In stru ctio ns fo r Use IntelliVue Patient Monitor MX600/MX700/MX800 Rel ease H.0 wi th Softwa re Revi sion H.1 x.
Part Number 453564260091 Printed in Germany 05/11 *453564260091*
Table of Contents 1 1 Introduction Introducing the Monitor Devices for Acquiring Measurements Operating and Navigating Operating Modes Understanding Screens Connecting Additional Displays to the Monitor Using the XDS Remote Display Using the Visitor Screen Understanding Profiles Understanding Settings Changing Wave Speeds Freezing Waves Using Labels Entering Measurements Manually Changing Monitor Settings Checking Your Monitor Revision Getting Started Disconnecting from Power Networked Monitoring Using th
Managing Patients Admitting a Patient Quick Admitting a Patient Editing Patient Information Discharging a Patient Transferring Patients Data Upload from an MMS Care Groups 95 95 96 97 97 98 102 105 5 ECG, Arrhythmia, ST and QT Monitoring 111 Skin Preparation for Electrode Placement Connecting ECG Cables Selecting the Primary and Secondary ECG Leads Checking Paced Status Understanding the ECG Display Monitoring Paced Patients Changing the Size of the ECG Wave Changing the Volume of the QRS Tone Changin
6 Monitoring Pulse Rate Entering the Setup Pulse Menu System Pulse Source Switching Pulse On and Off Using Pulse Alarms 7 Monitoring Respiration Rate (Resp) Lead Placement for Monitoring Resp Understanding the Resp Display Changing Resp Detection Modes Changing the Size of the Respiration Wave Changing the Speed of the Respiration Wave Using Resp Alarms Changing the Apnea Alarm Delay Resp Safety Information 8 Monitoring SpO2 SpO2 Sensors Applying the Sensor Connecting SpO2 Cables Measuring SpO2 SpO2 Signa
Calculating Temp Difference 182 11 Monitoring Invasive Pressure 183 Setting up the Pressure Measurement Zeroing the Pressure Transducer Adjusting the Calibration Factor Displaying a Mean Pressure Value Only Changing the Pressure Wave Scale Optimizing the Waveform Using the Wave Cursor Non-Physiological Artifact Suppression Choosing the Pressure Alarm Source Calibrating Reusable Transducer CPJ840J6 Calculating Cerebral Perfusion Pressure Calculating Pulse Pressure Variation Measuring Pulmonary Artery Wed
Setting up Spirometry 15 Monitoring tcGas Identifying tcGas Module Components Setting the tcGas Sensor Temperature Using the tcGas Site Timer Setting the tcGas Barometric Pressure Remembraning the tcGas Transducer Calibrating the tcGas Transducer Applying the tcGas Transducer Finishing tcGas Monitoring TcGas Corrections 16 Monitoring Intravascular Oxygen Saturation Selecting a Measurement Label Preparing to Monitor with the M1021A Wide Module Preparing to Monitor with the M1011A Narrow Module Further Info
20 Trends Viewing Trends Setting Up Trends Documenting Trends Trends Databases Screen Trends 21 Calculations Viewing Calculations Reviewing Calculations Performing Calculations Entering Values for Calculations Documenting Calculations 22 High Resolution Trend Waves Changing the Hi-Res Trend Waves Displayed Hi-Res Trend Wave Scales Hi-Res Trend Waves and OxyCRG Printing Hi-Res Trend Wave Reports Hi-Res Trend Wave Recordings 23 Event Surveillance 271 271 274 278 278 279 283 284 285 285 286 287 289 289 289
26 Printing Patient Reports 325 Starting Report Printouts Stopping Reports Printouts Setting Up Reports Setting Up Individual Print Jobs Checking Printer Settings Printing a Test Report Switching Printers On Or Off for Reports Dashed Lines on Reports Unavailable Printer: Re-routing Reports Checking Report Status and Printing Manually Printer Status Messages Sample Report Printouts 325 326 327 328 329 329 329 329 330 330 331 332 27 Using the Drug Calculator 337 Accessing the Drug Calculator Performing
31 Respiratory Loops 355 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 355 356 356 356 356 357 357 357 32 Laboratory Data 359 Viewing Received Data 33 Care and Cleaning General Points Cleaning the Monitor Disinfecting the Monitor Sterilizing the Monitor Cleaning, Sterilizing and Disinfecting Monitoring Accessories Cleaning the SO2 Optical Module Cleaning the Recorder Pri
SO2 Accessories for M1011A Recorder Accessories Battery Accessories 386 386 386 36 Specifications 387 Intended Use Manufacturer's Information Symbols Installation Safety Information Monitor Mounting Precautions Altitude Setting Monitor Safety Specifications EMC And Radio Regulatory Compliance Physical Specifications Environmental Specifications Performance Specifications Interface Specifications Measurement Specifications Safety and Performance Tests 387 387 389 390 393 393 393 393 395 397 399 401 405
1 1 Introduction These Instructions for Use are for clinical professionals using the IntelliVue MX600/MX700/MX800 patient monitor. This basic operation section gives you an overview of the monitor and its functions. It tells you how to perform tasks that are common to all measurements (such as entering data, switching a measurement on and off, setting up and adjusting wave speeds, working with profiles). The alarms section gives an overview of alarms.
1 Introduction The monitor stores data in trend, event, and calculation databases. You can see tabular trends (vital signs) and document them on a printer. You can view measurement trend graphs, with up to three measurements combined in each graph, to help you identify changes in the patient's physiological condition. You can view fast-changing measurement trends with beat to beat resolution and see up to four high resolution trend segments.
1 Introduction MX800: 1 2 3 4 5 6 Color coded alarm lamps Alarms Off lamp Power on/Standby switch with integrated LED: Green - On/ Standby, Red - Error AC power LED Mounting quick-release lever (when this is pressed the monitor is not fixed on the mounting) Part number and serial number Devices for Acquiring Measurements The patient monitor acquires patient measurements using the devices described in this section. You can also extend the measurement capabilities of your monitor with such devices.
1 Introduction Connect the FMS to the monitor via the measurement link cable (MSL). Use the MSL connector on the left-hand side to connect an additional MMS. Use the connector on the right to connect to the monitor. 1 2 3 4 5 X1 Multi-Measurement Module Multi-Measurement Module mount Flexible Module Rack FMS-8 Power on LED Interruption indicator 4-Slot Flexible Module Rack (FMS-4) The 4-Slot flexible module rack (FMS-4) lets you use up to four plug-in physiological measurement modules.
1 Introduction • Recorder (M1116B) • VueLink device interface (M1032A) • IntelliBridge EC10 • EEG (M1027A) • Bispectral Index - BIS (M1034A) • Spirometry (M1014A) You can plug in and unplug modules during monitoring. Insert the module until the lever on the module clicks into place. Remove a module by pressing the lever upwards and pulling the module out. A measurement automatically switches on when you plug the module in, and switches off when you unplug it.
1 Introduction X1 Connectors and Symbols 1 White ECG/Resp connector 2 Blue SpO2 connector 3 Red NBP connector 4 Combined pressure (red) and temperature (brown) connector - connect either invasive pressure transducer or temperature probe. You might have a version of the MMS that does not have this connector.
1 Introduction The X2 has the added capability to operate as a stand-alone monitor, and can be powered by a rechargeable battery. This makes it particularly suited to transport situations. When the X2 is disconnected from the original host monitor, it continues to monitor the patient as a stand-alone monitor running on battery power, eliminating the need for a separate transport monitor. When the X2 is connected to a new host monitor, it resumes its role as MMS, ensuring fully continuous monitoring.
1 Introduction X2 Controls and Indicators 1 External power LED. Green when monitor is powered from an external power source. 2 Battery status LED. Yellow when charging. Flashing red when battery is empty. 3 On/Standby LED. Green when monitor is on. Red indicates an error. 4 On/Standby switch. Disabled when X2 is connected to a host monitor 5 Main Screen key: closes all open menus/windows and returns to the main screen. 6 SmartKeys key: brings up SmartKeys on the screen.
1 Introduction X2 Patient Connectors, Right Side Showing symbols version (international) - English version has text labels 1 Pressure (option) 2 Temperature (option) 3 Noninvasive blood pressure 4 SpO2 5 ECG sync pulse output 6 ECG/Respiration 7 CO2 (option in place of Pressure and Temperature) X2 Left Side 1 Loudspeaker 2 MSL Connector. Connects to the external power supply or a host monitor via the MSL cable for AC mains operation, battery charging, and communication with a network.
1 Introduction M3014A, M3015A, M3015B and M3016A Capnography MMS Extensions The optional M3014A Capnography extension adds mainstream capnography or sidestream capnography, and optionally one pressure plus either a pressure or a temperature, Cardiac Output and Continuous Cardiac Output to the MMS.
1 Introduction The optional M3015A Microstream CO2 extension adds microstream capnography and optionally either pressure or temperature to the MMS. The optional M3015B Microstream CO2 extension adds microstream capnography, two pressures and a temperature to the MMS.
1 Introduction The cardiac output measurement in the M3014A is deactivated when the extension is used with an X2 MMS, even if the X2 is connected to an external power supply. The cardiac output measurement is only available when the X2 is connected to a host monitor.
1 Introduction Monitor information line Other screen elements 1 network connection indicator (documented in Information Center Instructions for Use) 10 alarm status area - shows active alarm messages 2 bed label 11 status line - shows information messages and prompting you for action 3 patient identification 12 close all open menus and windows and return to main screen 4 patient category 13 enter Main Setup menu 5 paced status 14 scroll right to display more SmartKeys 6 date and time
1 Introduction Using the Touchscreen Select screen elements by pressing them directly on the monitor's screen. Disabling Touchscreen Operation To temporarily disable touchscreen operation of the monitor, press and hold the Main Screen permanent key. A padlock will appear on the Main Screen permanent key. Press and hold the Main Screen permanent key again to re-enable the touchscreen operation.
1 Introduction 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. If you have an integrated PC (iPC) you may also see Smartkeys generated by applications on the iPC.
1 Introduction 28 start a delayed recording access pop-up recording keys access Vital Signs recording function access Select Waves recording function set wide automatic alarm limits set narrow automatic alarm limits access wedge procedure window access the Loops window review vital signs trend review graph trend access event surveillance access calculations access the calculator access the Drug Calculator gas analyzer - exit standby mode suppress zero for all gas measurements unpair equipm
1 Introduction Hardkeys A hardkey is a physical key on a monitoring device, such as the zero pressure key on the MMS or a setup key on a module. Pop-Up Keys Pop-up keys are task-related graphical keys that appear automatically on the monitor screen when required. For example, the Confirm pop-up key appears only when you need to confirm a change.
1 Introduction Keypad 6 Type numeric data on the keypad and press the Enter key to enter the data on the monitor. Navigation knob 7 Rotate the knob to highlight screen elements, then press to select the highlighted element. The remote control can be used with a USB cable connection to the monitor or without a cable using short range radio. When used without a cable, the remote control must be assigned to the monitor. The assignment is made in Configuration or Service mode.
1 Introduction Using the On-Screen Calculator You can use the on-screen calculator to perform any of the standard operations for which you would normally use a handheld calculator. • To access the on-screen calculator, select the Calculator SmartKey, or select Main Setup then Calculations followed by Calculator. Operating Modes When you switch the monitor on, it starts up in monitoring mode. To change to a different mode: 1 Select the Main Setup menu.
1 Introduction Standby suspends patient monitoring. All waves and numerics disappear from the display but all settings and patient data information are retained. A special Standby screen is displayed. This can be configured to a moving image or a blank screen. If a patient location is entered at the Information Center, this will also be displayed on the Standby screen (availability depends on Information Center revision). To resume monitoring, • Select anything on the screen or press any key.
1 Introduction Up to three modified Screens can be accessed via the Change Screen menu. To recall Screens, either • select the name of the Screen in the Change Screen menu or • use the previous/next arrows at the top of the Change Screen menu to move back and forth in the Screen history. The ten most recently-used Screens including up to three modified Screens can be accessed. After a patient discharge, the monitor's default Screen is shown.
1 Introduction Certain windows (for example: cardiac output procedure) can only be shown on one display at a time. If you try to open one of these windows when it is already shown on another display, you will see a blank gray window with a cross through it. Using the XDS Remote Display Using the IntelliVue XDS solution it is possible to view an independent monitor screen on an external display.
1 Introduction • Monitor Settings Each profile can have a choice of different predefined monitor settings. These relate to the monitor as a whole; for example, display brightness, alarms off/paused, alarm volume, QRS tone volume, tone modulation, prompt tone volume, wave speed, resp wave speed, pulse source. You can change from one complete profile to another or swap individual settings blocks (display/ monitor settings/measurement settings) to change a subset of a profile.
1 Introduction Locked Profiles Some profiles are locked, so that you cannot change them, even in Configuration Mode. These are indicated by this lock symbol. Understanding Settings Each aspect of how the monitor works and looks is defined by a setting.
1 Introduction Switching a Measurement On and Off When a measurement is off, its waves and numerics are removed from the monitor's screen. The monitor stops data acquisition and alarming for this measurement. A measurement automatically switches off if you disconnect its module or MMS. If you disconnect a transducer, the monitor replaces the measurement numeric with question marks.
1 Introduction 3 To set the speed to the wave group speed, select RespiratorySpeed, EEG Speed, or Global Speed. To set an individual channel speed, select a numeric value from the list of available speeds. This overrides the wave group speed setting and set the speed for the individual wave channel on the monitor Screen. The wave channel speed is independent of the wave (label) depicted in the channel, if you change the wave, the new wave will retain the set channel speed.
1 Introduction 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. Releasing Frozen Waves To release frozen waves, 1 Select a frozen wave. 2 Select Unfreeze Waves. All frozen waves are released. Using Labels You may have more than one instance of some measurements, for example pressure, being used simultaneously.
1 Introduction Be aware that connecting a monitor using the Full label set to an Information Center with certain software revisions may affect the availability of measurement information from the additional labels on the Information Center. See the Information Center documentation and your monitor's Configuration Guide for information on label set compatibility. Resolving Label Conflicts Each label must be unique, that is, it can only be assigned once.
1 Introduction When an X2 or MP5 is connected to a host monitor, the measurement selection window looks like this: X2 connected to host monitor MP5 connected to host monitor WARNING When an X2 or MP5 with an active measurement, say SpO2, is connected to a host monitor with the same measurement already active, the SpO2 measurement on the X2 or MP5 is deactivated and the Meas. DEACTIVATED INOP is displayed. The measurement can only be reactivated if the X2 or MP5 is disconnected from the host monitor.
1 Introduction If it is critical that the measurement labels are available at the Information Center and after transfers, the older monitors and the Information Center must be upgraded to the appropriate software revision. Entering Measurements Manually You can enter values into the monitor that have been measured with other equipment or manually (for example, manual temperatures, lab values).
1 Introduction Adjusting the Screen Brightness 1 Select the Brightness SmartKey. 2 Select the appropriate setting for the screen brightness. 10 is the brightest, 1 is the least bright. Optimum is suitable for most monitoring locations and optimizes power usage for battery powered monitors. Your monitor may be configured with a lower brightness for Standby mode and also (for battery powered monitors) for transport to conserve battery power.
1 Introduction Inspecting the Monitor WARNING If the monitor is mechanically damaged, or if it is not working properly, do not use it for any monitoring procedure on a patient. Contact your service personnel. 1 Before you start to make measurements, carry out the following checks on the monitor including all connected MMSs, modules, or MMS extensions. – Check for any mechanical damage. – Check all the external cables, plug-ins and accessories. 2 Plug the power cord into the AC power source.
1 Introduction 3 Refer to the appropriate measurement chapter for further details of how to perform the measurements you require. WARNING During MR imaging, remove all transducers, sensors and cables from the patient. Induced currents could cause burns. Disconnecting from Power The On/Standby switch does not disconnect the monitor from the ac power source. To disconnect, unplug the power cable.
1 Introduction Using the Integrated PC If your monitor has the optional integrated PC (iPC), you can run applications on the iPC. The applications display data on the monitor's display (or on a second independent display) that is generated on and retrieved from the iPC or externally. For details about applications, refer to the XDS/iPC Instructions for Use. The monitor runs independently of the iPC, and vice versa. WARNING • Some clinical applications may show data from another patient.
1 Introduction Using Input Devices with the iPC and Monitor You can connect input devices such as a mouse, trackball and keyboard to the rear of the patient monitor (using the left hand row of USB connectors) and use them for input to the monitor. Correspondingly you can connect input devices to the rear of the patient monitor (using the right hand row of USB connectors) or to the front USB connector and use them for the iPC. Input devices connected to the iPC can also be shared with the patient monitor.
1 Introduction 48 • Depending on how it is configured, your host monitor can determine whether the user interface of a connected monitor in companion mode is completely disabled or not, and what is displayed on the screen (a standard main screen, or a blank screen indicating Companion Mode). This is controlled by two monitor settings that are applied to the monitor in companion mode on connection. You can change the settings in Configuration Mode.
2 2 Alarms The alarm information here applies to all measurements. Measurement-specific alarm information is discussed in the sections on individual measurements. The monitor has two different types of alarm: patient alarms and INOPs. Patient Alarms Patient Alarms are red and yellow alarms. A red alarm indicates a high priority patient alarm such as a potentially life threatening situation (for example, asystole).
2 Alarms The monitor sounds an audible indicator for the highest priority alarm. If more than one alarm condition is active in the same measurement, the monitor announces the most severe. Your monitor may be configured to increase alarm indicator volume automatically during the time when the alarm is not acknowledged. Visual Alarm Indicators WARNING • No alarms are available on an X2 or MP5 when connected to a host monitor (Companion Mode is indicated).
2 Alarms INOP Lamp Color On Off Yellow 1.0 seconds 1.0 seconds Red 0.25 seconds 0.25 seconds If only patient alarms are present, and no INOPs, the patient alarms will use both left and right sections to flash (for red and yellow alarms) or light for approximately six seconds (for short yellow alarms). If only INOPs are present, and no patient alarms, red and yellow INOPs will use both left and right sections to flash but light blue INOPs will always light continuously in the left section only.
2 Alarms • Standard INOPs: an INOP tone is repeated every two seconds. ISO/IEC Standard Audible Alarms • Red alarms and red INOPs: A high pitched tone is repeated five times, followed by a configurable pause. • Two-star yellow alarms and yellow INOPs: A lower pitched tone is repeated three times, followed by a configurable pause. • One-star yellow alarms (short yellow alarms): The audible indicator is the same as for yellow alarms, but of shorter duration.
2 Alarms The severe INOPs for which this applies are: CUFF NOT DEFLATED (configurable to yellow or red) NBP CUFF OVERPRESS (configurable to yellow or red) !!INSERT BATTERY - X2 (yellow) Power Loss Tone When power is lost - no power is available via the power cable - a buzzer will sound, if so configured. The tone can be silenced by pressing the On/Off power switch. Acknowledging Alarms To acknowledge all active alarms and INOPs, select the Silence permanent key.
2 Alarms Alarm Reminder If Alarm Reminder is configured on for your monitor, you will get an audible reminder of alarm conditions that remain active after you have acknowledged the alarm. This reminder may take the form of a repetition of the alarm tone for a limited time, or an unlimited repetition of the alarm tone (this is the same as a new alarm). Alarm Reminder is not available for standard, light blue INOPs but for yellow and red INOPs.
2 Alarms To Switch Individual Measurement Alarms On or Off 1 Select the measurement numeric to enter its setup menu. 2 Select Alarms to switch between on and off. The alarms off symbol is shown beside the measurement numeric. While Alarms are Paused or Off • The red Alarms Paused lamp on the monitor front panel is lit. In the alarm field, the monitor displays the message ALARMS PAUSED 1:28 or ALARMS OFF, together with the alarms paused symbol or the alarms off symbol.
2 Alarms To extend the alarm pause time to five or 10 minutes, 1 Select one of the alarm fields. This calls up the Alarm Messages window. 2 Select either the pop-up key PauseAl. 5 Min or the pop-up key PauseAl. 10 Min. Each time you select one of these pop-up keys, the Alarm Pause Time is reset to five (or 10) minutes. Alarm Limits The alarm limits you set determine the conditions that trigger yellow and red limit alarms.
2 Alarms 1 2 3 Measurement labels, with alarms off symbol where appropriate Current alarm limits Graphic view of current yellow and red alarm limits and currently monitored measurement value. Off indicates the measurement is switched off • Select Show ST Limits to expand the list of ST leads and view the currently set alarm limits. Selecting Hide ST Limits hides the list again. You can use the pop-up keys that open with the Alarm Limits window to perform common tasks: – – – All Al. On/All Al.
2 Alarms T 1 Parameter label 2 High red alarm (view only) 3 High yellow alarm field. Select to open a pop-up list of high alarm limits 4 Alarms On/Off key - select to switch between alarms on or off 5 Preview Alarm AutoLimits for a measurement before applying 6 Select to apply wide AutoLimits 7 Select to apply narrow AutoLimits 8 Low yellow alarm field.
2 Alarms About Automatic Alarm Limits The monitor can automatically set alarm limits suited to your individual patient, using the Automatic Alarm Limits function (AutoLimits). This tells the monitor to adapt the alarm limits of selected measurements to the measured vital signs within a defined safe limit. The monitor calculates safe AutoLimits for each patient based on the measured values from the last 12 seconds.
2 Alarms WARNING Before using Smart Alarm Delays, make sure that you fully understand how the delay is applied and what the consequences are. Documenting Alarm Limits The alarm limits pop-up keys appear with the Alarm Limits and measurement alarm limits windows. • Select the Print Limits pop-up key to print an overview of all alarm limits on a connected printer. • Select the Record Limits pop-up key to send a recording of the alarm limits to a recorder.
2 Alarms When you select an item from the list, you can get additional information about that item. If you select a high or low limit alarm in the list, the Graphical Trends window will open to provide further data. If you select an alarm resulting from an event alarm notification, the Event Episode window for that event will open. If you select an alert other than a high or low alarm, a help text window opens with more information.
2 Alarms Alarm Latching Behavior Red & Yellow Measurement Alarms Non-latching alarms Alarm has not been acknowledged. Alarm tone on. Alarm lamp on. Alarm tone on. Alarm lamp Alarm message. Flashing on. Alarm message. Flashing numerics. numerics. Alarm condition still present. Alarm has been acknowledged. Visual and audible latching Visual latching, audible non-latching Alarm tone on. Alarm lamp on. Alarm message. Flashing numerics. Alarm condition All audible and visual alarm no longer present.
2 Alarms Alarm Recordings You can set up your monitor so that it automatically triggers alarm recordings at the Information Center, or if configured, to a printer as a realtime report. 1 Press the Main Setup SmartKey. 2 Select Alarms from the Main Setup menu. 3 Select Alarm Recording from the Alarms menu to open the Alarm Recordings menu. 4 Select a measurement from those listed for which you want to change the alarm condition that triggers an alarm recording. This opens a pop-up list.
2 Alarms 64
3 3 Patient Alarms and INOPs This chapter lists patient alarms alphabetically, and technical alarms (INOPs) arranged by the source of the INOP and then alphabetically, irrespective of their priority. All alarms and INOPs are listed here; the ones which can appear on your monitor will depend on the model and the individual options. For information on alarms and INOPs from the gas modules refer to your Gas Module Instructions for Use.
3 Patient Alarms and INOPs Alarm Message From Condition Indication ** BIS HIGH BIS The Bispectral Index value has exceeded the high alarm limit. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone ** BIS LOW BIS The Bispectral Index value has dropped below numeric flashes and low limit is the low alarm limit. highlighted, yellow alarm lamp, alarm tone ** CCO HIGH ** CCI HIGH CCO Continuous Cardiac Output or CC Index is above the high alarm limit.
3 Patient Alarms and INOPs Alarm Message From Condition Indication ** HR LOW ECG The heart rate has fallen below the low alarm limit. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. If configured to short yellow, the sound switches off after 5 seconds if Arrhythmia is switched on. * IRREGULAR HR ** IRREGULAR HR ECG/Arrhythmia Consistently irregular heart rhythm.
3 Patient Alarms and INOPs Alarm Message From Condition Indication *** LOW PRESS The measured pressure value is below the numeric flashes and low limit is extreme low alarm limit. highlighted, red alarm lamp, alarm s, d, or m after the label indicates whether the tone systolic, diastolic or mean pressure has crossed the limit. ** LOW PRESS The measured pressure value is below the low numeric flashes and low limit is alarm limit.
3 Patient Alarms and INOPs Alarm Message From Condition Indication ** ST- LOW ECG/ST The ST depression in lead is lower than the limit. numeric flashes and low alarm limit is highlighted, yellow alarm lamp, alarm tone * SVT ** SVT ECG/Arrhythmia A run of supraventricular beats greater than the numeric flashes, yellow alarm lamp, SVT run limit has been detected and the HR alarm tone has exceeded the SVT HR limit. ** Tblood HIGH C.O.
3 Patient Alarms and INOPs Alarm Message From Condition Indication ***BRADY/P xxx DISCONNECT PRESS The pressure is non-pulsatile and the mean pressure is continuously less than 10mmHg (1.3kPa).
3 Patient Alarms and INOPs INOP Message, Indication What to do Check Flex Texts INOP tone Check the names of the monitor menus, for example the labels for screens, profiles, event or trend group names, before you resume monitoring. If they are unexpected, there may be a problem with the monitor software. Contact your service personnel. Check Keyboard INOP tone Perform a visual and functional check of the keyboard. Contact your service personnel.
3 Patient Alarms and INOPs INOP Message, Indication What to do Meas. DEACTIVATED An X2 or MP5 has been connected to a host monitor (companion mode) and all derived measurements have been deactivated and/or measurements with a label conflict. The measurements can only be reactivated by disconnecting the measurement device from the host monitor.
3 Patient Alarms and INOPs Battery INOPs INOP Message, Indication What to do Batt 1 MISSING The monitor requires two batteries but can detect only one battery. Insert the missing battery Batt 2 MISSING immediately. INOP tone During this INOP, alarms cannot be paused or switched off. Batt EMPTY INOP tone, battery LED flashes During this INOP, alarms cannot be paused or switched off. The estimated remaining battery-powered operating time is less than 10 minutes. Replace the battery immediately.
3 Patient Alarms and INOPs INOP Message, Indication What to do CHECK BATT TEMP INOP tone The temperature of one or both batteries is too high. Check that ventilation openings (if applicable) are not blocked and monitor is not exposed to heat. Chk MSL Connection Check the MSL connection between X2/MP2 and the battery extension for damage or loose connections. Check also if a second X1 or X2 has been connected accidentally (e.g. in companion mode).
3 Patient Alarms and INOPs INOP Message, Indication What to do MMS UNSUPPORTED INOP tone The Multi-measurement Module is not supported by your monitor. Contact your service personnel. MMSExt.Unsupported INOP tone The MMS extensions not supported by your monitor. Contact your service personnel. NO PPV FROM FMS The measurement device does not supply a beat-to-beat arterial pressure value. Contact your service personnel.
3 Patient Alarms and INOPs INOP Message, Indication What to do LEAD OFF !! LEAD OFF !!! LEAD OFF Numeric is replaced by -?INOP tone Not all the required leads for ECG monitoring are connected. Check the ECG connections and make sure that the electrode indicated by [RA, LA, LL, RL, V or C] electrodes is attached. In EASI mode, all 5 electrodes must be connected.
3 Patient Alarms and INOPs Resp INOPs INOP Message, Indication What to do Resp EQUIP MALF Numeric is replaced by -?INOP tone Contact your service personnel. The RESP hardware is faulty. Resp ERRATIC Numeric is replaced by -?- 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 Not all the required leads for Resp monitoring are attached.
3 Patient Alarms and INOPs Temperature INOPs INOP Message, Indication What to do T1, T2, T3, T4 INOPs See INOPs Tamb INOPs See INOPs Tart INOPs See INOPs Tcereb INOPs See INOPs Tcore INOPs See INOPs DEACTIVATED INOP tone A Temp measurement label in the measurement device has been deactivated, either by connecting a Pressure transducer in the shared Press/Temp socket, or by deactivating the label in the Measurement Se
3 Patient Alarms and INOPs SpO2 INOPs INOP Message, Indication What to do DEACTIVATED INOP tone The SpO2 measurement label in the measurement device has been deactivated by deactivating the label in the Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, reactivate the measurement label in the Measurement Selection window. EQUIP MALF The MMS or module is faulty. Unplug and replug the MMS or module.
3 Patient Alarms and INOPs INOP Message, Indication What to do SENSOR OFF Numeric is replaced by -?INOP tone The SpO2 sensor is not properly applied to the patient. Apply the sensor following the instructions supplied by the manufacturer. UNKN.SENSOR Numeric is replaced by -?- The connected sensor or adapter cable is not supported by the SpO2 measurement. Use only specified sensors and cables.
3 Patient Alarms and INOPs INOP Message, Indication What to do DEACTIVATED INOP tone A Pressure measurement label in the measurement device or extension has been deactivated, either by connecting a Temp transducer in the shared Press/Temp socket, or by deactivating the label in the Measurement Selection window. The measurement automatically disappears from the display.
3 Patient Alarms and INOPs CO2 INOPs INOP Message, Indication What to do !! CO₂ OCCLUSION !!! CO₂ OCCLUSION Numeric is replaced by -?INOP tone The sample line or exhaust tube is blocked. Check the tubing, then disconnect and reconnect the sample line. If the INOP persists, connect a new sample line. CO₂ AUTO ZERO Numeric is replaced by -?if the Autozero lasts >15 sec, INOP tone sounds. The automatic zero calibration is in progress. This typically takes 10 seconds.
3 Patient Alarms and INOPs INOP Message, Indication What to do Wait until the sensor reaches operating temperature and the INOP disappears. CO₂ SENS.WARMUP Numeric is replaced by -?Microstream CO2: INOP tone Mainstream CO2: no INOP tone CO₂ UPDATE FW Numeric is replaced by -?INOP tone The software in the Measurement Extension does not match the software in the MMS. Contact your service personnel. CO₂ WAIT CAL2 Numeric is replaced by -?- Calibration on the first calstick cell is complete.
3 Patient Alarms and INOPs INOP Message, Indication What to do OPTMOD MALF The Optical Module memory is faulty, and calibration data cannot be stored for transport or during power failure. If this capability is needed, use another Optical Module. PRE-INS CAL The pre-insertion calibration is running. This typically takes one minute. During this time alarms are Numeric is replaced by -?switched off. Wait until the calibration is complete.
3 Patient Alarms and INOPs INOP Message, Indication What to do CCO NO PRESS at Information Center CCO/CCI cannot be calculated. Make sure that the pressure chosen in the Setup CCO menu under CCO From matches the pressure measured with the arterial catheter for CCO measurement. A pressure from an external device cannot be used. Select another pressure label, either ABP, Ao, ART, BAP, FAP, or UAP. CCO NOT SUPPORTED Numeric is replaced by -?INOP tone A catheter for transpulmonary C.O.
3 Patient Alarms and INOPs tcGas INOPs INOP Message, Indication What to do CAL FAILED A calibration failed. Check the calibration unit, gas pressure, and tubing connections, then restart the Numeric is replaced by -?calibration. If the calibration has failed more than once, remembrane the transducer and restart the INOP tone calibration. If this INOP persists, contact your service personnel.
3 Patient Alarms and INOPs EEG INOPs INOP Message, Indication What to do EEG EQUIP MALF INOP tone The EEG hardware is faulty. Contact your service personnel. EEG IMPEDANCE HIGH EEG1 IMPED. HIGH EEG2 IMPED. HIGH The signal electrode in one or both channels exceeds the user-selected impedance limit, or the impedance of a single electrode exceeds the limit. Check the impedance. If the impedance is too high, reconnect the electrodes according to the EEG monitoring setup guidelines.
3 Patient Alarms and INOPs INOP Message, Indication What to do BIS ELECTR. DISC. INOP tone One or more electrodes are not connected to the semi-reusable sensor cable. Check all electrode connections. BIS ENGINE DISCONN INOP tone BIS engine not connected OR Module Cable defective. Make sure that the Module Cable is properly connected. If INOP persists, replace the Module Cable. Silencing this INOP switches the measurement off. BIS ENGINE INCOMPT INOP tone BIS engine software is not supported.
3 Patient Alarms and INOPs INOP Message, Indication What to do BIS UNPLUGGED INOP tone Plug in the BIS module. Silencing this INOP switches off the measurement. BISx DISCONNECTED INOP tone The BISx is not connected to the BIS module or the BIS interface board. Silencing this INOP switches the measurement off. BISx INCOMPATIBLE INOP tone 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.
3 Patient Alarms and INOPs VueLink INOPs INOP Message, Indication What to do VueLink ALARM at Information Center A technical alarm is present on the VueLink module. The INOP text on the monitor is defined by the VueLink device driver. CHECK No information was received from the external device. The device may be switched off or SETUP disconnected. INOP tone VueLink INOP abbreviations may differ slightly depending on the device category.
3 Patient Alarms and INOPs INOP Message, Indication What to do EC10 INOP !! EC10 INOP !!! EC10 INOP at Information Center A technical alarm is present on the IntelliBridge EC10 module. On the monitor the indication is a red (!!!), yellow (!!) or cyan alarm lamp (as appropriate) and an INOP text that is defined by the IntelliBridge EC10 device driver. UNPLUGGED INOP tone The IntelliBridge module has been unplugged from the rack, or the whole rack has been disconnected.
3 Patient Alarms and INOPs ProtocolWatch INOPs INOP Message, Indication What to do PW In Conflict There is a patient information mismatch which has not yet been resolved (>15 minutes). PW: Check Settings Contact your service personnel. Settings could not be loaded or interpreted correctly. PW:Action Required The protocol currently running requires a user response. Check which pop-up window is displayed and provide the appropriate response.
3 Patient Alarms and INOPs INOP Message, Indication What to do cl NBP No Cradle The NBP Pod is not in its cradle. cl NBP Remove The temperature of the battery in the NBP Pod is too high. Remove the Cableless Measurement Device from the patient and contact service personnel. cl NBP Serv Batt The battery in the NBP Pod has reached the end of its useful life. It can no longer be charged. Contact your service personnel to replace the battery.
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4 4 Managing Patients Use the Patient Demographics window and its associated pop-up keys to admit, discharge, and transfer (ADT) patients. All patient demographic and ADT information is shared between the patient monitor and the Information Center, for example, patients admitted to the monitor are automatically admitted to a connected Information Center.
4 Managing Patients – – – – – – – – – – – Middle Name (if configured to appear): Enter the patient's middle name. Lifetime Id, Encounter Id: Whether these fields appear and how they are labeled can be configured for your hospital. One or both fields may be displayed and the labels may read: MRN, Case Id, Visit Id, or other alternatives. Enter the appropriate data for the fields displayed. Patient Cat.: Choose the patient category, either Adult, Pedi, or Neo.
4 Managing Patients 1 Select the Quick Admit SmartKey. 2 Enter the required data (ID fields or last name depending on configuration) with the keyboard or a barcode scanner. 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.
4 Managing Patients – – End Case - to print any configured end case reports or vital signs recording, discharge the patient and clear the patient database, then enter standby mode. If an End Case SmartKey is configured for your monitor, you can also select this instead and then confirm. To see which end case reports are set up for your monitor, select Main Setup, Reports, then Auto Reports. For each auto report, if End Case Report is set to On, this report will be printed when you select End Case.
4 Managing Patients Patient Information Stored in Monitor Stored in MMS and extensions Patient demographics (name, yes DOB, patient IDs) yes yes no Monitor settings (alarm pause time, alarm volume) Measurement settings for all yes measurements (alarm limits, measurement on/off, etc.
4 Managing Patients Transferring a Centrally-Monitored Patient with X2 or MP5 WARNING Measurements from a MMS extension connected to an X2 are not available when the X2 is running on battery power. They are only available when the X2 is running on external power, either when connected to a host monitor or the external power supply (M8023A).
4 Managing Patients – wait until the transfer has completed. 4 Connect the X2/MP5 to the new host monitor. The monitor detects a patient mismatch and a window will open showing your patient's data and asking Complete Transfer Of This Patient?. 5 Select Yes to complete the transfer. This re-admits the patient from the transfer list to the new monitor. This will upload the patient demographics, and, if configured, the measurement settings and trend data stored in the X2/MP5 to the receiving monitor.
4 Managing Patients patient demographics, and, if configured, the measurement settings and trend data stored in the X2/MP5 to the monitor. Verify that the settings for patient category and paced mode are correct. Data Upload from an MMS The Multi-Measurement Module stores eight hours of patient trend data at one-minute resolution.
4 Managing Patients the case of asystole. It is important that the patient category is set correctly so the ECG can be analyzed correctly and initial arrhythmia alarm limits set. In the case where an MP5 or X2 with an IntelliVue Instrument Telemetry interface is declared as a "telemetry device" at the Information Center and is connected to a host monitor, it is important to resolve an existing mismatch between the monitor and the Information Center before disconnecting the MP5/X2.
4 Managing Patients 1 Patient demographics 2 Patient category and paced status 3 Same Patient - see “Patient Mismatch - If Both Patient Data Sets Are Correct” on page 104. 4 New Patient - see “Patient Mismatch - If Neither Patient Data Set is Correct” on page 104. After you resolve the mismatch, the monitor displays a confirmation window that shows the patient that has been selected and where data will be erased, if applicable. Confirm your choice.
4 Managing Patients Patient Information This information is taken from... Patient Category the Multi-Measurement Module, if connected, otherwise the data is taken from the monitor. Date of Birth Height Weight Gender Paced Status Paced status is always set to Yes where there is a mismatch in patient information. Trend data if there is newer trend data stored in the MMS, it is uploaded to the monitor.
4 Managing Patients Understanding the Care Group Overview Bar The Care Group monitors' status is shown in symbol form in the Care Group overview bar. Flashing symbols indicate active alarms, symbols that are not flashing indicate alarms that have been acknowledged. Selecting a bed symbol calls up the window for that bed or a setup window to select this. The Care Group overview bar must be configured to display on the monitor Screen.
4 Managing Patients Care Group Symbols (four alternative display possibilities depending on space available) The alarms at this monitor are suspended The monitor is in standby mode The monitor is in Demonstration mode The current monitor 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.
4 Managing Patients Use the My Care Group pop-up keys to navigate through the Care Groups: My Unit lets you view a list of all the Information Centers in your Care Unit. Select an Information Center to see a list of the monitors connected to it. Select any monitor to see the Other Patient window for that bed. Other Units lets you view a list of all the Care Units in your Care Domain. Select any Care Unit to view a list of the Information Centers connected to it.
4 Managing Patients Note that a Screen with an embedded Other Bed screen element cannot be displayed on the D80 Intelligent Display. Changing the Screen may automatically change the bed shown in the other bed window. If you switch to a different Screen, you should check that the correct other bed is displayed.
4 Managing Patients Care Group Alarms Changes in the alarm status of beds in a Care Group are announced visually and audibly at all other beds in the same Care Group. The visual and audible indicators used depend on the monitor and Information Center configuration. When an alarm is detected at another bed in the Care Group, • the alarm status is shown in the Care Group overview bar as an icon. • a message informing you about the care group alarm is shown in the monitor status line.
5 5 ECG, Arrhythmia, ST and QT Monitoring The electrocardiogram (ECG) measures the electrical activity of the heart and displays it on the monitor as a waveform and a numeric. This section also tells you about arrhythmia monitoring (see “About Arrhythmia Monitoring” on page 129), ST monitoring (see “About ST Monitoring” on page 139) and QT monitoring (see “About QT/QTc Interval Monitoring” on page 149).
5 ECG, Arrhythmia, ST and QT Monitoring CAUTION To protect the monitor from damage during defibrillation, for accurate ECG information and to protect against noise and other interference, use only ECG electrodes and cables specified by Philips. Selecting the Primary and Secondary ECG Leads The monitor uses the primary and secondary lead to compute HR and to analyze and detect cardiac arrhythmias. They are also available for recordings and for display on the Information Center.
5 ECG, Arrhythmia, ST and QT Monitoring 1 Lead label of the displayed wave 2 1 mV calibration bar 3 Pacer spikes 4 Pace pulse markers 5 Current heart rate 6 Current heart rate alarm limits 7 EASI lead placement label (located here when present) 8 ECG Filter label ECG HR numeric: This is the heart rate derived from the monitored ECG.
5 ECG, Arrhythmia, ST and QT Monitoring • the normal QRS complex should be either completely above or below the baseline and it should not be biphasic. For paced patients, the QRS complexes should be at least twice the height of pace pulses. • the QRS complex should be tall and narrow • the P-waves and the T-waves should be less than 0.2 mV. For ease of identification on the screen, the pacer spikes can be configured to have a fixed size. They are then shown in the background as a dotted lines.
5 ECG, Arrhythmia, ST and QT Monitoring Comparing the wave size to the 1 mV calibration bar on the ECG wave segment can help you to get an idea of the true ECG signal strength. If you choose a fixed adjustment factor, the 1 mV calibration bar will be the same size for all the displayed ECG waves. If you choose Auto Size, or an individual size using the Size Up/Size Down keys, the calibration bar may be a different size for each wave.
5 ECG, Arrhythmia, ST and QT Monitoring selecting Filter may suppress the QRS complexes too much and thus interfere with the clinical evaluation of the ECG displayed on the monitor. This does not affect the ECG analysis performed by the monitor. If AutoFilter is set to On in Configuration Mode, the filter setting will automatically be set to Filter if electromagnetic interference is detected. – Diag: Use when diagnostic quality is required.
5 ECG, Arrhythmia, ST and QT Monitoring ECG Leads Monitored If you are using these leads are available: Resp is measured between electrodes: a 3-electrode set I, II, III RA and LL a 5-electrode set I, II, III, aVR, aVL, aVF, V and MCL RA and LL a 6-electrode set I, II, III, aVR, aVL, aVF, Va, Vb RA and LL a 10-electrode set I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6 RA and LL an EASI 5-electrode set I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6 I and A Changing Lead Sets To chang
5 ECG, Arrhythmia, ST and QT Monitoring Electrode labels AAMI EASI V3 Electrode colors IEC AAMI IEC C3 Brown/Green White/Green V4 C4 Brown/Blue White/Brown V5 C5 Brown/Orange White/Black V6 C6 Brown/Violet White/Violet Standard 3-Lead Placement 118 1 RA placement: directly below the clavicle and near the right shoulder 2 LA placement: directly below the clavicle and near the left shoulder 3 LL placement: on the left lower abdomen
5 ECG, Arrhythmia, ST and QT Monitoring Standard 5-Lead Placement 1 RA placement: directly below the clavicle and near the right shoulder 2 LA placement: directly below the clavicle and near the left shoulder 3 RL placement: on the right lower abdomen 4 LL placement: on the left lower abdomen 5 V placement: on the chest, the position depends on your required lead selection 6-Lead Placement For a 6-lead placement use the positions from the 5-lead diagram above but with two chest leads.
5 ECG, Arrhythmia, ST and QT Monitoring Chest Electrode Placement V1 on the fourth intercostal space at the right sternal border V2 on the fourth intercostal space at the left sternal border V3 midway between the V2 and V4 electrode positions V4 on the fifth intercostal space at the left midclavicular line V5 on the left anterior axillary line, horizontal with the V4 electrode position V6 on the left midaxillary line, horizontal with the V4 electrode position V3R -V6R on the right side of the chest in posi
5 ECG, Arrhythmia, ST and QT Monitoring Conventional 12-Lead ECG 1 V1 - V6 2 LA 3 RA 4 RL 5 LL In conventional 12-Lead ECG using 10 electrodes, an electrode is placed on the right arm, left arm, right leg, and left leg. Six V- electrodes are placed on the chest. The right leg electrode is the reference electrode. Limb electrodes: – – Place arm electrodes on the inside of each arm, between the wrist and the elbow. Place leg electrodes inside of each calf, between the knee and the ankle.
5 ECG, Arrhythmia, ST and QT Monitoring Modified 12-Lead ECG 1 LA 2 V1-V6 3 LL 4 RL 5 RA 6 Angle of Lewis If your institution uses modified 10 Lead ECG electrode placement (the Mason-Likar Lead System), place the four limb electrodes close to the shoulders and lower abdomen. The six V electrodes are placed on the chest in the same position as the conventional 12-lead placement.
5 ECG, Arrhythmia, ST and QT Monitoring Capture 12-Lead You can view a 12-Lead ECG on the screen, capture a 12-Lead ECG episode, preview the captured ECG data and then store it and send it to a connected Information Center for analysis. You can also print a 12-Lead report. The monitor can store one 12-Lead ECG episode at any time.
5 ECG, Arrhythmia, ST and QT Monitoring Setting Up the 12-Lead ECG In the Preview window, select the Setup 12 Lead pop-up key to choose settings for filter, gain, etc., if changes are needed. All changes apply to both the display and the printed 12-Lead report. Filter Applies a filter to the waveforms. Choices are 0.05-150Hz D, 0.5-150Hz eM, 0.5-40Hz M (or 0.5-55Hz M for pediatric and neonatal patient categories), 0.5-20Hz F. The selected filter will be displayed in the title bar of the pop-up keys.
5 ECG, Arrhythmia, ST and QT Monitoring Capture 12-Lead Pop-up Keys Here is a summary of all the pop-up keys available during 12-Lead ECG procedure: Pop-up Keys Selecting this pop-up key lets you Admit Patient enter the age and gender for the patient in the Patient Demographics window, to allow analysis of the 12-Lead ECG. Change View switch between the single column and two-column display of the realtime wave data. Capture Waves capture the current ECG waves and open the preview window.
5 ECG, Arrhythmia, ST and QT Monitoring EASI Electrode Placement 1 E (V) - on the lower sternum at the level of the fifth intercostal space 2 A (LL) - on the left midaxillary line at the same level as the E electrode 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 ECG and Arrhythmia Alarm Overview The ECG and arrhythmia alarms available depend on
5 ECG, Arrhythmia, ST and QT Monitoring Cardiotach Alarms Additional Alarms with Basic Additional Alarms with Arrhythmia Option Enhanced Arrhythmia Option ***Asystole ***Ventricular Tachycardia **Afib ***Ventricular Fibrillation/ Tachycardia **Pacer Not Capture **Supraventricular Tach **Pacer Not Pacing **Missed Beat ***Extreme Bradycardia **PVCs/min HIGH (PVC > limit/min) **Pause ***Extreme Tachycardia **Irregular HR **High heart rate **Ventricular Rhythm **Low heart rate **Run PVCs High
5 ECG, Arrhythmia, ST and QT Monitoring ECG Alarms Off Disabled Be aware that your hospital department may have decided to disable the Alarms Off setting for ECG in the monitor's Configuration Mode. In this case, HR alarms cannot be switched off in Monitoring Mode. If you try to switch off the HR alarms, you will see the message To activate enter Config and enable Alarms Off.
5 ECG, Arrhythmia, ST and QT Monitoring During surgery: Use the appropriate orange electrode ECG safety cable, or lead cable with an orange connector, for measuring ECG in the operating room. These cables have extra circuitry to protect the patient from burns during cautery, and they decrease electrical interference. This also reduces the hazard of burns in case of a defective neutral electrode at the HF device. These cables cannot be used for measuring respiration.
5 ECG, Arrhythmia, ST and QT Monitoring • optimizes ECG signal quality. This is important for arrhythmia analysis. The monitor continuously filters the ECG signal to remove baseline wander, muscle artifact, and signal irregularities. Also, if the Patient Paced status is set to Yes, pace pulses are filtered out to avoid processing them as QRS beats. • detects beats, for example, QRS complexes, identifying them for further analysis. • measures signal features such as R-wave height, width, and timing.
5 ECG, Arrhythmia, ST and QT Monitoring To prevent detection of P-waves or baseline noises as QRS complexes, the minimum detection level for QRS complexes is set at 0.15 mV, according to AAMI-EC 13 specifications. Adjusting the ECG wave size on the monitor display (gain adjustment) does not affect the ECG signal which is used for arrhythmia analysis. If the ECG signal is too small, you may get false alarms for pause or asystole.
5 ECG, Arrhythmia, ST and QT Monitoring Understanding the Arrhythmia Display Your monitor screen may look slightly different from the illustration. 1 Beat label 2 Pace pulse marks 3 Rhythm status message 4 PVC Numeric 5 HR Numeric 6 Ectopic status message 7 Delayed arrhythmia wave Viewing Arrhythmia Waves To review arrhythmia beat labels, in the Setup Arrhythmia menu, select Annotate Arrhy. The wave showing the primary ECG lead will be delayed by six seconds and shown on a gray background.
5 ECG, Arrhythmia, ST and QT Monitoring • Rhythm Status Messages -- to indicate the patient's rhythm. • Ectopic Status Messages -- to indicate the presence of ectopic beats. These status messages are shown on the right hand side of the primary ECG wave. They are updated every second, with the exception of the Sinus and Supraventricular (SV) rhythm messages.
5 ECG, Arrhythmia, ST and QT Monitoring Ectopic Status Message Explanation B or E (No message displayed) No ectopic activity within the last minute Run PVCs More than 2 consecutive PVCs within the last minute E Pair PVCs Pair PVCs within the last minute E Pacer Not Capt Pause with pace pulse (paced patient only) within the last minute B, E Pacer Nt Pacing Pause without pace pulse (paced patient only) within the last minute B, E Pause No beat detected for 1.
5 ECG, Arrhythmia, ST and QT Monitoring Automatic Arrhythmia Relearn Arrhythmia relearning is initiated automatically whenever: • ECG monitoring is switched on • The ECG Lead or Lead Label of the primary/secondary lead is changed manually, or when fallback occurs • A Leads Off INOP condition (that has been active for > 60 seconds) ends. If you are monitoring multi-lead arrhythmia and there is a change in one lead only, relearning happens only in the affected lead.
5 ECG, Arrhythmia, ST and QT Monitoring Yellow Arrhythmia Alarms Yellow arrhythmia alarms are short yellow alarms specific to arrhythmia-related patient conditions. Depending on your monitor and Information Center configuration, they may be shown with one or two stars. The heart rate alarms (High HR and Low HR) can be configured as short yellow or standard yellow alarms. When they are standard yellow alarms they exist independently of the other arrhythmia alarms and no timeout periods apply.
5 ECG, Arrhythmia, ST and QT Monitoring • if a more serious alarm condition is active in the same chain • if a timeout period is in effect for a particular alarm • if a timeout period is in effect for a higher alarm in that chain. See “Arrhythmia Alarm Chaining” on page 138 for more details on alarm chains. What is a Timeout Period? Timeout periods are automatically started when a yellow arrhythmia alarm is detected. During this period, the same alarm condition will not generate another alarm.
5 ECG, Arrhythmia, ST and QT Monitoring Arrhythmia Alarm Chaining When arrhythmia analysis is switched on, multiple alarm conditions may be present. Announcing all of the detected alarm conditions would be confusing, and might hide a more serious condition. For this reason, arrhythmia alarms are prioritized in three alarm "chains": PVC Alarms; Beat Detection Alarms, and Rate Alarms. Only the highest priority alarm condition in each chain is announced.
5 ECG, Arrhythmia, ST and QT Monitoring – – If there is an active Vent Bigeminy alarm, a PVCs > xx/min will not be triggered because it is lower on the same chain. However, a high HR alarm will become active because it is on a different chain. Higher priority alarms supersede previous alarms. For example, if a Vent Trigeminy alarm is active and a Pair PVCs occurs, the Pair alarm will be activated.
5 ECG, Arrhythmia, ST and QT Monitoring WARNING Some clinical conditions may make it difficult to achieve reliable ST monitoring, for example: • if you are unable to get a lead that is not noisy • if arrhythmias such as atrial fib/flutter are present, which may cause an irregular baseline • if the patient is continuously ventricularly paced • if the patient has left bundle branch block. You should consider switching ST monitoring off if these conditions are present.
5 ECG, Arrhythmia, ST and QT Monitoring Understanding the ST Display Your monitor screen may be configured to look slightly different from the illustrations. 1 ST numerics 2 Current HR alarm limits 3 Current heart rate ST Numerics Up to 12 ST numerics plus the ST index can be displayed on the monitor screen. They can be configured to show beside the measurement numerics, beside the ECG wave, or beside the ST snippet.
5 ECG, Arrhythmia, ST and QT Monitoring 1 ST label and numeric 2 Baseline ST numeric 3 Difference between current values and baseline values 4 1 mV calibration bar 5 Current snippet 6 ST baseline 7 Timestamp of most recently stored baseline snippet Updating ST Baseline Snippets ST analysis requires valid samples to measure and store a snippet. ST Snippets and ST values are updated every minute. If there is artifact in the signal, it may take longer for an ST snippet and an ST value to appear.
5 ECG, Arrhythmia, ST and QT Monitoring About the ST Measurement Points The ST value for each beat complex is the vertical difference between the ISO point and the ST point, as shown in the diagram below. The isoelectric (ISO) point provides the baseline, the ST point is at the midpoint of the ST segment. The J point is where the QRS complex changes its slope; as it is a fixed distance away from the ST point, it can be useful to help you position the ST point correctly.
5 ECG, Arrhythmia, ST and QT Monitoring 3 Use the Select Point pop-up key to scroll through the points and activate the point you need to adjust, then use the left and right arrow keys to move the measurement point. Each point is highlighted while active.
5 ECG, Arrhythmia, ST and QT Monitoring To position the ST-point (3) relative to the J-point: select either J+60 or J+80. Select J Point and use the arrow keys to move the J-Point and position the ST-point at the midpoint of the ST segment. To position the ST-point directly: select ST Point and use the left and right arrow keys to position the ST point at the midpoint of the ST segment. 4 Select the Apply Changes pop-up key to activate the new ST measurement points and recalculate all ST values.
5 ECG, Arrhythmia, ST and QT Monitoring Viewing ST Maps The monitor can derive a multi-axis portrait (map) from the ST analysis to help you detect changes in ST values. It displays two planes obtained from a multilead ECG in a multi-axis diagram, where each axis represents a lead. The ST value at the J point is given. The position of the axes within the diagram correspond to the placement of the ECG leads. Each ST value is assigned to either a limb lead, or to a chest lead.
5 ECG, Arrhythmia, ST and QT Monitoring If a lead is in INOP (the value is being measured but is invalid or unavailable because, for example, the corresponding ECG electrode is off), the area formed by the remaining ST leads is left open. If there is insufficient information (for example, there are less than three chest leads) for a second ST map to be displayed, the currently available ST values are displayed in place of the second ST map.
5 ECG, Arrhythmia, ST and QT Monitoring In this diagram, V4 was either temporarily switched off, or in INOP, for around 30 seconds. No data was recorded. Consequently, the affected maps are not closed. Viewing an ST Map To display an ST map, • In the Main Setup menu, select ST Map. Working in the ST Map Task Window You may need to activate the ST map task window to see all the data, and to access the pop-up keys. Select the map view on screen to activate its task window.
5 ECG, Arrhythmia, ST and QT Monitoring Changing the Trending Interval To determine how frequently the monitor displays a trended sample, 1 In Trend view, select Select Interval. 2 Select the required interval from the menu. The interval ranges between 12 seconds to 30 minutes. Printing an ST Map Report To print the most recently viewed (current or trend) window, 1 Select Main Setup then select Reports. 2 Select ST Map. 3 Press Print.
5 ECG, Arrhythmia, ST and QT Monitoring Because of the different algorithm approaches, a QT/QTc measurement from a diagnostic 12-lead program may differ from the realtime measurement on the monitor. Where Can I Find More Information? See the Application Note on QT/QTc Interval Monitoring and the QT Interval Monitoring Quick Guide supplied on your documentation DVD for detailed information on the QT algorithm and performance.
5 ECG, Arrhythmia, ST and QT Monitoring • Single-Lead mode - a single lead selected from all available leads (except the augmented leads) will be used for QT measurement. QT measurement will stop if the selected lead becomes unavailable. To select the mode, 1 Select the QT numeric to enter the Setup QT Analysis window. 2 Select QT Lead and select All, Primary Lead or one of the available single leads.
5 ECG, Arrhythmia, ST and QT Monitoring To set the baseline, • Select Set Baseline and set the value. If no baseline has been set for this patient, the first five minute value after the start of monitoring is automatically set as baseline. If you set a new baseline the previous baseline is discarded. As the ΔQTc alarm is based on the difference between the baseline and the current value, setting an inappropriate new baseline may prevent a ΔQTc alarm from being generated.
5 ECG, Arrhythmia, ST and QT Monitoring Additional Message Cause of Invalid QT Measurement End of T not Detected End of the T-Wave cannot be accurately detected QT out of Range QT measurement is outside the specified range of valid QT values (200-800 msec) QTc out of Range QTc measurement is outside the specified range of valid QTc values (200-800 msec) QTc Erratic QTc measurements are not stable Switching Individual QTc Alarms On and Off Each QTc alarm can be switched off individually.
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6 6 Monitoring Pulse Rate The pulse numeric counts the arterial pulsations that result from the mechanical activity of the heart in beats per minute (bpm). You can display a pulse from any measured SpO2 signal (pleth wave), or any arterial pressure (P, ABP, ART, Ao, PAP, UAP, FAP, BAP: see the Monitoring Invasive Pressure chapter for an explanation of the pressure labels). The displayed pulse numeric is labeled and colorcoded to match its source wave.
6 Monitoring Pulse Rate Switching Pulse On and Off To switch a particular pulse numeric on or off, enter the Setup Pulse menu via the measurement setup menu or wave menu of the pulse source. For example, to switch an SpO2 pulse numeric on or off, 1 Enter the Setup Pulse menu by selecting the Pulse numeric or by selecting Pulse in the Setup SpO₂ menu. 2 In the Setup Pulse menu, select the correct pulse label, e.g. Pulse (SpO₂), to toggle between On and Off.
6 Monitoring Pulse Rate WARNING Selecting Pulse as the active alarm source for HR/Pulse switches off the arrhythmia alarms listed in the section “ECG and Arrhythmia Alarm Overview” on page 126, including Asystole, Vfib and Vtach alarms, and the heart rate alarms. This is indicated by the message ECG/ARRH ALARM OFF (unless this has been configured off for your monitor), and the crossed-out alarm symbol beside the ECG heart rate numeric.
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7 7 Monitoring Respiration Rate (Resp) For the respiratory measurement (Resp), the monitor measures the thoracic impedance between two ECG electrodes on the patient's chest. Changes in the impedance due to thoracic movement produce the Resp waveform on the monitor screen. The monitor counts the waveform cycles to calculate the respiration rate (RR).
7 Monitoring Respiration Rate (Resp) Lateral Chest Expansion Some patients, especially neonates, expand their chests laterally. In these cases it is best to place the two respiratory electrodes in the right midaxillary and left lateral chest areas at the patient's maximum point of breathing movement to optimize the respiratory wave. Abdominal Breathing Some patients with restricted chest movement breathe mainly abdominally.
7 Monitoring Respiration Rate (Resp) • the detection level (a dotted line) is not displayed on the waveform, • the algorithm expects a heart rate and therefore needs at least 3 electrodes attached to the patient. If you are monitoring respiration with only two electrodes, the detection algorithm becomes less sensitive which may result in reduced breath detection performance.
7 Monitoring Respiration Rate (Resp) Changing the Speed of the Respiration Wave Resp waveforms are usually viewed at a slower speed than other waveforms. For this reason, the Resp measurement has its own speed control and is not affected by the wave speed settings of the other measurements. • Select the Resp wave to enter the Resp Wave menu, then select Change Speed. Choose the required speed from the pop-up list.
7 Monitoring Respiration Rate (Resp) To monitor respiration, use only the non-OR ECG accessories listed in the Resp section of the accessories chapter. You cannot measure respiration if you are using an orange OR ECG cable set. This is because of the higher internal impedance of the OR cable set, required for use if electrosurgery is being performed.
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8 Monitoring SpO2 8 Philips pulse oximetry uses a motion-tolerant signal processing algorithm, based on Fourier artifact suppression technology (FAST). It provides four measurements: • Oxygen saturation of arterial blood (SpO2) - percentage of oxygenated hemoglobin in relation to the sum of oxyhemoglobin and deoxyhemoglobin (functional arterial oxygen saturation). • Pleth waveform - visual indication of patient's pulse. • Pulse rate (derived from pleth wave) - detected pulsations per minute.
8 Monitoring SpO2 3 Apply the sensor to the patient. The application site should match the sensor size so that the sensor can neither fall off, nor apply excessive pressure. When using the M1195A Infant Finger Sensor, select a finger or toe with a diameter of between 7 and 8 mm (0.27" and 0.31"). When applying a M1193A neonatal sensor do not overtighten the strap. 4 Check that the light emitter and the photodetector are directly opposite each other.
8 Monitoring SpO2 2 During measurement, ensure that the application site: – has a pulsatile flow, ideally with a perfusion indicator value above 1.0. – has not changed in its thickness (for example, due to edema), causing an improper fit of the sensor.
8 Monitoring SpO2 Assessing a Suspicious SpO2 Reading Traditionally, pulse rate from SpO2 was compared with heart rate from ECG to confirm the validity of the SpO2 reading. With newer algorithms, such as FAST-SpO2, this is no longer a valid criteria because the correct calculation of SpO2 is not directly linked to the correct detection of each pulse.
8 Monitoring SpO2 Alarm Delays There is a delay between a physiological event at the measurement site and the corresponding alarm at the monitor. This delay has two components: • The general system delay time is the time between the occurrence of the physiological event and when this event is represented by the displayed numerical values. This delay depends on the algorithmic processing and the configured averaging time.
8 Monitoring SpO2 In example 1, the SpO2 value is dropping quickly and goes below the low alarm limit at the point marked a. At the point marked b it also crosses into the shaded area which represents the Smart Alarm Delay criteria - the low limit alarm is announced. The delay between the limit being crossed and the alarm being announced, the distance between a and b, is short. In example 2, the SpO2 value is dropping more slowly and goes below the low alarm limit at the point marked c.
8 Monitoring SpO2 WARNING High oxygen levels may predispose a premature infant to retrolental fibroplasia. If this is a consideration do NOT set the high alarm limit to 100%, which is equivalent to switching the high alarm off. Adjusting the Desat Limit Alarm The Desat alarm is a high priority (red) alarm notifying you of potentially life threatening drops in oxygen saturation. 1 In the Setup SpO₂ menu, select Desat Limit. 2 Adjust the limit.
8 Monitoring SpO2 Setting SpO2/Pleth as Pulse Source 1 In the Setup SpO₂ menu, select Pulse (SpO₂) to enter the Setup Pulse menu. 2 In the Setup Pulse menu, select System Pulseand select the correct SpO2 label from the pop-up list. Setting Up Tone Modulation If tone modulation is on, the QRS tone pitch lowers when the SpO2 level drops. Remember, the QRS tone is derived from either heart rate or pulse depending on which is currently selected as the active alarm source.
9 9 Monitoring NBP This monitor uses the oscillometric method for measuring NBP. In adult and pediatric mode, the blood pressure measurements determined with this device comply with the American National Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP10-1992) in relation to mean error and standard deviation, when compared to intra-arterial or auscultatory measurements (depending on the configuration) in a representative patient population.
9 Monitoring NBP Unattended measurement: Use clinical judgement to decide whether to perform frequent unattended blood pressure measurements in cases of severe blood clotting disorders because of the risk of hematoma in the limb fitted with the cuff. CAUTION If you spill liquid onto the equipment or accessories, particularly if there is a chance that it can get inside the tubing or the measurement device, contact your service personnel.
9 Monitoring NBP Preparing to Measure NBP 1 Connect the cuff to the air tubing. 2 Plug the air tubing into the red NBP connector. Avoid compression or restriction of pressure tubes. Air must pass unrestricted through the tubing. 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.
9 Monitoring NBP The measured NBP value, together with the corresponding pulse rate if this is switched on, will be displayed for one hour. After that the values are regarded as invalid and are no longer displayed. In Auto mode the measurement values may disappear more quickly (to be replaced by new measurement values), if the repeat time is set to less than one hour. Alarm Sources If you have parallel alarm sources, the sources are displayed instead of the alarm limits.
9 Monitoring NBP Action to be performed NBP Setup menu Start manual measurement Start/Stop Start Auto series SmartKeys MMS hardkey Start/Stop Start/ Stop --Start NBP Start STAT measurement NBP STAT NBP STAT STAT (for MMS without Pressure/Temp measurement) Start STAT Stop Manual measurements Start/Stop Start/Stop Start/ Stop Stop NBP Stop current Auto measurement Start/Stop Start/Stop Start/ Stop Stop NBP Stop current STAT measurement and end series Start/Stop Start/Stop Start/ Stop N
9 Monitoring NBP CAUTION Use clinical judgment to decide whether to perform repeated series of STAT measurements because of the risk of purpura, ischemia and neuropathy in the limb with the cuff. Enabling Automatic Mode and Setting Repetition Time 1 In the Setup NBP menu, select Mode and select Auto from the pop-up menu. 2 For an automatic measurement, select Repeat Time and set the time interval between two measurements.
9 Monitoring NBP Menu option Pressure value monitored Sys. systolic Dia. diastolic Mean mean Sys & Dia systolic and diastolic in parallel Dia & Mean diastolic and mean in parallel Sys & Mean systolic and mean in parallel Sys&Dia&Mean all three pressures in parallel If Mean is not selected as alarm source (Sys., Dia., or Sys & Dia selected), but the monitor can only derive a mean value, mean alarms will nevertheless be announced using the most recent mean alarm limits.
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10 10 Monitoring Temperature WARNING Measurements from an MMS extension connected to an X2 are not available when the X2 is running on its own battery power. They are only available when the X2 is powered by external power: when connected to a host monitor, to the external power supply (M8023A) or to the Battery Extension (865297). You can measure temperature using an X1 or X2 Multi-Measurement Module (MMS), one of the MMS extensions, or the temperature plug-in module.
10 Monitoring Temperature 2 Select the appropriate label from the list. 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.
11 11 Monitoring Invasive Pressure WARNING Measurements from an MMS extension connected to an X2 are not available when the X2 is running on its own battery power. They are only available when the X2 is powered by external power: when connected to a host monitor, to the external power supply (M8023A) or to the Battery Extension (865297). CAUTION Do not use the X2 in combination with monitors using an M1006A pressure module and the HP1290A pressure transducer.
11 Monitoring Invasive Pressure WARNING If measuring intracranial pressure (ICP, IC1 or IC2) with a sitting patient, level the transducer with the top of the patient's ear. Incorrect leveling may give incorrect values. Selecting a Pressure for Monitoring Tell the monitor which pressure you want to monitor by selecting its pressure label. The label is a unique identifier for each type of pressure.
11 Monitoring Invasive Pressure • if you think the monitor's pressure readings are not correct. When using a pressure module, the zero information is stored in the module. When a pressure module, with the transducer connected, is plugged into the monitor, the monitor will use the Zero stored in the module. Zeroing ICP (or IC1/IC2) Your hospital guidelines may require you to zero the ICP transducer less frequently than other transducers, due to the need for aseptic conditions.
11 Monitoring Invasive Pressure Using the Zero Hardkey Pressing the Zero hardkey for two seconds on the M1006B Pressure module starts a zero for the pressure currently measured with the module. Pressing the Zero hardkey for two seconds on the M3001A Multi-Measurement module zeros the pressure being measured by the Multi-Measurement module and the pressures from any connected MMS extensions.
11 Monitoring Invasive Pressure 1 In the Setup menu, select Cal. Factor. If the value here does not match that on the transducer, select the corresponding value from the list now in accordance with your hospital's procedure. 2 To confirm you want to use the new calibration factor, select the Confirm pop-up key. Displaying a Mean Pressure Value Only Use this when you want to see only the mean pressure. In the pressure's setup menu, select Mean only.
11 Monitoring Invasive Pressure Non-Physiological Artifact Suppression Some clinical procedures may affect blood pressure, for example, a flush procedure or a blood sample. Your monitor may be configured to suppress these non-physiological artifacts for a specified duration (Artifact Suppr. is configured to 30 sec, 60 sec, or 90 sec). During artifact suppression, the monitor shows the INOP message ARTIFACT, and a question mark is shown beside the pressure numerics.
11 Monitoring Invasive Pressure 1 Extreme Low Limit 2 Low Limit 3 High Limit 4 Extreme High Limit 5 Δ Extreme Low 6 Δ Extreme High You need to know which values have been configured for your monitor. Changing the high and low alarm limits automatically changes the extreme alarm limits within the allowed range. • To see the extreme pressure alarms set for your monitor, in the Setup menu, see the menu items Δ Extreme High and Δ Extreme Low.
11 Monitoring Invasive Pressure d. Open the port to the manometer. 1 Tubing to manometer 2 Syringe with heparinised solution 3 To pressure connector on monitor 4 Patient connection stoppered 5 Off 3 Move the syringe barrel in and raise the mercury to 200 mmHg (30 kPa). 200 mmHg is the recommended calibration pressure. 4 In the Setup menu, select Cal. Press. 5 Select the calibration pressure from the list, for example 200 mmHg.
11 Monitoring Invasive Pressure Message Corrective Action unable to calibrate - out of range Make sure that you have selected the value for Cal. Press that you are applying to the transducer, and repeat the calibration. unable to calibrate - no transducer Make sure that the transducer is connected and try again. unable to calibrate - unstable signal Make sure there are no disturbances to the transducer, and repeat the calibration. unable to calibrate - perform zero first No valid zero.
11 Monitoring Invasive Pressure CAUTION Older Multi-Measurement modules cannot supply a beat-to-beat arterial pressure value. In this case the monitor shows a NO PPV FROM MMS or NO PPV FROM FMS INOP.
11 Monitoring Invasive Pressure completion, the monitor stores the PAWP waveform display and prompts you to deflate the balloon. If the monitor cannot detect a wedging waveform you must use Store Trace to store the wedge and two reference waves manually. 7 Deflate the balloon when the monitor prompts you: Ready for balloon deflation and verify that the waveform returns to pulmonary artery shape. 8 If you need to start a new measurement, select Restart Wedge.
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12 12 Monitoring Cardiac Output The Cardiac Output (C.O.) measurement invasively measures cardiac output and other hemodynamic parameters using a technique called thermodilution. This can be used to determine the flow rate of a system by introducing a cold solution into the system and measuring the resulting drop in temperature at a downstream site. The temperature change is displayed as a curve in the C.O. procedure window, and the monitor calculates the C.O. value from this curve. The C.O.
12 Monitoring Cardiac Output Measured and Calculated Hemodynamic Parameters and Indexes PiCCO Method (Transpulmonary Thermodilution) Right Heart Thermodilution Continuous? Main Screen HemoCalc Main Continuous? Window Screen HemoCalc Window Blood Temperature (Tblood) Y Y N Y Y N C.O./C.I.: Cardiac Output N Y Y N Y Y CCO/CCI: Continuous Cardiac Output Y Y Y (in the C.O.
12 Monitoring Cardiac Output 1 Average - column of averaged values 2 Unit column 3 Continuously measured numeric 4 Prompt message field 5 Thermodilution curve of current trial 6 Curve alert message field 7 Current trial number 8 Setup information 9 Trial numbers for the trial curves 10 Trial curves 11 Results table of current trial 12 Trial curve scale • To change the measurement parameters shown in the results table of the procedure window, select the Table Contents pop-up key and choo
12 Monitoring Cardiac Output CCO/CCI settings can be changed in the Setup CCO menu. To access this menu, • select any of the continuously measured hemodynamic numerics (CCO, CCI.) on the screen. Entering the HemoCalc Window From the procedure window, select the pop-up key Hemo Calc to open the Hemo Calculations window. Measuring C. O. Using the PiCCO Method The PiCCO method combines transpulmonary thermodilution and pulse contour analysis on the blood pressure waveform.
12 Monitoring Cardiac Output Pulse Pressure Variation (PPV) is calculated from beat-to-beat arterial pressure values. Pulse pressure is the difference between the systolic and the diastolic pressure values for a single beat. Pulse pressure variation is defined as the maximal pressure less the minimum pressure divided by the average of these two pressures. WARNING • The monitor calculates PPV from beat-to-beat values of the arterial pressure selected for CCO.
12 Monitoring Cardiac Output Setting Up the PiCCO C.O. Measurement 1 2 3 4 5 6 7 8 9 10 C.O. Module C.O.
12 Monitoring Cardiac Output 5 If you are measuring CCO, set up the pressure measurement now. The CCO measurement requires a minimally dampened invasive pressure setup. You must ensure that there are no air bubbles in the pressure line or dome and use only specified accessories. 6 Check that the correct measurement method is selected. If a catheter is already connected to the Cardiac Output Interface Cable, the monitor automatically recognizes the method used. If not, in the Setup C.O.
12 Monitoring Cardiac Output Editing PiCCO C.O. Measurements It is important to identify and reject erroneous trials, as the monitor uses all the measurement trial values you do not reject to calculate the averaged cardiac output. 1 Review the trials. Irregular trials or trials marked with a "?" should be reviewed carefully. Consider the similarity of the values and the shape of the C.O. curve. A normal C.O. curve has one smooth peak and returns to the temperature baseline level after the peak.
12 Monitoring Cardiac Output For a trial to be eligible for calibration, the pressure signal must be continuously available and undisturbed starting 30 seconds before the first C.O. measurement of the series. Do not zero the pressure measurement, change the pressure label, or disturb the pressure signal in any other way during this time.
12 Monitoring Cardiac Output Setting up RH C.O. Measurements 1 2 3 4 5 6 7 8 9 204 C.O. Module C.O. Interface Cable Remote Start Switch Thermistor Connector Thermistor Connection Cable PA Catheter Injectate Temperature Probe Housing Injectate Syringe Injectate Temperature Probe 1 Set up the PA line using a PA catheter. 2 Attach the injectate temperature probe housing to the PA line. 3 Plug the C.O. interface cable into the C.O.
12 Monitoring Cardiac Output Ice-Bath Setup for RH Thermodilution C.O. Measurements If you are using the flow-through method illustrated above, the injectate temperature is measured at the time of injection by the temperature probe in the injectate temperature probe housing. If you are using the ice-bath setup, the injectate temperature probe and the injectate are both placed in an ice-bath and the probe measures the temperature of the contents of the ice bucket.
12 Monitoring Cardiac Output Documenting C.O. Measurements You can document C.O. measurements on the default printer or recorder. 1 In the procedure window, select the pop-up key Print/ Record. 2 From the pop-up list, choose: – Print Results to print the contents of the procedure window – Record Results to record the contents of the procedure window – Record Trial to send an individual trial curve to the recorder. C.O.
12 Monitoring Cardiac Output Patient Weight Cold Injectate Room Temperature Injectate ETVI < 10 ETVI ≥ 10 ETVI < 10 ETVI ≥ 10 < 3 kg 2 ml 2 ml 3 ml Use cold injectate < 10 kg 2 ml 3 ml 3 ml < 25 kg 3 ml 5 ml 5 ml < 50 kg 5 ml 10 ml 10 ml < 100 kg 10 ml 15 ml 15 ml ≥ 100 kg 15 ml 20 ml 20 ml C.O./CCO Curve Alert Messages After each measurement trial, the monitor analyzes the thermodilution curve.
12 Monitoring Cardiac Output C.O./CCO Curve Alert Messages Possible Causes Tinj off scale The Tinjectate is out of the range -1°C and 30°C. Cool down or heat up the injectate or change the injectate solution and repeat the measurement. Noisy baseline A blood temperature baseline drift that could not be compensated was detected during the C.O. measurement. Possible causes are: - Interference may be caused by a ventilator.
12 Monitoring Cardiac Output C.O./CCO Curve Alert Messages Possible Causes 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. Calculated value for C.O. may not be accurate. Very long curve The decay time of the curve is longer than 15 seconds. Very short curve Decay time of the curve is less than 0.5 seconds.
12 Monitoring Cardiac Output 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 extension module has been plugged in with different C.O. setup data from the previous data. The new C.O. setup data is read from the new C.O. device, and replaces the current data.
12 Monitoring Cardiac Output CAUTION During the cardiac output measurement procedure the blood temperature alarms are inactive. This is indicated by a crossed-out alarm symbol next to the temperature numeric. Making alarms inactive during this procedure prevents false alarms. The alarms are automatically reactivated when you have completed the measurement procedure.
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13 13 Monitoring Carbon Dioxide WARNING Measurements from an MMS extension connected to an X2 are not available when the X2 is running on its own battery power. They are only available when the X2 is powered by external power: when connected to a host monitor, to the external power supply (M8023A) or to the Battery Extension (865297). Only one CO2 measurement at a time is supported. Use the CO2 measurement to monitor the patient's respiratory status and to control patient ventilation.
13 Monitoring Carbon Dioxide Low etCO2 values: Leakages in the breathing system or sampling system may cause the displayed etCO2 values to be significantly too low. Always connect all components securely and check for leaks according to standard clinical procedures. Displacement of the nasal or combined nasal oral cannulas can cause lower than actual etCO2 readings. Even with combined nasal oral cannulas, the etCO2 readings may be slightly lower than actual in patients breathing through the mouth only.
13 Monitoring Carbon Dioxide WARNING Altitude Setting: The monitor is not equipped with automatic barometric pressure compensation. Before the CO2 measurement is used for the first time, the altitude must be set to the correct value. An incorrect altitude setting will result in incorrect CO2 readings. The CO2 readings will typically deviate 5% for every 1000m difference. CAUTION Use the CO2 measurement with Philips approved accessories only. Refer to the instructions for use provided with the accessory.
13 Monitoring Carbon Dioxide – 4 When you see the message CO₂ calibration done at on the status line, the zero calibration is finished and you can begin monitoring. Install the airway adapter at the proximal end of the circuit between the elbow and the ventilator Ysection. WARNING To prevent stress on the endotracheal tube, support the sensor and airway adapter. Position sensor cables and tubing carefully to avoid entanglement or potential strangulation.
13 Monitoring Carbon Dioxide – – – 4 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 CO₂ calibration done at on the status line, the zero calibration is finished and you can begin monitoring.
13 Monitoring Carbon Dioxide CAUTION Always disconnect the cannula, airway adapter or sample line from the sensor when not in use. Using the Sidestream Sensor Holder The holder delivered with the sensor can be used to clamp the sensor onto an IV pole or a shelf. 1 Push the sensor into the holder until it clicks into position. 2 Clamp the holder onto an IV pole, a shelf or another appropriate location. To remove the sensor from the holder, release the clip and pull the sensor out of the holder.
13 Monitoring Carbon Dioxide 2 Wait 20 minutes, allowing the transducer to reach its operating temperature and a stable thermal condition. 3 Perform an accuracy check and then, if necessary, calibrate the transducer. Checking Transducer Accuracy WARNING Check transducer accuracy at least once a week or if you doubt the CO2 readings. 1 In Setup CO₂ menu, select Cal. Mode to switch on calibration mode. 2 Look at the calibration value displayed in the Setup CO₂ menu next to Start CAL1.
13 Monitoring Carbon Dioxide CO₂ SENS.WARMUP message until the transducer reaches operating temperature. Wait until this disappears before starting the measurement. 2 To remove the transducer from the airway adapter, open the latch and pull out the airway adapter. WARNING To prevent stress on the endotracheal tube, support the transducer and airway adapter. To avoid infection, use only sterilized airway adapters.
13 Monitoring Carbon Dioxide Preparing to Measure Microstream CO2 Use appropriate accessories for: • the patient type (adult, pediatric or neonatal), • the ventilation situation (including humidification) • the duration - short term use, up to 24 hours (typically OR), or long term use (typically ICU). All accessories are for single patient use only. Using Microstream Accessories The Microstream measurement can be operated with the special Microstream accessories only.
13 Monitoring Carbon Dioxide Removing Exhaust Gases from the System WARNING Anesthetics: When using the Microstream CO2 measurement on patients who are receiving or have recently received anesthetics, connect the outlet to a scavenging system, or to the anesthesia machine/ ventilator, to avoid exposing medical staff to anesthetics. Use an exhaust tube to remove the sample gas to a scavenging system. Attach it to the MMS Extension at the outlet connector.
13 Monitoring Carbon Dioxide Correction Altitude (M3014A only) Altitude is set during installation. The monitor automatically applies an appropriate correction. O2 (M3014A only) In the Setup CO₂ menu, select Oxy. Corr and select a value between 20% and 100%, the default value is 20%. If you are not measuring the expired O2, estimate it by subtracting 5% from the inspired O2 then select the nearest value from the list.
13 Monitoring Carbon Dioxide WARNING Safety and effectiveness of the respiration measurement method in the detection of apnea, particularly the apnea of prematurity and apnea of infancy, has not been established. Prolonged delay: The selected apnea alarm delay may be prolonged by up to 17 seconds, if an apnea occurs during the automatic zero process. This applies to the Microstream (M3015A/B) measurement only. Deriving Alarms From awRR 1 In the Setup CO₂ menu, select awRR.
14 14 Monitoring Airway Flow, Volume and Pressure The M1014A Spirometry Module is designed to be used in combination with Philips-branded airway flow sensors and combined CO2/airway flow sensors. It produces a real time wave for flow, volume and pressure of respiratory gases together with numerics for analysis of ventilatory mechanics. The measurement provides: • Airway flow, airway volume and airway pressure waveform.
14 Monitoring Airway Flow, Volume and Pressure WARNING Electrical Shock Hazard: Do not open the module. Contact with exposed electrical components may cause electrical shock. Always turn off and remove power before cleaning the module. Refer servicing to qualified service personnel. Attaching the Flow Sensor CAUTION Use the M1014A Spirometry Module with Philips approved accessories only. Refer to the instructions for use provided with the accessory. 1 Select the appropriate flow sensor.
14 Monitoring Airway Flow, Volume and Pressure 3 Install the flow sensor or the combined CO2/Flow sensor at the proximal end of the breathing circuit between the elbow and the ventilator Y-piece. Make sure that the spirometry sensor is in a horizontal position with its tubing pointing upwards. The correct position is also indicated by an arrow on some of the sensors. (Graphic shows combined CO2/Flow Sensors).
14 Monitoring Airway Flow, Volume and Pressure • For routine performance of airway care, separate the system between the endotracheal tube and the airway adapter (neonatal circuit), or between the endotracheal tube and elbow (pediatric/adult circuit). Lavage and suctioning of the airway can then be performed without fluids and mucous accumulating on the airway adapter windows.
14 Monitoring Airway Flow, Volume and Pressure NOTE • During the purge cycle the pump will be heard • If the purge does not sufficiently clear the flow tubing lines, the flow sensor should be replaced • With each purge cycle, a zero calibration is automatically performed Adult Mode The system automatically purges the sensor tubing every ten minutes or less, depending on system conditions. In adult mode, the system will purge both sides of the line, one at a time, during each purge cycle.
14 Monitoring Airway Flow, Volume and Pressure Actual Gas Composition N2 O2 60 40 40 Gas Compensation Setting N2O Agent 60 Difference between measured and actual values 15% Incorrect Balance Gas Setting (N2O instead of N2) N2 O2 N2O Agent Actual Gas Composition 55 40 5 Gas Compensation Setting 60 40 0 Difference between measured and actual values 15% Incorrect Agent Percentage Setting Setting up Spirometry The following settings can be accessed through the Setup Spirometry menu.
14 Monitoring Airway Flow, Volume and Pressure WARNING Safety and effectiveness of the respiration measurement method in the detection of apnea, particularly the apnea of prematurity and apnea of infancy, has not been established. WARNING If an apnea occurs during a zero calibration or purge, the time delay between the start of apnea and the activation of the apnea alarm could be up to 10 seconds plus the configured apnea delay time.
14 Monitoring Airway Flow, Volume and Pressure Changing the Concentration of Inspired O2 and the Inspired Agents 1 In the Setup Spirometry menu, select Gas Compensation. 2 Select Inspired O₂ to change the concentration of inspired O2. Select Inspired Agent to change the concentration of the inspired agent(s). 3 Select the appropriate setting. Changing the Temperature of the Inspired Gas Depending on the type of ventilator environment (e.g.
15 15 Monitoring tcGas The tcGas module measures the partial pressure of the oxygen and carbon dioxide that diffuses through the skin, thereby providing a measure of these gases in the capillary blood. The monitor's settings for altitude and barometric pressure influence the measurement. The tcpO2/ tcpCO2 measurement is valid for an infant patient not under gas anesthesia. Anesthetic agents, such as halothane, can cause incorrect or drifting readings.
15 Monitoring tcGas 2 Choose a temperature value appropriate for your patient's age, weight and physical condition in accordance with your hospital policy. Usually, a higher transducer temperature gives a better correlation and a quicker response time. However, higher temperatures also increase the risk of skin burns. Most physicians prefer a temperature between 42°C (107°F) and 44°C (111°F), and a site time of four hours or less.
15 Monitoring tcGas Disabling the tcGas Site Timer Depending on your monitor's configuration, you might be able to disable the site timer. Remember, this means that the transducer heats indefinitely while on a patient. 1 In Setup tcGas menu, select Site Timer and switch this to Disabled. 2 Select the Confirm pop-up key. Setting the tcGas Barometric Pressure Altitude and barometric pressure affect tcGas values. The monitor derives barometric pressure from its altitude setting.
15 Monitoring tcGas 1 Connect the calibration unit to the inlet on the side of the module's calibration chamber using the recommended gas tubing. Different tubing will cause inaccurate measurements. 2 Plug the transducer cable into the module. Swing the calibration chamber cover open and insert the transducer into the chamber. Close the cover to secure the transducer. Set the transducer temperature at the monitor now. 3 On the 15210B calibration unit, turn the timer control clockwise as far as you can.
15 Monitoring tcGas Troubleshooting tcGas Calibration Perform each of the following steps, in order, until calibration is successful. 1 Check the calibration unit, then recalibrate, remembering to turn on the gas supply on the calibration unit. If the pressure indicator reading is in the out of gas zone, there is insufficient gas in the cylinder. Connect the gas tubing firmly to the calibration unit and to the module's calibration chamber.
15 Monitoring tcGas WARNING You must either remove the transducer before defibrillating, or remembrane and calibrate the transducer after defibrillating. CAUTION To avoid transducer damage, remove it from the patient during high frequency surgical procedures. Selecting the tcGas HeatPowerDisplay Mode The heat power display gives an indication of the skin's perfusion below the transducer and of the transducer's contact with the skin.
15 Monitoring tcGas Metabolism Correction for tcpCO2 CO2 production in the epidermis increases the CO2 value. Your monitor may be configured to automatically deduct a metabolism factor (only applies when CO₂ Correction is on). In the Setup tcGas menu, look at the value shown for the menu item MetabolismFactor. This is deducted from the CO2 value.
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16 Monitoring Intravascular Oxygen Saturation 16 Depending on the probe or catheter used and the measurement location, the two modules, M1011A and M1021A, measure the central venous oxygen saturation or mixed venous oxygen saturation continuously and invasively. The two modules can be differentiated by their size and their labeling. The M1011A is a single-width module (narrow) and is labeled SO2. The M1021A is a double-width module (wide) and is labeled SvO2.
16 Monitoring Intravascular Oxygen Saturation Do not use probes/catheters when they, or the packaging, are damaged. Always select the correct label for the measurement location and the catheter/probe in use. This is especially important when Protocol Watch is in use, to ensure that the correct limits are used for the criteria applied. CAUTION Use the modules with Philips approved accessories only. Refer to the instructions for use provided with the accessory.
16 Monitoring Intravascular Oxygen Saturation 1 Optical module 2 Balloon inflation stopcock 3 Hospira fiber optic catheter 4 Optical reference 5 Enter setup/calibration Connect the optical module (Hospira 50131) to the measurement module. Allow the optical module to warm up before you perform a calibration. Although the warm up message disappears from the screen after one minute, Hospira recommends letting the optical module warm up for 15 minutes for best accuracy.
16 Monitoring Intravascular Oxygen Saturation Inserting the Catheter 1 Remove the inner cover of the catheter tray. 2 Remove the catheter tip from the optical reference. Check the catheter's proper operation (for example: the balloon tip). 3 Prepare and insert the catheter in accordance with standard hospital practice. The SvO2 catheter is thin and flexible, treat it carefully. Avoid kinking, bending or grasping the catheter with forceps or a hemostat.
16 Monitoring Intravascular Oxygen Saturation Making the In-Vivo Calibration 1 Be prepared to draw a blood sample from the patient. 2 In the Setup menu, select Start In-VivoCal. 3 To clear the distal lumen, draw off and discard at least 2 ml of blood before taking the sample. 4 Draw a blood sample from the distal port of the catheter and flush the line according to standard hospital practice. 5 Obtain laboratory analysis of the sample using direct measurements.
16 Monitoring Intravascular Oxygen Saturation Changing the Lab Value Required for Entry You can change the lab value required to be entered: Hb [g/dl], Hb [mmol/l] or Hct [%]. 1 In the Setup menu, select Hb/Hct Entry. 2 Select your preferred lab value and unit. Preparing to Monitor with the M1011A Narrow Module In addition to the module, you need a Philips SO2 Optical Module and a compatible fiber optic probe or catheter.
16 Monitoring Intravascular Oxygen Saturation CAUTION Do not apply excessive tension to any sensor cable or part of the catheter. Performing In-Vivo Calibration Perform an in-vivo calibration: • when you place the catheter in a patient. • 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.
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17 17 Monitoring EEG The Electroencephalograph (EEG) module monitors the patient's cerebral function by measuring the electrical activity of the brain. It provides the monitor with two channels of realtime EEG waves, EEG trend information in the form of Compressed Spectral Arrays (CSA), and up to eight of the following numerics: Spectral Edge Frequency - The SEF is the frequency below which a defined percentage of the Total Power lies. The percentage is set in Configuration Mode.
17 Monitoring EEG 7 Check the electrode-to-skin impedance in the EEG Impedance / Montage window. 8 For good signal quality, keep all lead wires together and away from other electric devices and metallic bodies. Using the EEG Impedance/Montage Window To open the window, in the Setup EEG menu, select Show Montage, or select the EEG Montage SmartKey. The window may be configured to look slightly different on your monitor. 1 Electrode locations on the patient's head.
17 Monitoring EEG Changing the Impedance Limit The impedance limit can be set for all electrodes simultaneously in the Setup EEG menu, or in the EEG Impedance / Montage window using the pop-up keys. If the limit is exceeded during monitoring, an INOP will appear and the graphic impedance indicator will change.
17 Monitoring EEG Impedance Indicators Electrode/Skin Impedance Symbol Color Displayed Impedance Value Action Electrode not connected red no value connect electrode Noisy signal gray 60 kΩ (fixed) check electrode-to-skin connections Electrode connected, impedance above limit yellow measured value (e.g. 15 kΩ) check limit, check electrode-to-skin contact Electrode connected, impedance at or below limit green measured value (e.g.
17 Monitoring EEG The CSA contains the following information Lead label Status line for example, Fp1-T3, Fp2-T4 CSA label CSA1 or CSA2 according to EEG channel Montage label for example, Montage A Filter settings for example, 1-30 Hz Buffer label and time the buffer and interval between spectral lines on the CSA Current SEF Threshold can only be changed in Configuration Mode Spectral lines The energy at each frequency is computed and displayed as a spectral line Trendlines EEG values are sa
17 Monitoring EEG • If Show Gridlines is set to On in Configuration Mode, gridlines and the current wave scale values are shown with the EEG wave. • If Show Gridlines is set to Off in Configuration Mode, the current wave scale is indicated by a size bar beside the EEG wave. Changing Filter Frequencies The low and high pass filters screen out undesirable interference from the raw EEG wave display. The current EEG filter frequency settings are shown in the header of the CSA.
17 Monitoring EEG High-frequency Surgery - To reduce the hazard of burns in the high-frequency surgical neutral electrode connection, the EEG electrodes should not be located between the surgical site and the electrosurgical unit return electrode. EEG and Electrical Interference CAUTION Interference from a non-grounded instrument near the patient and electrosurgery interference can cause problems with the waveform and the CSA.
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18 18 Monitoring BIS Bispectral Index monitoring helps to monitor the level of consciousness of a patient under general anesthesia or sedation in the OR and ICU. The BIS sensor is placed on the patient's forehead to capture electroencephalographic (EEG) signals from which several numerics are derived, including a single BIS value representing the level of consciousness. See the chapter on Specifications for the BIS intended use statement.
18 Monitoring BIS Monitoring BIS Using the DSC and BIS Engine 1 1 BIS Engine Cable 2 BIS Module 3 BIS Engine 4 Digital Signal Converter (DSC) 5 Patient Interface Cable 6 BIS Sensor If you are monitoring BIS with the DSC and BIS Engine, a. Connect the BIS Engine to the BIS module using the BIS Engine Cable. b. Connect the digital signal converter (DSC) to the digital signal converter port on the front of the BIS Engine.
18 Monitoring BIS 1 If you are monitoring BIS using the BISx, a. Connect the BISx to the BIS module b. Use the clip on the rear of the BISx to affix it in a position convenient for your patient, not above the patient's head. 2 Attach the BIS sensor to the patient following the instructions supplied with the sensor. Make sure that the patient's skin is dry. Be aware that a wet sensor or a salt bridge may cause erroneous BIS and impedance values.
18 Monitoring BIS CAUTION Switching the continuous impedance check off will disable automatic notification to the user of impedance value changes, which may lead to incorrect BIS values. Therefore, this should only be done if the check interferes with or disturbs other measurements. BIS Cyclic Impedance Check This measures the exact impedance of each individual electrode. It causes a disturbed EEG wave, and the INOP BIS IMPEDANCE CHCK is shown on the monitor screen during the check.
18 Monitoring BIS 1 Reference Electrode 2 Ground Electrode 3 Signal Electrode(s) 4 Time of the most recent cyclic check BIS Impedance Indicators Electrode-to-Skin Impedance Symbol Color Action Electrode has no skin contact red Reconnect electrode, or check the sensorto-skin contact. If necessary, clean and dry skin. Too much signal noise, impedance cannot be measured gray Check sensor-to-skin contact. Press sensor more firmly to skin. If necessary, clean and dry skin.
18 Monitoring BIS Switching BIS and Individual Numerics On and Off To switch the BIS measurement on or off: • In the Setup BIS menu, select BIS and then On or Off as required. To switch individual numerics provided by the BIS Module on or off: • In the Setup BIS menu, select SQI, TP, SEF, SR, EMG, or Bursts and then On or Off as required. Changing the Scale of the EEG Wave Changing the scale only changes the visual appearance of the wave.
18 Monitoring BIS WARNING Conductive Parts: The conductive parts of sensors and connectors should not contact other conductive parts, including earth. High-frequency Surgery: To reduce the hazard of burns in the high-frequency surgical neutral electrode connection, the BIS sensor should not be located between the surgical site and the electrosurgical unit return electrode.
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19 Assigning a Telemetry Device and a Monitor to One Patient 19 It is possible to assign a monitor and a telemetry device to the same patient, resulting in the information from both devices being combined in one sector at the Information Center. This is called "pairing" and when a telemetry device and a monitor are paired, the measurement data from the telemetry device will be displayed on the monitor screen.
19 Assigning a Telemetry Device and a Monitor to One Patient 1 Select Main Setup then Measurements 2 Select Telemetry The Setup Telemetry menu will appear with only one entry Paired Equipment. 3 Enter here the equipment label of the telemetry device to be paired. Pairing at the monitor is only possible when the monitor already has a connection to the Information Center and the Information Center software version allows pairing at the monitor.
19 Assigning a Telemetry Device and a Monitor to One Patient • Controls on the Telemetry Device (e.g. nurse call) will be inactive when the device is directly connected to the monitor except in the case when the monitor has no network connection and data are transferred via the telemetry device.
19 Assigning a Telemetry Device and a Monitor to One Patient 2 Select the Silence Bed pop-up key. Depending on your Information Center configuration, the Silence Bed key may silence both telemetry alarms and bedside alarms. WARNING Even when the telemetry data is not visible on the screen, you may be silencing telemetry and monitor alarms, if the Information Center and monitor are so configured.
19 Assigning a Telemetry Device and a Monitor to One Patient Synchronized Settings If ECG is measured at the monitor, and then the patient is connected to a telemetry device for monitoring, the Information Center will use the monitor settings for the telemetry device.
19 Assigning a Telemetry Device and a Monitor to One Patient – telemetry data appear on the monitor 2 An MP5 or X2 is declared as a telemetry device and paired with an MX600/700/800 monitor direct or indirect connection – MP5/X2 measurement data appear on the monitor it is paired with – a telemetry transceiver cannot be used with the MP5/X2 3 A telemetry transceiver directly connected (SRR or for MP5 cable) to an MP5 or X2, that is connected (Companion Mode) to an MX600/700/800 monitor - direct connec
20 20 Trends Trends are patient data collected over time and displayed in graphic, tabular or histogram form to give you a picture of how your patient's condition is developing. Trend information is stored in the trends database for continuously-monitored measurements, such as ECG, as well as for aperiodicallymeasured parameters, such as Cardiac Output.
20 Trends Trends Pop-Up Keys When you open the graphic or tabular trends window, a selection of pop-up keys appears to let you navigate through the stored trend data and carry out trends-related tasks. Pop-Up Keys Selecting this pop-up key lets you.... Select Group see a pop-up list of trend groups and select a group for viewing. Select Interval see a pop-up list of available data resolution settings and select the level of detail shown in the trend view.
20 Trends 1 Select the graphical trend or the arrow pop-up keys to activate the cursor. 2 Use the arrow pop-up keys to move the trend cursor backwards and forwards in time, or 3 Place the cursor at a specific time by touching the graph. Viewing Vital Signs Trends 1 Aperiodic values are shown with a timestamp The currently-selected column is highlighted. The values can be configured to display in the same colors as the waves and numerics on the realtime display.
20 Trends Viewing Histogram Trends The title line of the window shows the label of the trended measurement and the resolution of the data; in the RR histogram above, 1 minute trend samples. The horizontal axis shows the range and unit of the displayed measurement. The vertical axis shows the percentage of time. The columns in the foreground show how much of the time the measured values fell into this range on the scale.
20 Trends Expanded View To expand the segment to fill the Graphical Trends window, • in the Segment menu, select Expand to have that segment enlarged to fill the window. In the expanded view, you can also highlight a measurement to make it more easily visible (for example when multiple ST trends are in one segment). To highlight a measurement, • in the Segment menu, select Highlight repeatedly until the highlight is on the required measurement.
20 Trends To change the selection of measurements in a trend group, either use the Change Group setting in the Segment menu or: 1 Select Main Setup, Trends, then Trend Groups. 2 Select the Trend Group you want to change and use the pop-up keys to Add, Change, or Delete the selection of measurements trended. To temporarily change the order in which the measurements are displayed in a group, 1 Select Main Setup, Trends, then Trend Groups.
20 Trends Graphical Trend Presentation Graphical trends and screen trends for measurements with compound values (for example ABP or CO2) can be viewed in line or band form. To change the presentation style, 1 Select Main Setup then select Trends. 2 Select Global Style and choose • Line to display the trends as a continuous line • Band to fill the area between the trend lines, for example, between the systolic and diastolic pressures, with color.
20 Trends Documenting Trends To print a Vital Signs or Graphical Trends report, • in the Vital Signs or Graph Trends window, select the pop-up key Print to print a report for the trend group currently on the monitor screen. Reports include the most recent information in the trends database and extend backwards in time according to the selected trend interval and your monitor's configuration. Trends reports can be printed on central or local printers.
20 Trends Trending Multiple-Value Measurements Some measurements generate multiple values, for example invasive pressure measurements can provide systolic, diastolic, and mean values. These values are trended as separate measurements. Screen Trends Trends configured to display permanently on special monitor Screens are called screen trends. The selection and number of measurement waves in the Screen Trend segment depends on your monitor configuration.
20 Trends 1 Select the screen trend. 2 Select Activate Cursor. You can now use the arrow keys to move the cursor across the time line. The values measured at the cursor time are shown next to the cursor. To de-activate the cursor, • Select Main Screen. Changing the Screen Trend View To switch between tabular, graphic, histogram and horizon views, select the screen trend then select Change View and select the required view. Tabular View Aperiodic measurements such as NBP, C.O., C.I.
20 Trends • a horizon, drawn in white, as a reference point or baseline to help you visualize changes in your patient's condition. The horizon can be set to represent your patient's current condition, or a target condition and can be a single value or a range. • a graphical trend, displaying patient data for the set TrendTime (1). • a trend indicator arrow, indicating how the patient trend has developed in the set time period (10 minutes, 5 minutes or 2 minutes) (2).
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21 21 Calculations 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 • Select the Calcs SmartKey to open the Calculations window. • Select the Calc Type field and select the required calculation type for display. Calculations Windows This example calculations window shows the Hemodynamic Calculations window. The ventilation and oxygenation windows are similar.
21 Calculations Pop-Up Keys Selecting this pop-up key lets you.... Resample Vitals use the most recent monitored values. Resampling sets the calculation time to the current time, and displays the corresponding values for the previous second. Perform Calc perform the displayed calculation using the currently-input values and store the calculation in the calculations database Print/Record print or record the displayed calculation.
21 Calculations Entering Values for Calculations The monitor automatically enters any available values for calculations. For aperiodically-measured values such as C.O., the monitor will re-use the most recent value in the calculation database until a new value becomes available. If the calculation time is the last C.O. time, values will be used from up to and including 30 minutes before the C.O. time, except for height and weight where the last available value will be used.
21 Calculations Comparing Dynamic Compliance Values If you compare the dynamic compliance value (COMP) from the ventilation calculations with the value from the Spirometry measurement you may see a difference. This comes from the different sampling methods: • The algorithm in the ventilation calculations takes into account only two sets of paired AWP/ AWV data: those from complete expiration and complete inspiration, when AWF is zero.
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22 22 High Resolution Trend Waves High resolution (hi-res) trend waves provide information for fast-changing parameters at a glance. They can help you to recognize trend patterns and to find interrelationships between measurements, by comparing changes in your patient's condition across different hi-res trend waves.This can aid in the early detection of cardiorespiratory and hemodynamic problems.
22 High Resolution Trend Waves 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 23 Event Surveillance Events are electronic records of episodes in your patient's condition. You can trigger them manually, or set them to trigger automatically during pre-defined clinical situations.
23 Event Surveillance Basic Event Surveillance Option C06 Neonatal Event Review Advanced Event Surveillance (NER) Option C07 Option C04 1 6 (one group can be configured NER to NER) 3 4 3 (plus 1 for episode recording) Triggers per measurement 1 2 1 Event Functionality Event groups Measurements per group Trigger types Simple ("at least one") Combined ("at least two") Simple ("at least one") Annotation no yes yes Average trend Snapshot events Average trend High resolution trend Snapshot
23 Event Surveillance When an event occurs, information for a predefined duration is stored. This is the event episode. It includes information from a defined period before the trigger, called the event pre-time. The episode time after the event is called the event post-time. If a further event occurs during the event post-time it changes a single event to a combined event (combi-event).
23 Event Surveillance Pop-Up Keys Start CAR Selecting this pop-up key lets you.... Stop CAR open the Start CAR window to start a Car seat Assessment Record (CAR) period or stop a currently running CAR. CAR Histogrm open the window showing the CAR SpO2 histogram move the cursor left or right to the next event to navigate through the events database. Placing the cursor over an event highlights it and shows the event values for the selected event. jump to the first or last event in the event database.
23 Event Surveillance The trigger condition for event groups is set in the monitor's Configuration Mode. If You Use Alarm Limits As Event Triggers The event capture is triggered automatically when your patient's values violate set alarm limits, or when a specified alarm condition, such as apnea, occurs. No events of this kind are triggered if alarms are switched off. Changing alarm limits changes the event trigger definitions.
23 Event Surveillance For a new event to be triggered by the same condition, the measured values for at least one of the triggers must cross back into the normal range and then recross the trigger threshold. Event Notification (Advanced Event Surveillance Only). You can be notified when an event is detected. For each event group you can define a type of notification depending on the severity of the event conditions.
23 Event Surveillance Setting Triggers and Notification for Advanced Event Surveillance 1 Group Name 2 Group Type 3 Notification Type 4 Episode Type 5 Trigger Condition 6 Measurements used as event triggers 1 Select the group name to enter the setup window for that group. 2 Set the trigger status to Activated, to have this event group trigger events, or Deactivated. 3 Set the episode type. Select the name of the current episode type and select an episode type from the pop-up list.
23 Event Surveillance 2 Select the required time period for the assessment. 3 Select Confirm to start the CAR. If the NER group was not active it will be activated automatically. During the CAR period an SpO2 histogram is also generated with 1 second samples. For general information about the presentation of data in a histogram, see “Viewing Histogram Trends” on page 274. The CAR SpO2 histogram is unique: it can only be accessed from the events function.
23 Event Surveillance The event counter counts the total number of events in the database. If more than one event group was set to trigger events within the event history, the event counter also counts the event group totals. Counting Combi-Events If one or more events occur during the same Episode Time, the monitor combines them and displays them as distinct events in one event episode, called a combi-event. The first event is the trigger event, and the others are follow-up events.
23 Event Surveillance Event Review Window To enter the Event Review window, select the graphic event summary, if available, or select the events pop-up key Show Review. When you open the Event Review window, it automatically shows the event group with the most recent event. • To view other event groups, select the pop-up key Review Group and select the group from the list. Event Episode Window To enter the Event Episode window, select the pop-up key Show Episode.
23 Event Surveillance The event values to the left of the measurement channels show the trigger threshold set and the maximum amount by which this limit was exceeded. In this example, Desat 71<85 tells you that 71 was the lowest SpO2 value measured during the event time and that the Desat trigger threshold was set to 85 when the event was triggered. If the event was manually triggered, the event value boxes display "manual".
23 Event Surveillance 1 Event total per event group 2 Event types 3 Total events in database 4 Event groups 5 Recording strip code 6 Patient information and medical record no. In graphic event review recordings, events are represented by bars, and each event group is printed on a separate channel. The timeline reflects the period stored in the database, either 24 hours (divided into 4 hour sections) or 8 hours (divided into one-hour sections).
23 Event Surveillance In tabular event review recordings, the events stored in the event database are shown in chronological order, with a number and time-stamp. The measurements in the event group are shown in the next columns, marked "Parameter 1, Parameter 2...", along with the event values measured at the time of the event. For each event, the trigger values are shown. This section of the recording is A4 or letter size, so that it fits in a patient file.
23 Event Surveillance The third section (3 above) shows the most important vital signs information, including numerics, active alarms, and any annotations made on the event episode. The fourth section (4 above) shows the numerics for all the currently monitored vital signs and any alarm conditions or INOPs active at the time the event was triggered. Event Reports Event reports can be printed on A4 and letter size paper on a printer connected locally or centrally to your monitor.
23 Event Surveillance Event Episode Reports The event episode report documents the patient information from the currently-selected event. See the “Event Recordings” on page 301 for an explanation of the report elements.
23 Event Surveillance Event Summary Reports (Advanced Event Surveillance only). The event summary report shows a graphical view and a tabular view of all events in the database for all groups.
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24 24 ProtocolWatch ProtocolWatch (PW) is a clinical decision support tool.
24 ProtocolWatch Depending on the option your monitor has, it may be that only the Severe Sepsis Screening phase is implemented. If, at the end of this phase sepsis has been confirmed, and the patient is transferred for treatment in the resuscitation and management phases, you can transfer the current state, the settings and the log from the SSC Sepsis Protocol in the MMS to another monitor with the full version of the SSC Sepsis Protocol.
24 ProtocolWatch CAUTION It is not possible to transfer SSC Sepsis Protocol data from a monitor with release F.0 software to another monitor with release G.0 software or above, and vice versa. Suspending the Protocol for 24 Hours To suspend the protocol for 24 hours: 1 Select Main Setup then ProtocolWatch followed by Suspend for 24 hours. 2 Select Confirm. The protocol will resume activity after 24 hours with Severe Sepsis Screening.
24 ProtocolWatch Select Confirm when the check boxes reflect the current patient status. Select Remind 15 min if you want to delay filling out this screen. (When you enter the screen manually this key will be a Cancel key, as no action is required in this case.
24 ProtocolWatch If you select Yes, the window for the Lactate measurement will reappear. If you select No, screening continues - comparing heart rate, temperature and respiration rate values against the screening criteria. Authorized Clinician Review To review the protocol, select Protocol Log. You can also print out the log to document the screening phase. Select Confirm to complete the screening phase and, if you have the appropriate monitor option, continue to the Sepsis Resuscitation Bundle phase.
24 ProtocolWatch Select the Enter Lact key to enter a lactate value. When you have entered a value, or if a lactate value had previously been entered, the box is checked. Check the Take Blood Cultures box when you have taken blood cultures. Check the Administer Intravenous Antibiotics box when you have started broad-spectrum antibiotic therapy. The remaining three recommendations are automatically compared to the Sepsis Resuscitation Bundle criteria, if the measurements are available on the monitor.
24 ProtocolWatch When the Sepsis Management Bundle phase begins, the ProtocolWatch Screen is automatically updated (if configured and available on the monitor). In the lower area of the Screen, the list of recommendations for the Sepsis Management Bundle replaces the list for the Sepsis Resuscitation Bundle. The timer shows the combined time for both phases.
24 ProtocolWatch After completion of the Sepsis Management Bundle a sepsis standby phase begins which allows time for further patient stabilization and recovery. During this phase Severe Sepsis Screening is suspended. The standby phase is by default 7 days but the length can be adjusted in Configuration Mode. Viewing And Printing The Protocol Log The Protocol Log stores all user interactions, alarms and phase transitions while the SSC Sepsis Protocol is running.
25 25 Recording The M1116B plug-in recorder records numerics for all active measurements and up to three waveforms. You can use it for local recording mounted in the monitor's FMS.
25 Recording Delayed Recordng Vital Signs RT A Recordng Alarm Limits RT B Recordng ST Segments RT C Recordng ECG QT Select Waves Setup Recordng HiRes Recordng Stop All Recordng All ECG Waves Quickstarting Recordings To quickstart any type of recording using a pre-configured recordings template, • Select the Recor- dings SmartKey and then select the pop-up key of the recording type you want to start.
25 Recording 2 Use the pop-up keys to choose up to three measurement waves to be printed on the recording. If you want fewer than three waves on the recording, select the waves you want then select the Continue pop-up key. 3 Select one of the recording speed pop-up keys to set the required recording speed. 4 Select the Start pop-up key to start the recording. Select Waves recordings use default values for any recorder settings not defined: runtime is continuous, overlapping is set to non-overlapping.
25 Recording Creating and Changing Recordings Templates To save you defining recording settings each time you start a recording, you can create templates for commonly-used types of recordings in the Setup Recording menu. You can create templates for one delayed recording, one alarm recording, three realtime recordings (two for MP20/30), and one high resolution recording. All ECG Waves recordings do not need to be configured, they always use the same format.
25 Recording Changing ECG Wave Gain The ECG Gain setting in the General Recording Setup window defines how every recorded ECG wave, irrespective of template or recording type, will appear on the recorder strip. This does not affect the displayed ECG wave, or printed ECG reports. To change the ECG gain setting for recordings, 1 In the Setup Recording menu select General. 2 Select ECG Gain.
25 Recording Recording type Operating mode Application area Patient category 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.
25 Recording Reloading Paper M1116B 1 Use the latch on the right side of the recorder door to pull the door open. 2 Remove the empty core. 3 Insert a new roll so that it fits snugly into its housing and the paper end is feeding from the top. Recommended paper: 40477A and 40477B. 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.
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26 26 Printing Patient Reports Starting Report Printouts Most patient reports can be printed by selecting Main Setup then Reports (or the Print Reports SmartKey) and then selecting the report name in the top half of the Reports menu. Report names are shown only for reports that have been correctly set up. Data from the time of the print request is printed, even if the print job is delayed in the printer queue.
26 Printing Patient Reports Starting the Different Types of Report Report types Report contents How to start printing reports Vital Signs Report depends on selected trend group, data resolution, and period. In the Vital Signs window, select Print/ Record, then select Print. In the Graphical Trends window, select Print.
26 Printing Patient Reports – Scheduled Rep. to select Off and switch off scheduled reports. Setting Up Reports As the content of context-linked reports, such as Cardiac Output, Calculations, and Wedge, is defined by the content of the procedure window these reports do not need to be set up, however a target printer can be configured in the Setup Reports menu.
26 Printing Patient Reports 1 Select Main Setup, Reports, then Auto Reports and select the Auto Report you want to set up (A, B, C, or D). 2 Select Report and assign a report type to the Auto Report. 3 Select End Case Report and switch to On if you want the selected report to print automatically when you select End Case to discharge a patient. Switch End Case Report to Off if the report is a Scheduled Report only. 4 Select Scheduled Rep.
26 Printing Patient Reports 3 Select Report Size to set the paper size to be used for the report: Unspecified to use the default size for the template chosen, Universal, A4, Letter, LrgUniversal, A3, or Ledger. The list of available sizes depends on the report type selected. 4 Select Orientation to set the orientation of the report printout: Unspecified to use the default size for the template chosen, Landscape or Portrait.
26 Printing Patient Reports If a section of a wave on a report is drawn with dashed lines, this tells you that a setting that affects the appearance of the wave on the screen was changed while the report was printing. For example, if you change the wave scale while a report is printing, the wave scale and wave size are changed immediately on the monitor screen and on the report.
26 Printing Patient Reports If an MP5 or an X2 is connected to a host monitor, all print requests which are stored in the print database are shown "grayed out" on the Reports Job List and will not be deleted with the Delete All Repts key. Printing Manually Those jobs shown in black will be printed automatically when a matching printer is available. If the Auto Print Dbs setting is Host Only or Never, some or all reports will not be printed automatically and will be shown in gray.
26 Printing Patient Reports Printer Status Message Possible causes and suggested action Printer unavailable -> job suspended The chosen device is unavailable. Check that the printer is properly connected and that paper is available. The requested report will start printing when the printer becomes available. Print database full -> job suspended The requested report does not fit into the print database.
26 Printing Patient Reports Alarm Limits Report 1 Measurement labels, with alarms off symbol where alarms are switched off 2 Graphic view of current alarm limits in relation to currently monitored measurement value 333
26 Printing Patient Reports Realtime Report 334 1 Patient demographic information, time stamp 2 Active Alarms and INOPs, followed by vital signs 3 Measurement waves section
26 Printing Patient Reports Cardiac Output Report ECG Reports 1 Patient information 2 Numeric block 3 Wave area Below the header on ECG Reports, the numeric block shows the current HR, PVC, and ST values. The wave area shows the printed waves for all available ECG leads. A 1 mV calibration bar is printed at the beginning of each wave. With the 3X4, 6X2, and 2X4 formats, a rhythm stripe prints a longer section of the ECG wave from the primary ECG lead for ECG rhythm evaluation.
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27 27 Using the Drug Calculator Drug mixtures for intravenous (IV) drug infusions combine information on drug dose, rate, amount, volume, concentration, and standardized rate. The Drug Calculator helps you to manage infusions by calculating one of these values at a time.
27 Using the Drug Calculator Accessing the Drug Calculator To access the Drug Calculator, select Main Setup then Calculations followed by Drug Calculator, or select the Drug Calc SmartKey, if configured. Performing Drug Calculations Using the service Support Tool, a list of drugs can be configured for the monitor containing predefined dosage recommendations and unit settings. Selecting the arrow beside the drug name in the Drug Calculator window opens a list of configured drugs.
27 Using the Drug Calculator Performing Calculations for a Non-Specific Drug If a list of drugs has not been configured for your monitor, you can use the Drug Calculator to calculate drug doses for a single, generic drug called ANY DRUG. Selecting the arrow beside the drug name in the Drug Calculator window shows that are no other drugs configured. 1 Enter three of these four values: dose, amount, volume, rate of the infusion solution.
27 Using the Drug Calculator 2 Select the correct patient category for your patient. If you have a neonatal or pediatric patient, the Rule Of 6 choice may be available. Select if required. 3 Enter the patient weight, if necessary. If available, the patient weight from the Patient Demographics window is entered automatically in the Drug Calculator window. To change the patient weight, select the Weight key then use the onscreen keypad to enter the correct value.
27 Using the Drug Calculator Using the Titration Table Use the Titration Table to see at a glance what dose your patient would receive of a drug at different infusion rates. By clicking on the title row of the table you can switch between the Dose increments and Rate increments view. Values outside of the recommended range are shown in red. To see the Titration Table, • in the Drug Calculator window, select the pop-up key Titr. Table. The Titration Table is configured with the service Support Tool.
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28 28 IntelliBridge EC10 Module An IntelliBridge EC10 module transmits information from a connected external device to your monitor. The IntelliBridge EC5 ID module is used to provide identification information from the external device. Data imported from the external device, for example waveforms, measurement numerics, settings and alarms, can be displayed on the monitor, passed on to an Information Center and included in trends as appropriate.
28 IntelliBridge EC10 Module Changing Waves and Numerics Displayed To change the waves and numerics from the IntelliBridge module displayed on the Screen, 1 Select Main Setup, Measurements, then to enter the setup menu for the connected device. 2 Select Setup Driver. 3 Select Setup Wavesor Setup Numerics and make the changes required. 4 Close the setup menu. The monitor takes a few seconds to activate the change.
28 IntelliBridge EC10 Module Alarms/INOPs from External Devices The IntelliBridge module itself generates INOPs, but does not generate alarms. If the external device's alarms are on, the module transmits these to the monitor. A message in the External Device Data window tells you either Device Alarms Ignored or Device Alarms Accepted or No Alarms Available. External device alarms status symbols precede some, but not all, measurement labels.
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29 29 VueLink Modules A VueLink module transmits information from a connected external device to your monitor. Each module can be connected to one of up to three preselected external devices, and supports alarms from the external device. Data from VueLink modules cannot be included in monitor trends when the label is a free-text label. The external device may show more information than is available on the monitor.
29 VueLink Modules See the documentation supplied with the VueLink module for a list of supported devices and accessories, and for configuration information. Connecting an External Device 1 Insert the module into the FMS or integrated module slot. 2 Check that the device selection LED (3) lights to show that it has correctly identified the external device. If not, select Main Setup, Measurements and then the name of the external device to enter the setup menu for the connected device.
29 VueLink Modules Viewing the VueLink Device Data Window 1 Mode information from external device 2 Name of external device 3 Type of external device 4 Device Alarms Accepted To view the VueLink device data window, either • select the setup hardkey on the VueLink module or the External Devices SmartKey, and then select the pop-up key for the device, or • in the Setup menu, select Show Device Data.
29 VueLink Modules Alarms/INOPs From External Devices The VueLink module itself generates INOPs, but does not generate alarms. If the external device's alarms are on, the module transmits these to the monitor. A message in the VueLink info window tells you, depending on the configuration setting, either Device Alarms Ignored or Device Alarms Accepted or, when the external device is not supplying alarm data, No Alarms Available.
30 30 Using Timers With the Timers function you can set timers to notify you when a specific time period has expired. CAUTION Do not use the timers to schedule critical patient-related tasks. Viewing Timers You can view currently active timers in the Timers window or directly on the Main Screen (if a timer has been substituted for a numeric).
30 Using Timers Timer Setup Pop-up Keys When you open the Timers window and select a timer, then select the setup key, the setup window opens and a selection of pop-up keys appear to let you activate and control the timers. Pop-Up Keys Selecting this pop-up key lets you.... Start start the timer. Stop stop the timer, allowing either restarting after a pause (Start key) or clearing (Clear key). Clear clear the timer, ending this timer episode.
30 Using Timers Timer Counting Direction Timers can count up or down, showing elapsed time or remaining time. No Limit timers automatically count up. To change the direction, in the Timers window: 1 Select the required timer and display the Setup window. 2 Select Direction to switch between Up and Down. Notification When a timer expires (except a No Limit timer), the color changes to red and a message appears in the status line on the Main Screen.
30 Using Timers To display a timer on the Main Screen: 1 Select the numeric you want to substitute. 2 Select Change Numeric. 3 Select Any Timer. 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 enter the setup screen for the currently selected timer. Change Timer select a different timer for display. Timers enter the Timers window.
31 31 Respiratory Loops Using a Spirometry module or a VueLink/IntelliBridge module connected to a ventilator, you can measure and store graphic representations of realtime respiratory loops. Respiratory loops can help you recognize changes in your patient's lung function, and they can also indicate a fault in the airway tubing (for example, if the respiratory loop does not close). You can measure: • Pressure-volume loops • Pressure-flow loops • Volume-flow loops.
31 Respiratory Loops To open the Loops window, and its associated pop-up keys, • select Main Setup then Loops, or select the Loops SmartKey, if configured. In the Loops window, in addition to the stored loops, two realtime airway waves and up to nine available numerics from the source device can be shown. Capturing and Deleting Loops Up to six loops of each kind can be stored for reference. To capture the current Loop and display it in the Loops window, • select the Capture Loop pop-up key.
31 Respiratory Loops Changing Loops Type To change the loop type, in the Loops window, select the Loop Type pop-up key (only available if the source device delivers three waves), then select • Press/Volume to display Pressure/Volume loops • Flow/Volume to display Volume/Flow loops • Press/Flow to display Pressure/Flow loops. or, if the source device only delivers two waves, 1 In the Loops window, select the Setup Device pop-up key to enter the setup window for the external device.
31 Respiratory Loops 358
32 32 Laboratory Data Laboratory data can be entered manually at the Information Center or at the monitor. For details on manual entry at the monitor, see “Entering Measurements Manually” on page 42. Selected laboratory data can be integrated on the monitor - values are then stored in the database and included in trends and reports and can be displayed as a numeric on the main screen. Which data can be stored and used on the monitor in this way is selected in Configuration Mode.
32 Laboratory Data 360
33 33 Care and Cleaning Use only the Philips-approved substances and methods listed in this chapter to clean or disinfect your equipment. Warranty does not cover damage caused by using unapproved substances or methods. Philips makes no claims regarding the efficacy of the listed chemicals or methods as a means for controlling infection. Consult your hospital's Infection Control Officer or Epidemiologist.
33 Care and Cleaning Cleaning the Monitor Clean with a lint-free cloth, moistened with warm water (40°C/104°F maximum) and soap, a diluted non-caustic detergent, tenside, ammonia- or alcohol-based cleaning agent. Do not use strong solvents such as acetone or trichloroethylene. Take extra care when cleaning the screen of the monitor because it is more sensitive to rough cleaning methods than the housing. Do not permit any liquid to enter the monitor case and avoid pouring it on the monitor while cleaning.
33 Care and Cleaning Product Name Product Type Ingredients Carpe DiemTM/MC Tb Wipes wipes 0.5% accelerated hydrogen peroxide Super Sani-Cloth wipes isopropanol 55% quaternary ammonium chlorides 0.5% wipes isopropanol 15% quaternary ammonium chlorides 0.25% wipes isopropanol < 0.15% quaternary ammonium chlorides 0.
33 Care and Cleaning 364 4 Thread the cloth cleaning strip instead of paper around the rubber roller until approximately two inches of the strip come out from the top of the roller. 5 Close the recorder door, aligning both ends of the strip over the top of the door. 6 Holding the top end of the cleaning strip between your thumb and forefinger, pull the strip through and out of the recorder. 7 Open the door and ensure that the paper cavity is dust-free. Re-thread the paper and replace the recorder.
34 34 Maintenance and Troubleshooting WARNING Schedule: Failure on the part of the responsible individual hospital or institution employing the use of this equipment to implement a satisfactory maintenance schedule may cause undue equipment failure and possible health hazards. Contact: If you discover a problem with any of the equipment, contact your service personnel, Philips, or your authorized supplier.
34 Maintenance and Troubleshooting Inspecting the Cables and Cords 1 Examine all system cables, the power plug and cord for damage. Make sure that the prongs of the plug do not move in the casing. If damaged, replace it with an appropriate Philips power cord. 2 Inspect the Measurement Link cable and ensure that it makes good connection with the MMS and the FMS. Make sure that there are no breaks in the insulation. 3 Inspect the cable connecting the MMS to the monitor.
34 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 Revisions.
34 Maintenance and Troubleshooting WARNING Ensure that the cylinder is completely empty before trying to remove the valve stem or drill a hole in the cylinder.
35 Accessories 35 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.
35 Accessories 3-Electrode Cable Sets Description Length AAMI Part No. IEC Part No. OR Grabber shielded 1.0 m M1675A M1678A ICU Grabber shielded 1.0 m M1671A M1672A ICU snap shielded 1.0 m M1673A M1674A ICU Clip non-shielded 0.45 m M1622A -- ICU Clip non-shielded 0.7 m M1624A M1626A Description Length AAMI Part No. IEC Part No. OR Grabber shielded 1.0 m/1.6 m M1973A M1974A ICU Grabber shielded 1.0 m/1.6 m M1968A M1971A ICU Snap shielded 1.0 m/1.
35 Accessories One-piece Cables Description Length AAMI Part No. IEC Part No. 3-lead Grabber, ICU 1.0 m 989803143181 989803143171 5-lead Grabber, ICU 1.0 m 989803143201 989803143191 Radio-translucent Cables Pack of five single wires, radio-translucent, 0.9 m, M1649A Set Combiners and Organizers Set combiners and organizers Part No.
35 Accessories 5-Electrode Cable Sets Description Length AAMI Part No. IEC Part No. OR Grabber shielded 1.0 m/1.6 m M1621A M1631A ICU Grabber shielded 1.0 m/1.6 m M1623A M1633A ICU Snap shielded 1.0 m/1.6 m M1625A M1635A ICU Clip non-shielded 0.7 m/1.3 m M1629A M1639A AAMI 3-Electrode One Length Piece Cables AAMI Part No. IEC 3-electrode One Piece Cables IEC Part No. OR Grabber 1.9 m M1970A OR Grabber M1980A ICU Snap 1.
35 Accessories NBP Accessories These cuffs and tubings are designed to have special protection against electric shocks (particularly regarding allowable leakage currents), and are defibrillator proof. You can use them during electrosurgery. Adult/Pediatric Reusable Comfort Cuffs Patient Category Limb Circumference Part No. Tubing Adult (Thigh) 42 to 54 cm M1576A Large Adult 34 to 43 cm M1575A Adult 27 to 35 cm M1574A M1598B (1.5 m) or M1599B (3 m) Small Adult 20.
35 Accessories Adult/Pediatric Single Patient Cuffs Patient Category Limb Circumference Part No. Tubing Adult (Thigh) 42 to 54 cm M1879A Large Adult 34 to 43 cm M1878A Adult 27 to 35 cm M1877A M1598B (1.5 m) or M1599B (3 m) Small Adult 20.5 to 28 cm M1876A Pediatric 14 to 21.5 cm M1875A Infant 10 to 15 cm M1874A Adult/Pediatric Single Patient, Soft Cuffs Patient Category Limb Circumference Part No.
35 Accessories Neonatal/Infant Single Patient, Soft Cuffs Cuffs Limb Circumference Part No. Tubing Size 1 3.1 to 5.7 cm M1866S Size 2 4.3 to 8.0 cm M1868S Size 3 5.8 to 10.9 cm M1870S M1596C (1.5 m) or M1597C (3 m) Size 4 7.1 to 13.1 cm M1872S Size 5 (Infant) 10 to 15 cm M1873S Neonatal/Infant Cuff Kits Cuff Kits Part No.
35 Accessories Transducer, accessories, sensor kits Part No.
35 Accessories Product Number Description Compatible with Opt. A01 Opt. A02 Comments Philips reusable sensors. M1191A/B Adult sensor (2 m cable), for patients over 50 kg. Any finger, except thumb. yes no M1191AL/BL M1191A/B with longer cable (3 m) yes no M1192A Small adult, pediatric sensor (1.5 m cable) for patients between 15 kg and 50 kg. Any finger except thumb. yes no M1193A Neonatal sensor (1.5 m cable) for patients between 1kg and 4 kg. Hand or foot.
35 Accessories Product Number Description Compatible with Opt. A01 M1134A Adhesive-free, Adult/Infant/Neonatal, 0.9 yes m cable Foot or hand for neonates < 3 kg Big toe or thumb for patients between 10 kg and 20 kg Any finger except thumb for patients > 40 kg Comments Opt. A02 no Use adapter cable M1943A or M1943AL. Option A01: Use adapter cable M1943A or M1943AL.
35 Accessories Product Number Description Compatible with Opt. A01 Opt. A02 Comments Extension / Adapter Cables for Philips and Nellcor Sensors M1941A Extension cable (2 m) yes yes For use with Philips reusable sensors and M1943A adapter cable. M1943A Adapter cable (1.1 m cable) yes no M1943AL Adapter cable (3 m cable) yes no Adapter cable for Philips/Nellcor disposable sensors.
35 Accessories Product Number Description Compatible with Opt. A01 Opt.
35 Accessories Temperature Probes Part No. Minimum measurement time for accurate readings Esophageal/Rectal Probe (French 12) 21090A 90 sec Foley Catheter Probe (12 French) M2255A 180 sec 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. Description Part No.
35 Accessories Mainstream CO2 Accessories 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 Description Part No.
35 Accessories Mainstream CO2 Accessories (for M3016A) Description Part No. CO2 Sensor M1460A Standard Airway Adapter (reusable) M1465A Small Airway Adapter (reusable) 14363A Microstream CO2 Accessories • "FilterLine Set" is a combination of a FilterLine with an Airway Adapter. • "H" in the accessory name indicates suitability for humidified ventilation and longer usage due to the active removal of humidity from the sample line. • "Smart CapnoLine" is a combined oral-nasal FilterLine.
35 Accessories Microstream accessory selection flowchart Is the patient intubated? Yes No Does the patient need oxygen? Yes Short-term (up to 6 hours) Long-term (up to 72 hours) No Short-term (up to 8 hours) Long-term (up to 24 hours) Long-term (up to 24 hours) Short-term (up to 8 hours) Short-term (up to 8 hours) Oral/Nasal Nasal Nasal Oral/Nasal Nasal Procedural Sedation, Critical Care, EMS, ED Critical Care, Sleep Critical Care, Sleep Procedural Lab, Long-term Lab Sedation, Critical Pain
35 Accessories Measurement of CO2 and Spirometry with Neonates For measurement of CO2 and Spirometry with neonates, the use of the M3014A Mainstream CO2 Extension, the M1014A Spirometry Module and the M2782A Combined CO2/Flow Sensor is recommended. The M1923A Filterline H Set Infant/Neonatal used for Microstream CO2 measurement with the M3015A Extension is not compatible with the M2786A Infant/Neonatal Flow Sensor for the spirometry measurement (M1014A).
35 Accessories Description Part No. Reusable 80 cm 5-lead cables with 6 mm silver/silverchloride leadwired cup electrodes (Pediatric/Neonatal) M1932A Reusable 80 cm 5-lead cables with clip M1934A Disposable EEG electrodes M1935A EC2™ Electrode Cream (conductive paste) M1937A BIS Accessories To re-order sensors, contact Aspect Medical Systems. BIS sensors are not available from Philips. SO2 Accessories for M1021A Contact your local Hospira representative for information on accessories.
35 Accessories Battery Accessories Description Part No.
35 Accessories 388
36 Specifications 36 Specifications The specifications in this section apply to the MX600, MX700 and MX800 patient monitors. The monitors are not user installable. They must be installed by qualified service personnel. Intended Use The monitor is intended to be used for monitoring and recording of, and to generate alarms for, multiple physiological parameters of adults, pediatrics, and neonates in health care facilities. The monitor is to be used by trained health care professionals.
36 Specifications Philips Medizin Systeme Boeblingen GmbH Hewlett-Packard-Str. 2 71034 Boeblingen Germany Visit our website at: www.healthcare.philips.com/us/. © Copyright 2011. Koninklijke Philips Electronics N.V. All Rights Reserved.
36 Specifications Symbols These symbols can appear on the monitor and its associated equipment.
36 Specifications Symbols Masimo SET technology Nellcor OxiMax compatible Uses FAST SpO2 algorithm Silence Alarms Alarms On/Off Alarms Switched Off Main Screen SmartKeys Back key ECG Sync Output/ Analog ECG Output Installation Safety Information WARNING If multiple instruments are connected to a patient, the sum of the leakage currents may exceed the limits given in IEC/EN60601-1, IEC60601-1-1, UL60601-1. Consult your service personnel. Grounding The monitor must be grounded during operation.
36 Specifications Rear of the Monitor 1 Serial/MIB (RS232) interface cards, type RJ45 or Flexible Nurse Call interface card or combination of both (optional) 2 AC power input 3 Protective earth screw hole 4 Equipotential ground connector 5 Measurement link connectors (MSL) (Two standard in MX800, one standard in MX600/700) 6 USB rear connectors (for remote control, keyboard, pointing devices, printer) 7 Serial RS232 connector 8 Nurse Call 9 Wired network connector 10 Video out connector
36 Specifications Left side of the Monitor 1 ECG Sync Output/Analog ECG output connector Right side of the Monitor 1 394 USB side connector (only present with the iPC)
36 Specifications Monitor Mounting Precautions Mount the monitor using either the Philips Quick Mount or Fix Mount solution or another approved mounting solution. Select the mounting equipment and the mounting position so that no patient, operator or other person can be harmed by a monitor removed intentionally or released accidentally from the mount.
36 Specifications IntelliVue 802.11 Bedside Adapter (Option J35 Wireless Network Adapter) FCC and Industry Canada Radio Compliance: This device complies with Part 15 of the FCC Rules and RSS-210 of Industry Canada. Operation is subject to the following two conditions: (1) this device may not cause harmful interference, and (2) this device must accept any interference received, including interference that may cause undesired operation.
36 Specifications IntelliVue Instrument Telemetry WMTS (US only) FCC Radio Compliance: This device complies with Part 15 of the FCC Rules. Operation is subject to the following two conditions: (1) this device may not cause harmful interference, and (2) this device must accept any interference received, including interference that may cause undesired operation.
36 Specifications Product Maximum Weight WxHxD M8025A Remote Alarm Device <300 g (<0.7 lb) 62 x 125 x 63 mm 2.4 x 5 x 2.5 in M1006B Invasive Press Module 190 g (6.7 oz) Option #C01: 225 g (7.9 oz) 36 x 99.6 x 97.5 mm 1.4 x 3.9 x 3.8 in M1029A Temperature Module 215 g (7.6 oz) 36 x 99.6 x 97.5 mm 1.4 x 3.9 x 3.8 in M1012A Cardiac Output Module 225 g (7.9 oz) 36 x 99.6 x 97.5 mm 1.4 x 3.9 x 3.8 in M1014A Spirometry Module 250 g (8.8 oz) 36 x 99.6 x 97.5 mm 1.4 x 3.9 x 3.
36 Specifications Environmental Specifications The monitor may not meet the performance specifications given here if stored or used outside the specified temperature and humidity ranges. When the monitor and related products have differing environmental specifications, the effective range for the combined products is that range which is common to the specifications for all products.
36 Specifications 4-Slot Flexible Module Rack 865243 Item Condition Range Temperature Range Operating 0 to 40°C (32 to 100°F) Storage -20 to 60°C (-4 to 140°F) Operating 15% to 95% Relative Humidity (RH) (non condensing) Storage 5% to 95% Relative Humidity (RH) Humidity Range Altitude Range Operating -500 m to 3000 m (10000 ft) Storage -500 m to 4600 m (15000 ft) Ingress Protection IPX1 Thermal Array Recorder Module M1116B Item Condition Range Temperature Range Operating +5 to 45°C
36 Specifications Performance Specifications MX600/700/800 Performance Specifications Power Specifications Indicators Power Consumption <200 W average Line Voltage 100 to 240 V Current 1.9 to 0.
36 Specifications MX600/700/800 Performance Specifications Real Time Clock Buffered Memory Range from: January 1, 1997, 00:00 to: December 31, 2080, 23:59 Accuracy better than 4 seconds per day Hold Time infinite if powered by AC; otherwise at least 48 hours (typical: >72 hours) Hold Time if powered by AC: infinite Contents Active settings, trends, patient data, realtime reports, events, review alarms without power: at least 8 hours X2 (M3002A) Performance Specifications Power Specifications
36 Specifications X2 (M3002A) Performance Specifications Real Time Clock Buffered Memory Range from: January 1, 1997, 00:00 to: December 31, 2080, 23:59 Accuracy <4 seconds per day (typically) Hold Time infinite if powered by host monitor or external power supply; otherwise at least 48 hours Hold Time if powered by host monitor or external power supply: infinite Contents Active settings, trends, patient data, realtime reports, review alarms without power: at least 48 hours (typical: >72 hours)
36 Specifications MX600/700/800 Interface Specifications MIB/RS232 USB Interface (4 ports) RS232 (Standard) RS232 (Independent display interface option) Basic Nurse Call Relay Flexible Nurse Call Relay IntelliVue Instrument Telemetry Wireless Network (USA only) IntelliVue Instrument Telemetry Wireless Network (except USA) Standard IEEE 1073-3.2-2000 Connectors RJ45 (8 pin) Mode Software-controllable BCC (RxD/TxD cross over) or DCC (RxD/TxD straight through) Power 5 V ±5 %, 100 mA (max.
36 Specifications MX600/700/800 Interface Specifications Measurement Link (MSL) Video Interface (standard) Video Interface (Independent display interface option) Connectors ODU out (Proprietary) Voltage 56 V ±10 % Power 45 W Power Sync. 5 V CMOS Level; 78.125 kHz (typ.) LAN signals IEEE 802.3 10-Base-T compliant Serial signals RS-422 compliant Connector DVI (digital and analog, single link) Digital video signals single link TMDS Analog video signals 0.
36 Specifications MX600/700/800 Interface Specifications Digital Pulse Output (ring) Output low voltage level <0.4 V @ I=-1 mA Output high voltage level >2.4 V @ I=1 mA Pulse Width 100 ms±10 ms (active high) Pulse Rise Time <1 ms (from 0.4 V to 2.
36 Specifications M8023A External Power Supply (for M3002A) Interface Specifications Measurement Link (MSL) Connectors Male ODU (Proprietary) Power 48 V output Power Sync. RS-422 compliant output 78.125 kHz (typical) LAN signals IEEE 802.3 10-Base-T compliant Serial signals RS-422 compliant output 78.125 kHz (typical) Local signals Not connected Integrated PC (iPC) Interface Specifications Ethernet LAN (external) USB Connector RJ-45 LAN Signals IEE 802.
36 Specifications ECG/Arrhythmia/ST Performance Specifications Cardiotach PVC Rate ST Numeric QT Numeric QTc Numeric ΔQTc Numeric QT-HR Numeric Sinus and SV Rhythm Ranges Bandwidth Bandwidth Range Adult/pedi: 15 to 300 bpm Neo range: 15 to 350 bpm Accuracy ±1% of range Resolution 1 bpm Sensitivity ≥200 µVpeak Range 0 to 300 bpm Resolution 1 bpm Range -20 to +20 mm Accuracy ±0.5 mm or 15%, whichever is greater Resolution 0.
36 Specifications ECG/Arrhythmia/ST Performance Specifications Common Mode Rejection Ratio Diagnostic mode: >86 dB (with a 51 kΩ/47 nF imbalance). Filter mode: >106 dB (with a 51 kΩ/47 nF imbalance).
36 Specifications ECG/Arrhythmia/ST Supplemental Information as required by AAMI EC11/13, IEC 60601-2-27 Heart Rate Averaging Method Three different methods are used: Normally, heart rate is computed by averaging the 12 most recent RR intervals. For runs of PVCs, up to 8 RR intervals are averaged to compute the HR. If each of 3 consecutive RR intervals is greater than 1200 ms (that is, rate less than 50 bpm), then the 4 most recent RR intervals are aver\-aged to compute the HR.
36 Specifications SpO2 Unless otherwise specified, this information is valid for SpO2 measured using the M3001A and M3002A Multi-measurement modules and the M1020B measurement module. The SpO2 Performance Specifications in this section apply to devices with Philips SpO2 technology. For SpO2 Performance Specifications valid for other SpO2 technologies, refer to the instructions for use provided with these devices.
36 Specifications SpO2 Performance Specifications SpO2 Range The specified accuracy is Option #A01 the root-mean-square Accuracy (RMS) difference between the measured values and the reference values 0 to 100% Philips Reusable Sensors: M1191A, M1191AL, M1191B, M1191BL, M1192A, = 2 % (70 % to 100 %) M1193A, M1194A, M1195A, M1196A = 3 % (70 % to 100 %) M1191T, M1192T, M1193T (Adult), M1196T = 3% (70% to 100%) M1193T (Neonate) = 4 % (70 % to 100 %) Philips Disposable Sensors with M1943A(L): M1132A, M1133A (
36 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: ≤15 mW 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% to 100% Range Adjustment Delay Adult: 50 to 100% Pedi/Neo: 30 to 100% 1% steps (0, 1, 2, 3,.
36 Specifications SpO2 Smart Alarm Delay Specifications The Smart Alarm Delay functionality is currently not available in the U.S.A. or in clinical environments under FDA control. Deviation from violated alarm limit Resulting alarm delay Short Medium Long 7% 10 sec 10 sec 14 sec 8% 10 sec 10 sec 12 sec 9% 10 sec 10 sec 11 sec >9% 10 sec 10 sec 10 sec NBP Complies with IEC 60601-2-30:1999/EN60601-2-30:2000.
36 Specifications NBP Performance Specifications Venipuncture Mode Inflation Inflation Pressure Automatic deflation after Adult 20 to 120 mmHg (3 to 16 kPa) Pediatric 20 to 80 mmHg (3 to 11 kPa) Neonatal 20 to 50 mmHg (3 to 7 kPa) Adult/pediatric 170 seconds Neonatal 85 seconds Measurement Validation: In adult and pediatric mode, the blood pressure measurements determined with this device comply with the American National Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP10 -
36 Specifications Invasive Pressure Performance Specifications Input Sensitivity Sensitivity: 5 µV/V/mmHg (37.5 µV/V/kPa) Adjustment range: ±10% Transducer Load Impedance: 200 to 2000 Ω (resistive) Output Impedance: ≤3000 Ω (resistive) Frequency Response dc to 12.5 Hz or 40 Hz Zero Adjustment Gain Accuracy Overall Accuracy Range ±200 mmHg (±26 kPa) Accuracy ±1 mmHg (±0.1 kPa) Drift Less than 0.1 mmHg/°C (0.013 kPa/°C) Accuracy ±1% Drift Less than 0.
36 Specifications Invasive Pressure Alarm Range Specifications Adjustment Delay Tachycardia Difference to high limit 0 to 50 bpm 5 bpm steps max. 14 seconds Clamping at 150 to 300 bpm 5 bpm steps Difference to low limit 0 to 50 bpm 5 bpm steps Clamping at 25 to 100 bpm 5 bpm steps Bradycardia max. 14 seconds Temp Complies with EN 12470-4:2000. Specified without transducer. Temp Performance Specifications Temp Range -1 to 45°C (30 to 113°F) Resolution 0.1°C (0.2°F) Accuracy ±0.1°C (±0.
36 Specifications M3015A Microstream CO2 Performance Specifications Rise Time 190 ms for neonatal mode (measured with FilterLine H for neonatal) 240 ms for adult mode (measured with FilterLine H for adult) Sample Flow Rate 50 + 15/-7.5 ml/minute Gas Sampling Delay Time Maximum: 3 seconds (2m sample lines) 6 seconds (4m sample lines) Sound Pressure Acoustic noise: <45 dBA Total System Response Time The total system response time is the sum of the delay time and the rise time.
36 Specifications M3014A Sidestream CO2 Performance Specifications CO2 Range 0 to 150 mmHg (0 to 20.0 kPa) Accuracy after 2 minutes warmup: For values between 0 and 40 mmHg: ±2.0 mmHg (±0.29 kPa) For values from 41 to 70 mmHg: ±5% of reading For values from 71 to 100 mmHg: ±8% of reading For values from 101 to 150 mmHg: ±10% of reading At respiration rates above 80 rpm, all ranges are ±12% of actual.
36 Specifications M3016A Mainstream CO2 Performance Specifications awRR Range 0 to 150 rpm Accuracy ±2 rpm Warm-up Time 20 minutes with CO2 transducer attached for full accuracy specification Response Time Less than 125 ms (for step from 10% to 90%) Mainstream CO2 Humidity Correction Factor Either BTPS or ATPD can be selected as the humidity correction factor for the Mainstream CO2 readings.
36 Specifications Gas or Vapor Gas Level (% volume fraction) Nitrous Oxide 60% M3002A/M3014A M3015A Additional deviation due to gas interference, measured at 0 40 mmHg CO2 ±1 mmHg ±5% Halothane 4% ±2 mmHg ±5% Enflurane 5% ±2 mmHg ±5% Isoflurane 5% ±2 mmHg ±5% Sevoflurane 5% ±2 mmHg ±5% Xenon 80% -5 mmHg ±5% Helium 50% ±1 mmHg ±5% Metered dose inhaler propellants - not specified for use Desflurane 15% +5 mmHg ±5% Ethanol 0.1% ±1 mmHg ±5% Isopropanol 0.
36 Specifications Spirometry Performance Specifications Pressure Wave (AWP) Respiration Rate numeric (RRspir) Range -20 to 120 cmH2O Accuracy ±2% or ±0.5 cmH2O whichever is greater Scales 10, 20, 40, 60, 80, 100, 120 cmH2O Scale Default 20 cmH2O (neonatal) 40 cmH2O (pediatric) 40 cmH2O (adult) Range 2 to 120 breaths/min Resolution 1 breath/min Inspired Minute Volume Range numeric (MVin) Resolution Expired Minute Volume Range numeric (MVexp) 0.01 to 5 l/min (neonatal) 0.
36 Specifications Spirometry Performance Specifications Barometric Pressure numeric (PB) Range Resolution 1 mmHg Peak Inspiratory Flow numeric (PIF) Range 0.3 to 25 l/min (neonatal) 1 to 100 l/min (pediatric) 2 to 180 l/min (adult) Resolution 0.1 l/min (neonatal) 1 l/min (pediatric/adult) Range 0.3 to 25 l/min (neonatal) 1 to 100 l/min (pediatric) 2 to 180 l/min (adult) Resolution 0.
36 Specifications C.O./CCO Alarm Specifications Range Adjustment Delay TBlood 17 to 43°C Steps of 0.5°C (17 to 35°C) Steps of 0.1°C (35 to 43°C) 10 seconds after the value exceeds the set limit range Steps of 1°F (63 to 95°F) Steps of 0.2°F (95 to 109°F) CCO 0.1 to 25.0 l/min 0.1 l/min (0.1 to 10.0 l/min) 0.5 l/min (10.0 to 25.0 l/min) 10 seconds after the value exceeds the set limit range tcGas Complies with IEC 60601-2-23:1999/EN60601-2-23:2000.
36 Specifications tcGas Alarm Specifications tcpO2 Range Adjustment Alarm Delay 10 to 745 mmHg 1.0 to 99.5 kPa 10 to 30 mmHg: 1 mmHg 1.0 to 4.0 kPa: 0.1 kPa 10 seconds after the value exceeds the set limit range. 32 to 100 mmHg: 2 mmHg 4.2 to 13 kPa: 0.2 kPa 105 to 745 mmHg: 5 mmHg 13.5 to 99.5 kPa: 0.5 kPa tcpCO2 10 to 195 mmHg 1.0 to 26 kPa 10 to 30 mmHg: 1 mmHg 1.0 to 4.0 kPa: 0.1 kPa 32 to 100 mmHg: 2 mmHg 4.2 to 13 kPa: 0.2 kPa 105 to 195 mmHg: 5 mmHg 13.5 to 26 kPa: 0.
36 Specifications EEG Performance Specifications Electrode Impedance Measurement Range 0 to 30 kΩ Accuracy ±1 kΩ Bandwidth 0.5 Hz to 50 Hz (-3 dB) Low Filter Cut-Off Frequencies 0.5, 1.0, 2.0, and 5.
36 Specifications Electromagnetic Compatibility (EMC) Specifications Take special precautions regarding electromagnetic compatibility (EMC) when using medical electrical equipment. You must operate your monitoring equipment according to the EMC information provided in this book. Portable and mobile radio frequency (RF) communications equipment can affect medical electrical equipment.
36 Specifications IEC 60601-1-2 test level Compliance level Electromagnetic environment guidance Electrostatic discharge (ESD) IEC 61000-4-2 ±6 kV contact ±8 kV air ±6 kV contact ±8 kV air Floors should be wood, concrete, or ceramic tile. If floors are covered with synthetic material, the relative humidity should be at least 30%.
36 Immunity test IEC 60601-1-2 test level Conducted RF IEC 61000-4-6 3 VRMS 150 kHz to 80 MHz Radiated RF IEC 61000-4-3 3 V/m 80 MHz to 2.5 GHz Compliance level Electromagnetic environment guidance 3 VRMS Recommended separation distance: (1 VRMS for respiration and BIS) d = 1.2√P 3 V/m Recommended separation distance: for respiration and BIS: d = 3.5√P (1 V/m for respiration 80 MHz to 800 MHz and BIS) d = 1.2√P 80 MHz to 800 MHz for respiration and BIS d = 3.5√P 800 MHz to 2,5 GHz d = 2.
36 Specifications Frequency of transmitter 150 kHz to 80 MHz 80 MHz to 800 MHz 800 MHz to 2,5 GHz d = 1.2√P d = 1.2√P d = 2.3√P for respiration and BIS: d = 3.5√P for respiration and BIS: d = 3.5√P for respiration and BIS: d = 7.0√P Rated max. output power of transmitter Separation distance Separation distance Separation distance 0.01 W 0.1 (0.4) m 0.1 (0.4) m 0.2 (0.7) m 0.1 W 0.4 (1.1) m 0.4 (1.1) m 0.7 (2.2) m 1W 1.3 (3.5) m 1.3 (3.5) m 2.3 (7.0) m 10 W 3.8 (11.1) m 3.8 (11.
37 Default Settings Appendix 37 Default Settings Appendix This appendix documents the most important default settings of your monitor as it is delivered from the factory. For a comprehensive list and explanation of default settings, see the Configuration Guide supplied with your monitor. The monitor's default settings can be permanently changed in Configuration Mode.
37 Default Settings Appendix Country-Description Line Frequency Units Weight Units Height ECG Cable Color Belize 60 lb in AAMI Benin 60 lb in AAMI Bermuda 60 kg cm AAMI Bhutan 60 lb in AAMI Bolivia 50 kg cm AAMI Bosnia and Herzegovina 50 kg cm IEC Botswana 50 kg cm IEC Bouvet Island 60 lb in AAMI Brazil 60 kg cm AAMI British Indian Ocean Territory 60 lb in AAMI Brunei 50 kg cm IEC Brunei Darussalam 50 kg cm AAMI Bulgaria 50 kg cm IEC Bur
37 Default Settings Appendix Country-Description Line Frequency Units Weight Units Height ECG Cable Color Czech Republic 50 kg cm IEC Denmark 60 lb in AAMI Djibouti 50 kg cm IEC Dominica 50 kg cm AAMI Dominican Republic 60 kg cm AAMI Ecuador 60 kg cm AAMI Egypt 50 kg cm IEC El Salvador 60 kg cm AAMI Equatorial Guinea 50 kg cm IEC Eritrea 50 kg cm IEC Estonia 50 kg cm IEC Ethiopia 50 kg cm IEC Falkland Islands, Malvinas 60 lb in AAMI Faro
37 Default Settings Appendix Country-Description Line Frequency Units Weight Units Height ECG Cable Color Heard Island and McDonald Islands 60 lb in AAMI Holy See, Vatican City State 60 lb in AAMI Honduras 60 kg cm AAMI Hong Kong 50 kg cm IEC Hungary 50 kg cm IEC Iceland 50 kg cm IEC India 50 kg cm IEC Indonesia 50 kg cm IEC Iran, Islamic Republic of 50 kg cm AAMI Iraq 50 kg cm AAMI Ireland 50 kg cm IEC Isle of Man 50 kg cm IEC Israel 50 kg
37 Default Settings Appendix Country-Description Line Frequency Units Weight Units Height ECG Cable Color Macedonia, The former Yugoslavian Republic of 50 kg cm IEC Madagascar 50 kg cm IEC Malawi 50 kg cm IEC Malaysia 50 kg cm IEC Maldives 60 lb in AAMI Mali 50 kg cm IEC Malta 50 kg cm IEC Marshall Islands 60 lb in AAMI Martinique 60 kg cm IEC Mauritania 50 kg cm IEC Mauritius 60 lb in AAMI Mayotte 60 lb in AAMI Mexico 60 kg cm AAMI Micr
37 Default Settings Appendix Country-Description Line Frequency Units Weight Units Height ECG Cable Color Oman 50 kg cm AAMI Pakistan 50 kg cm IEC Palau 60 lb in AAMI Palestinian Territory 50 kg cm AAMI Panama 60 lb in AAMI Papua New Guinea 60 lb in AAMI Paraguay 50 kg cm AAMI Peru 60 kg cm AAMI Philippines 60 kg cm AAMI Pitcairn 60 lb in AAMI Poland 50 kg cm IEC Portugal 50 kg cm IEC Puerto Rico 60 lb in AAMI Qatar 50 kg cm AAMI Re
37 Default Settings Appendix Country-Description Line Frequency Units Weight Units Height ECG Cable Color South Africa 60 lb in AAMI South Georgia and the South Sandwich Islands 60 lb in AAMI Spain 50 kg cm IEC Sri Lanka 60 lb in AAMI Sudan 50 kg cm IEC Suriname 60 kg cm AAMI Svalbard and Jan Mayen 60 lb in AAMI Swaziland 60 lb in AAMI Sweden 50 kg cm IEC Switzerland 50 kg cm IEC Syrian Arab Rep 50 kg cm AAMI Taiwan, Province of China 60 kg cm
37 Default Settings Appendix Country-Description Line Frequency Units Weight Units Height ECG Cable Color Viet Nam 50 kg cm IEC Virgin Islands (British) 50 kg cm AAMI Virgin Islands (US) 60 lb in AAMI Wallis and Futuna Islands 60 lb in AAMI Western Sahara 50 kg cm IEC Yemen 50 kg cm AAMI Zambia 60 lb in AAMI Zimbabwe 60 lb in AAMI Alarm and Measurement Default Settings The default wave speed for all measurements except Respiration is 25 mm/sec.
37 Default Settings Appendix Alarm Settings Factory Default H10/H20/H40 Keep Blinking No Relay1 Sensitiv. R&Y&C Relay2 Sensitiv. Red&Yellow Relay3 Sensitiv. Red CyanRelayLatency 5 sec Yel.
37 Default Settings Appendix Factory defaults H10/H20/H40 ECG Settings H30 (deviations from H10/H20/H40) Adult Pedi Neo Vb Lead V5 V5 V5 SyncPulse Sensit Medium Medium Medium SyncPulse Marker On On On PulseAlarms Tele Enabled Enabled Enabled Adult Pedi Neo Pulse Default Settings Factory defaults H10/H20/H40 Pulse Settings H30 (deviations from H10/H20/H40) Adult Pedi Neo Adult Pedi Neo Alarm Source Auto Auto Auto Auto Auto Auto Pulse (source label) On On On Syste
37 Default Settings Appendix Respiration Settings Factory defaults H10/H20/H40 H30 (deviations from H10/H20/H40) Adult Pedi Neo Alarms On On On Resp On On On Detection Auto (Trigger Mode) Auto (Trigger Mode) Auto (Trigger Mode) Color Yellow Yellow Yellow Adult Pedi Neo Off Off Off White White White SpO2 Default Settings SpO2 Settings Factory Defaults Adult Pedi Neo Mode Continuous Continuous Continuous Repeat Time 15 min 15 min 15 min Alarms On On On QRS Volum
37 Default Settings Appendix NBP Default Settings NBP Settings Factory defaults H10/H20/H30 H30 (deviations from H10/H20/H40) Adult Pedi Neo Pedi Neo Mode Auto Auto Manual Alarms from Sys. Sys. Sys.
37 Default Settings Appendix Invasive Pressure Default Settings ABP, P, P1, P2, P3, P4, Factory defaults H10/H20/H40 UAP, ART, Ao, FAP, BAP Adult Pedi Neo Settings H30 (deviations from H10/H20/H40) Adult Alarms from Sys. Sys. 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 (36) 70/50 (70) Alarms On On On Extreme Alarms Disabled Disabled Disabled Δ Extreme High 15 10 5 Δ Extreme Low 15 10 5 Sys. High Clamp/Dia.
37 Default Settings Appendix CVP, RAP, LAP, UVP Settings Factory defaults H10/H20/H40 Adult Pedi Neo Mean only Yes Yes Yes Filter 12 Hz 12 Hz 12 Hz Mercury Cal Yes Yes Yes Artifact Suppr. 60 sec 60 sec 60 sec Unit mmHg mmHg mmHg Color Cyan (light blue) Cyan (light blue) Cyan (light blue) PAP Settings H30 (deviations from H10/H20/H40) Adult Pedi Neo Blue Blue Blue Factory Defaults Adult Pedi Neo Alarms from Dia. Dia. Dia.
37 Default Settings Appendix Factory Defaults ICP, IC1, IC2 Settings Adult Pedi Neo Sys. Low Clamp/Dia. Low Clamp (Mean Low Clamp) 0/-5 (-5) 0/-5 (-5) 0/-5 (-5) Scale 30 30 30 Mean only Yes Yes Yes Filter 12 Hz 12 Hz 12 Hz Mercury Cal Yes Yes Yes Artifact Suppr. 60 sec 60 sec 60 sec Unit mmHg mmHg mmHg Color Magenta Magenta Magenta Cardiac Output Default Settings C.O.
37 Default Settings Appendix CO2 Default Settings CO2 Settings Factory defaults H10/H20/H40 H30 (deviations from H10/H20/H40) Adult Pedi Neo Adult Pedi Neo etCO₂ Low 30 30 30 25 25 25 etCO₂ High 50 50 50 60 60 60 imCO₂ High 4 4 4 CO₂ Alarms On On On Unit mmHg mmHg mmHg Scale 40 mmHg 40 mmHg 40 mmHg 50 50 50 imCO₂ On On On Off Off Off N₂O Corr. (only M3015A/M3016A) Off Off Off Oxygen Corr. (only M3014A) 16% 16% 16% Gas Corr.
37 Default Settings Appendix tcGas Default Settings tcGas Settings Factory Adult Factory Pedi Factory Neo tcpO₂ High Limit 80 mmHg 80 mmHg 80 mmHg tcpO₂ Low Limit 50 mmHg 50 mmHg 50 mmHg tcpO₂ Alarms On On On tcpCO₂ HighLimit 50 mmHg 50 mmHg 50 mmHg tcpCO₂ Low Limit 30 mmHg 30 mmHg 30 mmHg tcpCO₂ Alarms On On On Site Timer 4.0 hours 4.0 hours 4.0 hours Disable Timer Not Allowed Not Allowed Not Allowed Heat Switch Off (i.e.
37 Default Settings Appendix ScvO2 Settings Factory Adult Factory Pedi Factory Neo Low Limit 70% 70% 70% High Limit 80% 80% 80% Alarms On On On Light Intensity On On On Color Yellow Yellow Yellow SvO2 Default Settings SvO2 Settings Factory Adult Factory Pedi Factory Neo Low Limit 60% 60% 60% High Limit 80% 80% 80% Alarms On On On Light Intensity On On On Color Yellow Yellow Yellow Hb/Hct Entry Hct [%] Factor Entry Disabled ScvO2 Default Settings ScvO2 Set
37 Default Settings Appendix EEG Settings Factory Adult Factory Pedi Factory Neo High Filter 30 Hz 30 Hz 30 Hz Impedance Limit 5 kOhm 5 kOhm 5 kOhm Smoothing CSA On On On Color Yellow Yellow Yellow BIS Default Settings Factory defaults H10/H20/H40 BIS Settings H30 (deviations from H10/H20/H40) Adult Pedi Neo SQI On On On EMG On On On SR On On On SEF Off Off Off TP Off Off Off Bursts On On On Scale 100µV (or +/- 50µV if Show Gridlines is configured to Yes)
Index 1 # 10-Electrode (5+5)Cable Sets 370 10-Electrode (6+4)Cable Sets 370 10-Lead Placement 120 3-Electrode Cable Sets 370, 371 3-Electrode One Piece Cables 372 4-Slot Flexible Module Rack (FMS-4) 16 5-Electrode Cable Sets 370, 372 5-Electrode One Piece Cables 372 6-Electrode Cable Sets 370 6-Lead Placement 119 A Abdominal Breathing 160 Aberrantly-Conducted Beats 131 About Arrhythmia Monitoring 129 About Automatic Alarm Limits 59 About Compressed Spectral Arrays (CSA) 252 About ECG Leads 116 About Elec
C C.O. Injectate Guidelines 206 C.O. INOPs 84 C.O./CCO Curve Alert Messages 207 C.O./CCO Prompt Messages 209 C.O./CCO Safety Information 210 C.O.
Current View 146 D Dashed Lines on Reports 329 Data Exchange Between Information Centers 102 Data Upload from an MMS 102 Default Profile 35 Default Settings Appendix 429 Defining the Column Interval Using the NBP Measurement 277 Deriving Alarms From awRR 224 Determining a Pressure's Most Recent Zero 185 Devices for Acquiring Measurements 15 Direct Connection - Automatic Pairing 266 Disabling the tcGas Site Timer 235 Disabling Touchscreen Operation 26 Discharging a Patient 97 Disconnecting from Power 45 Dis
Hi-Res Trend Wave Recordings 290 Hi-Res Trend Wave Scales 289 Hi-Res Trend Waves and OxyCRG 289 Histogram View 280 Horizon View 280 How are Yellow Arrhythmia Alarms Indicated? 137 How Can You Combine Devices? 265 HR Alarms When Arrhythmia Analysis is Switched Off 128 Hypotension Evaluation 312 Intravascular Oxygen Saturation 423, 445 Introducing the Monitor 13 Introducing the Oscillometric NBP Measurement 173 Introduction 13 Invasive Pressure Accessories 375 Invasive Pressure Alarm Specifications 414 Invas
Monitoring SpO2 165 Monitoring tcGas 233 Monitoring Temperature 181 Monitoring the Sepsis Management Bundle Recommendations 315 Monitoring the Sepsis Resuscitation Bundle Recommendations 313 Moving Windows 26 N NBP 412 NBP Accessories 372 NBP Default Settings 440 NBP INOPs 77 NBP Timestamp 176 Neonatal and Pediatric Modes 229 Neonatal/Infant Cuff Kits 375 Neonatal/Infant Single Patient Cuffs 374 Neonatal/Infant Single Patient, Soft Cuffs 375 Networked Monitoring 45 New Patient Check 98 New/Dried Out Transd
Rhythm Status Messages 133 Right side of the Monitor 392 Run Time 352 Running a Car Seat Assessment Record 297 S Safety and Performance Tests 424 Sample Report Printouts 332 Saving and Calibrating PiCCO C.O.
System Pulse Source 155 T Tabular View 280 tcGas 422 tcGas Accessories 385 TcGas Corrections 238 tcGas Default Settings 445 tcGas INOPs 86 Technical Alarm Messages (INOPs) 70 Telemetry Data Window 266 Telemetry INOPs 91 Temp 415 Temperature Accessories 380 Temperature Correction for tcpCO2 238 Temperature Default Settings 440 Temperature INOPs 78 Testing Alarms 62 The Events Database 298 Timer Counting Direction 353 Timer Label 352 Timer Setup Pop-up Keys 352 Timer Types 351 Timer Volume 353 To Change the
Viewing Timers 351 Viewing Trends 271 Viewing Vital Signs Trends 273 Visual Alarm Indicators 50 Visual Alarm Status Information in the Other Bed Window 109 VueLink Default Settings 447 VueLink INOPs 90 VueLink Modules 347 W Weight 206 What is a Timeout Period? 137 Where Can I Find More Information? 130, 150 While Alarms are Paused or Off 55 Working in the ST Map Task Window 148 X X1 Connectors and Symbols 18 X1 Multi-Measurement Module (M3001A) 17 X2 Controls and Indicators 20 X2 Left Side 21 X2 Multi-Me
