen saturation has fallen below the low limit. The arterial oxygen saturation has exceeded the high alarm limit. The arterial oxygen saturation has fallen below the low alarm limit.
**ST<n> HIGH
**ST<n> LOW ECG/ST The ST elevation in lead <n> is higher than the limit. ECG/ST The ST depression in lead <n> is lower than the limit.
**ST MULTI <n>,<n> ECG/ST
**ST MULTI at Information Center ECG/ST
*/**SVT ECG/
Arrhythmia
***TACHY/P xxx>yyy or
***TACHY xxx>yyy
**Tblood HIGH
**Tblood LOW
**tcpO2 HIGH/
**tcpCO2 HIGH
**tcpO2 LOW/
**tcpCO2 LOW C.O. C.O. tcGas tcGas The ST depression or elevation is outside of the limit in two or more leads <n> and <n>
The ST depression or elevation is outside of the limit in two or more leads. Check on the monitor for more details about which leads are affected. A run of supraventricular beats greater than the SVT run limit has been detected and the HR has exceeded the SVT HR limit. exceeded the tachycardia limit. xxx denotes the highest measured value; yyy is the tachycardia limit. The blood temperature value has exceeded the high alarm limit. The blood temperature value has fallen below the low alarm limit. The tcpO2 or tcpCO2 value has exceeded the high alarm limit. The tcpO2 or tcpCO2 value has fallen below the low alarm limit. Press, SpO2 The heart rate from the Pulse signal has numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes and high alarm limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and low alarm limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and high alarm limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and low alarm limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, yellow alarm lamp, alarm tone
(on monitor) numeric flashes, yellow alarm lamp, alarm tone numeric flashes, yellow alarm lamp, alarm tone. numeric flashes, alarm limit is highlighted, red alarm lamp, alarm tone. numeric flashes, high alarm limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, low alarm limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, high alarm limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, low alarm limit is highlighted, yellow alarm lamp, alarm tone. 57 5 Patient Alarms and INOPs Patient Alarm Messages From Condition Indication Alarm Message
*/**/***TELE ALARM
**<Temperature label> HIGH
**<Temperature label> LOW
*/**VENT BIGEMINY
***VENT FIB/TACH
*/**VENT RHYTHM
*/**VENT TRIGEMINY
***VTACH Telemetry TEMP TEMP ECG/
Arrhythmia ECG ECG/
Arrhythmia ECG/
Arrhythmia ECG, Arrhythmia This is a generic alarm from the telemetry system. The specific alarm cause is indicated in the alarm message in the Telemetry Data Window. The temperature has exceeded the high alarm limit. The temperature has fallen below the low alarm limit. A dominant rhythm of N, V, N, V (N =
supraventricular beat, V = ventricular beat) was detected. A fibrillatory waveform for 4 consecutive seconds was detected. A dominant rhythm of adjacent Vs >
vent rhythm limit and ventricular HR <
VTach HR limit was detected. A dominant rhythm of N, N, V, N, N, V (N = supraventricular beat, V =
ventricular beat) was detected. Ventricular tachycardia has been detected (Consecutive PVCs exceed V-
Tach Run limit and HR exceeds V-Tach HR limit). A yellow (**) or red (***) patient alarm is present on the VueLink module. Check the monitor display for more detailed alarm information. yellow or red alarm lamp and alarm tone numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, red alarm lamp, alarm tone. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, yellow alarm lamp, short yellow audible alarm. numeric flashes, red alarm lamp, alarm tone.
(on monitor) yellow or red alarm lamp, alarm tone
**/***VueLink ALARM at Information Center VueLink 58 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) If an INOP interrupts monitoring and alarm detection, the measurement numeric will be replaced by -?-. If an INOP may lead to unreliable measurement values, a ? appears next to the numeric. INOP Message, Indication ABP INOPS ALL ECG ALARMS OFF Ao INOPS ART INOPS AWF CHANGE SCALE AWP CHANGE SCALE AWV CHANGE SCALE Bad Serverlink INOP tone BAP INOPS BATT EMPTY INOP tone, battery LED flashes During this INOP, alarms cannot be paused or switched off. BATT INCOMPAT INOP tone BATT LOW INOP tone BATT MALFUNCTION INOP tone, battery LED flashes During this INOP, alarms cannot be paused or switched off unless the monitor is connected to mains power. BATTERIES EMPTY or BATT 1/
BATT 2 EMPTY INOP tone, battery LED flashes During this INOP, alarms cannot be paused or switched off. BATTERIES INCOMP or BATT 1/
BATT 2 INCOMPAT INOP tone Source What to do PRESS ECG/
Arrhythmia See <Pressure label> INOPS (under Pressure). All ECG alarms have been switched off, or the HR alarm source is not ECG. To resume ECG alarm generation, switch ECG alarms on or select ECG as the alarms source. See <Pressure label> INOPS (under Pressure). See <Pressure label> INOPS (under Pressure). PRESS PRESS Spirometry Airway flow signal exceeds range of selected scale. Adjust scale to display complete wave. Spirometry Airway pressure signal exceeds range of selected scale. Adjust scale to display complete wave Spirometry Airway volume signal exceeds range of selected scale. Adjust Monitor PRESS Battery Battery Battery Battery Batteries Batteries scale to display complete wave. 1) An MMS with an incompatible software revision is connected to the monitor. This combination does not allow monitoring, OR 2) You cannot use this combination of monitor, MMS and cable. Switch off the monitor and contact your service personnel. See <Pressure label> INOPS (under Pressure). The estimated remaining battery-powered operating time is less than 10 minutes. Replace the battery immediately. If the condition persists and the monitor is not connected to mains power, this INOP is re-issued two minutes after you acknowledge it. The battery cannot be used with this monitor. Replace with the correct battery (M4607A). The estimated battery-powered operating time remaining is less than 20 minutes. The monitor cannot determine the battery status. If this INOP persists, replace the faulty battery. If the condition persists and the monitor is not connected to mains power, this INOP is re-
issued two minutes after you acknowledge it. Place the battery in a different monitor or in a battery charger. If the same INOP is shown, contact your service personnel. The estimated remaining battery-powered operating time of the indicated battery or batteries is less than 10 minutes. Replace the batteries immediately. If the condition persists and the monitor is not connected to mains power, this INOP is re-issued two minutes after you acknowledge it. The indicated battery or batteries cannot be used with this monitor. Replace with the correct battery or batteries as specified in this book. 59 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication BATTERIES LOW or BATT 1/
BATT 2 LOW INOP tone BATTERIES MALFUNC. or BATT 1/BATT 2/ BATTERY MALFUNCT. INOP tone, battery LED flashes During this INOP, alarms cannot be paused or switched off unless the monitor is connected to mains power. BATTERY LOW T BATT 1/BATT 2 MISSING INOP tone. During this INOP, alarms cannot be paused or switched off. BIS CABLE INCOMPAT INOP tone. BIS CABLE USAGE INOP tone. BIS DSC DISCONN INOP tone BIS DSC INCOMPT INOP tone BIS DSC MALFUNC BIS DSC UPDATE INOP tone BIS ELECTR. DISC INOP tone. BIS ENGINE DISCONN INOP tone BIS ENGINE INCOMPT INOP tone Source What to do Batteries The estimated battery-powered operating time remaining is less than 20 minutes. Batteries The monitor cannot determine the battery status. If this INOP persists, replace the faulty battery or batteries. If the condition persists and the monitor is not connected to mains power, this INOP is re-issued two minutes after you acknowledge it. Place the batteries in a different monitor or in a battery charger. If the same INOP is shown, contact your service personnel. Telemetry Batteries The battery in the Telemetry device is low and must be replaced soon. The monitor requires two batteries but can detect only one battery. Insert the missing battery immediately. BIS BIS BIS BIS BIS BIS BIS BIS BIS The semi-reusable sensor cable connected is unknown or not supported by your software revision. Replace it with a Philips-
supported sensor cable. The semi-reusable sensor cable has exceeded the maximum number of uses. Replace the cable. DSC is not properly connected OR either DSC or BIS engine may be faulty. Make sure that the DSC is properly connected to the BIS Engine. If INOP persists, replace DSC with a known good one of the same type. If INOP persists replace BIS engine. Silencing this INOP switches the measurement off. DSC is not supported by the BIS engine or new DSC connected to an old BIS engine. A software upgrade may be required. Contact your service personnel. Electrocautery used during self-test OR malfunction in the DSC hardware. Make sure not to use electrocautery during the self-test procedure. Disconnect and reconnect the DSC to the BIS engine. If the INOP persists, replace the DSC or contact your service personnel. DSC update currently being carried out. This INOP will disappear when the DSC update is finished. Do not disconnect the DSC during the update. No action is needed. One or more electrodes are not connected to the semi-reusable sensor cable. Check all electrode connections. BIS engine not connected OR Module Cable defective. Make sure that the Module Cable is properly connected. If INOP persists, replace the Module Cable. Silencing this INOP switches the measurement off. BIS engine software is not supported. A software upgrade may be required. Contact your service personnel. MP20/30 - BIS engine not supported. 60 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication BIS ENGINE MALFUNC INOP tone BIS EQUIP MALF INOP tone BIS HIGH IMPEDANCE INOP tone may sound BIS IMPEDANCE CHCK INOP tone may sound BIS ISOELECTRC EEG BIS LEAD OFF INOP tone may sound BIS OVERCURRENT INOP tone BIS SENSOR DISCONN INOP tone BIS SENSOR INCOMPT INOP tone BIS SENSOR MALFUNC INOP tone Source What to do BIS BIS BIS BIS BIS BIS BIS BIS BIS BIS Malfunction in the BIS engine hardware. Disconnect and reconnect the BIS engine. If the INOP persists, replace BIS engine. There is a malfunction in the BIS hardware. Unplug and replug the BIS module. If the INOP persists, contact your service personnel. Impedance of one or more electrode(s) is above the valid range, most often caused by bad skin preparation. Check the sensor montage and press the electrode pads firmly. If this INOP persists, replace the sensor(s) in question using correct skin preparation. If INOP persists, contact your service personnel. The Cyclic Impedance check is running. It will stop automatically if all impedances are within the valid range. If any electrodes do not pass the impedance test, check the sensor montage and press the electrode pads firmly. To manually stop the Cyclic Impedance Check, select Cyclic Check off in the Setup BIS menu. No discernible EEG activity is detected for longer than one minute. Check the patient. Check that the electrodes are properly connected. One or more electrodes have no skin contact and therefore impedances cannot be measured. Check the sensor montage and press the electrode pads firmly. If this INOP persists, replace the sensor(s) in question, using correct skin preparation. Unplug and replug the BIS module or, f or the MP20/MP30, disconnect and reconnect the BISx from the Interface board. If the INOP persists, contact your service personnel. The sensor is not properly connected to the patient interface cable (PIC) and/or the PIC is not properly connected to the DSC or BISx, or the sensor or PIC or DSC or BISx may be faulty. Check all the connections. Disconnect and reconnect the sensor, PIC, DSC, BISx. If the INOP persists, replace the sensor. If the INOP persists, replace PIC. If INOP persists, contact your service personnel. Silencing this INOP switches the measurement off. Unsupported sensor connected or sensor type unknown or not supported by your software revision. Replace the sensor, using only Philips supported sensors. Malfunction in the sensor hardware, most often caused by liquids permeating into the connectors OR patient interface cable (PIC) or DSC or BISx may be faulty. Replace the sensor. Manually initiate a Cyclic Impedance Check. Make sure all electrodes pass the test. Make sure that the both sides of the PIC connector (between PIC and sensor) are dry. If you are not sure that the connector is dry, replace the PIC until it has dried. If this INOP persists, contact your service personnel. 61 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication BIS SENSOR USAGE INOP tone BIS SQI < 15% (INOP tone) OR BIS SQI < 50% (no INOP tone) BIS UNPLUGGED INOP tone BISx DISCONNECTED INOP tone BISx INCOMPATIBLE INOP tone BISx MALFUNCTION INOP tone CANNOT ANALYZE ECG CANNOT ANALYZE QT CANNOT ANALYZE ST CCI NO BSA CCI numeric unavailable INOP tone CCO BAD PRESS SIGN numeric is replaced by -?-
INOP tone Source What to do BIS BIS BIS BIS BIS BIS ECG/
Arrhythmia QT ST C.O. C.O. Excessive sensor usage. Replace sensor. A Cyclic Impedance Check will start automatically. If the signal quality is below 50%, BIS numerics cannot be reliably derived. If the signal quality is below 15%, no BIS numerics can be derived. This may occur as a result of artifacts such as those generated from motion or the presence of electrocautery devices. Make sure the sensor is properly attached to the patient. Manually initiate a Cyclic Impedance Check. Make sure all electrodes pass the test. Make sure the patient is completely relaxed (even small motions of the facial muscles affect the signal quality). Plug in the BIS module. Silencing this INOP switches off the measurement. The BISx is not connected to the BIS module or the BIS interface board. Silencing this INOP switches the measurement off. The BISx software is not compatible with the BIS module or with the MP20/MP30 monitor software. A software upgrade may be required. Contact your service personnel. The BISx is faulty. Disconnect and reconnect it to the module or BIS interface board. If the INOP persists, replace the BISx. MP20/MP30 - Malfunction on interface board. If the INOP persists, contact your service personnel. The arrhythmia algorithm cannot reliably analyze the ECG data. Check the ECG signal quality of the selected primary and secondary leads. If necessary, improve lead position or reduce patient motion. If you have arrhythmia analysis on, and you are not getting a reliable HR because the signal is below a minimum amplitude, unstable, or contains artifact, and you have tried to improve the system performance by choosing another lead and changing electrodes, you should consider turning arrhythmia analysis off. The QT algorithm cannot generate a valid QT value for more than 10 minutes, or 1 minute in the initial phase. The ST algorithm cannot generate a valid ST value. Possible causes are large variations in the measured ST values for consecutive beats, or ventricular paced beats. Review the ECG signal quality and the ST measurement points. If the patient has a ventricular pacemaker, ST analysis is not possible. CCI cannot be calculated because the patient's body surface area is unknown. Enter the patient weight and height to provide the BSA for CCI calculation. The arterial pressure wave can currently not be used for pulse contour calculation for CCO or CCI measurement. Possible causes are air bubbles in the tubing or a physiological condition, for example severe arrhythmia. 62 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs Source What to do INOP Message, Indication CCO NO <Pressure label>
numeric is replaced by -?-
INOP tone may sound CCO NO CALIBRATION numeric is replaced by -?-
CCO NO PRESS at Information Center CCO NOT SUPPORTED numeric is replaced by -?-
INOP tone CCO/CCI OVERRANGE numeric is replaced by -?-
INOP tone CCO <Pressure label>
INVALID numeric is replaced by -?-
INOP tone may sound CCO PRESS INVALID at Information Center CCO PRESS OVERRANG numeric is replaced by -?-
INOP tone CCO PULSE OVERRANG numeric is replaced by -?-
INOP tone CCO/Tbl NO TRANSD Numeric is replaced by -?-
INOP tone CCO RECALIBRATE numeric is replaced by -?-
C.O. C.O. C.O. C.O. C.O. C.O. C.O. C.O. C.O. C.O. C.O. CENTRAL:TELE ONLY INOP tone Charge BATT1/BATT2 now INOP tone Monitor Batteries CCO/CCI cannot be calculated. Make sure that the pressure chosen in the Setup CCO menu under CCO From matches the pressure measured with the arterial catheter for CCO measurement. A pressure from an external device cannot be used. Select another pressure label, either ABP, Ao, ART, BAP, FAP, or UAP. The CCO measurement is currently not calibrated. CCO/CCI cannot be calculated. Make sure that the pressure chosen in the Setup CCO menu under CCO From matches the pressure measured with the arterial catheter for CCO measurement. A pressure from an external device cannot be used. Select another pressure label, either ABP, Ao, ART, BAP, FAP, or UAP. A catheter for transpulmonary C.O. measurements has been unplugged and replaced with a Right Heart C.O. catheter, or the measurement mode has been changed manually. Silencing this INOP switches the measurement off. The measured CCO or CCI value is not within the specified range for CCO/CCI measurement. The arterial pressure selected for pulse contour calculation for CCO is available but currently invalid. Make sure the pressure transducer is connected and the zero calibration is valid. The arterial pressure selected for pulse contour calculation for CCO is available but currently invalid. Make sure the pressure transducer is connected and the zero calibration is valid. The mean value of the arterial pressure values used for pulse contour calculation for CCO is below 0 mmHg or above 300 mmHg. The pulse rate of the pressure used for pulse contour calculation for CCO is below 30 bpm or above 240 bpm. No transducer attached to the module or catheter disconnected. The most recent CCO or CCI calibration was made over 8 hours ago or the arterial pressure measurement used for CCO calculation has been zeroed after the CCO calibration was performed. You should recalibrate CCO or CCI with transpulmonary C.O. measurements at least every 8 hours or when the hemodynamic condition of the patient has changed. The pressure measurement must be zeroed before a CCO calibration. System connectivity via telemetry device is limited (No alarms, only local numerics) when in companion mode and host monitor does not have system connectivity. Only telemetry device parameters can be displayed at central station. Battery must be charged. Connect the monitor to mains power or exchange the battery. 63 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication CHARGER MALFUNC INOP tone, battery LED may flash Check Alarm Lamps INOP tone. CHECK BATT TEMP INOP tone Check DrugSettings INOP tone Check ECG Settings INOP tone
!!CHECK ECG SOURCE INOP tone Check Flex Texts INOP tone CheckInternVoltage at Information Center Check Keyboard INOP tone Check Main Board 2 INOP tone. Check Monitor Func INOP tone. Check Monitor Temp INOP tone Check Mouse Device INOP tone. Check MSL Voltage INOP tone Check Network Conf INOP tone Check Nurse Relay INOP tone
!!Check Pairing INOP tone Source What to do Batteries Monitor Battery Monitor Telemetry Monitor Monitor Monitor Monitor Monitor Monitor Monitor Monitor Monitor/
Multi-
Measuremt Module Monitor Monitor Monitor There is a problem with the battery charger in the monitor. Connect the monitor to mains power and contact your service personnel. Perform a visual check of the alarm lamp to establish whether there is a problem. Contact your service personnel to check the internal connections to the alarm lamps. The temperature of one or both batteries is too high. Check that ventilation openings (if applicable) are not blocked and monitor is not exposed to heat. There was a problem loading the drug settings. Check that the settings are complete and correct. Synchronization of ECG settings between the monitor and Information Center has failed. Check that the ECG settings in use are appropriate. The telemetry device and the monitor both have valid ECG signals. Unpair the telemetry device and the monitor if they are no longer used for the same patient. Check the names of the monitor menus, for example the labels for screens, profiles, event or trend group names, before you resume monitoring. If they are unexpected, there may be a problem with the monitor software. Contact your service personnel. Potential problem with alarm lamps, display or interfaces detected. Contact your service personnel. This INOP will appear on the monitor as Check Monitor Func. Perform a visual and functional check of the keyboard. Contact your service personnel. There is a problem with the second main board in the monitor. Contact your service personnel. Potential problem with alarm lamps, display or interfaces detected. Contact your service personnel. This INOP may appear on the Information Center as CheckInternVoltage. The temperature inside the monitor is too high. Check that the monitor ventilation is not obstructed. If the situation continues, contact your service personnel. Perform a visual and functional check of the mouse input device. Contact your service personnel. There is a problem with the voltage of the Measurement Link
(MSL). Contact your service personnel. The monitor is receiving network topology information from more than one source, e.g. the Database Server and an Application Server. Contact your service personnel. There is a problem with the connection to the nurse relay. Contact your service personnel. There is a problem with device pairing. Check that the monitor and telemetry device are correctly paired. 64 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication Check Screen Res INOP tone Check Settings INOP tone Check SpeedPoint INOP tone. Check Touch Input INOP tone Check Waves INOP tone CHK ECG Sync Cable INOP tone Chk IndepDsp Cable CHK MSL Connection INOP tone Chk SpO2T Settings INOP tone C LEAD OFF HR Numeric is replaced by -?- for 10 seconds. INOP tone. CO2 AUTO ZERO Numeric is replaced by a -?-
if the Autozero lasts >15 sec, INOP tone sounds. CO2 CAL MODE CO2 numeric displays current CO2 value for accuracy check CO2 CAL RUNNING Numeric is replaced by a -?-
CO2 CHANGE SCALE CO2 CHK ADAPTER Numeric is replaced by a -?-
INOP tone. CO2 CHECK CAL Numeric is replaced by a -?-
INOP tone. Source What to do Monitor Monitor Monitor Monitor Monitor Monitor Monitor Monitor Telemetry ECG CO2 CO2 CO2 CO2 CO2 CO2 The Screen you have selected uses a resolution which is not supported by the display. The monitor will show a generic Screen instead until you select a different Screen. Contact your service personnel if you want the Screen deleted from the Profile(s) to avoid this in future. If this INOP appears, check the monitor and patient settings before you resume monitoring. If the settings are unexpected, there may be a problem with the monitor software. Contact your service personnel. Perform a visual and functional check of the SpeedPoint input device. Contact your service personnel. Perform a visual and functional check of the touch input device. Contact your service personnel. The options purchased with this monitor may not support the number of waves required to show the selected Screen, so some waves or high resolution trends are missing from the Screen. Select a different Screen with fewer waves. Contact your service personnel if you want the Screen deleted from the Profile(s) to avoid this in future. The ECG Sync is detecting an invalid signal, or the ECG Sync cable is disconnected. The monitor cannot communicate with the D80 Intelligent Display. Check the MSL coupling cable. The end with the grey connector must be connected to the Intelligent Display. Check that the MSL connector or cable are properly connected. Check the cable and connector for damage. Synchronization of SpO2T settings between the monitor and Information Center has failed. Check that the SpO2T settings in use are appropriate. The C electrode (AAMI: V electrode) has become detached from the patient or the lead set has been changed. Reattach the electrode or select New Lead Setup in the Setup ECG menu to confirm the new lead set. The automatic zero calibration is in progress. This typically takes 10 seconds. During this time the CO2 values may not be updated, or they may be replaced by -?-. Wait until the zero calibration is complete to resume monitoring. Currently no calibration is running. Accuracy can be checked by placing the transducer on the two cells of the calstick and starting calibration. To start monitoring, leave Cal. Mode. Wait until calibration is finished. The CO2 wave is clipped. Select a more appropriate wave scale to display the whole wave. Check that the sensor is connected to the airway adapter, clean the airway adapter, if necessary. Perform a zero calibration. If the INOP persists, contact your service personnel. The CO2 value is outside the measurement range. Perform an accuracy check for both calstick cells and, if necessary, recalibrate the transducer. 65 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) Source What to do CO2 C.O. C.O. CO2 CO2 CO2 CO2 CO2 CO2 CO2 CO2 CO2 CO2 The CO2 measurement label in the measurement device has been deactivated by deactivating the label in the Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, reactivate the measurement label in the Measurement Selection window. The Cardiac Output measurement label in the measurement device has been deactivated by deactivating the label in the Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, reactivate the measurement label in the Measurement Selection window. There is a problem with the C.O. hardware. Contact your service personnel. The Measurement Extension is faulty. Unplug and replug the Multi-Measurement Module with Extension. If you are using the mainstream method, unplug and replug the transducer or try another transducer. If the INOP persists, contact your service personnel. Make sure that the Cal cell was changed between CAL1 and CAL2. Repeat the calibration. If the INOP reappears, try another transducer. If the INOP persists, contact your service personnel. There is no CO2 sensor connected. If you silence this INOP the CO2 measurement will be switched off. There is no CO2 transducer connected. If you replace the transducer, the new transducer must be calibrated. If you silence this INOP the CO2 measurement will be switched off. Either the sample line is disconnected, or an incorrect line is attached. Check the connection. If necessary, connect another sample line (Use only the approved accessories). If you silence this INOP, the measurement will be switched off. The sample line or exhaust tube is blocked. Check the tubing, then disconnect and reconnect the sample line. If the INOP persists, connect a new sample line. The CO2 value is higher than the measurement range. If you suspect a false high value, contact your service personnel. The pump has been switched off for fifteen minutes. To switch it on again, select Pump On in the Setup CO2 menu. The Filterline is being purged to remove an occlusion in the line or airway adapter. If the occlusion is removed, the INOP will disappear. If not, the INOP CO2 OCCLUSION is displayed. Wait until the sensor reaches operating temperature and the INOP disappears. INOP Message, Indication CO2 DEACTIVATED INOP tone. C.O. DEACTIVATED INOP tone. C.O. EQUIP MALF Numeric is replaced by a -?-
INOP tone. CO2 EQUIP MALF Numeric is replaced by -?-
INOP tone. CO2 FAILED CAL Numeric is replaced by -?-
INOP tone. CO2 NO SENSOR Numeric is replaced by -?-
INOP tone. CO2 NO TRANSDUC Numeric is replaced by -?-
INOP tone. CO2 NO TUBING Numeric is replaced by -?-
INOP tone.
(!!/!!!)CO2 OCCLUSION Numeric is replaced by a -?-
INOP tone. CO2 OVERRANGE Numeric is replaced by -?-
INOP tone. CO2 PUMP OFF Numeric is replaced by a -?-. CO2 PURGING Numeric is replaced by a -?-
INOP tone. CO2 SENS. WARMUP Numeric is displayed with a -?-
Microstream CO2: INOP tone. Mainstream CO2: no INOP tone 66 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs Source What to do C.O. CO2 CO2 CO2 CO2 CO2 CPP CPP NBP NBP INOP Message, Indication C.O. UNPLUGGED numeric is replaced by -?-
INOP tone. CO2 UPDATE FW Numeric is replaced by a -?-
INOP tone. CO2 WAIT CAL2 Numeric is replaced by a -?-
CO2 ZERO FAILED Numeric is replaced by a -?-
INOP tone. CO2 ZERO REQUD Numeric is replaced by a -?-
INOP tone CO2 ZERO RUNNING CPP CHK SOURCES Numeric is replaced by a -?-
CPP CHK UNITS Numeric is replaced by a -?-
!!/!!!CUFF NOT DEFLAT Numeric is displayed with a -?-
Severe yellow/red INOP tone. During this INOP, alarms cannot be paused or switched off.
!!/!!!CUFF OVERPRESS Numeric displayed with -?- ;
Severe yellow/red INOP tone. During this INOP, alarms cannot be paused or switched off. CVP INOPS DEVICE CHECK SETUP INOP tone. DEVICE CHECK CONF. INOP tone. DEVICE DEMO DATA INOP tone Plug in the C.O. module. Silencing this INOP switches off the measurement. The software in the Measurement Extension does not match the software in the MMS. Contact your service personnel. Calibration on the first calstick cell is complete. Place the transducer on the other calstick cell and start the CAL2 calibration cycle. An error occurred during the last zero calibration. Check the airway adapter and clean, if necessary. Perform another zero calibration. If the INOP persists, contact your service personnel. Perform zero calibration for the CO2 sensor. If the INOP persists, contact your service personnel. Wait until zero calibration is finished. Not all measurements or values required to perform the calculation are available. Check the measurement sources. The monitor has detected a conflict in the units used for this calculation. Check the unit settings. Remove the cuff from the patient. Make sure that the tubing is not kinked or twisted and that the correct patient category is selected. Try repeating the measurement. You can silence the INOP, but the INOP message remains visible until the next NBP measurement is started or the Stop All SmartKey is selected.
[Adult or pediatric patients: The NBP cuff pressure has exceeded 15mmHg (2kPa) for more than 3 minutes. Neonatal patients: The NBP cuff pressure has exceeded 5mmHg
(0.7kPa) for more than 90 seconds.]
The NBP cuff pressure exceeds the overpressure safety limits. Remove the cuff from the patient. Make sure that the tubing is not kinked or twisted and that the correct patient category is selected. Try restarting the measurement. You can silence this INOP, but the INOP message remains visible until the next measurement is started or the Stop All SmartKey is selected. See <Pressure label> INOPS (under Pressure). PRESS IntelliBridge Device identification completed, but communication could not be established due to timeout. IntelliBridge INOP abbreviations may differ slightly depending on the device category. IntelliBridge Device identification completed, but communication could not be established due to error. IntelliBridge INOP abbreviations may differ slightly depending on the device category. IntelliBridge The device connected to the IntelliBridge module reports demo data but the monitor is not in DEMO mode. 67 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication DEVICE REAL DATA INOP tone
<Device> UNPLUGGED INOP tone. DEVICE UNSUPPORTED INOP tone.
<EC10/EC40> EQUIP MALF INOP tone. ECG/ARRH ALARM OFF
!!ECG/AR ALARM OFF ECG EQUIP MALF Numeric is displayed with a -?-
INOP tone. ECG EQUIP MALF T Numeric is displayed with a -?-
INOP tone.
(!!/!!!)<ECG LEAD> LEAD OFF Numeric is displayed with a -?-
INOP tone. ECG EL. NOISY <ECG LEAD>
(!!/!!!)ECG LEADS OFF ECG NOISY SIGNAL INOP tone. ECG ECG ECG ECG Source What to do IntelliBridge The monitor is in DEMO mode but the device connected to the IntelliBridge module reports data that are not flagged as demo data. IntelliBridge The IntelliBridge module has been unplugged from the rack, or the whole rack has been disconnected. Silencing this INOP switches off the measurement. IntelliBridge INOP abbreviations may differ slightly depending on the device category. IntelliBridge Device identification completed, but no appropriate device driver installed. IntelliBridge INOP abbreviations may differ slightly depending on the device category. IntelliBridge Malfunction in the IntelliBridge module. If this message ECG ECG appears repeatedly, the module must be replaced. Contact your service personnel. All ECG alarms have been switched off, or the HR alarm source is not ECG. To resume ECG alarm generation, switch ECG alarms on or select ECG as the alarm source. Contact your service personnel. The ECG hardware is faulty. Monitor Contact your service personnel. The ECG in the Telemetry device is faulty. Not all the required leads for ECG monitoring are connected. Check the ECG connections and make sure that the electrode indicated by <ECG lead> [RA, LA, LL, RL, V or C] electrodes is attached. In EASI mode, all 5 electrodes must be connected. The ECG signal from the named ECG electrodes [RA, LA, LL, RL, V (or C)] is noisy. Check the ECG connections and make sure that the electrode indicated is attached. Check that all of the required ECG leads are attached, and that none of the electrodes have been displaced. The ECG signal is too noisy. Check that the electrodes are properly placed and have not dried out. Remove any possible sources of signal noise (such as power cords) from the area around the cable and the patient. The ECG signal may be saturated or overloaded. Check that the ECG out cable is securely connected. Contact your service personnel. The EEG hardware is faulty. Contact your service personnel. The signal electrode in one or both channels exceeds the user-
selected impedance limit, or the impedance of a single electrode exceeds the limit. Check the impedance. If the impedance is too high, reconnect the electrodes according to the EEG monitoring setup guidelines. If the INOP persists, contact your service personnel. Reconnect specified electrode. ECG EcgOut EQUIP MALF INOP tone EEG EQUIP MALF INOP tone EEG IMPEDANCE HIGH or EEG1 and/or EEG2 IMPED. HIGH EEG EEG EEG<X> LEAD OFF <n>
[X = channel, n = electrode]
EEG 68 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs Source What to do INOP Message, Indication EEG<X> LEAD OFF
[X = channel]
at Information Center EEG<X> LEADS OFF
[X = channel]
EEG LINE NOISE EEG 1 or 2 LINE NOISE EEG MUSCLE NOISE EEG 1 or 2 MUSCLE NOISE EEG NO TRANSDUCER INOP tone EEG UNPLUGGED INOP tone EEG OVERRANGE, or EEG<X> OVERRANGE FAP INOPS FMS UNPLUGGED INOP tone. FMS UNSUPPORTED INOP tone. IC1/IC2 INOPS ICP INOPs Indep.Dsp Malfunc. Indep.Dsp NotSupp.
!!INSERT BATTERY Severe yellow INOP tone. During this INOP, alarms cannot be paused or switched off. Intell.Dsp Malf. INOP tone Intell.Dsp Missing Intell.Dsp Unsupp. Internal.Comm.Malf INOP tone INVALID LEADSET EEG EEG EEG EEG EEG EEG EEG PRESS FMS FMS PRESS PRESS Display Display Battery Display Display Display Monitor Telemetry One or more electrodes are not connected. Check in the EEG Impedance/Montage window on the monitor which electrode(s) are affected and reconnect the electrodes. Two or more electrodes are not connected. Check in the EEG Impedance/Montage window which electrodes are affected and reconnect the electrodes. Excessive line noise has been detected in either channel EEG1 or EEG2, or in both EEG channels. Keep all cables together and away from metallic bodies, other cables & radiated fields. Too much power above 30 Hz has been detected in channel EEG1 or EEG2, or both. Check the Electrode-to-Skin Impedance and reposition the electrode away from possible muscle activity, if necessary. The trunk cable is disconnected from the EEG plug-in module. Reconnect the trunk cable. Silencing this INOP switches the measurement off. Plug in module. Silencing this INOP switches off the measurement. Input signal is too high in one or both channels. This is usually caused by interfering signals such as line noise or electro-
surgery. X denotes the EEG channel. See <Pressure label> INOPS (under Pressure). Make sure that the Flexible Module Rack is connected to the monitor. All FMS measurements are off while the FMS is unplugged. The Flexible Module Rack is not supported by your monitor. Contact your service personnel. See <Pressure label> INOPS (under Pressure). See <Pressure label> INOPS (under Pressure). A problem has occurred with the second main display. Contact your service personnel. The monitor does not support a second main display. The monitor software is incompatible. Contact your service personnel. X2/MP2 only: There is no battery in the battery compartment. You cannot operate the monitor on AC mains while the battery compartment is open (not sealed with a battery). Load a battery immediately. There is a problem with the Intelligent Display. Check the MSL coupling cable then contact your service personnel. The monitor has lost contact with the connected Intelligent Display. Contact your service personnel. The monitor does not support the connected Intelligent Display. The monitor software is incompatible. There is a problem with I2C Bus communication in the monitor. Contact your service personnel. 69 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication LA LEAD OFF Numeric is replaced by -?- for 10 seconds; INOP tone. LAP INOPs LEADSET UNPLUGGED LL LEAD OFF Numeric is replaced by -?- for 10 seconds; INOP tone. MCC Reversed INOP tone MCC Unsupported INOP tone Meas. DEACTIVATED MEASSRV UNSUPPORTD INOP tone MMS Ext. EQUIP MALF INOP tone MMS Ext. UNPLUGGED INOP tone MMS Ext. Unpowered INOP tone MMSExt.Unsupported INOP tone MMS UNPLUGGED INOP tone. MMS UNSUPPORTED INOP tone.
!!/!!!MORE BED ALARMS At Information Center MSL Power High MSL Power Off INOP tone. MSL Power Overload INOP tone. Source What to do ECG PRESS Telemetry ECG Monitor Monitor MMS MMS Extension MMS Extension MMS Extension MMS Extension MMS MMS Monitor Monitor Monitor Monitor The LA electrode has become detached from the patient or the lead set has been changed. Reattach the electrode or select New Lead Setup in the Setup ECG menu to confirm the new lead set. See <Pressure label> INOPS (under Pressure). The leadset has been unplugged from the telemetry device. The LL electrode has become detached from the patient or the lead set has been changed. Reattach the electrode or select New Lead Setup in the Setup ECG menu to confirm the new lead set. The MSL coupling cable is reversed. Connect the end with the grey connector to the Intelligent Display. An MSL coupling cable has been connected to a device which does not support MSL coupling. An X2 or MP5 has been connected to a host monitor
(companion mode) and all derived measurements have been deactivated and/or measurements with a label conflict. The measurements can only be reactivated by disconnecting the measurement device from the host monitor. The Multi-Measurement module is not supported by the monitor. Contact your service personnel. Loss of communication between the Multi-Measurement Module and the MMS extension. Contact your service personnel. The MMS extension has been disconnected from the Multi-
Measurement Module. The MMS extension cannot operate while the Multi-
Measurement Module is running on battery power. The MMS extensions not supported by your monitor. Contact your service personnel. Make sure that the Multi-Measurement Module is connected to the monitor. All MMS measurements are off while the MMS is unplugged. The Multi-measurement Module is not supported by your monitor. Contact your service personnel. The monitor is associated with a telemetry device and is sending data to the Information Center via the telemetry device. There are currently more alarms at the bedside than can be transmitted to the Information Center. The power consumption of the devices connected to the Measurement Link (MSL) cable is too high. If this situation continues, the MSL will be switched off. Contact your service personnel. The power consumption of the devices connected to the Measurement Link (MSL) cable was too high for too long and the MSL has been switched off. Contact your service personnel. The power consumption of the devices connected to the Measurement Link (MSL) cable is much too high or there has been a short circuit. The MSL has been switched off. Contact your service personnel. 70 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs Source What to do INOP Message, Indication NBP Deactivated INOP tone. NBP EQUIP MALF Numeric is replaced by -?-
INOP tone. NBP INTERRUPTED Numeric is replaced by -?-
INOP tone. NBP NBP NBP NBP MEASURE FAILED Numeric may be displayed with a -?-
INOP tone. NBP No Central Monit. INOP tone Monitor The NBP measurement label in the measurement device has been deactivated by deactivating the label in the Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, reactivate the measurement label in the Measurement Selection window. Remove the cuff from the patient. The NBP hardware is faulty. Contact your service personnel. You can silence this INOP, but the INOP message remains visible until the next measurement is started or the Stop All SmartKey is selected. Check the tubing and cuff for leakages or kinks. Check that you are using the correct cuff size and placement, and that the correct patient category is selected. Try restarting the measurement. If the INOP occurs repeatedly, contact your service personnel. You can silence this INOP, but the INOP message remains visible until the next measurement is started or the Stop All SmartKey is selected. This INOP arises when the measurement needed longer than the maximum time for inflation, deflation or the total measurement. Check that you are using the correct cuff size and placement, and that the correct patient category is selected. Try restarting the measurement. You can silence this INOP, but the INOP message remains visible until the next measurement is started or the Stop All SmartKey is selected. Check the condition and suitability of the patient for NBP monitoring. Use another cuff to continue measuring. There is a problem with the communication to the network. Central monitoring is currently not possible (no patient alarms or information). Check the connection. Contact your service personnel.
!!/!!! NO DEVICE DATA NO DEVICE DATA NO ECG AT CENTRAL NO ECG SOURCE NO PPV FROM MeasSrv at Information Center NO PPV FROM <Device>
OUT OF AREA P/P1/P2/P3/P4 INOPS PAP INOPS PPV BAD <Pressure Label>
SIGNAL IntelliBridge Communication with connected device has been lost. Monitor Telemetry MMS or FMS MMS or FMS Telemetry PRESS PRESS PPV The ECG measured with the monitor ECG is not being sent to the Information Center via the telemetry device. A telemetry device is paired with the monitor but the Information Center is not detecting a valid ECG signal from either of them. The measurement device does not supply a beat-to-beat arterial pressure value. Contact your service personnel. The measurement device does not supply a beat-to-beat arterial pressure value. Contact your service personnel. The telemetry device has left the access point coverage area. See <Pressure label> INOPS (under Pressure). See <Pressure label> INOPS (under Pressure). The arterial pressure source selected for PPV is not providing a pulsatile signal. 71 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication PPV BAD SIGNAL at Information Center PPV CHK SOURCES
<Pressure label> ARTIFACT Numeric questionable
<Pressure label>
DEACTIVATED INOP tone
<Pressure label> EQUIP MALF Numeric is replaced by -?-
INOP tone.
<Pressure label> NO TRANSDUCER Numeric is replaced by -?-
INOP tone.
<Pressure label> NOISY SIGNAL Pulse numeric is replaced by -?-
INOP tone.
<Pressure label> NON-
PULSATILE Pulse numeric is replaced by -?-
INOP tone.
<Pressure label>
OVERRANGE Numeric is replaced by -?-
INOP tone.
<Pressure label> REDUCE SIZE
<Pressure label>
UNPLUGGED INOP tone.
<Pressure label>
ZERO+CHECK CAL Numeric is replaced by -?-
Source What to do PPV PPV PRESS PRESS PRESS PRESS PRESS PRESS PRESS PRESS PRESS PRESS The arterial pressure source selected for PPV is not providing a pulsatile signal. The arterial pressure source selected for PPV is unplugged or switched off. When this INOP has displayed for 1 minute PPV will be switched off. A non-physiological event is detected (for example, a flush or blood sample). A resulting high limit alarm will be suppressed. A Pressure measurement label in the measurement device or extension has been deactivated, either by connecting a Temp transducer in the shared Press/Temp socket, or by deactivating the label in the Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, either reconnect a Pressure transducer or reactivate the measurement label in the Measurement Selection window. Contact your service personnel. The pressure hardware is faulty. Make sure that the pressure transducer is connected to the measurement device or module. If you silence this INOP, the measurement will be switched off. This INOP can only arise when a pressure is selected as the pulse source. It occurs when the pulse detector finds a pulse rate above 350bpm. This is usually caused by movement artifact or electrical interference. This INOP can only arise when a pressure is selected as the pulse source. It occurs when the pulse rate being measured is less than 25 beats per minute or the amplitude is less than three mmHg. Check the catheter and connections to the patient. Make sure that the measurement has been properly prepared and zeroed, and that the transducer is level with the heart. If this INOP persists, try another transducer. Possible causes are a measured pressure outside the allowed pressure range, or a broken wire to the transducer. Increase the scale for the pressure wave. A Pressure measurement label has been deactivated, either by unplugging a module, or by deactivating the label in the Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, either replug the module or reactivate the measurement label in the Measurement Selection window. Perform a zero and check the calibration of the transducer. 72 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication
<pTemp label> CHECK PROBE Numeric is replaced by -?-
INOP tone.
<pTemp label> DEACTIVATED INOP tone.
<pTemp label> EQUIP MALF Numeric is replaced by -?-
INOP tone.
<pTemp label> INCOMPAT.
<pTemp label> MEAS FAILED Numeric is replaced by -?-
INOP tone.
<pTemp label> NO PROBE Numeric is replaced by -?-
INOP tone.
<pTemp label> OVERRANGE Numeric is replaced by -?-
INOP tone.
<pTemp label> PROBE MALF Numeric is replaced by -?-
INOP tone. pTaxil INOPS pToral INOPS pTrect INOPS
(!!)PW:Action Required PW:Check Settings PW in conflict RA LEAD OFF Numeric is replaced by -?-
INOP tone. RAP INOPS Rem.Alarmdev.Malf INOP tone Rem. Display Malf. Source What to do Predictive Temp Predictive Temp Predictive Temp Predictive Temp Predictive Temp Predictive Temp Predictive Temp Predictive Temp Predictive Temp Predictive Temp Predictive Temp Protocol Watch Protocol Watch Protocol Watch ECG PRESS Monitor Remote display Check that the probe holder is correctly installed and that a compatible probe is in use. If the INOP does not clear, remove the probe from the holder then replace it. If the INOP still does not clear, disconnect and reconnect the probe. The Predictive temperature has been deactivated. The Predictive Temperature hardware is defective. Contact your service personnel. The Predictive Temperature version is not supported by the monitor. The ambient temperature is outside the specified range (10 to 40C /50 to 104F). Bring the temperature into range to continue monitoring. If the INOP does not clear, disconnect and reconnect the probe. Connect a probe to the Predictive temperature unit. The temperature at the measurement site is out of range. Check that the probe is correctly located. If the INOP does not clear, disconnect and reconnect the probe. The connected probe may be defective. Disconnect and reconnect the probe. If the INOP does not clear, try another probe. See <pTemp label> INOPS See <pTemp label> INOPS See <pTemp label> INOPS The protocol currently running requires a user response. Check which pop-up window is displayed and provide the appropriate response. Contact your service personnel. Settings could not be loaded or interpreted correctly There is a patient information mismatch which has not yet been resolved (>15 minutes). The RA electrode has become detached from the patient or the lead set has been changed. Reattach the electrode or select New Lead Setup in the Setup ECG menu to confirm the new lead set. See <Pressure label> INOPS (under Pressure). There is a problem with the connection to the remote alert device. Contact your service personnel to check the remote alert device and its connections. There is a problem with an input device at the remote display. Perform a visual and functional check of all input devices. Contact your service personnel. 73 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication
!!/!!! REPLACE BATTERY T Severe yellow/red INOP tone. During this INOP, alarms cannot be paused or switched off. RESP EQUIP MALF Numeric is replaced by -?-
INOP tone. RESP ERRATIC Numeric is replaced by -?-
RESP LEADS OFF Numeric is replaced by -?-
INOP tone. RL LEAD OFF Numeric is replaced by -?- for 10 seconds; INOP tone. Settings Malfunc. INOP tone.
<SO2 Label> CAL FAILED Numeric is replaced by -?-
INOP tone.
<SO2 Label> CAL MODE Numeric is replaced by -?-
INOP tone.
<SO2 Label>CAL REQUIRED Numeric is replaced by -?-
INOP tone.
<SO2 Label> CANNOT MEAS Numeric is replaced by -?-
INOP tone.
<SO2 Label>CONFIG ERROR Numeric is replaced by -?-
INOP tone.
<SO2 Label> CONN OPTMOD Numeric is replaced by -?-
INOP tone.
<SO2 Label> EQUIP MALF Numeric displays -?-. INOP tone SO2 INCOMPATIBLE INOP tone
<SO2 Label> IN-VIVO CAL Source What to do Telemetry The battery in the telemetry device is almost empty and must be replaced. RESP Contact your service personnel. The RESP hardware is faulty. RESP RESP ECG Monitor SO2 SO2 SO2 SO2 SO2 SO2 SO2 SO2 SO2 The monitor has detected too many artifacts in the measured Resp signal. Check that the RA and LL electrodes are correctly attached and have not dried out. Not all the required leads for Resp monitoring are attached. Make sure that the RA and LL leads are attached. The RL electrode has become detached from the patient or the lead set has been changed. Reattach the electrode or select New Lead Setup in the Setup ECG menu to confirm the new lead set. The monitor cannot use the predefined settings for monitoring. Contact your service personnel. The calibration failed. Check the catheter-to-Optical-Module connection. Manually restart the calibration. Try another catheter and Optical Module. If the catheter is already inserted, perform an in-vivo calibration. Pre-insertion calibration is complete, but the catheter tip is still inside the optical reference. The catheter is now ready for insertion. There is no valid calibration data in the Optical Module. Perform either a pre-insertion or an in-vivo calibration. The signal is out of the normal range, and no oxygen saturation can be derived. Perform an in-vivo calibration. If the INOP persists, try another Optical Module and catheter. The Optical Module has been configured to SaO2 Mode. Use Change to Venous in the setup menu to reconfigure to venous saturation mode. The Optical Module was disconnected during data storage. Reconnect the Optical Module for at least 20 seconds. The SO2/SvO2 Module or Optical Module is faulty. Unplug and replug the Optical Module and SO2/SvO2 module. Exchange the modules. If the INOP persists, contact your service personnel. The SO2 Module or Optical Module is not supported. Contact your service personnel. The in-vivo calibration is not yet complete. Lab values must be stored to the Optical Module to complete the calibration. Either continue with the next steps of the current calibration or recall the previous calibration. 74 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication
<SO2 Label>LIGHT INTENS Numeric is replaced by -?-
INOP tone.
<SO2 Label> LOW LIGHT Numeric is replaced by -?-
INOP tone.
<SO2 Label> NO OPTMOD Numeric is replaced by -?-
INOP tone.
<SO2 Label> OPTMOD MALF
<SO2 Label> PRE-INS CAL Numeric displays -?-
INOP tone
<SO2 Label> UNPLUGGED Numeric displays -?-. INOP tone SO2 UPGRADE INOP tone
<SO2 Label> WARMUP Numeric is displayed with ?
SOME ECG ALRMS OFF Speaker Malfunct. INOP tone SPIRO MALFUNCTION SPIRO INCOMPATIBLE SPIRO UPGRADE SPIRO CANNOT MEAS SPIRO PURGE FAILED SPIRO UNKN. SENSOR SPIRO ALARMS SUPPR SPIRO PURGING SPIRO NO SENSOR Source What to do SO2 SO2 SO2 SO2 SO2 SO2 SO2 SO2 The intensity changed considerably since the last light intensity calibration. This may indicate that the catheter tip is positioned against a blood vessel wall or that there is low blood flow. Reposition the catheter (and perform a Light Intensity Calibration). The optical signal levels are too low. Check that the catheter is either in the optical reference or inserted into the patient. Check the catheter-to-Optical Module connection. If INOP persists, try another catheter and Optical Module. Connect the Optical Module. If the INOP persists, try another Optical Module. Silencing this INOP switches the measurement off. The Optical Module memory is faulty, and calibration data cannot be stored for transport or during power failure. If this capability is needed, use another Optical Module. The pre-insertion calibration is running. This typically takes one minute. During this time alarms are switched off. Wait until the calibration is complete. Measurement switched on and SO2/SvO2 module unplugged from the rack. The SO2 module is currently in upgrade mode. Monitoring is not possible in this mode. The Optical Module has not yet reached the operating temperature. Wait a few minutes until warm-up is finished. Arrhythmia This message appears (if configured to do so) when the on/off settings of the yellow arrhythmia alarms differ from the current Profile. Contact your service personnel to check the speaker and the connection to the speaker. Monitor Spirometry Module failure detected. Contact your service personnel. Spirometry Module revision not compatible with the host monitor software revision. Contact your service personnel. Spirometry The module is running a firmware upgrade. Wait until upgrade is completed before resuming monitoring. Spirometry Measurement is at its limit, e.g. ambient pressure out of range. Spirometry The purge operation could not be completed successfully. Check for kinked sensor tubings, hard occlusions and make sure that the pump is running and all valves are switching. Spirometry An unknown sensor ID code was detected. Use only the sensors listed in the Accessories chapter. Spirometry Alarming is suppressed for the spirometry module. Spirometry A purge operation is in progress - no data update on the screen. Wait until purge is complete. Spirometry No sensor detected. Make sure the correct sensor is attached to the breathing circuit. 75 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication SPIRO NO BREATH SPIRO GAS COMPENS?
SPIRO PATIENT CAT.
'SpO2 CHK SOURCES Numeric is replaced by -?-
'SpO2 CHK UNITS Numeric is replaced by -?-
<SpO2 label> DEACTIVATED INOP tone
<SpO2 label> EQUIP MALF Numeric is replaced by -?-
INOP tone.
<SpO2 label> ERRATIC Numeric is replaced by -?-
INOP tone.
<SpO2 label> EXTD. UPDATE Label is displayed with a -?-
(questionable numeric)
<SpO2 label> INTERFERNCE Numeric is replaced by -?-
INOP tone.
<SpO2 label> LOW PERF Label is displayed with a -?-
(questionable numeric)
<SpO2 label> NOISY SIGN. Numeric is replaced by -?-
INOP tone.
<SpO2 label> NON-PULSAT. Numeric is replaced by -?-
INOP tone.
<SpO2 label> NO SENSOR Numeric is replaced by -?-
INOP tone.
<SpO2 LABEL> POOR SIGNAL Label is displayed with a -?-
(questionable numeric) 76 Source What to do Spirometry No breath was detected for more than 25 seconds. Breath derived numerics are not available. Spirometry Gas compensation is set to gas analyzer but not all gases necessary for compensation are measured by a gas monitor. Some of the fall-back values provided by the user are used. Measurement accuracy might be reduced. SpO2 Difference SpO2 Difference SpO2 Spirometry Mismatch of patient size configured in the host monitor and sensor type plugged into the module. Check the instructions on selecting the correct sensor in the Spirometry chapter. Not all measurements or values required to perform the calculation are available. Check measurement sources. The monitor has detected a conflict in the units used for this calculation. Check the unit settings. The SpO2 measurement label in the measurement device has been deactivated by deactivating the label in the Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, reactivate the measurement label in the Measurement Selection window. The MMS or module is faulty. Unplug and replug the MMS or module. If the INOP persists, contact your service personnel. SpO2 SpO2 SpO2 SpO2 SpO2 SpO2 SpO2 SpO2 SpO2 Check the sensor placement. Try another adapter cable and sensor. If the INOP persists, contact your service personnel. The update period of displayed values is extended due to an NBP measurement on the same limb or an excessively noisy signal. There is too much interference, caused by a high level of ambient light and/or electrical interference. Cover the sensor to minimize ambient light. If the INOP persists, make sure that the sensor cable is not damaged or positioned too close to power cables. Accuracy may be compromised due to very low perfusion. Stimulate circulation at sensor site. If INOP persists, change the measurement site. Excessive patient movement or electrical interference is causing irregular pulse patterns. Try to reduce patient movement or to relieve the cable strain on the sensor. Check the perfusion at measurement site. If necessary, stimulate circulation or change measurement site. If the INOP is due to NBP measurement on the same limb, wait until the NBP measurement is finished. Make sure the SpO2 sensor is connected. If the INOP persists, try another adapter cable and sensor. If you silence this INOP, the measurement will be switched off. The signal condition of the SpO2 measurement is poor and measurement accuracy may be compromised. Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication
<SpO2 LABEL> PULSE?
Numeric is replaced by -?-
INOP tone
<SpO2 LABEL> SEARCHING Numeric unavailable
<SpO2 label> SENSOR MALF Numeric is replaced by -?-
INOP tone.
<SpO2 LABEL> SENSOR OFF Numeric is replaced by -?-
INOP tone
<SpO2 LABEL> UNKN.SENSOR Numeric is replaced by a -?-
<SpO2 LABEL> UNPLUGGED Numeric is replaced by -?-
INOP tone
<SpO2 LABEL> UPGRADE Label is displayed with a -?-, numeric is unavailable Sp - vO2 CHK SOURCES Numeric is replaced by -?-
Sp - vO2 CHK UNITS Numeric is replaced by -?-
SRR INTERFERENCE INOP tone SRR INVALID CHAN INOP tone SRR MALFUNCTION SVR/SVRI CHK SOURCES Numeric is replaced by -?-
SVR/SVRI CHK UNITS Numeric is replaced by -?-
SVR/SVRI SET CVP USED Numeric is replaced by -?-
T/T1/T2/T3/T4 INOPs TAAP DISABLED INOP tone Tamb INOPs Tart INOPs Source What to do SpO2 SpO2 SpO2 SpO2 SpO2 SpO2 SpO2 Sp - vO2 Sp - vO2 Monitor Monitor The detectable pulsations of the SpO2 signal are outside the specified pulse rate range. SpO2 is analyzing the patient signal to derive Pulse, SpO2 and Perf values. Please wait until the search analysis is complete. The SpO2 sensor or adapter cable is faulty. Try another adapter cable and sensor. If the INOP persists, contact your service personnel. The SpO2 sensor is not properly applied to the patient. Apply the sensor following the instructions supplied by the manufacturer. The connected sensor or adapter cable is not supported by the SpO2 measurement. Use only specified sensors and cables. An SpO2 measurement label has been deactivated, either by unplugging a module, or by deactivating the label in the Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, either replug the module or reactivate the measurement label in the Measurement Selection window. The SpO2 measurement is currently in UPGRADE mode. Monitoring is not possible in this mode. Not all measurements or values required to perform the calculation are available. Check measurement sources. The monitor has detected a conflict in the units used for this calculation. Check the unit settings. The short range radio connection has interference from another device. Try using another channel. The channel configuration of the Short Range Radio is invalid. Check channel and channel mask configuration. Malfunction in the short range radio device. If the INOP persists contact your service personnel. SVR/SVRI Not all measurements or values required to perform the calculation are available. Check measurement sources. SVR/SVRI The monitor has detected a conflict in the units used for this calculation. Check the unit settings. SVR/SVRI A CVP value is required for this calculation, but is not TEMP Monitor currently being measured. The monitor is using the CVP value preset in the Setup SVR menu. See <Temp label> INOPs (under Temp) The currently selected telemetry configuration on the monitor does not allow connection of telemetry devices to the monitor. TEMP TEMP See <Temp label> INOPs (under Temp) See <Temp label> INOPs (under Temp) 77 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication Tblood NO TRANSDUC Numeric is replaced by -?-
INOP tone Tblood OVERRANGE Numeric is replaced by -?-
Tcereb INOPS Tcore INOPs tcpO2 (or tcpCO2 or tcGas) CAL FAILED Numeric is replaced by -?-
INOP tone. tcpO2 (or tcpCO2 or tcGas) CAL REQUIRD Numeric is replaced by -?-
INOP tone. tcpO2 (or tcpCO2 or tcGas) CAL RUNNING Numeric displays first -?- , then numeric is displayed with a ?
tcpO2 (or tcpCO2 or tcGas) CHECK TIME tcpO2 (or tcpCO2 or tcGas) CHANGE SITE If Heat Switch Off is configured to Yes, numeric is replaced by -?-
INOP tone. tcpO2 (or tcpCO2 or tcGas) EQUIP MALF Numeric is replaced by -?-
INOP tone. tcpO2 (or tcpCO2 or tcGas) NO TRANSDUC Numeric is replaced by -?-
INOP tone. tcpO2 (or tcpCO2 or tcGas) STABILIZING Numeric is displayed with a ?
tcpO2 (or tcpCO2 or tcGas) UNPLUGGED Numeric is replaced by -?-
INOP tone. TELE CONFIG UNSUPP INOP tone Source What to do C.O. No transducer attached to the module or catheter disconnected. C.O. Tblood out of range 17C - 43C. TEMP TEMP tcGas tcGas tcGas See <Temp label> INOPs (under Temp) See <Temp label> INOPs (under Temp). A calibration failed. Check the calibration unit, gas pressure, and tubing connections, then restart the calibration. If the calibration has failed more than once, remembrane the transducer and restart the calibration. If this INOP persists, contact your service personnel. Calibration is required before applying the transducer to the patient. Insert a membraned transducer into the calibration chamber on the module, connect the calibration unit to the calibration chamber, open the gas valve and start the calibration. If this INOP occurs during a calibration, there may be a module or transducer malfunction: contact your service personnel. Wait until the tcpO2/tcpCO2 calibration is finished. tcGas Site Timer due to time out in 15 minutes or less. tcGas tcGas tcGas tcGas tcGas Site Timer has timed out. Change the application site to avoid skin burns. To reset the Site Timer, either calibrate and change the measurement site, or change the measurement site and reset the Site Timer manually by selecting the appropriate site time from the Setup TCGas menu. There is a malfunction in the transducer or module. Connect another transducer. If this INOP persists, contact your service personnel. No transducer is connected to the tcpO2/tcpCO2 module. Silencing the alarm switches off the measurement. The transducer has not yet reached the selected temperature and/or skin hyperemization is not yet finished. This INOP will disappear within three minutes. The measurement is switched on but the module is unplugged. The measurement automatically disappears from the display. Silencing this INOP switches off the measurement. Monitor Telemetry device not supported (companion mode) 78 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs Source What to do INOP Message, Indication
!!/!!!TELE DISCONNECT INOP tone TELE EQUIP MALF INOP tone TELE INCOMPATIBLE
!!/!!! TELE INOP Severe yellow/red INOP tone. Tele Sync Unsupp. INOP tone TELE UNSUPPORTED INOP tone
<'Temp> CHK SOURCES Numeric is replaced by -?-
<'Temp> CHK UNITS Numeric is replaced by -?-
<Temp label> DEACTIVATED INOP tone Telemetry Monitor Monitor Telemetry Telemetry Monitor TEMP Difference TEMP Difference TEMP
<Temp label> EQUIP MALF Numeric is replaced by -?-
INOP tone.
<Temp label> NO TRANSDUCER Numeric is replaced by -?-
INOP tone.
<Temp label> UNPLUGGED INOP tone TEMP TEMP TEMP Telemetry transceiver was disconnected or short range radio link was lost. For cable connections; check Telemetry interface, cable connection and setup. For short range radio connections: if the telemetry transceiver has not moved out-of-range, check for interference sources close to the monitor (bluetooth devices, DECT phones, cellular phones, microwaves, etc.) If this INOP persists, ask your service personnel to survey the interference sources. The telemetry device has a malfunction. Disconnect and reconnect the telemetry device. If the INOP reappears, replace the telemetry device. SRR-enabled telemetry device is not supported by this central software revision. Please check configuration. Check for further details at the Information Center or in the Telemetry Data window on the monitor. The MMS in use does not support synchronization of ECG and SpO2 settings between the monitor and central station after a telemetry device has been paired. Use an MMS with revision E.0 or above. This telemetry device is not supported for direct connection to the monitor. Not all measurements or values required to perform the calculation are available. Check measurement sources. The monitor has detected a conflict in the units used for this calculation. Check the unit settings. A Temp measurement label in the measurement device has been deactivated, either by connecting a Pressure transducer in the shared Press/Temp socket, or by deactivating the label in the Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, either reconnect a Temp transducer or reactivate the measurement label in the Measurement Selection window. Contact your service personnel. The temperature hardware is faulty. Make sure the TEMP probe is connected to the MMS or module. If you silence this INOP, the measurement will be switched off. A Temp measurement label has been deactivated, either by unplugging a module, or by deactivating the label in the Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, either replug the module or reactivate the measurement label in the Measurement Selection window. 79 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) Source What to do TEMP Try changing the application site of the transducer.
[The temperature is less than -1qC, or greater than 45qC.]
Monitor See <Temp label> INOPs (under Temp). TEMP TEMP TEMP TEMP TEMP TEMP PRESS Monitor TEMP IntelliBridge Incoming text from the IntelliBridge modules exceeds the maximum limit. Try unplugging one of the IntelliBridge modules. If the INOP occurs repeatedly contact your service personnel; a software upgrade may be necessary. The time has expired for the timer indicated in the INOP text. Clearing the timer clears the INOP. See <Temp label> INOPs (under Temp). See <Temp label> INOPs (under Temp). See <Temp label> INOPs (under Temp). See <Temp label> INOPs (under Temp) See <Temp label> INOPs (under Temp). See <Temp label> INOPs (under Temp) See <Pressure label> INOPS (under Pressure). There is a problem with the communication to the network and central monitoring is currently not possible. Check the connection. If the INOP persists, switch off the monitor and contact your service personnel. Perform a visual and functional check of all the monitor input devices. Contact your service personnel. See <Pressure label> INOPS (under Pressure). The V electrode (IEC: C electrode) has become detached from the patient or the lead set has been changed. Reattach the electrode or select New Lead Setup in the Setup ECG menu to confirm the new lead set. No cable or the wrong cable connected to the VueLink module, or incorrect device selected. Silencing this INOP switches the measurement off. VueLink INOP abbreviations may differ slightly depending on the device category. The wrong external device has been selected on the VueLink module, or the external device has not been correctly setup, or the wrong cable has been used to connect the device to the VueLink module. VueLink INOP abbreviations may differ slightly depending on the device category. PRESS ECG VueLink VueLink Monitor INOP Message, Indication
<Temp label> OVERRANGE Numeric is replaced by -?-
INOP tone. Tesoph INOPS TEXT UPLOAD FAILED INOP tone TimeExpired:<timer label>
INOP tone Tnaso INOPS Trect INOPS Tskin INOPS Ttymp INOPS Tven INOPS Tvesic INOPS UAP INOPS Unsupported LAN INOP tone User I/F Malfunct. INOP tone. UVP INOPS V LEAD OFF Numeric is replaced by -?- for 10 seconds; INOP tone.
<VueLink option> CHK CABLE INOP tone.
<VueLink option> CHK CONF. INOP tone. 80 Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication
<VueLink option> CHECK SETUP INOP tone. VueLnk EQUIP MALF INOP tone. VueLnk NO CONFIG INOP tone. VueLnk UNPLUGGED INOP tone. Source What to do VueLink VueLink VueLink VueLink No information was received from the external device. The device may be switched off or disconnected. VueLink INOP abbreviations may differ slightly depending on the device category. Malfunction in the VueLink module. If this message appears repeatedly, the module must be replaced. Contact your service personnel. VueLink INOP abbreviations may differ slightly depending on the device category. The VueLink module has not been configured during installation. The installation process should be completed by either your biomedical engineering department or the Philips service engineer. VueLink INOP abbreviations may differ slightly depending on the device category. The VueLink module has been unplugged from the rack, or the whole rack has been disconnected. The measurement automatically disappears from the display. Silencing this INOP switches off the measurement. VueLink INOP abbreviations may differ slightly depending on the device category. 81 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) 82 6 6Managing Patients Use the Patient Demographics window and its associated pop-up keys to admit, discharge, and transfer
(ADT) patients. All patient demographic and ADT information is shared between the patient monitor and the Information Center, for example, patients admitted to the monitor are automatically admitted to a connected Information Center. Admitting a Patient The monitor displays physiological data and stores it in the trends as soon as a patient is connected. This lets you monitor a patient who is not yet admitted. It is however important to admit patients properly so that you can identify your patient on recordings, reports, and networked devices. During admission you enter data that the monitor needs for safe and accurate operation. For example, the patient category setting determines the algorithm the monitor uses to process and calculate some measurements, the safety limits that apply for some measurements, and the alarm limit ranges. NOTE It is strongly recommended that the same patient data fields be configured to be mandatory at the monitor and the Information Center. To admit a patient, 1 Select the patient name field or select the Admit/Dischrge SmartKey to open the Patient Demographics window. SBed10 Adult Doe, John Patient Demographics Last Name
: Doe First Name
: John MRN Patient Cat. Admit Patient
: 12345678
: Adult Transfer Dischrge Patient End Case 83 6 Managing Patients Admitting a Patient 2 Clear any previous patient data by selecting the Dischrge Patient or End Case pop-up key and then Confirm. If you do not discharge the previous patient, you will not be able to distinguish data from the previous and current patients, for example, in the trend database. Select Admit Patient. 3 4 Enter the patient information: select each field and use the on-screen keyboard or choose from the pop-up list of alternatives to input information. Last Name: Enter the patients last name (family name), for example Smith. First Name: Enter the patients first name, for example Joseph. Middle Name (if configured to appear): Enter the patients middle name. Lifetime Id, Encounter Id: Whether these fields appear and how they are labelled can be configured for your hospital. One or both fields may be displayed and the labels may read:
MRN, Case Id, Visit Id, etc. Enter the appropriate data for the fields displayed. Patient Cat: Choose the patient category, either Adult, Pediatric, or Neonatal. Paced: Choose Yes or No (You must use Yes if your patient has a pacemaker). Height: Enter the patients height. Weight: Enter the patients weight. BSA: The monitor calculates the body surface area automatically. Date Of Birth: Enter the patients date of birth. Enter this in the form dd/mm/yyyy. Age: The monitor calculates the patient age automatically. Gender: Choose Male or Female. Notes: Enter any extra information about the patient or treatment. Select Confirm. The patient status changes to admitted. 5 Patient Category and Paced Status The patient category setting determines the algorithm the monitor uses to process and calculate some measurements, the safety limits that apply for some measurements, and the alarm limit ranges. The paced setting determines whether the monitor shows pacemaker pulses or not. When Paced is set to No, pace pulses are filtered and therefore do not show in the ECG wave. WARNING Patient Category and Paced status will always contain a value, regardless of whether the patient is fully admitted or not. If you do not specify settings for these fields, the monitor uses the default settings from the current profile, which might not be correct for your patient. Patient category Changing the patient category may change the arrhythmia and NBP alarm limits. Always check alarm limits to make sure that they are appropriate for your patient. Paced status For paced patients, you must set Paced to Yes. If it is incorrectly set to No, the monitor could mistake a pace pulse for a QRS and fail to alarm during asystole. Admitting a Centrally-Monitored Patient You can admit a patient at either the bedside or the Information Center. When you admit a patient, the patients name appears on the bedside monitor and the Information Center. 84 Quick Admitting a Patient 6 Managing Patients If you do not fill in all patient information required by the Information Center, the Information Center may reject the admission. Complete all the required fields and try again to admit the patient. Quick Admitting a Patient Use Quick Admit only if you do not have the time or information to fully admit a patient. Complete the rest of the patient demographic details later. Select the Quick Admit SmartKey. 1 2 Enter the required data (ID fields or Last Name depending on configuration) with the keyboard. Select Enter. In the confirmation window, select Confirm to discharge the previous patient (if confirmation is configured). 3 4 5 Check that patient category and paced status are correct for the new patient. If the monitor is connected to an Information Center and only the ID field is entered, the patient name is set to - - - at the Information Center. Complete the rest of the demographic details as soon as possible to fully identify the patient on the network, on the monitor and on printed reports. To complete the details, select Admit Patient again and complete all required fields. Editing Patient Information To edit the patient information after a patient has been admitted, select the patient name field on the Main Screen to open the Patient Demographics window, and make the required changes. Discharging a Patient WARNING Always perform a discharge before starting monitoring for a new patient, even if your previous patient was not admitted. Failure to do so can lead to data being attributed to the wrong patient. A discharge:
clears the information in the Patient Demographics window erases all patient data (including trend data) from the monitor and Information Center. This ensures that data from a previous patient are not mixed with data from the new patient. resets patient category and paced settings to the settings defined in the default Profile resets all monitor and measurement settings as well as the active Screen to the settings defined in the default Profile discharges the patient from the Information Center. When a patient is discharged from the monitor or from an Information Center, all patient data is deleted. Make sure that you have printed out any required reports before discharging. Check that a functioning central printer is available before you use End Case. To discharge a patient, Select the patient name field or select the Admit/Dischrge SmartKey to open the Patient Demographics window and associated pop-up keys. 1 85 6 Managing Patients Transferring Patients 2 Select the pop-up key for either:
End Case - to print any configured end case reports or vital signs recording, discharge the patient and clear the patient database, then enter standby mode. If an End Case SmartKey is configured for your monitor, you can also select this instead and then confirm. To see which end case reports are set up for your monitor, select Main Setup -> Reports ->
Auto Reports. For each auto report, if End Case Report is set to On, this report will be printed when you select End Case. See the section on AutoReports for information on setting up end case reports. Dischrge Patient - to discharge the patient without printing any reports. New Patient Check The monitor can be configured to ask you in certain situations:
after a specified power-off period after a specified standby period when no basic vitals (HR, RR, Pulse, SpO2, NBP) have been measured for a specified period whether a new patient is now being monitored. The pop-up window is entitled Is this a new Patient?. The monitor offers a Yes key to discharge the previous patient and begin monitoring a new patient and a No key to continue monitoring with the current patient data and settings. The time periods for the three conditions can be configured independently. Transferring Patients To save you from having to enter the same patient data multiple times and enable patient transfer without loss of data, patient demographic information is shared between patient monitors and Information Centers. Transferring a Centrally-Monitored Patient with the Monitor 1 Scenario: A centrally-monitored patient is moved with the monitor to another monitoring location on the same Information Center database server without interrupting the collection of patient trend information. Select the patient name field or select the Admit/Dischrge SmartKey to open the Patient Demographics window, then select the Transfer pop-up key. If the patient is not admitted or not monitored by an Information Center, the Transfer key is inactive
(grayed-out). This step preserves the patients demographic data during the transfer. 2 At the new location, connect the monitor to the network (only needed for wired networks). If the monitor detects a patient mismatch, a window will open showing your patients data and asking Complete transfer of this patient?. Select Yes to complete the transfer. 3 4 Verify that the settings for patient category and paced mode are correct. If you accidentally transfer a patient, use Re-Admit to restore this patients data to the Information Center. If you are not connected to the network, select Clear Transfer to leave transfer mode. The patient data remains in the monitor. 86 Transferring Patients 6 Managing Patients Data Exchange Between Information Centers You can transfer demographic data and trend data from one IIC to another by selecting Transfer on the patient monitor. Trend data is not shared between Information Centers and monitors. Resolving Patient Information Mismatch When you connect together devices which store patient demographic data, for example:
an MMS and a monitor, an X2 or MP5 and a host monitor, a monitor and an Information Center, the system compares patient category, paced status, and unique patient identification in order to synchronize this information. If configured to do so, the monitor indicates a mismatch if the information is not identical. WARNING 1 When a monitor is connected to an Information Center by the wireless IntelliVue Instrument 2 Telemetry interface, the patient data will automatically be merged in the case of a transfer. This means there is no patient discharge at the monitor and settings and trend data will be retained. You will see a message on the monitor and the Patient Demographics window will automatically appear so that you can check the data and change it if necessary. It is important to resolve the mismatches as soon as they are identified. Failure to do so could result in using incorrect/confusing data to make clinical decisions. Certain settings, for example Paced and Patient Category, may not match between the Information Center and the monitor. If the Paced status is set incorrectly, the system could mistake a pace pulse for a QRS and fail to alarm in the case of asystole. It is important that the Patient Category is set correctly so the ECG can be analyzed correctly and initial arrhythmia alarm limits set. In the case where an MP5 or X2 with an IntelliVue Instrument Telemetry interface is declared as a telemetry device at the Information Center and is connected to a host monitor, it is important to resolve an existing mismatch between the monitor and the Information Center before disconnecting the MP5/X2. Failure to do so discharges the MP5/X2 and synchronizes the demographics and settings to the Information Center. Manually Resolving Patient Mismatch The source of the patient mismatch is indicated by question marks (???) and displayed in the status line at the bottom of the screen (Patient ???, Patient Category ??? or Paced ???). The Select Patient window automatically opens so you can decide which patient data to use. You do not have to resolve the mismatch immediately, but the indicators remain until you do. For some common mismatch situations, the monitor will simplify the resolution by suggesting a solution for the mismatch. For example, when a patient arrives after transport and the Transfer key has been selected, the monitor will show this patients data and ask Complete transfer of this patient?. You can then select Yes to complete the transfer. If you select No you will go to the Select Patient window. After you resolve the mismatch, the monitor displays a confirmation window that shows the patient that has been selected and where data will be erased, if applicable. Confirm your choice. The monitor automatically displays the Patient Demographics window after confirmation. Verify that the settings shown are correct for the patient. 87 6 Managing Patients Transferring Patients Gender, date of birth, height, weight, and nursing notes do not generate a mismatch. If these fields are different on different devices, the monitor resolves them itself. For example, it may take date of birth from the Information Center, whilst taking gender from the monitor. Always check the Patient Demographics after combining patients, to ensure that you are satisfied with the results. Change them if necessary. WARNING After resolving a patient mismatch, check that the monitor settings (especially patient category, paced status and alarm limits) are correct for the patient. Patient Mismatch - If One Set of Patient Data is Correct If there is a mismatch between an Information Center and a monitor, choose the data set you want to continue using for this patient by selecting one of the sectors in the Select Patient window. After you resolve the mismatch, the monitor displays a confirmation window that shows the patient that has been selected and where data will be erased, if applicable. Confirm your choice. The monitor automatically displays the Patient Demographics window after confirmation. Verify that the settings shown are correct for the patient. Select Patient DOE, JOHN F 1234HG9556, 2008/00123 Adult Non-Paced MILLER, Adult Paced Same Patient New Patient Patient Mismatch - If Neither Patient Data Set is Correct A patient mismatch where neither set of patient data is correct might occur if you connect a new MMS to a monitor in order to prepare for a new patient, before you actually start measuring. Select New Patient if you are sure that none of the information is correct. This discharges all patients, erases all data in both the monitor and MMS, resets all settings to the default Profile, and lets you admit a new patient. Patient Mismatch - If Both Patient Data Sets Are Correct A patient mismatch where both sets of patient data are correct might occur if you admit a new patient at the monitor (or Information Center) before the patient arrives at your unit and then connect the MMS that was used during the patient transport to the monitor. Select Same Patient if the patient information is different, but you are sure it is the same patient. This merges the demographics and updates them in the Information Center, monitor, and MMS, according to this table. Be aware that your monitor may be configured to merge trend data from the MMS and the monitor, and to upload measurement settings from the MMS to the monitor. 88 7 7ECG, Arrhythmia, ST and QT Monitoring The electrocardiogram (ECG) measures the electrical activity of the heart and displays it on the monitor as a waveform and a numeric. This section also tells you about arrhythmia monitoring (see page 105), ST monitoring (see page 117) and QT monitoring (see page 127). Skin Preparation for Electrode Placement Good electrode-to-skin contact is important for a good ECG signal, as the skin is a poor conductor of electricity. Select sites with intact skin, without impairment of any kind. 1 2 Clip or shave hair from sites as necessary. 3 Wash sites thoroughly with soap and water, leaving no soap residue. We do not recommend using ether or pure alcohol, because this dries the skin and increases the resistance. 4 Dry skin thoroughly. 5 Gently abrade the skin using ECG skin preparation paper to remove dead skin cells to improve the conductivity of the electrode site. Connecting ECG Cables 1 Attach the clips or snaps to the electrodes before placing them. If you are not using pre-gelled electrodes, apply electrode gel to the electrodes before placement. Place the electrodes on the patient according to the lead placement you have chosen. 2 89 7 ECG, Arrhythmia, ST and QT Monitoring Selecting the Primary and Secondary ECG Leads 1 - ECG Connector 1 3 Attach the electrode cable to the patient cable. 4 Plug the patient cable into the white ECG connector on the monitor. An ECG waveform and numeric appears on the monitor display. CAUTION To protect the monitor from damage during defibrillation, for accurate ECG information and to protect against noise and other interference, use only ECG electrodes and cables specified by Philips. Selecting the Primary and Secondary ECG Leads The monitor uses the primary and secondary lead to compute HR and to analyze and detect cardiac arrhythmias. They are also available for recordings and for display on the Information Center. The secondary lead is only used if your monitor is configured for multi-lead (instead of single-lead) arrhythmia analysis. You should choose a lead as primary or secondary lead that has the following characteristics:
the QRS complex should be either completely above or below the baseline and it should not be biphasic the QRS complex should be tall and narrow the P-waves and T-waves should be less than 0.2 mV To select a lead as primary or secondary lead:
In the Setup ECG menu, select Primary or Secondary, then select the appropriate lead. You can assign any available lead whether it is currently displayed or not. Checking Paced Status It is important to set the paced status correctly when you start monitoring ECG. To change the paced status in the Setup ECG menu, select Paced to toggle between Yes or No. 90 Understanding the ECG Display 7 ECG, Arrhythmia, ST and QT Monitoring WARNING Pace pulse rejection must be switched on for paced patients by setting Paced to Yes. Switching pace pulse rejection off for paced patients may result in pace pulses being counted as regular QRS complexes, which could prevent an asystole event from being detected. When changing profiles, and at admission/discharge, always check that paced status is correct for the patient. Some pace pulses can be difficult to reject. When this happens, the pulses are counted as a QRS complex, and could result in an incorrect HR and failure to detect cardiac arrest or some arrhythmias. Make sure that pace pulses are detected correctly by checking the pace pulse markers on the display. Keep pacemaker patients under close observation. Understanding the ECG Display Your display may be configured to look slightly different. 1 8 2 3 4 5 M EASI 7 Paced Rhythm HR bpm 6 1 2 3 4 5 6 7 8 Lead label of the displayed wave 1 mV calibration bar Pacer spikes Pace pulse markers Current heart rate Current heart rate alarm limits EASI lead placement label ECG Filter label ECG HR numeric: This is the heart rate derived from the monitored ECG. Pace pulse markers: These are shown if the Paced status has been set to Yes, the pacer spikes are not configured to have a fixed size, and the patient has a paced signal. Pacer Spikes: The pacer spikes are shown in white, unless the ECG wave is white, then they will be green. If the pacer spikes have been configured to have a fixed size, they will be displayed in the background as a dotted line. 91 7 ECG, Arrhythmia, ST and QT Monitoring Monitoring Paced Patients 1 Pacer spikes configured to have a fixed size 1 Defibrillator synchronization marks: If an HP/Agilent/Philips defibrillator is connected, the synchronization marks (vertical lines on the ECG wave) are shown on the ECG wave. The synchronization marks will be shown in yellow, unless the ECG wave is yellow, then they will be green. If so configured, the monitor can supply its own synchronization marks; in this case the synchronization marks from a defibrillator will not be shown. ST numerics in ECG wave: ST numerics can be configured to show underneath the ECG wave on the left side. Monitoring Paced Patients An ECG optimized for monitoring a paced patient should look like this:
1 2 1 2 Normal Beats Pace Pulses/Beats You should choose a lead as primary or secondary lead that has these characteristics:
the normal QRS complex should be either completely above or below the baseline and it should not be biphasic. For paced patients, the QRS complexes should be at least twice the height of pace pulses. the QRS complex should be tall and narrow the P-waves and the T-waves should be less than 0.2 mV. For ease of identification on the screen, the pacer spikes can be configured to have a fixed size. They are then shown in the background as a dotted lines. The length of the dotted line is fixed to the wave channel height and is independent of the actual pacer amplitude. 92 Changing the Size of the ECG Wave 7 ECG, Arrhythmia, ST and QT Monitoring Setting the Paced Status (Pace Pulse Rejection) In the Setup ECG menu, select Paced to toggle between Yes and No. You can also change the paced status in the Patient Demographics window. When Paced is set to Yes:
Paced Pace Pulse Rejection is switched on. This means that pacemaker pulses are Non-Paced not counted as extra QRS complexes. pace pulse marks are shown on the ECG wave as a small dash (only when the pacer spikes are not configured to have a fixed size) the paced symbol is displayed under the HR label. When Paced is set to No, pacer spikes are not shown in the ECG wave. Be aware that switching pace pulse rejection off for paced patients may result in pace pulses being counted as regular QRS complexes, which could prevent an asystole event from being detected. Avoiding Pace Pulse Repolarization Tails Some unipolar pacemakers display pace pulses with repolarization tails. These tails may be counted as QRSs in the event of cardiac arrest or other arrhythmias. If you note a visible repolarization tail, choose a lead that decreases the size of the repolarization tail. 1 Repolarization tail
(note width) 1 Changing the Size of the ECG Wave If any of the displayed ECG waves is too small or clipped, you can change the size of one or all of the ECG waves on the screen. Changing the adjustment factor only changes the visual appearance of the ECG wave on the screen. It does not affect the ECG signal analyzed by the monitor. Comparing the wave size to the 1 mV calibration bar on the ECG wave segment can help you to get an idea of the true ECG signal strength. If you choose a fixed adjustment factor, the 1 mV calibration bar will be the same size for all the displayed ECG waves. If you choose AutoSize, or an individual size using the Size Up / Size Down keys, the calibration bar may be a different size for each wave. To Change the Size of an Individual ECG Wave 1 Select the wave segment you want to change. This calls up the lead menu for this segment. 93 7 ECG, Arrhythmia, ST and QT Monitoring Changing the Volume of the QRS Tone 2 In the lead menu, select Size Up to increase wave size or Size Down to decrease the size. Selecting AutoSize lets the monitor choose the optimal adjustment factor for all displayed ECG waves. To Change the Size of all the ECG Waves To change the size of all the ECG waves on the screen by a fixed adjustment factor, 1 2 In the Setup ECG menu, select Adjust Size. Select the required adjustment factor from the line of pop-up keys. Size x0.5 to halve the wave size Size x1 to display the wave without zoom Size x2 to double the wave size Size x4 to multiply the wave size by four Changing the Volume of the QRS Tone The QRS tone is derived from either the HR or Pulse, depending on which is currently selected as the alarm source. The QRS volume can be set from 0 to 10 (0 means off). To change the QRS volume, in the Setup ECG menu select QRS Volume and then select the appropriate volume from the pop-up list. Changing the ECG Filter Settings The ECG filter setting defines how ECG waves are smoothed. An abbreviation indicating the filter type is shown underneath the lead label on the monitor display. Filter settings do not affect ST measurement. To change the filter setting, in the Setup ECG menu, select Filter and then select the appropriate setting. Monitor: Use under normal measurement conditions. Ext. Monitor: Use for pediatric and neonatal patients when diagnostic quality is required but low frequency interference or a wandering baseline may be expected. The upper edge frequency is the same as the Diag setting and the lower edge frequency is the same as the Monitor setting. Filter: The filter reduces interference to the signal. It should be used if the signal is distorted by high frequency or low frequency interference. High frequency interference usually results in large amplitude spikes making the ECG signal look irregular. Low frequency interference usually leads to a wandering or rough baseline. In the operating room, the Filter reduces artifacts and interference from electro-surgical units. Under normal measurement conditions, selecting Filter may suppress the QRS complexes too much and thus interfere with the clinical evaluation of the ECG displayed on the monitor. This does not affect the ECG analysis performed by the monitor. If AutoFilter is set to On in Configuration Mode, the filter setting will automatically be set to Filter if electromagnetic interference is detected. 94 Selecting Positions of Va and Vb Chest Leads (for 6-lead placement) 7 ECG, Arrhythmia, ST and QT Monitoring Diag: Use when diagnostic quality is required. The unfiltered ECG wave is displayed so that changes such as R-wave notching or discrete elevation or depression of the ST segments are visible. The setting Diag selects the highest available ECG bandwidth which is 0.05 to 150 Hz for the Adult, Pedi and Neo patient category. The term diagnostic relates only to the ECG bandwidth requirements for diagnostic electrocardiographic devices as outlined in the ANSI/AAMI standard EC11-1991. When you are using a telemetry transmitter connected via short range radio to the monitor, the upper bandwidth for all filter settings is limited to 40 Hz. Selecting Positions of Va and Vb Chest Leads (for 6-
lead placement) The two chest leads for the 6-lead placement can be positioned at any two of the V1 to V6 positions. Select the positions you have used in the Setup ECG menu, so that the chest leads will be correctly labeled. In the Setup ECG menu, select Va Lead. Select the position used from the list. Select Vb Lead and select the position used from the list 1 2 3 Choosing EASI or Standard Lead Placement You must enable either standard lead placement or EASI lead placement. In the Setup ECG menu, select Placement and then Standard or EASI. EASI is shown beside the 1mV calibration bar on the ECG wave on the display, and EASI is marked on any printouts. See the section on EASI ECG Lead Placement for electrode placement diagrams. About ECG Leads To make it possible to compare measured ECG signals, the electrodes (or lead sets) are placed in standardized positions, forming so-called leads. To obtain ECG signals optimized for use in diagnosis and patient management in different care environments, different lead sets in varying lead placements can be used. You can use either standard lead placements or EASI lead placements with this monitor. When placing electrodes, choose a flat, non-muscular site where the signal will not be interfered with by either movement or bones. Correct lead placement is always important for accurate diagnosis. Especially in the precordial leads, which are close to the heart, QRS morphology can be greatly altered if an electrode is moved away from its correct location. 95 7 ECG, Arrhythmia, ST and QT Monitoring ECG Lead Fallback ECG Leads Monitored If you are using a 3-electrode set a 5-electrode set a 6-electrode set a 10-electrode set an EASI 5-electrode set these leads are available:
Resp is measured between electrodes:
RA and LL I, II, III RA and LL I, II, III, aVR, aVL, aVF, V and MCL I, II, III, aVR, aVL, aVF, Va, Vb RA and LL I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6 RA and LL I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6 I and A Changing Lead Sets To change the ECG lead set, When adding leads: place the additional electrodes as required - the monitor automatically recognizes the new lead placement. When removing leads: there are two possibilities - removing the complete chest leads block or removing individual leads. If you unplug the chest lead block from the trunk cable connector, the monitor will automatically recognize the new lead placement. Remove individual leads by removing the electrodes. The monitor will issue a Lead Off INOP message; select New Lead Setup in the Setup ECG menu and the INOP message will disappear. ECG Lead Fallback If fallback is configured on and there is a leads off INOP in the primary lead (and in the secondary lead, if you are using multi-lead monitoring) for longer than 10 seconds, and if another lead is available, this available lead automatically becomes the primary lead. This is known as lead fallback. When the Leads Off condition is corrected, the leads are automatically switched back. This setting can only be changed in Configuration Mode. ECG Lead Placements The labels and colors of the ECG electrodes differ according to the standards that apply for your hospital. The electrode placement illustrations in this chapter use the AAMI labels and colors. Electrode labels Electrode colors AAMI EASI IEC AAMI RA LA LL RL V V1 V2 I S A N E R L F N C C1 C2 White Black Red Green Brown Brown/Red Brown/Yellow IEC Red Yellow Green Black White White/Red White/Yellow 96 ECG Lead Placements 7 ECG, Arrhythmia, ST and QT Monitoring Electrode labels Electrode colors AAMI EASI IEC AAMI V3 V4 V5 V6 C3 C4 C5 C6 Brown/Green Brown/Blue Brown/Orange Brown/Violet IEC White/Green White/Brown White/Black White/Violet Standard 3-Lead Placement 1 2 1 2 3 RA placement: directly below the clavicle and near the right shoulder LA placement: directly below the clavicle and near the left shoulder LL placement: on the left lower abdomen 3 Standard 5-Lead Placement 1 I aVR V aVL II 5 a V F 2 III 3 4 RA placement: directly below the clavicle and near the right shoulder LA placement: directly below the clavicle and near the left shoulder RL placement: on the right lower abdomen LL placement: on the left lower abdomen V placement: on the chest, the position depends on your required lead selection 97 7 ECG, Arrhythmia, ST and QT Monitoring ECG Lead Placements 6-Lead Placement For a 6-lead placement use the positions from the 5-lead diagram above but with two chest leads. The two chest leads, Va and Vb, can be positioned at any two of the V1 to V6 positions shown in the chest electrode diagram below. The Va and Vb lead positions chosen must be selected in the ECG Setup Menu to ensure correct labeling. Chest Electrode Placement For accurate chest electrode placement and measurement, it is important to locate the fourth intercostal space. 1 2 Locate the second intercostal space by first palpating the Angle of Lewis (the little bony protuberance where the body of the sternum joins the manubrium). This rise in the sternum is where the second rib is attached, and the space just below this is the second intercostal space. Palpate and count down the chest until you locate the fourth intercostal space. Angle of Lewis 2 3 4 V3R V4R V1 V2 V3 VE V6 V4 V5 V7 V1 placement: on the fourth intercostal space at the right sternal border V2 placement: on the fourth intercostal space at the left sternal border V3 placement: midway between the V2 and V4 electrode positions V4 placement: on the fifth intercostal space at the left midclavicular line V5 placement: on the left anterior axillary line, horizontal with the V4 electrode position V6 placement: on the left midaxillary line, horizontal with the V4 electrode position V3R to V6R placement: on the right side of the chest in positions corresponding to those on the left VE placement: over the xiphoid process V7 placement: on posterior chest at the left posterior axillary line in the fifth intercostal space V7R placement: on posterior chest at the right posterior axillary line in the fifth intercostal space 98 ECG Lead Placements 7 ECG, Arrhythmia, ST and QT Monitoring 10-Lead Placement When monitoring 12-leads of ECG, using a 10-Electrode Lead Placement, it is important to correctly place electrodes and to label all 12-lead ECG reports with the correct lead placement. Conventional 12-Lead ECG 1 2 5 4 3 1 - V1 - V6 2 - LA 3 - LL 4 - RL 5 - RA In conventional 12-Lead ECG using 10 electrodes, an electrode is placed on the right arm, left arm, right leg, and left leg. Six V-
electrodes are placed on the chest. The right leg electrode is the reference electrode. Limb electrodes:
Place arm electrodes on the inside of each arm, between the wrist and the elbow. Place leg electrodes inside of each calf, between the knee and the ankle. Chest electrodes:
V1 - on the 4th intercostal space at the right sternal border V2 - on the 4th intercostal space at the left sternal border V3 - midway between the V2 and V4 electrode positions V4 - on the 5th intercostal space at the left midclavicular line V5 - on the left anterior axillary line, horizontal with the V4 electrode position V6 - on the left midaxillary line, horizontal with the V4 electrode position 99 7 ECG, Arrhythmia, ST and QT Monitoring Capture 12-Lead Modified 12-Lead ECG 6 5 1 2 4 3 1 - LA 2 - V1 - V6 3 - LL 4 - RL 5 - RA 6 - Angle of Lewis If your institution uses modified 10 Lead ECG electrode placement (the Mason-Likar Lead System), place the four limb electrodes close to the shoulders and lower abdomen. The six V electrodes are placed on the chest in the same position as the conventional 12-lead placement. Choosing Standard or Modified Electrode Placement If your institution uses modified 10 Lead ECG electrode placement (the Mason-Likar Lead System), you must switch ModLdPlcmt to On in the monitor. To do this, in the Setup ECG menu, select ModLdPlcmt to toggle between On and Off. When ModLdPlcmt is set to On, 12 Lead ECG Reports will be labelled 12 Lead ECG Report (Mason-Likar), and captured 12-lead ECGs will be labelled Mason-Likar to the right of the bandwidth annotation at the Information Center. When ModLdPlcmt is set to Off, 12 Lead ECG Reports will be labelled 12 Lead ECG Report, and captured 12-lead ECGs will not be annotated at the Information Center. WARNING Do not use ECG analysis interpretation statements and measurements for 12-lead ECGs obtained using the modified (Mason-Likar) limb electrode placement. This may lead to misdiagnosis since the modified (Mason-Likar) limb electrode placement does not look the same as the conventional 12-lead ECG and may mask inferior infarction due to calculated axis, R, P and T wave magnitudes shifts and ST slope. Do not export 12-lead ECGs obtained using the modified (Mason-Likar) limb electrode placement. Captured 12-Lead ECGs using the modified (Mason-Likar) limb electrode placement exported from the Information Center are not annotated with the Mason-Likar label. Capture 12-Lead If the monitor is connected to an Information Center via a wired network, the Capture 12-Lead SmartKey may be configured. Selecting this exports 12-Lead ECG information to the Information Center for analysis. For details see the Instructions for Use supplied with the Information Center. 100 EASI ECG Lead Placement 7 ECG, Arrhythmia, ST and QT Monitoring EASI ECG Lead Placement Using a standard 5-electrode set in EASI lead placement you can monitor up to 12 standard ECG leads simultaneously and continuously at the bedside. EASI provides a monitoring method for trending ST segment changes that can provide an early indication of ischemia. WARNING EASI-derived 12-lead ECGs and their measurements are approximations to conventional 12-lead ECGs. As the 12-lead ECG derived with EASI is not exactly identical to the 12-lead conventional ECG obtained from an electrocardiograph, it should not be used for diagnostic interpretations. Respiratory monitoring is also possible with the EASI placement; respiration is measured between the I and A electrodes. Place the electrodes as accurately as possible to obtain the best quality EASI measurements. When EASI lead placement is selected, EASI is shown beside the 1mV calibration bar on the ECG wave on the display, and EASI is marked on any recorder strips and printouts. When EASI lead placement is selected, EASI is shown beside the 1mV calibration bar on the ECG wave on the display, and EASI is marked on any printouts. EASI Monitoring During INOP Conditions If one of the derived EASI leads has an INOP condition (for example, LEAD OFF), a flat line is displayed. After 10 seconds, the directly acquired EASI AI, AS, or ES lead (depending on which is available) is displayed with the corresponding lead label. This causes an arrhythmia relearn. EASI Electrode Placement 1 E (V) on the lower sternum at the level of the fifth intercostal space on the left midaxillary line at the same level as the E electrode on the upper sternum on the right midaxillary line at the same level as the E electrode reference electrode - can be anywhere, usually below the sixth rib on the right hip 2 3 4 5 A (LL) S (LA) I (RA) N 2 1 3 4 5 101 7 ECG, Arrhythmia, ST and QT Monitoring ECG and Arrhythmia Alarm Overview ECG and Arrhythmia Alarm Overview The ECG and arrhythmia alarms available depend on which measurements are switched on, and the arrhythmia option enabled for your monitor. Cardiotach alarms are available when HR is on and the active alarm source is ECG, but arrhythmia is switched off Basic arrhythmia alarms are available when Arrhythmia is switched on Advanced arrhythmia alarms are available when Arrhythmia is switched on and the Advanced Arrhythmia option has been enabled for your monitor Cardiotach Alarms Additional Alarms with Basic Arrhythmia Option Additional Alarms with Enhanced Arrhythmia Option
***Asystole
***Ventricular Tachycardia
**Afib
***Ventricular Fibrillation/
Tachycardia
***Extreme Bradycardia
***Extreme Tachycardia
**Pacer Not Capture
**Pacer Not Pacing
**PVCs/min HIGH(PVC >
limit/min)
**High heart rate
**Low heart rate
**Supraventricular Tach
**Missed Beat
**Pause
**Irregular HR
**Ventricular Rhythm
**Run PVCs High
**Pair PVCs
**R-on-T PVCs
**Ventricular bigeminy
**Ventricular trigeminy
**Non-sustain VT
**Multiform PVCs 102 Using ECG Alarms 7 ECG, Arrhythmia, ST and QT Monitoring Using ECG Alarms ECG alarms can be switched on and off and the high and low alarm limits changed just like other measurement alarms, as described in the Alarms section. Special alarm features which apply only to ECG are described here. Extreme Alarm Limits The extreme rate alarms, Extreme Tachy and Extreme Brady, generated by the active alarm source, either HR or Pulse, are set in Configuration Mode by adding a set value (the ' value) to the high and low alarm limits. Extreme Brady Limit Low Limit High Limit Extreme Tachy Limit
' Extreme Brady
' Extreme Tachy You need to know which value has been configured for your monitor. Changing the high and low alarm limits automatically changes the extreme alarm limits within the allowed range. To see the extreme rate alarms set for your monitor, in the Setup ECG menu, see the menu items
'ExtrTachy and 'ExtrBrady. ECG Alarms Off Disabled Be aware that your hospital department may have decided to disable the setting ECG Alarms Off in the monitors Configuration Mode. In this case, HR alarms cannot be switched off in Monitoring Mode. If you try to switch off the HR alarms, you will see the message To activate enter Config and enable Alarms Off. HR Alarms When Arrhythmia Analysis is Switched Off When arrhythmia analysis is switched off, only these HR-related alarms will be detected:
the asystole alarm the ventricular fibrillation/tachycardia alarm the extreme tachycardia and extreme bradycardia alarms the high heart rate and low heart rate alarms. Enhanced Asystole Detection In order to improve alarming on asystole under certain conditions, you can set Asystole Detect. in Configuration Mode to Enhanced. In enhanced mode an asystole alarm will be suppressed for up to five seconds if a valid beat-to-beat Pulse is detected from a Pressure. 103 7 ECG, Arrhythmia, ST and QT Monitoring ECG Safety Information ECG Safety Information CAUTION Interference from instruments near the patient and ESU interference can cause problems with the ECG wave. See the monitor specifications for more information. WARNING Defibrillation and Electrosurgery: Do not touch the patient, or table, or instruments, during defibrillation. After defibrillation, the screen display recovers within 10 seconds if the correct electrodes are used and applied in accordance with the manufacturers instructions. ECG cables can be damaged when connected to a patient during defibrillation. Check cables for functionality before using them again. According to AAMI specifications the peak of the synchronized defibrillator discharge should be delivered within 60 ms of the peak of the R wave. The signal at the ECG output on the IntelliVue patient monitors is delayed by a maximum of 30 ms. Your biomedical engineer should verify that your ECG/Defibrillator combination does not exceed the recommended maximum delay of 60 ms. When using electrosurgical (ES) equipment, never place ECG electrodes near to the grounding plate of the ES device, as this can cause a lot of interference on the ECG signal. General: When you are connecting the electrodes or the patient cable, make sure that the connectors never come into contact with other conductive parts, or with earth. In particular, make sure that all of the ECG electrodes are attached to the patient, to prevent them from contacting conductive parts or earth. During surgery: Use the appropriate orange electrode ECG safety cable, or lead cable with an orange connector, for measuring ECG in the operating room. These cables have extra circuitry to protect the patient from burns during cautery, and they decrease electrical interference. This also reduces the hazard of burns in case of a defective neutral electrode at the HF device. These cables cannot be used for measuring respiration. Pacemaker failure: During complete heart block or pacemaker failure to pace/capture, tall P-waves
(greater than 1/5 of the average R-wave height) may be erroneously counted by the monitor, resulting in missed detection of cardiac arrest. Patients exhibiting intrinsic rhythm: When monitoring paced patients who exhibit only intrinsic rhythm, the monitor may erroneously count pace pulses as QRS complexes when the algorithm first encounters them, resulting in missed detection of cardiac arrest. The risk of missing cardiac arrest may be reduced by monitoring these patients with low heart rate limit at or slightly above the basic/demand pacemaker rate. A low heart rate alarm alerts you when the patients heart rate drops to a level where pacing is needed. Proper detection and classification of the paced rhythm can then be determined. Filtered ECG signal from external instruments: Instruments such as defibrillators or telemetry units produce a filtered ECG signal. When this signal is used as an input to the bedside monitor, it is filtered again. If this twice-filtered signal is passed to the arrhythmia algorithm, it may cause the algorithm to fail to detect pace pulses, pacemaker non-capture, or asystole, thus compromising paced patient monitoring performance. 104 About Arrhythmia Monitoring 7 ECG, Arrhythmia, ST and QT Monitoring External pacing electrodes: When a pacemaker with external pacing electrodes is being used on a patient, arrhythmia monitoring is severely compromised due to the high energy level in the pacer pulse. This may result in the arrhythmia algorithms failure to detect pacemaker noncapture or asystole. Fusion beat pacemakers: Pacemakers that create fusion beats (pace pulse on top of the QRS complex) cannot be detected by the monitors QRS detector. Rate adaptive pacemakers: Implanted pacemakers which can adapt to the Minute Ventilation rate may occasionally react on the Impedance measurement used by patient monitors for the determination of the Resp value and execute pacing with the maximum programmed rate. Switching off the Resp measurement can prevent this. About Arrhythmia Monitoring Arrhythmia analysis provides information on your patients condition, including heart rate, PVC rate, rhythm, and ectopics. The monitor uses the user-selected primary and secondary ECG leads for single-
lead or multi-lead arrhythmia analysis. During arrhythmia analysis, the monitor continuously optimizes ECG signal quality. This is important for arrhythmia analysis. The monitor continuously filters the ECG signal to remove baseline wander, muscle artifact, and signal irregularities. Also, if the Patient Paced status is set to Yes, pace pulses are filtered out to avoid processing them as QRS beats. detects beats, for example, QRS complexes, identifying them for further analysis. measures signal features such as R-wave height, width, and timing. creates beat templates, and classifies and labels beats to aid in rhythm analysis and alarm detection. examines the ECG signal for ventricular fibrillation, asystole, and noise. Arrhythmia Options Your monitor has either the basic or the enhanced arrhythmia option. Both options provide rhythm and ectopic status messages and beat labelling. The number of rhythms being classified, events being detected, and alarms generated differs according to the option. The alarms available with the different options are listed in the section ECG and Arrhythmia Alarm Overview on page 102, the rhythm and ectopic messages detected are listed in Arrhythmia Status Messages on page 109. Where Can I Find More Information?
See the Application Notes on ST and Arrhythmia supplied on your documentation DVD for detailed information on the arrhythmia algorithm and its clinical application. 105 7 ECG, Arrhythmia, ST and QT Monitoring Switching Arrhythmia Analysis On and Off Switching Arrhythmia Analysis On and Off In the Setup Arrhy menu, select Arrhythmia to toggle between On and Off. Select the Confirm pop-up key which appears at the bottom of the screen. 1 2 Be aware that when arrhythmia analysis is switched off, the message Arrhythmia Off appears beside the ECG wave, if configured to do so only the HR-related alarms are detected (the asystole alarm, the ventricular fibrillation/
tachycardia alarm, the extreme tachycardia and extreme bradycardia alarms, the high heart rate and low heart rate alarms) HR High and HR Low alarms behave like normal yellow alarms, no timeout periods are active. Choosing an ECG Lead for Arrhythmia Monitoring It is important to select a suitable lead for arrhythmia monitoring. Guidelines for non-paced patients are:
QRS complex should be tall and narrow (recommended amplitude > 0.5 mV) R-Wave should be above or below the baseline (but not bi-phasic) T-wave should be smaller than 1/3 R-wave height the P-wave should be smaller than 1/5 R-wave height. For paced patients, in addition to the above, the pace pulse should be:
not wider than the normal QRS the QRS complexes should be at least twice the height of pace pulses large enough to be detected, with no re-polarization. To prevent detection of P-waves or baseline noises as QRS complexes, the minimum detection level for QRS complexes is set at 0.15 mV, according to AAMI-EC 13 specifications. Adjusting the ECG wave size on the monitor display (gain adjustment) does not affect the ECG signal which is used for arrhythmia analysis. If the ECG signal is too small, you may get false alarms for pause or asystole. Aberrantly-Conducted Beats As P-waves are not analyzed, it is difficult and sometimes impossible for the monitor to distinguish between an aberrantly-conducted supraventricular beat and a ventricular beat. If the aberrant beat resembles a ventricular beat, it is classified as ventricular. You should always select a lead where the aberrantly-conducted beats have an R-wave that is as narrow as possible to minimize incorrect calls. Ventricular beats should look different from these normal beats. Instead of trying to select two leads with a narrow R-wave, it may be easier to just select one lead and use single lead arrhythmia monitoring. Extra vigilance is required by the clinician for this type of patient. Atrial Fibrillation Alarm The monitor performs atrial fibrillation analysis using information about the RR irregularity, PR interval variability and P wave variability. In order to generate an Afib alarm the following criteria must be detected for 1 minute:
normal beat RR intervals must be irregular 106 Understanding the Arrhythmia Display 7 ECG, Arrhythmia, ST and QT Monitoring PR interval deviation must be large P-wave region must not match well Atrial fibrillation analysis is only available for adult patients and atrial fibrillation detection cannot be performed on PVCs or Paced beats. Since most atrial flutters have regular RR intervals, they cannot be detected by the atrial fibrillation algorithm. An Afib alarm can be falsely detected in the presence of:
sinus arrhythmia, muscle noise, or electrode motion artifact. If you also have monitors with earlier software revisions, the Afib alarm will not be generated after a transfer to one of these monitors. Always leave the Irregular HR alarm switched on, so that this alarm can be generated in such situations. See the Application Note on Arrhythmia/ST supplied on your documentation DVD for detailed information on the arrhythmia algorithm and ECG analysis. Intermittent Bundle Branch Block Bundle branch and the other fascicular blocks create a challenge for the arrhythmia algorithm. If the QRS during the block changes considerably from the learned normal, the blocked beat may be incorrectly classified as ventricular, causing false PVC alarms. You should always select a lead where the bundle branch block beats have an R-wave that is as narrow as possible to minimize incorrect calls. Ventricular beats should look different from these normal beats. Instead of trying to select two leads with a narrow R-wave, it may be easier to just select one lead and use single lead arrhythmia monitoring. Extra vigilance is required by the clinician for this type of patient. Understanding the Arrhythmia Display Your monitor screen may look slightly different from the illustration. II M 1 P 1mV 7 2 P P 3 Paced Rhythm Pair PVCs Delayed 6 4 PVC 2 5 HR 75 1 2 3 Beat label Pace pulse marks Rhythm status message 107 7 ECG, Arrhythmia, ST and QT Monitoring Understanding the Arrhythmia Display 4 5 6 7 PVC Numeric HR Numeric Ectopic status message Delayed arrhythmia wave Viewing Arrhythmia Waves To review arrhythmia beat labels, in the Setup Arrhy menu, select Annotate Arrhy. The wave showing the primary ECG lead will be delayed by six seconds and shown on a grey background. Beat labels will be annotated above the ECG wave and Delayed will be written beside it. To return to the normal ECG primary lead display, select Annotate Arrhy again. Arrhythmia Beat Labels Arrhythmia beat labels tell you how the monitor is classifying beats. N = Normal V = Ventricular Ectopic S = Supra-ventricular Premature P = Paced
' = Pacer spike
= Biventricular Pacer Spike L = Learning patient's ECG A = Artifact (noisy episode)
? = Insufficient information to classify beats I = Inoperative condition (e.g., LEADS OFF) M = Pause or missed beat 108 Understanding the Arrhythmia Display 7 ECG, Arrhythmia, ST and QT Monitoring Arrhythmia Status Messages The monitor displays two types of status messages:
Rhythm Status Messages -- to indicate the patients rhythm. Ectopic Status Messages -- to indicate the presence of ectopic beats. These status messages are shown on the right hand side of the primary ECG wave. They are updated every second, with the exception of the Sinus and Supraventricular (SV) rhythm messages. The Sinus and SV rhythm messages are updated based on the current heart rate, taking into account the patient category (adult, pediatric, or neonatal). For the message to change from one rhythm status to another, the HR must be in the new range for five beats. If you have basic arrhythmia capability, you will get only messages for the alarms provided with this level. Rhythm Status Messages The label B or E indicates basic (B) or enhanced (E) arrhythmia capability. Rhythm Status Message Description ASYSTOLE VENT FIB/TACH V-TACH SUSTAINED V-TACH VENT RHYTHM No QRS for 4 consecutive seconds in absence of vent fib or chaotic signal A fibrillatory wave for 4 consecutive seconds A dominant rhythm of adjacent Vs and a HR > the V-Tach Heart Rate Limit Ventricular tachycardia rhythm for more than 15 seconds A dominant rhythm of adjacent PVCs and a HR dthe V-Tach HR Limit A dominant rhythm of N, V, N, V A dominant rhythm of N, N, V, N, N, V A dominant rhythm of paced beats Consistently irregular rhythm A dominant rhythm of SV beats preceded by P-waves VENT BIGEMINY VENT TRIGEMINY PACED RHYTHM IRREGULAR HR SINUS BRADY SINUS RHYTHM SINUS TACHY SV BRADY SV RHYTHM SV TACHY UNKNOWN ECG RHYTHM Rhythm cannot be determined LEARNING ECG LEARNING RHYTHM CANNOT ANALYZE ECG ECG signal is predominantly invalid and therefore cannot be Algorithm is learning the ECG beat morphology Algorithm is learning the rhythm of the classified beats A dominant rhythm of SV beats not preceded by P-waves analyzed B or E B, E B, E B, E E E E E B, E E B, E B, E B, E B, E B, E B, E 109 7 ECG, Arrhythmia, ST and QT Monitoring Arrhythmia Relearning Ectopic Status Messages The label B or E indicates basic (B) or enhanced (E) arrhythmia capability. Ectopic Status Message Explanation B or E
(No message displayed) RUN PVCs PAIR PVCs PACER NOT CAPT PACER NT PACING PAUSE R-ON-T PVCs MULTIFORM PVCs FREQUENT SVPBs SVPBs SV BEATS PACED BEATS No ectopic activity within the last minute E More than 2 consecutive PVCs within the last minute E Pair PVCs within the last minute B, E Pause with pace pulse (paced patient only) within the last minute Pause without pace pulse (paced patient only) within the last minute B, E No beat detected for 1.75 x average R-R interval for HR <120, or No beat for 1 second with HR >120 (non-paced patient only), or No beat detected for more than the set pause threshold. R-ON-T detected within the last minute Multiform PVCs detected within the last minute SVPB count within last minute is greater than 5 1-5 SVPBs in the last minute with a sinus rhythm and no Vs SV count within last minute and rhythm status is PACED Paced beat count within last minute and rhythm status is NOT PACED E E E E B, E B, E E Arrhythmia Relearning During a learning phase:
Alarm timeout periods are cleared Stored arrhythmia templates are cleared Asystole, Vfib, and HR alarms (when there are enough beats to compute the HR) are active. No other alarms are active. Initiating Arrhythmia Relearning Manually 1 To initiate relearning manually, in the Setup Arrhy menu, select Relearn Arrhy. While the monitor is learning, the delayed arrhythmia wave displays the beat label L and the Next, the monitor determines the dominant rhythm. The beats are labeled N, and the rhythm rhythm status message Learning ECG. status message changes to Learning Rhythm. 2 After relearning is complete, you should check the delayed arrhythmia wave to ensure that the algorithm is labeling the beats correctly. 3 If beats are still not classified correctly, check that the ECG is optimized for arrhythmia monitoring. You may need to select a different lead or change the electrodes or electrode positions if there is excessive noise, unstable voltage, low amplitude, or large P- or T-waves. 110 Arrhythmia Alarms 7 ECG, Arrhythmia, ST and QT Monitoring Automatic Arrhythmia Relearn Arrhythmia relearning is initiated automatically whenever:
ECG monitoring is switched on The ECG Lead or Lead Label of the primary/secondary lead is changed manually, or when fallback occurs A Leads Off INOP condition (that has been active for > 60 seconds) ends. If you are monitoring multi-lead arrhythmia and there is a change in one lead only, relearning happens only in the affected lead. During this learning phase, the system will continue monitoring using the other lead. Therefore, the delayed arrhythmia wave is not labeled L and there is no Learning ECG rhythm status message. In addition, alarm timeout periods are maintained, stored arrhythmia templates are maintained for the operative lead, and all alarms switched on are active. Arrhythmia Relearn and Lead Fallback Lead fallback triggers an automatic arrhythmia relearn. WARNING If arrhythmia learning takes place during ventricular rhythm, the ectopics may be incorrectly learned as the normal QRS complex. This may result in missed detection of subsequent events of V-Tach and V-
Fib. For this reason you should:
take care to initiate arrhythmia relearning only during periods of predominantly normal rhythm and when the ECG signal is relatively noise-free be aware that arrhythmia relearning can happen automatically respond to any INOP messages (for example, if you are prompted to reconnect electrodes) be aware that a disconnected EASI electrode triggers an arrhythmia relearn on all leads always ensure that the arrhythmia algorithm is labeling beats correctly. Arrhythmia Alarms Arrhythmia alarms can be switched on and off and the alarm settings changed just like other measurement alarms, as described in the Alarms section. Special alarm features which apply only to arrhythmia are described here. The different alarms detected and generated by the monitor depend on the level of arrhythmia analysis that is enabled. For a complete list of arrhythmia alarms and INOPs, see the Alarms chapter. The monitor detects arrhythmia alarm conditions by comparing ECG data to a set of pre-defined criteria. An alarm can be triggered by a rate exceeding a threshold (for example, HR >xx), an abnormal rhythm (for example, Ventricular Bigeminy), or an ectopic event (for example, Pair PVCs). 111 7 ECG, Arrhythmia, ST and QT Monitoring Arrhythmia Alarms Yellow Arrhythmia Alarms Yellow arrhythmia alarms are short yellow alarms specific to arrhythmia-related patient conditions. Depending on your monitor and Information Center configuration, they may be shown with one or two stars. The heart rate alarms (High HR and Low HR) can be configured as short yellow or standard yellow alarms. When they are standard yellow alarms they exist independently of the other arrhythmia alarms and no timeout periods apply. WARNING When arrhythmia analysis is on, all yellow ECG and arrhythmia alarms are short yellow alarms (one-
star). This means that the yellow alarm lamp and the tones are active for six seconds only, after which the blinking numeric and the alarm message remain for up to three minutes. The only exception to this are the HR High and Low alarms which can be configured as standard yellow alarms. Red alarms behave as usual. Arrhythmia Alarms and Latching When using arrhythmia analysis, Visual Latching and Audible Latching should be on for red alarms, or at least Visual Latching should be on. Because of the transient nature of arrhythmia alarms, many arrhythmia conditions may go unnoticed if alarm latching is off. This setting can only be changed in Configuration Mode. Switching Individual Arrhythmia Alarms On and Off Some arrhythmia alarms can be individually switched on or off. They are:
Pacer not capture, Pacer not pace, Non-Sustain VT, Vent Rhythm, Run PVCs, Pair PVCs, R-on-T PVCs, V.Bigeminy, V.Trigeminy, Multif.PVCs, Pause, SVT, Irregular HR, Missed Beat, PVCs/min and Afib. To switch individual alarms on or off, in the Setup Arrhythmia menu, select the alarm from the list to toggle between On and Off. The monitor displays the INOP message SOME ECG ALRMS OFF, if configured, when more alarms are switched off than configured in your active profile. Switching All Yellow Arrhythmia Alarms On or Off All yellow arrhythmia alarms can be switched on and off together. To do this, In the Setup Arrhythmia menu, select All Yellow Off or All Yellow On. Adjusting the Arrhythmia Alarm Limits Some arrhythmia alarms have limits which can be individually adjusted. They are:
Vtach HR, Vtach Run, PVCs/min, Vent Rhythm, SVT HR, SVT Run, Asystole Thresh., Pause Threshold. 1 To adjust alarm limits, in the Setup Arrhythmia menu, select the alarm to be adjusted. 2 Select the appropriate setting from the pop-up list. 112 Arrhythmia Alarms 7 ECG, Arrhythmia, ST and QT Monitoring Arrhythmia Alarm Timeout Periods Normally, an arrhythmia alarm is announced when an alarm condition is detected. However, there are certain situations that can inhibit the audible and visible indications of the alarm even though the alarm condition was detected. These include:
if a more serious alarm condition is active in the same chain if a timeout period is in effect for a particular alarm if a timeout period is in effect for a higher alarm in that chain. See Arrhythmia Alarm Chaining on page 114 for more details on alarm chains. What is a Timeout Period?
Timeout periods are automatically started when a yellow arrhythmia alarm is detected. During this period, the same alarm condition will not generate another alarm. Alarm conditions further down the same arrhythmia alarm chain will also not generate an alarm, but alarms further up the chain will: see Arrhythmia Alarm Chaining on page 114). This setting can only be changed in Configuration Mode. To view the timeout period configured for your monitor, in the Setup Arrhythmia menu, see the menu items TimeOut 1st and TimeOut 2nd. Resetting the Timeout Period To reset the timeout period, press the Alarms key and then reselect it. How are Yellow Arrhythmia Alarms Indicated?
When a yellow arrhythmia alarm is generated, it triggers visual and audible indicators. Yellow arrhythmia alarms are always set to latch visually for three minutes except HR High/Low alarms, if configured to standard yellow. Depending on the alarm condition, audible and visual alarm indicators will appear as follows:
Alarm Condition Example Audible Indicators Short yellow alarm tone sounds ... Visual Indicators Alarm message displayed ... Single alarm instance Non-sustained V-tach Continuous alarm condition PVCs/min HIGH Same intermittent alarm condition Pair of PVCs when alarm condition is initially detected when alarm condition is initially detected and - as an alarm reminder - every time the configured time out period has expired each time the alarm condition is detected, provided that the configured timeout period has expired for 3 minutes (latching time) until the alarm condition stops, plus a maximum of three minutes latching time 113 7 ECG, Arrhythmia, ST and QT Monitoring Arrhythmia Alarms If you silence a yellow arrhythmia alarm and the alarm condition still exists, the visual indicators continue until the condition stops. You will get an alarm reminder every time the configured timeout period has expired. If you silence a yellow arrhythmia alarm and the alarm condition has stopped, the visual indicators are immediately cleared. Silencing an alarm does not reset its time out period, so you will not get a realarm for the same condition or lower on the chain until the timeout expires. Arrhythmia Alarm Chaining When arrhythmia analysis is switched on, multiple alarm conditions may be present. Announcing all of the detected alarm conditions would be confusing, and might hide a more serious condition. For this reason, arrhythmia alarms are prioritized in three alarm chains: PVC Alarms; Beat Detection Alarms, and Rate Alarms. Only the highest priority alarm condition in each chain is announced. Lower priority alarms in the same chain will not be announced while an alarm is active or during the configured timeout period. If alarm conditions of equal severity from different chains are detected, the alarm condition that occurred most recently is announced. The exception is Irregular HR, which only occurs if no other alarms are occurring. See ECG and Arrhythmia Alarm Overview on page 102 for information on which alarms are included in the different arrhythmia options. See Arrhythmia Alarm Timeout Periods on page 113 for an explanation of how alarm timeouts work. 114 Arrhythmia Alarms 7 ECG, Arrhythmia, ST and QT Monitoring Red Arrhythmia Alarms Asystole Vent Fib/Tach V-Tach Extreme Tachy/Extreme Brady Yellow Arrhythmia Alarms Beat Detection Alarms Chain Rate Alarms Chain Pause Pacer Not Captured/
Pacer Not Pacing/
Missed Beat SVT HR High/ HR Low*
AFib Irregular HR
(occurs only if no other arrhythmia alarms are present) First level timeout period
(TimeOut 1st) Second level timeout period
(TimeOut 2nd) y t i r o i r p r e h g i h y t i r o i r p r e w o l PVC Alarms Chain Non-sustain VT/
Vent Rhythm Run PVCs Pair PVCs R-on-T PVCs Vent Bigeminy Vent Trigeminy PVCs > xx/min Multiform PVCs
*If HR High/Low alarms are configured as standard yellow alarms, they are independent of the arrhythmia alarms and are not in the Rate alarms chain. If there is an active Vent Bigeminy alarm, a PVCs > xx/min will not be triggered because it is lower on the same chain. However, a high HR alarm will become active because it is on a different chain. Higher priority alarms supersede previous alarms. For example, if a Vent Trigeminy alarm is active and a Pair PVCs occurs, the Pair alarm will be activated. Understanding PVC-Related Alarms PVC-related alarms are detected on the basis of the current ventricular heart rate and the number of consecutive PVCs counted (referred to as PVC Runs). Example: This diagram illustrates the conditions under which PVC alarms would be generated if the Vent Rhythm Run limit is set to 12, the V-Tach Run Limit is set to eight, and the V-Tach HR Limit is set to 100. 115 7 ECG, Arrhythmia, ST and QT Monitoring Arrhythmia Alarms V-Tach Run Limit
** Non-Sustain VT PVC Run < 8 HR > 100
**Pair PVCs PVC =
2
***V-Tach PVC Run t8 HR > 100 V-Tach Heart Rate Limit 100
** Run PVCs PVC Run > 2butd12 HR d 100
** Vent Rhythm PVC Run > 12 HR d 100 1 2 3 4 5 6 7 8 9 10 11 12 14 15 Number of Consecutive PVCs (PVC Run) Ventricular Rhythm Run Limit e t a R t r a e H r a u c i r t n e V l You will see that if both the V-Tach Heart Rate Limit and the V-Tach Run Limit are exceeded, a red V-Tach alarm is generated if the ventricular heart rate exceeds the V-Tach Heart Rate Limit but not the V-Tach Run Limit, a yellow Non-Sustain VT alarm is generated. 116 About ST Monitoring 7 ECG, Arrhythmia, ST and QT Monitoring About ST Monitoring The monitor performs ST segment analysis on normal and atrially paced beats and calculates ST segment elevations and depressions. This information can be displayed in the form of ST numerics and snippets on the monitor. All available leads can be monitored continuously. The ECG waveform does not need to be displayed on the monitor for ST Segment analysis. ST analysis is always performed using a dedicated filter which ensures diagnostic quality. If you are monitoring ECG using an ECG filter mode other than Diagnostic, the ST segment of the ECG wave may look different from the ST segment of the ST snippet for the same wave. For diagnostic evaluation of the ST segment, always switch to Diagnostic filter mode or use the ST snippet. WARNING Some clinical conditions may make it difficult to achieve reliable ST monitoring, for example:
if you are unable to get a lead that is not noisy if arrhythmias such as atrial fib/flutter are present, which may cause an irregular baseline if the patient is continuously ventricularly paced if the patient has left bundle branch block. You should consider switching ST monitoring off if these conditions are present. This monitor provides ST level change information; the clinical significance of the ST level change information should be determined by a physician. ST segment monitoring is intended for use with adult patients only and is not clinically validated for use with neonatal and pediatric patients. For this reason, the recommended - and default - setting for ST monitoring in neonatal and pediatric modes is ST Analysis: Off. Switching ST On and Off To switch all ST monitoring on or off, in the Setup ST Analysis menu, select ST Analysis to toggle between On and Off. Selecting Leads for ST Analysis You select which leads to use for ST analysis in the Setup ST Analysis menu. To see the current list of leads selected for ST analysis:
1 Enter the Setup ST Analysis menu. 2 Select Setup ST Leads. This opens the Setup ST Leads pop-up window. Leads chosen for ST monitoring are listed here. There are two pop-up keys at the bottom of the screen:
Add Delete If all leads are already selected, the Add pop-up key is disabled. To choose a lead for ST monitoring:
1 Select the Add key at the bottom of the Setup ST Leads window. This opens the Choices pop-up window. 117 7 ECG, Arrhythmia, ST and QT Monitoring Understanding the ST Display and Windows 2 Choose a lead from the list for ST monitoring. This closes the Choices window and adds the selected lead to the list of chosen leads. To disable ST monitoring for a lead:
1 Choose a lead from the list in the Setup ST Leads window. 2 Select the Delete key. This removes this lead from the list. NOTE The order in which ST leads are listed in the Setup ST Leads menu determines the order in which ST leads are displayed on the monitor screen. To change the order in which ST leads are displayed, 1 2 In the Setup ST Leads menu, choose a lead from the list. Select the Sort Up or Sort Down key to move the lead up or down in the list. Understanding the ST Display and Windows Your monitor screen may be configured to look slightly different from the illustrations. 2 3 1 ST-II 1.2 ST-V 2.5 ST-aVR -3.0 1 2 3 ST numerics Current HR alarm limits Current heart rate ST Numerics Up to 12 ST numerics plus the ST index can be displayed on the monitor screen. They can be configured to show beside the measurement numerics, beside the ECG wave, or beside the ST snippet. A positive ST value indicates ST segment elevation; a negative value indicates depression. ST numerics are displayed in the order in which you select ST leads for analysis. If there is additional space in the field assigned to ST numerics, the monitor will display extra numerics in the order in which they appear in the Setup ST Analysis -> Setup ST Leads list. Any ST leads switched on for analysis that do not fit in the assigned numerics field are shown in succession in place of the last ST numeric. ST Index The ST index numeric (STindx) is the sum of the absolute values for the ST leads V2, V5, aVF. Because it is based on absolute values, it is always a positive number. If you havent selected one of the leads V2, V5, and aVF for ST analysis, the STindx numeric will display a question mark ?. To switch the ST index numeric on or off for display, in the Setup ST Analysis menu, select ST-Index to toggle between On and Off. 118 Updating ST Baseline Snippets 7 ECG, Arrhythmia, ST and QT Monitoring ST Snippets ST snippets show a one second wave segment for each measured ST lead. The most recent snippet is drawn in the same color as the ECG wave, usually green, superimposed over the stored baseline snippet, drawn in a different color. The comparison shows any deviation in the measurement since the baseline snippet was stored, for example as a result of a procedure carried out on the patient. The information is updated once per minute. You can see ST snippets in the Adjust ST Points window or the ST Baseline window. ST Baseline Window The ST Baseline Window shows an ST snippet drawn on a grid. The current ST numeric and the ST numeric stored with the baseline are shown, as well as the difference between these two numerics. A ? in front of the difference numeric indicates that the ST measurement points were adjusted since the baseline snippet was stored. To view the ST Baseline window, select the ST numerics, then ST Baseline. 1 2 ST-II
-0.30.8?-1.1 ST Baseline 3 4 5 6 1mv 1sec ST Baseline from 04 Apr 07 9:38 1 2 3 4 5 6 ST label and numeric Baseline ST numeric and difference since baseline was stored 1mV calibration bar Current snippet ST baseline Timestamp of most recently stored baseline snippet Updating ST Baseline Snippets ST analysis requires valid samples to measure and store a snippet. ST Snippets and ST values are updated every minute. If there is artifact in the signal, it may take longer for an ST snippet and an ST value to appear. The first baseline is stored automatically after ST monitoring is started, or when a new patient is admitted. To update ST baselines, Select the ST numerics then ST Baseline to open the ST Baseline window. In the ST Baseline window, select Update Baseline to store all current snippets as baselines. This deletes all previously-stored baselines. 1 2 119 7 ECG, Arrhythmia, ST and QT Monitoring About the ST Measurement Points About the ST Measurement Points The ST value for each beat complex is the vertical difference between the ISO point and the ST point, as shown in the diagram below. The isoelectric (ISO) point provides the baseline, the ST point is at the midpoint of the ST segment. The J point is where the QRS complex changes its slope; as it is a fixed distance away from the ST point, it can be useful to help you position the ST point correctly. R-wave peak at 0 msec J point, for example, 48 msec T Difference = ST value P Q S Isoelectric point set to -80 msec ST measurement point, for example, J + 60 msec CAUTION The ST measurement points need to be adjusted when you start monitoring, and if the patient's heart rate or ECG morphology changes significantly, as this may affect the size of the QT interval and thus the placement of the ST point. Artifactual ST segment depression or elevation may occur if the isoelectric point or the ST point is incorrectly set. Always ensure that ST measurement points are appropriate for your patient. Adjusting ST Measurement Points Depending on your monitors configuration, the ST point can be positioned either relative to the J-point. In the Adjust ST Points window, the pop-up keys ISO Point, J Point and ST Point are visible and can be adjusted. or directly by selecting a numeric value for the ST point. In the Adjust ST Points window, you can adjust the ISO and ST point. The ST Uses setting can only be changed in Configuration Mode. To adjust the ST measurement points, In the Setup ST Analysis menu, select Adjust ST Points to open the Adjust ST Points window. Alternatively, you can use the Adjust ST Points pop-up key in the ST Baseline window. Select a suitable ECG lead for ST measurement, with a visible J-point and a visible P wave. Use the up and down arrow keys to scroll through the ST snippets for the other ECG leads. 1 2 120 About the ST Measurement Points 7 ECG, Arrhythmia, ST and QT Monitoring 3 Select the ST point you need to adjust by touching the appropriate point on the screen. The current choice is highlighted (ISO point -80 in the screen example). ST label and the ST numeric that would apply using the current points 1mV calibration bar ST-I 0.1 Adjust ST Points Cursors for adjusting ST points Highlighted ST point 1mv 1sec ST Points adjusted at 04 Apr 07 11:38 Update Apply Changes The ISO-point cursor positions the isoelectric point relative to the R-wave peak. The relation is shown beside the ISO-point in milliseconds. Position the ISO-point in the middle of the flattest part of the baseline (between the P and Q waves or in front of the P wave). ISO The J-point cursor positions the J-point relative to the R-wave peak. It helps you to correctly position the ST-point. Position the J-point at the end of the QRS complex and the beginning of the ST segment. The J-point cursor is not available if your monitor is configured to let you set the ST point directly. To position the ST-point relative to the J-point:
select either J + 60 or J + 80. Select J Point and use the arrow keys to move the J-Point and position the ST-point at the midpoint of the ST segment. To position the ST-point directly:
select ST Point and use the left and right arrow keys to position the ST point at the midpoint of the ST segment. Select the Apply Changes pop-up key to activate the new ST measurement points and recalculate all ST values. The most recent ST Points adjustment time is displayed in the Adjust ST Points window. This information is cleared when a patient is discharged or when a new Profile is loaded into the monitor. 4 121 7 ECG, Arrhythmia, ST and QT Monitoring ST Alarms 5 To update the ST snippet shown in the Adjust ST Points window, select the Update pop-
up key. ST Alarms ST alarms are yellow alarms. Each ST lead has its own alarm limit. ST alarms are triggered when an ST value exceeds its alarm limit for more than one minute. Switching ST alarms off switches off alarms for all ST leads. If more than one ST measurement is in alarm, the monitor only displays the alarm message of the ST lead which is currently furthest from its set alarm limits. Single- or Multi-lead ST Alarming Be aware that if multi-lead ST alarming is switched on, only alarms involving more than one ST lead will be announced. To choose individual or multi-lead ST alarming, In the Setup ST Analysis menu, select ST Alarm Mode and select either Single ST or Multi ST. Changing ST Alarm Limits The monitor can detect alarms on each ST lead separately, so you can set high and low ST alarm limits individually for each ST lead. You can also set separate alarm limits for single-lead and multi-lead ST monitoring. Set the high and low alarm limits based on your assessment of the patient's clinical condition, unit protocols, physician orders or medication specified limits. A good guideline is + 1.0 mm or - 1.0 mm from the patients's ST, or follow your hospital protocol. In the Setup ST Analysis menu, select ST Alarm Mode and select Single ST or Multi ST. Select the alarm to be adjusted. 1 2 3 Select the appropriate setting. Viewing ST Maps The monitor can derive a multi-axis portrait (map) from the ST analysis to help you detect changes in ST values. It displays two planes obtained from a multilead ECG in a multi-axis diagram, where each axis represents a lead. The ST value at the J point is given. The position of the axes within the diagram correspond to the placement of the ECG leads. Each ST value is assigned to either a limb lead, or to a chest lead. Every axis shows the polarity of the lead it represents. By joining adjacent ST values, the monitor obtains the ST map. The contour line, and the map shading, is shown in the same color as the ECG parameter. Current View In current view, the monitor displays an ST map that corresponds to the current ST values. Three or more leads per plane are necessary to display a map. The left of the following diagram shows leads I, II, III, aVR, aVL, and aVF on the limb leads. On the right, the V-leads (V1, V2, V3, V4, V5, and V6) are on the chest leads. 122 Viewing ST Maps 7 ECG, Arrhythmia, ST and QT Monitoring SBed10 Adult ST Map (Current) ST-II HIGH Limb Leads Chest Leads Size Up Trend View Size Down Select Interval Show Baseline Print Show Values If an ST lead is switched off, its axis is not shown in the map. ST map ST label and polarity of corresponding lead Scroll to view more pop-up keys If a lead is in INOP (the value is being measured but is invalid or unavailable because, for example, the corresponding ECG electrode is unplugged), the area formed by the remaining ST leads is left open. If there is insufficient information (for example, there are less than three chest leads) for a second ST map to be displayed, the currently available ST values are displayed in place of the second ST map. Limb Leads ST-I ST-II ST-aVR ST-aVL ST-aVF 123 7 ECG, Arrhythmia, ST and QT Monitoring Viewing ST Maps Additionally, when both ST maps are displayed, you can view the currently available ST values in the ST Map window (Current or Trend) at any time. To do this, select the Show Values pop-up key. The ST values are shown in place of the second ST map, and the pop-up key text changes to Hide Values. Select the Hide Values pop-up key and the display shows both ST maps again. SBed10 Adult ST Map (Current) ST-II HIGH Limb Leads ST-I ST-II ST-VI ST-V2 ST-V3 ST-V4 ST-V5 ST-V6 ST-aVF Size Up Size Down Show Baseline Hide Values ST values are shown where the STmap for the chest leads is normally displayed. Select the Show Values pop-up key to see the current ST values. Select Hide Values and the display shows both ST maps again. Trend View In trend view, you can see up to four trended ST maps, and the current ST map, simultaneously. You can configure the time interval between trended samples. The most recent map is shown in the same color as the parameter itself. Past values change from white through dark gray. In the diagram below, the time interval between trends is 12 seconds. The first trended sample is white and is 12 seconds old. The second trended sample corresponds to the ST values 24 seconds ago and so forth. The ST values on the diagrams show the current ST values. If a lead is turned off, its axis is no longer shown. This has no impact on the presentation of trended values that were recorded while the lead was still on. In the diagram below, lead V4 was switched off 20 seconds ago. The current ST values and the first trended value reflect this change in the lead setup. All other maps are displayed the way in which they were recorded. SBed10 Adult ST Map (Trend) ST-II HIGH Limb Leads Chest Leads 5 min trending interval Show Values Show Baseline Print Scroll to view more pop-up keys Size Up Current View Size Down Select Interval 124 Viewing ST Maps 7 ECG, Arrhythmia, ST and QT Monitoring In this diagram, V4 was either temporarily switched off, or in INOP, for around 30 seconds. No data was recorded. Consequently, the affected maps are not closed. Viewing an ST Map To display an ST map, In the Setup ST Analysis menu, select ST Map. Working in the ST Map Task Window You may need to activate the ST map task window to see all the data, and to access the pop-up keys. Select the map view on screen to activate its task window. Once you activate it, you can perform the tasks detailed here. Switching Between ST Map Views To switch between views, Select Current View or Trend View to toggle between views. If your trend view is empty, you need to adjust the priority of this measurement in the trending priority list. See Trend Priority on page 191. Displaying an ST Reference Baseline You can display an ST reference baseline for the current view, or for the trended view. The baseline is shown in yellow. However, if the ECG color is yellow, the baseline is shown in green. Use this baseline to detect ST changes. The baseline is derived automatically whenever the monitor relearns arrhythmia and also on user request. Select Show Baseline/Hide Baseline to toggle between baseline display on and off. Updating an ST Map Reference Baseline To update the baseline, In the Setup ST Analysis menu, select ST Baseline -> Update baseline. Changing the Scale of the ST Map To change scale, Select Size Up or Size Down to alter the size at which monitor displays the map. 125 7 ECG, Arrhythmia, ST and QT Monitoring Viewing ST Maps Changing the Trending Interval To determine how frequently the monitor displays a trended sample, In Trend view, select Select Interval. Select the required interval from the menu. The interval ranges between 12 seconds to 30 minutes. 1 2 Printing an ST Map Report To print the most recently viewed (current or trend) window, Select Main Setup - > Reports. Select ST Map. Press Print. 1 2 3 126 About QT/QTc Interval Monitoring 7 ECG, Arrhythmia, ST and QT Monitoring About QT/QTc Interval Monitoring The QT interval is defined as the time between the beginning of the Q-wave and the end of the T-wave. It measures the total duration of the depolarization (QRS duration) and repolarization (ST-T) phases of the ventricular action potential. QT interval monitoring can assist in the detection of prolonged QT interval syndrome. R P T Q S QT interval The QT interval has an inverse relationship to heart rate. Faster heart rates shorten the QT interval and slower heart rates prolong the QT interval. Therefore there are several formulas used to correct the QT interval for heart rate. The heart rate corrected QT interval is abbreviated as QTc. The monitor uses as a default the Bazett correction formula and the alternative Fridericia formula can be selected in Configuration Mode. For QT interval monitoring to be effective, basic or enhanced arrhythmia monitoring should be turned on. QT Measurement Algorithm The QT values are updated every five minutes except in the initial phase (first five minutes) where they are updated once per minute. Normal or atrial paced beats and beats with a similar morphology are averaged to form a representative waveform for further processing. Normal beats followed by a premature QRS will be excluded from the measurements to prevent the premature beat from obscuring the end of the T-wave. If the algorithm cannot form a representative waveform, for example because the morphology of the beats is too varied, a CANNOT ANALYZE QT INOP will be generated after 10 minutes. This is also the case if normal beats have been falsely labelled so that the algorithm does not have enough valid beats to make QT measurements. No QT value is calculated if the QT-HR is
>150 bpm (Adult) or >180 bpm (Pedi/Neo). Because of the different algorithm approaches, a QT/QTc measurement from a diagnostic 12-lead program may differ from the realtime measurement on the monitor. Where Can I Find More Information?
See the Application Note on QT/QTc Interval Monitoring and the QT Interval Monitoring Quick Guide supplied on your documentation DVD for detailed information on the QT algorithm and performance. 127 7 ECG, Arrhythmia, ST and QT Monitoring About QT/QTc Interval Monitoring Indications For Use Of QT Interval Monitoring Of special concern for QT monitoring is the administration of QT prolonging drugs to patients identified with risk factors for Torsade de Pointe. Females, older patients and patients with bradycardia, impaired left ventricular function (ischemia, left ventricular hypertrophy), hypokalemia and hypomagnesemia are in this increased risk category. Limitations For Use Of QT Interval Monitoring Some conditions may make it difficult to achieve reliable QT monitoring, for example:
the T-wave is very flat T-waves are not well defined due to atrial flutter or atrial fibrillation the end of the T-wave is difficult to define because of the presence of U-waves a high heart rate causes the P-wave to encroach on the end of the previous T-wave noise or high QRS morphology variation For these cases you should select a lead with a good T-wave amplitude and no visible flutter activity, and without a predominant U-wave or P-wave. Some conditions such as left or right bundle branch block or hypertrophy can lead to a widened QRS complex. If a long QTc is observed you should verify it to ensure that it is not caused by QRS widening. Because normal beats followed by ventricular beats are not included in the analysis, no QT measurement will be generated in the presence of a bigeminy rhythm. If the heart rate is extremely high (over 150 bpm for adults and over 180 bpm for pediatrics and neonates) QT will not be measured. When the heart rate changes, it can take several minutes for the QT interval to stabilize. For reliable QTc calculation it is important to avoid a region where the heart rate is changing. WARNING QT/QTc measurements should always be verified by a qualified clinician. Selecting The QT Leads For QT Monitoring you can select one of the following three modes:
All Leads mode - all available leads (I, II, III, V, MCL, V1 - V6) are used to produce a global QT measurement. For EASI lead placement, directly acquired AI, AS and ES leads are used. Primary-Lead mode - the primary lead will be used for QT measurement. If the original primary lead becomes unavailable or is changed, QT measurement will continue with the new primary lead. Single-Lead mode - a single lead selected from all available leads (except the augmented leads) will be used for QT measurement. QT measurement will stop if the selected lead becomes unavailable. To select the mode, Select the QT numeric to enter the Setup QT Analysis window. Select QT Lead and select All, Primary Lead or one of the available single leads. 1 2 When using the All Leads mode, make sure when you compare QT values that they are based on the same set of leads. 128 About QT/QTc Interval Monitoring 7 ECG, Arrhythmia, ST and QT Monitoring Changing the lead(s) used for QT measurements will not cause the baseline to be reset. QT View In the QT View window you can verify that the QT algorithm detects correct Q and T points. The current waves are shown in the upper half of the window and the baseline waves in a different color below. The Q and T points are marked with a vertical line. By selecting one of the lead labels at the top of the window you can highlight the corresponding wave; the other waves are shown in gray. The underlined lead labels are the leads used for the QT calculation. By selecting the numeric area you can highlight all underlined leads. Changing The View To A Single Wave Set To view one set of waves in a larger scale, you can cycle through the different views, Select Current view to see the set of current waves. Select Baseline view to see the set of baseline waves. Select Split view to return to the combined view with current and baseline waves. 1 2 3 Setting The QT Baseline In order to quantify changes in the QTc value, you can set a QTc baseline. For example to assess the effect of medication on the QT interval you can set the current value as the baseline before you begin medication. This baseline will then be used to calculate the 'QTc value. To set the baseline, Select Set Baseline and set the value. 129 7 ECG, Arrhythmia, ST and QT Monitoring QT Alarms If no baseline has been set for this patient, the first five minute value after the start of monitoring is automatically set as baseline. If you set a new baseline the previous baseline is discarded. As the 'QTc alarm is based on the difference between the baseline and the current value, setting an inappropriate new baseline may prevent a 'QTc alarm from being generated. Discharging a patient clears the baseline. Printing The QT Waves To start a printout, Select Print QT. Recording The QT Waves To start a recording, Select Record QT. QT Alarms There are two QT alarms, QTc high limit alarm and 'QTc high alarm. The QTc high limit alarm is generated when the QTc value exceeds the set limit for more than 5 minutes. The 'QTc alarm is generated when the difference between the current value and the baseline value exceeds the set limit for more than 5 minutes. The CANNOT ANALYZE QT INOP and the ?_will be displayed when no QT measurement could be calculated for 10 minutes. Up to this time the previous valid value will be displayed. The following additional messages on the cause of the invalid measurements may also be displayed. Additional Message QT Startup Asystole or Leads Off Cause of Invalid QT Measurement QT monitoring was just turned on or has been reset 1 Not all specified leads needed to perform QT analysis are available, or 2 Asystole condition is detected Not enough valid QRS complexes to generate a QT measurement Insufficient Valid Leads Invalid rhythm for QTc Not enough valid RR intervals to generate QT-HR, the averaged HR High QT-HR used for QTc calculation QT-HR exceeds the specified upper limit of 150 bpm (for adults) or 180 bpm (for neonates and pediatrics) R-wave of the signal is too small T-wave of the signal is too small End of the T-Wave cannot be accurately detected QT measurement is outside the specified range of valid QT values (200-
800 msec) QTc measurement is outside the specified range of valid QTc values
(200-800 msec) QTc measurements are not stable Small R Wave Small T Wave End of T Not detected QT Out Of Range QTc Out Of Range QTc Erratic 130 Switching QT Monitoring On and Off 7 ECG, Arrhythmia, ST and QT Monitoring Switching Individual QTc Alarms On and Off Each QTc alarm can be switched off individually. To switch an alarm on or off, in the Setup QT Analysis menu, select QTc Alarm or
'QTc Alarm to toggle between On and Off. Changing QTc Alarm Limits Set the high alarm limits based on your assessment of the patient's clinical condition, unit protocols, physician orders or medication specified limits. In the Setup QT Analysis menu, select High Limit. Select the appropriate setting. Select 'High Limit. Select the appropriate setting. 1 2 3 4 Switching QT Monitoring On and Off To switch all QT monitoring on or off, in the Setup QT Analysis menu, select QT Analys. to switch between On and Off. 131 7 ECG, Arrhythmia, ST and QT Monitoring Switching QT Monitoring On and Off 132 8 8Monitoring Pulse Rate The pulse numeric counts the arterial pulsations that result from the mechanical activity of the heart in beats per minute (bpm). You can display a pulse from any measured SpO2 signal (pleth wave), or any arterial pressure (P, ABP, ART, Ao, PAP, UAP, FAP, BAP: see the pressure section for an explanation of the pressure labels). The displayed pulse numeric is labeled and color-coded to match its source wave. If the pulse numeric is not displayed, see the Setup Pulse menu to check whether it is switched on. Entering the Setup Pulse Menu If a pulse numeric is displayed on the screen, select it to enter the Setup Pulse (Pulse Source) menu. If no pulse numeric is visible, in the Setup SpO2 menu or a Setup arterial pressure menu, select Pulse (Pulse Source). System Pulse Source The currently selected system pulse source is shown in the setup menus of the pulse source measurements. The pulse rate chosen as system pulse:
is monitored as system pulse and generates alarms when you select pulse as the active alarm source is sent via the network to the Information Center, if available is trended in the HighRes Trends and stored in the monitors databases. To define which pulse rate is used as system pulse, 1 2 In the Setup Pulse menu, select System Pulse. Select one of the SpO2 or arterial pressure labels from the pop-up list, or select Auto. If you select Auto, the monitor automatically chooses a pulse rate to be used as system pulse. It looks through the list from top to bottom and activates the first pulse rate that is switched on and available. If your selected pulse source measurement becomes unavailable or is switched off, the monitor will use the next measurement from the list as system pulse until the selected pulse source measurement becomes available again. 133 8 Monitoring Pulse Rate Switching Pulse On and Off Switching Pulse On and Off To switch a particular pulse numeric on or off, enter the Setup Pulse menu via the measurement setup menu or wave menu of the pulse source. For example, to switch an SpO2 pulse numeric on or off, 1 Enter the Setup Pulse menu by selecting the Pulse numeric or by selecting Pulse in the Setup SpO2 menu. In the Setup Pulse menu, select Pulse (Pulse Source) to toggle between On and Off. 2 Using Pulse Alarms You can change pulse rate alarm limits in the ECG/Pulse Alarms menu which can be accessed from the Setup Pulse menu or the Setup ECG menu by selecting AlarmSrc (xxx) where xxx is the current alarm source. Changing the alarm limits for a specific Pulse numeric changes the alarm limits for all pulse rate alarms and heart rate alarms. Pulse alarms are only generated when the active alarm source is set to Pulse, a pulse source is set as system pulse and pulse alarms are switched on. Selecting the Active Alarm Source: ECG or Pulse?
In most cases the HR and Pulse numerics are identical. In order to avoid simultaneous alarms on HR and Pulse, the monitor uses either ECG or Pulse as its active alarm source. To change the alarm source, select AlarmSrc in the ECG/Pulse Alarms menu, then select ECG: if you want the HR to be the alarm source for HR/Pulse. Pulse: If you select Pulse as the active alarm source, the monitor will prompt you to confirm your choice. Be aware that if you select Pulse as the alarm source, all arrhythmia and ECG HR alarms are switched off. Auto: If the AlarmSrc is set to Auto, the monitor will use the heart rate from the ECG measurement as the alarm source whenever the ECG measurement is switched on and at least one ECG lead can be measured without an INOP condition. The monitor will automatically switch to Pulse as the alarm source if:
a valid ECG lead can no longer be measured and a Pulse source is switched on and available, The monitor then uses the pulse rate from the measurement currently active as system pulse. While Pulse is the alarm source, all arrhythmia and ECG HR alarms are switched off. If an ECG lead becomes available again, the monitor automatically uses HR as alarm source. Note: If ECG is switched off, the monitor will always change to Pulse as alarm source, if a Pulse is available. One exception to this rule can arise when you have a telemetry device paired with your monitor. The monitor ECG is then deactivated but the monitor may be configured to allow only ECG as the active alarm source. In this case the monitor will not switch to Pulse as alarm source and Pulse will not be available as a selection in the ECG/Pulse Alarms menu. 134 Using Pulse Alarms 8 Monitoring Pulse Rate WARNING Selecting Pulse as the active alarm source for HR/Pulse switches off the arrhythmia alarms listed in the section ECG and Arrhythmia Alarm Overview on page 102, including Asystole, Vfib and Vtach alarms, and the heart rate alarms. This is indicated by the message ECG/ARRH ALARM OFF (unless this has been configured off for your monitor), and the crossed-out alarm symbol beside the ECG heart rate numeric. The message ECG/ARRH ALARM OFF can be configured off, or to switch to a yellow
(medium severity) INOP after a fixed number of hours. High and low pulse rate and extreme bradycardia and extreme tachycardia alarms from pulse are active. Alarm Source Selection Disabled If Alarm Source Selection is disabled, you cannot change the alarm source. If you try to change the source, the monitor displays the message To activate enter Config and enable Alarm Source Selection. This setting can only be changed in Configuration Mode. Changing HR/Pulse Alarm Limits As Pulse and HR share the same high and low alarm limits, if you change the alarm limit in the Setup Pulse menu, the high or low alarm limits for HR in the Setup ECG menu change automatically, and vice versa. The only exceptions are caused by a low limit clamp for each measurement: the lowest value for Pulse when derived from SpO2 is 30 bpm; for HR 15 bpm, and for Pressure 25 bpm. Extreme Alarm Limits The extreme rate alarms, Extreme Tachy and Extreme Brady, generated by the active alarm source, either HR or Pulse, are set in Configuration Mode by adding a set value to the high and low alarm limits. You need to know what value has been configured for your monitor. Changing the high and low alarm limits automatically changes the extreme alarm limits within the allowed range. To see the values added to the high and low limit alarms to create the extreme rate alarms for your monitor, in the Setup ECG menu, see the menu items Extr.Tachy and Extr.Brady. QRS Tone The active alarm source is also used as a source for the QRS tone. You can change the tone volume in the Setup SpO2 and Setup ECG menus and the QRS tone modulation in the Setup SpO2 menu. WARNING The audible QRS tone might be influenced by external interference and is not intended to be used as a substitute for ECG based arrhythmia analysis. If arrhythmia detection is needed, do not rely on the audible QRS tone. 135 8 Monitoring Pulse Rate Using Pulse Alarms 136 9 9Monitoring Respiration Rate
(Resp) For the respiratory measurement (Resp), the monitor measures the thoracic impedance between two ECG electrodes on the patients chest. Changes in the impedance due to thoracic movement produce the Resp waveform on the monitor screen. The monitor counts the waveform cycles to calculate the respiration rate (RR). Lead Placement for Monitoring Resp Correct patient skin preparation techniques for electrode placement are important for Resp measurement: you will find this information in the chapter on ECG. The Resp measurement uses the standard ECG cable sets and lead placements. You can use any of the different types of ECG cable sets - 3-lead, 5-lead, 6-lead or 10-lead, using either standard or EASI placement - to measure Resp, as long as you use ICU ECG cables. The Resp signal is always measured between two of the ECG electrodes. If you are using standard ECG electrode placement, Resp is measured between the RA and LL electrodes. If you are using EASI ECG electrode placement, Resp is measured between the I and A electrodes. Optimizing Lead Placement for Resp If you want to measure Resp and you are already measuring ECG, you may need to optimize placement of the two electrodes between which Resp will be measured for some patients. Repositioning ECG electrodes from standard positions, especially when you are using EASI ECG electrode placement, results in changes in the ECG waveform and may influence ST and arrhythmia interpretation. Cardiac Overlay Cardiac activity that affects the Resp waveform is called cardiac overlay. It happens when the Resp electrodes pick up impedance changes caused by the rhythmic blood flow. Correct electrode placement can help to reduce cardiac overlay: avoid the liver area and the ventricles of the heart in the line between the respiratory electrodes. This is particularly important for neonates. 137 9 Monitoring Respiration Rate (Resp) Understanding the Resp Display Lateral Chest Expansion Some patients, especially neonates, expand their chests laterally. In these cases it is best to place the two respiratory electrodes in the right midaxillary and left lateral chest areas at the patients maximum point of breathing movement to optimize the respiratory wave. Abdominal Breathing Some patients with restricted chest movement breathe mainly abdominally. In these cases, you may need to place the left leg electrode on the left abdomen at the point of maximum abdominal expansion to optimize the respiratory wave. Understanding the Resp Display The Resp measurement is displayed on the monitor as a continuous wave and a numeric respiration rate. If the detected respiration rate is close to the heart rate, this is indicated by the text HR = RR next to the respiration wave if you are in manual monitoring mode. Your monitor screen may look slightly different from the illustration. 1 Ohm calibration bar Manually-set Resp detection level Resp 1 Ohm Resp numeric and label 22RR Changing Resp Detection Modes The Resp detection level can be set either automatically or manually. To change the resp detection mode, in the Setup Resp menu, select Detection to toggle between the settings. Auto Detection Mode In Auto Detection Mode, the monitor adjusts the detection level automatically, depending on the wave height and the presence of cardiac artifact. Note that in Auto Detection Mode, the detection level (a dotted line) is not displayed on the waveform, 138 Changing the Size of the Respiration Wave 9 Monitoring Respiration Rate (Resp) the algorithm expects a heart rate and therefore needs at least 3 electrodes attached to the patient. If you are monitoring respiration with only two electrodes, the detection algorithm becomes less sensitive which may result in reduced breath detection performance. Use Auto Detection Mode for situations where:
the respiration rate is not close to the heart rate breathing is spontaneous, with or without continuous positive airway pressure (CPAP) patients are ventilated, except patients with Intermittent Mandatory Ventilation (IMV). Manual Detection Mode In Manual Detection Mode you must set the Resp detection level. In the Setup Resp menu, select Manual Up or Manual Down. Use the dotted detection level line in the Resp waveform to determine when the desired level is reached. Once set, the detection level will not adapt automatically to different respiration depths. It is important to remember that if the depth of breathing changes, you may need to change the detection level. Use Manual Detection Mode for situations where:
the respiration rate and the heart rate are close. patients have Intermittent Mandatory Ventilation. respiration is weak. Try repositioning the electrodes to improve the signal. Resp Detection Modes and Cardiac Overlay In Auto Detection Mode: If you are monitoring Resp and the ECG is switched off, the monitor cannot compare the ECG and Resp rates to detect cardiac overlay. The respiration detection level is automatically set higher to prevent the detection of cardiac overlay as respiration. In Manual Detection Mode: Cardiac overlay can in certain situations trigger the respiration counter. This may lead to a false indication of a high respiration rate or an undetected apnea condition. If you suspect that cardiac overlay is being registered as breathing activity, raise the detection level above the zone of cardiac overlay. If the Resp wave is so small that raising the detection level is not possible, you may need to optimize the electrode placement as described in the section Lateral Chest Expansion. Changing the Size of the Respiration Wave WARNING When monitoring in Manual Detection Mode, make sure to check the respiration detection level after you have increased or decreased the size of the respiration wave. In the Setup Resp menu, select Size Up to increase the size of the wave or Size Down to decrease it. 139 9 Monitoring Respiration Rate (Resp) Changing the Speed of the Respiration Wave Changing the Speed of the Respiration Wave Resp waveforms are usually viewed at a slower speed than other waveforms. For this reason, the Resp measurement has its own speed control and is not affected by the wave speed settings of the other measurements. Select the Resp wave to enter the Resp Wave menu, then select Change Speed. Choose the required speed from the pop-up list. This defines the speed at which the wave is drawn across the screen in millimeters per second (mm/s). Using Resp Alarms Resp alarms can be switched on and off and the high and low alarm limits can be changed just like other measurement alarms, as described in the Alarms chapter. Changing the Apnea Alarm Delay The apnea alarm is a high priority red alarm used to detect apneas. The apnea alarm delay time defines the time period between the point where the monitor cannot detect any respiration activity and the indication of the apnea alarm. In the Setup Resp menu, select Apnea Time. Select the appropriate setting. 1 2 Resp Safety Information WARNING Respiration detection level If you do not set the detection level for the respiration correctly in manual detection mode, it may not be possible for the monitor to detect apnea. If you set the detection level too low, the monitor is more likely to detect cardiac activity, and to falsely interpret cardiac activity as respiratory activity in the case of apnea. Apnea The respiration measurement does not recognize obstructive and mixed apneas it only indicates an alarm when a pre-adjusted time has elapsed since the last detected breath. The safety and effectiveness of the respiration measurement method in the detection of apnea, particularly the apnea of prematurity and apnea of infancy, has not been established. Interference If operating under conditions according to the EMC Standard EN 60601-1-2 (Radiated Immunity 3V/m), field strengths above 1V/m may cause erroneous measurements at various frequencies. Therefore it is recommended to avoid the use of electrically radiating equipment in close proximity to the respiration measurement unit. Resp Accessories To monitor respiration, use only the non-OR ECG accessories listed in the Resp section of the accessories chapter. You cannot measure respiration if you are using an orange OR ECG cable set. This is because of the higher internal impedance of the OR cable set, required for use if electro-surgery is being performed. 140 Resp Safety Information 9 Monitoring Respiration Rate (Resp) Rate adaptive pacemakers: Implanted pacemakers which can adapt to the Minute Ventilation rate may occasionally react on the Impedance measurement used by patient monitors for the determination of the Resp value and execute pacing with the maximum programmed rate. Switching off the Resp measurement can prevent this. 141 9 Monitoring Respiration Rate (Resp) Resp Safety Information 142 10 10Monitoring SpO2 Philips pulse oximetry uses a motion-tolerant signal processing algorithm, based on Fourier artefact suppression technology (FAST). It provides four measurements:
Oxygen saturation of arterial blood (SpO2) - percentage of oxygenated hemoglobin in relation to the sum of oxyhemoglobin and deoxyhemoglobin (functional arterial oxygen saturation). Pleth waveform - visual indication of patients pulse. Pulse rate (derived from pleth wave) - detected pulsations per minute. Perfusion indicator - numerical value for the pulsatile portion of the measured signal caused by arterial pulsation. The monitors are also compatible with SpO2 technologies from other manufacturers. Please refer to the instructions for use provided with these devices for further information. SpO2 Sensors Familiarize yourself with the instructions for use supplied with your sensor before using it. In particular, check that the sensor being used is appropriate for your patient category and application site. CAUTION Do not use OxiCliq disposable sensors in a high humidity environment, such as in neonatal incubators or in the presence of fluids, which may contaminate sensor and electrical connections causing unreliable or intermittent measurements. Do not use disposable sensors on patients who have allergic reactions to the adhesive. Applying the Sensor 1 Follow the SpO2 sensors instructions for use, adhering to all warnings and cautions. 2 Remove colored nail polish from the application site. 3 Apply the sensor to the patient. The application site should match the sensor size so that the sensor can neither fall off, nor apply excessive pressure. When using the M1195A Infant Finger Sensor, select a finger or toe with a diameter of between 7 and 8 mm (0.27 and 0.31). When applying a M1193A neonatal sensor do not overtighten the strap. 143 10 Monitoring SpO2 Connecting SpO2 Cables 4 Check that the light emitter and the photodetector are directly opposite each other. All light from the emitter must pass through the patients tissue. WARNING Loose Sensor: If a sensor is too loose, it might compromise the optical alignment or fall off. If it is too tight, for example because the application site is too large or becomes too large due to edema, excessive pressure may be applied. This can result in venous congestion distal from the application site, leading to interstitial edema, hypoxemia and tissue malnutrition. Skin irritations or lacerations may occur as a result of the sensor being attached to one location for too long. To avoid skin irritations and lacerations, periodically inspect the sensor application site and change the application site at least every four hours. Venous Pulsation: Do not apply sensor too tightly as this results in venous pulsation which may severely obstruct circulation and lead to inaccurate measurements. Ambient Temperature: At elevated ambient temperatures be careful with measurement sites that are not well perfused, because this can cause severe burns after prolonged application. All listed sensors operate without risk of exceeding 41C on the skin if the initial skin temperature does not exceed 35C. Extremities to Avoid: Avoid placing the sensor on extremities with an arterial catheter, or intravascular venous infusion line. Connecting SpO2 Cables Connect the sensor cable to the color-coded socket on the monitor. You can connect some Philips sensors directly to the monitor. For other sensors, use the corresponding adapter cable. CAUTION Extension cables: Do not use more than one extension cable (M1941A). Do not use an extension cable with Philips reusable sensors or adapter cables with part numbers ending in -L (indicates long cable version). Electrical Interference: Position the sensor cable and connector away from power cables, to avoid electrical interference. Humidity: For neonatal patients, make sure that all sensor connectors and adapter cable connectors are outside the incubator. The humid atmosphere inside can cause inaccurate measurements. Measuring SpO2 1 Select the correct patient category setting (adult/pediatric and neonatal), as this is used to optimize the calculation of the SpO2 and pulse numerics. 2 During measurement, ensure that the application site:
has a pulsatile flow, ideally with a perfusion indicator value above 1.0. has not changed in its thickness (for example, due to edema), causing an improper fit of the sensor. 144 SpO2 Signal Quality Indicator (Fast SpO2 only) 10 Monitoring SpO2 WARNING Inspect the application site every two to three hours to ensure skin quality and correct optical alignment. If the skin quality changes, move the sensor to another site. Change the application site at least every four hours. CAUTION Injected dyes such as methylene blue, or intravascular dyshemoglobins such as methemoglobin and carboxyhemoglobin may lead to inaccurate measurements. Interference can be caused by:
High levels of ambient light or strobe lights or flashing lights (such as fire alarm lamps). (Hint:
cover application site with opaque material.) Electromagnetic interference. Excessive patient movement and vibration. SpO2 Signal Quality Indicator (Fast SpO2 only) The SpO2 numeric is displayed together with a signal quality indicator (if configured and enough space is available) which gives an indication of the reliability of the current values. The level to which the triangle is filled shows the quality of the signal; the indicator below shows a medium signal quality, the signal quality is at a maximum when the triangle is completely filled. SpO2 Assessing a Suspicious SpO2 Reading Traditionally, pulse rate from SpO2 was compared with heart rate from ECG to confirm the validity of the SpO2 reading. With newer algorithms, such as FAST-SpO2, this is no longer a valid criteria because the correct calculation of SpO2 is not directly linked to the correct detection of each pulse. When pulse rate is very low, or strong arrhythmia is present, the SpO2/Pleth pulse rate may differ from the heart rate calculated from ECG but this does not indicate an inaccurate SpO2 value. If you doubt the measured SpO2, use the signal quality indicator (if available) or the pleth wave and perfusion indicator instead to assess the signal quality. NOTE With pulse oximetry, sensor movement, ambient light (especially strobe lights or flashing lights) or electromagnetic interference can give unexpected intermittent readings when the sensor is not attached to a patient. Especially bandage-type sensor designs are sensitive to minimal sensor movement that might occur when the sensor is dangling. 145 10 Monitoring SpO2 Changing the Averaging Time Changing the Averaging Time Depending on the monitor configuration, you may be able to change the averaging time for the SpO2 values. The averaging time represents the approximate time period used for the calculation. The exact averaging algorithm depends on the SpO2 technology (option) used and on the signal conditions. The longer the averaging time, the longer the time needed until the SpO2 value reflects the physiological event. Fast averaging is useful for situations where an extremely fast measurement is required or few artifacts are expected. Use slow averaging where you expect the number of artifacts to be relatively high. In the SpO2 Setup, select Average. Select the required averaging time from the list. 1 2 Setting the Measurement Mode When a telemetry device supplies SpO2T to the monitor via short range radio transmission, the monitor will have a manual measurement mode available. This allows SpO2 measurements to be made on request and not continuously, helping to save the telemetry devices battery power. To set the measurement mode, In the SpO2 Setup, select Mode. Select Continuous or Manual mode. 1 2 Making a Manual Measurement When the measurement mode is set to manual, In the SpO2 Setup, select Measure SpO2. When manual measurements are made, there will be no continuous SpO2 monitoring or alarming. The manual measurement value reflects a momentary status. The numerics from SpO2T measurements made in manual mode, for example SpO2T, PerfT, PulseT, will remain for a time on the main screen. They are annotated with the time that the measurement was made to distinguish them from continuously measured values. Perf T Understanding SpO2 Alarms This refers to SpO2 specific alarms. See the Alarms section for general alarm information. SpO2 offers high and low limit alarms, and a high priority desat alarm. You cannot set the low alarm limit below the desat alarm limit. 146 Pleth Wave 10 Monitoring SpO2 CAUTION If you measure SpO2 on a limb that has an inflated NBP cuff, a non-pulsatile SpO2 INOP can occur. If the monitor is configured to suppress this alarm there may be a delay of up to 60 seconds in indicating critical patient status, such as sudden pulse loss or hypoxia. Alarm Delays There is a delay between a physiological event at the measurement site and the corresponding alarm at the monitor. This delay has two components:
The time between the occurrence of the physiological event and when this event is represented by the displayed numerical values. This delay depends on the algorithmic processing and the configured averaging time. The longer the averaging time configured, the longer the time needed until the numerical values reflect the physiological event. The time between the displayed numerical values crossing an alarm limit and the alarm indication on the monitor. This delay is the combination of the configured alarm delay time plus the general system delay time (see Monitor Performance Specifications on page 251). Adjusting the Alarm Limits In the Setup SpO2 menu:
Touch the high limit on the alarm limits menu button. Choose the high alarm limit from the pop-
up list that opens. Touch the low limit on the alarm limits menu button. Choose the low alarm limit from the pop-up list that opens. WARNING High oxygen levels may predispose a premature infant to retrolental fibroplasia. If this is a consideration do NOT set the high alarm limit to 100%, which is equivalent to switching the alarm off. Adjusting the Desat Limit Alarm The Desat alarm is a high priority (red) alarm notifying you of potentially life threatening drops in oxygen saturation. In the Setup SpO2 menu, select DesatLimit. 1 2 Adjust the limit. Pleth Wave The Pleth wave is autoscaled to maximum display size. It decreases only when the signal quality becomes marginal. It is NOT directly proportional to the pulse volume. If you need an indication of change in pulse volume, use the perfusion indicator. 147 10 Monitoring SpO2 Perfusion Numeric minimum size for reliable SpO2 value Perfusion Numeric The perfusion numeric (Perf) gives a value for the pulsatile portion of the measured signal caused by the pulsating arterial blood flow. As pulse oximetry is based on the pulsatile nature of the signal, you can also use the perfusion numeric as a quality indicator for the SpO2 measurement. Above 1 is optimal, between 0.3-1 is acceptable. Below 0.3 is marginal; reposition the sensor or find a better site. Perfusion Change Indicator The perfusion change indicator is a graphic symbol which shows the change in the perfusion value, relative to a reference value which you can set. To set the current perfusion value as the reference value:
In the Setup SpO2 menu, select Set Perf Ref.. When a reference value has been set, the perfusion change indicator is displayed next to the perfusion numeric. Perfusion change indicator Setting SpO2/Pleth as Pulse Source In the Setup SpO2 menu, select Pulse (SpO2) to enter the Setup Pulse menu. In the Setup Pulse menu, select SystPulse and select SpO2 from the pop-up list. 1 2 Setting Up Tone Modulation If tone modulation is on, the QRS tone pitch lowers when the SpO2 level drops. Remember, the QRS tone is derived from either heart rate or pulse depending on which is currently selected as the active alarm source. In the Setup SpO2 menu, select Tone Mod. to toggle between Yes (for on) and No (for off). 148 Setting the QRS Volume 10 Monitoring SpO2 Tone modulation is licensed under US patent US 4,653,498 from Nellcor Puritan Bennett Incorporated. Setting the QRS Volume In the Setup SpO2 menu, select QRS Volume and set the appropriate QRS tone volume. 149 10 Monitoring SpO2 Setting the QRS Volume 150 11 11Monitoring NBP This monitor uses the oscillometric method for measuring NBP. In adult and pediatric mode, the blood pressure measurements determined with this device comply with the American National Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP10-1992) in relation to mean error and standard deviation, when compared to intra-arterial or auscultatory measurements
(depending on the configuration) in a representative patient population. For the auscultatory reference, the fifth Korotkoff sound was used to determine the diastolic pressure. In neonatal mode, the blood pressure measurements determined with this device comply with the American National Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP10-
1992) in relation to mean error and standard deviation, when compared to intra-arterial measurements in a representative patient population. The NBP measurement is suitable for use in the presence of electrosurgery and during the discharge of a cardiac defibrillator according to IEC 601-2-30:1999/EN 60601-2-30:2000. A physician must determine the clinical significance of the NBP information. Introducing the Oscillometric NBP Measurement Oscillometric devices measure the amplitude of pressure changes in the occluding cuff as the cuff deflates from above systolic pressure. The amplitude suddenly increases as the pulse breaks through the occlusion in the artery. As the cuff pressure decreases further, the pulsations increase in amplitude, reach a maximum (which approximates to the mean pressure), and then diminish. Studies show that, especially in critical cases (arrhythmia, vasoconstriction, hypertension, shock), oscillometric devices are more accurate and consistent than devices using other noninvasive measuring techniques. WARNING Patient Category: Select the correct patient category setting for your patient. Do not apply the higher adult inflation, overpressure limits and measurement duration to neonatal patients. Intravenous infusion: Do not use the NBP cuff on a limb with an intravenous infusion or arterial catheter in place. This could cause tissue damage around the catheter when the infusion is slowed or blocked during cuff inflation. Skin Damage: Do not measure NBP on patients with sickle-cell disease or any condition where skin damage has occurred or is expected. Unattended measurement: Use clinical judgement to decide whether to perform frequent unattended blood pressure measurements on patients with severe blood clotting disorders because of the risk of hematoma in the limb fitted with the cuff. 151 11 Monitoring NBP Preparing to Measure NBP CAUTION If you spill liquid onto the equipment or accessories, particularly if there is a chance that it can get inside the tubing or the measurement device, contact your service personnel. Measurement Limitations Measurements are impossible with heart rate extremes of less than 40 bpm or greater than 300 bpm, or if the patient is on a heart-lung machine. The measurement may be inaccurate or impossible:
if a regular arterial pressure pulse is hard to detect with cardiac arrhythmias with excessive and continuous patient movement such as shivering or convulsions with rapid blood pressure changes with severe shock or hypothermia that reduces blood flow to the peripheries with obesity, where a thick layer of fat surrounding a limb dampens the oscillations coming from the artery on an edematous extremity. Measurement Methods There are three methods of measuring NBP:
Manual - measurement on demand. Auto - continually repeated measurements (between one and 120 minute adjustable interval). Sequence - up to four measurement cycles which will run consecutively, with number of measurements and interval between them configurable for each cycle. STAT - rapid series of measurements over a five minute period, then the monitor returns to the previous mode. Use only on supervised patients. Reference Method The NBP measurement reference method can be Auscultatory (manual cuff) or Invasive (intra-
arterial). For further information, see the Application Note on NBP supplied on the monitor documentation CD-ROM. In Adult and Pediatric mode to check the current setting, select Main Setup -> Measurements
-> NBP, and check whether the Reference setting is set to Auscult. or Invasive. This setting can only be changed in Configuration Mode. In Neonatal mode, to comply with safety standards, invasive is always used as the reference method. This setting cannot be changed and is not visible in any operating mode. Preparing to Measure NBP 1 Connect the cuff to the air tubing. 152 Preparing to Measure NBP 11 Monitoring NBP 2 Plug the air tubing into the red NBP connector. Avoid compression or restriction of pressure tubes. Air must pass unrestricted through the tubing. 3 Make sure that you are using a Philips-approved correct sized cuff and that the bladder inside the cover is not folded or twisted. A wrong cuff size, and a folded or twisted bladder, can cause inaccurate measurements. The width of the cuff should be in the range from 37% to 47% of the limb circumference. The inflatable part of the cuff should be long enough to encircle at least 80% of the limb. 4 Apply the cuff to a limb at the same level as the patients heart. If it is not, you must use the measurement correction formula to correct the measurement. The marking on the cuff must match the artery location. Do not wrap the cuff too tightly around the limb. It may cause discoloration, and ischemia of the extremities. Inspect the application site regularly to ensure skin quality and inspect the extremity of the cuffed limb for normal color, warmth and sensitivity. If the skin quality changes, or if the extremity circulation is being affected, move the cuff to another site or stop the blood pressure measurements immediately. Check more frequently when making automatic or stat measurements. Correcting the Measurement if Limb is not at Heart Level To correct the measurement if the limb is not at heart level, to the displayed value add 0.75mmHg (0.10kPa) for each centimeter higher or add 1.9mmHg (0.25kPa) for each inch higher. deduct 0.75mmHg (0.10kPa) for each centimeter lower or deduct 1.9mmHg (0.25kPa) for each inch lower. Understanding the NBP Numerics Alarm source Measurement Mode Sys. Auto Timestamp/
Timer Alarm limits Systolic Diastolic Mean pressure Depending on the NBP numeric size, not all elements may be visible. Your monitor may be configured to display only the systolic and diastolic values. Alarm Sources if you have parallel alarm sources, the sources are displayed instead of the alarm limits. NBP Timestamp depending on the configured NBP Time setting, the time shown beside the NBP numeric can be:
Meas Time: the time of the most recent NBP measurement, or Next Meas: the time until the next measurement in an automatic series, displayed with a graphic representation of the remaining time, as shown here. 153 11 Monitoring NBP Starting and Stopping Measurements During measurements the cuff pressure is displayed instead of the units and the repeat time. An early systolic value gives you a preliminary indication of the systolic blood pressure during measurement. Starting and Stopping Measurements Use the Setup menu or SmartKeys to start and stop measurements. CAUTION Use clinical judgement to decide whether to perform repeated series of STAT measurements because of the risk of purpura, ischemia and neuropathy in the limb with the cuff. Enabling Automatic Mode and Setting Repetition Time 1 2 In the Setup NBP menu, select Mode and select Auto from the pop-up menu. For an automatic measurement, select Repeat and set the time interval between two measurements. Enabling Sequence Mode and Setting Up The Sequence 1 2 3 In the Setup NBP menu, select Mode and select Sequence from the pop-up menu. Select Setup Sequence to open the Setup Sequence window. Up to four measurement cycles can be setup which will run consecutively. For each cycle you can set the number of measurements and the interval between them. If you want to run less than four cycles in a sequence, you can set the number of measurements for one or more cycles to Off. Select each sequence in turn and select the number of measurements and the time interval between the measurements. 4 To have measurements continue after the sequence, set the number of measurements for your last cycle to Continuous and this cycle will run indefinitely. CAUTION Be aware that, if none of the cycles are set to Continuous, NBP monitoring will end after the last measurement of the cycle. When the NBP measurement mode is set to Sequence, the repetition time for Auto mode cannot be changed. Choosing the NBP Alarm Source You can monitor for alarm conditions in systolic, diastolic and mean pressure, either singly or in parallel. Only one alarm is given, with the priority of mean, systolic, diastolic. In the Setup NBP menu, select Al. from and choose from:
154 Switching Pulse from NBP On/Off 11 Monitoring NBP Menu option Pressure value monitored systolic Sys. diastolic Dia. mean Mean systolic and diastolic in parallel Sys&Dia diastolic and mean in parallel Dia&Mean Sys&Mean systolic and mean in parallel Sys&Dia&Mean all three pressures in parallel If mean is not selected as alarm source (Sys, Dia, or Sys&Dia selected), but the monitor can only derive a mean value, mean alarms will nevertheless be announced using the most recent mean alarm limits. When no value can be derived an NBP MEASURE FAILED INOP will be displayed. Switching Pulse from NBP On/Off In the process of making the NBP measurement, a pulse value can be derived and displayed. The pulse value is displayed together with the time the measurement was made. After one hour the value becomes invalid. There are no alarms associated with pulse from NBP. To switch the display of the pulse value on or off:
In the NBP Setup menu select Pulse (NBP). Pulse from NBP Pulse NBP Sys. Auto Assisting Venous Puncture You can use the NBP cuff to cause sub-diastolic pressure. The cuff deflates automatically after a set time (adult/pediatric 170 seconds, neonatal 85 seconds) if you do not deflate it. 1 In the NBP Setup menu select VeniPuncture. Puncture vein and draw blood sample. 2 3 Reselect VeniPuncture to deflate the cuff. During measurement, the NBP display shows the inflation pressure of the cuff and the remaining time in venous puncture mode. 155 11 Monitoring NBP Calibrating NBP Cuff pressure Venous puncture measurement mode NBP
(60) VP Time left in venous puncture mode 01:45 Calibrating NBP NBP is not user-calibrated. Cuff-pressure transducers must be verified and calibrated, if necessary, at least once every two years by a qualified service professional. See the Service Guide for details. 156 12 12Monitoring Temperature WARNING Measurements from an MMS extension connected to the monitor are not available when the monitor is running on battery power. They are only available when the monitor is powered by the external power supply (M8023A). You can measure temperature using the built-in temperature measurement (optional), or one of the MMS extensions. Temp measurement automatically switches on when you connect a probe. You can switch the measurement off manually. Making a Temp Measurement 1 2 3 Select the correct type and size of probe for your patient. If you are using a disposable probe, connect the probe to the temperature cable. Plug the probe or temperature cable into the temperature connector socket. Temp connector socket 4 Apply the probe to the patient. You are advised to use a protective rubber cover on rectal probes. 5 Select an appropriate temperature label. 6 Check that the alarm settings (on or off, high and low limits) are appropriate for this patient and this type of temperature measurement. 157 12 Monitoring Temperature Calculating Temp Difference WARNING Make sure you set alarm limits for the correct label. The alarm limits you set are stored for that particular label only. Changing the label may change the alarm limits. Selecting a Temperature for Monitoring Tell the monitor which temperature you want to monitor by selecting its temperature label. The label is a unique identifier for each type of temperature. When you choose a label, the monitor uses that labels stored color and alarm settings. In the Setup <Temp> menu, select Label. Select the appropriate label from the list. 1 2 Temp Tart Tcore Tesoph non-specific temperature label. arterial temperature core temperature esophageal temperature Trect Tskin Tven Tnaso rectal temperature skin temperature venous temperature nasopharyngeal temperature Extended Temperature Label Set The following additional labels are available if Label Set is set to Full. This setting can only be changed in Configuration Mode. Note that if your monitor is connected to an Information Center, the additional labels in the extended label set may not be correctly displayed. See the Configuration Guide for your monitor for more information. T1, T2, T3, T4 Tamb Tcereb Ttymp Tvesic Non-specific temperature labels ambient temperature cerebral temperature tympanic temperature vesical temperature Calculating Temp Difference The monitor can calculate and display the difference between two temperature values by subtracting the second value from the first. The difference is labeled 'Temp. 1 In the Main Setup menu, select Measurements. In the Setup 'Temp menu, select First Temp. Label the measurement source as appropriate. Select Second Temp. Label the measurement source as appropriate. 2 3 4 5 158 13 13Monitoring Invasive Pressure WARNING Measurements from an MMS extension connected to the monitor are not available when the monitor is running on battery power. They are only available when the monitor is powered by the external power supply (M8023A). CAUTION Do not use the MP2 in combination with other monitors using an M1006A pressure module and the HP1290A pressure transducer. This may cause interference on the respiration or invasive pressure signals. You can measure pressure using the monitors built-in pressure measurement (optional), or one of the MMS extensions. Setting up the Pressure Measurement 1 Plug in the pressure cable. Pressure connector 2 3 Prepare the flush solution. Flush the system to exhaust all air from the tubing. Ensure that the transducer and stopcocks are free of air bubbles. WARNING If air bubbles appear in the tubing system, flush the system with the infusion solution again. Air bubbles may lead to a wrong pressure reading. 159 13 Monitoring Invasive Pressure Setting up the Pressure Measurement 4 Connect the pressure line to the patient catheter. 5 6 If you are using an infusion pressure cuff with the pressure line, attach the pressure cuff to the fluid to be infused. Inflate it according to your standard hospital procedure, then start the infusion. Position the transducer so that it is level with the heart, approximately at the level of the midaxillary line. WARNING If measuring intracranial pressure (ICP, IC1 or IC2) with a sitting patient, level the transducer with the top of the patients ear. Incorrect leveling may give incorrect values. Selecting a Pressure for Monitoring Tell the monitor which pressure you want to monitor by selecting its pressure label. The label is a unique identifier for each type of pressure. When you choose a label, the monitor uses that labels stored settings, for example color, wave scale and alarm settings. The label also determines which algorithm is used to process the pressure signal, so an incorrect label can lead to incorrect pressure values. In the Setup <Press> menu, select Label. Select the appropriate label from the list. 1 2 Label ABP ART Ao CVP ICP LAP Description Arterial blood pressure Arterial blood pressure (alternative) Aortic pressure Central venous pressure Intracranial pressure Left atrial pressure Label P PAP RAP UAP UVP Description Non-specific pressure label Pulmonary artery pressure Right atrial pressure Umbilical arterial pressure Umbilical venous pressure Extended Pressure Label Set The following additional labels are available if Label Set is set to Full. This setting can only be changed in Configuration Mode. Note that if your monitor is connected to an Information Center, the additional labels in the extended label set may not be correctly displayed. See the Configuration Guide for your monitor for more information. Description Label BAP FAP IC1, IC2 P1, P2, P3, P4 Alternative non-specific pressure labels Brachial arterial pressure Femoral arterial pressure Alternative intracranial pressures 160 Zeroing the Pressure Transducer 13 Monitoring Invasive Pressure Zeroing the Pressure Transducer To avoid inaccurate pressure readings, the monitor requires a valid zero. Zero the transducer in accordance with your hospital policy (at least once per day). You must perform a zero:
when you use a new transducer or tubing every time you reconnect the transducer cable to the monitor if you think the monitors pressure readings are not correct. Zeroing ICP (or IC1/IC2) Your hospital guidelines may require you to zero the ICP transducer less frequently than other transducers, due to the need for aseptic conditions. When you zero an ICP transducer, the zero values are automatically stored and you will not be prompted to repeat the zero procedure. If you want to simultaneously zero all pressures except ICP, disconnect the ICP transducer from the monitor while zeroing. Reconnecting the transducer recalls the stored values. WARNING If you select the label ICP (or IC1/IC2), the measurement device uses the most recently stored zero. Therefore, make sure you zeroed the transducer correctly in accordance with the transducer manufacturers instructions and your hospital policy. When you use a transducer that you cannot rezero after placement, ensure that you keep the measuring device with the patient so that you are certain you have the correct zero data for this patient. Determining a Pressures Most Recent Zero The monitor displays the most recent zero on the status line. If this has timed-out after you have performed a zero, redisplay the information in the status line by entering the pressures setup menu. Zeroing a Pressure Measurement WARNING Invasive pressure alarms (and pulse alarms, if derived from invasive pressure) are temporarily suppressed until 30 seconds after the transducer finishes zeroing. 1 Turn off the stopcock to the patient. 2 Vent the transducer to atmospheric pressure, to compensate for the static and atmospheric pressure exerted on the transducer. In the setup menu for the pressure, select Zero <Press>. 3 4 When you see the message <Press> zero done at <date and time> on the status line, (for example, ABP zero done at 13 Mar 02 23.35) close the stopcock to atmospheric pressure, and open the stopcock to the patient. CAUTION When using high frequency ventilation, ensure that the tubing from the ventilator does not touch the arterial line, or connect with it indirectly, while zeroing the pressure. This could cause small pressure variations which can interfere with the zero procedure. 161 13 Monitoring Invasive Pressure Adjusting the Calibration Factor Zeroing All Pressures Simultaneously WARNING Before zeroing all pressures, make sure that all pressure transducers are vented to atmospheric pressure. If you are measuring pressures with more than one measuring device, using the Zero Press SmartKey to initiate the zeroing calls up a list of all active pressures. Select the pressure you want to zero or select All Press to zero all pressures simultaneously. Troubleshooting the Zero The status line lists the probable cause of an unsuccessful zero:
Corrective Action The hardware is faulty. Contact your service personnel. may be faulty. Replace the adapter cable and try again. If it fails, replace the transducer and try again. If it still fails, contact your service personnel. Message cant zero;
equipment malf. cant zero;
excessive offset Make sure the transducer is vented to air and try again. If this fails, the hardware cant zero -
unstable signal cant zero - no transducer cant zero;
pulsat. pressure Make sure that the transducer is vented to air, not to the patient, and try again. unable to zero -
timed out switch <Press> on first Try pressing the Zero key again. If this fails, replace the transducer and adapter cable and contact your service personnel. Pressure measurement is switched off. To switch it on, in the Setup Pressure menu, select the pressures label. Make sure that the transducer is connected and try again. If this fails, exchange the adapter cable and try again. If this fails, exchange the transducer. Adjusting the Calibration Factor Each time you use a reusable transducer, compare the calibration factor written on your transducer with the calibration factor shown on the monitor. To ensure accurate measurement, they must be the same. In the Setup <Press> menu, select Cal. Factor. If the value here does not match that on the transducer, select the corresponding value from the list now in accordance with your hospitals procedure. 1 2 To confirm you want to use the new calibration factor, select the Confirm popup. Displaying a Mean Pressure Value Only Use this when you want to see only the mean pressure. In the pressures setup menu, select Mean only. Toggle between On to display mean pressure value only, and Off to display all pressure values (systolic, diastolic and mean). 162 Changing the Pressure Wave Scale 13 Monitoring Invasive Pressure Changing the Pressure Wave Scale 1 2 3 Select the label of the pressure wave whose scale you want to set to enter the Setup menu. In the Setup <Press> menu, (for example ABP) select Scale. Select a value from the pop-up list:
a positive value sets the top gridline. The bottom gridline is set at zero. a negative value sets the bottom gridline. The middle gridline is set at zero. Optimizing the Waveform In the Setup <Press> menu, select Optimum Scale to let the monitor select the best minimum and maximum scales for the current wave. Non-Physiological Artifact Suppression Some clinical procedures may affect blood pressure, for example, a flush procedure or a blood sample. Your monitor may be configured to suppress these non-physiological artifacts for a specified duration
(Artifact Suppression is configured to 30, 60, or 90 seconds). During artifact suppression, the monitor shows the INOP message <Pressure label> ARTIFACT, and a question mark is shown beside the pressure numerics. Pressure alarms and the Pulse NON-PULSATILE INOP are suppressed during the configured period. The CPP high alarm is not suppressed. Choosing the Pressure Alarm Source WARNING Make sure you set alarm limits for the correct label. The alarm limits you set are stored for that particular label only. Changing the label may change the alarm limits. You can monitor for alarm conditions in systolic, diastolic and mean pressure, either singly or in parallel. Only one alarm is given at a time, in this order of priority: mean, systolic, diastolic. In the Setup <Press> menu, select Al. from and choose the source. Pressure value monitored Menu option Sys. Dia. Mean Sys & Dia Dia & Mean Sys & Mean Sys&Dia&Mean Select and set the High Limit and Low Limit for the pressure(s) you have selected. systolic diastolic mean systolic and diastolic in parallel diastolic and mean in parallel systolic and mean in parallel all three pressures in parallel 163 13 Monitoring Invasive Pressure Choosing the Pressure Alarm Source Extreme Alarm Limits The extreme pressure alarms, Extreme High and Extreme Low, can be made available for your monitor in Configuration Mode and are additional to the standard High and Low limit alarms. They are generated by the active pressure alarm source, and are setup in Configuration Mode by adding a set value (the ' value) to the high and low alarm limits. This value can be set for each pressure label individually. Extreme Low Limit Low Limit High Limit Extreme High Limit
' Extreme Low
' Extreme High You need to know which values have been configured for your monitor. Changing the high and low alarm limits automatically changes the extreme alarm limits within the allowed range. To see the extreme pressure alarms set for your monitor, in the Setup <Press> menu, see the menu items 'Extr. High and 'Extr. Low. The extreme pressure alarms are high priority, red alarms, marked *** in the alarm message. 164 Calibrating Reusable Transducer CPJ840J6 13 Monitoring Invasive Pressure Calibrating Reusable Transducer CPJ840J6 Depending on your monitors configuration, you may be able to perform a calibration in monitoring mode. Perform a mercury calibration when you use a new transducer, and at regular intervals according to your hospital policy. You require:
standard sphygmomanometer. sterile 10cc syringe with heparinised solution. 3-way stopcock. approximately 25cm of tubing. Making the Pressure Calibration WARNING Never perform the invasive pressure calibration while a patient is being monitored. 1 Zero the transducer. 2 Connect the syringe and manometer. a. Attach the tubing to the manometer. b. Connect the 3-way stopcock to the stopcock that is not connected to the patient catheter when you measure a patient. c. Attach the syringe to one port and the manometer tubing to the other port. d. Open the port to the manometer. tubing to manometer Syringe with heparinised solution Patient connection stoppered Off PRESS M1006A T PRESS ZERO Pressure connector on monitor 12 PIN 3 Move the syringe barrel in and raise the mercury to 200mmHg (30kPa). 200mmHg is the recommended calibration pressure. In the Setup Pressure menu, select Cal. Press. 4 165 13 Monitoring Invasive Pressure Calculating Cerebral Perfusion 5 Select the calibration pressure from the list, for example 200 mmHg. Select Confirm to recalculate the calibration factor using the applied pressure. 6 7 When the monitor displays <Press> calibration done at <date and time>, remove the manometer tubing, syringe and extra stopcock. We recommend you replace the transducer dome and tubing with sterile ones. Label the transducer with the calibration factor shown in the Cal. Factor field in the pressures setup menu. 8 9 Reconnect the patient and start measuring again. Troubleshooting the Pressure Calibration The status line lists the probable cause of an unsuccessful calibration. Message cant calibr.; equipmt malf. cant calibrate;out of range cant calibr.; no transd. cant cal.; unstable signal cant calibr.;do zero first Corrective Action Contact your service department. The pressure hardware is faulty. Make sure that you have selected the value for Cal. Press that you are applying to the transducer, and repeat the calibration. Make sure that the transducer is connected and try again. Make sure there are no disturbances to the transducer, and repeat the calibration. No valid zero. Zero the transducer. Calculating Cerebral Perfusion The monitor can calculate the difference between mean arterial pressure and the intracranial pressure. The difference is labeled CPP. In the Main Setup menu, select Measurements. In the Setup CPP menu, select ABP, ART, Ao, BAP or FAP as the arterial pressure source. 1 2 166 14 14Monitoring Carbon Dioxide WARNING Measurements from an MMS extension connected to the monitor are not available when the monitor is running on battery power. They are only available when the monitor is powered by the external power supply (M8023A). Only one CO2 measurement at a time is supported. Use the CO2 measurement to monitor the patients respiratory status and to control patient ventilation. There are two methods for measuring carbon dioxide in the patients airway:
Mainstream measurement uses a CO2 sensor attached to an airway adapter directly inserted into the patients breathing system. This method is available using the monitors built-in CO2 measurement
(optional), the M3014A Capnography Extension or the M3016A Mainstream Extension. Sidestream measurement takes a sample of the respiratory gas with a constant sample flow from the patients airway and analyzes it with a remote CO2 sensor. You can measure sidestream CO2 using the monitors built-in CO2 measurement (optional) or using the M3014A Capnography Extension, or the M3015A Microstream CO2 Extension. In both cases, the measurement principle is infrared transmission, where the intensity of infrared light passing the respiratory gas is measured with a photo detector. As some of the infrared light is absorbed by the CO2 molecules, the amount of light passing the gas probe depends on the concentration of the measured CO2. When using a wet ventilator circuit, monitor mainstream CO2 if available, in preference to sidestream CO2. The partial pressure is calculated from the gas concentration by multiplying the concentration value with the ambient pressure. The measurement provides:
a CO2 waveform. an end tidal CO2 (etCO2) value: the CO2 value measured at the end of the expiration phase. an inspired minimum CO2 (imCO2): the smallest value measured during inspiration. an airway respiration rate (awRR): the number of breaths per minute, calculated from the CO2 waveform. 167 14 Monitoring Carbon Dioxide Measuring CO2 using the CO2 Option or M3014A Depending on the Max Hold setting configured for your monitor, the etCO2 numeric shows either the highest CO2 value measured within the configured time period (Max Hold set to 10 sec or 20 sec) or the etCO2 numeric shows breath-to-breath value (Max Hold set to Off). WARNING Correlation: The etCO2 readings do not always correlate closely with paCO2, especially in neonatal patients and patients with pulmonary disease, pulmonary embolism or inappropriate ventilation. Pharmaceuticals in aerosols: Do not measure CO2 in the presence of pharmaceuticals in aerosols. Explosion Hazard: Do not use in the presence of flammable anesthetics or gases, such as a flammable anesthetic mixture with air, oxygen or nitrous oxide. Use of the devices in such an environment may present an explosion hazard. Failure of operation: if the measurement or a sensor fails to respond as described, do not use it until the situation has been corrected by qualified personnel. Low etCO2 values: Leakages in the breathing system or sampling system may cause the displayed etCO2 values to be significantly too low. Always connect all components securely and check for leaks according to standard clinical procedures. Displacement of the nasal or combined nasal oral cannulas can cause lower than actual etCO2 readings. Even with combined nasal oral cannulas, the etCO2 readings may be slightly lower than actual in patients breathing through the mouth only. Measuring CO2 using the CO2 Option or M3014A The monitor (with the CO2 option) or the M3014A Capnography Extension measures partial pressure of carbon dioxide in a patients expired gas using the mainstream method or the sidestream method. The mainstream CO2 measurement can be used, with appropriate accessories, with intubated adult, pediatric and neonatal patients. The sidestream CO2 measurement can be used, with appropriate accessories, with intubated and nonintubated adult, pediatric, infant and neonatal patients. With intubated patients, a sample of the respiratory gas is drawn from the patients breathing circuit through an airway adapter and a gas sampling tube. With non-intubated patients, the gas sample is drawn through a nasal or oral-nasal cannula. WARNING Altitude Setting: The monitor is not equipped with automatic barometric pressure compensation. Before the CO2 measurement is used for the first time, the altitude must be set to the correct value. An incorrect altitude setting will result in incorrect CO2 readings. The CO2 readings will typically deviate 5% for every 1000m difference. Electrical Shock Hazard: Do not open the monitor or measurement device. Contact with exposed electrical components may cause electrical shock. Always turn off and remove power before cleaning the sensor, monitor or measurement device. Do not use a damaged sensor or one with exposed electrical contacts. Refer servicing to qualified service personnel. Preparing to Measure Mainstream CO2 You must perform a zero as described in this procedure each time you use a new airway adapter. 1 Attach the sensor connector to the CO2 connector on the monitor (when the optional CO2 measurement is integrated) or on the extension. 168 Measuring CO2 using the CO2 Option or M3014A 14 Monitoring Carbon Dioxide 2 Wait 2 minutes, allowing the sensor to reach its operating temperature and a stable thermal condition. 3 Choose the appropriate airway adapter and connect it to the sensor head. The airway adapter clicks into place when seated correctly. 4 To zero the sensor:
expose the sensor to room air and keep it away from all sources of CO2 including the ventilator, the patients breath and your own. in the setup menu for the CO2, select Start Zero Cal. When you see the message Zero done at <date and time> on the status line, the zero calibration is finished and you can begin monitoring. 5 Install the airway adapter at the proximal end of the circuit between the elbow and the ventilator Y-section. WARNING To prevent stress on the endotrachial tube, support the sensor and airway adapter. Position sensor cables and tubing carefully to avoid entanglement or potential strangulation. Do not apply excessive tension to any cable. Replace the airway adapter, if excessive moisture or secretions are observed in the tubing or if the CO2 waveform changes unexpectedly without a change in patient status. To avoid infection, use only sterilized, disinfected or disposable airway adapters. Inspect the airway adapters prior to use. Do not use if airway adapter appears to have been damaged or broken. Observe airway adapter color coding for patient population. Preparing to Measure Sidestream CO2 1 Plug the sensor cable into the monitors CO2 input connector. Allow the sensor two minutes warm up time 2 Connect the cannula, airway adapter, or sample line as appropriate, to the sensor. It will click into place when seated correctly. 3 To zero the sensor:
169 14 Monitoring Carbon Dioxide Measuring CO2 using the CO2 Option or M3014A expose the sensor to room air and keep it away from all sources of CO2 including the ventilator, the patients breath and your own. In the setup menu for the CO2, select Start Zero Cal. When you see the message Zero done at <date and time> on the status line, the zero calibration is finished and you can begin monitoring. 4 For intubated patients requiring an airway adapter: Install the airway adapter at the proximal end of the circuit between the elbow and the ventilator Y-
section. For intubated patients with an integrated airway adapter in the breathing circuit.: Connect the male luer connector on the straight sample line to the female port on the airway adapter. For non-intubated patients: Place the nasal cannula onto the patient. For patients prone to mouth breathing use an oral-nasal cannula. For nasal or oral-nasal cannulas with oxygen delivery, place the cannula on the patient as shown then attach the oxygen supply tubing to the oxygen delivery system and set the prescribed oxygen flow. WARNING Always connect the airway adapter to the sensor before inserting the airway adapter into the breathing circuit. In reverse, always remove the airway adapter from the breathing circuit before removing the sensor. CAUTION Always disconnect the cannula, airway adapter or sample line from the sensor when not in use. Using the Sidestream Sensor Holder The holder delivered with the sensor can be used to clamp the sensor onto an IV pole or a shelf. 1 Push the sensor into the holder until it clicks into position. 2 Clamp the holder onto an IV pole, a shelf or another appropriate location. To remove the sensor from the holder, release the clip and pull the sensor out of the holder. clip 170 Measuring Mainstream CO2 using M3016A 14 Monitoring Carbon Dioxide Removing Exhaust Gases from the System WARNING Anesthetics: When using the sidestream CO2 measurement on patients who are receiving or have recently received anesthetics, connect the outlet to a scavenging system, to avoid exposing medical staff to anesthetics. Use an exhaust tube to remove the sample gas to a scavenging system. Attach it to the sidestream sensor at the outlet connector. Measuring Mainstream CO2 using M3016A The M3016A Mainstream CO2 Extension measures partial pressure of carbon dioxide in a patients expired gas using the mainstream method. When using the appropriate accessories you can use the mainstream CO2 measurement with ventilated adults, pediatric and neonatal patients. WARNING Infra-red radiation: Do not expose the airway adapter or M1460A transducer to infra-red radiation during use. This may cause incorrect readings. Preparing to Measure Mainstream CO2 1 Attach the transducer connector to the CO2 connector on the M3016A extension. 2 Wait 20 minutes, allowing the transducer to reach its operating temperature and a stable thermal condition. 3 Perform an accuracy check and then, if necessary, calibrate the transducer. Checking Transducer Accuracy WARNING Check transducer accuracy at least once a week or if you doubt the CO2 readings. 1 2 3 4 5 In Setup CO2 menu, select Cal. Mode to switch on calibration mode. Look at the calibration value displayed in the Setup CO2 menu next to Start CAL1. Is it the same as the value on the calstick? If not, calibrate the transducer now. Place the transducer on the low cell of the calstick (labelled 0.0 mmHg or ZERO). The reading on the screen should be zero within 1 mmHg within one minute. Place the transducer on the high cell of the calstick. The reading on the screen should be within 1 mmHg of the value on the calstick within one minute. If both readings are in range, you can leave calibration mode and begin monitoring. If either of the readings is out of range, calibrate the transducer. Calibrating the Transducer 1 Check that the windows on the calstick are clean and clear. Place the transducer on one of the calstick cells and select Start CAL1. 2 171 14 Monitoring Carbon Dioxide Measuring Mainstream CO2 using M3016A other cell and select Start CAL2 then press Confirm. 3 Enter the calibration value printed on the calstick then press Confirm to start calibration. 4 When the message CO2 CAL1 done;Start CAL2 cal appears, put the transducer on the 5 When you see the message CO2 cal done;leave Cal. Mode, calibration is complete. Select Cal. Mode to switch calibration mode off. You cannot monitor in calibration mode. 6 Attaching and Removing the CO2 Transducer Airway Adapter CO2 Transducer 1 Open the latch and place the transducer onto the airway adapter. Place the airway adapter in the patients breathing circuit between the endotracheal tube and the Y-
piece. You may see the CO2 SENSOR WARMUP message until the transducer reaches operating temperature. Wait until this disappears before starting the measurement. 2 To remove the transducer from the airway adapter, open the latch and pull out the airway adapter. WARNING To prevent stress on the endotrachial tube, support the transducer and airway adapter. To avoid infection, use only sterilized airway adapters. 172 Measuring Microstream CO2 using M3015A 14 Monitoring Carbon Dioxide Measuring Microstream CO2 using M3015A The M3015A Microstream CO2 Extension measures the partial pressure of carbon dioxide in a patients expired gas using Microstream technology. The measurement is equipped with an automatic barometric pressure compensation. Preparing to Measure Microstream CO2 Use appropriate accessories for:
the patient type (adult, pediatric or neonatal), the ventilation situation (including humidification) the duration - short term use, up to 24 hours (typically OR), or long term use (typically ICU). All accessories are for single patient use only. Using Microstream Accessories The Microstream measurement can be operated with the special Microstream accessories only. Refer to the instructions for use provided with the accessory. For intubated patient with non-humidified ventilation, you can use a Microstream FilterLine set. For humidified ventilation, use a FilterLine H Set. For non-intubated patients, the gas sample is taken through a Nasal FilterLine, or a Smart CapnoLine
(which is a combined oral-nasal FilterLine). In parallel to the measurement of the CO2, oxygen (O2) may be delivered to the patient to support gas exchange. This is done by using an O2/CO2 FilterLine, or a Smart CapnoLine O2 (a combined oral-nasal O2/CO2 FilterLine). Using the FilterLine and Airway Adapter 1 Attach the female Luer connector to the CO2 inlet connector on the extension by pushing the socket cover down and screwing the connector into place. inlet connector cover outlet connector 2 Check that the FilterLine is not kinked. 3 Change the FilterLine if a CO2 OCCLUSION INOP appears on the monitor or if the readings become extremely erratic. 173 14 Monitoring Carbon Dioxide Setting up all CO2 Measurements Disconnect the FilterLine during suctioning and nebulizing therapies. Check the table in the Microstream CO2 Accessories section of the Accessories chapter for typical usage times for the different Microstream accessories. CO2 values for non-intubated patients using Microstream accessories will always tend to be lower than for intubated patients. If values appear extremely low, check whether the patient is breathing through the mouth or whether one nostril is blocked Removing Exhaust Gases from the System WARNING Anesthetics: When using the Microstream CO2 measurement on patients who are receiving or have recently received anesthetics, connect the outlet to a scavenging system, or to the anesthesia machine/
ventilator, to avoid exposing medical staff to anesthetics. Use an exhaust tube to remove the sample gas to a scavenging system. Attach it to the MMS Extension at the outlet connector. Suppressing Zero Calibration SmartKey, if configured. To prevent an automatic zero calibration from being started in the next five minutes, in the Setup CO2 menu, select No Zero For 5Min, or select the Suppress CO2 Zero Selecting No Zero For 5Min or selecting the Suppress CO2 Zero SmartKey again before the timer has timed out resets the timer to five minutes, unless an AutoZero became due during the previous suppression. Setting up all CO2 Measurements These tasks are common to all CO2 measurements except where otherwise noted. Adjusting the CO2 Wave Scale In the CO2 Wave menu or the Setup CO2 menu, select Scale. 1 2 Choose a suitable scale range from the pop-up list. Setting up CO2 Corrections Temperature, water vapor in the patients breath, barometric pressure, and the proportions of O2, N2O and Helium in the mixture all influence CO2 absorption. If values seem inaccurately high or low, check that the monitor is using the appropriate corrections. Correction Altitude
(M3014A only) Altitude is set during installation. The monitor automatically applies an appropriate correction. 174 Setting up all CO2 Measurements 14 Monitoring Carbon Dioxide Correction O2
(M3014A only) Humidity N2O
(M3016A mainstream and M3015A microstream only) Gas
(M3014A only) Agent
(M3014A only) In the Setup CO2 menu, select Oxy. Corr and select a value between 20% and 100%, the default value is 20%. If you are not measuring the expired O2, estimate it by subtracting 5% from the inspired O2 then select the nearest value from the list. At installation, the monitor is configured to automatically apply either Body Temperature Pressure Saturated (BTPS) or Ambient Temperature Pressure Dry (ATPD). To see which, go to the Setup CO2 menu, and scroll down to look at Hum. Corr or HumidityCorr. In the Setup CO2 menu, select N2O Corr. and turn on or off. If N2O is present in the ventilation gas mixture, you must turn this on. If the N2O correction is not available in the Setup CO2 menu, the CO2 measurement in your MMS Extension does not require N2O correction or it is setup with Gas Corr. (see below). In the Setup CO2 menu, select Gas Corr. and select Helium, N2O or turn off. If Helium or N2O is present in the ventilation gas mixture, you must make the appropriate selection. If the Gas correction is not available in the Setup CO2 menu, the CO2 measurement in your MMS Extension does not require N2O or Helium correction or the N2O correction is setup with N2O Corr. (see above). In the Setup CO2 menu, select Agt. Corr. and select the concentration of the anesthetic agent (between 0.0% and 20.0%). If an anesthetic agent is present in the ventilation gas mixture, you must select the appropriate concentration. Suppressing Sampling (not Mainstream CO2) available. To temporarily stop sampling, in the Setup CO2 menu, select Pump 15Min Off or use the CO2 Pump Off SmartKey if Selecting Pump 15Min Off again before fifteen minutes have passed resets the timer to fifteen minutes. To re-start the pump, in the Setup CO2 menu, select Pump On. Changing CO2 Alarms This refers to CO2 specific alarms. See the Alarms section for general alarm information. You change CO2 alarm settings in the Setup CO2 menu. To switch etCO2 alarms on and off:
Select etCO2 Alarms and toggle between On and Off. To change the etCO2 alarm limits:
Touch the high limit on the alarm limits menu button. Choose the high alarm limit from the pop-
up list that opens. Touch the low limit on the alarm limits menu button. Choose the low alarm limit from the pop-up list that opens. 175 14 Monitoring Carbon Dioxide Setting up all CO2 Measurements To change the imCO2 high limit:
Select imCO2 High and choose the high alarm limit from the pop-up list that opens. Changing the Apnea Alarm Delay This determines the time limit after which the monitor alarms if the patient stops breathing. In the Setup CO2 menu, select awRR. In Setup awRR menu, select Apnea. 1 2 3 Choose the apnea alarm delay time. WARNING Safety and effectiveness of the respiration measurement method in the detection of apnea, particularly the apnea of prematurity and apnea of infancy, has not been established. Prolonged delay: The selected apnea alarm delay may be prolonged by up to 17 seconds, if an apnea occurs during the automatic zero process. This applies to the Microstream (M3015A) measurement only. Deriving Alarms From awRR 1 In the Setup CO2 menu, select awRR. In the Setup awRR menu, select Alarms. 2 3 Choose On to derive alarms from the airway respiration signal or Off to disable them. Changing awRR Alarm Limits In the Setup CO2 menu, select awRR. Select High Limit to set the upper alarm limit. Select Low Limit to set the lower alarm limit. Select the appropriate setting. 1 2 3 176 15 15Assigning Two Devices to One Patient It is possible to assign a monitor and a telemetry device to the same patient, resulting in the information from both devices being combined in one sector at the Information Center. This is called pairing and when a telemetry device and a monitor are paired, the measurement data from the telemetry device will be displayed on the monitor screen. A telemetry device can be:
any Philips telemetry device (only for indirect connections, see below). a TRx+/TRx+ Intellivue Telemetry system transceiver. How Can You Combine Devices?
With an indirect connection, using standard telemetry transmission - the data are sent to the monitor via the Information Center and arrive with a delay of several seconds at the monitor. With a direct connection to the monitor, via a short range radio link - the data arrive with a minimal delay on the monitor screen. Indirect Connection - Manual Pairing The telemetry device can be paired with the monitor at the Information Center or at the monitor. For detailed information regarding pairing and configuration at the Information Center, see the Information Center Instructions for Use. To pair the monitor with a telemetry device at the monitor:
1 Select Main Setup then Measurements Select Telemetry 2 The Setup Telemetry menu will appear with only one entry Paired Equipment. 3 Enter here the equipment label of the telemetry device to be paired. Pairing at the monitor is only possible when the monitor already has a connection to the Information Center and the Information Center software version allows pairing at the monitor. Telemetry Data Window The measurements from the telemetry device are shown in the telemetry data window on the monitor when there is no direct connection via short range radio link. 177 15 Assigning Two Devices to One Patient How Can You Combine Devices?
TELE INOP Delayed
* TELE ALARM
** HR 140>120 SOME ECG ALRMS OFF HR NBP Sys.
%SpO2T Telemetry data window Auto 10 min etCO2 imCO2 WARNING All data presented in the telemetry data window are delayed for several seconds. If you need realtime data, for example for defibrillation, always use the monitor ECG instead of telemetry. As long as the ECG is being measured with the telemetry device there will be no ECG signal available at the ECG Sync Pulse output. Direct Connection - Automatic Pairing The following direct connections are possible:
a TRx+4841A Intellivue Telemetry system transceiver connected via short range radio (SRR) link to an MP2 with SRR capability. If a telemetry device is assigned to a monitor via a direct short range radio link, the monitor and the telemetry device are automatically paired at the Information Center (if configured). The measured data from the telemetry device ECG and, if available, SpO2T will appear on the monitor screen and will be sent through the monitor to the Information Center. The ECG waves and numerics appear in place of the monitors own ECG, and SpO2T is displayed as an additional measurement. When ECG is measured with the telemetry device there will be no Respiration measurement derived. WARNING When ECG is being measured with a telemetry device directly connected to the monitor, there will be no ECG signal available at the ECG analog output or ECG Sync Pulse output and no synchronization marks on the ECG wave. A No ECG Out message will appear in the ECG wave channel. When a telemetry device is connected to the monitor, arrhythmia relearning is initiated, and again when the telemetry device is disconnected. 178 How Can You Combine Devices?
15 Assigning Two Devices to One Patient Controls on the Telemetry Device (e.g. nurse call) will be inactive when the device is directly connected to the monitor except in the case when the monitor has no network connection and data are transferred via the telemetry device. See the "Enhancing Telemetry Monitoring with the Monitor" chapter. Assigning a Telemetry Transceiver with an SRR Adapter to a Monitor Monitors which have this capability have a short range radio symbol A telemetry device with a short range radio adapter can be assigned to a monitor directly. To assign a telemetry device to a monitor:
on the model label. 1 2 3 Press the Check button on the telemetry device. The measurement selection key on the monitor will change to show the assign telemetry icon Select the assign telemetry icon. In the Assign Telemetry Device menu, select the correct equipment label for the telemetry device. 4 Check that the assignment is successful and that transmission has begun:
A Tele Device assigned message appears on the monitor a tone sounds at the telemetry device and the Laeds Off indicators light the ECG wave appears on the monitor To confirm that the correct telemetry device has been assigned, open the ECG Setup menu. The title of the menu contains the equipment label of the telemetry device; check that this is the correct label. If a monitor is already paired to another device, you cannot assign a telemetry device to that monitor. If the telemetry device goes out-of-range or loses the short range radio connection, it will switch over to standard telemetry transmission to the Information Center. In this case, the telemetry data is displayed in the Telemetry Data Window as described above. If a monitor is manually paired with a telemetry device with a short range radio adapter, the short range radio assignment will be automatically made. If a telemetry device disappears from the list in the Assign Telemetry Device menu, press the Check button on the telemetry device again. If the monitor is not configured to be used with a telemetry device, the assign telemetry icon will appear crossed out If the devices are unpaired, the short range radio connection will be ended. WARNING Short range radio connections are subject to interruption due to interference from other radio sources in the vicinity, including microwaves, bluetooth devices and DECT phones. Outside the operating frequency band and 5% above and below, i.e. the exclusion band according IEC 60601-1-2, section 36.202.3a)4), the short range radio connection is immune up to 3V/m in the frequency range from 80 MHz to 2.0 GHz and up to 1V/m in the frequency range from 2.0 to 2.3 GHz. Depending on the strength and duration of the interference, the interruption may occur for an extended period. A loss of connection, due to moving out-of-range, interference, or for other reasons, is indicated with a TELE DISCONNECT INOP. 179 15 Assigning Two Devices to One Patient How Can You Combine Devices?
Correct channel configuration is important, refer to the Configuration Guide for details. If a TELE DISCONNECT INOP occurs when the telemetry device goes out-of-range, the INOP will disappear (without being silenced) as soon as the ECG signal from the telemetry device is available at the Information Center via standard telemetry transmission. SpO2T Manual Mode When a telemetry device with a short range radio connection supplies SpO2T to the monitor, the monitor will have a manual measurement mode available. This allows SpO2 measurements to be made on request and not continuously, helping to save battery power. To ensure there is no gap in SpO2 measurements when moving from standard telemetry transmission to short range radio transmission, the measurement mode will always be set to continuous in this situation unless manual mode is set in both the telemetry device and the monitor. Unassigning a Telemetry Transceiver with SRR Adapter at the Monitor If a monitor and a telemetry device are paired, the assignment and the short range radio connection will be ended when the devices are unpaired (see Unpairing the Monitor and Telemetry Device on page 180). If the monitor does not have a connection to an Information Center, you must manually end the assignment and the short range radio connection. 1 2 3 Select the Measurement Selection key. In the Measurement Selection window, select the Tele pop-up key. In the Tele device window select Unassign Tele. Refer also to Use Models With Telemetry on page 202 for further related use modes. Unpairing the Monitor and Telemetry Device If the patient will no longer be monitored with the telemetry device, or only with the telemetry device and no longer with the monitor, you need to end the device pairing. After unpairing, the Information Center will receive data exclusively from the monitor or from the telemetry device:
select the Unpair To Mon. SmartKey to end pairing and have the Information Center receive the measurement data from the monitor select the Unpair To Tele SmartKey to end pairing and have the Information Center receive the measurement data from the telemetry device or use the Unpair function at the Information Center. NOTE The Unpair SmartKeys and pop-up keys appear only on the monitor which is directly involved in pairing. 180 Functions Available When the Telemetry Data Window is Displayed 15 Assigning Two Devices to One Patient Functions Available When the Telemetry Data Window is Displayed Controlling the Telemetry Device from the Bedside You can change settings for a paired telemetry device at the monitor:
1 Select the telemetry data screen element Select the Setup Tele pop-up key 2 The Setup Telemetry menu will appear with the settings available for the telemetry device. These will normally include: adjusting heart rate alarms, ECG size control, selecting primary/secondary lead, relearning arrhythmia, and selecting the arrhythmia analysis mode. The Equipment label of the paired device is also shown here. Viewing and Silencing Telemetry Alarms at the Bedside When a telemetry device is paired with the monitor, telemetry alarms will also be indicated on the monitor, in addition to the main indication at the Information Center. If configured, a generic Tele Alarm message will appear in the alarm status area with standard alarm tones. The Tele Alarm message will have the color and * or ! coding corresponding to the severity of the alarm. The specific alarm message (for example *HR Low) will appear in the Telemetry Data Window. If configured, alarms generated from a paired telemetry device can be silenced at the bedside. Either the monitor Silence key is configured to silence both monitor and telemetry alarms (must be configured at the Information Center) or the Silence Bed pop-up key will be available:
1 Select the telemetry screen element. Select the Silence Bed pop-up key. 2 Depending on your Information Center configuration, the Silence Bed key may silence both telemetry alarms and bedside alarms. WARNING Even when the telemetry data is not visible on the screen, you may be silencing telemetry and monitor alarms, if the Information Center and monitor are so configured. Suspending Telemetry Alarms When you select Pause Alarms or Alarms Off at the monitor, the alarms are off or paused for the bedside measurements. When you switch alarms off or pause alarms at the Information Center, both telemetry and monitor alarms are affected. Refer to the Information Center Instructions for Use for more details on the Suspend/Pause alarms behavior of the Information Center and telemetry device. Using Standby When you select Standby mode at the monitor, the bedside goes into Standby mode but the telemetry device will continue monitoring. Refer to the Information Center Instructions for Use for details on the Standby behavior of the Information Center and telemetry device. 181 15 Assigning Two Devices to One Patient Functions Available For Devices Connected Via SRR Functions Available For Devices Connected Via SRR Telemetry Device Tele 1 The Telemetry Device window can be opened from the Measurement Selection window, by selecting the Tele pop-up key, or via Main Setup -> Telemetry Device. The window shows the equipment label of the assigned telemetry device and, for monitors with SRR capability, a battery status symbol and a symbol indicating the signal quality of the SRR link If the monitor has a connection to an Information Center, the pop-up keys Unpair to Mon. and Unpair to Tele let you end the device pairing. After unpairing, the Information Center will receive data exclusively from the monitor or from the telemetry device. If the monitor does not have a connection to an Information Center, or there is a pairing mismatch, the Unassign Tele pop-up key lets you end the telemetry device assignment and close the SRR link. Temporarily Stopping the Short Range Radio Connection To temporarily disable the SRR connection for this device, for example, in case of interference:
Select the Stop SRR pop-up key. This closes the SRR link and the telemetry device switches over to standard telemetry transmission. The battery status symbol will no longer be shown and the SRR quality indicator symbol will be crossed out. To return to SRR use:
Select the Start SRR pop-up key and press the Check button on the telemetry transceiver. Setting Up Measurements The Setup ECG and Setup SpO2T pop-up keys give you access to the measurement setup menus. The Measmt. Select. pop-up key takes you directly to the Measurement Selection window where all connected measurement devices are shown. General Telemetry-related Functions The following functions are valid for directly and indirectly connected telemetry devices. 182 General Telemetry-related Functions 15 Assigning Two Devices to One Patient ECG Source Tracking at the Information Center The Information Center continuously checks whether a valid ECG signal is coming from the monitor or the telemetry device. If you unplug the ECG patient cable from the monitor and plug it into the telemetry device, the Information Center will automatically switch to monitoring the ECG from the telemetry device. At the monitor, its own ECG measurement will be deactivated the ECG Setup menu will no longer be accessible. When you unplug the patient cable from the telemetry device and plug it back into the monitor again, the Information Center will switch back to monitoring the ECG from the monitor. The ECG measurement will be activated again at the monitor. Note that in this case, as the screen switches back to the monitors own measurements, the SpO2T measurement (if present) will no longer be displayed. In the same way the source is tracked when a telemetry device is directly connected to a monitor, then disconnected and vice versa. In case of ambiguity, a yellow INOP message !!CHECK ECG SOURCE indicates that more than one valid ECG source is active. Synchronized Settings If ECG is measured at the monitor, and then the patient is connected to a telemetry device for monitoring, the Information Center will use the monitor settings for the telemetry device. In general, the following settings will be synchronized:
Heart Rate ECG Arrhythmia ST QT SpO2T HR/Pulse Alarm On/Off, Heart Rate High/Low Limit, Primary Lead, Secondary Lead, Va Lead1, Vb Lead1, Lead Placement Analysis Mode, Asystole Threshold, Pause Threshold, VTach HR, VTach Run, PVCs/min, Vent. Rhythm, SVT HR, SVT Run, PVCs/
min On/Off, Pacer not capture On/Off, Pacer not pace On/Off, Non-
Sustain On/Off, Vent. Rhythm On/Off, Run PVCs On/Off, Pair PVCs On/Off, Missed Beat On/Off, Pause On/Off, R-on-T On/Off, Vent. Bigeminy On/Off, Vent. Trigeminy On/Off, Multiform PVCs On/Off, Irregular HR On/Off, SVT On/Off, Afib On/Off ST Analysis On/Off, ST Alarm On/Off, ISO Point, J point, ST point, ST Priority List, Single ST Alarm Limit, Multi ST Alarm Limit QT analysis On/Off, QT Lead, QTc High Alarm On/Off, 'QTc Alarm On/Off, QTc High Limit, 'QTc High Limit, QTc Formula2, QT Baseline SpO2 Alarms on/off, SpO2 Alarm limits NBP Alarm Suppression On/Off, Pulse(SpO2) On/Off 1.Va and Vb leads are reset to default (V2, V5) if the configured Va or Vb lead for the telemetry device is not one of V1 through V6. 2.These setting will only be synchronized when the Information Center supports QT Analysis for Telemetry. WARNING Not all settings are synchronized; after changing the ECG source, always check that the settings are appropriate. Va and Vb leads are reset to default (V2, V5) if the configured Va or Vb lead for the telemetry device is not one of V1 through V6 183 15 Assigning Two Devices to One Patient General Telemetry-related Functions If later the patient is disconnected from the telemetry device, and reconnected to the monitor again, any changes in the settings made in the meantime will be passed on to the monitor. In this way, settings continuity is preserved when the ECG source changes. Settings synchronization can only take place when there is no patient information mismatch between the monitor and the Information Center. If a Check ECG Settings or CHECK PAIRING INOP appears always check that the ECG settings, especially the paced setting, are appropriate for your patient. 184 16 16Enhancing Telemetry Monitoring with the Monitor You can use a monitor without a network connection to view measurement data from a telemetry transceiver at the bedside. You can also use the monitor to make additional measurements and send this measurement data to the Information Center via the telemetry transceiver. The monitor can so be used as a mobile viewer and measurement device, and is set up to simplify the assign/unassign procedures when used with short range radio. Monitor and Telemetry Transceiver Requirements The monitor and the telemetry transceiver need a direct connection via a short range radio link. Not all revisions of the telemetry transceiver can be used directly with the monitor, if you connect a device that cannot be used you will see a TELE UNSUPPORTED INOP. Data Sent to the Information Center The data sent to the Information Center includes numerics from NBP, SpO2, Pulse from SpO2 and predictive temperature. INOPs from these measurements, battery INOPs and a general INOP generated by alarms from any other measurement (MORE BED ALARMS) will also be transmitted. NOTE The monitor must be configured appropriately to support direct connection to a telemetry transceiver;
refer to the Configuration Guide for details. Changing Assignment to a New Telemetry Transceiver 1 Assign the telemetry transceiver to the monitor; see Assigning a Telemetry Transceiver with an SRR Adapter to a Monitor on page 179. 2 Make the required measurements; the data will be automatically sent to the Information Center via the telemetry transceiver. It is not necessary to unassign the telemetry transceiver. This will happen automatically when the next telemetry transceiver is assigned. The patient is also discharged (if configured), ensuring that the measurement data is erased before data from the next patient appears. Always assign the telemetry transceiver before you start making measurements. 185 16 Enhancing Telemetry Monitoring with the Monitor 186 17 17Trends Trends are patient data collected over time and displayed in graphic or tabular form to give you a picture of how your patients condition is developing. Trend information is stored in the trends database for continuously-monitored measurements, such as ECG, as well as for aperiodically-
measured parameters, such as Cardiac Output. Viewing Trends Trend information can be viewed embedded as a screen element on specially-designed Screens, or you can open a trend window over the current Screen. To view trends embedded as a screen element, enter the Change Screen window, then select a Screen designed to show an embedded trend window. To open the tabular trends window, select Main Setup > Trends >
Vitals Trend, or select the Vitals Trend SmartKey. To open the graphic trends window over the current Screen, select Main Setup > Trends > Graph Trend, or select the Graph Trend SmartKey. Vitals Trend Graph Trend The trend windows open displaying the most recent data and are updated as new data is stored. A timescale along the bottom of the screen shows you where you are in the trends database. The preview column on the right-hand side shows the latest available measurement value. The preview column is updated every five minutes or whenever an NBP or other aperiodic measurement is completed. A question mark (?) beside a value means that the data may not be reliable, due perhaps to an INOP condition in the measurement. Your monitor screen may look slightly different to the examples shown in this chapter. Trends Pop-Up Keys When you open the graphic or tabular trends window, a selection of pop-up keys appears to let you navigate through the stored trend data and carry out trends-related tasks. 187 17 Trends Viewing Trends Pop-Up Keys Select Group Select Interval Print Vital Signs Graph Trend Selecting this pop-up key lets you.... see a pop-up list of trend groups and select a group for viewing. see a pop-up list of available data resolution settings and select the level of detail shown in the trend view. print a graphic trends report of the data in the current window. The report will use the current trend interval settings. move the cursor one step to the left or right to navigate through the trends database timeline. move the cursor one page to the left or right to navigate through the trends database timeline. scroll up and down the screen to see measurement trends that do not fit in the current view. open the current trend view in tabular form. The displayed time period and resolution stay the same. open the current trend view in graphic form. The displayed time period and resolution stay the same. Viewing Graphic Trends Graphical Trends: Standard HR SpO2 RR 4 Apr Select Group Vital Signs Print Select Interval Scroll to view more pop-up keys A cursor spanning all measurements in the trend group helps you to navigate through the trends database and shows you your current position in the database. When the cursor is moved across the time line, the values measured at the cursor time are shown in the right hand column. In graphical trends, aperiodic measurement trends are shown as an asterisk, NBP has a special symbol. To use the trend cursor to navigate in time through the trends database, 1 Select the graphical trend or the arrow pop-up keys to activate the cursor. 2 Use the arrow pop-up keys to move the trend cursor backwards and forwards in time, or 188 Setting Up Trends 17 Trends 3 Place the cursor at a specific time by touching the graph. Viewing Vital Signs Trends Vital Signs: Standard HR SpO2 etCO2 imCO2 RR awRR Select Interval Select Group Graph Trend Print Aperiodic values are shown with a timestamp Scroll to view more pop-up keys The currently-selected column is highlighted. The values can be configured to display in the same colors as the waves and numerics on the realtime display. Any values available for display before the next scheduled update are shown in the right hand column, with a timestamp in brackets. If more than one value is available for an aperiodic trend for a certain trend period, all measured values are stored in the database and the value closest to the timestamp is shown in the Vital Signs display marked with an arrow. Setting Up Trends Trends are set up in Configuration Mode. You can make temporary changes to trends settings such as trend groups, priorities, or scales in Monitoring Mode. The general settings for all Trends are under Main Setup -> Trends. Settings for a single segment in graphical trends or for the corresponding trend group can be made more easily in that segment menu. Making Segment Settings The Graphical Trends window is divided into measurement segments, each of which has its own settings. To enter the segment menu, select the left hand column of the segment, where the measurement label is displayed. Expanded View To expand the segment to fill the Graphical Trends window, in the Segment menu, select Expand to have that segment enlarged to fill the window. 189 17 Trends Setting Up Trends In the expanded view, you can also highlight a measurement to make it more easily visible (for example when multiple ST trends are in one segment). To highlight a measurement, in the Segment menu, select Highlight repeatedly until the highlight is on the required measurement. To return the segment to its original size, in the Segment menu, select Expand again. Trend Scales for Segment Measurements To change the trend scales for a measurement in the current segment:
1 2 In the segment menu, select the measurement label Select Upper to change the upper limit of the scale or Lower to change the lower limit of the scale. Optimum Scale To have the monitor automatically select an optimum scale for viewing, based on current values, in the Segment menu, select Optimum Scale. This scale change is temporary. When the graphical trend window is closed the scale reverts back to the setting in Parameter Scales. To switch off automatic optimum scaling, in the Segment menu, select Optimum Scale again. Trend Group To add or remove measurements for this trend group or change the order of the existing measurements:
In the Segment menu, select Change Group 1 2 Use the Add, Change, Sort Up and Sort Down popup keys to change or re-order the group as required. No. of Segments In an embedded graphical trend window, you can select the number of segments to be displayed in the Segment menu:
In the Segment menu, select No. of Segments Trend Groups The measurements grouped in trend groups define the trends displayed together in the Vital Signs or Graphics Trends windows and printed in trends reports and recordings. The sequence of the measurements in the group defines the order in which they are displayed. Measurements listed between dotted line separators are displayed overlapping. The trend group All contains all available measurements, you cannot change the order or selection of this group. To change the selection of measurements in a trend group, either use the Change Group setting in the Segment menu or:
190 Setting Up Trends 17 Trends 1 2 Select Main Setup -> Trends -> Trend Groups Select the Trend Group you want to change and use the pop-up keys to Add, Change, or Delete the selection of measurements trended. To temporarily change the order in which the measurements are displayed in a group, Select Main Setup -> Trends -> Trend Groups Select the Trend Group and then the measurement you want to move and use the Sort Up/
Sort Down pop-up keys. 1 2 Trend Interval The trend interval defines the resolution of trend data shown on the Screen. To set the trend resolution, in the Vital Signs or Graphical Trends window, Select the Select Interval pop-up key and then select the required interval from the list. Trend Priority The monitor stores trend information for all monitored measurements, if configured to do so. If your configuration restricts the number of measurements trended, you must choose which measurements will be included. A priority list is used to select the trended measurements. To see the measurement priority list for trending, In the Main Setup menu, select Trends. Select Trend Priority. 1 2 To add measurements to the priority list, Select the pop-up key Add and choose from the pop-up list of available measurements. 1 2 Use the Sort Up and Sort Down pop-up keys to change the priority order. Trend Parameter Scales Parameter scales define how the trend waveform will appear on the screen and in trend reports. Separate scales can be set for adult, pediatric, and neonatal patient trends. To change the trend parameter scales settings, either use the Scale setting in the Segment menu or:
1 In the Main Setup menu, select Trends. Select Parameter Scales. Select the measurement or parameter you want to change from the list. Select the pop-up key Change to call up the Scale menu. In the Scale menu, select the parameter label you want to define settings for. Select Adult, Pedi, and Neo and use the pop-up keypad to enter new upper and lower scale definitions. 2 3 4 5 Graphical Trend Presentation Graphical trends and screen trends for measurements with compound values (for example ABP or CO2) can be viewed in line or band form. To change the presentation style, Select Main Setup -> Trends 1 191 17 Trends Documenting Trends Select Global Style and choose 2 Line to display the trends as a continuous line Band to fill the area between the trend lines, for example, between the systolic and diastolic pressures, with color. ABP 240 50 This sample ABP trend shows the continuously-
measured values for the systolic, diastolic and mean pressures displayed in band form. Documenting Trends To print a Vital Signs or Graphical Trends report, in the Vital Signs or Graph Trends window, select the pop-up key Print to print a report for the trend group currently on the monitor screen. Reports include the most recent information in the trends database and extend backwards in time according to the selected trend interval and your monitors configuration. Trends reports can be printed on central or local printers. Trends Databases The trend databases store information for up to 16 measurements for up to 48 hours. The values in the trends database are stored as measured by the monitor, they are not averaged values. The trend resolution defines how often a value is stored. In general, if more than one value is available for storage in the trends database, the most recent value is used. Some values in the trends are marked with arrows. This indicates that for this time period, more values were available and the most recent one is shown. Example database configuration In this example, we see that the monitor stores the most recent data at the highest resolution, older data are stored at a lower resolution. 4 hours @ 12 second resolution means that the monitor stores trend data every 12 seconds, for the most recent four hours. 192 Screen Trends 17 Trends
- 48 hours
- 24 hours
- 4 hours now time 4 hours @12 second resolution 24 hours @ 1 minute resolution 48 hours @ 5 minute resolution Aperiodic Trends Database Aperiodic trends do not count toward the maximum number of trends allowed by the trend configuration. Trend data for aperiodic measurements is stored in a separate database and timestamped with the measurement time. Trending Multiple-Value Measurements Some measurements generate multiple values, for example invasive pressure measurements can provide systolic, diastolic, and mean values. These values are trended as separate measurements. Screen Trends Trends configured to display permanently on special monitor Screens are called screen trends. The selection and number of measurement waves in the Screen Trend segment depends on your monitor configuration. Screen trends are color-coded to match the measurement wave and numerics, and they can be viewed in graphical, tabular, histogram or horizon format. If you do not see screen trends on the monitor Screen, select a different Screen, one that is configured to show screen trends. Screen trends are only available on specially designed Screens. Screen Trend information is taken from the Trends database. If you do not see a Screen Trend for a particular measurement on the Screen, check the trend priority list to ensure that this measurement is being trended. 193 17 Trends Screen Trends SBed9 HR Adult SpO2 ALARMS OFF Perf Arrhythmia Off 1mV Auto 15 min Temp Measurement numerics Measurement wave M NBP Sys. NBPs 65
-60min
-30min NBPs ABP 240 50 65
-30min
-60min NBP graphical screen trend Example of other graphical screen trends: ABP SBed9 HR Adult Pulse ALARMS OFF SpO2 Arrhythmia Off 1mV Auto 15 min Temp Measurement numerics Measurement wave M NBP NBP Sys. Tabular screen trend 194 Screen Trends 17 Trends Setting the Screen Trend Time 1 2 To set the ScreenTrend Time for all graphical, histogram and horizon screen trends (global trend time), Select a screen trend then select Setup Trend, or select Main Setup -> Trends. Select ScreenTrend Time and select the required time: 30 minutes, one, two, four, eight, or twelve hours. This is now the Global screen trend time and defines the period of trend information shown for all screen trends. To set a different ScreenTrend Time for a screen trend or a group of aligned screen trends, 1 2 3 Select a screen trend Select Change TrendTime Select the required trend time. Selecting Global leaves the trend time set to the global screen trend time. Changing the Selection of Screen Trends Displayed 1 2 Select the screen trend. Select Change Trend and select the required trend from the list of available trends. Select Blank to remove the selected trend from the Screen. If you do not see Change Trend in the screen trend menu, the trend is aligned to display with the measurement wave. Changing the wave automatically changes the trend. To display two or more screen trends overlapping, 1 2 Select the screen trend to open the screen trend menu, Select Change Trend -> Add Trend and select a screen trend from the pop-up list. Activating the Cursor for Screen Trends To activate the cursor for Screen Trends:
1 2 Select the screen trend. Select Activate Cursor You can now use the arrow keys to move the cursor across the time line. The values measured at the cursor time are shown next to the cursor. To de-activate the cursor, Press the Main Screen key. Changing the Screen Trend View To switch between tabular, graphic, histogram and horizon views, select the screen trend then select Change View and select the required view. Tabular View Aperiodic measurements such as NBP, can be viewed as a screen trend in tabular form. The measured values and their timestamps are shown, with the measurement label. 195 17 Trends Screen Trends NBP Sys. Horizon View The horizon view presents trend information superimposed over a defined baseline or base range. This helps you visualize changes in your patients condition since the baseline was set. The horizon view is made up of:
a horizon, drawn in white, as a reference 1 2 3 point or baseline to help you visualize changes in your patients condition. The horizon can be set to represent your patients current condition, or a target condition and can be a single value or a range. a graphical trend, displaying patient data for the set TrendTime (1). a trend indicator arrow, indicating how the patient trend has developed in the set time period
(10 minutes, 5 minutes or 2 minutes) (2). a deviation bar, showing how the currently measured value deviates from the set horizon (3). The height of the deviation bar is an indication of the extent of the change in your patients condition relative to the (horizon) baseline. Your monitor may not be configured to show all elements of the screen trend horizon view. Setting the Horizon The horizon is the reference value to which deviations in the measurements are compared. 1 To set the horizon, select the horizon trend 2 the same, the horizon is a baseline - if the values are different the horizon is a range. Select Set High Horizon to select the upper horizon value. If the high and low horizon values are Set Low Horizon to select the lower horizon value. Auto Horizon to set the horizon for the selected horizon trend to the currently-measured Auto All to reset the horizon for all horizon screen trends to the currently-measured values Set Horizon to set the horizon to a specific value from a pop-up list. value Setting the Horizon Trend Scale The horizon trend scale is defined with respect to the horizon. If your horizon is set to 100 and you select 20 as the horizon scale delta, the upper limit of the horizon scale will be 120 and lower limit 80. To set the horizon trend scale delta, 1 Select the horizon trend. 196 Screen Trends 17 Trends 2 Select Set Scale Delta and select a value to define the distance between the horizon and the upper and lower scale limits. Be aware that changing the horizon trend scale can change the angle of the trend indicator, without the patients condition having changed. If a measurement exceeds the outer limits of the scale, the wave will be clipped and you must either reset the horizon or the horizon trend scale to display the values outside the scale limits. Setting the Time Period for the Trend Indicator Arrow The time period for which the trend indicator arrow can be set in the Trends window. Select Main Setup > Trends Select HorizonArrowTime. Select 10, 5 or 2 minutes. 1 2 3 197 17 Trends Screen Trends 198 18 18 Recording Central Recording For central recording from the bedside, your monitor must be connected via a network to an Information Center. You can use either the M1116B 2-Channel Recorder or the standalone M3160A 4-Channel Recorder. See the documentation supplied with the Information Center for information on the 4-Channel Recorder. Starting and Stopping Recordings The recordings pop-up keys let you start and stop recordings. Select the Main Setup SmartKey then select Recordings to call up the line of pop-up keys. Scroll right or left to see any pop-up keys not displayed. Delayed Recordng RT A Recordng RT B Recordng Select Waves Setup Recordng Stop all Recordng Recording Without a Template To record without a preconfigured template, selecting the waves you require, Select the Main Setup SmartKey then select Recordings. Select the pop-up key Select Waves, 1 2 3 Use the pop-up keys to choose up to three measurement waves to be printed on the recording. If 4 you want fewer than three waves on the recording, select the waves you want then select the Continue pop-up key. Select one of the recording speed pop-up keys to set the required recording speed. Select the Start pop-up key to start the recording. 5 Select Waves recordings use default values for any recorder settings not defined: runtime is continuous, overlapping is set to non-overlapping. 199 18 Recording Overview of Recording Types Overview of Recording Types Delayed Alarm Realtime (RT) Type of recording manual central Recording Destination Information recorded automatic, triggered by defined alarm conditions central printer manual central from the start trigger minus the delay time from the start trigger minus the delay time N/A from the start trigger Number of waves up to 2 up to 2 Speed Runtime Stops Delay Time Overlap 50, 25, 6.25 mm/sec 25 mm/sec N/A N/A automatically automatically 10, 15 seconds 10, 15 seconds Off On (up to 2 waves) Off On (up to 2 waves) N/A = not applicable N/A N/A N/A N/A N/A N/A up to 2 50, 25, 6.25 mm/sec continuously manually none Off On (up to 2 waves) Creating and Changing Recordings Templates To save you defining recording settings each time you start a recording, you can create templates for commonly-used types of recordings in the Setup Recording menu. You can create templates for one delayed recording, one alarm recording and two realtime recordings (Realtime A and Realtime B). Changing recordings templates changes the settings that will be used each time a recording of this name is triggered. Select the Main Setup SmartKey to call up the Main Setup menu. Select Recordings. Select the Setup Recording pop-up key to enter the Setup Recordings menu. Select the name of the template you want to create or change. Each recording name is linked to a recording type: delayed, alarm, and realtime. Recording names can be changed in the monitors Configuration Mode. 1 2 3 4 5 Design the template by selecting each menu item and entering the information for the template. Recorder: choose which recorder the recording will print to (Central 2-Ch. or Central 4-
Ch. recorder, or a printer (for realtime reports in alarm recording only)). Channels 1 - 4: choose which waveform to record in each channel. In addition to the currently available waves, you can choose from several other settings which make an automatic allocation when the recording starts:
Alarm Par will always record the measurement in alarm in the chosen recorder channel Primary Lead will always record the current primary lead in the chosen recorder channel 200 Recorder Status Messages 18 Recording Secondary Lead will always record the current secondary lead in the chosen recorder channel Overlap: define whether the recorded waveforms will be printed overlapping or beside each other. Speed: choose the recording print speed. Delay Time: Delayed recordings start documenting on the recorder strip from a pre-set time before the recording is started. This interval is called the Delay Time and can be set as specified in the table on page 200. This setting can only be changed in Configuration Mode. Runtime: see how long this type of recording is configured to run. This setting can only be changed in Configuration Mode. Continuous recordings run indefinitely. Central Config - if available in the General menu, select this setting to use the recording settings made for the centrally-connected recorder. Maintaining Recording Strips Recording ink sometimes fades when covered with transparent tape. Avoid covering any part of a recording that is clinically relevant (annotation or waveforms) when taping a recording strip to a patient record or other patient documentation. Recorder Status Messages CAUTION If no central recorder is available, alarm recordings may be lost. The message No alarm recording available will be displayed. This message is not shown if Printer is configured as the alarm recording destination. Recorder Status Messages
<Recording name> running Explanation The named recording is currently running. No alarm recording available No recorder available. Alarm recordings will be lost. Try configuring Printer as the alarm recording destination. The named recorder is out of paper. Central Recorder out of paper Central Recorder door open The door of the specified recorder is open. 201 18 Recording Recorder Status Messages 202 19 19Printing Patient Reports Starting Report Printouts Most patient reports can be printed by selecting Main Setup - > Reports (or the Reports SmartKey) and then selecting the report name in the top half of the Reports menu. Report names are shown only for reports that have been correctly set up. Data from the time of the print request is printed, even if the print job is delayed in the printer queue. Your monitor can also be set up to automatically print all reports when a matching printer is available. To set this up 1 2 Select Main Setup - > Reports Select Auto Print Dbs. Always will print all reports when a matching printer is available. Host only will print the reports stored on the host monitor when a matching printer is available. Reports stored in the companion database (shown in grey on the Reports Job List) must be manually sent to the printer. See Checking Report Status and Printing Manually on page 207. Never will print no reports automatically; all reports stored in the host or companion database must be manually sent to the printer. See Checking Report Status and Printing Manually on page 207. Depending on availability, reports can be printed on printers connected to the Information Center, an external PC-based print server or into the print database. Print jobs stored in the database are automatically printed when a print device with a matching paper size becomes available. Print jobs in the print database are not deleted after a patient discharge. A new patient can be admitted and their reports are saved in addition to the previous reports. Always admit your patient so that reports can be clearly assigned to a patient. Report types Report contents Vital Signs Report Graphic Trends Report ECG Reports ST Map Report depends on selected trend group, data resolution, and period. Depends on format selected ST data in a transversal and/or horizontal multiaxis diagram, How to start printing reports In the Vital Signs window, select Print In the Graphic Trends window, select Print Select the ECG Report SmartKeys, if configured In the ST Map window, select Print. 203 19 Printing Patient Reports Stopping Reports Printouts Report types Report contents Alarm Limits Report Realtime Reports Battery Report Graphic and numeric report of all current alarm limits Patient data and numerics, and either:
all displayed waves OR all measured waves OR all measured RT waves Battery serial number, information on the currently-measured and potential charge status of the battery Central Report A/B/C These are reports configured at the Information Center. Monitors connected via the IntelliVue Instrument Telemetry wireless network can have these reports available. How to start printing reports In the Alarm Limits window, select Print Limits Select the Realtime Reports SmartKey, if configured In the Battery Status window, select Print Status. In the Main Setup select Reports then Central Report A, B or C. Stopping Reports Printouts To stop Reports printing, in the Reports menu, select Delete Report to stop the current print job Delete All Repts to cancel all queued report printouts Scheduled Rep. to toggle to Off and switch off scheduled reports. Setting Up Reports ECG report layout and Auto Reports settings must be defined in Configuration Mode. The content you define in the individual Setup Reports menus will be used in all reports of this type: for example, if you set a print speed of 50 mm/sec in the ECG Reports menu, every ECG report will be printed at this speed, irrespective of format. Setting Up ECG Reports 1 The settings you choose in the ECG Reports menu apply for all ECG reports printed. To set up ECG Reports, Select Main Setup -> Reports -> ECG Reports. Note the report layout configured for your monitor, either Internat. or Cabrera. This setting is inactive (grayed-out) in Monitoring Mode and can only be changed in Configuration Mode. Select ECG Gain and set the required ECG Gain to define how ECG waves will appear on the ECG report printouts. Select Speed and select the report print speed. Select Annotation and toggle to On if the printed ECG wave should be annotated with beat labels or not. See the chapter on ECG for a list of beat labels. Pace pulse marks are automatically printed beside the wave for paced patients. 3 4 2 Setting Up Vital Signs and Graphic Trend Reports The settings you choose in the Vital Signs Report and Graphical Trend Report menus apply for all Vital Signs and Graphic Trend reports printed. 204 Setting Up Individual Print Jobs 19 Printing Patient Reports To set up Vital Signs and Graphic Trend reports, 1 2 3 4 Select Main Setup -> Reports -> Vital Signs Rep. or Graph Trend Rep. Select Trend Group and select the group you want to print on the report. The groups available depend on your monitors trend configuration. Select Period and select the period of time for which trend data should be printed on the report. If Automatic Period is configured to On, all trend data for the current patient will be printed, irrespective which trend period is selected. Select Interval (Vital Signs Reports only) and select the resolution of the trend data printed on the report, Setting Up Auto Reports Auto Reports print automatically when a specified trigger occurs. There are two types of Auto Reports:
Scheduled Reports, which print at predefined intervals, and End Case Reports, which print when a patient is discharged using the End Case function. An Auto Report can be both a Scheduled Report and an End Case report. To set up Auto Reports, 1 2 3 4 Select Main Setup -> Reports -> Auto Reports and select the Auto Report you want to set up (A, B, C, or D). Select Report and assign a report type to the Auto Report. Select End Case Report and toggle to On if you want the selected report to print automatically when you select End Case to discharge a patient. Toggle End Case Report to Off if the report is a Scheduled Report only. Select Scheduled Rep. and toggle to On if you want the selected report to print at predefined intervals, starting at a predefined time of day. The start time you set applies for every following day. For example, if you set a start time of 07:00 and a repeat time of six hours, the first report will print at 07:00 every day, the next at 13:00 and so on. To set the time of day at which you want the report to print every day: select Start Hour and Start Minute and select the required time from the pop-up list To set the time interval in minutes between two scheduled reports: select Rep. Freq.(Hr) and Rep. Freq.(Min) and select the time interval from the pop-up list. If you are setting up an end case report, these settings will be inactive (grayed-out). Toggle Scheduled Rep. to Off if the report is an End Case Report only. 5 Repeat the procedure for all Auto Reports you want to set up. All Auto Reports or Scheduled Reports set to On print automatically at the predefined trigger. Be aware that the monitors memory for reports is limited. If the memory is full, Auto Reports cannot be printed and the information may be lost. Setting Up Individual Print Jobs To adjust the appearance of individual print jobs, in the Reports menu, 1 Select Main Setup -> Reports -> Setup Reports to enter the Setup Reports menu. 205 19 Printing Patient Reports Checking Printer Settings 2 3 4 5 6 Select Report and then select the report you want to set up. Select Report Type and then select the reports template you want the report selected in Step 2 to use. The selection of templates listed depends on the report type selected. Each template includes patient demographic data, and each Realtime Report also includes alarm and INOP information. In addition, the templates include:
VisibleWaves: all waves currently visible, in the order they appear on the screen. All Waves: all measured waves, RT Waves: all currently measured realtime waves, according to the monitors priority list. Vital Signs: trend information in tabular form. Graph Trend: trend information in graphic form. ECG3X4, ECG6X2, ECG12X1, ECG4X2, ECG8X1, ECG12X1(2P): ECG reports. Alarm Limits: a list of all currently set alarm limits. Select Report Size to set the paper size to be used for the report: Unspecified to use the default size for the template chosen, Universal, A4, Letter, LrgUniversal, A3, or Ledger. The list of available sizes depends on the report type selected. Select Orientation to set the orientation of the report printout: Unspecified to use the default size for the template chosen, Landscape or Portrait. Select Target Device and choose which printer the print job will be sent to: Unspec. to use the default printer, or choose from the list of printer names defined at the Information Center or in the monitors Configuration Mode (for example, Remote 1 or Database). Some settings may be inactive (grayed-out) in this menu for reports that can only be started in a special window. Checking Printer Settings The printer settings for your monitor are defined in Configuration Mode. The printer settings Paper Size, Resolution, Color Support, and Duplex Option for the active printer are visible but inactive (grayed-out) in the Setup Printers menu. When Print Database is selected as active printer only the Paper Size setting will be shown. To enter the Setup Printers menu, in the Reports menu, select Setup Printers. Printing a Test Report A test report can be printed in Configuration mode, refer to the Service Guide for details. Switching Printers On Or Off for Reports You can enable or disable printer status to switch individual printers on or off for report printouts. In the Setup Printers menu, select Printer and then select the name of the device you want to switch on or off for Reports printing from the pop-up list. 1 206 Dashed Lines on Reports 19 Printing Patient Reports 2 Select Printer Status to toggle between the settings Enabled and Disabled. If you set this to Disabled, no reports will be printed to the named printer. If the monitor detects that no printer of a particular type is available, the Enabled/Disabled setting will automatically be set to Disabled and grayed out. Dashed Lines on Reports If a section of a wave on a report is drawn with dashed lines, this tells you that a setting that affects the appearance of the wave on the screen was changed while the report was printing. For example, if you change the wave scale while a report is printing, the wave scale and wave size are changed immediately on the monitor screen and on the report. To indicate that the scale information printed at the beginning of the report no longer matches the currently used scale, the wave will be printed using dashed lines, starting from the moment the change took place. Some examples of settings that cause dashed lines in reports if changed during printing are: Filter mode, ECG lead placement, wave scale, measurement unit, paced/non-paced setting, and measurement mode. Note that as ECG waves are drawn with a fixed gain on reports (either 10 mm/
mV or 20 mm/mV), changing the ECG wave scale will not cause dashed-line reports. To avoid dashed lines on reports, wait 15 seconds after changing a setting before you trigger a report. Unavailable Printer: Re-routing Reports If you send a report to be printed on a printer that is not available, for example, because it has run out of paper, this print job is suspended and stored in the monitors memory. If the target device of this print job was set to Unspecified, the monitor will periodically try to resend the print job to the first printer listed in the Setup Printers menu under Printer that is set to Enabled and that has paper of the correct size. To allow the report to print, you must either solve the problem with the target printer, or re-route the print job to another printer with paper of the correct size. To re-route a print job, Enable the new target printer by selecting it in the Setup Printers menu and toggling to Enabled. As the monitor tries to send the report to the printers in the order they are listed, you must make sure that all the printers above the new target printer are disabled. If the target device of the print job was set to a specific printer, re-routing is not possible. Checking Report Status and Printing Manually A list of all print requests which are waiting, printing or stored can be viewed in the Reports Job List. To view the list, in the Reports menu, select Reports Job List. The following information is displayed for each print request:
Report title Patient name (except for system reports such as the battery status report) 207 19 Printing Patient Reports Printer Status Messages Request date and time Report paper format Job status: Preparing, Printing, Waiting, In Database, In Companion, Retry, Cancelling, Error Individual reports can be deleted from the list with the Delete Report key, and all reports with the Delete All Reps key. CAUTION The reports job list includes privacy information, in the form of the patient name with the related report title and date. It is advisable to provide controlled access to this data to ensure confidentiality. Printing Manually Those jobs shown in black will be printed automatically when a matching printer is available. If the Auto Print Dbs setting is Host only or Never, some or all reports will not be printed automatically and will be shown in grey. Any jobs shown in grey must be printed manually; to do this, 1 In the Reports Job List, select the required report Select Print Report. 2 Selecting Print All Reps. will send all reports to the printer. Printer Status Messages Printer Status Message Print job queued
<Printer name>
Print job cant queue;queue full Cancelling all print jobs Cancelling the active print job Deleted N print jobs;discharge Deleted N print jobs; hotstart Print failed;No report configurd Printing on
<Printer name>
Possible causes and suggested action The report has been placed in the queue for the named printer. The printer queue is full and the monitor cannot accept another report request. Wait until some more reports have been printed, then try again, OR A report has been triggered that uses a paper size unavailable with the target printer. Try another printer, if available, or change the paper size of the print request. Stop All Reports has been selected in the Report menu, OR The Operating Mode has been changed from Monitoring Mode to Demonstration or Service Mode. The current report is being cancelled as the result of a user request. When a patient is discharged, all queued reports are cancelled except those stored in the print database. N is the number of reports cancelled. The monitor has restarted and all report requests have been cancelled except those stored in the print database. N is the number of reports cancelled. A report has been triggered which has not been correctly set up. Enter the setup menu for the report type to set up the report. A report is in progress, or the monitor is waiting for the central printer to accept the print job. 208 Sample Report Printouts 19 Printing Patient Reports Printer Status Message NoPrinter <Printer name>;job susp Print Database full->job suspnd. Job <Printer name>
fail;
Print job on
<Printer name>
done Possible causes and suggested action The chosen device is unavailable. Check that the printer is properly connected and that paper is available. The requested report will start printing when the printer becomes available. The requested report does not fit into the print database. You can select another printer to print the report (see Unavailable Printer: Re-routing Reports on page 207). Alternatively you can delete another report from the Reports Job List (using the Stop report key) to create space for your report. A report cannot be started on the requested printer. One of three reasons will also be shown in the status message:
data requisition error (data error) - an internal error has caused data required for the report to be unavailable, try starting the report again. printer unavailable (no printer)- make sure the printer is plugged in, switched on, and has paper loaded. data unavailable (no data) - the connected X2 or MP5 has been removed before the data for the report was transferred. The report has been printed. Sample Report Printouts Each report header contains the patients bed label, last name and first name, middle name (if there is enough space) the patient ID, the date and time, and the name of the report. The report footer contains the hospital label and page number, and the last page contains a note to mark the report end. The monitor may be configured to leave a space on the top left or right of the report printout to enable you to stick a patient address label on it. This setting is called the Addressograph and it can only be changed in the monitors Configuration Mode. 209 19 Printing Patient Reports Sample Report Printouts Alarm Limits Report NBed6 Alarm Limits HR ST-I ST-II ST-III ST-aVR ST-aVL Doe, John ST-aVF ST-V1 ST-V2 ST-V3 ST-V4 ST-V5 123456789-P1 19 Apr 07 15:59:37 ST-V6 SpO2 NBPs ABPs RR Apnea Time 20 sec Measurement labels, with alarms off symbol where alarms are switched off Graphic view of current alarm limits in relation to currently monitored measurement value Realtime Report NBed6 Realtime Report Doe, John 123456789-P1 19 Apr 07 15:59:54 Patient Cat.: Adult Paced: No Gender: Male
**ABPs HIGH SpO2 NON-PULSAT. HR 60 bpm 0 /m PVC 0.0 mm ST-I 0.0 mm ST-II ST-III 0.0 mm Date of Birth: 19 Nov 1963 Age: 43 years Height: 69 in Patient Cat.: Adult Paced: No ST-aVR ST-aVL ST-aVF ST-V1 ST-V2 ST-V3 ST-V4 ST-V5 0.0 mm 0.0 mm 0.0 mm 0.0 mm 0.0 mm 0.0 mm
-0.1 mm 0.0 mm ST-V6 SpO2 Pulse Perf NBPPulse ABP ST-V5 0.0 mm
-?- bpm
119/81 (93) mmHg 0.0 mm Bandwidth 0.5-40 Hz Non-Paced 10mm/mV 25mm/sec Patient demographic information, time stamp Active Alarms and INOPs, followed by vital signs Measurement waves section 210 19 Printing Patient Reports Sample Report Printouts ECG Reports Patient information Numeric block Wave area Below the header on ECG Reports, the numeric block shows the current HR, PVC, and ST values. The wave area shows the printed waves for all available ECG leads. A 1 mV calibration bar is printed at the beginning of each wave. With the 3X4, 6X2, and 2X4 formats, a rhythm stripe prints a longer section of the ECG wave from the primary ECG lead for ECG rhythm evaluation. The ECG signal bandwidth, the patients paced status, the ECG gain, and the print speed are printed at the bottom of the wave area. Pace pulse marks are automatically printed beside the wave for paced patients. Beat labels can be set to print on the rhythm stripe. The 12X1 (2P) format prints the report over two pages. ECG Report type Available Formats Available Paper Sizes 12-Lead ECG Multi-lead ECG 3X4 landscape 6X2 landscape 12X1 portrait 12X1 landscape 12X1 (2P) landscape 2X4 landscape 8X1 portrait 8X1 landscape A4, letter, A3, ledger A4, letter, A3, ledger A4 and letter only A4, letter, A3, ledger A4, letter (2 pages) A4, letter, A3, ledger A4 and letter only A4, letter, A3, ledger Other Reports See the sections on Trends for other example reports. 211 19 Printing Patient Reports Sample Report Printouts 212 20 20Care and Cleaning Use only the Philips-approved substances and methods listed in this chapter to clean or disinfect your equipment. Warranty does not cover damage caused by using unapproved substances or methods. Philips makes no claims regarding the efficacy of the listed chemicals or methods as a means for controlling infection. Consult your hospitals Infection Control Officer or Epidemiologist. For comprehensive details on cleaning agents and their efficacy refer to Guidelines for Prevention of Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to Health Care and Public-
Safety Workers issued by the U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, Atlanta, Georgia, February 1989. See also any local policies that apply within your hospital, and country. General Points Keep your monitor, cables and accessories free of dust and dirt. After cleaning and disinfection, check the equipment carefully. Do not use if you see signs of deterioration or damage. If you need to return any equipment to Philips, decontaminate it first. Observe the following general precautions:
Always dilute according to the manufacturers instructions or use lowest possible concentration. Do not allow liquid to enter the case. Do not immerse any part of the equipment or any accessories in liquid. Do not pour liquid onto the system. Never use abrasive material (such as steel wool or silver polish). Never use bleach. WARNING If you spill liquid on the equipment, battery, or accessories, or they are accidentally immersed in liquid, contact your service personnel or Philips service engineer. Do not operate the equipment before it has been tested and approved for further use. 213 20 Care and Cleaning Cleaning the Monitor Cleaning the Monitor Clean with a lint-free cloth, moistened with warm water (40C/104F maximum) and soap, a diluted non-caustic detergent, tenside, ammonia- or alcohol-based cleaning agent. Do not use strong solvents such as acetone or trichloroethylene. Take extra care when cleaning the screen of the monitor because it is more sensitive to rough cleaning methods than the housing. Do not permit any liquid to enter the monitor case and avoid pouring it on the monitor while cleaning. Do not allow water or cleaning solution to enter the measurement connectors. Wipe around, not over, connector sockets. CAUTION To clean the touch-enabled display, disable the touch operation by switching off the monitor during the cleaning procedure, or by pressing and holding the Main Screen key for two seconds. Press the Main Screen key again to re-enable touch operation. Recommended cleaning agents are:
Tensides (dishwasher detergents) Ammonias Alcohol Disinfecting the Monitor Edisonite Schnellreiniger Dilution of Ammonia <3%, Window cleaner Ethanol 70%, Isopropanol 70%, Window cleaner
, Alconox CAUTION Solutions: Do not mix disinfecting solutions (such as bleach and ammonia) as hazardous gases may result. Hospital policy: Disinfect the product as determined by your hospitals policy, to avoid long term damage to the product. Clean equipment before disinfecting. Recommended types of disinfecting agents are:
Base Alcohol Aldehyde Approved Agents Ethanol up to 70%
1- and 2- Propanol up to 70%
Glutaraldehyde up to 3.6%
Sterilizing the Monitor Sterilization is not recommended for this monitor, related products, accessories or supplies unless otherwise indicated in the Instructions for Use that accompany the accessories and supplies. 214 Cleaning, Sterilizing and Disinfecting Monitoring Accessories 20 Care and Cleaning Cleaning, Sterilizing and Disinfecting Monitoring Accessories To clean, disinfect and sterilize reusable transducers, sensors, cables, leads, and so forth, refer to the instructions delivered with the accessory. Cleaning Batteries and the Battery Compartment Wipe with a lint-free cloth, moistened with warm water (40C/104F maximum) and soap. Do not use strong solvents. Do not soak the battery. 215 20 Care and Cleaning Cleaning Batteries and the Battery Compartment 216 21 21Using Batteries When monitoring a patient, one Philips M4607A rechargeable Lithium Ion battery must always be inserted into the battery compartment on the right side of the monitor. This applies even when you are running the monitor from the external power supply. The battery seals the battery compartment, thereby preventing the ingress of fluids or foreign bodies. A severe yellow INOP (!!INSERT BATTERY) will be issued if the monitor is connected to AC mains without a battery fully inserted in the battery compartment. This INOP will persist until a battery is loaded. Battery compartment To use the monitor with battery power, disconnect the MSL cable (connecting the external power supply) from the monitor. You can switch between battery-powered and mains-powered (AC) operation without interrupting monitoring. The battery recharges automatically when the monitor is connected to the external power supply
(M8023A). 217 21 Using Batteries Battery Power Indicators Battery Power Indicators The battery LED and battery status information on the Main Screen, in combination with INOP messages and prompts, help you keep track of the battery power status. The indicators always show the remaining capacity in relation to the batterys actual maximum capacity, which may lessen as the battery ages. You can see the actual capacity in the Battery Status window. Battery LED The battery LED on the front panel of the monitor is indicated by a battery symbol. Battery LED Battery LED Colors Yellow Red, flashing If the monitor is connected to the external power supply
(M8023A), this means battery charging If the monitor is running on battery power, this means Red, flashes intermittently battery or charger malfunction less than 10 minutes power remaining battery malfunction The battery LED is yellow during charging and switches off when the battery is charged. Battery Status on the Main Screen Battery status information can be configured to display permanently on all Screens. It shows the status of the battery, with the battery power remaining and, when the battery is not charging, an estimate of the monitoring time this represents. Battery power gauge: This shows the remaining battery power. It is divided into sections, each representing 20% of the total power. If three sections are filled, as in this example, this indicates that 60% battery power remains. If no battery is detected, a blank battery gauge marked with a flashing red X is displayed. If no data is available from the battery, a question mark is shown in the gauge. 218 Battery Power Indicators 21 Using Batteries Battery status/malfunction indicator: Normal battery function is indicated by the battery power gauge, together with the remaining operating time, on the Main Screen. You are informed of problems or changes in the status of the battery by the battery status/malfunction indicator. This consists of a blank battery gauge containing a symbol. If the symbol is red, this indicates a critical situation. You can check the specific cause of the problem by looking at the symbol(s) displayed in the Battery Status window (see page 219). Battery status indicator Battery malfunction indicator
Alternates with the battery gauge on the Main Screen. Check in the Battery Status window to see which status symbol is displayed to identify the cause.
X The red ! flashes. Critical battery situation or malfunction. Check in the Battery Status window to see which malfunction indicator is displayed, or refer to the INOP, to identify the cause. Indicator for missing battery
(flashing red X). An INOP is issued when the battery compartment is empty, and the monitor is connected to AC mains via the external power supply. This !!INSERT BATTERY INOP is suppressed for 15 seconds while the monitor is connected to AC mains power, allowing you sufficient time to load a new battery. After silencing, the INOP cycles every 10 seconds until a battery is loaded. Monitoring Time Available: While the monitor is running on battery power, a time is displayed below the battery power gauge. No time is displayed when the monitor is running on AC mains power via the external power supply (M8023A). This is the estimated monitoring time available with the current battery power. Note that this time fluctuates depending on the system load (the display brightness and how many measurements you carry out), the age of the battery, and the remaining capacity of the battery. Battery Status Window To access the Battery Status window and its associated pop-up keys, select the battery status information on the Screen, or select Main Setup -> Battery. Battery Status TimeToEmpty:
2:33 hrs Capacity remaining fullCharge
[mAh]
[mAh]
Capacity, remaining tells you how much power is left in the battery. Capacity, fullCharge tells you how much power the battery can hold when fully charged. 219 21 Using Batteries Checking Battery Charge TimeToEmpty tells you approximately how long you can continue to use the monitor with this battery. Note that this time fluctuates depending on the system load (the display brightness and how many measurements you carry out), the age of the battery, and the remaining capacity of the battery. TimeToFull is shown in place of TimeToEmpty if the monitor is connected to mains power via the M8023A external power supply, and tells you how much time is left until the battery is charged to 90%. You can use the M8043A Smart Battery Charger to charge the batteries externally. Battery status/malfunction symbols: If a problem is detected with the battery, an INOP may be issued, and the following symbols are displayed in the Battery Status window, where they may be accompanied by a battery status message providing more details. Messages appear in the line where TimeToFull/TimetoEmpty is shown. Symbols indicating critical situations are colored red. Battery status symbols Battery malfunction symbols battery is empty
(red) incompatible battery battery not charging as the temperature is above or below the specified range
(red) battery malfunction battery requires maintenance
(red) battery has no power left charging stopped to protect the battery
(red) battery temperature too high Printing Battery Reports To print the information in the Battery Status window on a connected printer, 1 Select the battery status information on the Screen to open the Battery Status window Select the Print Status pop-up key. 2 Checking Battery Charge To check the charge status of a battery in a monitor, see the battery power gauge on the Screen or select Main Setup -> Battery to enter the Battery Status window. To check the charge status of a battery that is not connected to a monitor or battery charger, press the black dot marked PUSH on the labeled side of the battery. The remaining charge is indicated by four LEDs on the electronic fuel gauge directly above the dot. Each LED represents 25% of charge. If all LEDs are lit, the battery is fully charged, if only one LED is lit, 25% or less charge is left. Replacing a Battery To replace the battery, 1 Press the battery eject button. This releases the battery. 220 Optimizing Battery Performance 21 Using Batteries Battery eject button The INOP !!INSERT BATTERY is suppressed for 15 seconds, allowing you sufficient time to load a new battery. 2 Remove the battery from the compartment. 3 Slide the new battery into position with the contacts facing downwards. It should click into position when it is fully inserted. Click!
Optimizing Battery Performance The performance of rechargeable batteries may deteriorate over time. Battery maintenance as recommended here can help to slow down this process. Display Brightness Setting In the Main Setup menu, select User Interface -> Brightness - > Optimum. This selects a level of brightness suitable for most monitoring locations that uses less battery power than brighter settings. Satisfy yourself that this level of brightness is suitable for your monitoring location. Note that your monitor may be configured to dim or brighten the display brightness automatically when you disconnect from power, to suit the most common transport scenario
(TransportBrightn setting). 221 21 Using Batteries Battery Safety Information Charging a Battery A battery can be charged in a monitor during monitoring. You can also use the M8043A Smart Battery Charger to charge batteries. 1 Insert the battery into a monitor connected to the external power supply (M8023A). 2 Charge the battery until it is full, the battery LED goes out, and the battery power gauge is filled. In certain situations, internal temperature conditions may mean that the battery will not charge. This is sometimes necessary to protect the battery from damage, and does not indicate a malfunction. In this case you must use the M8043A Smart Battery Charger to charge the battery. Conditioning a Battery You must condition a battery when its battery requires maintenance symbol shows on the Screen. Do not interrupt the charge or discharge cycle during conditioning. CAUTION Do not use a monitor being used to monitor patients to condition batteries. The monitor switches off automatically when there is no battery power left. You can also use the M8043A Smart Battery Charger for external battery conditioning (requires adapter, order number 4512 610 17451). For details please see the Instructions for Use for the Smart Battery Charger. Do not use any other battery chargers or conditioners. To condition a battery using a monitor, 1 2 Charge the battery until it is completely full. Open the Battery Status window and check Insert the battery into a monitor connected to the external power supply. that the Batt Fully Charged message is displayed. 3 Disconnect the monitor from mains power, and let the monitor run until there is no battery power left and the monitor switches itself off. 4 Reconnect the monitor to mains power and charge the battery until it is full for use or charge to 50% for storage. Storing a Battery A battery should not remain inside the monitor if it is not used for a longer period of time. Batteries should be charged to a maximum of 50% for storage. NOTE The battery will discharge over time if it is stored inside the monitor when not connected to AC power via the external power supply (M8023A). The reported values for remaining capacity and runtime will become less accurate when the battery is stored in this way for a longer period of time (that is, several weeks). Battery Safety Information WARNING Use only Philips batteries part number M4607A. Use of a different battery may present a risk of fire or explosion. Do not open batteries, or dispose of them in fire, or cause them to short circuit. They may ignite, explode, leak or heat up, causing personal injury. 222 Battery Safety Information 21 Using Batteries Dispose of used batteries promptly and in an environmentally-responsible manner. Do not dispose of the battery in normal waste containers. Consult your hospital administrator to find out about local arrangements. CAUTION Do not disassemble, heat above 100C (212F) or incinerate the batteries, to avoid the risk of fire and burns. Keep batteries out of the reach of children and in their original package until you are ready to use them. If battery leakage should occur, use caution in removing the battery. Avoid contact with skin. Refer to qualified service personnel. 223 21 Using Batteries Battery Safety Information 224 22 22Maintenance and Troubleshooting WARNING Schedule: Failure on the part of the responsible individual hospital or institution employing the use of this equipment to implement a satisfactory maintenance schedule may cause undue equipment failure and possible health hazards. Contact: If you discover a problem with any of the equipment, contact your service personnel, Philips, or your authorized supplier. Inspecting the Equipment and Accessories You should perform a visual inspection before every use, and in accordance with your hospitals policy. With the monitor switched off:
1 Examine unit exteriors for cleanliness and general physical condition. Make sure that the housings are not cracked or broken, that everything is present, that there are no spilled liquids and that there are no signs of abuse. Inspect all accessories (cables, transducers, sensors and so forth). If any show signs of damage, do not use. 2 3 Switch the monitor on and make sure the backlight is bright enough. Check that screen is at its full brightness. If the brightness is not adequate, contact your service personnel or your supplier. Inspecting the Cables and Cords 1 Examine all system cables, the power plug and cord for damage. Make sure that the prongs of the 2 plug do not move in the casing. If damaged, replace it with an appropriate Philips power cord. Inspect the patient cables, leads and their strain reliefs for general condition. Make sure there are no breaks in the insulation. Make sure that the connectors are properly engaged at each end to prevent rotation or other strain. 3 Apply the transducer or electrodes to the patient, and with the monitor switched on, flex the patient cables near each end to make sure that there are no intermittent faults. 225 22 Maintenance and Troubleshooting Maintenance Task and Test Schedule Maintenance Task and Test Schedule The following tasks are for Philips-qualified service professionals only. All maintenance tasks and performance tests are documented in detail in the service documentation supplied on the monitor documentation CD. Ensure that these tasks are carried out as indicated by the monitors maintenance schedule, or as specified by local laws. Contact a Philips-qualified service provider if your monitor needs a safety or performance test. Clean and disinfect equipment to decontaminate it before testing or maintaining it. Maintenance and Test Schedule Frequency Monitor Tests Safety checks. Selected tests on the basis of IEC 60601-1 At least once every two years, or as needed, after any repairs where the power supply is removed or replaced, or if the monitor has been dropped. Monitor Maintenance Check ECG synchronization of the monitor and defibrillator (only if hospital protocol requires use of monitor during defibrillation) Measurement Tests Performance assurance for all measurements not listed below. Measurement Maintenance NBP calibration Microstream CO2 calibration and performance test Mainstream and sidestream CO2 calibration check Battery Maintenance Battery At least once every two years, or as needed. At least once every two years, or if you suspect the measurement values are incorrect. At least once every two years, or as specified by local laws. At least once a year or after 4000 operating hours. At least once a year, or if you suspect the measurement values are incorrect. See the section on Maintaining Batteries 226 Troubleshooting 22 Maintenance and Troubleshooting Troubleshooting If you suspect a problem with an individual measurement, read the Instructions for Use and doublecheck that you have set up the measurement correctly. If you suspect an intermittent, system-wide problem call your service personnel. You may be asked for information from the status log. To view the status log, In the Main Setup menu, select Revision. 1 2 View the status log by selecting Status Log from the Monitor Revision window. Disposing of the Monitor WARNING To avoid contaminating or infecting personnel, the environment or other equipment, make sure you disinfect and decontaminate the monitor appropriately before disposing of it in accordance with your countrys laws for equipment containing electrical and electronic parts. For disposal of parts and accessories such as thermometers, where not otherwise specified, follow local regulations regarding disposal of hospital waste. You can disassemble the monitor as described in the Service Guide. You will find detailed disposal information on the following web page:
http://www.medical.philips.com/main/company/sustainability/recycling/patient_monitoring/
The Recycling Passports located there contain information on the material content of the equipment, including potentially dangerous materials which must be removed before recycling (for example, batteries and parts containing mercury or magnesium). Do not dispose of waste electrical and electronic equipment as unsorted municipal waste. Collect it separately, so that it can be safely and properly reused, treated, recycled, or recovered. Disposing of Empty Calibration Gas Cylinders 1 Empty the cylinder completely by pushing in the pin of the regulator valve or by pulling out the pin of the fill valve using a tire valve stem wrench or a pair of needle nose pliers. 2 When the cylinder is empty, either remove the valve stem from the fill (or regulator) hole, or drill a hole in the cylinder. 3 Write Empty on the cylinder and dispose of it appropriately for scrap metal. WARNING Ensure that the cylinder is completely empty before trying to remove the valve stem or drill a hole in the cylinder. 227 22 Maintenance and Troubleshooting Disposing of Empty Calibration Gas Cylinders 228 23 23Accessories You can order parts and accessories from Philips supplies at www.medical.philips.com or consult your local Philips representative for details. WARNING Reuse: Never reuse disposable transducers, sensors, accessories and so forth that are intended for single use, or single patient use only. Reuse may compromise device functionality and system performance and cause a potential hazard. Philips approval: Use only Philips-approved accessories. Using non-Philips-approved accessories may compromise device functionality and system performance and cause a potential hazard. Packaging: Do not use a sterilized accessory if its packaging is damaged. ECG/Resp Accessories This symbol indicates that the cables and accessories are designed to have special protection against electric shocks (particularly regarding allowable leakage currents), and are defibrillator proof. The following cables may not all be available in all countries. Please check availability with your local Philips supplier. Recommended Cables Trunk Cables 3-Electrode Cable Set 5-Electrode Cable Set 6-Electrode Cable Set 10-Electrode Cable set
(5+5) 10-Electrode Cable set
(6+4) Part No. M1669A Length 2.7m M1668A 2.7m M1667A 2.7m M1663A 2.0m M1665A 2.7m 229 23 Accessories 3-Electrode Cable Sets ECG/Resp Accessories Description Length AAMI Part No. IEC Part No. OR Grabber shielded ICU Grabber shielded ICU snap shielded ICU Clip non-shielded ICU Clip non-shielded 1.0m 1.0m 1.0m 0.45m 0.7m M1675A M1671A M1673A M1622A M1624A M1678A M1672A M1674A
M1626A 5-Electrode Cable Sets Description OR Grabber shielded ICU Grabber shielded ICU Snap shielded ICU Miniclip non-shielded Length 1.0m/1.6m 1.0m/1.6m 1.0m/1.6m 0.7m/1.3m AAMI Part No. IEC Part No. M1973A M1968A M1644A M1647A M1974A M1971A M1645A M1648A 6-Electrode Cable Sets Description OR Grabber ICU Grabber ICU Snap Length 1.0m/1.6m 1.0m/1.6m 1.0m/1.6m AAMI Part No. IEC Part No. M1684A M1680A M1682A M1685A M1681A M1683A 10-Electrode (5+5)Cable Sets Description Length AAMI Part No. IEC Part No. ICU Grabber, chest, shielded ICU Snap, chest, shielded OR Grabber, chest, shielded 1.0m 1.0m 1.0m For Limb Leads see 5-electrode cable sets M1976A M1602A M1979A M1978A M1604A M1984A 10-Electrode (6+4)Cable Sets Description Length AAMI Part No. IEC Part No. ICU Grabber, chest, shielded ICU Snap, chest, shielded OR Grabber, chest, shielded 1.0m 1.0m 1.0m For Limb Leads see 6-electrode cable sets M1532A M1537A M1557A M1533A M1538A M1558A 230 ECG/Resp Accessories One-piece Cables 23 Accessories Description 3-lead Grabber, ICU 5-lead Grabber, ICU Length 1.0m 1.0m AAMI Part No. IEC Part No. 989803143181 989803143201 989803143171 989803143191 Radio-translucent Cables Pack of five single wires, radio-translucent, 0.9m, M1649A Set Combiners and Organizers Set combiners and organizers Set combiner Set organizer for shielded leadsets - grabber and snap Set organizer for non-
shielded lead sets - miniclip 3-electrode 5-electrode 3-electrode 4-electrode 5-electrode 6-electrode 3-electrode 5-electrode Bedsheet clip Replacement red cover for trunk cable (for 5-electrode cable sets) Part No. M1501A M1502A M1503A M1664A M1504A M1679A M1636A M1638A M1509A 989808148861 Supported Cables Trunk Cables Length 3-Electrode Cable Set 5-Electrode Cable Set AAMI Part No. M1540C M1500A IEC Part No. M1550C M1510A AAMI Part No. M1560C M1520A IEC Part No. M1570C M1530A 0.9m 2.7m 231 23 Accessories 3-Electrode Cable Sets ECG/Resp Accessories Description Length AAMI Part No. IEC Part No. OR ICU Grabber shielded ICU snap shielded ICU Clip non-shielded ICU Clip non-shielded 1.0m 1.0m 1.0m 0.45m 0.7m M1601A M1603A M1605A M1608A M1609A M1611A M1613A M1615A M1618A M1619A 5-Electrode Cable Sets Description OR Grabber shielded ICU Grabber shielded ICU Snap shielded ICU Clip non-shielded Length 1.0m/1.6m 1.0m/1.6m 1.0m/1.6m 0.7m/1.3m AAMI Part No. IEC Part No. M1621A M1623A M1625A M1629A M1631A M1633A M1635A M1639A 3-Electrode One Piece Cables AAMI 3-Electrode One Piece Cables Length OR Grabber ICU Snap 1.9m 1.9m AAMI Part No. M1970A M1972A IEC 3-electrode One Piece Cables OR Grabber ICU Grabber IEC Part No. M1980A M1981A 5-Electrode One Piece Cables AAMI 5-electrode One Piece Cables Length OR Grabber ICU Snap 2.5m 2.5m AAMI Part No. M1975A M1977A IEC 5-electrode One Piece Cables IEC Part No. OR Grabber ICU Grabber M1985A M1986A Set Combiners and Organizers Set combiners and organizers Set combiner Set organizer Bedsheet clip 3-electrode 5-electrode Shielded 3-electrode Shielded 5-electrode Part No. M1501A M1502A M1503A M1504A M1509A 232 NBP Accessories 23 Accessories NBP Accessories These cuffs and tubings are designed to have special protection against electric shocks
(particularly regarding allowable leakage currents), and are defibrillator proof. You can use them during electrosurgery. Adult/Pediatric Multi-Patient Comfort Cuffs and Disposable Cuffs Patient Category Limb Circumference Bladder Width Adult (Thigh) Large Adult Adult Small Adult Pediatric Infant Reusable Cuff Kits 20 cm 16 cm 13 cm 42 to 54 cm 34 to 43 cm 27 to 35 cm 20.5 to 28 cm 10.5 cm 14 to 21.5 cm 8 cm 10 to 15 cm 5.5 cm Disposable cuff Part No. M1879A M1878A M1877A M1876A M1875A M1874A Reusable cuff Part No. Tubing M1598B (1.5m) or M1599B (3m) M1576A M1575A M1574A M1573A M1572A M1571A Cuff Kits Part No. M1577A Infant, pediatric, small adult, adult Small adult, adult, large adult, thigh M1578A Infant, pediatric, small adult, adult, large adult, thigh M1579A Adult/Pediatric Antimicrobial Coated Reusable cuffs Patient Category (color) Limb Circumference
(cm) 45 - 56.5 Adult Thigh (grey) Large Adult X-Long (burgundy) 35.5 - 46.0 35.5 - 46.0 Large Adult (burgundy) 27.5 - 36.5 Adult X-Long (navy blue) Adult (navy blue) 27.5 - 36.5 20.5 - 28.5 Small Adult (royal blue) 13.8 - 21.5 Pediatric (green) Infant (orange) 9 - 14.8 Bladder Width Part No. Tubing M1598B
(1.5m) or M1599B (3m) 21.0 cm 17.0 cm 17.0 cm 13.5 cm 13.5 cm 10.6 cm 8.0 cm 5.4 cm M4559A M4558A M4557A M4556A M4555A M4554A M4553A M4552A 233 23 Accessories Invasive Pressure Accessories Adult/Pediatric Soft Single Patient Single-Hose Disposable Cuffs Patient Category Adult (Thigh) Large Adult X-Long Large Adult Adult X-Long Adult Small Adult Pediatric Infant Limb Circumference
(cm) Bladder Width Part No. Tubing M1598B (1.5m) or M1599B (3m) 45 - 56.5 cm 35.5 - 46 cm 35.5 - 46 cm 27.5 - 36.5 27.5 - 36.5 cm 20.5 - 28.5 cm 15.0 - 21.5 cm 9 - 15 cm 20.4 cm 16.4 cm 16.4 cm 13.1 cm 13.1 cm 10.4 cm 8.0 cm 5.6 cm M4579A M4578A M4577A M4576A M4575A M4574A M4573A M4572A Neonatal/Infant Cuffs (Disposable, non-sterile) Cuffs Size 1 Size 2 Size 3 Size 4 Limb Circumference
(cm) 3.1 to 5.7 cm 4.3 to 8.0 cm 5.8 to 10.9 cm 7.1 to 13.1 cm Bladder Width Part No. Tubing 2.2 cm 2.8 cm 3.9 cm 4.7 cm M1866A M1868A M1870A M1872A M1596B (1.5m) or M1597B (3m) Invasive Pressure Accessories These transducers and accessories are designed to have special protection against electric shocks (particularly regarding allowable leakage currents), and are defibrillator proof. Transducer, accessories, sensor kits Reusable pressure transducer 5 PV/.V/mmHg sensitivity Sterile disposable pressure domes for CPJ840J6 (pack of 50) Transducer holder for CPJ840J6 (pack of 4) IV pole mount for CPJ840J6 Single channel disposable sensor kit (20) - (EU/EFTA only) Dual channel disposable sensor kit (20) (EU/EFTA only) Transducer holder for M1567/8A (EU/EFTA only) IV pole mount for M1567/8A (EU/EFTA only) Adapter cable for disposable sensor kit 3,0m for M1567/8A Monitoring Line Set Part No CPJ840J6 CPJ84022 CPJ84046 CPJ84447 M1567A M1568A M2271A M2272C M1634A CPJ84026 234 SpO2 Accessories SpO2 Accessories 23 Accessories Some Nellcor sensors contain natural rubber latex which may cause allergic reactions. See the Instructions for Use supplied with the sensors for more information. M1901B, M1902B, M1903B and M1904B disposable sensors are not available in USA from Philips. Purchase Nellcor sensors and adapter cables directly from Tyco Healthcare. Do not use more than one extension cable with any sensors or adapter cables. Do not use an extension cable with:
Masimo adapter cables, Philips reusable sensors or adapter cables with part numbers ending in -L (indicates Long version). All listed sensors operate without risk of exceeding 41C on the skin, if the initial skin temperature does not exceed 35C. Make sure that you use only the accessories that are specified for use with this device, otherwise patient injury can result. Product Number Description Philips reusable sensors. Comments M1191A/B M1191AL/
BL M1192A M1193A M1194A M1195A M1196A Adult sensor (2m cable), for patients over 50 kg. Any finger, except thumb. M1191A/B with longer cable (3 m) No adapter cable required. Small adult, pediatric sensor (1.5m cable) for patients between 15 kg and 50 kg. Any finger except thumb. Neonatal sensor (1.5m cable) for patients between 1kg and 4 kg. Hand or foot. Ear sensor (1.5m cable) for patients more than 40 kg. Infant sensor (1.5m cable) for patients between 4kg and 15 kg. Any finger except thumb. Adult clip sensor (3m cable) for patients over 40 kg. Any finger except thumb. No adapter cable required. 235 23 Accessories SpO2 Accessories Product Number M1191T M1192T M1193T M1196T Description Comments Requires M1943
(1 m) or M1943AL
(3 m) adapter cable Adult sensor (0.45m cable), for patients over 50 kg. Any finger, except thumb. Small adult, pediatric sensor (0.45m cable) for patients between 15 kg and 50 kg. Any finger except thumb. Neonatal sensor (0.9m cable) for patients between 1kg and 4 kg. Hand or foot. Adult clip sensor (0.9m cable) for patients over 40 kg. Any finger except thumb. No adapter cable required. No adapter cable required. M1191ANL Special Edition (SE) M1192AN M1193AN M1194AN M1195AN Adult sensor (3m cable), for patients over 50 kg. Any finger, except thumb. Special Edition (SE) Small adult, pediatric sensor (1.5m cable) for patients between 15 kg and 50 kg. Any finger except thumb. Special Edition (SE) Neonatal sensor (1.5m cable) for patients between 1kg and 4 kg. Hand or foot. Special Edition (SE) Ear sensor (1.5m cable) for patients more than 40 kg. Special Edition (SE) Infant sensor (1.5m cable) for patients between 4 kg and 15 kg. Any finger except thumb. Philips disposable sensors. Not available in the USA and Canada. M1904B M1903B M1902B M1901B Identical to OxiMax MAX-A Identical to OxiMax MAX-P Identical to OxiMax MAX-I Identical to OxiMax MAX-N Philips disposable sensors. Available worldwide. M1131A Adult/Pediatric finger sensor, 0.45m cable (patient size >20 kg) Use adapter cable M1943A or M1943AL. Use adapter cable M1943A or M1943AL. 236 SpO2 Accessories 23 Accessories Product Number M1132A M1133A Description Comments Infant finger or toe sensor, 0.9m cable
(patient size 3 - 10 kg) Adult/Infant/Neonatal, 0.9m cable Foot or hand for neonates < 3 kg Big toe or thumb for patients between 10kg and 20kg Any finger except thumb for patients
> 40kg Use adapter cable M1943A or M1943AL. Use adapter cable M1943A or M1943AL. NELLCOR disposable sensors (must be ordered from Nellcor) OxiMax MAX-A OxiMax MAX-AL OxiMax MAX-P OxiMax MAX-I OxiMax MAX-N Oxisensor II D-25 Oxisensor II D-20 Oxisensor II I-20 Oxisensor II N-25 OxiCliq A OxiCliq P OxiCliq I OxiCliq N Adult finger sensor (patient size >30 kg) OxiMax MAX-A with long cable Use adapter cable M1943A or M1943AL. Pediatric foot/hand sensor (patient size 10-50 kg) Infant foot/hand sensor (patient size 3-20 kg) Adult finger or neonatal foot/hand sensor (patient size >40 kg or <3 kg) Adult sensor (patient size >30kg) Pediatric sensor (patient size 10-50 kg) Infant sensor (patient size 3-20 kg) Neonatal sensor (patient size <3 kg or
>40 kg) See OxiMax MAX-A See OxiMax MAX-P See OxiMax MAX-I See OxiMax MAX-N Use adapter cable M1943A or M1943AL Use adapter cable M1943A or M1943AL together with OC-3 adapter cable. Extension / Adapter Cables for Philips and Nellcor Sensors M1941A Extension cable (2 m) M1943A M1943AL Adapter cable (1.1 m cable) Adapter cable (3 m cable) For use with Philips reusable sensors and adapter cables. Adapter cable for Philips/Nellcor disposable sensors. 237 23 Accessories SpO2 Accessories Product Number OC-3 Description Comments Adapter Cable for OxiCliq sensors Available from Nellcor only. Product Number Description MASIMO LNOP LNOP DC-I LNOP DC-IP LNOP YI LNOP TC-I MASIMO LNCS LNCS DC-I LNCS DC-IP LNCS TC-I reusable sensors. Adult Finger Sensor (> 30 kg) Pediatric Finger Sensor (10 - 50 kg) Multi-site Sensor (> 1 kg) Ear Sensor (> 30 kg) reusable sensors. Adult reusable Sensor (> 30 kg) Pediatric reusable Sensor (10 - 50 kg) Reusable ear Sensor (> 30 kg) disposable adhesive sensors. MASIMO LNOP LNOP Adt LNOP Adtx LNOP Pdt LNOP Pdtx LNOP Inf-L LNOP Neo-L Adult Sensor (> 30 kg) Adult Sensor (> 30 kg) Pediatric Sensor (10 - 50 kg) Pediatric Sensor (10 - 50 kg) Infant Toe Sensor (3 - 20 kg) Neonatal Sensor (<3kg) or Adult adhesive Sensor (> 40 kg) LNOP NeoPt-L Neonatal Pre-Term Sensitive Skin Sensors (<1kg) MASIMO LNCS LNCS Adtx LNCS Pdtx LNCS Inf-L LNCS Neo-L disposable adhesive sensors. Adult Finger Sensor (> 30 kg) Pediatric Finger Sensor (10 - 50 kg) Infant Toe Sensor (3 - 20 kg) Neonatal Foot Sensor (< 3 kg) or Adult Finger Sensor (> 40 kg) Philips Part Number 989803140321 989803140331 n/a 989803140341 989803148281 989803148291 989803148301 989803140231 n/a 989803140261 n/a 989803140311 989803140291 989803140301 989803148231 989803148241 989803148251 989803148271 LNCS NeoPt-L Neonatal pre-term sensitive skin Sensor 989803148261
(< 1 kg) Adapter Cable for MASIMO sensors. LNOP MP12 LNOP MP Series Patient Cable (3.6 m) Adapter Cable for Masimo LNOP Sensors LNCS MP Series Patient Cable (3.0 m) Adapter Cable for Masimo LNCS Sensors 451261000761 989803148221 LNC MP10 238 Temperature Accessories 23 Accessories The monitor uses Masimo certified pulse oximetry for reduced noise and low perfusion performance with Masimo Sensors under the Masimo NR&LP protocol available from Masimo Temperature Accessories Temperature Probes Reusable General purpose probe Small flexible vinyl probe (Infant/Pediatric) Attachable surface probe Disposable General purpose probe Skin probe Esophageal/Stethoscope Probe (12 French) Esophageal/Stethoscope Probe (French 18) Esophageal/Stethoscope Probe (French 24) Foley Catheter Probe (12 French) Foley Catheter Probe (16 French) Foley Catheter Probe (18 French) Adapter cable 1.5m Adapter cable 3.0m Part No. Minimum measurement time for accurate readings 90 sec 60 sec 60 sec 90 sec 60 sec 180 sec 210 sec 310 sec 180 sec 180 sec 180 sec 21075A 21076A 21078A M1837A 21091A 21093A 21094A 21095A M2255A 21096A 21097A 21082B 21082A Mainstream CO2 Accessories Description CO2 Sensor Adult/Pediatric Airway Adapter (reusable) Infant Airway Adapter (reusable) Adult Airway Adapter (single-patient use) Infant Airway Adapter (single-patient use) Part No. M2501A M2513A M2516A M2533A M2536A 239 23 Accessories Sidestream CO2 Accessories Sidestream CO2 Accessories Description CO2 Sensor Nasal and Oral-Nasal Cannulas CO2 Nasal Cannula, Adult CO2 Nasal Cannula, Pediatric CO2 Nasal Cannula, Infant CO2 / O2 Nasal Cannula, Adult CO2 / O2 Nasal Cannula, Pediatric CO2 / O2 Nasal Cannula, Infant CO2 Oral-Nasal Cannula, Adult CO2 Oral-Nasal Cannula, Pediatric CO2 / O2 Oral-Nasal Cannula, Adult CO2 / O2 Oral-Nasal Cannula, Pediatric Airway Adapters Airway Adapter Set, ET > 4.0 mm Airway Adapter Set, ET =< 4.0 mm Airway Adapter Set H, ET > 4.0 mm Airway Adapter Set H, ET =< 4.0 mm Straight Sample Lines Straight Sample Line Straight Sample Line H Part No. M2741A M2744A M2745A M2746A M2750A M2751A 989803144471 M2756A M2757A M2760A M2761A M2768A 989803144531 M2772A M2773A M2776A M2777A Mainstream CO2 Accessories (for M3016A) Description CO2 Sensor Standard Airway Adapter (reusable) Small Airway Adapter (reusable) Part No. M1460A M1465A 14363A Microstream CO2 Accessories FilterLine Set is a combination of a FilterLine with an Airway Adapter. H in the accessory name indicates suitability for humidified ventilation and longer usage due to the active removal of humidity from the sample line. Smart CapnoLine is a combined oral-nasal FilterLine. 240 Battery Accessories 23 Accessories Smart CapnoLine O2 is a combined oral-nasal-O2-CO2 FilterLine. NIV Line is a nasal FilterLine suitable for mask ventilation (for example, C-PAP). Single purpose means CO2 measurement only, dual purpose means CO2 measurement and O2 delivery. The accessories are supplied in packs of 25. Microstream accessory selection flowchart Yes Is the patient intubated?
No Does the patient need oxygen?
Yes No Short-term
(up to 6 hours) Long-term Short term Long term Long-term Short term
(up to 72 hours)
(up to 8 hours)
(up to 24 hours)
(up to 24 hours)
(up to 8 hours) Short term
(up to 8 hours) Oral/Nasal Nasal Nasal Oral/Nasal Nasal Key Applications Critical Care OR, EMS, ED Procedural Sedation, Critical Care, EMS, ED Critical Care, Sleep Lab, Long-term Pain Management Critical Care, Sleep Lab Procedural Sedation, Critical Care, EMS, ED EMS, ED Philips part numbers (A = Adult, P= Pediatric, I = Infant, N = Neonate) CapnoLine HO2:
A: M4680A P: M4681A CapnoLine H:
A: M4689A P: M4690A I/N: M4691A NIV Line:
A: 4686A P: M4687A Smart CapnoLine:
A: M2526A P: M2524A Smart CapnoLine Plus Long A:989803160301*
Smart CapnoLine O2:
A: M2522A P: M2520A Smart CapnoLine O2 Long A:989803160281*
P:989803160271*
FilterLine Set:
A/P: M1920A FilterLine Set Long:
A/P:989803160241*
FilterLine:
M1925A*
FilterLine H Set:
A/P: M1921A I/N: M1923A FilterLine H Set Long A/P:989803160251*
I/N:989803160261*
VitaLine H Set:
A/P:989803159571*
I/N: 989803159581*
FilterLine H:
M1926A*
*Not available in all geographies. Battery Accessories Description Battery Charger and Conditioner (requires size adapter 4512 610 17451 to charge M4607A battery) Size adapter for M4607A battery Part No. M8043A 4512 610 17451 241 23 Accessories Battery Accessories 242 24 24Specifications Intended Use The monitor is intended to be used for monitoring and recording of, and to generate alarms for, multiple physiological parameters of adults, pediatrics, and neonates in a hospital environment and during patient transport inside and outside of the hospital environment. The monitor is intended for use by health care professionals. The monitor is only for use on one patient at a time. It is not intended for home use. Not a therapeutic device. Rx only: U.S. Federal Law restricts this device to sale by or on the order of a physician. ST segment monitoring is intended for use with adult patients only and is not clinically validated for use with neonatal and pediatric patients. The ECG measurement is intended to be used for diagnostic recording of rhythm and detailed morphology of complex cardiac complexes (according to AAMI EC 11). NOTE1 Hospital Environment The monitor is suitable for use in all medically used rooms which fulfil the requirements regarding electrical installation according to IEC60364-7-710 Requirements for special installations or locations
- Medical locations, or corresponding local regulations. NOTE2 EMC Environment All measurements (except the sidestream CO2 measurement with M2741A sensor) and system interfaces (except short range radio and wireless LAN) are, in addition, suitable for use in establishments directly connected to the public low-voltage supply network that supplies buildings used for domestic purposes (see table in Electromagnetic Emissions on page 267). The monitor is indicated for use by health care professionals whenever there is a need for monitoring the physiological parameters of patients. WARNING The monitors are not intended for use in an MRI environment or in an oxygen-enriched environment
(for example, hyperbaric chambers. Manufacturers Information You can write to Philips at this address 243 24 Specifications Symbols Philips Medizin Systeme Boeblingen GmbH Hewlett-Packard-Str. 2 71034 Boeblingen Germany Visit our website at: www.philips.com. Copyright 2002 - 2008. Koninklijke Philips Electronics N.V. All Rights Reserved. Trademark Acknowledgement The following are trademarks of Nellcor Puritan Bennett Incorporated: Nellcor, Durasensor, Dura-
Y, Oxiband, Oxicliq, OxiMax. MAX-FAST is a trademark of Mallinckrodt Inc. Microstream, FilterLine, and Smart CapnoLine are trademarks or registered trademarks of Oridion Systems Ltd. Masimo, Masimo SET, and LNOP are federally registered trademarks of the Masimo Corporation. Other product and company names mentioned in this book may be trademarks of their respective owners. Symbols These symbols can appear on the monitor and its associated equipment. These symbols can appear on the monitor and its associated equipment (depending on options). Symbols Refer to accompanying documents On/Off/Standby Main Screen DC power source Battery symbol Battery Eject SmartKeys ECG Sync Pulse Output indicator Pressure connector Temperature connector NBP connector SpO2 connector Connection direction indicator Connector has special protection against electric shocks and is defibrillator proof Uses FAST SpO2 algorithm 244 Installation Safety Information 24 Specifications Symbols Silence Alarms Alarms Alarms Off ECG connector Error LED LAN connection indicator for connection to a wired network IntelliVue Instrument Telemetry wireless network Monitor supports 12-
lead ECG built-in short range radio interface 2002-
06 Identifies year and month of manufacture Always use separate collection for waste electrical and electronic equipment (WEEE) built-in wireless network Installation Safety Information WARNING If multiple instruments are connected to a patient, the sum of the leakage currents may exceed the limits given in IEC/EN60601-1, IEC60601-1-1, UL60601-1. Consult your service personnel. Earthing The monitor must be earthed during operation. The earthing is for functional purposes and does not provide protection against electric shock. The protection against electric shock in this device is provided by double and/or reinforced insulation. If a three-wire receptacle is not available, consult the hospital electrician. Never use a three-wire to two-
wire adapter. Combining equipment Combinations of medical equipment with non-medical equipment must comply with IEC 60601-1-1. Never use a multiple portable socket-outlet or extension cord when combining equipment unless the socket outlet is supplied specifically for use with that equipment. All network cables must be unshielded. Network Cables Connectors The actual placement of boards and configuration of connections for your monitor depends on how your hardware has been configured. See the symbols table on page 244 to see which symbols are used to mark the connections. WARNING Connect only medical devices to the ECG output connector socket. Connecting the ECG sync out to external equipment should only be done by a qualified user. Do not touch the patient when you have contact to the ECG output connector socket. 245 24 Specifications Altitude Setting Always connect the ECG sync cable first to the external device and then to the monitor. Wherever possible, pre-install the cable before the patient is brought into the vicinity of the equipment. Altitude Setting Altitude affects CO2 measurements. The monitor must be configured at installation to the correct altitude. Monitor Safety Specifications 0366 The monitor complies with the Medical Device Directive 93/42/EEC. In addition, the product complies with:
IEC 60601-1:1988 + A1:1991 + A2:1995; EN60601-1:1990 + A1:1993 + A2:1995; UL 60601-
1:2003; CAN/CSA C22.2#601.1-M90; JIS T 0601-1:1999; IEC 60601-1-1:2001; EN 60601-1-
1:2001; IEC 60601-1-2:2001; EN 60601-1-2:2001. Classification (according to IEC 60601-1): Class II, Type CF, Continuous Operation. The possibility of hazards arising from software errors was minimized in compliance with ISO 14971:2000, EN60601-1-4:1996 + A1:1999 and IEC 60601-1-4:1996 + A1:1999. EMC And Radio Regulatory Compliance This ISM device complies with Canadian ICES-001. Cet appareil ISM est conforme a la norme NMB-
001 du Canada. The MP2 including IntelliVue Instrument Telemetry WMTS (US only) complies with part 15 of the FCC Rules. Operation is subject to the condition that this device does not cause harmful interference. Operation of this equipment requires the prior coordination with a frequency coordinator designated by the FCC for the Wireless Medical Telemetry Service. The MP2 including IntelliVue Instrument Telemetry ISM (2.4 GHz) - FCC and Industry Canada Radio Compliance: This device complies with Part 15 of the FCC Rules and RSS-210 of Industry Canada. Operation is subject to the following two conditions: (1) this device may not cause harmful interference, and (2) this device must accept any interference received, including interference that may cause undesired operation. Any changes or modifications to this equipment not expressly approved by Philips Medical Systems may cause harmful radio frequency interference and void your authority to operate this equipment. The radio device used in this product is in compliance with the essential requirements and other relevant provisions of Directive 1999/5/EC (Radio Equipment and Telecommunications Terminal Equipment Directive). Class 2 radio equipment. Member states may apply restrictions on putting this device into service or placing it on the market. This product is intended to be connected to the Publicly Available Interfaces (PAI) and used throughout the EEA. 246 Out-Of-Hospital Transport - Standards Compliance 24 Specifications The MP2 including the Wireless IntelliVue Adapter - FCC and Industry Canada Radio Compliance:
This device complies with Part 15 of the FCC Rules and RSS-210 of Industry Canada. Operation is subject to the following two conditions: (1) this device may not cause harmful interference, and (2) this device must accept any interference received, including interference that may cause undesired operation. Any changes or modifications to this equipment not expressly approved by Philips Medical Systems may cause harmful radio frequency interference and void your authority to operate this equipment. The maximum antenna gain permitted (for devices in the 5250-5350 MHz and 5470-5725 MHz bands) complies with the e.i.r.p. limits as stated in RSS-210. The maximum antenna gain permitted (for devices in the 5725-5825 MHz band) complies with the e.i.r.p. limits specified for point-to-point operation, as stated in RSS-210. The device for the band 5150-5250 MHz is only for indoor usage to reduce potential for harmful interference to co-channel mobile satellite systems. CAUTION High power radars are allocated as primary users (meaning they have priority) of 5250-5350 MHz and 5650-5850 MHz and these radars could cause interference and /or damage to LE-LAN devices. The radio device used in this product is in compliance with the essential requirements and other relevant provisions of Directive 1999/5/EC. This product is intended to be connected to the Publicly Available Interfaces (PAI) and used throughout the EEA. The radio component contained in this device is compliant to Council Directive 1999/5/
EC (Radio Equipment and Telecommunications Terminal Equipment Directive) In addition the product complies with: ETSI EN 300 328; ETSI EN 301 893; AS/NZS 4771+A1;
ARIB STD-T66. The MP2 including the short range radio interface - FCC and Industry Canada Radio Compliance:
This device complies with Part 15 of the FCC Rules and RSS-210 of Industry Canada. Operation is subject to the following two conditions: (1) this device may not cause harmful interference, and (2) this device must accept any interference received, including interference that may cause undesired operation. Any changes or modifications to this equipment not expressly approved by Philips Medical Systems may cause harmful radio frequency interference and void your authority to operate this equipment. The radio device used in this product is in compliance with the essential requirements and other relevant provisions of Directive 1999/5/EC (Radio Equipment and Telecommunications Terminal Equipment Directive). Class 1 radio equipment. In addition the product complies with: ETSI EN 300 328; AS/NZS 4771+A1; ARIB STD-T66. Out-Of-Hospital Transport - Standards Compliance The MP2 patient monitor with measurements and interfaces other than those listed below cannot be used for patient transport outside of the hospital environment. The MP2 patient monitor, with the following measurements and interfaces:
ECG/Respiration, NBP, SpO2, Pressure, Temperature, CO2 (only Mainstream Sensor M2501A) LAN, Battery 247 24 Specifications Out-Of-Hospital Transport - Standards Compliance can be used in a transport environment such as a road ambulance, airplane or helicopter. For this purpose the monitor fulfils the following additional mechanical, EMC and environmental requirements:
Shock Tests according to IEC TR 60721-4-7, Class 7M3. Test procedure according to IEC/EN 60068-2-27 (peak acceleration up to 100 g). Random Vibration according to IEC TR 60721-4-7, Class 7M3. Test procedure according to IEC/
EN 60068-2-64 (RMS acceleration 5 g). Sinusoidal Vibration according to IEC TR 60721-4-7, Class 7M3. Test procedure according to IEC/EN 60068-2-6 (acceleration up to amplitude 2 g). Bump Test according to IEC/EN60068-2-29 (peak acceleration 15 g, 1000 bumps). Free Fall Test according to EN1789 (covers also IEC TR 60721-4-7 and Class 7M3). Test procedure according to EN 60068-2-32 (height 0.75 m). Specification for degrees of protection provided by enclosures according to IEC/EN 60529: IP 32 EN 1789 +A1:2003 Medical vehicles and their equipment - Road ambulances (chapter 6 - Medical Devices). Radiated susceptibility 20 V/m according to EN ISO 9919 (SpO2) and EN ISO 21647 (CO2). Altitude Range from -500 to 3000 m operating and -500 to 4600 m storage and transportation. Extended radiated susceptibility tests The MP2 patient monitor with its out-of-hospital parameter set provides a general immunity level of 20 V/m with only few restrictions. Details are as listed below:
GSM 900: Immunity at 900 MHz (uplink mobile phone), 20 V/m (ECG:10V/m), duty cycle 1:8 GSM 1800: Immunity at 1800 MHz (uplink mobile phone), 20 V/m, duty cycle 1:8. DECT: Immunity at 1800 MHz (digital cordless phone), 20 V/m, duty cycle 1:24 AM: 1 kHz Immunity from 80 MHz to 1.0 GHz (any radio communication unit, broadcasting and TV transmitter), 20 V/m, modulation factor 80%. (ECG: 20 V/m except 600-950 MHz where it is 10 V/m and Temperature which holds 3 V/m over the full range). CAUTION Temperature measurement accuracy may be compromised in the presence of strong electromagnetic fields (>3 V/m) in certain small frequency bands. Magnetic Field emission according to MIL STD 461E, Chapter RE101: Radiated emissions, magnetic field, 30 Hz to 100 kHz. Limit class: Army. Magnetic Field susceptibility: Radiated susceptibility, magnetic field, 50, 60 and 400 Hz, 18 T(15 A/m) Operating ambient temperature testing over the range from 0 to 40C (32 to 100F). Operating ambient humidity testing up to 95% RH at 40C (100F), non condensing. NOTE Additional requirements can be necessary for transport situations in air, on water or in difficult terrain in certain countries, e.g. EU. 248 Out-Of-Hospital Transport - Standards Compliance 24 Specifications Physical Specifications Specification Comments Maximum Weight 1.25 kg
(2.8 lb) Size (W x H x D) 188 x 99 x 86 mm 7.4 x 3.9 x 3.4 in including battery, without options without handle and options M8023A External Power Supply Weight and Dimensions Maximum Weight 700 g 10%
(1.5 lb 10%) Size (W x H x D) 207 x 70 x 113 mm 8.1 x 2.8 x 4.4 in Environmental Specifications The monitor may not meet the performance specifications given here if stored or used outside the specified temperature and humidity ranges. The monitor is protected against ingress of objects and fluids according to IEC 60529 IP32 (applies to all options intended for out-of-hospital use). However, do not expose the monitor directly to heavy rain. When the monitor and related products have differing environmental specifications, the effective range for the combined products is that range which is common to the specifications for all products. Item Condition Range Temperature Range Temperature Range with the Wireless IntelliVue Adapter or IntelliVue Instrument Telemetry Wireless Network or when charging the battery Humidity Range Operating Storage including transportation Operating 0 to 40C (32 to 104F)
-20 to 60C (-4 to 140F) 0 to 35C (32 to 95F) Operating Storage including transportation 15% to 95% Relative Humidity (RH) 5% to 95% Relative Humidity (RH) 249 24 Specifications Monitor Performance Specifications Item Altitude Range Ingress Protection Condition Range Operating Storage including transportation Monitor External Power Supply
(M8023A)
-500 m to 3000 m (10000 ft)
-500 m to 4600 m1 (15000 ft) IP32 (protected against ingress of water when the water is dripping vertically and the monitor is tilted up to 15) IP31(protected against the ingress of solid foreign objects 2.5 mm in diameter or larger, and the ingress of water when the water is dripping vertically) when rested on its rubber feet on a flat, level surface. IP32 when mounted as shown in the section Mounting the External Power Supply (M8023A) on page 3 of the Installation chapter and as described in the Service Guide. 1.Sufficient for flight altitudes up to 12,000 m with pressurized cabins. Monitor Performance Specifications Performance Specifications Power Specifications Power consumption Battery Specifications Operating Voltage Operating Time
(with new, fully charged battery at 25C) Charge Time
<12 W average
<30 W while battery is loading 36 to 60 V DC floating Basic monitoring configuration: 2.5 hours
(Brightness set to Optimum, ECG/Resp, SpO2 measurements in use, NBP measurement every 15 minutes) When monitor is off: 2 hours When monitor is in use, and connected to the external power supply (M8023A), without MMS extensions: 12 hours approx. red (crossed-out alarm symbol) LED red/yellow/light blue (cyan) LED green / red LED green LED yellow (charging)/red blinking (empty) LED green LED 12 or 16 numerics @ 12 sec, 1 minute, 5 minute resolution. Multiple choices of number of numerics, resolution and duration depending on trend option and application area. For example:
For neonatal, you can choose between 12 and 16 numerics. Alarms Off Alarms On/Standby / Error AC Power Battery External Power Audible feedback for user input Prompt tone QRS tone, or SpO2 modulation tone 4 different alarm sounds Resolution Information Indicators Sounds Trends 250 Monitor Performance Specifications 24 Specifications Performance Specifications Alarm signal Review Alarms Real Time Clock System delay Pause duration Extended alarm pause Information Capacity Range Accuracy Hold Time Buffered Memory Hold Time Contents less than 3 seconds 1,2,3 minutes or infinite, depending on configuration 5 or 10 minutes all alarms / inops, main alarms on/off, alarm silence and time of occurrence 300 items from: January 1, 1997, 00:00 to: December 31, 2080, 23:59
<4 seconds per day (typically) infinite if powered by external power supply; otherwise at least 48 hours if powered by external power supply: infinite without power: at least 48 hours Active settings, trends, patient data, realtime reports, review alarms M8023A External Power Supply Performance Specifications Power Specifications Power consumption Line Voltage Current Frequency AC Power Indicators Monitor Interface Specifications
<12 W average
<30 W peak 100 to 240 V ~
1.3 to 0.7 A 50/60 Hz ~
green LED Measurement Link
(MSL) ECG Sync Pulse Output
(See Connectors on page 246 for safety-
related information) Connectors Power Power Sync. LAN signals Serial signals Local signals Cable detection Marker In Wave Output Connector Output levels Isolation Pulse Width Delay from R-wave peak to start of pulse Minimum required R-
wave amplitude Female ODU (Proprietary) 30 V to 60 V input RS-422 compliant input 78.125k Hz (typical) IEEE 802.3 10-Base-T compliant RS-422 compliant Provided for connecting measurement extensions Yes No No Binder Series 709/719 Output low <0.8 V @ I = -4 mA Output high >2.4 V @ I = 4 mA None 100 +/-10 ms (high) 20 ms maximum per AAMI EC13 0.5 V 251 24 Specifications Monitor Performance Specifications Monitor Interface Specifications Wireless Network Device Interface
(integrated, for compatible network options see below) Signals Frequency Band RD+/-, TD+/-: IEEE 802.3 10Base-T, PWR, GND 12.5 V 20%, 3.5 W continuous USA: 2.400 2.483GHz, 5.15 ~ 5.35Ghz, 5.725 ~ 5.825Ghz Europe: 2.400 2.483GHz, 5.15~ 5.35Ghz, 5.47 ~ 5.725Ghz Japan: 2.400 2.483GHz, 4.90 5.091GHz, 5.15 5.25GHz China: 2.400 2.483GHz, 5.725 ~5.85Ghz Modulation Technique 802.11b/g Effective radiated power DSSS (DBPSK, DQPSK, CCK) OFDM (BPSK,QPSK, 16-QAM, 64-QAM) 802.11a OFDM (BPSK,QPSK, 16-QAM, 64-QAM) 2.4 GHz FCC: max 18 dBm ETSI: max 18 dBm 5 GHz FCC: max 24 dBm ETSI: max 18 dBm Internal SRR interface IEEE 802.15.4 2.4 GHz ISM (2.400 - 2.483 GHz) Short Range Radio Interface1 Type Technology Frequency Band Modulation Technique DSSS (O -QPSK) Effective radiated power max. 0 dBm (1 mW) 1.The short range radio interface is compatible with the following telemetry devices: TRx4841A/TRx4851A IntelliVue Telemetry System Transceiver. M8023A External Power Supply Interface Specifications Measurement Link
(MSL) Connectors Power Power Sync. LAN signals Serial signals Local signals Male ODU (Proprietary) 48 V output RS-422 compliant output 78.125 kHz (typical) IEEE 802.3 10-Base-T compliant RS-422 compliant output 78.125 kHz (typical) Not connected Display Specifications Integrated QVGA Display Sweep Speeds Resolution Refresh frequency Useful screen Pixel size 6.25, 12.5, 25 and 50 mm/s;
320 x 240 60 Hz 72 x 54 mm (2.8 x 2.1 in) 0.22 x 0.22 mm 252 M4607A Battery Specifications 24 Specifications Compatible Devices IntelliVue Instrument Telemetry Wireless Network (USA only) Internal WMTS Adapter Technology IntelliVue Instrument Telemetry Wireless Network (except USA) Internal ISM Adapter Technology compatible with Philips Cellular Telemetry System
(CTS), cellular infrastructure WMTS, 1395-1400 MHz and 1427-1432 MHz compatible with Philips Cellular Telemetry System
(CTS), cellular infrastructure 2.4 GHz ISM IntelliVue 802.11 Bedside Adapter (Wireless Network Adapter) Internal Wireless Adapter IEEE 802.11a/b/g 2.4 GHz and 5 GHz ISM Band Frequency Band Frequency Band Technology Frequency Band M4607A Battery Specifications One battery is required for battery operation of the monitor. M4607A Battery Specifications Physical Specifications W x D x H Weight Performance Specifications 66 mm (2.36 in) x 80 mm (3.15 in) x 20 mm (0.79 in) 160 g 5%
Nominal Voltage Rated Capacity at discharge C/5 10.8 Volt 1000 mAh (typical) Environmental Specifications Temperature Range Humidity Range Battery Type Safety Electromagnetic Compatibility (EMC) Communication Standard Discharge 0 to 60qC (32 to 122qF) Charge 0 to 60qC (32 to 122qF) Storage and Transportation: -20 to 65qC (-4 to 140qF) Operating: 15% to 95% Relative Humidity (RH) Storage and Transportation: 5% to 95% Relative Humidity (RH) Lithium Ion Mangan, 10.8 V, 1000 mAh, complies with UL 2054 complies with the requirements for FCC Type B computing Device, and EN 61000-4-2 and EN 61000-3-2 complies with the SMBus specification v1.1 253 24 Specifications Measurement Specifications Measurement Specifications See the Appendix on Default Settings for a list of the settings the monitor is initially shipped with. ECG/Arrhythmia/ST/QT Complies with IEC 60601-2-25:1993 + A1:1999 /EN60601-2-25:1995 + A1:1999, IEC 60601-2-
27:2005/EN60601-2-27:2006, IEC 60601-2-51:2003 /EN 60601-2-51:2003 and AAMI EC11/
EC13:1991/2002. ECG/Arrhythmia/ST Performance Specifications Cardiotach Range Accuracy Resolution Sensitivity Range Resolution Range Accuracy Resolution Range Accuracy Resolution Range Resolution Range Resolution Range - adult Range - pediatric and neonatal Brady Normal Tachy PVC Rate ST Numeric QT Numeric QTc Numeric
'QTc Numeric QT-HR Numeric Sinus and SV Rhythm Ranges Bandwidth Adult/pedi: 15 to 300 bpm Neo range: 15 to 350 bpm 1% of range 1 bpm t200 Vpeak 0 to 300 bpm 1 bpm
-20 to +20 mm 0.5 mm or 15%, whichever is greater 0.1 mm 200 to 800 ms 30 ms 8 ms 200 to 800 ms 1 ms
-600 to +600 ms 1 ms 15 to 300 bpm 15 to 350 bpm Adult: 15 to 59 bpm Pedi: 15 to 79 bpm Neo: 15 to 89 bpm Adult: 60 to 100 bpm Pedi: 80 to 160 bpm Neo: 90 to 180 bpm Adult: >100 bpm Pedi: >160 bpm Neo: >180 bpm Adult/neo/pedi: 0.05 to 150 Hz Neo/pedi: 0.5 to 150 Hz Diagnostic Mode Extended Monitoring Mode Monitoring Mode Adult: 0.5 to 40 Hz Filter Mode Neo/pedi: 0.5 to 55 Hz Adult/neo/pedi: 0.5 to 20 Hz 254 Measurement Specifications 24 Specifications ECG/Arrhythmia/ST Performance Specifications Bandwidth when the ECG is transmitted from a telemetry device via short range radio Adult/neo/pedi: 0.05 to 40 Hz Neo/pedi: 0.5 to 40 Hz Diagnostic Mode Extended Monitoring Mode Monitoring Mode Adult: 0.5 to 40 Hz Filter Mode Differential Input Impedance Common Mode Rejection Ratio Electrode Offset Potential Tolerance Auxiliary Current
(Leads off Detection) Input Signal Range Neo/pedi: 0.5 to 40 Hz Adult/neo/pedi: 0.5 to 20 Hz
>2 M: RA-LL leads (Resp)
>5 M: at all other leads (at 10 Hz including patient cable) Diagnostic mode: >86 dB (with a 51 k:/47 nF imbalance). Filter mode: >106 dB (with a 51 k:/47 nF imbalance). 500 mV Active electrode: <100 nA Reference electrode: <900 nA 5 mV ECG/Arrhythmia/ST/QT Alarm Specifications HR Extreme Tachy Extreme Brady Run PVCs PVCs Rate Vent Tach HR Vent Tach Run Vent Rhythm Run SVT HR SVT Run ST High ST Low QTc High
'QTc High Range 15 to 300 bpm maximum delay: 10 seconds according to AAMI EC 13-1992 standard Difference to high limit 0 to 50 bpm Clamping at 150 to 300 bpm Difference to low limit 0 to 50 bpm Clamping at 15 to 100 bpm 2 PVCs 1 to 99 PVCs/minute 20 to 300 bpm 3 to 99 PVCs/minute 3 to 99 PVCs/minute 120 to 300 bpm 3 to 99 SV beats
-19.8 to +20 mm
-20 to +19.8 mm 200 ms to 800 ms 30 ms to 200 ms Adjustment Adult:1 bpm steps (15 to 40 bpm) 5 bpm steps (40 to 300 bpm) Pedi/Neo:1 bpm steps (15 to 50 bpm) 5 bpm steps (50 to 300 bpm) 5 bpm steps 5 bpm steps 5 bpm steps 5 bpm steps Not adjustable by user 1 PVC 5 bpm 1 PVC 1 PVC 5 bpm 1 SV beat 0.2 mm 0.2 mm 10 ms steps 10 ms steps ECG/Arrhythmia/ST Supplemental Information as required by AAMI EC11/13 Respiration Excitation Waveform Noise Suppression Sinusoidal signal, 260 PA, 40.5 kHz RL drive gain 44 dB max., max. voltage 1.8 Vrms 255 24 Specifications Measurement Specifications ECG/Arrhythmia/ST Supplemental Information as required by AAMI EC11/13 Time to Alarm for Tachycardia Vent Tachycardia 1 mVpp,206 bpm Vent Tachycardia 2 mVpp,195 bpm Tall T-Wave Rejection Capability Heart Rate Averaging Method Response Time of Heart Rate Meter to Change in Heart Rate Heart Rate Meter Accuracy and Response to Irregular Rhythm Accuracy of Input Signal Reproduction Pacemaker Pulse Rejection Performance Gain 0.5, Range 6.5 to 8.4 seconds, Average 7.2 seconds Gain 1.0 Range 6.1 to 6.9 seconds, Average 6.5 seconds Gain 2.0, Range 5.9 to 6.7 seconds, Average 6.3 seconds Gain 0.5, Range 5.4 to 6.2 seconds, Average 5.8 seconds Gain 1.0, Range 5.7 to 6.5 seconds, Average 6.1 seconds Gain 2.0, Range 5.3 to 6.1 seconds, Average 5.7 seconds Exceeds ANSI/AAMI EC 13 Sect. 3.1.2.1(c) minimum recommended 1.2 mV T-Wave amplitude Three different methods are used:
Normally, heart rate is computed by averaging the 12 most recent RR intervals. For runs of PVCs, up to 8 RR intervals are averaged to compute the HR. If each of 3 consecutive RR intervals is greater than 1200 ms
(that is, rate less than 50 bpm), then the 4 most recent RR intervals are averaged to compute the HR. HR change from 80 to 120 bpm:
Range: [6.4 to 7.2 seconds] Average: 6.8 seconds HR change from 80 to 40 bpm:
Range: [5.6 to 6.4 sec] Average: 6.0 seconds Ventricular bigeminy: 80 bpm Slow alternating ventricular bigeminy: 60 bpm Rapid alternating ventricular bigeminy: 120 bpm Bidirectional systoles: 90 bpm Methods A and D were used to establish overall system error and frequency response. Rejection of pacemaker pulses with amplitudes from 2 mV to 700 mV and widths from 0.1 ms to 2.0 ms (Method A) Respiration Respiration Performance Specifications Respiration Rate Range Accuracy Resolution Bandwidth Noise Adult/pedi: 0 to 120 rpm Neo: 0 to 170 rpm at 0 to 120 rpm 1 rpm at 120 to 170 rpm 2 rpm 1 rpm 0.3 to 2.5 Hz (6 dB) Less than 25 m:(rms) referred to the input 256 Measurement Specifications 24 Specifications Respiration Alarm Specifications High Low Range Adult/pedi: 10 to 100 rpm Neo: 30 to 150 rpm Adult/pedi: 0 to 95 rpm Neo: 0 to 145 rpm Adjustment under 20 rpm: 1 rpm steps over 20 rpm: 5 rpm steps under 20 rpm: 1 rpm steps over 20 rpm: 5 rpm steps Apnea Alarm 10 to 40 seconds 5 second steps Delay max. 14 seconds for limits from 0 to 20 rpm:
max. 4 seconds for limits above 20 rpm: max. 14 seconds 257 24 Specifications SpO2 Measurement Specifications Complies with EN ISO 9919:2005 (except alarm system; alarm system complies with IEC 60601-2-
49:2001). Measurement Validation: The SpO2 accuracy has been validated in human studies against arterial blood sample reference measured with a CO-oximeter. Pulse oximeter measurements are statistically distributed, only about two-thirds of the measurements can be expected to fall within the specified accuracy compared to CO-oximeter measurements. Display Update Period: Typical: 2 seconds, Maximum: 30 seconds. Maximum with NBP INOP suppression on60 seconds. 0 to 100%
Philips Reusable Sensors:
M1191A, M1191AL, M1191ANL, M1191B, M1191BL, M1192A, M1192AN = 2% (70% to 100%) M1193A, M1193AN, M1194A, M1194AN, M1195A, M1195AN, M1196A = 3% (70% to 100%) M1191T, M1192T, M1193T (Adult), M1196T = 3% (70% to 100%) M1193T (Neonate) = 4% (70% to 100%) Philips Disposable Sensors with M1943A(L):
M1132A, M1133A (adult/infant) = 2%
M1901B, M1902B, M1903B, M1904B, M1131A, M1133A (neonate)
= 3% (70% to 100%) NellcorPB Sensors with M1943A(L):
MAX-A, MAX-AL, MAX-P, MAX-I, MAX-N, D-25, D-20, I-20, N-
25, OxiCliq A, P, I, N = 3% (70% to 100%) Masimo Reusable Sensors with LNOP MP12 or LNC MP10:
LNOP DC-I, LNOP DC-IP, LNOP YI, LNCS DC-1, LNCS DC-IP:
2% (70% to 100%) LNOP TC-I, LNCS TC-I: 3.5% (70% to 100%) Masimo Disposable Sensors with LNOP MP12 or LNC MP10:
LNOP Adt, LNOP Adtx, LNOP Pdt, LNOP Pdtx, LNOP Inf-L, LNCS Adtx, LNCS Pdtx, LNCS Inf-L: 2% (70% to 100%) LNOP Neo-L, LNOP NeoPt-L, LNCS Neo-L, LNCS NeoPt-L: 3%
(70% to 100%) 1%
30 to 300 bpm 2% or 1 bpm, whichever is greater 1 bpm Wavelength range: 500 to 1000 nm Emitted Light Energy: d15 mW Information about the wavelength range can be especially useful to clinicians (for instance, when photodynamic therapy is performed) 70% to 100%
Range Accuracy SpO2 Performance Specifications SpO2 The specified accuracy is the root-mean-
square (RMS) difference between the measured values and the reference values Resolution Range Accuracy Resolution Pulse Sensors Pulse Oximeter Calibration Range 258 Measurement Specifications 24 Specifications SpO2 Alarm Specifications SpO2 Desat Pulse Tachycardia Bradycardia Range Adult: 50 to 100%
Pedi/Neo: 30 to 100%
Adult: 50 to Low alarm limit Pedi/Neo: 30 to Low alarm limit 30 to 300 bpm Adjustment 1% steps 1% steps Adult:
1 bpm steps (30 to 40 bpm) 5 bpm steps (40 to 300 bpm) Pedi/Neo:
1 bpm steps (30 to 50 bpm) 5 bpm steps (50 to 300 bpm) Difference to high limit 0 to 50 bpm 5 bpm steps 5 bpm steps Clamping at 150 to 300 bpm Difference to low limit 0 to 50 bpm 5 bpm steps 5 bpm steps Clamping at 30 to 100 bpm Delay
(0, 1, 2, 3,... 30)
+4 seconds max. 14 seconds max. 14 seconds max. 14 seconds NBP Complies with IEC 60601-2-30:1999/EN60601-2-30:2000. NBP Performance Specifications Measurement Ranges Systolic Diastolic Mean Pulse Rate Accuracy Pulse Rate Measurement Accuracy Pulse Rate Range Measurement Time Adult: 30 to 270 mmHg (4 to 36 kPa) Pedi: 30 to 180 mmHg (4 to 24 kPa) Neo: 30 to 130 mmHg (4 to 17 kPa) Adult: 10 to 245 mmHg (1.5 to 32 kPa) Pedi: 10 to 150 mmHg (1.5 to 20 kPa) Neo: 10 to 100 mmHg (1.5 to 13 kPa) Adult: 20 to 255 mmHg (2.5 to 34 kPa) Pedi: 20 to 160 mmHg (2.5 to 21 kPa) Neo: 20 to 120 mmHg (2.5 to 16 kPa) Adult: 40 to 300 Pedi: 40 to 300 Neo: 40 to 300 Max. Std. Deviation: 8 mmHg (1.1 kPa) Max. Mean Error: 5 mmHg (0.7 kPa) 40 to 100 bpm: 5 bpm 101 to 200 bpm: 5% of reading 201 to 300 bpm: 10% of reading
(average over NBP measurement cycle) 40 to 300 bpm Typical at HR >60 bpm Auto/manual/sequence: 30 seconds (adult) 25 seconds (neonatal) Stat: 20 seconds Maximum time: 180 seconds (adult/pediatric) 90 seconds (neonates) 259 24 Specifications Measurement Specifications NBP Performance Specifications Cuff Inflation Time Initial Cuff Inflation Pressure Auto Mode Repetition Times STAT Mode Cycle Time Venipuncture Mode Inflation Inflation Pressure Adult Pediatric Neonatal Adult/pediatric Neonatal Automatic deflation after Typical for normal adult cuff: Less than 10 seconds Typical for neonatal cuff: Less than 2 seconds Adult: 165 15 mmHg Pedi: 130 15 mmHg Neo: 100 15 mmHg 1, 2, 2.5, 3, 5, 10, 15, 20, 30, 45, 60 or 120 minutes 5 minutes 20 to 120 mmHg (3 to 16 kPa) 20 to 80 mmHg (3 to 11 kPa) 20 to 50 mmHg (3 to 7 kPa) 170 seconds 85 seconds Measurement Validation: In adult and pediatric mode, the blood pressure measurements determined with this device comply with the American National Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP10 - 1992) in relation to mean error and standard deviation, when compared to intra-arterial or auscultatory measurements (depending on the configuration) in a representative patient population. For the auscultatory reference the 5th Korotkoff sound was used to determine the diastolic pressure. In neonatal mode, the blood pressure measurements determined with this device comply with the American National Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP10 -
1992 and AAMI/ANSI SP10A -1996) in relation to mean error and standard deviation, when compared to intra-arterial measurements in a representative patient population. NBP Alarm Specifications Range Systolic Adjustment 10 to 30 mmHg: 2 mmHg (0.5 kPa)
>30 mmHg: 5 mmHg (1 kPa) Diastolic Mean Adult: 30 to 270 mmHg (4 to 36 kPa) Pedi: 30 to 180 mmHg (4 to 24 kPa) Neo: 30 to 130 mmHg (4 to 17 kPa) Adult: 10 to 245 mmHg (1.5 to 32 kPa) Pedi: 10 to 150 mmHg (1.5 to 20 kPa) Neo: 10 to 100 mmHg (1.5 to 13 kPa) Adult: 20 to 255 mmHg (2.5 to 34 kPa) Pedi: 20 to 160 mmHg (2.5 to 21 kPa) Neo: 20 to 120 mmHg (2.5 to 16 kPa) NBP Overpressure Settings Adult Pedi Neo
>300 mmHg (40 kPa) >2 sec
>300 mmHg (40 kPa) >2 sec
>150 mmHg (20 kPa) >2 sec not user adjustable 260 Measurement Specifications 24 Specifications Invasive Pressure and Pulse Complies with IEC 60601-2-34:2000/EN60601-2-34:2000. Invasive Pressure Performance Specifications Measurement Range Pulse Rate Range Accuracy Resolution Input Sensitivity Transducer Frequency Response Zero Adjustment Gain Accuracy Range:
Accuracy Drift Accuracy Drift Non linearity and Hysteresis
(including transducer) Volume displacement of CPJ840J6 Overall Accuracy 40 to 360 mmHg 25 to 350 bpm 1% Full Range 1 bpm Sensitivity:5 V/V/mmHg (37.5 V/V/kPa) Adjustment range:10%
Load Impedance:200 to 2000 : (resistive) Output Impedance:d3000 : (resistive) dc to 12.5 Hz or 40 Hz 200 mmHg (26 kPa) 1 mmHg (0.1 kPa) Less than 0.1 mmHg/C (0.013 kPa/C) 1%
Less than 0.05%/C Error of d0.4% FS (@CAL 200 mmHg) 4% of reading or 4 mmHg (0.5 kPa), whichever is greater 0.1 mm3 /100 mmHg Invasive Pressure Alarm Specifications Range Pressure 40 to 360 mmHg
(5.0 to 48 kPa) Extreme High Extreme Low Pulse Difference to high limit 0 to 25 mmHg Clamping at -40 to 360 mmHg Difference to low limit 0 to 25 mmHg Clamping at -40 to 360 mmHg 25 to 300 bpm Delay max. 12 seconds Adjustment
-40 to 50 mmHg 2 mmHg (0.5 kPa)
>50 mmHg 5 mmHg (1 kPa) 5 mmHg steps (0.5 kPa) 5 mmHg steps (1.0 kPa) 5 mmHg steps (0.5 kPa) 5 mmHg steps (1.0 kPa) Adult:
1 bpm steps (25 to 40 bpm) 5 bpm steps (40 to 300 bpm) Pedi/Neo:
1 bpm steps (25 to 50 bpm) 5 bpm steps (50 to 300 bpm) 261 24 Specifications Measurement Specifications Invasive Pressure Alarm Specifications Range Tachycardia Adjustment 5 bpm steps Difference to high limit 0 to 50 bpm Clamping at 150 to 300 bpm Difference to low limit 0 to 50 bpm Clamping at 25 to 100 bpm 5 bpm steps 5 bpm steps 5 bpm steps Delay max. 14 seconds max. 14 seconds Bradycardia Temp Complies with EN 12470-4:2000. Specified without transducer. Temp Performance Specifications Temp Range Resolution Accuracy Average Time Constant 1 to 45qC (30 to 113qF) 0.1qC (0.2qF) 0.1qC (0.2qF) Less than 10 seconds Temp Alarm Specifications Temp High/Low Alarms Range 1 to 45qC (30 to 113qF) Adjustment
-1 to 35qC (30 to 95qF), 0.5qC (1.0qF) steps 35 to 45qC (95 to 113qF), 0.1qC (0.2qF) steps The CO2 measurement in the monitor, M3014A and M3015A complies with EN ISO 21647:2004 +
Cor.1:2005 (except alarm system; alarm system complies with IEC 60601-2-49:2001). M3015A Microstream CO2 Performance Specifications CO2 Range Accuracy 0 to 150 mmHg (0 to 20 kPa), or 20% CO2, whichever is lower Up to 5 minutes during warmup: 4 mmHg or 12%, whichever is greater After 5 minutes warmup:
0 to 40 mmHg (0 to 5.3 kPa):2.2 mmHg (0.3 kPa) Above 40 mmHg (5.3 kPa):(5.5% + (0.08%/mmHg above 40 mmHg)) of reading These specifications are valid for 21% O2 and N2 balance, up to 35qC ambient temperature, up to 60 rpm in adult mode and 100 rpm in neonatal mode. Outside of these conditions the accuracy reaches at a minimum 4 mmHg or 12% of the reading, whichever is greater. Numeric: 1.0 mmHg (0.1 kPa) Wave: 0.1 mmHg (0.01 kPa) Included in Accuracy specifications 0 to 150 rpm 0 to 40 rpm: 1 rpm 41 to 70 rpm: 2 rpm 71 to 100 rpm: 3 rpm
>100 rpm: 5% of reading 5 minutes for full accuracy specification Resolution Stability Range Accuracy awRR Warm-up Time CO2 262 Measurement Specifications 24 Specifications M3015A Microstream CO2 Performance Specifications Rise Time 190 ms for neonatal mode
(measured with FilterLine H for neonatal) 240 ms for adult mode
(measured with FilterLine H for adult) 50 + 15/-7.5 ml/minute Maximum:
3 seconds (2m sample lines) 6 seconds (4m sample lines) Acoustic noise: <45 dBA The total system response time is the sum of the delay time and the rise time. Sound Pressure Total System Response Time Sample Flow Rate Gas Sampling Delay Time M3014A Mainstream CO2 Performance Specifications CO2 Range Accuracy 0 to 150 mmHg (0 to 20.0 kPa) after 2 minutes warmup:
For values between 0 and 40 mmHg: 2.0 mmHg (0.29 kPa) For values from 41 to 70 mmHg: 5% of reading For values from 71 to 100 mmHg: 8% of reading The specifications are valid for standard gas mixtures, balance air, fully hydrated at 35C, Pabs = 760 mmHg, flow rate = 2 l/min. Numeric: 1.0 mmHg (0.1 kPa) Wave: 0.1 mmHg (0.01 kPa) 0.8 mmHg over four hours Accuracy specification will be maintained over a 120 hour period 2 to 150 rpm 1 rpm 2 minutes with CO2 transducer attached for full accuracy specification Less than 60 ms (with adult or infant reusable or disposable adapter) Resolution Stability:
Short term drift Long term drift Range Accuracy awRR Warm-up Time Response Time M3014A Sidestream CO2 Performance Specifications CO2 Range Accuracy 0 to 150 mmHg (0 to 20.0 kPa) after 2 minutes warmup:
For values between 0 and 40 mmHg: 2.0 mmHg (0.29 kPa) For values from 41 to 70 mmHg: 5% of reading For values from 71 to 100 mmHg: 8% of reading For values from 101 to 150 mmHg: 10% of reading At respiration rates above 80 rpm, all ranges are 12% of actual. The specifications are valid for gas mixtures of CO2, balance N2, dry gas at 760 mmHg within specified operating temperature range. Numeric: 1.0 mmHg (0.1 kPa) Wave: 0.1 mmHg (0.01 kPa) 0.8 mmHg over four hours Accuracy specification will be maintained over a 120 hour period 2 to 150 rpm 1 rpm 263 Resolution Stability:
Short term drift Long term drift Range Accuracy awRR 24 Specifications Measurement Specifications M3014A Sidestream CO2 Performance Specifications Warm-up Time Sample Flow Rate Total System Response Time Operating Temperature 2 minutes with CO2 sensor attached for full accuracy specification 50 10 ml/minute 3 seconds 0 to 40C (32 to 100F) M8102A/M3014A Mainstream and Sidestream CO2 Humidity Correction Factor Either BTPS or ATPD can be selected as the humidity correction factor for the CO2 readings. The formula for the correction calculation is:
PATPD
PBTPS Pabs
Pabs PH2O Where p = partial pressure, Pabs = absolute pressure, and PH2O = 42 mmHg @35C and 100% RH. M3016A Mainstream CO2 Performance Specifications CO2 Range Accuracy 4 to 150 mmHg (-0.5 to 20.0 kPa) after 20 minutes warmup and calibration:
For values between 0 and 40 mmHg: 2.2 mmHg (0.29 kPa) For values between 40 and 76 mmHg: 5.5% of reading The specifications are valid for 45% O2 and N2 or N2O balance. Outside these conditions the accuracy reaches at a minimum the requirements of EN864/ISO9918. Numeric: 1.0 mmHg (0.1 kPa) Wave: 0.1 mmHg (0.01 kPa) 1.0 mmHg over a 7 day period 0 to 150 rpm 2 rpm 20 minutes with CO2 transducer attached for full accuracy specification Less than 125 ms (for step from 10% to 90%) Resolution Stability Range Accuracy awRR Warm-up Time Response Time Mainstream CO2 Humidity Correction Factor Either BTPS or ATPD can be selected as the humidity correction factor for the Mainstream CO2 readings. The formula for the correction calculation is:
PATPD
PBTPS Pabs
Pabs PH2O Where p = partial pressure, Pabs = absolute pressure, and PH2O = 47 mmHg @37qC and 100% RH. 264 Measurement Specifications 24 Specifications CO2 Alarm Specifications etCO2 High etCO2 Low imCO2 High Range 20 to 95 mmHg (2 to 13 kPa) 1 mmHg (0.1 kPa) 10 to 90 mHg (1 to 12 kPa) Adjustment 2 to 20 mmHg
(0.3 to 3.0 kPa) steps of 1 mmHg
(0.1 kPa) awRR High Adult/pedi: 10 to 100 rpm Neo: 30 to 150 rpm awRR Low Adult/pedi: 0 to 95 rpm Neo: 0 to 145 rpm under 20 rpm: 1 rpm steps over 20 rpm:5 rpm steps Apnea delay 10 to 40 seconds 5 second steps Delay M8102A/M3014A/M3016A: less than 14 seconds M3015A: less than18 seconds. M8102A/M3014A/M3016A: less than 14 seconds M3015A: less than18 seconds. M8102A/M3014A/M3016A: less than 14 seconds M3015A: less than18 seconds. M3015A:
settings <20 rpm: less than 8 seconds
>20 rpm: less than 18 seconds M8102A/M3014A/M3016A settings <20 rpm: less than 4 seconds
>20 rpm: less than 14 seconds set apnea delay time +4 seconds
(M8102A/M3014A/M3016A) or 8 seconds (M3015A) Interfering Gas and Vapor Effects On CO2 Measurement Values The specified deviations for M8102A/M3014A are valid when the appropriate corrections are switched on and set correctly. Gas or Vapor Nitrous Oxide Halothane Enflurane Isoflurane Sevoflurane Xenon Helium Metered dose inhaler propellants Desflurane Ethanol Isopropanol Acetone Methane Gas Level
(% volume fraction) 60 4 5 5 5 80 50
15 0.1 0.1 0.1 1.0 M3015A M8102A/M3014A Additional deviation due to gas interfence, measured at 0 - 40 mmHg CO2 1 mmHg 2 mmHg 2 mmHg 2 mmHg 2 mmHg
-5 mmHg 1 mmHg not specified for use 5%
5%
5%
5%
5%
5%
5%
+5 mmHg 1 mmHg 1 mmHg 1 mmHg 1 mmHg 5%
5%
5%
5%
5%
265 24 Specifications Safety and Performance Tests Safety and Performance Tests You must observe any national regulations on the qualification of the testing personnel and suitable measuring and testing facilities. See the maintenance section for a list of required tests. Safety and performance tests, and what to do if the instrument does not meet these specifications are described in the Installation and Service guide. Electromagnetic Compatibility (EMC) Specifications Take special precautions regarding electromagnetic compatibility (EMC) when using medical electrical equipment. You must operate your monitoring equipment according to the EMC information provided in this book. Portable and mobile radio frequency (RF) communications equipment can affect medical electrical equipment. Accessories Compliant with EMC Standards All accessories listed in the accessories section comply, in combination with the monitor, with the requirements of IEC 60601-1-2:2001 + A1:2004. WARNING Using accessories other than those specified may result in increased electromagnetic emission or decreased electromagnetic immunity of the monitoring equipment. Electromagnetic Emissions The monitor is suitable for use in the electromagnetic environment specified in the table below. You must ensure that it is used in such an environment Emissions test Radio Frequency (RF) emissions Compliance Group 1 RF emissions CISPR 11 for the MP2 or X2 with all accessories except the M2741A Sidestream CO2 sensor RF emissions CISPR 11 for the MP2 or X2 whenever used with the M2741A Sidestream CO2 sensor Class B Class A Avoiding Electromagnetic Interference The monitor uses RF energy only for its internal function. Therefore, its RF emissions are very low and are not likely to cause any interference in nearby electronic equipment The monitor is suitable for use in all establishments, including domestic establishments and those directly connected to the public low-voltage supply network that supplies buildings used for domestic purposes. The monitor is suitable for use in all establishments other than those directly connected to the public low-voltage power supply network that supplies buildings used for domestic purposes. Avoiding Electromagnetic Interference (Resp) The respiration (Resp) measurement is a very sensitive measurement that measures a very small signal. Technological limitations do not allow higher immunity levels than 1 V/m for radiated RF electromagnetic fields and 1 Vrms for conducted disturbances induced by RF fields. Electromagnetic fields with field strengths above 1 V/m and conducted disturbances above 1 Vrms may cause erroneous measurements. Therefore Philips recommends that you avoid using electrically radiating equipment in the close proximity of this measurement. 266 Safety and Performance Tests 24 Specifications WARNING The monitor should not be used next to or stacked with other equipment. If you must stack the monitor, you must check that normal operation is possible in the necessary configuration before you start monitoring patients. Electromagnetic Immunity The monitor is suitable for use in the specified electromagnetic environment. The user must ensure that it is used in the appropriate environment as described below. IEC 60601-1-2 test level 6 kV contact 8 kV air Compliance level 6 kV contact 8 kV air 2 kV for power supply lines 1 kV for input/output lines 2 kV for power supply lines 1 kV for input/output lines 1 kV differential mode 2 kV common mode 1 kV differential mode 2 kV common mode
<5% UT
(>95% dip in UT) for 0.5 cycles 40% UT
(60% dip in UT) for 5 cycles 70% UT
(30% dip in UT) for 25 cycles
<5% UT
(>95% dip in UT) for 5 sec 3 A/m
<5% UT
(>95% dip in UT) for 0.5 cycles 40% UT
(60% dip in UT) for 5 cycles 70% UT
(30% dip in UT) for 25 cycles
<5% UT
(>95% dip in UT) for 5 sec 3 A/m Immunity test Electrostatic discharge (ESD) IEC 61000-4-2 Electrical fast transient/burst IEC 61000-4-4 Surge IEC 61000-4-5 Voltage dips, short interruptions and voltage variations on power supply input lines IEC 61000-4-
11 Power frequency
(50/60 Hz) magnetic field IEC 61000-4-8 Electromagnetic environment guidance Floors should be wood, concrete, or ceramic tile. If floors are covered with synthetic material, the relative humidity should be at least 30%. Mains power quality should be that of a typical commercial and/or hospital environment Mains power quality should be that of a typical commercial and/or hospital environment Mains power quality should be that of a typical commercial and/or hospital environment. If the user of the monitor requires continued operation during power mains interruptions, it is recommended that the monitor is equipped with an internal battery or is powered from an uninterruptible power supply. Power frequency magnetic fields should be a t levels characteristic of a typical location in a typical commercial and/or hospital environment In this table, UT is the a.c. mains voltage prior to application of the test level. Recommended Separation Distance WARNING The monitor, equipped with a wireless network interface, intentionally receives RF electromagnetic energy for the purpose of its operation. Therefore, other equipment may cause interference, even if that other equipment complies with CISPR emission requirements. In the following table, P is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer and d is the recommended separation distance in metres
(m). The values given in brackets are for respiration. 267 24 Specifications Safety and Performance Tests Portable and mobile RF communications equipment should be used no closer to any part of the monitor, including cables, than the recommended separation distance calculated from the equation appropriate for the frequency of the transmitter. Field strengths from fixed RF transmitters, as determined by an electromagnetic site survey, should be less than the compliance level in each frequency range. Interference may occur in the vicinity of equipment marked with this symbol:
Immunity test Conducted RF IEC 61000-4-6 IEC 60601-1-2 test level 3 VRMS 150 kHz to 80 MHz Compliance level 3 VRMS
(1 VRMS for respiration) Radiated RF IEC 61000-4-3 3 V/m 80 MHz to 2.5 GHz 3 V/m
(1 V/m for respiration) For short range radio, see note1. Electromagnetic environment guidance Recommended separation distance:
1,2 P d
for respiration:
3,5 P d Recommended separation distance:
80 MHz to 800 MHz d 1,2 P
80 MHz to 800 MHz for respiration d 3,5 P
800 MHz to 2,5 GHz d 2,3 P
800 MHz to 2,5 GHz for respiration d 7,0 P
2.0 to 2,3 GHz for short range radio d 7,0 P
1.If ECG/SpO2 signals are acquired from a telemetry device via short range radio the compliance level is 3V/m except in the range 2.0 to 2.3 GHz where it is 1 V/m. Field strengths from fixed transmitters, such as base stations for radio (cellular, cordless) telephones and land mobile radios, amateur radio, AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy. To assess the electromagnetic environment due to fixed RF transmitters, an electromagnetic site survey should be considered. If the measured field strength in the location in which the monitor is used exceeds the applicable RF compliance level above, the monitor should be observed to verify normal operation. If abnormal performance is observed, additional measures may be necessary, such as reorienting or relocating the monitor. These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects, and people. 268 Safety and Performance Tests 24 Specifications Recommended separation distances from portable and mobile RF communication equipment The monitor is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled. The customer or user of the monitor can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment and the monitor as recommended below, according to the maximum output power of the communications equipment. In the following table, P is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer and d is the recommended separation distance in metres
(m). The values given in brackets are for those measurements which do not use the general formula. Frequency of transmitter 150 kHz to 80 MHz 80 MHz to 800 MHz 800 MHz to 2,5 GHz d
1,2 P d
1,2 P d
2,3 P for respiration:
d
3,5 p for respiration:
d
3,5 P for respiration:
d
7,0 P for short range radio in the range 2.0 to 2.3 GHz:
d
7,0 P Separation distance (m) 0.1 (0.4) 0.4 (1.1) 1.3 (3.5) 3.8 (11.1) 12.0 (35.0) Separation distance (m) 0.1 (0.4) 0.4 (1.1) 1.3 (3.5) 3.8 (11.1) 12.0 (35.0) Separation distance (m) 0.2 (0.7) 0.7 (2.2) 2.3 (7.0) 7.3 (22.1) 23.0 (70.0) Equation Rated max. output power of transmitter (W) 0.01 0.1 1 10 100 Electrosurgery Interference/Defibrillation/Electrostatic Discharge The equipment returns to the previous operating mode within 10 seconds without loss of any stored data. Measurement accuracy may be temporarily decreased while performing electro-surgery or defibrillation. This does not affect patient or equipment safety. Do not expose the equipment to x-ray or strong magnetic fields (MRI). Fast Transients/Bursts The equipment will return to the previous operating mode within 10 seconds without loss of any stored data. If any user interaction is required, the monitor indicates with a technical alarm (INOP). Restart time After power interruption, an ECG wave will be shown on the display after 30 seconds maximum. 269 24 Specifications Safety and Performance Tests 270 25 25Default Settings Appendix This appendix documents the most important default settings of your monitor as it is delivered from the factory. For a comprehensive list and explanation of default settings, see the Configuration Guide supplied with your monitor. The monitors default settings can be permanently changed in Configuration Mode. Note: If your monitor has been ordered preconfigured to your requirements, the settings at delivery will be different from those listed here. Country-Specific Default Settings Certain default settings are specific to a particular country. These are listed here for all countries alphabetically. Country-Description Line Frequency Units Afghanistan land Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas, The Bahrain Bangladesh Barbados Belarus Belgium 50/60 [Hz]
50 50 50 50 60 60 50 60 60 50 50 50 60 50 50 50 60 50 60 50 50 50 Weight kg, lb kg kg kg kg lb lb kg lb lb kg kg kg kg kg kg kg kg kg lb kg kg kg ECG Cable Color Units Height in, cm IEC, AAMI cm cm cm cm in in cm in in cm cm cm cm cm cm cm cm cm in cm cm cm AAMI IEC IEC IEC AAMI AAMI IEC AAMI AAMI AAMI AAMI IEC AAMI AAMI IEC IEC AAMI AAMI AAMI AAMI IEC IEC 271 25 Default Settings Appendix Country-Specific Default Settings Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Islands Cocos Keeling Islands Colombia Comoros Congo Congo, Democratic Republic of the Cook Islands Costa Rica Cte d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands, Malvinas Faroe Islands Fiji 60 60 60 60 50 50 50 60 60 60 50 50 50 50 50 50 50 60 60 60 50 60 50 50 60 60 60 60 50 50 60 60 50 50 60 50 50 60 50 50 60 60 50 60 50 50 50 50 60 60 60 lb lb kg lb kg kg kg lb kg lb kg kg kg kg kg kg kg kg lb kg kg lb kg kg lb lb kg lb kg kg lb kg kg kg kg kg kg lb kg kg kg kg kg kg kg kg kg kg lb lb lb in in cm in cm cm cm in cm in cm cm cm cm cm cm cm cm in cm cm in cm cm in in cm in cm cm in cm cm cm cm cm cm in cm cm cm cm cm cm cm cm cm cm in in in AAMI AAMI AAMI AAMI AAMI IEC IEC AAMI AAMI AAMI AAMI IEC IEC IEC IEC IEC IEC AAMI AAMI AAMI IEC AAMI AAMI IEC AAMI AAMI AAMI AAMI IEC IEC AAMI AAMI IEC IEC IEC IEC IEC AAMI IEC AAMI AAMI AAMI IEC AAMI IEC IEC IEC IEC AAMI AAMI AAMI 272 Country-Specific Default Settings 25 Default Settings Appendix 50 Finland 50 France 50 French Guiana 60 French Polynesia 60 French Southern Territories 50 Gabon 50 Gambia, The 60 Georgia 50 Germany 50 Ghana 60 Gibraltar 50 Greece 60 Greenland 50 Grenada 50 Guadeloupe 60 Guam 60 Guatemala 50 Guernsey 60 Guinea 60 Guinea-Bissau 60 Guyana 60 Haiti 60 Heard Island and McDonald Islands 60 Holy See, Vatican City State 60 Honduras 50 Hong Kong 50 Hungary 50 Iceland 50 India 50 Indonesia 50 Iran, Islamic Republic of 50 Iraq 50 Ireland 50 Isle of Man 50 Israel 50 Italy 50 Jamaica 60 Japan 50 Jersey 50 Jordan 50 Kazakhstan 50 Kenya 60 Kiribati Korea, Democratic Peoples Republic of 60 60 Korea, Republic of 50 Kuweit Kyrgyzstan 60 50 Lao Peoples Democratic Republics 50 Latvia 50 Lebanon Lesotho 50 kg kg kg lb lb kg kg lb kg kg lb kg lb kg kg lb kg kg lb lb kg kg lb lb kg kg kg kg kg kg kg kg kg kg kg kg kg kg kg kg kg kg lb lb kg kg lb kg kg kg kg cm cm cm in in cm cm in cm cm in cm in cm cm in cm cm in in cm cm in in cm cm cm cm cm cm cm cm cm cm cm cm cm cm cm cm cm cm in in cm cm in cm cm cm cm IEC IEC IEC AAMI AAMI IEC IEC AAMI IEC IEC AAMI IEC AAMI AAMI IEC AAMI AAMI IEC AAMI AAMI AAMI AAMI AAMI AAMI AAMI IEC IEC IEC IEC IEC AAMI AAMI IEC IEC IEC IEC AAMI IEC IEC AAMI IEC IEC AAMI AAMI AAMI AAMI AAMI IEC IEC AAMI IEC 273 25 Default Settings Appendix Country-Specific Default Settings Liberia Libyan Arab. Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia, The former Yugoslavian Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federal States of Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Islands Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru 50 60 60 50 50 60 50 50 50 50 60 50 50 60 60 50 60 60 60 60 60 60 60 50 50 50 50 60 50 60 60 50 50 60 50 60 50 50 60 60 60 50 50 50 60 50 60 60 50 60 kg lb lb kg kg lb kg kg kg kg lb kg kg lb kg kg lb lb kg lb lb lb lb kg kg kg kg lb kg lb lb kg kg lb kg kg kg kg lb lb lb kg kg kg lb kg lb lb kg kg cm in in cm cm in cm cm cm cm in cm cm in cm cm in in cm in in in in cm cm cm cm in cm in in cm cm in cm in cm cm in in in cm cm cm in cm in in cm cm IEC AAMI AAMI IEC IEC AAMI IEC IEC IEC IEC AAMI IEC IEC AAMI IEC IEC AAMI AAMI AAMI AAMI AAMI AAMI AAMI IEC AAMI IEC IEC AAMI IEC AAMI AAMI IEC AAMI AAMI AAMI AAMI IEC IEC AAMI AAMI AAMI IEC AAMI IEC AAMI AAMI AAMI AAMI AAMI AAMI 274 Country-Specific Default Settings 25 Default Settings Appendix Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Serbia & Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Rep Taiwan, Province of China Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia 60 60 50 50 60 50 60 50 50 50 60 60 50 60 50 60 60 60 50 50 50 50 60 50 50 50 50 60 50 60 60 50 60 50 60 60 60 50 50 50 60 60 60 50 60 60 60 60 60 50 kg lb kg kg lb kg lb kg kg kg lb kg kg lb kg lb lb lb kg kg kg kg lb kg kg kg kg lb kg lb lb kg lb kg kg lb lb kg kg kg kg lb lb kg lb lb lb lb lb kg cm in cm cm in cm in cm cm cm in cm cm in cm in in in cm cm cm cm in cm cm cm cm in cm in in cm in cm cm in in cm cm cm cm in in cm in in in in in cm AAMI AAMI IEC IEC AAMI AAMI AAMI IEC IEC IEC AAMI AAMI AAMI AAMI AAMI AAMI AAMI AAMI AAMI IEC IEC IEC AAMI IEC IEC IEC IEC AAMI IEC AAMI AAMI IEC AAMI IEC AAMI AAMI AAMI IEC IEC AAMI AAMI AAMI AAMI AAMI AAMI AAMI AAMI AAMI AAMI IEC 275 25 Default Settings Appendix Country-Specific Default Settings Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine UK United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands (British) Virgin Islands (US) Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe 50 60 60 60 60 60 50 50 50 60 60 50 60 60 60 50 50 60 60 50 50 60 60 kg lb kg lb lb lb kg kg kg lb lb kg lb lb lb kg kg lb lb kg kg lb lb cm in cm in in in cm cm cm in in cm in in in cm cm in in cm cm in in IEC AAMI AAMI AAMI AAMI AAMI IEC AAMI IEC AAMI AAMI AAMI AAMI AAMI AAMI IEC AAMI AAMI AAMI IEC AAMI AAMI AAMI 276 Alarm and Measurement Default Settings 25 Default Settings Appendix Alarm and Measurement Default Settings Settings are only entered once per table row if they are the same for all patient categories1. Alarm Default Settings Alarm Settings Alarm Volume Alarms Off Pause Al. 5min Pause Al. 10min Auto Alarms Off Alarm Off Reminder Visual Latching Audible Latching Alarm Reminder Reminder Time Alarm Sounds Red Alarm Interval Yel. Al. Interval Alarm Low Red Alarm Volume Yell. Alarm Volume Inop Volume Auto Increase Vol. Increase Vol Delay Keep Blinking Relay 1 Sensitiv. Relay 2 Sensitiv. Relay 3 Sensitiv. Inop Relay Latency Yel. Relay Latency Alarm Text No Centr Mon Min Vol Factory Default 5 2 min. Enabled Enabled Off Off Red & Yell Red & Yell On 3 min Traditional 10 sec 20 sec 4 AlarmVol +2 AlarmVol +0 AlarmVol +0 2 Steps 20 sec No R & Y & I Red & Yell Red 5 sec 2 sec Standard 4 1.A profile Outdoor exists for use in typical outdoor conditions (bright sunlight, higher ambient noise). See the Configuration Guide for details. 277 25 Default Settings Appendix ECG, Arrhythmia, ST and QT Default Settings ECG, Arrhythmia, ST and QT Default Settings ECG Settings High Limit Low Limit Alarms Alarm Source ECG QRS Volume Primary Lead Secondary Lead Analysis Mode Lead Placement Mod. Lead Placment Filter Speed Auto Filter Default ECG Size Color Asystole Thresh
'ExtrTachy Tachy Clamp
'ExtrBrady Brady Clamp ALL ECG IN. Fallback Alarms Off Alarm Source Sel. Va Lead Vb Lead SyncPulse sensit SyncPulse Marker Fallback ECGTele Arrhythmia Settings Arrhythmia Pause Threshold VTach HR VTach Run 278 Pedi 160 bpm 75 bpm Neo 200 bpm 100 bpm 3.0 sec 220 bpm 240 bpm 50 bpm Factory Defaults Adult 120 bpm 50 bpm On Auto On 1 II V Multi-lead Standard Off Monitor 25 mm/s Off x1 Green 4.0 sec 20 bpm 200 bpm 20 bpm 40 bpm On On Enabled Enabled V2 V5 Medium On Enabled Factory Defaults Adult On 2.0 sec 100 5 Pedi 120 Neo Off 1.5 sec 150 ECG, Arrhythmia, ST and QT Default Settings 25 Default Settings Appendix Pedi 200 5 Neo 210 5 Arrhythmia Settings Vent Rhythm SVT HR SVT Run PVCs/min Non-Sustain Vent Rhythm Run PVCs Pair PVCs R-On-T PVCs V.Bigeminy V.Trigeminy PVCs/min Multif. PVCs Pacer N. Cap Pacer N. Pac Pause Missed Beat SVT Afib IrregularHR HR Alarms TimeOut 1st TimeOut 2nd Arrhy Off Message SOME ECG IN Factory Defaults Adult 14 180 5 10 On On On On On On On On On On On On On On On On Short Yell 3 min 10 min Yes On 279 25 Default Settings Appendix ECG, Arrhythmia, ST and QT Default Settings Lead-independent ST Settings ST Alarm Mode Alarms ST Analysis ST-Index ISO Point J Point ST Point Pedi Off Factory Defaults Adult Single ST On On On
-80 ms 48 ms J+60 Neo Lead I, II, III, V, aVR, aVL, aVF, V1-6, MCL Settings Factory Defaults Factory Adult Factory Pedi Factory Neo ST(Label) On Off For Alarm Mode = Single-ST ST(Label) High ST(Label) Low For Alarm Mode = Multi-ST ST(Label) High ST(Label) Low QT Settings QT Lead QTc High Limit
'QTc Limit QTc High Alarm On/Off
'QTc High Alarm On/Off QT Analysis QTc Formula
+2.0 mm
-2.0 mm
+1.0 mm
-1.0 mm Factory Defaults Factory Adult Factory Pedi Factory Neo 480 ms 460 ms All 500 ms 60 ms On On Off Bazett 280 Pulse Default Settings 25 Default Settings Appendix Pulse Default Settings Pulse Settings Alarms Source Pulse (Label) System Pulse Alarms Off Alarm Source Sel. Pulse Alarm Settings Pulse (SpO2) Pulse Alarms High Limit Low Limit
' Extr Brady Brady Clamp
' Extr Tachy Tachy Clamp Factory Defaults Adult Auto On SpO2 Enabled Enabled Factory Defaults Adult On Off 120 bpm 50 bpm 20 bpm 40 bpm 20 bpm 200 bpm Pedi Neo Pedi Neo 160 bpm 75 bpm 200 bpm 100 bpm 40 bpm 50 bpm 220 bpm 240 bpm Pulse alarms use the settings of the currently selected Pulse alarm source. Respiration Default Settings Respiration Settings Factory Defaults Adult Pedi High Limit Low Limit Apnea Time Alarms Resp Auto/Manual Resp Speed Color 30 rpm 8 rpm 20 sec On On Auto (Trigger Mode) 6.25 mm/s Yellow Neo 100 rpm 30 rpm 281 25 Default Settings Appendix SpO2 Default Settings SpO2 Default Settings SpO2 Settings Alarms QRS Volume Tone Modulation Tone Mod. Type Speed Perfusion Average NBP Alarm Suppr. Extd. Auto OnOff Color Factory Defaults Pedi Neo Adult On 1 Yes Enhanced 25 mm/s On 10 sec On Disabled light blue (cyan) SpO2 Alarm Default Settings Setting Desat Limit Low Limit High Limit Desat delay High Alarm delay Low Alarm delay Parameter Alarms On/Off Label Pulse Settings Pulse (SpO2) On/Off Pulse Alarms On/Off Pulse High Limit Pulse Low Limit
'Extr Brady Brady Clamp
' ExtrTachy Tachy Clamp Adult 80 90 100 20 sec 10 sec 10 sec on SpO2 on on 120 bpm 50 bpm 20 bpm 40 bpm 20 bpm 200 bpm Pediatric Neonatal 80 90 100 20 sec 10 sec 10 sec on SpO2 on on 160 bpm 75 bpm 20 bpm 40 bpm 20 bpm 220 bpm 80 85 95 20 sec 10 sec 10 sec on SpO2 on on 200 bpm 100 bpm 20 bpm 50 bpm 20 bpm 240 bpm 282 NBP Default Settings 25 Default Settings Appendix NBP Default Settings NBP Settings Mode Alarms from High Alarm Limit Low Alarm Limit Alarms NBP Repetition Time Pulse (NBP) Unit Done Tone Start Time VP Pressure Reference Color Factory Defaults Adult Auto Sys. 160/90 (110) 90/50 (60) On On 10 min On mmHg Off Synchronized 60 mmHg Auscultatory Red Temperature Default Settings Temp Settings Low Limit High Limit Alarms Unit Range Color Factory Defaults Adult 36 39 On qC 35...43 Green Pedi Neo Manual 120/70 (90) 70/40 (50) 90/60 (70) 40/20 (24) 40 mmHg 30 mmHg Invasive Pedi Neo Invasive Pressure Default Settings ABP, ART, Ao, BAP, FAP, P, P1, P2, P3, P4, UAP Settings Alarms from High Limit Low Limit Alarms Extreme Alarms Factory Defaults Adult Sys. 160/90 (110) 90/50 (70) On Disabled Pedi Neo 120/70 (90) 70/40 (50) 90/60 (70) 55/20 (36) 283 25 Default Settings Appendix Invasive Pressure Default Settings Pedi 10 10 140/80 (100) 60/35 (45) 100 Neo 5 5 105/75 (75) 45/15 (30) 100 ABP, ART, Ao, BAP, FAP, P, P1, P2, P3, P4, UAP Settings
'Extreme High
'Extreme Low High Clamp Low Clamp Scale Speed Mean Only Filter Mercury Cal. Artifact Suppr. Unit Color Factory Defaults Adult 15 15 190/100 (125) 80/45 (65) 150 25 mm/s No 12 Hz Yes 60 sec mmHg Red Factory Defaults CVP, RAP, LAP, UVP Settings Adult Pedi Neo 10/2 (4) 2/-4 (0) 10/2 (4) 2/-4 (0) 5 5 15/5 (10) 0/-5 (-5) 5 5 15/5 (10) 0/-5 (-5) Alarms from High Limit Low Limit Alarms Extreme Alarms
'Extreme High
'Extreme Low High Clamp Low Clamp Scale Speed Mean Only Filter Mercury Cal. Artifact Suppr. Unit Color Average in Mon. Signal Quality Mean 14/6 (10) 6/-4 (0) On Enabled 5 5 20/10 (15) 0/-5 (-5) 30 25 mm/s Yes 12 Hz Yes 60 sec mmHg light blue (cyan) No On 284 Invasive Pressure Default Settings 25 Default Settings Appendix Pedi Neo 60/4 (26) 24/-4 (12) Enabled 5 5 65/5 (35) 15/-5 (5) 60/4 (26) 24/-4 (12) Enabled 5 5 65/5 (35) 15/-5 (5) Pedi Neo 10/2 (4) 2/-4 (0) Enabled 10 10 15/5 (-5) 0/-5 (0) 10/2 (4) 2/-4 (0) Enabled 10 10 15/5 (-5) 0/-5 (0) PAP Settings Alarms from High Limit Low Limit Alarms Extreme Alarms
'Extreme High
'Extreme Low High Clamp Low Clamp Scale Speed Mean Only Filter Mercury Cal. Artifact Suppr. Unit Color Factory Defaults Adult Dia. 34/16 (20) 10/0 (0) On Enabled 5 5 45/20 (25) 5/-5 (-5) 30 25 mm/s No 12 Hz Yes 60 sec mmHg Yellow ICP, IC1, IC2 Settings Factory Defaults Alarms from High Limit Low Limit Alarms Extreme Alarms
'Extreme High
'Extreme Low Low Clamp High Clamp Scale Speed Mean Only Filter Mercury Cal. Artifact Suppr. Unit Color Adult Mean 14/6 (10) 6/-4 (0) On Enabled 10 10 20/10 (-5) 0/-5 (0) 30 25 mm/s Yes 12 Hz Yes 60 sec mmHg Magenta 285 25 Default Settings Appendix CO2 Default Settings CO2 Default Settings Factory Defaults CO2 Settings etCO2 low etCO2 high imCO2 high CO2 Alarms Unit Scale ImCO2 N2O Corr (only M3015A/M3016A) Oxygen Corr (only M3014A) Gas Corr (only M3014A) Humidity Corr Max Hold AwRR AwRR Alarms AwRR high limit AwRR low limit Apnea time Color Adult 30 50 4 on mmHg 40 mmHg on Off 16%
Off BTPS Off On On 30 8 20 secs Yellow Pedi Neo 100 30 286
10-lead placement (ECG) 99 12-lead placement (ECG) 99 3-lead placement (ECG) 97 5-lead placement (ECG) 97 A AAMI ECG lead labels 96 abdominal breathing and Resp electrode placement 138 aberrantly conducted beats 106 accessories 10-electrode cable sets 230 3-electrode cable sets 230, 232 5-electrode cable sets 230, 232 5-electrode one piece cables 232 6-electrode cable sets 230 CO2 173 CO2 (mainstream) 239, 240 CO2 (microstream) 240 ECG 229 NBP adult cuffs 234 comfort cuffs 233 disposable cuffs 233 multi-patient comfort cuff kits 233 neonatal/infant cuffs
(disposable) 234 reusable cuffs 233 single-hose disposable cuffs 234 Nellcor 235 pressure 234 Pulsion 234 resp 229 set combiners and organizers 231, 232 SpO2 235 Nellcor adhesive sensors
(disposable) 235 Philips sensors (disposable) 235 Philips sensors (reusable) 235 temperature 239 trunk cables 229, 231 active alarms 39 address, Philips 244 addressograph (printer configuration setting) 209 adjusting ST measurement points 120 adjusting wave scale (pressure) 163 adjusting wave size (CO2) 174 admit editing information 85 quick admit 85 admitting a patient 83 airway adapter CO2, microstream accessory 173 alarm latching 50, 112 alarm limits changing 46 checking 45 manually adjusting 46 narrow 48 report 210 ST 122 switching auto limits on/off 48 using automatic limits 48 wide 48 window 45 alarm recording choosing recorded measurements 200 alarm source selection, disabled 135 alarms acknowledging 42 active 39 active SpO2 source 148 alphabetical listing 53 apnea delay 176 apnea delay time (Resp) 140 arrhythmia 39 audible indicators 41 awrr limits 176 chaining 114 CO2 specific 175 CO2, apnea delay 176 CO2, awRR 176 desat, SpO2 147 effect on pressure alarms during zero 161 extending pause time 44 high priority 39 INOP 39 ISO/IEC standard 41 key 16 limit, SpO2 260 message field 17 NBP source 154 off indicator 17 patient messages 53 pausing 43 1Index physiological 53 pleth as source 148 recordings 51 red 39 reminder 43 restarting 44 reviewing window 49 selftest 51 silencing 42 SpO2 high and low limits 147 SpO2 specific 146 ST 122 suspended symbol 44 switching on and off 44 temperature 157 testing 51 tone configuration 41 traditional 41 visual indicators 40 volume, changing 41 yellow 39 alarms key 16 alphabetical listing of alarms 53 analog output ECG 246 apnea alarm delay CO2 176 apnea alarm delay time (RESP) 140 apnea alarms and Resp detection modes 140 arrhythmia aberrantly conducted beats 106 analysis, how it works 105 atrial fibrillation and flutter 106 beat labels 108 initiating learning 110, 111 intermittent bundle branch block 107 learning during ventricular rhythm 111 levels of analysis 102, 105 monitoring non-paced patients 106 monitoring paced patients 106 options 105 relearning 110 relearning and lead fallback 111 status messages 109 switching on/off 106 understanding the display 107 arrhythmia alarms 39, 111 adjusting alarm limits 112 all yellow on/off 112 i chaining 114 latching 112 multiple 114 pvc-related alarms 115 sinus and SV rhythm ranges 257, 260 switching on/off 112 timeout periods 113 arrhythmia monitoring and defibrillation 104 arrhythmia options 102 arrhythmia relearning with EASI INOP 101 arterial pressure source 166 arterial pulsation 143 artifact suppression (pressure) 163 atrial fibrillation and flutter 106 audlatching (arrhythmia alarms) 112 auto alarm limits switching on/off 48 using 48 auto detection mode (Resp) 138 autofilter 94 automatic arrhythmia relearn 111 automatic default setting 27 automatic NBP repeat time 154 autosize ECG wave 94 awRR alarm limits 176 awRR alarms CO2 176 B baseline ST map, updating 125 ST, updating 119 basic arrhythmia option 102, 105 battery and display brightness 221 battery reports 220 battery status window 219 charge status 220 compartment 217 conditioning 222 conserving power 221 indicators 218 LED 218 malfunction indicator 219 malfunction symbols 218 monitoring time 219 power gauge 218 recharging 217 replacing 220 safety information 222 ii status indicator 18, 219 symbol 245 time to empty 220 time to full 220 battery eject symbol 245 battery performance optimizing 221 battery status indicator 18 beat labels arrhythmia 108 bed information 33 blood pressure. See also NBP (non-invasive) or PRESS (invasive) Brightness SmartKey 30 brightness, adjusting 30 C calculating cerebral perfusion 166 calculating temperature difference 158 calibrating CO2 transducer 171 calibration interval, NBP 226 NBP 156 pressure 165 pressure transducer 165 capnography mainstream 14 Microstream 14 carbon dioxide, see CO2 167 cardiac overlay and Resp detection modes 139 when measuring Resp 137 cardiotach alarms 102 cautions 9 central recorder choosing 200 cerebral perfusion 166 chaining 114 change screen menu 23 change screen window 16, 24 Changing 23 changing ECG lead sets 96 changing Resp detection mode 138 changing Resp wave size 139 changing Resp wave speed 140 changing screen content 23 channels recorder 200 checking battery charge 220 checking paced status 90 checklist delivery 2 installation 1 cleaning infection control 213 method 214 monitoring accessories 215 recommended substances 214 CO2 airway adapter 173 alarms, apnea delay 176 alarms, awRR 176 alarms, specific 175 awRR alarm limits 176 checking transducer accuracy 171 correction, humidity 175 correction, N2O 175 corrections 174 FilterLine 173 measuring mainstream 168, 171 measuring microstream 173 method, mainstream 167 method, microstream 167 method, sidestream 167 microstream accessories 173 microstream extension 173 removing exhaust gases 171, 174 transducer, calibrating 171 transducer, using 172 troubleshooting 174 wave scale, adjusting 174 CO2 (mainstream). accessories 239, 240 CO2 (microstream). accessories 240 conditioning batteries 222 configuration mode 22 entering 7 conflict label 28 connecting power 4 connecting temperature probe 157 connection direction symbol 245 connectors 246 temp 157 conventional 12-lead ECG 99 correcting the NBP measurement 153 CPAP (RESP) 139 cuff pressure, NBP 154 selection, NBP 153 current view ST map 122 D damage mechanical 31 damage claims 2 date, setting 7, 30 DC power symbol 245 default profile 26 default settings 271 checking country-specific 7 defibrillation and arrhythmia monitoring 104 and ECG monitoring 104 synchronization marks 91 defibrillator proof symbol 245 defibrillator synch maintenance interval 226 delay time recording 201 demonstration mode 22 desat alarm, SpO2 147 detection modes (Resp) 138 diagnostic (ECG filter setting) 95 discharging a patient 85 disconnect INOPs silencing 43 disinfecting infection control 213 recommended substances 214 display arrhythmia 107 ECG 91 NBP 153 Resp 138 ST 118 display brightness 221 display settings 25 disposal gas cylinder 227 parts and accessories 227 dual Temp measurement 158 dyshemoglobins intravascular (SpO2) 145 E early systolic blood pressure, NBP 154 EASI activating 95 ECG monitoring 101 lead placement 101 EASI ECG lead labels 96 ECG 89 accessories 229 alarms off (Config Mode) 103 changing lead sets 96 choosing electrode sites 95 conventional 12-lead 99 external pacing electrodes 105 filter settings 94 fusion beat pacemakers 105 intrinsic rhythm 104 modified 12-lead 99 New Lead Setup 96 pacemaker failure 104 rate adaptive pacemakers 105 unfiltered 95 wave size 93 ECG analog output 246 ECG cable for operating room 104 ECG cables, connecting 90 ECG connector 90 ECG display 91 ECG electrode colors 96 ECG electrode placement during electro-surgery 104 ECG gain in reports 204 ECG lead labels 96 ECG lead placement choosing EASI/Standard 95 ECG leads monitored 96 ECG report 211 lead layout 204 ECG safety information 104 ECG source tracking 183 ECG wave autosize 94 calibration bar 94 ectopic status messages (arrhythmia monitoring) 110 electrical output symbol 245 electrode placement (ECG) 89 conventional 12-lead 99 modified 12-lead 99 electrode placement (Resp) 137 with abdominal breathing 138 with lateral chest expansion 138 electro-surgery and ECG 104 EMC interference Resp 140 EMI filter for ECG 94 end case discharging a patient 85 report, printing 85 end case reports setup 205 enhanced arrhythmia option 102, 105 exclamation mark symbol 245 exhaust gases, removing 171, 174 extension cable for SpO2 144 external pacing electrodes and ECG monitoring 105 extreme bradycardia alarm 103, 135 extreme pressure alarms 164 extreme rate alarms 103, 135 extreme tachycardia alarm 103, 135 F fallback (ECG) 96 FAST Fourier artefact suppression technology 143 filter (ECG filter setting) 94 filter (ECG) 94 FilterLine CO2, microstream accessory 173 flushing invasive pressure accessories 159 functional arterial oxygen saturation 143 fusion beat pacemakers and ECG monitoring 105 G gas cylinder empty, disposing of 227 getting started 31 global trend time 195 graphic trends 188 graphic trends report 192 H hemodynamic measurement extension 15 hemodynamic MMS extension 15 horizon trend trend time 195 HR = RR (Resp) 138 HR alarms when arrhythmia off 103 HR alarms off (Config Mode) 103 HR and pulse alarm source selection 135 HR from (heart rate source) 134 humidity correction CO2 175 I IEC ECG lead labels 96 If 183 IIT 32 IMV (Resp) 139 indicators battery malfunction 219 battery status 18, 219 infection control iii cleaning 213 disinfecting 213 sterilizing 213 Information Center central recording 199 transferring patients 86 INOPs indicators 39 message field 17 silencing 43 installation checklist 1 connectors 246 personnel 1 Instructions for Use intended audience 9 IntelliVue Instrument Telemetry System
(IIT) 32 intermittent bundle branch block 107 intermittent mandatory ventilation
(Resp) 139 interruption symbol 245 intravascular dyshemoglobins (SpO2) 145 intrinsic rhythm 104 ISO point (ST) 120 J J point (ST) 120 K keyboard, on screen 21 keys alarms 16 main screen 16 pop-up 21 silence 16 SmartKeys 16 L label conflict resolution 28 label conflicts,resolving 28 labels 28 changing 28 LAN connection 4 latching alarms 50 alarms, behavior 50 latching arrhythmia alarms 112 lateral chest expansion (neonates) monitoring Resp 138 lead fallback and arrhythmia relearning 111 lead fallback (ECG) 96 lead labels (ECG) 96 iv lead placement activating EASI/Standard 95 for Resp measurement 137 leads monitored (ECG) 96 Leads Off INOP (ECG) 96 levels of arrhythmia analysis 105 M main screen key 16 main setup 19 mains power connecting to 3 mainstream capnography 14 mainstream CO2 measuring 168, 171 maintenance cables 225 cords 225 measurements, schedule 226 microstream CO2, calibration 226 schedule 225 visual inspection 225 malfunction symbols battery 218 manual detection mode (Resp) 139 and apnea alarms 140 manufacture date symbol 245 manufacturers information 244 map ST 122 Mason-Likar lead system 99 max hold setting (CO2) 168 measurement adjusting a wave 27 preparation 31 setting up 27 wave speed, changing 27 measurement extension M3012A 15 M3015A 14 M3016A 14 measurement label 17 measurement labels 28 changing 28 measurement points, ST 120 measurement server ECG connector 90 measurement settings 25 measurement setup menu 18 measurements setting up 31 switching on and off 27 mechanical damage 31 menu main setup 19 measurement setup 18 merging patient data 88 messages alarm 17 INOP 17 status and prompt 18 methemoglobin (SpO2) 145 Microstream capnography 14 microstream CO2 173 accessories 173 maintenance, calibration 226 measuring 173 mismatch patient data, resolving 87 MMS extensions 14 modified 12-lead ECG 99 modifying screens 23 monitor inspecting before use 31 quick operating giude 6 starting monitoring 32 switching on 31 monitor (ECG filter setting) 94 monitor defaults 271 monitor revision how to find 30 monitor settings 25 changing 30 monitoring preparation 31 starting 31 monitoring mode 22 mounting power supply 3 mounting information 3 MSL cable 4 multi-lead ST alarming 122 N N2O correction CO2 175 narrow alarm limits 48 NBP adult cuffs 234 alarm source 154 ANSI/AAMI SP10-1992 151 automatic mode, enabling 154 calibrating 156 calibration interval 226 comfort cuff kits 233 comfort cuffs 233 cuff pressure 154 cuff, applying 153 cuff, selecting 153 cuff, tightness 153 disposable cuffs 233 how the measurement works 151 measurement correction 153 measurement limitations 152 measurement methods, auto 152 measurement methods, manual 152 measurement methods, sequence 152 measurement methods, stat 152 measurement, starting 154 measurement, stopping 154 neonatal cuffs (disposable) 234 numerics 153 oscillometric method 151 pediatric cuffs 234 preparing to measure 152 repeat time 153 repeat time for automatic 154 repetition time, setting 154 reusable cuffs 233 single-hose disposable cuffs 234 site inspection 153 time of last measurement 153 units 153 venous puncture 155 neonates Resp electrode placement 138 network connection indicator 17 networked monitoring 33 new features 35 non-invasive blood pressure. See NBP non-paced patients arrhythmia monitoring 106 numerics explanation of NBP display 153 O on-screen keyboard 21 operating modes 22 configuration 22 demonstration 22 monitoring 22 passcode protection 22 service 22 operating room ECG cable 104 orange ECG cable 104 organizers 231, 232 Oridion Systems Ltd 244 oscillometric NBP measurement method 151 overlap in recordings 201 overlapping screen trends 195 P pace pulse rejection (ECG) about 91 switching on/off 93 paced patients arrhythmia monitoring 106 repolarization tails 93 safety information 104 setting status 104 paced status 17 checking 90 pacemaker failure 104 paper size for reports 206 parameter scales trends 191 passcode protection 22 patient admit 83 category, NBP 151 discharge 85 end case 85 patient alarm messages 53 patient category field 17 patient demographics window 83 patient mismatch 87 patient name field 17 patient reports contents 209 patient trends viewing 187 paused alarms 43 extending time 44 restarting 44 performance specifications pressure 255, 262 performance test 267 perfusion indicator 143, 144, 148 Philips contact information 244 physiological alarms 39 pleth alarm source 148 pleth wave 147 pleth waveform 143 Pop 21 pop-up keys 21 power connecting 4 connection 3 disconnecting from mains power disconnecting from 32 power supply 4 mounting 3 power-on LED 4 preparing skin for ECG 89 pressure alarms during zero 161 arterial source 166 calibration pressure 165 cerebral perfusion, calculating 166 performance specifications 255, 262 wave scale 163 wave size 163 zeroing the transducer 161 pressure accessories 234 pressure artifact suppression 163 pressure of NBP cuff 154 pressure transducer calibration 165 zeroing 161 primary lead (ECG) selecting 90 print job suspended 207 printer disabling 206 settings 206 status messages 208 unavailable 207 printing ST map reports 126 status log 227 trends reports 192 priority list for trends 191 probes disposable temperature 157 profiles 25 default profile 26 patient category 26 swapping a complete profile 26 swapping setting block 26 prompts 18 pulse alarms 134 system pulse source 133 pulse numerics for SpO2 144 PVC-related alarms 115 Q QRS tone 135 changing volume 30 QRS tone pitch, SpO2 148 QRS volume, changing 94 QT alarms 130 QT baseline 129 QT measurement algorithm 127 v QT monitoring limitations 128 QT/QTc monitoring 127 quick admit 85 R radiated field immunity Resp 140 rate adaptive pacemakers and ECG monitoring 105 realtime report 210 realtime reports content 206 recorder status messages 201 recording central 199 changing recording type 200 channels 200 choosing central recorder 200 choosing recording speed 201 creating templates 200 preventing fading ink 201 runtime 201 setting the runtime 201 setup menu 200 starting and stopping 199 wave overlap 201 recording alarms 51 recording delay time 201 recycling 227 rejecting pace pulses 91 relearning arrhythmia 110 reminder, alarm 43 replacing batteries 220 repolarization tails 93 reports alarm limits 210 battery reports 220 choosing paper size 206 contents 209 ECG 211 end case 205 patient trends 192 realtime report 210 re-routing 207 scheduled 205 setting up 204 ST map 126 stopping printouts 204 re-routing reports 207 resolution trends 191 resolving patient mismatch 87 resp accessories 229 Resp alarms vi apnea alarm delay time 140 Resp detection level and apnea detection 140 Resp detection modes and cardiac overlay 139 changing 138 Resp display 138 Resp monitoring and cardiac overlay 137 Resp safety information 140 Resp wave changing size 139 changing speed 140 restarting paused alarms 44 retrolental fibroplasia (SpO2) 147 reviewing alarms window 49 rhythm status messages (arrhythmia monitoring) 109 runtime setting recording runtime 201 S safety maintenance interval 226 monitor 246 safety information batteries 222 ECG 104 Resp 140 safety test 267 safety tests performance tests 5 power on test 5 system 5 visual inspection 5 same patient data merge 88 scale ECG wave 93 Resp wave 139 scales for trends waveforms 191 scheduled reports 205 screen adjusting brightness 30 screen trend trend time 195 screen trends 193 screens changing content 23 switching 23 understanding 23 visitor screen 24 secondary lead (ECG) selecting 90 selecting the primary lead (ECG) 90 selecting the secondary lead (ECG) 90 selftest alarms 51 sensor disposable SpO2 143 sequence mode 154 service mode 22 set combiners 231, 232 setting up trends 189 setting up reports 204 setting up the sepuence 154 settings 26 about 26 default 271 measurement settings 26 monitor settings 26 screen settings 26 synchronized telemetry and monitor 183 settings blocks 25 Setup Recording menu 200 short yellow alarms on/off 112 signal quality of SpO2 145 silence key 16 sinus and SV rhythm ranges 257, 260 skin preparation ECG 89 SmartKeys 19 key 16 SmartKeys key 16 SmartKeys symbol 245 source tracking ECG 183 specifications 243 arrhythmia 255 speed recording 201 wave speed, changing 27 SpO2 accessories 235 active alarm source 148 alarms specific to 146 arterial pulsation 143 assessing suspicious reading 145 connecting the cables 144 disposable sensors 143 extension cable 144 FAST technology 143 Nellcor adhesive sensors
(disposable) 235 perfusion indicator 143, 144, 148 Philips sensors (disposable) 235 Philips sensors (reusable) 235 pleth as alarm source 148 pleth wave 147 pleth waveform 143 pulse numerics 144 QRS tone 148 signal quality 145 site inspection 145 site selection 143 tone modulation 148 SpO2 desat alarm 147 SpO2 limit alarms 147 ST adjusting alarm limits 122 alarms 102, 122 baseline, updating 119 ensuring diagnostic quality 117 filtering 117 measurement points, adjusting adjusting 120 multi-lead alarms 122 numerics in ECG wave 92 snippets 119 ST display 118 ST map baseline, updating 125 current view 122 report, printing printing ST map report 126 scale, changing scale ST map 125 task window 125 trend view 124 trending interval, changing 126 trending priority 125 ST maps 122 ST point 120 standard 10-lead placement 99 standard 3-lead placement 97 standard 5-lead placement (ECG) 97 standby mode 22 Standby screen 22 standby symbol 245 starting monitoring 32 status line 18 status log printing 227 status messages printer 208 recorder 201 status messages (arrhythmia) 109 ectopic 110 rhythm 109 sterilizing infection control 213 stopping reports printouts 204 surgical ECG cable 104 suspended alarm 44 suspicious SpO2 reading 145 switching on monitor 31 switching screens 23 symbols 244 battery 218 synchronization marks (defibrillator) 91 system pulse 133 systolic blood pressure, NBP, early 154 T tabular trends 189 Tamb 158 task window for ST map 125 Tcereb 158 telemetry alarms 181 suspending at bedside 181 telemetry device controlling from bedside 181 silencing alarms at bedside 181 unpairing 180 temperature 157 accessories 239 alarm settings 157 connecting probe to monitor 157 difference, calculating 158 dual Temp measurement 158 extended label set 158 first 158 label 158 making a measurement 157 probe, disposable 157 probe, selecting 157 second 158 temperature probe connecting 157 templates creating for recordings 200 test blocks, how to perform 5 testing alarms 51 time, setting 7, 30 tone configuration, alarm 41 tone mod (SpO2) 148 tone modulation 148 touchscreen disable/re-enable 16 using 18 transducer CO2, accuracy 171 CO2, calibrating 171 pressure, zeroing 161 transferring centrally-monitored patients 86 transport brightness setting 221 trend time 195 global 195 trend view ST map 124 trending interval ST map 126 trends resolution 191 screen trends 193 setting parameter scales 191 setup 189 viewing 187 trends pop-up keys 187 trends priority list 191 ST map 125 troubleshooting CO2 174 trunk cables accessories 229, 231 Ttymp 158 Tvesic 158 U Understanding 25 unfiltered ECG signal 95 unpacking 2 unpairing 180 user interface settings changing 30 V V electrode placement (ECG) 98 venous puncture 155 viewing arrhythmia waves 108 viewing trends 187 visible waves report 206 visitor screen 24 vislatching (arrhythmia alarms) 112 vital signs report 192 voltage setting 4 volume alarm 41 W warnings 9 wave adjusting 27 changing speed 27 scale (CO2) 174 vii scale (pressure) 163 size (CO2) 174 size (pressure) 163 wave channel speed 28 wave group speed 28 wave size Resp 139 wave size (ECG) changing 93 wave speed eeg speed wave speed global speed 27 respiratory speed 27 wave speed (Resp) 140 whats new 35 wide alarms limits 48 wired network connection symbol 245 Z zero effect on pressure alarms 161 zeroing pressure transducer 161 viii
1 2 3 4 | User Manual addendum | Users Manual | 42.20 KiB |
Addendum to the Instructions for Use 1English Addendum to the Instructions for Use This addendum provides additional or corrected information for the following IntelliVue Instructions for Use (software revision G.01.xx):
MP20-MP90 Patient Monitor (M8000-9001K)
MP5 Patient Monitor (M8105-9001C)
MP2 Patient Monitor (M8102-9001B)
X2 Multi-Measurement Module (M3002-9001B) If your Instructions for Use has a different part number, you may discard this addendum, otherwise please store it with your monitor documentation. CO2 Alarm Specifications For Microstream CO2 in the MP5 and for the M3015A, the CO2 alarm specifications are as follows:
CO2 Alarm Specifications etCO2 High etCO2 Low imCO2 High Delay less than 21 seconds. less than 21 seconds. Adjustment Range 20 to 95 mmHg (2 to 13 kPa) 1 mmHg (0.1 kPa) 10 to 90 mmHg (1 to 12 kPa) 2 to 20 mmHg
(0.3 to 3.0 kPa) Adult/pedi: 10 to 100 rpm Neo: 30 to 150 rpm Adult/pedi: 0 to 95 rpm Neo: 0 to 145 rpm 10 to 40 seconds steps of 1 mmHg
(0.1 kPa) under 20 rpm: 1 rpm steps over 20 rpm:5 rpm steps 5 second steps awRR High awRR Low Apnea delay less than 21 seconds. settings <20 rpm: less than 8 seconds
>20 rpm: less than 21 seconds set apnea delay time + 8 seconds (with 2 m sample lines) or 11 seconds (with 4 m sample lines). IntelliVue Telemetry Transceiver User Information For complete user information, including accessory listings and specifications, for the M4841A/
M4851A TRx/TRx+ IntelliVue Telemetry Transceiver, please refer to the Instructions for Use provided with the device. MP2/X2 Including the Wireless IntelliVue Adapter Radiofrequency Radiation Exposure Information For body worn operation, this equipment has been tested and meets the FCC RF exposure guidelines when used with the accessories supplied or those approved for use with this product. Use of other accessories may not ensure compliance with FCC RF exposure guidelines. 3 Addendum to the Instructions for Use MP5/MP5T - Intended Use The monitor is intended to be used for monitoring and recording of, and to generate alarms for, multiple physiological parameters of adults, pediatrics, and neonates in a hospital environment. The MP5 and MP5T monitors are also intended for use during patient transport inside the hospital environment; only the MP5 monitor for use during patient transport outside of the hospital environment. The MP5 and MP5T when used with TRx 4841A/4851A IntelliVue Telemetry System Transceiver are intended for use in a hospital environment and during patient transport inside the hospital environment. Measurement Modules You can plug in and unplug modules during monitoring. Insert the module until the lever on the module clicks into place. Remove a module by pressing the lever upwards and pulling the module out. A measurement automatically switches on when you plug the module in, and switches off when you unplug it. Reconnecting a module to the same monitor restores its label and measurement settings, such as alarms limits. If you connect it to a different monitor, the module remembers only its label. 4
frequency | equipment class | purpose | ||
---|---|---|---|---|
1 | 2009-07-21 | 5260 ~ 5320 | NII - Unlicensed National Information Infrastructure TX | Class II permissive change or modification of presently authorized equipment |
2 | 5745 ~ 5825 | DTS - Digital Transmission System | ||
3 | 2009-03-06 | 5745 ~ 5825 | DTS - Digital Transmission System | Original Equipment |
4 | 5260 ~ 5320 | NII - Unlicensed National Information Infrastructure TX |
app s | Applicant Information | |||||
---|---|---|---|---|---|---|
1 2 3 4 | Effective |
2009-07-21
|
||||
1 2 3 4 |
2009-03-06
|
|||||
1 2 3 4 | Applicant's complete, legal business name |
Philips Medical Systems North America Co.
|
||||
1 2 3 4 | FCC Registration Number (FRN) |
0025978651
|
||||
1 2 3 4 | Physical Address |
3000 Minuteman Road
|
||||
1 2 3 4 |
Andover, Massachusetts 01810-1099
|
|||||
1 2 3 4 |
United States
|
|||||
app s | TCB Information | |||||
1 2 3 4 | TCB Application Email Address |
g******@ict.cetecom.de
|
||||
1 2 3 4 |
k******@ict.cetecom.de
|
|||||
1 2 3 4 | TCB Scope |
A4: UNII devices & low power transmitters using spread spectrum techniques
|
||||
app s | FCC ID | |||||
1 2 3 4 | Grantee Code |
PQC
|
||||
1 2 3 4 | Equipment Product Code |
WLANBV1
|
||||
app s | Person at the applicant's address to receive grant or for contact | |||||
1 2 3 4 | Name |
D******** S****
|
||||
1 2 3 4 | Title |
Principal Scientist / Project Leader
|
||||
1 2 3 4 | Telephone Number |
+ 1 9********
|
||||
1 2 3 4 | Fax Number |
1-978********
|
||||
1 2 3 4 |
d******@philips.com
|
|||||
app s | Technical Contact | |||||
n/a | ||||||
app s | Non Technical Contact | |||||
n/a | ||||||
app s | Confidentiality (long or short term) | |||||
1 2 3 4 | 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 2 3 4 | 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?: | No | ||||
1 2 3 4 | Yes | |||||
1 2 3 4 | If so, specify the short-term confidentiality release date (MM/DD/YYYY format) | 04/20/2009 | ||||
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 2 3 4 | Is this application for software defined/cognitive radio authorization? | No | ||||
1 2 3 4 | Equipment Class | NII - Unlicensed National Information Infrastructure TX | ||||
1 2 3 4 | DTS - Digital Transmission System | |||||
1 2 3 4 | Description of product as it is marketed: (NOTE: This text will appear below the equipment class on the grant) | WLAN Module | ||||
1 2 3 4 | Related OET KnowledgeDataBase Inquiry: Is there a KDB inquiry associated with this application? | No | ||||
1 2 3 4 | Modular Equipment Type | Single Modular Approval | ||||
1 2 3 4 | Purpose / Application is for | Class II permissive change or modification of presently authorized equipment | ||||
1 2 3 4 | Original Equipment | |||||
1 2 3 4 | Composite Equipment: Is the equipment in this application a composite device subject to an additional equipment authorization? | Yes | ||||
1 2 3 4 | 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 2 3 4 | Grant Comments | PC2 to allow portable host devices. Output Power listed is conducted. The antenna(s) used for this transmitter must be installed to provide a separation distance of at least 20 cm from all persons and must not be co-located or operating in conjunction with any other antenna or transmitter, except as shown in this filing. Highest reported SAR value is: Part 15: Body: 0.443 W/kg. | ||||
1 2 3 4 | PC2 to allow portable hosts devices. Output Power listed is conducted. The antenna(s) used for this transmitter must be installed to provide a separation distance of at least 20 cm from all persons and must not be co-located or operating in conjunction with any other antenna or transmitter, except as shown in this filing. Highest reported SAR value is: Part 15: Body: 0.443 W/kg | |||||
1 2 3 4 | Output Power listed is conducted. The antenna(s) used for this transmitter must be installed to provide a separation distance of at least 20 cm from all persons and must not be co-located or operating in conjunction with any other antenna or transmitter, except as shown in this filing. | |||||
1 2 3 4 | Is there an equipment authorization waiver associated with this application? | No | ||||
1 2 3 4 | 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 2 3 4 | Firm Name |
CTC advanced GmbH (former CETECOM ICT Services )
|
||||
1 2 3 4 | Name |
G****** S********
|
||||
1 2 3 4 | Telephone Number |
49-68********
|
||||
1 2 3 4 | Fax Number |
49-68********
|
||||
1 2 3 4 |
t******@ctcadvanced.com
|
|||||
Equipment Specifications | |||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Line | Rule Parts | Grant Notes | Lower Frequency | Upper Frequency | Power Output | Tolerance | Emission Designator | Microprocessor Number | |||||||||||||||||||||||||||||||||
1 | 1 | 15E | CC | 5180 | 5240 | 0.01641 | |||||||||||||||||||||||||||||||||||
1 | 2 | 15E | CC | 5260 | 5320 | 0.04592 | |||||||||||||||||||||||||||||||||||
Line | Rule Parts | Grant Notes | Lower Frequency | Upper Frequency | Power Output | Tolerance | Emission Designator | Microprocessor Number | |||||||||||||||||||||||||||||||||
2 | 1 | 15C | CC | 2412 | 2462 | 0.18836 | |||||||||||||||||||||||||||||||||||
2 | 2 | 15C | CC | 5745 | 5825 | 0.11429 | |||||||||||||||||||||||||||||||||||
Line | Rule Parts | Grant Notes | Lower Frequency | Upper Frequency | Power Output | Tolerance | Emission Designator | Microprocessor Number | |||||||||||||||||||||||||||||||||
3 | 1 | 15C | CC | 2412 | 2462 | 0.18836 | |||||||||||||||||||||||||||||||||||
3 | 2 | 15C | CC | 5745 | 5825 | 0.11429 | |||||||||||||||||||||||||||||||||||
Line | Rule Parts | Grant Notes | Lower Frequency | Upper Frequency | Power Output | Tolerance | Emission Designator | Microprocessor Number | |||||||||||||||||||||||||||||||||
4 | 1 | 15E | CC | 5180 | 5240 | 0.01641 | |||||||||||||||||||||||||||||||||||
4 | 2 | 15E | CC | 5260 | 5320 | 0.04592 |
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