I n t e l l i V u e M P 2 0 / 30 , M P 4 0/ 5 0 a n d M P 6 0 / 70 / 8 0/ 9 0 I NS TR UCTI ON S FOR US E IntelliVue Patient Monitor MP20/30, MP40/50, MP60/70/80/90 R e l ea se D. 0 wi th So ft wa r e R e v is i on D . 0 0.
Part Number M8000-9001G Printed in Germany 02/06 4512 610 13551 *M8000-9001G*
M8000-9001G Table Of Contents 1 1 Basic Operation Introducing the IntelliVue Family IntelliVue MP20/MP30 MP20/MP30 Major Parts and Keys IntelliVue MP40/MP50 MP40/MP50 Major Parts and Keys IntelliVue MP60/MP70 MP60/MP70 Major Parts and Keys IntelliVue MP80/MP90 MP80/MP90 Major Parts and Keys D80 Intelligent Display Remote Alarm Device Docking Station Related Products Flexible Module Server (M8048A) Measurement Modules Multi-Measurement Server (M3001A) Measurement Server Extensions M3014A, M3015A and M301
Understanding Profiles Swapping a Complete Profile Swapping a Settings Block Default Profile Locked Profiles Understanding Settings Changing Measurement Settings Switching a Measurement On and Off Switching Numerics On and Off Adjusting a Measurement Wave Changing Wave Speeds Changing the Wave Group Speed Changing Wave Speed for a Channel Freezing Waves Freezing An Individual Wave Freezing All Waves Measuring Frozen Waves Changing The Wave Speed Updating The Frozen Wave Releasing Frozen Waves Using Labe
3 Alarms Visual Alarm Indicators Audible Alarm Indicators Alarm Tone Configuration Traditional Audible Alarms (HP/Agilent/Philips/Carenet) ISO/IEC Standard 9703-2 Audible Alarms Changing the Alarm Tone Volume Minimum Volume for No Central Monitoring INOP Acknowledging Alarms Acknowledging Disconnect INOPs Alarm Reminder (ReAlarm) Pausing or Switching Off Alarms To Pause All Alarms To Switch All Alarms Off To Switch Individual Measurement Alarms On or Off While Alarms are Paused or Off Restarting Paused A
Discharging a Patient Transferring Patients Transferring a Centrally-Monitored Patient Transferring a Patient with an MMS (no Central Station) Data Upload from an MMS Data Exchange Between Information Centers Resolving Patient Information Mismatch Manually Resolving Patient Mismatch Patient Mismatch - If One Set of Patient Data is Correct Patient Mismatch - If Neither Patient Data Set is Correct Patient Mismatch - If Both Patient Data Sets Are Correct Automatically Resolving Patient Mismatch Care Groups
Standard 3-Lead Placement Standard 5-Lead Placement Chest Electrode Placement 10-Lead Placement Conventional 12-Lead ECG Modified 12-Lead ECG Choosing Standard or Modified Electrode Placement Labelling 12-Lead ECG Reports Capture 12-Lead EASI ECG Lead Placement ECG, Arrhythmia, and ST Alarm Overview Using ECG Alarms Extreme Alarm Limits ECG Alarms Off Disabled HR Alarms When Arrhythmia Analysis is Switched Off HR Alarms When Arrhythmia Analysis is Switched On ECG Safety Information About Arrhythmia Monit
Behavior of Silenced Arrhythmia Alarms Arrhythmia Alarm Chaining Understanding PVC-Related Alarms About ST Monitoring Switching ST On and Off Selecting ST Leads for Analysis Understanding the ST Display Updating ST Baseline Snippets Recording ST Segments About the ST Measurement Points Adjusting ST Measurement Points ST Alarms Single- or Multi-lead ST Alarming Changing ST Alarm Limits Viewing ST Maps Current View Trend View Viewing an ST Map Working in the ST Map Task Window Switching Between ST Map Vi
Manual Detection Mode Resp Detection Modes and Cardiac Overlay 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 133 133 133 134 134 134 134 9 Monitoring SpO2 SpO2 Sensors Applying the Sensor Connecting SpO2 Cables Measuring SpO2 Assessing a Suspicious SpO2 Reading Understanding SpO2 Alarms Alarm Delays Adjusting the Alarm Limits Adjusting the Desat Limit Alarm Pleth Wave Perfusion (Pleth) Indicat
12 Monitoring Invasive Pressure Setting up the Pressure Measurement Selecting a Pressure for Monitoring Extended Pressure Label Set Zeroing the Pressure Transducer Zeroing ICP (or IC1/IC2) Determining a Pressure’s Most Recent Zero Zeroing a Pressure Measurement Using the Zero Hardkey Zeroing All Pressures Simultaneously Troubleshooting the Zero Adjusting the Calibration Factor Displaying a Mean Pressure Value Only Changing the Pressure Wave Scale Optimizing the Waveform Non-Physiological Artifact Suppress
Documenting C.O. Measurements C.O. Injectate Guidelines Guidelines for Right Heart Thermodilution C.O. Injectate Guidelines for PiCCO C.O. Injectate Injectate Volume, Patient Weight and ETVI Values (PiCCO Only) C.O./CCO Curve Alert Messages C.O./CCO Prompt Messages C.O./CCO Warning Messages C.O.
Spirometry Values Window Alarms and Alarm Limits Changing the Apnea Alarm Delay Automatic Alarm Suppression Choosing Measured AWV Components Setting the Gas Compensation Mode Changing the Type of Balance Gas Changing the Concentration of Inspired O2 and the Inspired Agents Changing the Temperature of the Inspired Gas 192 192 192 193 193 193 193 193 194 16 Monitoring tcGas Identifying tcGas Module Components Setting the tcGas Sensor Temperature Using the tcGas Site Timer Setting the tcGas Site Timer Resta
Changing the Impedance Limit About Electrode-to-Skin Impedance Impedance Indicators About Compressed Spectral Arrays (CSA) Changing CSA Settings Changing EEG Settings Switching EEG Numerics On and Off Changing the Scale of the EEG Waves for Display Changing Filter Frequencies Changing the Speed of the EEG Wave EEG Reports EEG Safety Information EEG and Electrical Interference 209 210 210 211 212 212 212 212 213 213 213 214 214 19 Monitoring BIS BIS Monitoring Setup Monitoring BIS Using the DSC and BIS
Trend Parameter Scales Graphical Trend Presentation Documenting Trends Trends Databases Aperiodic Trends Database Trending Multiple-Value Measurements Screen Trends Setting the Screen Trend Time Changing the Selection of Screen Trends Displayed Activating the Cursor for Screen Trends Changing the Screen Trend View Tabular View Horizon View Setting the Horizon Setting the Horizon Trend Scale 227 228 228 229 229 229 229 230 231 231 231 231 232 232 232 21 Calculations Viewing Calculations Calculations Wind
Triggering Events Manually The Events Database Viewing Events Event Counter Counting Combi-Events Counting Neonatal Event Review (NER) Events Event Summary Window Event Review Window Event Episode Window Annotating Events Documenting Events Documenting Event Review Documenting an Event Episode Event Recordings Event Review Recordings Event Episode Recordings Event Reports Event Review Reports Event Episode Reports Event Summary Reports 246 247 247 247 248 248 249 249 250 251 251 251 252 252 252 253 253
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 Printer Status Messages Sample Report Printouts Alarm Limits Report Realtime Report Cardiac Output Report ECG Reports Other Reports 270 270 271 271 271 271 272 272 273 274 275 276 276 26 Using the Drug Calculator Accessing the Drug Calculator Performing Drug Calculations About the Rule of Six Performing Calculations for a
29 Respiratory Loops Viewing Loops Capturing and Deleting Loops Showing/Hiding Loops Changing Loops Display Size Using the Loops Cursor Changing Loops Type Setting Up Source Device Documenting Loops 289 289 290 290 291 291 291 291 292 30 Care and Cleaning General Points Cleaning Disinfecting Cleaning Monitoring Accessories Sterilizing Cleaning the Recorder Printhead (M1116B only) Cleaning the Batteries and Battery Compartment 293 293 294 294 294 295 295 295 31 Using the Batteries Battery Power Indicator
33 Accessories ECG/Resp Accessories Trunk Cables 3-Electrode Cable Sets 5-Electrode Cable Sets 10-Electrode Cable Sets 3-Electrode One Piece Cables 5-Electrode One Piece Cables Set Combiners and Organizers NBP Accessories Adult/Pediatric Multi-Patient Comfort Cuffs and Disposable Cuffs Reusable Cuff Kits Adult/Pediatric Antimicrobial Coated Reusable cuffs Adult/Pediatric Soft Single Patient Single-Hose Disposable Cuffs Neonatal/Infant Cuffs (Disposable, non-sterile) Invasive Pressure Accessories SpO2 Acce
802.
tcGas Default Settings SvO2 Default Settings EEG Default Settings BIS Default Settings VueLink Default Settings xviii 379 379 380 380 381
1 Basic Operation 1 These Instructions for Use are for clinical professionals using the IntelliVue MP20/MP30 (M8001A/ M8002A), MP40/50 (M8003A/M8004A) and MP60/70/80/90 (M8005A/M8007A/M8008A/ M8010A) patient monitors. Unless otherwise specified, the information here is valid for all the above IntelliVue patient monitors. The basic operation section gives you an overview of the monitor and its functions.
1 Basic Operation Introducing the IntelliVue Family Your monitor stores data in trend, event, and calculation databases. You can see tabular trends (vital signs) and document them on a local or remote printer. You can view measurement trend graphs, with up to three measurements combined in each graph, to help you identify changes in the patient’s physiological condition. You can view fast-changing measurement trends with beat to beat resolution and see up to four high resolution trend segments.
Introducing the IntelliVue Family 1 Basic Operation MP20/MP30 Major Parts and Keys MP20/MP30 left side 1 2 1 2 3 4 3 4 5 5 1 Color-coded alarm lamps 2 Alarms off lamp 3 Model indicator 4 ECG out 5 Navigation Point 6 Part number and serial number 7 Mounting quick-release lever 6 6 7 7 MP20/MP30 front panel 1 2 3 4 5 6 1 On/Standby switch 2 On/Standby LED 3 Error LED 4 Battery status LED 5 AC power operation LED 6 “read the documentation” symbol 7 Mounting quic
1 Basic Operation Introducing the IntelliVue Family IntelliVue MP40/MP50 The IntelliVue MP40/MP50 (M8003A/M8004A) patient monitor has a 12-inch TFT LCD flat panel SVGA display. The standard input devices for the MP50 are the Touchscreen and integrated navigation point; the MP40 is supplied with an integrated navigation point only. Up to six waves can be shown on MP40/MP50 Screens, 12 ECG traces can be shown on the 12-Lead ECG Screen.
Introducing the IntelliVue Family 1 Basic Operation MP40/MP50 front panel 1 2 3 4 5 6 1 On/Standby switch 2 On/Standby LED 3 Error LED 4 Battery status LED 5 AC power operation LED 6 “read the documentation” symbol 7 Mounting quick-release lever 7 MP40/MP50 LED Colors and their Meanings On/Standby LED Green when monitor is switched on Error LED Red if there is a problem with the monitor Battery LED Green, yellow, and red.
1 Basic Operation Introducing the IntelliVue Family MP60/MP70 Major Parts and Keys 3 2 1 4 5 11 10 9 8 7 1 Color coded alarm lamps 2 Alarms Off lamp 3 Display 4 Model indicator 5 SpeedPoint (optional for MP70) 6 Part number and serial number 7 Mounting quick-release lever 8 AC power LED 9 Error LED 10 Power on/standby switch 11 Power on LED 6 IntelliVue MP80/MP90 Note: The MP80 monitor (M8008A) is not available in the USA.
Introducing the IntelliVue Family 1 Basic Operation MP80/MP90 Major Parts and Keys AC Power LED Power on LED Error LED Power on Switch Processing Unit Display Unit D80 Intelligent Display The D80 Intelligent Display can be used as a third main display with the MP90 monitor. You then have three displays able to be configured individually and to be operated independently.
1 Basic Operation Related Products Docking Station MP20/30/ 40/50 only WARNING The docking station provides quick mounting and connections in a one-step operation. By placing the monitor on the docking station and closing the lever you can make the connection to power and to a wired network, if present. If the docking station is in a tilted position, you must hold the monitor in place while closing the locking lever.
Related Products 1 Basic Operation 1 2 3 4 1 Multi-Measurement Server 2 Measurement server mount 3 Flexible Module Server 4 Power on LED 5 Interruption indicator 5 Measurement Modules You can use up to eight measurement modules with the Flexible Module Server (M8048A), two additional modules in the integrated module slots in the MP60/MP70, and up to four in the integrated slots in the MP40/MP50.
1 Basic Operation Related Products Example Module (Pressure) 1 Module name 2 Setup key LED 3 Setup key to enter setup menu of measurement modules or VueLink device data window 1 4 Connector socket for patient cable/ transducer 3 5 Second module-specific key, for example Zero PRESS 2 Press 80x80 5 4 Multi-Measurement Server (M3001A) The Multi-Measurement Server (MMS) can simultaneously monitor 3-, 5- or 10-lead ECG (including arrhythmia and ST monitoring), respiration, SpO2, NBP and eithe
Related Products 1 Basic Operation M3001A Connectors and Symbols 5 4 3 1 White ECG/Resp connector 2 Blue SpO2 connector 3 Red NBP connector 4 & Combined pressure (red) and temperature 5 (brown) connector - connect either invasive pressure transducer or temperature probe. You might have a version of the MMS that does not have this connector.
1 Basic Operation WARNING Related Products The measurement server extensions can only function when they are connected to a measurement server. If the measurement server is removed during monitoring, the measurements from both the measurement server and the measurement server extension are lost.
Related Products 1 Basic Operation M3012A Hemodynamic Measurement Server Extension Connection to MMS Pressure connectors (red) The M3012A Hemodynamic Measurement Server Extension (HMSE) can be connected to the M3001A Multi-Measurement Server to provide the following additional measurements: Temperature, Pressure, an additional Pressure or Temperature, and C.O. and CCO measurements.
1 Basic Operation Operating and Navigating Operating and Navigating Everything you need to operate the monitor is contained on its screen. Almost every element on the screen is interactive. Screen elements include measurement numerics, waveforms, screen keys, information fields, alarms fields and menus. The configurability of the monitor means that often you can access the same element in different ways.
Operating and Navigating 1 Basic Operation Selecting Screen Elements Select a screen element to tell the monitor to carry out the actions linked to the element. For example, select the Patient Identification element to call up the Patient Demographics window, or select the HR numeric to call up the Setup ECG menu. Select the ECG wave segment to call up the ECG lead menu.
1 Basic Operation Operating and Navigating Using the SpeedPoint 1 2 3 4 5 integrated SpeedPoint (MP60/MP70 only) 6 7 Remote SpeedPoint (all monitors) 1 Silence - acknowledges all active alarms by switching off audible alarm indicators and lamps. Behavior follows the Silence permanent key configuration. 2 Alarms Off/Pause Alarms- pauses alarm indicators. Behavior follows the Pause Alarms permanent key configuration. 3 Main Screen - close all open menus and windows and return to the main screen.
Operating and Navigating 1 Basic Operation Using the Navigation Point MP20/MP30/ MP40/MP50 Only 1 Silence - acknowledges all active alarms by switching off audible alarm indicators and lamps. Exact behavior depends on permanent key configuration 2 Alarms Off/Pause Alarms - pauses alarm indicators. Exact behavior depends on Pause Alarms permanent key configuration 3 Main Screen - closes all open menus and windows and return to the main screen. 4 Back - takes you back one step to the previous menu.
1 Basic Operation Operating and Navigating SmartKeys A SmartKey is a configurable graphical key, located at the bottom of the main screen. It gives you fast access to functions. The selection of SmartKeys available on your monitor depends on your monitor configuration and on the options purchased.
Operating and Navigating 1 Basic Operation start a delayed recording Realtime Record SmartKey to access popup recording keys set wide automatic alarm limits set narrow automatic alarm limits access wedge procedure window access the Loops window review vital signs trend review graph trend access event surveillance access calculations access the calculator access the Drug Calculator gas analyzer - exit standby mode suppress zero for all gas measurements unpair equipment access ST Map applicat
1 Basic Operation Operating and Navigating Using the On-Screen Keyboard Use this as you would a conventional keyboard. Enter the information by selecting one character after another. Use the Shift and capital Lock keys to access uppercase letters. Use the Back key to delete single characters, or use the Clr key to delete entire entries. Select Enter to confirm what you have entered and close the on-screen keyboard.
Operating Modes 1 Basic Operation Operating Modes When you switch the monitor on, it starts up in monitoring mode. To change to a different mode: 1 Select the Main Setup menu. 2 Select Operating Modes and choose the mode you require. Your monitor has four operating modes. Some are passcode protected. • Monitoring Mode: This is the normal, every day working mode that you use for monitoring patients. You can change elements such as alarm limits, patient category and so forth.
1 Basic Operation Understanding Screens Understanding Screens Your monitor comes with a set of preconfigured Screens, optimized for common monitoring scenarios such as OR adult, or ICU neonatal. A Screen defines the overall selection, size and position of waves, numerics and SmartKeys on the monitor screen when you switch on. You can easily switch between different Screens during monitoring. Screens do NOT affect alarm settings, patient category and so forth.
Using Additional Displays In the Change Screen menu, the changed Screen is shown linked to the original Screen and marked with an asterisk. Up to three modified Screens can be accessed via the Change Screen menu. To recall Screens, either ♦ select the name of the Screen in the Change Screen menu or ♦ 1 Basic Operation Change Screen 6 Waves A Split Screen A Loops Cardiac Output use the previous/next arrows at the top of the Change Screen menu to move back and forth in the Screen history.
1 Basic Operation Understanding Profiles 1 Select Profiles in the monitor info line of the first display, 2 Select Display 1, Display 2, or Display 3 then select the Screen you want to display on the that display from the list of available Screens. When two displays are mounted next to each other or one above the other, a special Screen can be assigned which spans across both displays. The Screen content for these Tall and Wide Screens can then use the increased area available with two displays.
Understanding Profiles 1 Basic Operation Profiles Profile : Profile A Patient Category: Adult Measurement A Paced : No Measurement B Display : S-014 Measurement C Meas Settings: Measurement A Measurement D Monitor Settings: Monitor A Profiles Menu, showing current settings Available choices in measurement menu You can change from one complete profile to another or swap individual settings blocks (display screen/monitor settings/measurement settings) to change a subset of a profile.
1 Basic Operation Understanding Settings Swapping a Settings Block 1 Select Profiles in the monitor info line, or select the Profiles SmartKey. 2 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.
Changing Wave Speeds 1 Basic Operation • via the Main Setup SmartKey - if you want to setup a measurement when the measurement is switched off, use the Main Setup SmartKey and select Measurements. Then select the measurement name from the popup list. With this SmartKey you can access any setup menu in the monitor. • via the Measurement Selection key. This guide always describes the entry method using the setup menu. But you can use any method you prefer.
1 Basic Operation 3 Freezing Waves Select a value from the list of available speeds. Changing Wave Speed for a Channel To change the wave speed of an individual wave channel, 1 Enter the Wave menu for a measurement by selecting its wave. 2 Select Change Speed. 3 To set the speed to the wave group speed, select RespiratorySpeed, EEG Speed, or Global Speed. To set an individual channel speed, select a numeric value from the list of available speeds.
Using Labels 1 Basic Operation Changing The Wave Speed Lowering the wave speed compresses the wave and lets you view a longer time period. Increasing the speed expands the waveform, giving you a more detailed view. To change the wave speed: 1 Select the frozen wave. 2 Select Change Speed. 3 Select a speed from the list. Updating The Frozen Wave To update the wave, that is freeze the current wave: 1 Select the frozen wave. 2 Select Freeze Again.
1 Basic Operation Using Labels 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 monitor’s Configuration Mode. Any labels already being used in the monitor are shown “grayed-out” in the list and cannot be selected.
Changing Monitor Settings 2 3 1 Basic Operation Select the device whose label you want to correct. Use the measurement selection pop-up keys to resolve the conflict. Select either: – Change Label to assign a different label to the conflicting label – De-activate: to disable the conflicting device. It retains its label for future use but becomes invisible to the monitor, as though it had been unplugged.
1 Basic Operation Checking Your Monitor Revision 2 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. 3 Select Store Date, Time to change the date and time. Checking Your Monitor Revision 1 Select Main Setup -> Revision to open the Monitor Revision menu. 2 Select the correct device from the device pop-up keys.
Disconnecting from Power 1 Basic Operation 2 Connect the required modules, Measurement Servers, or measurement server extensions. 3 Check that you have the correct patient cables and transducers plugged in. The connectors are color-coded to the patient cables and transducers for easy identification. Starting Monitoring After you switch on the monitor, 1 Admit your patient to the monitor.
1 Basic Operation Using Remote Applications 1 In the Main Setup menu, select Remote Applics, or select the Remote Applications SmartKey. 2 Select the required application from the pop-up list of available applications. 3 Operate the application with your preferred monitor input device: touchscreen, SpeedPoint, navigation point, keyboard or mouse. Remote Application Popup Keys Pop-Up Keys Selecting this pop-up key lets you....
2 What’s New? 2 This section lists the most important new features and improvements to the monitor and its user interface introduced with each release. Further information is provided in other sections of this book. You may not have all of these features, depending on the monitor configuration purchased by your hospital. What’s New in Release D.
2 What’s New? What’s New in Release C.0? What’s New in Release C.0? IntelliVue MP80 The MP80 patient monitor is a new addition to the IntelliVue patient monitor family. The functionality is similar to that of the MP70 but with the flexibility of component modularity as in the MP90. M3014A Capnography Extension The M3014A Capnography Extension offers a new measurement combination - mainstream CO2, cardiac output, invasive pressure and invasive pressure/temperature.
What’s New in Release B.1? 2 What’s New? Trends • In graphical trends, a segment menu allows direct adjustment of trend scales, automatic scale optimization, expanded view for an individual segment. • In graphical and horizon Screen Trends a cursor is available. • In the Vital Signs window, the values can be shown with the parameter color. Events • Events can be configured to be signaled as alarms (advanced event surveillance only).
2 What’s New? What’s New in Release B.
What’s New in Release A.2? 2 What’s New? What’s New in Release A.2? 12-Lead ECG recordings: 12-Lead ECG waves and numerics can be sent to a connected recorder High-Resolution Trend Report: high-resolution trend report can be sent to a connected printer ST Snippets ST snippets, showing a one second wave segment for each measured ST lead, can be permanently displayed on the Screen or called up as required.
2 What’s New? 40 What’s New in Release A.
3 Alarms 3 The alarm information here applies to all measurements. Measurement-specific alarm information is discussed in the sections on individual measurements. The monitor has three alarm levels: red, yellow, and INOP. Red and yellow alarms are patient 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).
3 Alarms Visual Alarm Indicators Visual Alarm Indicators Alarm message: An alarm message text appears in the alarm status area at the top of the screen indicating the source of the alarm. If more than one measurement is in an alarm condition, the message changes every two seconds, and has an arrow ( ) at the side. The background color of the alarm message matches the alarm priority: red for red alarms, yellow for yellow alarms, and light blue for INOPs.
Audible Alarm Indicators 3 Alarms Traditional Audible Alarms (HP/Agilent/Philips/Carenet) • Red alarms: A high pitched sound is repeated once a second. • Two-star yellow alarms: A lower pitched sound is repeated every two seconds. • One-star yellow alarms (arrhythmia alarms): The audible indicator is the same as for yellow alarms, but of shorter duration. • INOPs: an INOP tone is repeated every two seconds.
3 Alarms Acknowledging Alarms Acknowledging Alarms To acknowledge all active alarms and INOPs, select the Silence permanent key. This switches off the audible alarm indicators and alarm lamps. Alternatively, you can acknowledge alarms by pressing the Silence hardkey on the MMS or on the SpeedPoint. The hardkeys follow the behavior configured for the permanent key. Silence A check mark beside the alarm message indicates that the alarm has been acknowledged.
Pausing or Switching Off Alarms 3 Alarms To Pause All Alarms ♦ ♦ Select the Pause Alarms permanent key. If your monitor is configured to infinite pause time, the permanent key is labelled Alarms Off, and selecting it switches alarms off. Pause Alarms Or press the Alarms hardkey on the SpeedPoint or Navigation Point. The hardkey follows the behavior configured for the permanent key.
3 Alarms Alarm Limits Restarting Paused Alarms ♦ To manually switch on alarm indication again after a pause, select the permanent key Pause Alarms (or Alarms Off ) again. Alarm indication starts again automatically after the pause period expires. If the monitor is configured to stay paused infinitely, you must select Alarms Off again to restart alarm indication.
Alarm Limits 3 Alarms Viewing All Alarm Limits The Alarm Limits overview window lists the currently set alarm limits for all measurements. If an Apnea alarm delay time is set, this is also shown. The Alarms Off symbol is shown beside the measurement label of any measurement whose alarm switched off. To open the Alarm Limits window, either select any alarm field to open the Alarm Messages window, then select the Alarm Limits pop-up key, or select the Alarm Limits SmartKey, if configured.
3 Alarms Alarm Limits These pop-up keys are not available in the window for changing individual alarm limits which you access by selecting the measurement label in the Alarm Limits window. Changing Alarm Limits To change individual measurement alarm limits using the measurement’s Setup Menu, 1 in the measurement’s setup menu, select the alarm limit you want to change. This calls up a list of available values for the alarm limit. 2 Select a value from the list to adjust the alarm limit.
Alarm Limits 3 Alarms If you set the yellow alarm limit outside the red alarm limit, the monitor will automatically set the red alarm to the yellow alarm limit. When an ST measurement is in the Change Limits window there are also two pop-up keys available labeled All ST Narrow/All ST Wide. With these keys you can set Auto Limits for all ST Leads.
3 Alarms Reviewing Alarms Reviewing Alarms To review the currently active alarms and INOPs, select any of the alarm status areas on the monitor screen. The Alarm Messages window pops up. All alarms and INOPs are erased from the monitor’s alarm history when you discharge a patient, or if you change to Demonstration Mode. Alarm Messages Window The Alarm Messages window shows all the currently active alarms and INOPs in chronological order, beginning at the top with the most recent.
Understanding Alarm Messages 3 Alarms Understanding Alarm Messages If you do not immediately understand an INOP or alarm message, refer to its help text. ♦ In the Alarm Messages window, select the INOP message. This calls up a help window with an explanation of the INOP message and, where appropriate, a suggested solution for the problem. Alarm Messages Resp LEADS OFF LL LEAD OFF ** awRR LOW The lead LL has become detached from the patient or the lead set has been changed.
3 Alarms Testing Alarms Alarm Latching Behavior Red and Yellow Measurement Alarms Non-latching alarms Alarm has not been acknowledged. Alarm tone on. Alarm lamp on. Alarm message. Flashing numerics. Alarm condition still present. Visual and audible Visual latching, latching audible non-latching Alarm condition All audible and visual Alarm tone on. no longer present. alarm indicators Alarm lamp on. automatically stop. Alarm message. Flashing numerics. Alarm has been acknowledged.
4 Patient Alarms and INOPs 4 This chapter lists patient alarms and technical alarms (INOPs) alphabetically, irrespective of their priority. INOPs start on page 59. For information on alarms and INOPs from the gas modules refer to your Gas Module Instructions for Use. Patient Alarm Messages The measurement labels and abbreviations for pressure, temperature, SpO2, and anesthetic agent alarms are explained in the individual chapters.
4 Patient Alarms and INOPs 54 Patient Alarm Messages Alarm Message From Condition Indication ***BRADY (Pulse) or ***BRADY xxx
Patient Alarm Messages 4 Patient Alarms and INOPs Alarm Message From Condition Indication **HR HIGH ECG The heart rate high alarm limit has been numeric flashes and high limit exceeded. is highlighted, yellow alarm lamp, alarm tone. The sound switches off after 5 seconds if Arrhythmia is On. **HR LOW ECG The heart rate has fallen below the low alarm limit. **imCO2 HIGH CO2, Resp, AGM The inspired minimum CO2 high alarm numeric flashes and high limit limit has been exceeded.
4 Patient Alarms and INOPs Alarm Message Patient Alarm Messages From */**NON-SUSTAIN VT ECG/ Arrhythmia Condition A run of Vs having a ventricular HR>V- numeric flashes, yellow alarm Tach HR limit, but lasting for less than lamp, short yellow audible the V-Tach Run limit has been detected. alarm. */**PACER NOT CAPT ECG/ A missed beat with a pace pulse was Arrhythmia detected. (paced patients only) 56 Indication numeric flashes, yellow alarm lamp, short yellow audible alarm.
Patient Alarm Messages 4 Patient Alarms and INOPs Alarm Message From Condition Indication **RR HIGH RESP The respiration rate has exceeded the high alarm limit. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. **RR LOW RESP The respiration rate has dropped below numeric flashes and low limit the low alarm limit. is highlighted, yellow alarm lamp, alarm tone. */**RUN PVCs HIGH ECG/ Arrhythmia A run of PVCs greater than 2 was detected.
4 Patient Alarms and INOPs Patient Alarm Messages Alarm Message From Condition Indication **tcpO2 LOW/ **tcpCO2 LOW tcGas The tcpO2 or tcpCO2 value has fallen below the low alarm limit. numeric flashes, low alarm limit is highlighted, yellow alarm lamp, alarm tone. ** HIGH TEMP The temperature has exceeded the high numeric flashes and high limit alarm limit. is highlighted, yellow alarm lamp, alarm tone.
Technical Alarm Messages (INOPs) 4 Patient Alarms and INOPs Technical Alarm Messages (INOPs) The measurement labels and abbreviations for pressure, temperature, SpO2, anesthetic agent, and VueLink INOP messages are explained in the individual chapters. INOP Message, Indication Source What to do ABP INOPS PRESS See INOPS (under Pressure). ALL ECG ALARMS OFF ECG/ All ECG alarms have been switched off, or the HR alarm Arrhythmia source is not ECG.
4 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication Source What to do BIS CABLE INCOMPAT INOP tone. BIS The semi-reusable sensor cable connected is unknown or not supported by your software revision. Replace it with a Philipssupported sensor cable. BIS CABLE USAGE INOP tone. BIS The semi-reusable sensor cable has exceeded the maximum number of uses. Replace the cable. BIS DSC DISCONN BIS DSC is not properly connected OR either DSC or BIS engine may be faulty.
Technical Alarm Messages (INOPs) 4 Patient Alarms and INOPs INOP Message, Indication Source What to do BIS ISOELECTRC EEG BIS No discernible EEG activity is detected for longer than one minute. Check the patient. Check that the electrodes are properly connected. BIS LEAD OFF BIS One or more electrodes have no skin contact and therefore impedances cannot be measured. Check the sensor montage and press the electrode pads firmly.
4 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication Source What to do BISx INCOMPATIBLE BIS 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. BIS 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.
Technical Alarm Messages (INOPs) 4 Patient Alarms and INOPs INOP Message, Indication Source What to do CCO PRESS INVALID at Information Center C.O. The arterial pressure selected for pulse contour calculation for CCO is available but currently invalid. Make sure the pressure transducer is connected and the zero calibration is valid. CCO PRESS OVERRANG numeric is replaced by -?INOP tone C.O.
4 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication Source What to do Check Mouse Device INOP tone. Monitor Perform a visual and functional check of the mouse input device. Contact your service personnel. Check MSL Voltage INOP tone Monitor/ Measuremt Server There is a problem with the voltage of the Measurement Server Link (MSL). Contact your service personnel.
Technical Alarm Messages (INOPs) 4 Patient Alarms and INOPs INOP Message, Indication Source What to do CO2 CHECK CAL Numeric is replaced by a - ? INOP tone. CO2 The CO2 value is outside the measurement range. Perform an accuracy check for both calstick cells and, if necessary, recalibrate the transducer. C.O. EQUIP MALF Numeric is replaced by a - ? INOP tone. C.O. There is a problem with the C.O. hardware. Contact your service personnel. CO2 EQUIP MALF Numeric is replaced by - ? INOP tone.
4 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication Source What to do CO2 ZERO FAILED Numeric is replaced by a - ? INOP tone. CO2 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. CO2 ZERO REQUIRED Numeric is replaced by a - ? INOP tone CO2 Perform zero calibration for the CO2 sensor.
Technical Alarm Messages (INOPs) 4 Patient Alarms and INOPs INOP Message, Indication Source What to do EEG LEAD OFF [X = channel] at Information Center EEG 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. EEG LEADS OFF [X = channel] EEG Two or more electrodes are not connected. Check in the EEG Impedance/Montage window which electrodes are affected and reconnect the electrodes.
4 Patient Alarms and INOPs 68 Technical Alarm Messages (INOPs) INOP Message, Indication Source What to do LEADS OFF Numeric is replaced by -?- for 10 seconds; INOP tone. ECG Check that all of the required ECG leads are attached, and that none of the electrodes have been displaced. LL LEAD OFF Numeric is replaced by -?- for 10 seconds; INOP tone. ECG The LL electrode has become detached from the patient or the lead set has been changed.
Technical Alarm Messages (INOPs) 4 Patient Alarms and INOPs INOP Message, Indication Source What to do NBP INTERRUPTED Numeric is replaced by -?INOP tone. NBP 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.
4 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication Source What to do EQUIP MALF Numeric displayed with -?INOP tone. PRESS Contact your service personnel. The pressure hardware is faulty. NO TRANSDUCER Numeric is replaced by -?INOP tone. PRESS Make sure that the pressure transducer is connected to the measurement server or module server. If you silence this INOP, the measurement will be switched off.
Technical Alarm Messages (INOPs) 4 Patient Alarms and INOPs INOP Message, Indication Source What to do RESP ERRATIC Numeric is replaced by -?- RESP 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. RESP LEADS OFF Numeric is replaced by -?INOP tone. RESP Not all the required leads for Resp monitoring are attached. Make sure that the RA and LL leads are attached.
4 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication Source What to do DEACTIVATED INOP tone SpO2 You have connected a measurement server that uses a label the monitor has already assigned to a different source. To activate the new source, choose a new label in the Measurement Selection window. EQUIP MALF Numeric is replaced by -?INOP tone. SpO2 The MMS is faulty. Unplug and replug the MMS.
Technical Alarm Messages (INOPs) 4 Patient Alarms and INOPs INOP Message, Indication Source What to do UPGRADE SpO2 The SpO2 measurement is currently in UPGRADE mode. Monitoring is not possible in this mode. Sp - vO2 CHK SOURCES Numeric is replaced by -?- Sp - vO2 Not all measurements or values required to perform the calculation are available. Check measurement sources.
4 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication Source What to do SvO2 UNABL TO MEAS SvO2 numeric is replaced by -?-. INOP tone SvO2 The signal is out of the normal range, and no SvO2 value can be derived. Perform an in-vivo calibration. If the INOP persists, try another Optical Module and catheter. SvO2 UNPLUGGED SvO2 numeric is replaced by -?-. INOP tone SvO2 Measurement switched on and SvO2 module unplugged from the rack.
Technical Alarm Messages (INOPs) 4 Patient Alarms and INOPs INOP Message, Indication Source What to do tcpO2 (or tcpCO2 or tcGas) EQUIP MALF Numeric is replaced by -?INOP tone. tcGas There is a malfunction in the transducer or module. Connect another transducer. If this INOP persists, contact your service personnel. tcpO2 (or tcpCO2 or tcGas) NO TRANSDUC Numeric is replaced by -?INOP tone. tcGas No transducer is connected to the tcpO2/tcpCO2 module.
4 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication Source What to do Ttymp INOPS TEMP See INOPs (under Temp) Tven INOPS TEMP See INOPs (under Temp). Tvesic INOPS TEMP See INOPs (under Temp) UAP INOPS PRESS See INOPS (under Pressure). Unsupported LAN Monitor There is a problem with the communication to the network and central monitoring is currently not possible. Check the connection.
5 Managing Patients 5 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.
5 Managing Patients – – – – – – – – – – – 5 Quick Admitting a Patient First name: Enter the patient’s first name, for example Joseph. MRN: Enter the patient’s medical record number (MRN), for example 12345678. Patient Cat: Choose the patient category, either Adult, Pediatric, or Neonatal. Paced: Choose Yes or No (You must use “Yes” if your patient has a pacemaker). Height: Enter the patient’s height. Weight: Enter the patient’s weight. BSA: The monitor calculates the body surface area automatically.
Editing Patient Information 5 Managing Patients 3 Select Enter. 4 In the confirmation window, select Confirm to discharge the previous patient (if confirmation is configured). 5 Check that patient category and paced status are correct for the new patient. If the monitor is connected to an Information Center and only the MRN is entered, the patient name is set to - - - . The patient name field on the monitor shows Not Admitted and the patient name space on printed reports is blank.
5 Managing Patients Transferring Patients Transferring Patients To save you from having to enter the same patient data multiple times and enable patient transfer without loss of data, information can be shared between measurement servers, patient monitors, and Information Centers.
Data Upload from an MMS 5 Managing Patients 4 At the new location, connect the MMS to the monitor. If the monitor detects a patient conflict, the patient selection window will be displayed. 5 Select Continue MMS and Confirm your selection. This re-admits the patient from the transfer list to the new monitor, completing the transfer. This will upload the patient demographics, and, if configured, the measurement settings and trend data stored in the MMS to the receiving monitor.
5 Managing Patients Data Exchange Between Information Centers 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 5 Managing Patients Patient Mismatch - If One Set of Patient Data is Correct ♦ ♦ If there is a mismatch between an Information Center and a monitor, choose the data set you want to continue using for this patient, either: Patient Selection Continue Central: to continue with the patient demographics from the Information Center, discharge the patient in the monitor, and use the default monitor profile.
5 Managing Patients Care Groups 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.
Care Groups 5 Managing Patients Monitors must be assigned to these Care Groups at the Information Center. There is a third care group which can be assigned locally at the bedside. This is the My Central care group which includes all beds (up to 16) from the Information Center your bed is connected to. This care group setting is typically used in facilities with only one Information center. The selection of beds is automatic and cannot be changed.
5 Managing Patients Care Groups Care Group Symbols (used in the Care Group overview bar and the My Care Group window) This is a telemetry bed This bed is on a wireless network This bed is on a wired network This is a “paired” bed, with a bedside monitor and a telemetry transmitter assigned. Viewing the My Care Group Window This window shows the alarm status, bed name, and patient name for every bed in the Care Group.
Care Groups 5 Managing Patients Viewing the Other Bed Window The Other Bed window lets you view a subset of the waveform and numeric information from another bed on the same network. Waves and numeric information from another bed are delayed. If configured, Other Bed information is displayed in color, using the colors defined by the Information Center. To open the Other Bed window, ♦ MP60/MP70/MP80/MP90: select the required bed label or patient name in the Care Group Overview Bar.
5 Managing Patients Care Groups Note that changing the Screen may automatically change the bed shown in the other bed window. If you switch to a different Screen, you should check if the correct other bed is displayed. Other Bed Pop-Up Keys Select the Other Patients SmartKey or the Other Bed window or embedded screen element to access the associated pop-up keys: Next Wave lets you view waveforms not currently shown in the other bed window.
Care Groups 5 Managing Patients Automatic alarm notification can be switched off permanently in the monitor’s Configuration Mode or at the Information Center. To temporarily disable and re-enable automatic alarm notification at the bedside monitor, for example if you want to carry out a procedure, in Monitoring Mode: 1 Select the network symbol on the monitor screen to call up the Network menu. 2 Select Auto Window to toggle between the settings Enabled and Disabled.
5 Managing Patients Care Groups Telemetry Data Overview Screen Element Bed4 Bed1 Room3 Bed5 Bed7 Mayer, John Adult Bed9 23Feb 17:51 Room1 Room3 Profiles Room1 Room4 Telemetry Tele 3 HR PVC MCL 1mV 1mV Delayed Pleth Telemetry data overview screen element Pulse WARNING CO2 etCO2 mmHg NBP mmHg Temp Perf awRR rpm Waves and numeric information on the telemetry screen element are delayed for several seconds.
6 ECG, Arrhythmia, and ST Monitoring 6 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 107) and ST monitoring (see page 117). 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. 1 Select sites with intact skin, without impairment of any kind.
6 ECG, Arrhythmia, and ST Monitoring Selecting the Primary and Secondary ECG Leads 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.
Understanding the ECG Display 6 ECG, Arrhythmia, and ST Monitoring Understanding the ECG Display Your display may be configured to look slightly different. 1 mV calibration bar Lead label of the displayed wave Pace pulse marks Defibrillator synchronization marks Pacer spikes HR M EASI ECG Filter label EASI lead placement label Current heart rate alarm limits Current heart rate ECG numeric: This is derived from the monitored ECG.
6 ECG, Arrhythmia, and ST Monitoring Changing the Size of the ECG Wave Setting the Paced Status (Pace Pulse Rejection) ♦ In the Setup ECG menu, select Paced to toggle between Yes and No. Paced You can also change the paced status in the Patient Demographics window. When Paced is set to Yes: – Pace Pulse Rejection is switched on. This means that pacemaker pulses are not counted as extra QRS complexes.
Changing the Volume of the QRS Tone 6 ECG, Arrhythmia, and ST Monitoring 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 Lead menu, select Adjust Size. Select the required adjustment factor from the line of pop-up keys. – Size x0.
6 ECG, Arrhythmia, and ST Monitoring Choosing EASI or Standard Lead Placement – Diag (Diagnostic): Use when diagnostic quality is required. The unfiltered ECG wave is displayed so that changes such as R-wave notching or discrete elevation or depression of the ST segments are visible. The setting Diag selects the highest available ECG bandwidth which is 0.05 to 150 Hz for the Adult and 0.5 to 150 Hz for the Pedi and Neo patient category.
ECG Lead Fallback 6 ECG, Arrhythmia, and ST Monitoring will issue a Lead Off INOP message. Select New Lead Setup and the INOP message will disappear. ECG Lead Fallback If fallback is configured on and there is a leads off INOP in the primary lead (and in the secondary lead, if you are using multi-lead monitoring) for longer than 10 seconds, and if another lead is available, this available lead automatically becomes the primary lead. This is known as lead fallback.
6 ECG, Arrhythmia, and ST Monitoring ECG Lead Placements Standard 3-Lead Placement RA placement: directly below the clavicle and near the right shoulder LA RA LA placement: directly below the clavicle and near the left shoulder LL placement: on the left lower abdomen LL Standard 5-Lead Placement RA placement: directly below the clavicle and near the right shoulder RA LA I II R V RL placement: on the right lower abdomen aV L aV III 98 LL placement: on the left lower abdomen V placement: on t
ECG Lead Placements 6 ECG, Arrhythmia, and ST Monitoring Chest Electrode Placement For accurate chest electrode placement and measurement, it is important to locate the fourth intercostal space. 1 Locate the second intercostal space by first palpating the Angle of Lewis (the little bony protuberance where the body of the sternum joins the manubrium). This rise in the sternum is where the second rib is attached, and the space just below this is the second intercostal space.
6 ECG, Arrhythmia, and ST Monitoring ECG Lead Placements 10-Lead Placement When monitoring 12-leads of ECG, using a 10-Electrode Lead Placement, it is important to correctly place electrodes and to label all 12-lead ECG reports with the correct lead placement. Conventional 12-Lead ECG In conventional 12-Lead ECG using 10 electrodes, an electrode is placed on the right arm, left arm, right leg, and left leg. Six Velectrodes are placed on the chest. The right leg electrode is the reference electrode.
ECG Lead Placements 6 ECG, Arrhythmia, and ST Monitoring Modified 12-Lead ECG 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. Angle of Lewis LA RA V1 - V6 RL The six V electrodes are placed on the chest in the same position as the conventional 12-lead placement.
6 ECG, Arrhythmia, and ST Monitoring Capture 12-Lead – 12 Lead ECG Reports will be labelled 12 Lead ECG Report (Mason-Likar). – Captured 12-lead ECGs will be labelled Mason-Likar to the right of the bandwidth annotation at the Information Center. When Mod. LeadPlacement is set to Off, – 12 Lead ECG Reports will be labelled 12 Lead ECG Report. – Captured 12-lead ECGs will have no annotation next to the bandwidth annotation at the Information Center.
EASI ECG Lead Placement 6 ECG, Arrhythmia, and ST Monitoring EASI Electrode Placement 3 4 2 1 1 E (V) on the lower sternum at the level of the fifth intercostal space 2 A (LL) on the left midaxillary line at the same level as the E electrode 3 S (LA) on the upper sternum 4 I (RA) on the right midaxillary line at the same level as the E electrode 5 N reference electrode - can be anywhere, usually below the sixth rib on the right hip 5 103
6 ECG, Arrhythmia, and ST Monitoring ECG, Arrhythmia, and ST Alarm Overview ECG, Arrhythmia, and ST Alarm Overview The ECG, arrhythmia, and ST alarms available depend on which measurements are switched on, and the arrhythmia option enabled for your monitor.
Using ECG Alarms 6 ECG, Arrhythmia, and ST 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.
6 ECG, Arrhythmia, and ST Monitoring WARNING ECG Safety Information 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. According to AAMI specifications the peak of the synchronized defibrillator discharge should be delivered within 60 ms of the peak of the R wave.
About Arrhythmia Monitoring 6 ECG, Arrhythmia, and ST Monitoring About Arrhythmia Monitoring Arrhythmia analysis provides information on your patient’s condition, including heart rate, PVC rate, rhythm, and ectopics. The monitor uses the user-selected primary and secondary ECG leads for singlelead or multi-lead arrhythmia analysis. During arrhythmia analysis, the monitor continuously • optimizes ECG signal quality. This is important for arrhythmia analysis.
6 ECG, Arrhythmia, and ST Monitoring Switching Arrhythmia Analysis On and Off Switching Arrhythmia Analysis On and Off 1 In the Setup Arrhythmia menu, select Arrhythmia to toggle between On and Off. 2 Select the Confirm pop-up key which appears at the bottom of the screen.
Understanding the Arrhythmia Display 6 ECG, Arrhythmia, and ST Monitoring 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.
6 ECG, Arrhythmia, and ST Monitoring Understanding the Arrhythmia Display Arrhythmia Status Messages The monitor displays two types of status messages: • Rhythm Status Messages -- to indicate the patient’s rhythm. • Ectopic Status Messages -- to indicate the presence of ectopic beats. These status messages are shown on the right hand side of the primary ECG wave. They are updated every second, with the exception of the Sinus and Supraventricular (SV) rhythm messages.
Arrhythmia Relearning 6 ECG, Arrhythmia, and ST Monitoring Ectopic Status Messages The label B or E indicates basic (B) or enhanced (E) arrhythmia capability.
6 ECG, Arrhythmia, and ST Monitoring Arrhythmia Alarms Automatic Arrhythmia Relearn Arrhythmia relearning is initiated automatically whenever: • ECG monitoring is switched on • The ECG Lead or Lead Label 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.
Arrhythmia Alarms 6 ECG, Arrhythmia, and ST Monitoring Yellow Arrhythmia Alarms Yellow arrhythmia alarms are short yellow alarms specific to arrhythmia-related patient conditions. Depending on your monitor and Information Center revision, they may be shown with one or two stars. WARNING When arrhythmia analysis is on, all yellow alarms connected with ECG are short (one-star).
6 ECG, Arrhythmia, and ST Monitoring Arrhythmia Alarms 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 115). This setting can only be changed in Configuration Mode.
Arrhythmia Alarms 6 ECG, Arrhythmia, and ST Monitoring Arrhythmia Alarm Chaining When arrhythmia analysis is switched on, multiple alarm conditions may be present. Announcing all of the detected alarm conditions would be confusing, and might hide a more serious condition. For this reason, arrhythmia alarms are prioritized in three alarm “chains”: PVC Alarms; Beat Detection Alarms, and Rate Alarms. Only the highest priority alarm condition in each chain is announced.
6 ECG, Arrhythmia, and ST Monitoring Arrhythmia Alarms Understanding PVC-Related Alarms PVC-related alarms are detected on the basis of the current ventricular heart rate and the number of consecutive PVCs counted (referred to as PVC Runs). Changing one alarm limit automatically changes linked alarm limits.
About ST Monitoring 6 ECG, Arrhythmia, and ST Monitoring About ST Monitoring The monitor performs ST segment analysis on normal and atrially paced beats and calculates ST segment elevations and depressions. This information can be displayed in the form of ST numerics and snippets on the monitor. All available leads can be monitored continuously. The ECG waveform does not need to be displayed on the Screen for ST Segment analysis.
6 ECG, Arrhythmia, and ST Monitoring Understanding the ST Display Understanding the ST Display Your monitor screen may be configured to look slightly different from the illustrations. ST Numerics Up to 12 ST numerics plus the ST index can be displayed on the monitor 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.
Updating ST Baseline Snippets ST label and numeric Baseline ST numeric and difference since baseline was stored 6 ECG, Arrhythmia, and ST Monitoring ST Baseline ST-II -0.8 1.9 ?-2.7 1mV calibration bar Current snippet ST baseline ST Baseline stored at 14 Feb 03 9:38 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.
6 ECG, Arrhythmia, and ST 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.
About the ST Measurement Points 3 6 ECG, Arrhythmia, and ST Monitoring Use the Select Point pop-up key to scroll through the points and activate the point you need to adjust, then use the left and right arrow keys to move the measurement point. Each point is highlighted while active. ST label and the ST numeric that would apply using the current points Adjust ST Points ST-I 0.
6 ECG, Arrhythmia, and ST Monitoring 5 ST Alarms 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.
Viewing ST Maps 6 ECG, Arrhythmia, and ST Monitoring alarm status indicator 12-Lead EASI indicator ST index (for EASI) ST Map (Current) EASI Limb leads ST map EASI Chest Leads ST label, value and polarity of corresponding lead If an ST lead is switched off, its axis is not shown in the map. If a lead is in INOP (the value is being measured but is invalid or unavailable because, for example, the corresponding ECG electrode is unplugged), the area formed by the remaining ST leads is left open.
6 ECG, Arrhythmia, and ST Monitoring Viewing ST Maps 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.
Viewing ST Maps 6 ECG, Arrhythmia, and ST Monitoring 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.
6 ECG, Arrhythmia, and ST Monitoring 126 Viewing ST Maps
7 Monitoring Pulse Rate 7 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 (ABP, ART, Ao, BAP, FAP, PAP, UAP, P: 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.
7 Monitoring Pulse Rate Switching Pulse On and Off Switching Pulse On and Off To switch a particular pulse numeric on or off, enter the Setup Pulse menu via the measurement setup menu or wave menu of the pulse source. For example, to switch an 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. 2 In the Setup Pulse menu, select Pulse (Pulse source) to toggle between On and Off.
Using Pulse Alarms WARNING 7 Monitoring Pulse Rate Selecting Pulse as the active alarm source for HR/Pulse switches off the arrhythmia alarms listed in the section “ECG, Arrhythmia, and ST Alarm Overview” on page 104, and the heart rate alarms. This is indicated by the message All ECG Alarms Off (unless this has been configured off for your monitor), and the crossed-out alarm symbol beside the ECG heart rate numeric.
7 Monitoring Pulse Rate 130 Using Pulse Alarms
8 Monitoring Respiration Rate (Resp) 8 For the respiratory measurement (Resp), the monitor measures the thoracic impedance between two ECG electrodes on the patient’s chest. Changes in the impedance due to thoracic movement produce the Resp waveform on the monitor screen. The monitor counts the waveform cycles to calculate the respiration rate (RR).
8 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 patient’s maximum point of breathing movement to optimize the respiratory wave. Abdominal Breathing Some patients with restricted chest movement breathe mainly abdominally.
Changing the Size of the Respiration Wave 8 Monitoring Respiration Rate (Resp) • the algorithm expects a heart rate and therefore needs at least 3 electrodes attached to the patient. If you are monitoring respiration with only two electrodes, the detection algorithm becomes less sensitive which may result in reduced breath detection performance.
8 Monitoring Respiration Rate (Resp) Changing the Speed of the Respiration Wave Changing the Speed of the Respiration Wave Resp waveforms are usually viewed at a slower speed than other waveforms. For this reason, the Resp measurement has its own speed control and is not affected by the wave speed settings of the other measurements. ♦ Select the Resp wave to enter the Resp Wave menu, then select Change Speed. Choose the required speed from the pop-up list.
Resp Safety Information 8 Monitoring Respiration Rate (Resp) Rate adaptive pacemakers: Implanted pacemakers which can adapt to the Minute Volume may occasionally react on the Impedance measurement used by patient monitors for the determination of the Resp value and execute pacing with the maximum programmed rate. Switching off the Resp measurement can prevent this.
8 Monitoring Respiration Rate (Resp) 136 Resp Safety Information
9 Monitoring SpO2 9 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 patient’s pulse. • Pulse rate (derived from pleth wave) - detected pulsations per minute.
9 Monitoring SpO2 Connecting SpO2 Cables select a finger or toe with a diameter of between 7 and 8 mm (0.27” and 0.31”). When applying a M1193A neonatal sensor do not overtighten the strap. 4 WARNING Check that the light emitter and the photodetector are directly opposite each other. All light from the emitter must pass through the patient’s tissue. Loose Sensor: If a sensor is too loose, it might compromise the optical alignment or fall off.
Assessing a Suspicious SpO2 Reading 9 Monitoring SpO2 – has not changed in its thickness (for example, due to edema), causing an improper fit of the sensor. 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. Using an SpO2 sensor during MR imaging can cause severe burns.
9 Monitoring SpO2 Understanding SpO2 Alarms 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. CAUTION If you measure SpO2 on a limb that has an inflated NBP cuff, a non-pulsatile SpO2 INOP can occur.
Perfusion (Pleth) Indicator 9 Monitoring SpO2 minimum size for reliable SpO2 value Perfusion (Pleth) Indicator The perfusion indicator gives a numerical 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 indicator as a quality indicator for the SpO2 measurement. Above 1 is optimal, between 0.3-1 is acceptable. Below 0.
9 Monitoring SpO2 142 1 From the Main Setup menu, select Measurements. 2 From the ∆SpO2 Setup menu, select First SpO2. 3 Choose the first measurement source. 4 Select Second SpO2. 5 Choose the second measurement source.
10 Monitoring NBP 10 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.
10 Monitoring NBP Preparing to Measure NBP CAUTION If you spill liquid onto the equipment or accessories, particularly if there is a chance that it can get inside the tubing or the MMS, 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.
Preparing to Measure NBP 10 Monitoring NBP NBP 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.
10 Monitoring NBP Starting and Stopping Measurements – 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. 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.
Choosing the NBP Alarm Source 10 Monitoring NBP Choosing the NBP Alarm Source You can monitor for alarm conditions in systolic, diastolic and mean pressure, either singly or in parallel. Only one alarm is given, with the priority of mean, systolic, diastolic. In the Setup NBP menu, select Alarms from and choose from: Menu option Pressure value monitored Sys. systolic Dia.
10 Monitoring NBP 148 Calibrating NBP
11 Monitoring Temperature 11 You can measure temperature using the Multi-Measurement Server (MMS), one of the measurement server extensions, or the temperature plug-in module. Temp measurement automatically switches on when you connect a probe. You can switch the measurement off manually. Making a Temp Measurement 1 Select the correct type and size of probe for your patient. 2 If you are using a disposable probe, connect the probe to the temperature cable.
11 Monitoring Temperature Calculating Temp Difference Temp non-specific temperature label. Trect rectal temperature Tart arterial temperature Tskin skin temperature Tcore core temperature Tven venous temperature Tesoph esophageal temperature Tnaso 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.
12 Monitoring Invasive Pressure 12 You can measure pressure using the Multi-Measurement Server (MMS), one of the measurement server extensions or the pressure plug-in module. Setting up the Pressure Measurement 1 Plug in the pressure cable. MMS WARNING Module 2 Prepare the flush solution. 3 Flush the system to exhaust all air from the tubing. Ensure that the transducer and stopcocks are free of air bubbles.
12 Monitoring Invasive Pressure WARNING Zeroing the Pressure Transducer If measuring intracranial pressure (ICP) with a sitting patient, level the transducer with the top of the patient’s ear. Incorrect leveling may give incorrect values. Selecting a Pressure for Monitoring Tell the monitor which pressure you want to monitor by selecting its pressure label. The label is a unique identifier for each type of pressure.
Zeroing the Pressure Transducer 12 Monitoring Invasive Pressure 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.
12 Monitoring Invasive Pressure Adjusting the Calibration Factor If you are measuring pressures with more than one measuring device, using the Zero SmartKey to initiate the zeroing calls up a list of all active pressures. Select the pressure you want to zero or select All Press to zero all pressures simultaneously. Troubleshooting the Zero The status line lists the probable cause of an unsuccessful zero: Message Corrective Action unable to zero equipment malfunction The hardware is faulty.
Optimizing the Waveform 3 12 Monitoring Invasive Pressure 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 menu, select Optimum Scale to let the monitor select the best minimum and maximum scales for the current wave.
12 Monitoring Invasive Pressure Calibrating Reusable Transducer CPJ840J6 Calibrating Reusable Transducer CPJ840J6 Depending on your monitor’s configuration, you may be able to perform a calibration in monitoring mode. Perform a mercury calibration when you use a new transducer, and at regular intervals according to your hospital policy. You require: • standard sphygmomanometer. • sterile 10cc syringe with heparinised solution. • 3-way stopcock. • approximately 25cm of tubing.
Calculating Cerebral Perfusion 12 Monitoring Invasive Pressure 5 Select the calibration pressure from the list, for example 200 mmHg. 6 Select Confirm to recalculate the calibration factor using the applied pressure. 7 When the monitor displays calibration done at , remove the manometer tubing, syringe and extra stopcock. We recommend you replace the transducer dome and tubing with sterile ones. 8 Label the transducer with the calibration factor shown in the Cal.
12 Monitoring Invasive Pressure Measuring Pulmonary Artery Wedge Pressure • The clinical value of the derived PPV information must be determined by a physician. According to recent scientific literature, the clinical relevance of PPV information is restricted to sedated patients receiving controlled mechanical ventilation and mainly free from cardiac arrhythmia. To select an arterial pressure as PPV source: 1 In the Main Setup menu, select Measurements.
Editing the Wedge 12 Monitoring Invasive Pressure not be displayed or recorded properly. To avoid this, switch out of optimum scale before performing a wedge procedure. 3 Use the Reference Wave 1 and 2 popup keys to select any ECG or respiratory wave as reference waves. 4 Select Wave Speed if you want to synchronize all displayed waves to your preferred speed. 5 Inflate the balloon when the monitor prompts you: Ready for balloon inflation. The waveform changes from the PAP to the PAWP wave.
12 Monitoring Invasive Pressure Identifying the Pressure Analog Output Connector Identifying the Pressure Analog Output Connector analog output (module M1006B, option C01 only) 160
13 Monitoring Cardiac Output 13 The Cardiac Output (C.O.) measurement invasively measures cardiac output and other hemodynamic parameters using a technique called thermodilution. This can be used to determine the flow rate of a system by introducing a cold solution into the system and measuring the resulting drop in temperature at a downstream site. The temperature change is displayed as a curve in the C.O. procedure window, and the monitor calculates the C.O. value from this curve. The C.O.
13 Monitoring Cardiac Output Hemodynamic Parameters Hemodynamic Parameters This table illustrates the hemodynamic parameters available with each method, whether they are measured continuously, and whether they can be shown on the monitor’s resting display or in the HemoCalc Window.
Using the C.O. Procedure Window 13 Monitoring Cardiac Output Using the C.O. Procedure Window The C.O. procedure window displays up to six trials (measurement curves) with the trial number and the C.O. value under the thermodilution curve. When you open the window, a line of pop-up keys automatically appears to let you carry out C.O.-related tasks. This example shows the procedure window for the transpulmonary (PiCCO) Method. The window may be configured to look slightly different on your monitor.
13 Monitoring Cardiac Output Accessing the Setup C.O. and Setup CCO Menus Accessing the Setup C.O. and Setup CCO Menus C.O. settings can be changed in the Setup C.O. menu. To access this menu, ♦ press the C.O. hard key on the C.O. module ♦ select any of the discontinuous C.O. numerics (for example, C.O., C.I.) on the screen. CCO/CCI settings can be changed in the Setup CCO menu. To access this menu, ♦ select any of the continuously measured hemodynamic numerics (CCO, CCI.) on the screen.
Measuring C. O. Using the PiCCO Method 13 Monitoring Cardiac Output Setting Up the PiCCO C.O. Measurement C.O. Module 1 Set up the arterial line using the arterial catheter (transpulmonary catheter) and the transducer kit from Pulsion Medical Systems. It must be placed in one of the bigger systemic arteries, for example, the femoral or the axillary artery. You must use the approved catheters and puncture locations. 2 Set up the central venous line.
13 Monitoring Cardiac Output Measuring C. O. Using the PiCCO Method 8 Check that the correct arterial catheter constant is selected. If the catheter is recognized by the monitor, the catheter constant is automatically displayed and cannot be changed manually. If it is not recognized, in the C.O. procedure window, select CathCt and use the pop-up keypad to enter the correct value. The catheter constant is usually written either on the catheter or on the catheter packaging.
Measuring C. O. Using the PiCCO Method 13 Monitoring Cardiac Output you can accept or reject trials directly by tipping on the trial curve. Discard conspicuously different values. The background of rejected trials is red and the background of accepted trials is green. The monitor recalculates the average values after you reject or accept trials. If all values are different from each other, there may be true hemodynamic instability caused, for example, by severe cardiac arrhythmia.
13 Monitoring Cardiac Output Measuring C.O. Using the Right Heart Thermodilution Method Measuring C.O. Using the Right Heart Thermodilution Method In the right heart thermodilution method, a fluid of known volume and temperature is injected into the right atrium through the proximal port of a pulmonary artery (PA) (Swan-Ganz) catheter.
Documenting C.O. Measurements 13 Monitoring Cardiac Output If you are using the ice-bath setup, the injectate temperature probe and the injectate are both placed in an ice-bath and the probe measures the temperature of the contents of the ice bucket. Setting the Computation Constant Check that the correct Computation Constant is entered in the C.O. procedure window.
13 Monitoring Cardiac Output 2 C.O. Injectate Guidelines From the pop-up list, choose: – Print Results to print the contents of the C.O. procedure window – Record Results to record the contents of the C.O. procedure window – Record Trial to send an individual trial curve to the recorder. C.O. Injectate Guidelines The greater the injectate volume and the colder the temperature, the more accurate the measurement. Reduced injectate volume or higher injectate temperature may reduce the specified accuracy.
C.O./CCO Curve Alert Messages 13 Monitoring Cardiac Output C.O./CCO Curve Alert Messages After each measurement trial, the monitor analyzes the thermodilution curve. If the curve appears abnormal, a curve alert message appears in the C.O. procedure window. A question mark symbol (“?”) may appear next to the cardiac output numeric if any of these messages appear. The curve alert messages are not error messages and do not necessarily mean that the measured values are invalid. C.O.
13 Monitoring Cardiac Output C.O./CCO Prompt Messages C.O./CCO Curve Alert Messages Possible Causes Check Injectate Temperature Probe Type The recorded Tinj signal is uncharacteristic for the M1646 injectate temperature probe. The probe may be defective or an incorrect probe type may have been used. Unsteady Baseline There is a noisy baseline, and thermal baseline drift. Multiple Peaks Caused by faulty injection technique. Abnormal Decay Time May be caused by low cardiac output.
C.O./CCO Warning Messages 13 Monitoring Cardiac Output C.O./CCO Warning Messages Warning messages contain important information about the C.O. measurement. C.O./CCO Warning Messages Possible Causes Next measurement erases older curve Six curves are stored, this is the maximum possible. If another measurement is stored, the oldest thermodilution curve will be erased. Previous C.O. Setup Data replaced A C.O. module or measurement server extension has been plugged in with different C.O.
13 Monitoring Cardiac Output C.O./CCO Safety Information CAUTION During the cardiac output measurement procedure the blood temperature alarms are inactive. This is indicated by a crossed-out alarm symbol next to the temperature numeric. Making alarms inactive during this procedure prevents false alarms. The alarms are automatically reactivated when you have completed the measurement procedure.
14 Monitoring Carbon Dioxide 14 Use the CO2 measurement to monitor the patient’s respiratory status and to control patient ventilation. There are two methods for measuring carbon dioxide in the patient’s airway: • Mainstream measurement uses a CO2 sensor attached to an airway adapter directly inserted into the patient’s breathing system. This method is available with the M3014A Capnography Extension and the M3016A Mainstream Extension to the M3001A Multi-Measurement Server.
14 Monitoring Carbon Dioxide WARNING Using the Capnography Extension (M3014A) 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.
Using the Capnography Extension (M3014A) 3 4 5 WARNING 14 Monitoring Carbon Dioxide Choose the appropriate airway adapter and connect it to the sensor head. The airway adapter clicks into place when seated correctly. To zero the sensor: – expose the sensor to room air and keep it away from all sources of CO2 including the ventilator, the patient’s breath and your own. – in the setup menu for the CO2, select Start Zero Cal.
14 Monitoring Carbon Dioxide Using the Capnography Extension (M3014A) – expose the sensor to room air and keep it away from all sources of CO2 including the ventilator, the patient’s breath and your own. – In the setup menu for the CO2, select Start Zero Cal. – When you see the message Zero done at on the status line, the zero calibration is finished and you can begin monitoring.
Using the Mainstream CO2 Extension (M3016A) 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. 14 Monitoring Carbon Dioxide To remove the sensor from the holder, release the clip and pull the sensor out of the holder.
14 Monitoring Carbon Dioxide Using the Mainstream CO2 Extension (M3016A) 4 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. 5 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.
Using the Microstream CO2 Extension (M3015A) 2 WARNING 14 Monitoring Carbon Dioxide To remove the transducer from the airway adapter, open the latch and pull out the airway adapter. To prevent stress on the endotrachial tube, support the transducer and airway adapter. To avoid infection, use only sterilized airway adapters.
14 Monitoring Carbon Dioxide Using the Microstream CO2 Extension (M3015A) 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.
Setting up Mainstream and Sidestream CO2 14 Monitoring Carbon Dioxide Suppressing Zero Calibration To prevent an automatic zero calibration from being started in the next five minutes, ♦ in the Setup CO2 menu, select No Zero for 5 Min, or select the Suppress CO2 Zero SmartKey, if configured. Selecting No Zero for 5 Min or selecting the Suppress CO2 Zero SmartKey again before the timer has timed out resets the timer to five minutes, unless an AutoZero became due during the previous suppression.
14 Monitoring Carbon Dioxide Setting up Mainstream and Sidestream CO2 Correction Agent (M3014A only) In the Setup CO2 menu, select Agent Corr and select the concentration of the anesthetic agent (between 0.0% and 20.0%). If an anesthetic agent is present in the ventilation gas mixture, you must select the appropriate concentration. Suppressing Sampling (not Mainstream CO2) To temporarily stop sampling, ♦ in the Setup CO2 menu, select Pump 15Min Off or use the CO2 Pump Off SmartKey if available.
Setting up Mainstream and Sidestream CO2 2 Select High Limit to set the upper alarm limit. Select Low Limit to set the lower alarm limit. 3 Select the appropriate setting.
14 Monitoring Carbon Dioxide 186 Setting up Mainstream and Sidestream CO2
15 Monitoring Airway Flow, Volume and Pressure 15 The M1014A Spirometry Module is designed to be used in combination with Philips-branded airway flow sensors and combined CO2/airway flow sensors. It produces a real time wave for flow, volume and pressure of respiratory gases together with numerics for analysis of ventilatory mechanics. The measurement provides: • Airway flow, airway volume and airway pressure waveform.
15 Monitoring Airway Flow, Volume and Pressure Attaching the Flow Sensor Attaching the Flow Sensor CAUTION Use the M1014A Spirometry Module with Philips approved accessories only. Refer to the instructions for use provided with the accessory. 1 Select the appropriate flow sensor. Make sure that you are using the correct sensor for the respective patient category. Otherwise accuracy may be reduced. Pediatric/Adult Flow Sensor (M2785A).
Attaching the Flow Sensor Pediatric/adult sensor WARNING 15 Monitoring Airway Flow, Volume and Pressure Pediatric sensor Infant/Neonatal sensor 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 or tubing. Replace the sensor, if excessive moisture or secretions are observed in the tubing and cannot be removed by a purge cycle.
15 Monitoring Airway Flow, Volume and Pressure Zero Calibration • A volume waveform as displayed below on the left may be an indicator of an air leak: Abnormal waveform due to leak Normal waveform In general, if MVexp or TVexp are significantly smaller than MVin or TVin, the tubing should be checked for leaks. Zero Calibration The zero calibration maintains the accuracy of the spirometry waves and numerics by regularly compensating for drifts within the measurement section.
Manual Purging 15 Monitoring Airway Flow, Volume and Pressure Adult Mode The system automatically purges the sensor tubing every ten minutes or less, depending on system conditions. In adult mode, the system will purge both sides of the line, one at a time, during each purge cycle. The higher the pressure, the more frequent the purging. This action anticipates increased moisture migration into the sensor tubing due to the increase in circuit pressure.
15 Monitoring Airway Flow, Volume and Pressure N2 Setting up Spirometry O2 N2O Agent Actual Gas Composition 55 40 5 Gas Compensation Setting 60 40 0 Difference between measured and actual values 15% Table 2 Incorrect Agent Percentage Setting Setting up Spirometry The following settings can be accessed through the Setup Spirometry menu. Optimizing Scale Settings In the Setup Spirometry menu, select Optimize Scales.
Setting up Spirometry 15 Monitoring Airway Flow, Volume and Pressure WARNING Safety and effectiveness of the respiration measurement method in the detection of apnea, particularly the apnea of prematurity and apnea of infancy, has not been established. WARNING If an apnea occurs during a zero calibration, the time delay between the start of apnea and the activation of the apnea alarm could be up to 10 seconds plus the configured apnea delay time.
15 Monitoring Airway Flow, Volume and Pressure 3 Setting up Spirometry Select the appropriate setting. Changing the Temperature of the Inspired Gas Depending on the type of ventilator environment (e.g. if you are using a Heat Moisture Exchanger) you may want to change the temperature setting of the inspired gas: N O TE 194 1 In the Setup Spirometry menu, select Gas Compensation. 2 Select Inspired Temp to change the temperature of the inspired gas. 3 Select the appropriate temperature setting.
16 Monitoring tcGas 16 The tcGas module measures the partial pressure of the oxygen and carbon dioxide that diffuses through the skin, thereby providing a measure of these gases in the capillary blood. The monitor’s settings for altitude and barometric pressure influence the measurement. The tcpO2/ tcpCO2 measurement is valid for an infant patient not under gas anesthesia. Anesthetic agents, such as halothane, can cause incorrect or drifting readings.
16 Monitoring tcGas Setting the tcGas Sensor Temperature Setting the tcGas Sensor Temperature 1 In the Setup tcGas menu, select Transducer Temp. 2 Choose a temperature value appropriate for your patient’s age, weight and physical condition in accordance with your hospital policy. Usually, a higher transducer temperature gives a better correlation and a quicker response time. However, higher temperatures also increase the risk of skin burns.
Setting the tcGas Barometric Pressure 16 Monitoring tcGas Restarting the tcGas SiteTimer To restart the site timer without recalibration (for example, after the site time has elapsed): 1 In the Setup tcGas menu, select Site Time. 2 Enter and confirm your desired time. Disabling the tcGas Site Timer Depending on your monitor’s configuration, you might be able to disable the site timer. Remember, this means that the transducer heats indefinitely while on a patient.
16 Monitoring tcGas 1 Unscrew the protection cap from the transducer and hook the O-ring remover under both O-rings to remove them. 2 Remove both of the clear plastic membranes using your fingers. 3 Clean the transducer head, including the groove and rim, with absorbent paper to remove all old electrolyte (old electrolyte causes incorrect values) and apply approximately two drops of electrolyte solution to the transducer head.
Calibrating the tcGas Transducer 16 Monitoring tcGas Calibrating the tcGas Transducer You can use either a Philips (15210B) or a Radiometer TCC3 calibration unit and a gas cylinder whose pressure indicator is above the ‘out-of-gas’ zone (black on 15210B, red on TCC3). To maintain accuracy, it is recommended to calibrate the transducer every four hours, even if the monitor does not prompt you to do so.
16 Monitoring tcGas 4 Calibrating the tcGas Transducer Press CAL on the module until the light above the key comes on and wait (three - 20 minutes) for the “calibration complete” message to appear on the monitor. Alternatively, in the Setup tcGas menu, select Start Calibration. To save gas on 15210B, if the timer control dial is not in the start position when the monitor displays the calibration complete message, turn the dial counterclockwise to the start position.
Applying the tcGas Transducer 16 Monitoring tcGas Applying the tcGas Transducer 1 Peel protection film from fixation ring. Using a finger, press the sticky side of the ring on to clean, dry skin. Press around the outside to ensure a good seal. Apply three to five drops of contact fluid in the ring’s center. Remove transducer from chamber. 2 Align the arrow on the transducer with the tab on the ring and fasten by turning turn a quarterturn clockwise. Wait 10-20 minutes for readings to stabilize.
16 Monitoring tcGas Finishing tcGas Monitoring Selecting the tcGas HeatPowerDisplay Mode The heat power display gives an indication of the skin’s perfusion below the transducer and of the transducer’s contact with the skin. If the transducer loses contact, the heat power value drops significantly. When perfusion is poor you need less heat power to maintain the transducer temperature. ♦ In the Setup tcGas menu, select HeatPowerDisplay to toggle between Relative and Absolute.
17 Monitoring SvO2 17 MP60/70/ 80/90 monitors only WARNING The SvO2 module measures the percentage of mixed venous oxygen saturation continuously and invasively using the Hospira, Inc. (formerly Abbott Laboratories) OptiCath family of catheters routed via the right side of the heart into the pulmonary artery. Can be used only with the MP60/MP70/ MP80/MP90 monitors. Injected dyes, such as methylene blue, or intravascular dyshemoglobin may lead to inaccurate measurements.
17 Monitoring SvO2 Preparing to Monitor SvO2 Preparing to Monitor SvO2 In addition to an SvO2 module, you need a Hospira OptiCath catheter, and 50131 Optical Module. Use only the Hospira accessories listed in the Accessories section. 1 optical module 2 balloon inflation stopcock 3 Hospira fiber optic catheter 4 optical reference 5 enter setup/ calibration 4 5 1 3 2 Connect the optical module (Hospira 50131) to the SvO2 module.
Inserting the Catheter 17 Monitoring SvO2 3 Place the optical connector into the optical module (with the label “TOP” facing upwards) and close the lid. 4 In the Setup SvO2 menu, select Start Pre-InsCal. Ensure that the tip of the catheter is still in the optical reference. 5 Insert the catheter when you see the message SvO2 calibration completed - catheter ready for insertion. If the calibration fails, repeat the calibration before inserting the catheter.
17 Monitoring SvO2 Performing In-Vivo Calibration Performing In-Vivo Calibration Perform an in-vivo calibration: • if you place the catheter in a patient without performing a pre-insertion calibration. • if the catheter was disconnected from the optical module. • when the catheter has been in the patient for 24 hours. • if any significant change in light intensity occurs that the monitor cannot correct automatically.
18 Monitoring EEG 18 The Electroencephalograph (EEG) module monitors the patient’s cerebral function by measuring the electrical activity of the brain. It provides the monitor with two channels of realtime EEG waves, EEG trend information in the form of Compressed Spectral Arrays (CSA), and up to eight of the following numerics: Spectral Edge Frequency (SEF): The SEF is the frequency below which a defined percentage of the Total Power lies. The percentage is set in Configuration Mode.
18 Monitoring EEG EEG Monitoring Setup EEG Monitoring Setup 1 Plug the trunk cable into the EEG module in the Flexible Module Server. 2 Prepare the patient’s skin prior to placing the electrodes. Good electrode-to-skin contact is important for a good EEG signal, as the skin is a poor conductor of electricity. – Shave hair from sites, if necessary. – Wash sites thoroughly with soap and water. We do not recommend using ether or pure alcohol, because this dries the skin and increases the resistance.
Using the EEG Impedance/Montage Window 18 Monitoring EEG Choosing an EEG Electrode Montage 1 To activate one of the five pre-configured electrode montages, select the arrow beside the label in the EEG Impedance/Montage window and choose a montage from the list. 2 Attach the electrodes as illustrated in the EEG Impedance/Montage window. The five default electrode montage configurations can be modified and renamed in Configuration Mode. Montage Name EEG1+ EEG1- Label1 EEG2+ EEG2- Label2 Mont.
18 Monitoring EEG Using the EEG Impedance/Montage Window About Electrode-to-Skin Impedance Electrode-to-skin impedance is the main quality indicator for the measured EEG signal. During normal EEG monitoring, electrode-to-skin impedance is measured continuously and disconnected electrodes are detected. The impedance value for each single, independent signal electrode is displayed in the EEG Impedance/Montage window.
About Compressed Spectral Arrays (CSA) 18 Monitoring EEG About Compressed Spectral Arrays (CSA) The continuous EEG signal is sampled periodically and this value is stored in a frame. Each frame is processed using Fast Fourier Transformation (FFT) to provide a frequency spectrum displayed as a compressed spectral array (CSA). The CSA window provides an overview of the patient’s EEG values over time. It may be configured to look slightly different on your monitor.
18 Monitoring EEG Changing EEG Settings Changing CSA Settings When CSAs are shown embedded on the Main Screen, select the CSA to show the pop-up keys. When the CSA is shown in a window over the current screen, the pop-up keys are always displayed. Setup CSA This menu entry lets you Buffer choose one of the three pre-configured buffers. A buffer defines the interval between the spectral lines displayed in the CSA.
EEG Reports 18 Monitoring EEG Changing Filter Frequencies The low and high pass filters screen out undesirable interference from the raw EEG wave display. The current EEG filter frequency settings are shown in the header of the CSA. Changing filter settings affects the EEG wave and all the EEG numerics. Whenever the filter setting is changed, a filter change marker appears next to the spectral lines.
18 Monitoring EEG EEG Safety Information EEG Safety Information EEG Configuration and Monitor Upgrades The A.2 monitor release (software revision A.20.xx) introduced a new feature that lets you rename EEG montages. It is not possible to clone EEG settings between montages with different names, therefore all EEG settings are reset to factory defaults during any upgrade/downgrade/cloning actions that mix releases/software revisions/configurations before A.2/ A.20.xx with subsequent versions.
19 Monitoring BIS 19 Bispectral Index monitoring helps to monitor the level of consciousness of a patient under general anesthesia or sedation in the OR and ICU. The BIS sensor is placed on the patient’s forehead to capture electroencephalographic (EEG) signals from which several numerics are derived, including a single BIS value representing the level of consciousness. See the chapter on Specifications for the BIS intended use statement.
19 Monitoring BIS BIS Monitoring Setup BIS Monitoring Setup There are two BIS solutions available for use with the M1034A BIS module: using the DSC and BIS engine or using the BISx. Monitoring BIS Using the DSC and BIS Engine Aspect BIS Engine 185-0111 Aspect Digital Signal Converter 185-0124 BIS Module Aspect Patient Interface Cable 186-0131 BIS Engine Cable Aspect BIS Sensor 1 If you are monitoring BIS with the DSC and BIS engine, a.
BIS Monitoring Setup 19 Monitoring BIS Monitoring BIS using the BISx BIS Module Aspect BISx 185-0145-PH Aspect Patient Interface Cable 186-0131 Aspect BIS Sensor 1 BIS Interface Board Aspect BISx Aspect BIS Sensor 185-0145-PH If you are monitoring BIS using the BISx, a. Connect the BISx device to the BIS module or BIS Interface board connector (MP20/MP30) b. Use the clip on the rear of the BISx device to affix it in a position convenient for your patient, not above the patient’s head.
19 Monitoring BIS BIS Continuous Impedance Check Manufacturer’s Information BISx, the BIS Engine, the DSC, the Patient Interface Cable and the BIS Sensors are manufactured by Aspect Medical Systems. BIS Continuous Impedance Check This checks: • the combined impedance of the signal electrodes plus the reference electrode. This is done continuously and does not affect the EEG wave. As long as the impedances are within the valid range, there is no notification of this check or its results.
BIS Window 19 Monitoring BIS ♦ select Stop Cyclic Check in the BIS Impedance Check Window. If you stop a Cyclic Impedance Check before the ground electrode has passed, a ground electrode impedance check will be started automatically. This cannot be switched off. BIS Window ♦ To open the BIS window, in the Setup BIS menu, select Show Sensor. The window may look slightly different on your monitor.
19 Monitoring BIS Changing the BIS Smoothing Rate Changing the BIS Smoothing Rate The smoothing rate defines how the monitor averages the BIS value. ♦ To change the smoothing rate, in the Setup BIS menu, select BIS Smoothing Rate then choose either: – 15 seconds: this provides increased responsiveness to changes in the patient’s state. – 30 seconds: this provides a smoother BIS trend with decreased variability and sensitivity to artifacts.
BIS Safety Information 19 Monitoring BIS BIS Safety Information For information on the use of BIS in specific monitoring situations and on pharmacological responses to the anesthetic agents Nitrous Oxide (when used as the sole anesthetic agent), Ketamine, and Etomidate, please contact Aspect Medical Systems to request a copy of their publication “A Clinician’s Guide to the Bispectral Index®”.
19 Monitoring BIS 222 BIS Safety Information
20 Trends 20 Trends are patient data collected over time and displayed in graphic or tabular form to give you a picture of how your patient’s condition is developing. Trend information is stored in the trends database for continuously-monitored measurements, such as ECG, as well as for aperiodicallymeasured parameters, such as Cardiac Output. Viewing Trends Trend information can be viewed embedded as a screen element on specially-designed Screens, or you can open a trend window over the current Screen.
20 Trends Viewing Trends Viewing Graphic Trends Graphical Trends: All HR SpO2 ABP 9 Apr Graphical Trends Select Group Select Interva Print Vital Signs 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.
Setting Up Trends 20 Trends 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.
20 Trends Setting Up Trends 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.
Setting Up Trends 20 Trends 1 In the Segment menu, select No. of Segments 2 Select 1, 2, or 3 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.
20 Trends Documenting Trends 1 In the Main Setup menu, select Trends. 2 Select Parameter Scales. 3 Select the measurement or parameter you want to change from the list. 4 Select the pop-up key Change to call up the Scale menu. 5 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.
Trends Databases 20 Trends Trends Databases Depending on the purchased options and the monitor’s configuration, the trends databases store information for up to 32 measurements for up to 72 hours. The values in the trends database are stored as measured by the monitor, they are not averaged values. The trend resolution defines how often a value is stored. In general, if more than one value is available for storage in the trends database, the most recent value is used.
20 Trends Screen Trends 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.
Screen Trends 20 Trends Changing the Selection of Screen Trends Displayed 1 Select the screen trend. 2 Select Change Trend and select the required trend from the list of available trends. Select Blank to remove the selected trend from the Screen. If you do not see Change Trend in the screen trend menu, the trend is aligned to display with the measurement wave. Changing the wave automatically changes the trend.
20 Trends Screen Trends Horizon View The horizon view presents trend information superimposed over a defined baseline. This helps you visualize changes in your patient’s condition since the baseline was set. The horizon view is made up of: • a horizon, drawn in white, as a reference 1 point or baseline to help you visualize changes in your patient’s condition. The horizon can be set to represent your patient’s current condition, or a target condition.
21 Calculations 21 Calculations are patient data that is not directly measured but calculated by the monitor when you provide it with the appropriate information. Your monitor can perform the following hemodynamic, oxygenation, and ventilation calculations. Hemodynamic Oxygenation Ventilation Cardiac Index (C.I.
21 Calculations Viewing Calculations Calculations Windows This example calculations window shows the hemodynamic calculations window. The ventilation and oxygenation windows are similar. Calculations input values Indexed calculation values Output values Calculation type Calculations C.O. Hemodynamic HR ABPs BSA C.I.
Reviewing Calculations 21 Calculations Pop-Up Keys Selecting this pop-up key lets you.... Cardiac Output access the C.O. procedure window. Hemo Review open the hemodynamic calculations review window. Vent Review open the ventilation calculations review window. Oxygen Review open the oxygenation calculations review window. Reviewing Calculations ♦ To enter the calculations review window, select the Oxy Review, Ventil Review, or Hemo Review pop-up key as required.
21 Calculations Entering Values for Calculations Entering Values for Calculations The monitor automatically enters any available values for calculations. For aperiodically-measured values such as C.O., the monitor will re-use the most recent value in the calculation database until a new value becomes available. ♦ To enter calculations values manually or edit automatically-entered values, select the value field to open the on-screen keyboard and use this to enter the correct value.
Documenting Calculations ♦ 21 Calculations To check the current setting, select the patient name to enter the Patient Demographics menu. BSA(B) indicates that the Boyd formula is used; BSA(D) indicates that the Dubois formula is used. Documenting Calculations ♦ To send a Calculations recording to a connected recorder, in the Calculations window, select the Print/Record pop-up key, then select the Record Calc pop-up key.
21 Calculations 238 Documenting Calculations
22 High Resolution Trend Waves 22 High resolution (hi-res) trend waves provide information for fast-changing parameters at a glance. They can help you to recognize trend patterns and to find interrelationships between measurements, by comparing changes in your patient’s condition across different hi-res trend waves. This can aid in the early detection of cardiorespiratory and hemodynamic problems.
22 High Resolution Trend Waves Printing Hi-Res Trend Wave Reports Printing Hi-Res Trend Wave Reports To print hi-res trend waves on reports, you can choose to print either • all VisibleWaves - prints all waves and hi-res trend waves currently displayed • All Waves - prints realtime waves and hi-res trend waves for all currently-monitored measurements • HiRes Waves - prints hi-res trend waves for the currently-monitored measurements • OxyCRG Waves - prints hi-res trend waves for btbHR, SpO2, and Resp.
23 Event Surveillance 23 Events are electronic records of episodes in your patient’s condition. You can trigger them manually, or set them to trigger automatically during pre-defined clinical situations.
23 Event Surveillance Event Functionality Event Groups Basic Event Surveillance Option C06 Advanced Event Surveillance Option C07 Average trend Average trend High resolution trend Snapshot events High Resolution Trend Graphic Event Review window, graphic Event Episode window Summary view, graphic and tabular Event Review window, graphic and tabular Event Episode window Graphic and tabular Event Review window, graphic and tabular Event Episode window 25 events for 24 hours 25 events for 24 hours
Events Pop-Up Keys 23 Event Surveillance The episode type defines the level of detail captured in an event episode. The higher the data resolution, the shorter the period that the monitor can store in its memory. High-resolution data is suited for neonatal applications, where the clinical situation may change very quickly. In adult monitoring, where the patient’s status typically changes more gradually, a longer trend may be more informative.
23 Event Surveillance Event Triggers Pop-Up Keys Selecting this pop-up key lets you.... jump to the first or last event in the event database. Vitals View Graphic View toggle between a tabular and graphic version of the Event Episode window currently viewed. Table Review Graphic Review toggle between a tabular and graphic version of the Event Review window currently viewed. Delete Event delete the currently-selected event from the database. The monitor asks you to confirm this deletion.
Event Triggers 23 Event Surveillance If you use alarm limits as event triggers, the event capture is triggered automatically when your patient’s values violate set alarm limits, or when a specified alarm condition, such as apnea, occurs. No events of this kind are triggered if alarms are switched off. Changing alarm limits changes the event trigger definitions.
23 Event Surveillance 2 Select the name of the current episode type to set the episode pre/post time. Event Triggers Event Setup Group Name: Group 1 Episode Type: Average Trend (20min): -10/+10 min Activated All ***/** Alarms HR (Pulse) 3 sec for HIGH Set the event trigger SpO2 for each All ***/** Alarms measurement. Resp Select each trigger name and select, if available, either an alarm trigger, or a user-defined trigger from the pop-up trigger list.
The Events Database 23 Event Surveillance For manually-triggered events. patient information for the time leading up to the trigger moment is stored using the settings of the assigned event group. The Events Database The maximum number of events that can be stored in the event database depends on the database configuration and the level of event surveillance used. The event database is set up in the monitor’s Configuration Mode.
23 Event Surveillance Viewing Events Counting Combi-Events If one or more events occur during the same Episode Time, the monitor combines them and displays them as distinct events in one event episode, called a combi-event. The first event is the trigger event, and the others are follow-up events. For example, if an apnea event is followed 40 seconds later by a brady event, the brady event is not counted as a single event but as part of the apnea event.
Viewing Events 23 Event Surveillance Event Summary Window (Advanced Event Surveillance only). The Event Summary window shows the number of stored events in each event group and the total number of events in the database. Vertical bars mark events on a timeline showing the position of the stored events in the event database.
23 Event Surveillance Viewing Events Event Review (Total: 4) HR Brady SpO2 DESAT Resp APNEA Manual Total Event bars: Each event bar represents one event. The height indicates the event severity. Bars that extend over more than one channel represent combi-events. Manually-captured events are marked with a bar above the timeline instead of in the measurement channels. Event values: Event information for the currently-selected event is shown on the left of the review window.
Annotating Events 23 Event Surveillance Event Episode Trigger event values, highlighted HR Brady 104 < 110 SpO2 Follow-on event values Desat 71 < 85 Timeline, showing episode Pre/Posttime Active event group Resp 7 Jul NER The event values to the left of the measurement channels show the trigger threshold set and the maximum amount by which this limit was exceeded.
23 Event Surveillance 2 Documenting Events For a graphic Event Review recording, select the Record Graphic pop-up key. For a tabular Event Review recording, select the Record Tabular pop-up key. To print an Event Report, select the Print Review pop-up key. Documenting an Event Episode 1 In the Event Episode window, select the pop-up key Print/Record. This calls up the event documentation pop-up keys. 2 To make an Event Episode recording, select the Record pop-up key.
Documenting Events 23 Event Surveillance In tabular event review recordings, the events stored in the event database are shown in chronological order, with a number and time-stamp. # Time Group Parameter 1 Parameter 2 Parmeter 3 1 23 Jan 02 07:56 Neuro Resp BIS LOW 51<60 ABP 2 23 Jan 02 07:59 Stand HR(Pulse) ard TACHY 201>180 ST-II SpO2 3 23 Jan 02 08 02 Neuro Resp HIGH 76 60 BIS ABP The measurements in the event group are shown in the next columns, marked “Parameter 1, Parameter 2...
23 Event Surveillance Documenting Events Event Review Reports The event review report documents all the events stored in the event database for a selected group.
Documenting Events 23 Event Surveillance Event Episode Reports The event episode report documents the patient information from the currently-selected event. See the section on event recordings for an explanation of the report elements. Event Summary Reports (Advanced Event Surveillance only). The event summary report shows a graphical view and a tabular view of all events in the database for all groups.
23 Event Surveillance 256 Documenting Events
24 24 Recording MP40/MP50/ The M1116B plug-in recorder records numerics for all active measurements and up to three MP60/MP70/ waveforms. You can use it for local recording mounted either in the monitor’s FMS or in the integrated MP90 module slots (MP40/MP50, MP60/MP70).
24 Recording Starting and Stopping Recordings MP20/MP30 The integrated recorder records numerics for all active measurements and up to three waveforms. MP20/MP30 Integrated Recorder Central Recording For central recording from the bedside, your monitor must be connected via a network to an Information Center. You can use either the M1116B recorder or the standalone M3160A 4-Channel Recorder. Recordings made on the M3160A may look slightly different to those described here.
Overview of Recording Types 24 Recording To quickstart a delayed recording, ♦ M1116B ♦ only Select the SmartKey Delayed Record to immediately start a delayed recording. You can also start a delayed recording by pressing the RUN/CONT key on the recorder module. Extending Recordings Timed (non-continuous) recordings stop when their runtime is over. Continuous recordings continue until stopped manually or by an INOP condition.
24 Recording All ECG Waves Recordings Procedure or Context Delayed Alarm Realtime (RT) All ECG Waves HiResTrnd Type of recording manual automatic, triggered by defined alarm conditions manual manual manual manual, use the context window’s popup keys to start Local or Central local and central local and central local and central local only local only local only from the start trigger minus the delay time from the start trigger from the start trigger, in realtime from the start trigger
Changing ECG Wave Gain 24 Recording 3 Select the name of the template you want to create or change. Each recording name is linked to a recording type, delayed, alarm, realtime, and high res trends. Recording names can be changed in the monitor’s Configuration Mode. 4 Design the template by selecting each menu item and entering the information for the template. • Recorder: choose which recorder the recording will print to (Local, Central 2-Ch. or Central 4Ch.).
24 Recording Recording Priorities Recording Priorities Manually-started recordings have priority over automatically-started recordings. If an automatically-triggered alarm recording is running, and a realtime or delayed recording is manually started, the alarm recording is stopped and the manually-requested recording is started. More recent manually-started recordings have priority over older manually-started recordings.
Sample Recording Strip Recording type Operating mode Application area Patient category 24 Recording Code Meaning 90 Realtime 8A Delayed 0B Alarm 91 Context (Procedures) M Monitoring D Demo C Configuration S Service I ICU O OR C CCU N NICU A Adult P Pediatric N Neonatal Recorded Waveforms A selection of up to three waveforms is recorded, marked with wave labels and wave scale information.
24 Recording Reloading Paper Reloading Paper M1116B MP20/MP30 1 Use the latch on the right side of the recorder door to pull the door open. 2 Remove the empty core. 3 Insert a new roll so that it fits snugly into its housing and the paper end is feeding from the top. 4 Pull out some paper and fold along the front edge at a 45° angle. This makes it easier to feed the paper under the roller as shown. 5 Feed the paper through and pull some paper out from the top of the roller.
Recorder Status Messages 24 Recording Recorder Status Messages Recorder Status Messages Explanation running The named recording is currently running. No alarm recording available No alarm recording can be made on the selected recorder. If available, try selecting another recorder. If a local recorder was selected, the monitor will try to reroute the recording. Recordings sent to a central recorder cannot be rerouted. Alarm recordings may be lost.
24 Recording 266 Recorder Status Messages
25 Printing Patient Reports 25 Starting Reports 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.
25 Printing Patient Reports Stopping Reports Printouts Report types Report contents How to start printing reports Alarm Limits Report Graphic and numeric report of all current alarm limits In the Alarm Limits window, select Print Limits Realtime Reports, including oxyCRG Reports (Neonatal Event Review) patient data and numerics, and either: Select the Realtime Reports SmartKey, if all displayed waves OR all measured configured waves OR all measured RT waves Or all measured HiRes waves, OR oxyCRG wa
Setting Up Reports 25 Printing Patient Reports Setting Up Vital Signs and Graphic Trend Reports The settings you choose in the Setup Vital Signs Report and Graphical Trend Report menus apply for all Vital Signs and Graphic Trend reports printed. To set up Vital Signs and Graphic Trend reports, 1 Select Main Setup -> Reports -> Vital Signs Rep. or Graph Trend Rep. 2 Select Trend Group and select the group you want to print on the report. The groups available depend on your monitor’s trend configuration.
25 Printing Patient Reports Setting Up Individual Print Jobs Setting Up Individual Print Jobs To adjust the appearance of individual print jobs, in the Reports menu, 1 Select Main Setup -> Reports -> Setup Reports to enter the Setup Reports menu. 2 Select Report and then select the report you want to set up. 3 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.
Printing a Test Report 25 Printing Patient Reports Printing a Test Report A test report can be printed in Configuration mode, refer to the Service Guide for details. Switching Printers On Or Off for Reports You can enable or disable printer status to switch individual printers on or off for report printouts. 1 In the Setup Printers menu, select Printer and then select the name of the device you want to switch on or off for Reports printing from the pop-up list.
25 Printing Patient Reports Printer Status Messages Printer Status Messages Printer Status Message Possible causes and suggested action Print job could not be queued The printer queue is full and the monitor cannot accept another report request. Wait until some more reports have been printed, then try again, OR 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.
Sample Report Printouts 25 Printing Patient Reports Alarm Limits Report Patient Name Measurement labels, with alarms off symbol where alarms are switched off Graphic view of current alarm limits in relation to currently monitored measurement value 273
25 Printing Patient Reports Realtime Report Patient demographic information, time stamp Active Alarms and INOPs, followed by vital signs Measurement waves section, including HiRes waves 274 Sample Report Printouts
Sample Report Printouts 25 Printing Patient Reports Cardiac Output Report Patient information Numbered trial curves Trial information in tabular form 275
25 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.
26 Using the Drug Calculator 26 Drug mixtures for intravenous (IV) drug infusions combine information on drug dose, rate, amount, volume, concentration, and standardized rate. The Drug Calculator helps you to manage infusions by calculating one of these values at a time.
26 Using the Drug Calculator Performing Drug Calculations Performing Drug Calculations Using the service Support Tool, a list of drugs can be configured for the monitor containing predefined dosage recommendations and unit settings. Selecting the arrow beside the drug name in the Drug Calculator window opens a list of configured drugs. Contact your pharmacist if you have any questions about the drugs in the list.
Performing Drug Calculations 3 26 Using the Drug Calculator When you have entered three values, the Drug Calculator automatically calculates the unknown fourth value and shows it in the highlighted field. Standardized rate and concentration are also calculated. Performing Calculations for a Specific Drug 1 2 Select the arrow beside Any Drug, then select the required drug from the list of drugs. This opens the Drug Calculator window for the selected drug.
26 Using the Drug Calculator Charting Infusion Progress Charting Infusion Progress The Drip Table shows you at a glance how much of the infusion has been administered to your patient and how much time is left. ♦ Drip Table Amount Lidocaine To see the Drip Table, in the Drug Calculator window, select the Drip Table pop-up key. If the DripTime exceeds 24 hours, the DripTime timestamp shows - - :- - : - - .
27 VueLink Modules 27 A VueLink module transmits information from a connected external device to your monitor. Each module can be connected to up to three external devices, and supports alarms from the external device. Although the external device may transmit more information, the number of waves and numerics you can view simultaneously on your monitor’s main screen depends on the module type. Type A modules support one wave and two numerics, type B modules support two waves and six numerics.
27 VueLink Modules Connecting an External Device Connecting an External Device 1 Insert the module into the FMS or integrated module slot. 2 Check that the device selection LED (c) lights to show that it has correctly identified the external device. If not, select Main Setup -> Measurements -> to enter the setup menu for the connected device, headed Setup .
Using VueLink Screens 27 VueLink Modules Using VueLink Screens Your monitor may be configured to show VueLink device data permanently on the Screens. Select the device data window to display the VueLink pop-up keys that let you access the setup menu and carry out VueLink tasks. Switching VueLink On and Off ♦ To switch VueLink measurements on and off, in the Setup VueLink menu, select Device Interface to toggle between the settings On and Off.
27 VueLink Modules Language Conflict with External Device Drivers Language Conflict with External Device Drivers You should avoid language conflicts between the VueLink module device driver and the monitor. Be aware that if you connect a VueLink module with a different operating language to the monitor, the monitor will show: • measurement labels in the monitor language • alarm and INOP texts in the VueLink module device driver language.
28 Using Timers 28 With the Timers function you can set timers to notify you when a specific time period has expired. CAUTION Do not use the timers to schedule critical patient-related tasks. Viewing Timers You can view currently active timers in the Timers window or directly on the Main Screen (if a timer has been substituted for a numeric).
28 Using Timers Timer Setup Pop-up Keys Timer Types There are four types of timer: Basic, Enhanced, Cyclic and No Limit. A Basic timer has a single, defined run time and progress is shown in the progress bar. An Enhanced timer is like a Basic timer but the progress bar shows progress beyond the end of the run time. A Cyclic timer is like a Basic timer but restarts automatically when the run time is expired.
Displaying Timers On The Main Screen 28 Using Timers Run Time The run time can be set between 1 minute and 96 hours. No Limit timers have no run time. To set the run time, in the Timers window: 1 Select the required timer to display the Setup window. 2 Select Run Time. 3 Select a run time from the list. Timer Counting Direction Timers can count up or down, showing elapsed time or remaining time. No Limit timers automatically count up.
28 Using Timers Displaying A Clock On The Main Screen Main Screen Timer Pop-up Keys When you select a timer displayed on the Main Screen, additional pop-up keys become available: Pop-Up Keys Selecting this pop-up key lets you.... Setup “Label” enter the setup screen for the currently selected timer. Change Timer select a different timer for display.
29 Respiratory Loops 29 Using a VueLink module connected to a ventilator, you can measure and store graphic representations of realtime respiratory loops. Respiratory loops can help you recognize changes in your patient’s lung function , and they can also indicate a fault in the airway tubing (for example, if the respiratory loop does not close). You can measure: • Pressure-volume loops • Pressure-flow loops • Volume-flow loops.
29 Respiratory Loops Capturing and Deleting Loops Loops: Ohmeda 7900 To open the Loops window, and its associated pop-up keys, ♦ select Main Setup -> Loops, or select the Loops SmartKey, if configured. In the Loops window, in addition to the stored loops, three realtime airway waves and six available numerics from the source device can be shown. Loop capture in progress......
Changing Loops Display Size 29 Respiratory Loops Changing Loops Display Size To change the loops display size, in the Loops window, select the pop-up key Select Size then select • Size x 0.5 to display loops at half the usual size • Size x 1 to display loops at the usual size • Size x 2 to display loops at twice the usual size This does not affect the size of loops printed in reports. Using the Loops Cursor To view the coordinates for any point on a stored loop, 1 Select the pop-up key Select Loop.
29 Respiratory Loops Documenting Loops Documenting Loops 1 In the Loops window, select the pop-up key Print Loop 2 From the list of available loops, select an individual loop, or select Print All to print a report of all For each loop, the report prints • the currently-displayed loop, with the loop capture timestamp • up to six realtime numerics provided by the loop source device • SpO2, etCO2, PO2, and PCO2 numerics from the patient monitor, if available.
30 Care and Cleaning 30 Use only the Philips-approved substances and methods listed in this chapter to clean or disinfect your equipment. Warranty does not cover damage caused by using unapproved substances or methods. Philips makes no claims regarding the efficacy of the listed chemicals or methods as a means for controlling infection. Consult your hospital’s Infection Control Officer or Epidemiologist.
30 Care and Cleaning Cleaning Cleaning Clean with a lint-free cloth, moistened with warm water (40°C/104°F maximum) and soap, a diluted non-caustic detergent, tenside, ammonia- or alcohol-based cleaning agent. Do not use strong solvents such as acetone or trichloroethylene. Take extra care when cleaning the screen of the monitor because it is more sensitive to rough cleaning methods than the housing. Do not permit any liquid to enter the monitor case and avoid pouring it on the monitor while cleaning.
Sterilizing 30 Care and Cleaning Sterilizing Sterilization is not recommended for this monitor, related products, accessories or supplies unless otherwise indicated in the Instructions for Use that accompany the accessories and supplies. Cleaning the Recorder Printhead (M1116B only) If you run recordings at low speed (1 or 2cm/min) for extended periods, deposits of paper debris may collect on the print head making recordings unevenly fainter in horizontal stripes. 1 Remove the recorder.
30 Care and Cleaning 296 Cleaning the Batteries and Battery Compartment
31 Using the Batteries 31 IntelliVue MP20/MP30/ MP20/MP30: one OR two Philips MP40/MP50 M4605A rechargeable Lithium Ion only batteries must be inserted into the battery compartment at the rear of the monitor to use the MP20/MP30 monitor with battery power. Battery compartment MP40/MP50: two Philips M4605A rechargeable Lithium Ion batteries must be inserted into the battery compartment at the rear of the monitor to use the MP40/MP50 monitor with battery power.
31 Using the Batteries Battery Power Indicators The MP60/MP70/MP80/MP90 monitors cannot be powered by battery. You can switch between battery-powered and mains-powered (AC) operation without interrupting monitoring. The batteries recharge automatically whenever the monitor is connected to mains power. Battery operation may not be available in all geographies.
Battery Power Indicators 31 Using the Batteries Battery status symbols: These symbols tell you the status of the batteries (see table below) and which battery compartment they are in, either 1 or 2. Battery power gauge: This shows the remaining battery power in the combined batteries. It is divided into sections, each representing 20% of the total power. If three and a half sections are shaded, as in this example, this indicates that 70% battery power remains.
31 Using the Batteries Checking Battery Charge 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 hrs Capacity remaining fullCharge TimeToEmpty: 5hrs 10 min Batt 1 Batt 2 [mAh] [mAh] Capacity, Remaining tells you how much power is left in each battery. Capacity, Full Charge tells you how much power each battery can hold when fully charged.
Replacing Batteries 31 Using the Batteries charge. If all LEDs are lit, the battery is fully charged, if only one LED is lit, 25% or less charge is left. Replacing Batteries MP40/MP50 You can replace batteries without switching off the monitor, if you replace them one at a time and if the remaining battery has sufficient power. The Battery Missing INOP is suppressed for 30 seconds while you exchange each battery.
31 Using the Batteries Optimizing Battery Performance Display Brightness Setting ♦ In the Main Setup menu, select User Interface -> Brightness - > Optimum. This selects a level of brightness suitable for most monitoring locations that uses less battery power than brighter settings. Satisfy yourself that this level of brightness is suitable for your monitoring location.
Battery Safety Information 31 Using the Batteries Battery Safety Information WARNING Use only Philips batteries part number M4605A. Use of a different battery may present a risk of fire or explosion. Do not open batteries, or dispose of them in fire, or cause them to short circuit. They may ignite, explode, leak or heat up, causing personal injury. Dispose of used batteries promptly and in an environmentally-responsible manner. Do not dispose of the battery in normal waste containers.
31 Using the Batteries 304 Battery Safety Information
32 Maintenance and Troubleshooting 32 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.
32 Maintenance and Troubleshooting Maintenance Task and Test Schedule 4 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. 5 Apply the transducer or electrodes to the patient, and with the monitor switched on, flex the patient cables near each end to make sure that there are no intermittent faults.
Troubleshooting 32 Maintenance and Troubleshooting Troubleshooting If you suspect a problem with an individual measurement, read the Instructions for Use and doublecheck that you have set up the measurement correctly. If you suspect an intermittent, system-wide problem call your service personnel. You may be asked for information from the status log. To view the status log, 1 In the Main Setup menu, select Revision.
32 Maintenance and Troubleshooting 308 Disposing of Empty Calibration Gas Cylinders
33 Accessories 33 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.
33 Accessories ECG/Resp Accessories Description Length AAMI Part No. IEC Part No. ICU Grabber shielded 1.0m M1603A M1613A ICU snap shielded 1.0m M1605A M1615A ICU Clip non-shielded 0.45m M1608A M1618A ICU Clip non-shielded 0.7m M1609A M1619A 5-Electrode Cable Sets Description Length AAMI Part No. IEC Part No. OR Grabber shielded 1.0m/1.6m M1621A M1631A ICU Grabber shielded 1.0m/1.6m M1623A M1633A ICU Snap shielded 1.0m/1.6m M1625A M1635A ICU Clip non-shielded 0.7m/1.
NBP Accessories 33 Accessories Set Combiners and Organizers Set combiners and organizers Part No. Set combiner 3-electrode M1501A 5-electrode M1502A Shielded 3-electrode M1503A Shielded 5-electrode M1504A Set organizer Bedsheet clip M1509A 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.
33 Accessories NBP Accessories Adult/Pediatric Antimicrobial Coated Reusable cuffs Patient Category (color) Limb Circumference (cm) Bladder Width Part No. Tubing Adult Thigh (grey) 45 - 56.5 21.0 cm M4559A Large Adult X-Long (burgundy) 35.5 - 46.0 17.0 cm M4558A M1598B (1.5m) or Large Adult (burgundy) 35.5 - 46.0 17.0 cm M4557A M1599B (3m) Adult X-Long (navy blue) 27.5 - 36.5 13.5 cm M4556A Adult (navy blue) 27.5 - 36.5 13.5 cm M4555A Small Adult (royal blue) 20.5 - 28.5 10.
Invasive Pressure Accessories 33 Accessories 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.
33 Accessories SpO2 Accessories The M1020B SpO2 module with Option A02 may not be available in all countries. Some sensors may not be available in all countries. Always use the MAX-FAST forehead sensor with the foam headband provided by Nellcor. Make sure that you use only the accessories that are specified for use with this device, otherwise patient injury can result. Option A01 is the Philips FAST-SpO2 version; Option A02 is the Nellcor OxiMax-compatible version.
SpO2 Accessories 33 Accessories Product Number Description M1191ANL Special Edition (SE) Compatible with: Opt. A01 Opt. A02 yes yes yes yes yes yes yes yes yes yes Adult sensor (3m cable), for patients over 50 kg. Any finger, except thumb. M1192AN Comments Special Edition (SE) No adapter cable required. Small adult, pediatric sensor (1.5m cable) for patients between 15 kg and 50 kg. Any finger except thumb. M1193AN Special Edition (SE) Neonatal sensor (1.
33 Accessories Product Number SpO2 Accessories Description Compatible with: Comments Opt. A01 Opt.
SpO2 Accessories 33 Accessories Product Number Description Compatible with: Oxiband OXI-A/N Adult / neonatal sensor no yes Oxiband OXI-P/I Pediatric / infant sensor no yes Durasensor DS100A Adult finger clip sensor no yes no yes Comments Opt. A01 Opt. A02 Dura-Y D-YS Y-sensor Must use M1943NL adapter cable Extension / Adapter Cables for Philips and Nellcor Sensors M1941A Extension cable (2 m) yes yes For use with Philips reusable sensors and adapter cables.
33 Accessories Temperature Accessories The Philips M3001A option A01 Multi-Measurement server and the M1020B option A01 SpO2 Module use Masimo certified pulse oximetry for reduced noise and low perfusion performance with Masimo Sensors under the Masimo NR&LP protocol available from Masimo.
Cardiac Output (C.O.) Accessories 33 Accessories Temperature Probes Part No. Minimum measurement time for accurate readings Foley Catheter Probe (16 French) 21096A 180 sec Foley Catheter Probe (18 French) 21097A 180 sec Adapter cable 1.5m 21082B Adapter cable 3.0m 21082A Cardiac Output (C.O.) Accessories See Pressure accessories for PULSION continuous cardiac output accessories.
33 Accessories Mainstream CO2 Accessories (for M3014A) Mainstream CO2 Accessories (for M3014A) Description Part No. CO2 Sensor M2501A Adult/Pediatric Airway Adapter (reusable) M2513A Infant Airway Adapter (reusable) M2516A Adult Airway Adapter (single-patient use) M2533A Infant Airway Adapter (single-patient use) M2536A Sidestream CO2 Accessories (for M3014A) Description Part No.
Microstream CO2 Accessories 33 Accessories 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. • “Smart CapnoLine O2” is a combined oral-nasal-O2-CO2 FilterLine.
33 Accessories tcGas Accessories tcGas Accessories This symbol indicates that the specified transducer (but not its membranes) is designed to have special protection against electric shocks (particularly regarding allowable leakage currents), and is defibrillator proof. Description Part No.
SvO2 Accessories 33 Accessories BIS Sensors To re-order sensors outside North America, contact your nearest Philips sales office and quote the Philips ordering number. In North America, contact Aspect Medical Systems.
33 Accessories Recorder Accessories Recorder Accessories Description Part No.
34 Installation and Specifications 34 The specifications in this section apply to the MP20, MP30, MP40, MP50, MP60, MP70, MP80 and MP90 patient monitors, unless otherwise stated. The monitors are not user installable. They must be installed by qualified service personnel. Intended Use The monitors are intended to be used for monitoring, recording, and alarming of multiple physiological parameters of adults, pediatrics, and neonates in health care facilities.
34 Installation and Specifications Manufacturer’s Information Manufacturer’s Information You can write to Philips at this address Philips Medizin Systeme Boeblingen GmbH Hewlett-Packard-Str. 2 71034 Boeblingen Germany Visit our website at: www.philips.com. © Copyright 2002 - 2005. Koninklijke Philips Electronics N.V. All Rights Reserved.
Manufacturer’s Information 34 Installation and Specifications Trademark Acknowledgement PiCCOΤΜ is a trademark of Pulsion Medical Systems AG. Bispectral Index and BIS are trademarks of Aspect Medical Systems Inc, and are registered in the USA, EU and other countries. OxisensorΤΜ II, Oxi-CliqΤΜ, and OxiMaxΤΜ are trademarks of Tyco Healthcare Group LP, Nellcor Puritan Bennett Division. Microstream, FilterLine, and Smart CapnoLine are trademarks or registered trademarks of Oridion Systems Ltd.
34 Installation and Specifications Symbols Symbols These symbols appear on the monitor and its associated equipment. Symbols Refer to accompanying documents Equipotential grounding Connection direction indicator Alternating current (On some older measurement servers and extensions, and modules, this symbol may indicate the gas input.
Installation Safety Information 34 Installation and Specifications Symbols Philips remote device (SpeedPoint or Alarm Device) connection indicator Antenna connector Analog interface indicator for connection to any analog video display Battery symbol Digital interface indicator for connection to any digital video display 12V LAN/SER Non-ionizing radiation symbol Data input/output symbol Locked position Unlocked position 12 Volt DC LAN connection indicator for connection to serial interface 12V 1
34 Installation and Specifications Installation Safety Information MP20/MP30 MP20/MP30 Left side of monitor 1 1 MMS and one extension 2 ECG analog output/marker input connector 2 MP20/MP30 Rear of monitor 1 10 2 11 330 3 4 5 6 7 8 9 1 Measurement Server Link connector 2 AC power inlet 3 Remote alarm connector 4 Analog video out connector 5 Wired network connector 6 Wireless network connector 7 Battery compartment 8 Equipotential grounding 9 Protective earth 10 Space for
Installation Safety Information 34 Installation and Specifications MP40/MP50 MP40/MP50 Rear of monitor 10 1 Space for optional interface boards, e.g.
34 Installation and Specifications Installation Safety Information MP40/MP50 Left side of monitor 1 1 MMS and one extension 2 Plug-in module slots 3 ECG analog output/marker input connector 3 2 MP60/MP70 Right side of monitor (MP60/70) 1 1 Serial/MIB (RS232) connectors (optional), type RJ45 2 2 Parallel printer connector 3 Keyboard connector 4 Mouse/trackball connector 5 Main measurement server link (MSL) 6 Wired network connector 7 Wireless network connector 3 4 5 8 Analog vid
Installation Safety Information 34 Installation and Specifications Left side of monitor (MP60/70) 1 MMS patient cable connectors 2 Slot for integrated recorder module or measurement module 3 Additional measurement server link (MSL) cable (alternative or additional to MSL on right of monitor) 4 ECG analog output/marker input connector 1 2 3 4 333
34 Installation and Specifications Installation Safety Information MP80/MP90 MP80/MP90 (rear of processing unit) - MP80 does not have the top row of connectors 2 3 4 5 6 7 8 9 10 1 11 21 334 20 19 18 17 16 15 14 13 12 1 Serial/MIB (RS232) connectors, type RJ45 12 ECG analog output/marker input 2 Serial/MIB (RS232) connectors, type RJ45 13 Wired network connector 3 Independent display - remote alarm device connector 14 Wireless network connector 4 Keyboard connector 15 P
Installation Safety Information 34 Installation and Specifications MP80/MP90 (front of processing unit) 1 2 3 5 4 6 7 8 1 AC Power LED 5 Power supply 2 Error LED 6 AC power input 3 Power on LED 7 Protective earth screw hole 4 Power on switch 8 Equipotential grounding point 802.11 Bedside Adapter (Wireless Network Adapter) 802.11 Bedside Adapter (can be used with all monitors) 1 Antenna 2 LEDs - green and yellow LEDs light up during startup while selftests are performed.
34 Installation and Specifications Altitude Setting Altitude Setting Altitude affects tcGas and CO2 measurements. The monitor must be configured at installation to the correct altitude. Monitor Safety Specifications 0366 The monitors, together with the Multi-Measurement Server (M3001A), and the Flexible Module Server (M8048A), all modules and measurement server extensions, comply with the Medical Device Directive 93/42/EEC.
Monitor Safety Specifications 34 Installation and Specifications The OEM radio device used in this product is in compliance with the essential requirements and other relevant provisions of Directive 1999/5/EC. This product is intended to be connected to the Publicly Available Interfaces (PAI) and used throughout the EEA.
34 Installation and Specifications Monitor Safety Specifications Product Max Weight W x H x D M3016A < 450 g < 190 x 98 x 40 mm Measurement Server Extension Mainstream CO2 < 0.99 lb < 7.5 x 4 x 1.6 in M8048A < 3500g < 320 x 120 x 35 mm Flexible Module Server (FMS) < 7.7lb 12.6 x 4.7 x 5.3 in M8045A 2700g 250 x 160 x 270 mm Docking Station 5.95lb 9.8 x 6.3 x 10.6 in M8025A < 300 g 62 x 125 x 63 mm Remote Alarm Device < 0.7 lb 2.4 x 5 x 2.
Monitor Safety Specifications 34 Installation and Specifications Environmental Specifications The monitor may not meet the performance specifications given here if stored or used outside the specified temperature and humidity ranges. When the monitor and related products have differing environmental specifications, the effective range for the combined products is that range which is common to the specifications for all products.
34 Installation and Specifications Monitor Safety Specifications Measurement Server M3001A, Measurement Server Extensions M3016A M3015A, M3014A, M3012A, Measurement Modules, and Flexible Module Server M8048A Item Condition Range Temperature Range Operating 0 to 45 °C (32 to 113 °F) Non-operating -40 to 70 °C (-40 to 158 °F) Operating 95% Relative Humidity (RH) max. @ 40 °C (104 °F). M3015A only non-condensing. Non-operating 90% Relative Humidity (RH) max.
M4605A Battery Specifications 34 Installation and Specifications Thermal Array Recorder Module M1116B Item Condition Range Humidity Range Operating 95% Relative Humidity (RH) max @ 40°C (104°F) (non condensing) Non-operating 95% Relative Humidity (RH) max @ 65°C (150°F) (non condensing) Operating up to 3048 m (10000 ft) Non-operating up to 3048 m (10000 ft) Altitude Range Remote SpeedPoint M8026A Item Condition Range Temperature range Operating 0 ... 55 °C (32 ...
34 Installation and Specifications Monitor Performance Specifications M4605A Battery Specifications Discharge 0 to 50 °C (32 to 122 °F) Charge 0 to 45 °C (32 to 113 °F) Storage -20 to 60 °C (-4 to 140 °F) Temperature Range Humidity Range 40% to 95% Relative Humidity (RH) Battery Type Smart Battery 10.
Monitor Performance Specifications 34 Installation and Specifications MP20/30, MP40/50, MP60/70/80/90 Battery Specifications Operating Time Basic monitoring configuration: 5 hours MP20/MP30 (with 2 new, fully charged batteries) (Brightness set to Optimum, MMS connected, NBP measurement every 15 minutes) Extended monitoring configuration: 4 hours (Brightness set to Optimum, MMS and measurement server extension connected, NBP every 15 minutes, Recorder, every 15 minutes) Operating Time Basic monitori
34 Installation and Specifications Monitor Performance Specifications MP20/30, MP40/50, MP60/70/80/90 Events Information trigger condition and time, event classification and associated detailed view of episode data Episode data configurable (except MP20/30), either: 4 minutes of high resolution trend or 20 minutes of numerics trend @ 12 sec. resolution or 15 seconds of 4 waves @ 125 samples/sec.
Monitor Performance Specifications 34 Installation and Specifications Monitor Interface Specifications Network Parallel Printer Port Dual PS/2 Inputs Dual MIB/RS232 MIB-ready/RS-232 Interface (not available in all geographies) Standard IEEE 802.3 10-Base-T Connector RJ45 (8 pin) Isolation 1.5 kV Standard IEEE 1284-I Connector DB-25 Signals Level 1 and Level 2 (switchable) Isolation 1.
34 Installation and Specifications Monitor Performance Specifications Monitor Interface Specifications Wireless Network Device Interface Connector 8 pin Mini-DIN Signals RD+/-, TD+/-: IEEE 802.3 10Base-T, PWR, GND 12.5 V ±20%, 3.5 W continuous Remote Application Support Technology Citrix® and ICA® (Independent Computing Architecture) client, Tunneling Control Engine (TCE) Capabilities a monitor connected to a Philips Application Server can show a Windows application on the monitor display.
Monitor Performance Specifications 34 Installation and Specifications Display Specifications Video Interface MP60/ MP70/MP80/MP90 SXGA (MP80, MP90, D80 only), XGA Horizontal Frequency 48.4 kHz or 60.0 kHz or 64.0 kHz Video Signals 0.
34 Installation and 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 Complies with IEC 60601-2-25:1993 + A1:1999 /EN60601-2-25:1995 + A1:1999, IEC 60601-2-27/ EN60601-2-27:1994, IEC 60601-2-51:2003 /EN 60601-2-51:2003 and AAMI EC11/EC13:1991/ 2002.
Measurement Specifications 34 Installation and Specifications ECG/Arrhythmia/ST Alarm Specifications Range Adjustment HR 15 to 300 bpm maximum delay: 10 seconds according to AAMI EC 13-1992 standard 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) Extreme Tachy Difference to high limit 0 to 50 bpm 5 bpm steps Clamping at 150 to 300 bpm 5 bpm steps Extreme Brady Difference to low limit 0 to 50 bpm 5 bpm steps Clamping
34 Installation and Specifications Measurement Specifications ECG/Arrhythmia/ST Supplemental Information as required by AAMI EC11/13 Heart Rate Averaging Method Three different methods are used: Normally, heart rate is computed by averaging the 12 most recent RR intervals. For runs of PVCs, up to 8 RR intervals are averaged to compute the HR. If each of 3 consecutive RR intervals is greater than 1200 ms (that is, rate less than 50 bpm), then the 4 most recent RR intervals are averaged to compute the HR.
Measurement Specifications 34 Installation and Specifications 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. Max.
34 Installation and Specifications Measurement Specifications SpO2 Performance Specifications Pulse Range 30 to 300 bpm Accuracy ±2% or 1 bpm, whichever is greater Resolution 1 bpm Sensors Wavelength range: 500 to 1000 nm Emitted Light Energy: ≤ 15mW Information about the wavelength range can be especially useful to clinicians (for instance, when photodynamic therapy is performed) Pulse Oximeter Calibration Range SpO2 Alarm Specifications 70 - 100% Range Adjustment Delay SpO2 Adult: 50 to
Measurement Specifications 34 Installation and Specifications NBP Performance Specifications Measurement Time Typical at HR > 60bpm Auto/manual: 30 seconds (adult) 25 seconds (neonatal) Stat: 20 seconds Maximum time: 180 seconds (adult/pediatric) 90 seconds (neonates) Cuff Inflation Time Typical for normal adult cuff: Less than 10 seconds Typical for neonatal cuff: Less than 2 seconds Initial Cuff Inflation Pressure Adult: 165 ±15 mmHg Pedi: 130 ±15 mmHg Neo: 100 ±15 mmHg Auto Mode Repetition Times
34 Installation and Specifications Measurement Specifications NBP Overpressure Settings Adult > 300 mmHg (40 kPa) > 2 sec Pedi > 300 mmHg (40 kPa) > 2 sec Neo > 150 mmHg (20 kPa) > 2 sec not user adjustable Invasive Pressure and Pulse Complies with IEC 60601-2-34:2000/EN60601-2-34:2000. Invasive Pressure Performance Specifications Measurement Range Pulse Rate –40 to 360 mmHg Range 25 to 350 bpm Accuracy ±1% Full Range Resolution 1 bpm Input Sensitivity Sensitivity:5µV/V/mmHg (37.
Measurement Specifications 34 Installation and Specifications Invasive Pressure Alarm Specifications Range Adjustment Delay Pressure -40 to 30 mmHg 2 mmHg (0.5 kPa) max. 12 seconds –40 to 360 mmHg (–5.
34 Installation and Specifications Measurement Specifications CO2 The CO2 measurement in M3014A and M3015A complies with EN ISO 21647 (except alarm system; alarm system complies with IEC 60601-2-49:2001) M3015A Microstream CO2 Performance Specifications CO2 awRR Range 0 to 98mmHg (0 to 13 kPa), or 13% CO2, whichever is lower Accuracy 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.
Measurement Specifications 34 Installation and Specifications M3014A Mainstream CO2 Performance Specifications CO2 awRR Range 0 to 150 mmHg (0 to 20.0 kPa) Accuracy after 2 minutes warmup: For values between 0 and 40 mmHg:±2.0 mmHg (±0.29 kPa) For values from 41 to 70 mmHg: ±5% of reading For values from 71 to 100 mmHg: ±8% of reading The specifications are valid for standard gas mixtures, balance air, fully hydrated at 35°C, Pabs = 760 mmHg, flow rate = 2 l/min. Resolution Numeric: 1.0 mmHg (0.
34 Installation and Specifications Measurement Specifications Where p = partial pressure, Pabs = absolute pressure, and PH2O = 42 mmHg @35°C and 100% RH. M3016A Mainstream CO2 Performance Specifications CO2 awRR Range –4 to 150 mmHg (-0.5 to 20.0 kPa) Accuracy after 20 minutes warmup and calibration: For values between 0 and 40 mmHg:±2.2 mmHg (±0.29 kPa) For values between 40 and 76 mmHg:±5.5% of reading The specifications are valid for 45% O2 and N2 or N2O balance.
Measurement Specifications 34 Installation and Specifications Interfering Gas and Vapor Effects On CO2 Measurement Values The specified deviations for M3014A are valid when the appropriate corrections are switched on and set correctly.
34 Installation and Specifications Measurement Specifications Spirometry Performance Specifications Volume Wave (AWV) Range Accuracy 0 to 100 ml (neonatal 0 to 400 ml (pediatric) 0 to 3000 ml (adult) ±5% or ±3 ml (neonatal) ±12 ml (pediatric) ±90 ml (adult), whichever is greater Scales 50, 100, 200, 600, 800, 1000, 2000, 3000 ml Scale Default 50 ml (neonatal 200 ml (pediatric) 800 ml (adult) Pressure Wave (AWP) Range Accuracy ±2% or ±0.
Measurement Specifications 34 Installation and Specifications Spirometry Performance Specifications Negative Inspiratory Pressure numeric Range -20 to 0 cmH2O Resolution 1 cmH2O Mean Airway Pressure Range Plateau Pressure numeric Positive EndExpiratory Pressure numeric (PEEP) Barometric Pressure numeric (PB) Resolution 1 cmH2O Range 0 to +120 cmH2O Resolution 1 cmH2O Range 0 to 99 cmH2O Resolution 1 cmH2O Range 400 to 800 mmHg Resolution 1 mmHg Peak Inspiratory Flow Range numeric (PIF)
34 Installation and Specifications Measurement Specifications C.O./CCO Performance Specifications ITBV CCO Blood Temperature Range 50 to 6000 ml Accuracy + 10% or 30 ml Repeatability + 5% or 20 ml Range 0.1 to 25.0 l/min Standard Deviation 10% or 0.3 l/min Display Update 2 seconds nominal Range 17,0 to 43°C (62,6 to 109,4°F) Injectate Temperature Range -1 to 30°C C.O./CCO Alarm Specifications Range Adjustment Delay TBlood Steps of 0.5°C (17 to 35°C) Steps of 0.
Measurement Specifications 34 Installation and Specifications tcGas Performance Specifications tcpCO2 response time, including transducer < 50 s Warm-up Time < 3 minutes Site Timer 0.5, 1, 1.5, 2, 2.5, 3, 4, 5, 6, 7, or 8 hours. Change Site alarm when site time is expired and configurable automatic heating switch-off Transducer Heating Available Temperatures 37.0°C, 41.0 to 45°C in steps of 0.5°C tcGas Alarm Specifications Range Adjustment Alarm Delay tcpO2 10 to 745 mmHg 1.0 to 99.
34 Installation and Specifications Measurement Specifications EEG Performance Specifications Leakage Current <=10 µA @ 110Vac Input Signal Range 1 mVp-p Differential Input Impedance >15 MΩ @ 10 Hz Max. DC Input Offset Voltage ±320 mV Input Protection Against defibrillation (5 kV) and electrosurgery Common Mode Rejection >105 dB @ 5kΩ imbalance and 60 Hz Noise <0.
Safety and Performance Tests 34 Installation and Specifications Safety and Performance Tests You must observe any national regulations on the qualification of the testing personnel and suitable measuring and testing facilities. See the maintenance section for a list of required tests. Safety and performance tests, and what to do if the instrument does not meet these specifications are described in the Installation and Service guide.
34 Installation and Specifications Safety and Performance Tests 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.
Safety and Performance Tests 34 Installation and Specifications 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 Compliance level Electromagnetic environment guidance 3 VRMS 3 VRMS Recommended separation distance: 150 kHz to 80 MHz (1 V for respiration RMS and BIS) d = 1.2 P : for respiration and BIS: d = 3.5 P : Radiated RF IEC 61000-4-3 3 V/m 3 V/m 80 MHz to 2.
34 Installation and Specifications Frequency of transmitter Equation Safety and Performance Tests 150 kHz to 80 MHz 150 kHz to 800 MHz 800 MHz to 2,5 GHz d = 1.2 P d = 1.2 P d = 2.3 P for respiration and BIS: for respiration and BIS: for respiration and BIS: d = 3.5 p d = 3.5 P d = 7.0 P Separation distance (m) Separation distance (m) Rated max. output power of transmitter (W) Separation distance (m) 0.01 0.1 (0.4) 0.1 (0.4) 0.2 (0.7) 0.1 0.4 (1.1) 0.4 (1.1) 0.7 (2.2) 1 1.3 (3.
35 Default Settings Appendix 35 This appendix documents the most important default settings of your monitor as it is delivered from the factory. For a comprehensive list and explanation of default settings, see the Configuration Guide supplied with your monitor. The monitor’s default settings can be permanently changed in Configuration Mode. Settings are only entered once per table row if they are the same for all patient categories.
35 Default Settings Appendix Alarm Default Settings Alarm Default Settings Alarm Settings Factory Default H10 / H20 / H40 Alarm Volume 5 Alarms Off 3 min. Pause Al. 5min Enabled H30 (deviations from H10/20/40) Pause Al. 10min Enabled Auto Alarms Off Off Alarm Off Reminder Off Visual Latching Red & Yell Red Only Audible Latching Red & Yell Off Alarm Reminder On Reminder Time 3 min Alarm Sounds Traditional Red Alarm Interval 10 sec Yel. Al.
ECG, Arrhythmia, and ST Default Settings 35 Default Settings Appendix Factory defaults H10 / H20 / H40 H30 (deviations from H10/20/40) Adult Adult ECG Settings Primary Lead II Secondary Lead V Analysis Mode Multi-lead Lead Placement Standard Mod. Lead Placment Off Filter Monitor Speed 25mm/s Auto Filter Off Default ECG Size x1 Color Green Asystole Thresh 4.0 sec ∆ ExtrTachy 20 bpm Tachy Clamp 200 bpm ∆ ExtrBrady 20 bpm Brady Clamp 40 bpm ALL ECG IN.
35 Default Settings Appendix ECG, Arrhythmia, and ST Default Settings Factory defaults H10 / H20 / H40 H30 (deviations from H10/20/40) Adult Neo Adult Off Arrhythmia Settings 372 Pedi Arrhythmia On Off Pause Threshold 2.0 sec 1.5 sec VTach HR 100 VTach Run 5 Vent Rhythm 14 120 150 200 210 5 5 SVT HR 180 SVT Run 5 PVCs/min 10 Non-Sustain On Vent Rhythm On Run PVCs On Pair PVCs On Off R-On-T PVCs On Off V.Bigeminy On Off V.
Pulse Default Settings 35 Default Settings Appendix Lead I, II, III, V, aVR, aVL, aVF, V1-6, MCL Settings Factory Adult Factory Pedi ST(Label) On Off Factory Neo For Alarm Mode = Single-ST ST(Label) High +2.0 mm ST(Label) Low -2.0 mm For Alarm Mode = Multi-ST ST(Label) High +1.0 mm ST(Label) Low -1.
35 Default Settings Appendix Respiration Default Settings Respiration Default Settings Factory defaults H10 / H20 / H40 H30 (deviations from H10/20/40) Adult Adult Respiration Settings Pedi Neo High Limit 30 rpm 100 rpm Low Limit 8 rpm 30 rpm Apnea Time 20 sec Alarms On Resp On Auto/Manual Auto (Trigger Mode) Resp Speed 6.25mm/s Color Yellow Pedi Neo Off White SpO2 Default Settings SpO2 Settings Factory Adult Alarms On QRS Volume 1 Tone Modulation Yes Tone Mod.
NBP Default Settings 35 Default Settings Appendix SpO2 Alarm Default Settings Setting adult pediatric neonatal Pulse Alarms On/Off on on on Pulse High Limit 120 bpm 160bpm 200 bpm Pulse Low Limit 50 bpm 75 bpm 100 bpm ∆ Extr Brady 20 bpm 20 bpm 20 bpm Brady Clamp 40 bpm 40 bpm 50 bpm ∆ ExtrTachy 20 bpm 20 bpm 20 bpm Tachy Clamp 200 bpm 220 bpm 240 bpm NBP Default Settings Factory defaults H10 / H20 / H40 H30 (deviations from H10/20/40) Adult Adult NBP Settings Pedi Neo
35 Default Settings Appendix Invasive Pressure Default Settings Invasive Pressure Default Settings ABP, ART, Ao, BAP, Factory defaults H10 / H20 / H40 FAP, P, P1, P2, P3, Adult Pedi Neo P4, UAP Settings Adult Alarms from Sys. High Limit 160/ 90 (110) 120/ 70 (90) 90/ 60 (70) 180/ 90 (110) Low Limit 90/ 50 (70) 70/ 40 (50) 55/ 20 (35) 70/ 50 (70) Alarms On Scale 150 100 100 Speed 25mm/s Mean Only No Filter 12 Hz Mercury Cal. Yes Artifact Suppr.
Cardiac Output Default Settings Invasive Pressure Settings 35 Default Settings Appendix PAP Settings Factory Adult ICP, IC1, IC2 Settings Factory Pedi Factory Neo Factory Adult Factory Pedi Factory Neo Mean Only No Yes Filter 12 Hz 12 Hz Mercury Cal. Yes Yes Artifact Suppr. 60 sec 60 sec Unit mmHg mmHg Color Yellow Magenta Cardiac Output Default Settings Factory defaults H10 / H20 / H40 H30 (deviations from H10/20/40) Adult Adult C.O.
35 Default Settings Appendix CO2 Default Settings CO2 Default Settings Factory defaults H10 / H20 / H40 H30 (deviations from H10/20/40) CO2 Settings Adult Adult etCO2 low 30 25 etCO2 high 50 60 imCO2 high 4 CO2 Alarms on Unit mmHg Scale 40 mmHg 50 ImCO2 on Off N2O Corr (only M3015A/ M3016A) Off Pedi Neo Pedi Neo Oxygen Corr (only 16% M3014A) Gas Corr (only M3014A) Off Humidity Corr BTPS Max Hold Off AwRR On AwRR Alarms On AwRR high limit 30 100 AwRR low limit 8
tcGas Default Settings 35 Default Settings Appendix tcGas Default Settings tcGas Settings Factory Adult tcpO2 High 80 mmHg tcpO2 Low 50 mmHg tcpO2 Alarms On tcpCO2 High 50 mmHg tcpCO2 Low 30 mmHg tcpCO2 Alarms On Site Time 4.0 hours Disable Timer Not Allowed Heat Switch Off (i.e., after Site Timer elapsed) No Transducer Temp. 43.
35 Default Settings Appendix EEG Default Settings EEG Default Settings EEG Settings Factory Adult TP, SEF On MDF, PPF, Delta, Theta, Alpha, Beta Off Factory Pedi Factory Neo SEF Threshold 90 % Numeric Average 8 sec Wave Scale 100uV (or +/- 50uV if Show Gridlines is configured to Yes) Show Gridlines No Low Filter 0.
VueLink Default Settings 35 Default Settings Appendix VueLink Default Settings Device Alarms Ignored Color Green 381
35 Default Settings Appendix 382 VueLink Default Settings
# 10-lead placement (ECG) 100 12-lead placement (ECG) 100 3-lead placement (ECG) 98 4-channel recorder 258 5-lead placement (ECG) 98 A AAMI ECG lead labels 97 abdominal breathing and Resp electrode placement 132 aberrantly conducted beats 108 AC power input 332 accessories 10-electrode cable sets 310 3-electrode cable sets 309 3-electrode one piece cables 310 5-electrode cable sets 310 5-electrode one piece cables 310 Aspect Medical Systems 322 C.O.
pvc-related alarms 116 short yellow 105 sinus and SV rhythm ranges 350, 352 switching on/off 113 timeout periods 113 yellow 113 arrhythmia monitoring and defibrillation 106 arrhythmia options 104 arrhythmia relearning with EASI INOP 102 arterial catheter constant (PiCCO) 166 arterial pressure source 157, 158 arterial pulsation 137 arterial values 195 artifact suppression (pressure) 155 Aspect Medical Systems Inc 327 atrial fibrillation and flutter 108 audlatching (arrhythmia alarms) 113 auto alarm limits sw
other bed window 87 pop-up window 88 catheter SvO2, insertion 205 catheter constant, setting (PiCCO) 166 catheter preparation SvO2 204 cautions 1 CCO calibration status indicators 167 choosing the correct pressure source 166 how the measurement works 161 PiCCO method 164 central recorder choosing 261 cerebral perfusion 157 CFI 162 chaining 115 change screen menu 22 changing ECG lead sets 96 changing EEG wave scale 212 changing EEG wave speed 213 changing Resp detection mode 132 changing Resp wave size 133 c
display settings 24 disposal gas cylinder 307 parts and accessories 307 documenting events 251 dosemeter (drug calculator) 279 dPmax 162 drip table (drug calculator) 280 drug calculator 277 DSC (BIS) software revision 221 dual SpO2 141 dual Temp measurement 150 dyshemoglobins intravascular (SpO2) 139 E early systolic blood pressure, NBP 146 EASI activating 96 ECG monitoring 102 lead placement 102 EASI ECG lead labels 97 ECG 91 accessories 309 alarms off (Config Mode) 105 changing lead sets 96 choosing elec
connecting via VueLink 282 external pacing electrodes and ECG monitoring 106 extreme bradycardia alarm 105, 129 extreme rate alarms 105, 129 extreme tachycardia alarm 105, 129 F fallback (ECG) 97 FAST Fourier artefact suppression technology 137 filter (ECG filter setting) 95 filter (ECG) 95 filter frequencies (EEG) 213 FilterLine CO2, microstream accessory 182 filters BIS 220 flexible module server - see FMS 8 flushing invasive pressure accessories 151 FMS connecting to monitor 8 modules 8 functional arter
low pass filter (BIS) 220 LVCI 162 M M1116B 257 M3160A recorder 258 main screen overview 14 mainstream capnography 12 mainstream CO2 accessories 176, 188 measuring 176, 179 maintenance cables 305 cords 305 measurements, schedule 306 microstream CO2, calibration 306 schedule 305 visual inspection 305 major parts and keys MP20 MP30 3 MP40 MP50 4 malfunction symbols battery 298 manual detection mode (Resp) 133 and apnea alarms 134 manually triggering events 246 manufacture date symbol 328 manufacturer’s infor
oscillometric method 143 pediatric cuffs 312 preparing to measure 144 repeat time 145 repeat time for automatic 146 repetition time, setting 146 reusable cuffs 311 single-hose disposable cuffs 312 site inspection 145 time of last measurement 145 units 145 venous puncture 147 neonatal event counting 248 neonates Resp electrode placement 132 NER setup 245 network connection indicator 14 network connector, wired 332 network connector, wireless 332 networked monitoring 33 new features 35 non-invasive blood pres
printing C.O. measurements 169 calculations reports 237 event reports 251 ST map reports 125 status log 307 trends reports 228 wedge 159 priority list for trends 227 probes disposable temperature 149 profiles 24 default profile 26 patient category 25 swapping 25 swapping setting block 26 prompt messages C.O.
re-triggering events 245 retrolental fibroplasia (SpO2) 140 review calculations 235 reviewing alarm messages 50 reviewing alarms 50 reviewing alarms window 50 RH method computation constant 169 rhythm status messages (arrhythmia monitoring) 110 right heart thermodilution method (C.O.) 168 right heart thermodilution setup (C.O.
scale ST map 125 task window 124 trend view 123 trending interval, changing 125 trending priority 124 ST maps 122 ST point 120 standard 10-lead placement 100 standard 3-lead placement 98 standard 5-lead placement (ECG) 98 standardized rate 277 standby symbol 328 starting monitoring 33 status line 14 status log printing 307 status messages printer 272 recorder 265 status messages (arrhythmia) 110 ectopic 111 rhythm 110 sterilizing infection control 293 stopping reports printouts 268 suppression ratio (BIS) 2
volume alarm 43 touch tone volume 31 volume-flow loops 289 VueLink alarm messages 283 device driver conflicts 284 language conflicts 284 module 281 module options 281 module setup 282 visible waves and numerics 281 Z zero effect on pressure alarms 153 zeroing pressure transducer 152 W warnings 1 wave adjusting 27 changing speed 27 scale (CO2) 183, 192 scale (pressure) 154 size (CO2) 183, 192 size (pressure) 154 wave channel speed 28 wave group speed 27 wave scale (EEG) changing 220 wave size Resp 133 wave
xii
