ft ra D In str uct ion s fo r Use IntelliVue Patient Monitor MX800 R e l e a s e H .0 w it h S o f tw a re R e v is i o n H . 0 x .
Part Number 453564208131 Printed in Germany 07/10 *453564208131*
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 Entering Measurements Manually Changing Monitor Settings Checking Your Monitor Revision Getting Started Disconnecting from Power Networked Monitoring Using the Integrated
Quick Admitting a Patient Editing Patient Information Discharging a Patient Transferring Patients Data Upload from an MMS Care Groups 94 95 95 96 100 103 5 ECG, Arrhythmia, ST and QT Monitoring 109 Skin Preparation for Electrode Placement Connecting ECG Cables Selecting the Primary and Secondary ECG Leads Checking Paced Status Understanding the ECG Display Monitoring Paced Patients Changing the Size of the ECG Wave Changing the Volume of the QRS Tone Changing the ECG Filter Settings Selecting Positions
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 180 11 Monitoring Invasive Pressure 181 Setting up the Pressure Measurement Zeroing the Pressure Transducer Adjusting the Calibration Factor Displaying a Mean Pressure Value Only Changing the Pressure Wave Scale Optimizing the Waveform Using the Wave Cursor Non-Physiological Artifact Suppression Choosing the Pressure Alarm Source Calibrating Reusable Transducer CPJ840J6 Calculating Cerebral Perfusion Calculating Pulse Pressure Variation Measuring Pulmonary Artery Wedge Pressu
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 269 269 272 276 276 277 281 282 283 283 284 285 287 287 287
26 Printing Patient Reports 323 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 323 324 325 326 327 327 328 328 328 329 330 331 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 387 387 387 36 Specifications 389 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 389 389 391 392 395 395 395 395 397 399 401 404 408
1 Introduction 1 These Instructions for Use are for clinical professionals using the IntelliVue 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 With the optional Integrated PC, you have computer functionality directly in the monitor. You can use standard applications (e.g. Web browsers), connect to the hospital network or intranet, and run a second independent display with content from the patient monitor. An IntelliVue X2 or MP5 can be connected to your monitor, where it acts as a multi-measurement module, acquiring measurements for the host monitor.
1 Introduction Flexible Module Rack (M8048A) The flexible module rack (FMS) lets you use up to eight plug-in physiological measurement modules. The maximum number of specific module types that can be used simultaneously in an FMS is: five pressure modules, four temperature modules, four VueLink or IntelliBridge modules (any combination). Connect the FMS to the monitor via the measurement link cable (MSL). Use the MSL connector on the left-hand side to connect an additional MMS.
1 Introduction The connector socket on the front of each module is the same color as the corresponding connector plug on the transducer or patient cable. Press the Setup key on the module's front to display the measurement's setup menu on the monitor screen. When the setup menu is open, a light appears above the key. Some modules have a second key. On the pressure module, for example, it initiates a zeroing procedure.
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 X2 Overview 1 On/Standby switch 2 Power and battery indicators (see “X2 Controls and Indicators” on page 18) 3 3.5-inch TFT LCD touchscreen QVGA display 4 Alarm lamps (see “X2 Controls and Indicators” on page 18) 5 Battery eject button 6 Hard keys (see “X2 Controls and Indicators” on page 18) 7 Measurement connectors (see “X2 Patient Connectors, Right Side” on page 19) 8 Battery compartment X2 Controls and Indicators 18 1 External power LED.
1 Introduction 5 Main Screen key: closes all open menus/windows and returns to the main screen. 6 SmartKeys key: brings up SmartKeys on the screen. 7 Alarms key: turns alarms On/Off, or pauses them. 8 Silence key 9 Active alarm lamp. Red or yellow, depending on alarm level. Blinks until active alarm is acknowledged. 10 Active INOP alarm lamp in light blue. Blinks until active INOP is acknowledged. 11 Alarms off indicator.
1 Introduction MMS Extensions The MMS extensions connect to the X1 and X2 MMS and use the MMS settings and power. Trend data and measurement settings from the measurements in the extensions are stored in the MMS. WARNING • The MMS extensions can only function when they are connected to an MMS. If the MMS is removed during monitoring, the measurements from both the MMS and the extension are lost.
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 26 access patient reports zero invasive pressure transducer start a delayed recording access pop-up recording keys access Vital Signs recording function access Select Waves recording function set wide automatic alarm limits set narrow automatic alarm limits access wedge procedure window access the Loops window review vital signs trend review graph trend access event surveillance access calculations access the calculator access the Drug Calculator gas analyzer - exit standby
1 Introduction display external device information access timers access ProtocolWatch set standard or EASI lead placement switch CO2 pump off new lead setup enter data manually start/stop car seat assessment record open the Histogram window open Unit Conversion window 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.
1 Introduction Using the Remote Control The remote control provides you with direct access to five hard keys, a navigation knob and a numeric keypad: Hardkeys 1 Silence - acknowledges all active alarms by switching off audible alarm indicators and lamps. Behavior follows the Silence permanent key configuration. 2 Alarms Off/Pause Alarms- pauses alarm indicators. Behavior follows the Pause Alarms permanent key configuration.
1 Introduction Using the SmartKeys Key The SmartKeys hard key on the remote control displays a block of SmartKeys on the monitor screen. Nine SmartKeys appear in a 3 by 3 matrix which corresponds to the layout of the numeric pad on the remote control. Pressing the 1 key on the remote control selects the top left SmartKey, pressing the 8 key selects the bottom center SmartKey. The . and the key can be used to select the arrow keys to page up and down in the available SmartKeys.
1 Introduction • Monitoring Mode: This is the normal, every day working mode that you use for monitoring patients. You can change elements such as alarm limits, patient category and so forth. When you discharge the patient, these elements return to their default values. Changes can be stored permanently only in Configuration Mode. You may see items, such as some menu options or the altitude setting, that are visible but ‘grayed out’ so that you can neither select nor change them.
1 Introduction Understanding Screens Your monitor comes with a set of pre-configured Screens, optimized for common monitoring scenarios such as OR adult, or ICU neonatal. A Screen defines the overall selection, size and position of waves, numerics and other elements on the monitor screen when you switch on. You can easily switch between different Screens during monitoring. Screens do NOT affect alarm settings, patient category and so forth.
1 Introduction If the monitor is switched off and then on again, modified Screens are erased from the monitor's memory and cannot be recalled. If a modified Screen was the last active Screen when the monitor was switched off, it is retained (unless Automat. Default is configured to Yes). Connecting Additional Displays to the Monitor You can connect a second display, showing the same Screen as the main display, to your monitor, for viewing only.
1 Introduction For more details, including limitations and restrictions, refer to the Instructions for Use for the XDS Application. Using the Visitor Screen If a visitor Screen is configured for your monitor, you can use it to clear the screen of all waves and numerics but continue to monitor the patient with active alarms and trend storage at the bedside and Information Center. You can change the name of the visitor Screen in Configuration Mode.
1 Introduction WARNING If you switch to a different profile, the patient category and paced status normally change to the setting specified in the new profile. However some profiles may be set up to leave the patient category and paced status unchanged. Always check the patient category, paced status, and all alarms and settings, when you change profiles. When you leave Demonstration Mode, the monitor uses the default profile.
1 Introduction Screen Settings, to define the selection and appearance of elements on each individual Screen Measurement settings, to define settings unique to each measurement, for example, high and low alarm limits Monitor settings, including settings that affect more than one measurement or Screen and define general aspects of how the monitor works, for example, alarm volume, reports and recordings, and display brightness.
1 Introduction Adjusting a Measurement Wave To quickly adjust wave-related measurement settings (such as speed or size), select the measurement wave itself. This displays the measurement wave menu, which has only wave-related measurement settings. Changing Wave Speeds Lowering the wave speed compresses the wave and lets you view a longer time period. Increasing the speed expands the waveform, giving you a more detailed view.
1 Introduction Freezing All Waves To freeze all waves on the screen, 1 Select the Freeze Waves SmartKey. All realtime waves are replaced with frozen waves. Measuring Frozen Waves To measure a frozen wave, 1 Select the frozen wave. If you are using touch, this automatically positions the vertical cursor. The cursor can be repositioned by touching the required point on the wave, or 2 Using the SpeedPoint or another pointing device or touch: use the right/left arrow keys to move the vertical cursor.
1 Introduction 2 Select Label. 3 Choose a label from the list. The monitor automatically applies the scale, color, etc. settings stored in the Profile for the label you select. You can change scale settings in Monitoring Mode, but color can only be changed in the monitor's Configuration Mode. Any labels already being used in the monitor are shown "grayed-out" in the list and cannot be selected. About Label Sets Your monitor may be configured to use a Restricted or Full label set.
1 Introduction All the currently available measurement devices, for example MMSs, MMS extensions, measurement modules, Gas analyzers, devices connected to a host monitor and manually entered measurements (marked ), are depicted in the Measurement Selection window. De-activated devices are grayed-out (here the Temp measurement on the left) Any measurement labels causing a label conflict are shown in red.
1 Introduction – – – De- Activate: to disable the conflicting device. It retains its label for future use but becomes invisible to the monitor, as though it had been unplugged. When the device has been deactivated the question marks under the measurement selection key will be replaced by XXX. Setup : to enter the Setup menu for the measurement and change the conflicting device's label to a different label.
1 Introduction 6 For compound labels, for example ABPs, ABPd and ABPm, select the Format field to select whether all values are required or a single value. 7 Select Save. When a manually entered value has been configured to display as a numeric on the screen, you can also enter a new value for this measurement by selecting the numeric, then selecting Enter MeasValues. Manually entered measurement values are marked with a * on the display, in trends, and so forth.
1 Introduction 3 Select Store Date, Time to change the date and time. If your monitor is connected to an Information Center, the date and time are automatically taken from this. Once it is set, the internal clock retains the setting even when you switch off the monitor. WARNING Changing the date or time will affect the storage of trends and events. Checking Your Monitor Revision 1 Select Main Setup then select Revisions to open the Monitor Revision menu.
1 Introduction Power On/Power Off Behavior The general rules determining the behavior of the monitor when connected to, or disconnected from power are as follows: • A monitor that was switched on prior to a temporary power loss switches on again when power is restored. • A monitor that was switched off prior to a temporary power loss remains off when power is restored. • An X2 or MP5 switches on automatically when connected to a running host monitor.
1 Introduction Networked Monitoring You can connect your monitor to an Information Center on a network, using one of the optional interfaces: • Standard wired LAN • Wireless LAN • IntelliVue Instrument Telemetry System (IIT). WARNING Do not connect patient monitors to the standard hospital network. Additionally, when an IntelliVue X2 or MP5 is equipped with IIT and declared at the Information Center as a telemetry device, it allows data continuity when paired to a host monitor.
1 Introduction 1 Select Main Setup then Internal PC. 2 In the Internal PC menu, select Switch PC On to start the iPC. Viewing the iPC Desktop on the Monitor Display If the Desktop is not displayed on the monitor display: 1 Select the iPC icon, or 2 Select Main Setup Î Internal PC Î Show PC Window. To hide the Desktop again, select Main Screen. Adjusting the iPC Audio Volume The Audio from the iPC is normally configured to be off.
1 Introduction • In some situations, shutting down the iPC can take a little time. The monitor will go into Standby mode until the shutdown is complete. By touching the touchscreen, you can bring the monitor back into operating mode. If you do this, the iPC will restart when the shutdown is complete. • If the shutdown cannot be completed within a certain time, a window will open giving the reason: for example, that a file has not been saved, or that updates are being installed.
2 Alarms 2 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 Extending the Alarm Pause Time If your monitor has extended alarm pause enabled, you can extend the alarm pause time. Use this to prevent alarms being indicated, for example, while you are washing a patient or carrying out a procedure. Only extend the alarm pause time when you are sure that clinical personnel are available to monitor the patient's condition closely. 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 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 Visual and audible latching Visual latching, audible non-latching Alarm has not been acknowledged. Alarm condition still present. Alarm tone on. Alarm lamp on. Alarm message. Flashing numerics. Alarm tone on. Alarm lamp on. Alarm message. Flashing numerics. Alarm tone on. Alarm lamp on. Alarm message. Flashing numerics. Alarm condition no longer present. All audible and visual alarm indicators automatically stop.
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 62
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 ** awRR LOW CO2, Resp, AGM The airway respiration rate has dropped below numeric flashes and low limit is the low alarm limit. highlighted, yellow alarm lamp, alarm tone ** BIS HIGH BIS The Bispectral Index value has exceeded the high alarm limit. ** BIS LOW BIS The Bispectral Index value has dropped below numeric flashes and low limit is the low alarm limit.
3 Patient Alarms and INOPs Alarm Message From Condition Indication *** EXTREME BRADY ECG The bradycardia limit has been exceeded. numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone ** 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.
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 CANNOT ANALYZE ST The ST algorithm cannot generate a valid ST value. Possible causes are large variations in the measured ST values for consecutive beats, or ventricular paced beats. Review the ECG signal quality and the ST measurement points. If the patient has a ventricular pacemaker, ST analysis is not possible. ECG EL. NOISY The ECG signal from the named ECG electrodes [RA, LA, LL, RL, V (or C)] is noisy.
3 Patient Alarms and INOPs Pulse INOPs INOP Message, Indication What to do PULSE NO ALARMING Numeric is replaced by -?INOP tone Pulse has no alarming because the system pulse is measured by an external device. Select another pulse source to enable pulse alarming. 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.
3 Patient Alarms and INOPs INOP Message, Indication What to do NBP DEACTIVATED INOP tone The NBP measurement label in the measurement device has been deactivated by deactivating the label in the Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, reactivate the measurement label in the Measurement Selection window. NBP EQUIP MALF Numeric is replaced by -?INOP tone Remove the cuff from the patient. The NBP hardware is faulty.
3 Patient Alarms and INOPs INOP Message, Indication What to do UNPLUGGED A Temp measurement label has been deactivated, either by unplugging a module, or by deactivating the label in the Measurement Selection window. INOP tone The measurement automatically disappears from the display. To switch the measurement on again, either replug the module or reactivate the measurement label in the Measurement Selection window.
3 Patient Alarms and INOPs INOP Message, Indication What to do NONPULSAT. Numeric is replaced by -?INOP tone Check the perfusion at measurement site. If necessary, stimulate circulation or change measurement site. If the INOP is due to NBP measurement on the same limb, wait until the NBP measurement is finished. POOR SIGNAL Numeric is replaced by -?(questionable numeric) The signal condition of the SpO2 measurement is poor and measurement accuracy may be compromised.
3 Patient Alarms and INOPs INOP Message, Indication What to do FAP INOPs See INOPs IC1 / IC2 INOPs See INOPs ICP INOPs See INOPs LAP INOPs See INOPs P / P1 / P2 / P3 / P4 INOPs See INOPs PAP INOPs See INOPs PPV BAD SIGNAL The arterial pressure source selected for PPV is not providing a pulsatile signal.
3 Patient Alarms and INOPs INOP Message, Indication What to do ZERO+CHECK CAL Numeric is replaced by -?- Perform a zero and check the calibration of the transducer. RAP INOPs See INOPs UAP INOPs See INOPs UVP INOPs See 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.
3 Patient Alarms and INOPs INOP Message, Indication What to do CO₂ NO TUBING Numeric is replaced by -?INOP tone Either the sample line is disconnected, or an incorrect line is attached. Check the connection. If necessary, connect another sample line (Use only the approved accessories). If you silence this INOP, the measurement will be switched off. CO₂ OVERRANGE Numeric is replaced by -?INOP tone The CO2 value is higher than the measurement range.
3 Patient Alarms and INOPs INOP Message, Indication What to do EQUIP MALF Numeric is replaced by -?INOP tone The SO2/SvO2 Module or Optical Module is faulty. Unplug and replug the Optical Module and SO2/ SvO2 module. Exchange the modules. If the INOP persists, contact your service personnel. INCOMPAT. INOP tone The SO2 Module or Optical Module is not supported. Contact your service personnel. IN-VIVO CAL The in-vivo calibration is not yet complete.
3 Patient Alarms and INOPs C.O. INOPs INOP Message, Indication What to do C.O. DEACTIVATED INOP tone The Cardiac Output measurement label in the measurement device has been deactivated by deactivating the label in the Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, reactivate the measurement label in the Measurement Selection window. C.O. EQUIP MALF Numeric is replaced by -?INOP tone There is a problem with the C.O. hardware.
3 Patient Alarms and INOPs INOP Message, Indication What to do CCO RECALIBRATE Numeric is replaced by -?- The most recent CCO or CCI calibration was made over 8 hours ago or the arterial pressure measurement used for CCO calculation has been zeroed after the CCO calibration was performed. You should recalibrate CCO or CCI with transpulmonary C.O. measurements at least every 8 hours or when the hemodynamic condition of the patient has changed.
3 Patient Alarms and INOPs INOP Message, Indication What to do EQUIP MALF Numeric is replaced by -?INOP tone There is a malfunction in the transducer or module. Connect another transducer. If this INOP persists, contact your service personnel. NO TRANSDUC Numeric is replaced by -?INOP tone No transducer is connected to the tcpO2/tcpCO2 module. Silencing the alarm switches off the measurement.
3 Patient Alarms and INOPs BIS INOPs INOP Message, Indication What to do BIS CABLE INCOMPAT INOP tone The semi-reusable sensor cable connected is unknown or not supported by your software revision. Replace it with a Philips-supported sensor cable. BIS CABLE USAGE INOP tone The semi-reusable sensor cable has exceeded the maximum number of uses. Replace the cable. BIS DSC DISCONN INOP tone DSC is not properly connected OR either DSC or BIS engine may be faulty.
3 Patient Alarms and INOPs INOP Message, Indication What to do BIS SENSOR DISCONN INOP tone The sensor is not properly connected to the patient interface cable (PIC) and/or the PIC is not properly connected to the DSC or BISx, or the sensor or PIC or DSC or BISx may be faulty. Check all the connections. Disconnect and reconnect the sensor, PIC, DSC, BISx. If the INOP persists, replace the sensor. If the INOP persists, replace PIC. If INOP persists, contact your service personnel.
3 Patient Alarms and INOPs INOP Message, Indication What to do SPIRO NO BREATH No breath was detected for more than 25 seconds. Breath derived numerics are not available. SPIRO NO SENSOR No sensor detected. Make sure the correct sensor is attached to the breathing circuit. SPIRO PATIENT CAT. Mismatch of patient size configured in the host monitor and sensor type plugged into the module. Check the instructions on selecting the correct sensor in the chapter on “Spirometry” on page 422.
3 Patient Alarms and INOPs IntelliBridge INOPs INOP Message, Indication What to do DEVICE CHECK CONF. INOP tone Device identification completed, but communication could not be established due to error. DEVICE CHECK SETUP INOP tone Device identification completed, but communication could not be established due to timeout. DEVICE DEMO DATA INOP tone The device connected to the IntelliBridge module reports demo data but the monitor is not in DEMO mode.
3 Patient Alarms and INOPs INOP Message, Indication What to do INVALID LEADSET LEADSET UNPLUGGED The leadset has been unplugged from the telemetry device. NO ECG SOURCE A telemetry device is paired with the monitor but the Information Center is not detecting a valid ECG signal from either of them. !!TELE DISCONNECT !!!TELE DISCONNECT INOP tone Telemetry transceiver was disconnected or short range radio link was lost. For cable connections; check Telemetry interface, cable connection and setup.
3 Patient Alarms and INOPs Cableless Measurement Device INOPs INOP Message, Indication What to do cl NBP Batt Empty The remaining battery time of the NBP Pod is below 30 minutes. Change the battery. cl NBP Batt Incomp The battery in use with the NBP Pod is incompatible. Replace it with one approved for use with the NBP Pod. cl NBP Batt Low The remaining battery time of the NBP Pod is below 2 hours. cl NBP Batt Malf There is a malfunction in the NBP Pod's battery system.
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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, etc. Enter the appropriate data for the fields displayed. – – – – – – – – – Patient Cat.: Choose the patient category, either Adult, Pedi, or Neo.
4 Managing Patients 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. If the monitor is connected to an Information Center and only the ID field is entered, the patient name is set to - - - at the Information Center.
4 Managing Patients – printed when you select End Case. See the section on AutoReports for information on setting up end case reports. Dischrge Patient - to discharge the patient without printing any reports. New Patient Check The monitor can be configured to ask you in certain situations: • after a specified power-off period • after a specified standby period • when no basic vitals (HR, RR, Pulse, SpO2, NBP) have been measured for a specified period whether a new patient is now being monitored.
4 Managing Patients Patient Information Stored in Monitor 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 102 below. 4 New Patient - see “Patient Mismatch - If Neither Patient Data Set is Correct” on page 102 below. 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 ECG, Arrhythmia, ST and QT Monitoring 5 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 127), ST monitoring (see “About ST Monitoring” on page 137) and QT monitoring (see “About QT/QTc Interval Monitoring” on page 147).
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 8 ECG Filter label ECG HR numeric: This is the heart rate derived from the monitored ECG. Pace pulse markers: These are shown if the Paced status has been set to Yes, the pacer spikes are not configured to have a fixed size, and the patient has a paced signal.
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 Changing the adjustment factor only changes the visual appearance of the ECG wave on the screen. It does not affect the ECG signal analyzed by the monitor. Comparing the wave size to the 1 mV calibration bar on the ECG wave segment can help you to get an idea of the true ECG signal strength. If you choose a fixed adjustment factor, the 1 mV calibration bar will be the same size for all the displayed ECG waves.
5 ECG, Arrhythmia, ST and QT Monitoring usually leads to a wandering or rough baseline. In the operating room, the Filter reduces artifacts and interference from electrosurgical units. Under normal measurement conditions, selecting Filter may suppress the QRS complexes too much and thus interfere with the clinical evaluation of the ECG displayed on the monitor. This does not affect the ECG analysis performed by the monitor.
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 V2 Electrode colors IEC AAMI IEC C2 Brown/Yellow White/Yellow V3 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 116 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 136 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 Monitoring Pulse Rate 6 The pulse numeric counts the arterial pulsations that result from the mechanical activity of the heart in beats per minute (bpm). You can display a pulse from any measured SpO2 signal (pleth wave), or any arterial pressure (P, ABP, ART, Ao, PAP, UAP, FAP, BAP: see the pressure section for an explanation of the pressure labels). The displayed pulse numeric is labeled and color-coded to match its source wave.
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 124, 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 8 Monitoring SpO2 Philips pulse oximetry uses a motion-tolerant signal processing algorithm, based on Fourier artifact suppression technology (FAST). It provides four measurements: • Oxygen saturation of arterial blood (SpO2) - percentage of oxygenated hemoglobin in relation to the sum of oxyhemoglobin and deoxyhemoglobin (functional arterial oxygen saturation). • Pleth waveform - visual indication of patient's pulse. • Pulse rate (derived from pleth wave) - detected pulsations per minute.
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 Measuring SpO2 1 Select the correct patient category setting (adult/pediatric and neonatal), as this is used to optimize the calculation of the SpO2 and pulse numerics. 2 During measurement, ensure that the application site: – has a pulsatile flow, ideally with a perfusion indicator value above 1.0. – has not changed in its thickness (for example, due to edema), causing an improper fit of the sensor.
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 CAUTION If you measure SpO2 on a limb that has an inflated noninvasive blood pressure cuff, a non-pulsatile SpO2 INOP can occur. If the monitor is configured to suppress this alarm there may be a delay of up to 60 seconds in indicating a critical status, such as sudden pulse loss or hypoxia. Alarm Delays There is a delay between a physiological event at the measurement site and the corresponding alarm at the monitor.
8 Monitoring SpO2 Examples In the examples, the SpO2 low alarm limit is set to 90%, and the Smart Alarm Delay is configured on. The measured SpO2 signal is represented by the dotted curve. The vertical axis (V) shows the change in the SpO2 value and the horizontal axis (T) shows the time. In example 1, the SpO2 value is dropping quickly and goes below the low alarm limit at the point marked a.
8 Monitoring SpO2 Adjusting the Alarm Limits In the Setup SpO₂ menu: • Select High Limit then choose the high alarm limit. • Select Low Limit then choose the low alarm limit. WARNING High oxygen levels may predispose a premature infant to retrolental fibroplasia. If this is a consideration do NOT set the high alarm limit to 100%, which is equivalent to switching the alarm off.
8 Monitoring SpO2 When a reference value has been set, the perfusion change indicator is displayed next to the perfusion numeric. 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.
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 In Adult and Pediatric mode, to check the current setting, select Main Setup then Measurements followed by NBP, and check whether the Reference setting is set to Auscultatory or Invasive. This setting can only be changed in Configuration Mode. Preparing to Measure NBP 1 Connect the cuff to the air tubing. 2 Plug the air tubing into the red NBP connector. Avoid compression or restriction of pressure tubes. Air must pass unrestricted through the tubing.
9 Monitoring NBP Understanding the NBP Numerics 1 Alarm source 2 Measurement Mode 3 Timestamp/Timer 4 Mean pressure 5 Diastolic 6 Systolic 7 Alarm limits Depending on the NBP numeric size, not all elements may be visible. Your monitor may be configured to display only the systolic and diastolic values. The measured NBP value, together with the corresponding pulse rate if this is switched on, will be displayed for one hour.
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 Start/Stop and end series 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 Monitoring Temperature 10 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 3 Position the transducer so that it is level with the heart, approximately at the level of the midaxillary line. WARNING If measuring intracranial pressure (ICP, IC1 or IC2) with a sitting patient, level the transducer with the top of the 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.
11 Monitoring Invasive Pressure Zeroing the Pressure Transducer To avoid inaccurate pressure readings, the monitor requires a valid zero. Zero the transducer in accordance with your hospital policy. You must perform a zero: • when you use a new transducer or tubing • every time you reconnect the transducer cable to the monitor • if you think the monitor's pressure readings are not correct. When using a pressure module, the zero information is stored in the module.
11 Monitoring Invasive Pressure 4 When you see the message zero done at on the status line, close the stopcock to atmospheric pressure, and open the stopcock to the patient. CAUTION When using high frequency ventilation, ensure that the tubing from the ventilator does not touch the arterial line, or connect with it indirectly, while zeroing the pressure. This could cause small pressure variations which can interfere with the zero procedure.
11 Monitoring Invasive Pressure Message Corrective Action unable to zero - no transducer Make sure that the transducer is connected and try again. If this fails, exchange the adapter cable and try again. If this fails, exchange the transducer. unable to zero pulsatile pressure Make sure that the transducer is vented to air, not to the patient, and try again. unable to zero - timed Try pressing the Zero hardkey or Zero key again.
11 Monitoring Invasive Pressure Using the Wave Cursor When the pressure wave is selected, you can display a cursor in the wave. It appears as a white horizontal line in the wave. Using the pop-up keys you can move the cursor up or down to the required position and store the corresponding value.
11 Monitoring Invasive Pressure Menu option Pressure value monitored 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 Select and set the High Limit and Low Limit for the pressure(s) you have selected.
11 Monitoring Invasive Pressure • approximately 25cm of tubing. Making the Pressure Calibration WARNING Never perform the invasive pressure calibration while a patient is being monitored. 1 Zero the transducer. 2 Connect the syringe and manometer. a. Attach the tubing to the manometer. b. Connect the 3-way stopcock to the stopcock that is not connected to the patient catheter when you measure a patient. c. Attach the syringe to one port and the manometer tubing to the other port. d.
11 Monitoring Invasive Pressure 9 Reconnect the patient and start measuring again. Troubleshooting the Pressure Calibration The status line lists the probable cause of an unsuccessful calibration. Message Corrective Action unable to calibrate - equipment malfunction Contact your service department. The pressure hardware is faulty. 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.
11 Monitoring Invasive Pressure – – • during ventilation with tidal volumes lower than 8 ml/kg for patients with acute right ventricular dysfunction ("cor pulmonale"). The PPV measurement has been validated only for adult patients To select an arterial pressure as PPV source: 1 In the Main Setup menu, select Measurements. 2 In the Setup PPV menu, select ABP, ART, Ao, BAP, P or FAP as the arterial pressure source.
11 Monitoring Invasive Pressure 3 Use the Refernce Wave 1 and Refernce Wave 2 pop-up keys to select any ECG or respiratory wave as reference waves. 4 Select Change Speed if you want to change the speed of the displayed wave. The speed can also be changed in the screen for editing the wedge. 5 Select Change Scale to change the wave scale of the PAP. The same scale will be used in the screen for editing the wedge.
11 Monitoring Invasive Pressure Identifying the Pressure Analog Output Connector 1 192 Analog output (module M1006B, option C01 only)
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 9 202 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 Check Injectate Temperature Probe Type The recorded Tinj signal is uncharacteristic for the M1646 injectate temperature probe. An incorrect probe type may have been used. Unsteady baseline There is a noisy baseline, and thermal baseline drift. Multiple peaks Caused by faulty injection technique. Abnormal decay time May be caused by low cardiac output. Calculated value for C.O. may not be accurate.
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 Monitoring Carbon Dioxide 13 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 zero 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 Preparing to Measure Mainstream CO2 1 Attach the transducer connector to the CO2 connector on the M3016A extension. 2 Wait 20 minutes, allowing the transducer to reach its operating temperature and a stable thermal condition. 3 Perform an accuracy check and then, if necessary, calibrate the transducer. Checking Transducer Accuracy WARNING Check transducer accuracy at least once a week or if you doubt the CO2 readings. 1 In Setup CO₂ menu, select Cal.
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 2 In Setup awRR menu, select Apnea Time. 3 Choose the apnea alarm delay time. WARNING Safety and effectiveness of the respiration measurement method in the detection of apnea, particularly the apnea of prematurity and apnea of infancy, has not been established. Prolonged delay: The selected apnea alarm delay may be prolonged by up to 17 seconds, if an apnea occurs during the automatic zero process. This applies to the Microstream (M3015A/B) measurement only.
14 Monitoring Airway Flow, Volume and Pressure 14 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 1 If you are using a combined CO2/Flow sensor, connect it to the CO2 sensor head first. The airway adapter clicks into place when seated correctly. 2 Click the connector into place in the flow sensor receptacle on the monitor before connecting to the breathing circuit. 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.
14 Monitoring Airway Flow, Volume and Pressure • Periodically check the flow sensor and tubing for excessive moisture or secretion build up. Perform a purge cycle if droplets are visible within the sensor or tubing. Repeat if necessary. If purging does not remove the droplets, replace the sensor. • For routine performance of airway care, separate the system between the endotracheal tube and the airway adapter (neonatal circuit), or between the endotracheal tube and elbow (pediatric/adult circuit).
14 Monitoring Airway Flow, Volume and Pressure Automatic Purging A double lumen connecting line (tubing) connects the flow sensors to the patient monitor. The M1014A Spirometry Module includes an automatic and manual purge feature which provides a flush of room air to keep the sensor tubing free from water condensation and patient secretions. This feature is available for the adult, pediatric, and neonatal modes. The purge will begin with the exhalation portion of the ventilator cycle.
14 Monitoring Airway Flow, Volume and Pressure NOTE If you unintentionally switch the gas compensation to the incorrect setting, the accuracy of the measured flow and volume values may be significantly reduced.
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 16 Monitoring Intravascular Oxygen Saturation Depending on the probe or catheter used and the measurement location, the two modules, M1011A and M1021A, measure the central venous oxygen saturation or mixed venous oxygen saturation continuously and invasively. The two modules can be differentiated by their size and their labeling. The M1011A is a single-width module (narrow) and is labeled SO2. The M1021A is a double-width module (wide) and is labeled SvO2.
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 The probe/catheter should be replaced after it has been in place for 72 hours. 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.
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17 Monitoring EEG 17 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 Status line Lead label 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 s
17 Monitoring EEG 1 In the Setup EEG menu, select Wave Scale to call up a list of wave scales. 2 Select the required scale from this list. Scaling information is displayed with each EEG wave. • 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.
17 Monitoring EEG EEG Safety Information WARNING Do not touch the patient, or table, or instruments during defibrillation. When connecting electrodes and/or patient cables, ensure that the EEG leads and connectors do not come into contact with other conductive parts or earth. High-frequency Surgery - To reduce the hazard of burns 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.
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18 Monitoring BIS 18 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 Aspect BIS Engine 185-0111 4 Aspect Digital Signal Converter 185-0124 5 Aspect Patient Interface Cable 186-0131 6 Aspect 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 Monitoring BIS using the BISx 1 1 BIS Module 2 Aspect BISx 185-0145-PH 3 Aspect Patient Interface Cable 1860131 4 Aspect BIS Sensor If you are monitoring BIS using the BISx, a. Connect the BISx device to the BIS module b. Use the clip on the rear of the BISx device to affix it in a position convenient for your patient, not above the patient's head. 2 Attach the BIS sensor/BIS electrodes to the patient following the instructions supplied with the sensor.
18 Monitoring BIS BIS Continuous Impedance Check This checks: • the combined impedance of the signal electrodes plus the reference electrode. This is done continuously and does not affect the EEG wave. As long as the impedances are within the valid range, there is no notification of this check or its results. • the impedance of the ground electrode. This is done every ten minutes and takes approximately 4 seconds.
18 Monitoring BIS BIS Window To open the BIS window, in the Setup BIS menu, select Show Sensor. The window may look slightly different on your monitor. The graphic in the BIS Window automatically adapts to show the type of sensor you are using, showing three or four electrodes as required. Each symbol in the graphic represents an electrode and illustrates the most recentlymeasured impedance status of the electrodes.
18 Monitoring BIS In addition to the symbols, the impedance value in kOhm is also displayed. Changing the BIS Smoothing Rate The smoothing rate defines how the monitor averages the BIS value. To change the smoothing rate, in the Setup BIS menu, select Smoothing Rate then choose either: – – 15 sec: this provides increased responsiveness to changes in the patient's state. 30 sec: this provides a smoother BIS trend with decreased variability and sensitivity to artifacts.
18 Monitoring BIS BIS Safety Information For information on the use of BIS in specific monitoring situations and on pharmacological responses to the anesthetic agents Nitrous Oxide (when used as the sole anesthetic agent), Ketamine, and Etomidate, please contact Aspect Medical Systems to request a copy of their publication "A Clinician's Guide to the Bispectral Index®".
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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 • When a telemetry device is connected to the monitor, arrhythmia relearning is initiated, and again when the telemetry device is disconnected. • Controls on the Telemetry Device (e.g. nurse call) will be inactive when the device is directly connected to the monitor except in the case when the monitor has no network connection and data are transferred via the telemetry device.
19 Assigning a Telemetry Device and a Monitor to One Patient If configured, alarms generated from a paired telemetry device can be silenced at the bedside. Either the monitor Silence key is configured to silence both monitor and telemetry alarms (must be configured at the Information Center) or the Silence Bed pop-up key will be available: 1 Select the telemetry screen element. 2 Select the Silence Bed pop-up key.
19 Assigning a Telemetry Device and a Monitor to One Patient In case of ambiguity, a yellow INOP message !!CHECK ECG SOURCE indicates that more than one valid ECG source is active. Synchronized Settings If ECG is measured at the monitor, and then the patient is connected to a telemetry device for monitoring, the Information Center will use the monitor settings for the telemetry device.
19 Assigning a Telemetry Device and a Monitor to One Patient Use Models With Telemetry The standard use model combining a monitor and a telemetry device involves pairing the two devices so that the data measured by the telemetry device appears on the monitor screen - and at the Information Center in the same patient sector as the monitor data.
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 To use the trend cursor to navigate in time through the trends database, 1 Select the graphical trend or the arrow pop-up keys to activate the cursor. 2 Use the arrow pop-up keys to move the trend cursor backwards and forwards in time, or 3 Place the cursor at a specific time by touching the graph. Viewing Vital Signs Trends 1 Aperiodic values are shown with a timestamp The currently-selected column is highlighted.
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 2 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 3 Enter any values that must be entered or edited manually. Select the value field and then use the pop-up keypad to enter the required values. Select Enter to confirm each entered value. Manuallyentered values are marked with an asterisk (*). Entering Values for Calculations The monitor automatically enters any available values for calculations. For aperiodically-measured values such as C.O.
21 Calculations • To check the current setting, select the patient name to enter the Patient Demographics menu. BSA(B) indicates that the Boyd formula is used; BSA(D) indicates that the Dubois formula is used. 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.
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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 Event Episodes When an event occurs, information for a predefined duration is stored. This is the event episode. It includes information from a defined period before the trigger, called the event pre-time. The episode time after the event is called the event post-time. If a further event occurs during the event post-time it changes a single event to a combined event (combi-event).
23 Event Surveillance Events Pop-Up Keys Depending on the events view you choose, a selection of the events pop-up keys let you navigate through the stored events and carry out events-related tasks. Pop-Up Keys Selecting this pop-up key lets you.... Event Setup open the Event Setup menu. Show Episode open the Event Episode window to review the selected event in detail. Show Review open the Event Review window.
23 Event Surveillance If more than one trigger is available for the measurements in the active event group, the trigger condition may be At Least One Param., At Least Two Param., At Least Three Par., or All Four Parameter. If the trigger is At Least One Param. (this is short for 'at least one measurement parameter'), the monitor starts an event capture if a trigger occurs in any of this event group's measurements. If the trigger is At Least Three Par.
23 Event Surveillance If You Set Use-defined Deviation Triggers You can define event triggers that are independent of specific limits and based instead on deviations from the current values. You must set a deviation and a period of time in which the deviation occurs. There are three types of deviation available: ANY Deviation, UP Deviation where only changes in a positive direction are detected and DOWN Deviation where only changes in a negative direction are detected.
23 Event Surveillance 3 Set the event trigger for each measurement. Select each trigger name and select, if available, either an alarm trigger, or a user-defined trigger from the pop-up trigger list. If you select a user-defined trigger, set the required threshold level and delay time. 4 Set the trigger status to Activated to start event triggering. If the status is Deactivated event surveillance is effectively switched off. 5 Select Confirm to confirm your changes.
23 Event Surveillance Running a Car Seat Assessment Record In the NER group you can run a Car Seat Assessment Record (CAR). This is a special period of event surveillance using the current setup of the NER group. To start a CAR period: 1 Select the Start CAR pop-up key or SmartKey. 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.
23 Event Surveillance Event Summary and Event Counter Vertical bars mark events in the Event Summary window. The timeline shows the position of the stored events in the event database. Selecting this view activates a cursor that lets you navigate across the timeline. Use the Show Episode pop-up key to select individual events for review in the Event Episode window. It also calls up the events pop-up keys. The event counter counts the total number of events in the database.
23 Event Surveillance symbol meaning group activated, notification set to *alarm group activated, notification set to screen prompt group is activated, notification is switched off no symbol group not activated Selecting the Event Summary window calls up the events pop-up keys.
23 Event Surveillance Depending on the event group settings, the Event Episode window shows either 20 minutes of average trend event information, four minutes of high-resolution event information, or 15 seconds of realtime wave information.
23 Event Surveillance 2 For a graphic Event Review recording, select the Record Graphic pop-up key. For a tabular Event Review recording, select the Record Tabular pop-up key. For a CAR review report, select the Print CAR pop-up key To print an Event Report, select the Print Review pop-up key. Documenting an Event Episode 1 In the Event Episode window, select the pop-up key Print/ Record. This calls up the event documentation pop-up keys.
23 Event Surveillance 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). In tabular event review recordings, the events stored in the event database are shown in chronological order, with a number and time-stamp.
23 Event Surveillance The second section (2 below) shows the waveforms recorded during the episode. The trigger moment is marked with a triangle and divides the episode into the pre/post time. Any calibration marks and grid marks on the screen are automatically printed on the recording. If there are four measurements in the event group being recorded, two waveforms will be recorded in two separate waveforms segments.
23 Event Surveillance Event Episode Reports The event episode report documents the patient information from the currently-selected event. See the section on event recordings for an explanation of the report elements.
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 The selection of pop-up keys available depends on the monitor you are using. 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 1 Either: Select the Recor- dings SmartKey then select the pop-up key Select Waves. Or: Select the SmartKey Record Waves. 2 Use the pop-up keys to choose up to three measurement waves to be printed on the recording. If you want fewer than three waves on the recording, select the waves you want then select the Continue pop-up key. 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.
25 Recording All ECG Waves Recordings An All ECG Waves recording shows a 4 second recording of each lead with a calibration bar preceding each ECG lead. All available leads are recorded sequentially in the standardized lead order. The recording is realtime, that is, the information recorded is not simultaneous.
25 Recording Central Config: if available in the General menu, select this setting to use the recording settings made for the centrally-connected recorder. Changing ECG Wave Gain The ECG Gain setting in the General Recording Setup window defines how every recorded ECG wave, irrespective of template or recording type, will appear on the recorder strip. This does not affect the displayed ECG wave, or printed ECG reports.
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 – – – Delete Report to stop the current print job Delete All Repts to cancel all queued report printouts Scheduled Rep. to select Off and switch off scheduled reports. Setting Up Reports As the content of context-linked reports, such as Cardiac Output, Calculations, and Wedge, is defined by the content of the procedure window these reports do not need to be set up, however a target printer can be configured in the Setup Reports menu.
26 Printing Patient Reports Setting Up Auto Reports Auto Reports print automatically when a specified trigger occurs. There are two types of Auto Reports: Scheduled Reports, which print at predefined intervals, and End Case Reports, which print when a patient is discharged using the End Case function. An Auto Report can be both a Scheduled Report and an End Case report. To set up Auto Reports, 1 Select Main Setup, Reports, then Auto Reports and select the Auto Report you want to set up (A, B, C, or D).
26 Printing Patient Reports 2 Select Report Type and then select the reports template you want the report selected in Step 2 to use. The selection of templates listed depends on the report type selected. Each template includes patient demographic data, and each Realtime Report also includes alarm and INOP information. In addition, the templates include: VisibleWaves: all waves currently visible, in the order they appear on the screen. All Waves: all measured waves.
26 Printing Patient Reports Switching Printers On Or Off for Reports You can enable or disable printer status to switch individual printers on or off for report printouts. 1 In the Setup Printers menu, select Printer and then select the name of the device you want to switch on or off for Reports printing from the pop-up list. 2 Select Printer Status to toggle between the settings Enabled and Disabled. If you set this to Disabled, no reports will be printed to the named printer.
26 Printing Patient Reports Checking Report Status and Printing Manually A list of all print requests which are waiting, printing or stored can be viewed in the Reports Job List. To view the list, in the Reports menu, select Reports Job List.
26 Printing Patient Reports Printer Status Messages Printer Status Message Possible causes and suggested action Print job queued for The report has been placed in the queue for the named printer. Print job could not be queued (insufficient resources) The printer queue is full and the monitor cannot accept another report request.
26 Printing Patient Reports Sample Report Printouts Each report header contains the patient's bed label, last name and first name, middle name (if there is enough space) the patient ID, the date and time, and the name of the report. The report footer contains the hospital label and page number, and the last page contains a note to mark the report end. The monitor may be configured to leave a space on the top left or right of the report printout to enable you to stick a patient address label on it.
26 Printing Patient Reports Alarm Limits Report 332 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
26 Printing Patient Reports Realtime Report 1 Patient demographic information, time stamp 2 Active Alarms and INOPs, followed by vital signs 3 Measurement waves section 333
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.
26 Printing Patient Reports Other Reports See the sections on Trends and Calculations and the chapter on Event Surveillance for other example reports.
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27 Using the Drug Calculator 27 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, and 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 VueLink Modules 29 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 The device labels (2) on the module indicate for which external devices the module is configured. The selection LED (3) shows which device is currently active. The device label text may differ slightly from the labels on the external devices. 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.
29 VueLink Modules Viewing the VueLink Device Data Window 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. Select the device data window then the Setup Device key to open the setup menu for the connected device.
29 VueLink Modules Alarms from external devices are: • transmitted to the monitor. For all numerics configured in the setup menu, an alarm condition is announced at the monitor. For one or more measurements not configured in the setup menu, an alarm is announced as a text message for the highest priority alarm. Priority is determined at the external device. • always non-latching on the monitor. • announced as a flashing numeric while the alarm condition persists.
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 Laboratory Data 32 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 40. 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 Care and Cleaning 33 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 spray 0.5% accelerated hydrogen peroxide 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 5-Electrode Cable Sets 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 10-Electrode (6+4)Cable Sets Description Length AAMI Part No. IEC Part No. ICU Grabber, chest, shielded 1.0 m M1532A M1533A ICU Snap, chest, shielded 1.0 m M1537A M1538A OR Grabber, chest, shielded 1.0 m M1557A M1558A For Limb Leads see 6-electrode cable sets 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.
35 Accessories Supported Cables Trunk Cables Length 3-Electrode Cable Set 5-Electrode Cable Set AAMI Part No. IEC Part No. AAMI Part No. IEC Part No. 0.9 m M1540C M1550C M1560C M1570C 2.7 m M1500A M1510A M1520A M1530A 3-Electrode Cable Sets Description Length AAMI Part No. IEC Part No. OR 1.0 m M1601A M1611A ICU Grabber shielded 1.0 m M1603A M1613A ICU snap shielded 1.0 m M1605A M1615A ICU Clip non-shielded 0.45 m M1608A M1618A ICU Clip non-shielded 0.
35 Accessories 5-Electrode One Piece Cables AAMI 5-electrode One Piece Cables Length AAMI Part No. IEC 5-electrode One Piece Cables IEC Part No. OR Grabber 2.5 m M1975A OR Grabber M1985A ICU Snap 2.5 m M1977A ICU Grabber M1986A Set Combiners and Organizers Set combiners and organizers Part No.
35 Accessories Reusable Cuff Kits Cuff Kits Part No. Infant, pediatric, small adult, adult M1577A Small adult, adult, large adult, thigh M1578A Infant, pediatric, small adult, adult, large adult, thigh M1579A Adult/Pediatric Antimicrobial Coated Reusable cuffs Patient Category (color) Limb Circumference Bladder Width Part No. Tubing Adult Thigh (gray) 45 - 56.5 cm 21.0 cm M4559A Large Adult X-Long (burgundy) 35.5 - 46.0 cm 17.0 cm M4558A Large Adult (burgundy) 35.5 - 46.0 cm 17.
35 Accessories Neonatal/Infant Cuffs (Disposable, non-sterile) Cuffs Limb Circumference Bladder Width Part No. Tubing Size 1 3.1 to 5.7 cm 2.2 cm M1866A Size 2 4.3 to 8.0 cm 2.8 cm M1868A Size 3 5.8 to 10.9 cm 3.9 cm M1870A M1596B (1.5 m) or M1597B (3 m) Size 4 7.1 to 13.1 cm 4.
35 Accessories SpO2 Accessories This section lists accessories for use with Philips SpO2 technology. For accessory lists for other SpO2 technologies, refer to the instructions for use provided with these devices. Some Nellcor sensors contain natural rubber latex which may cause allergic reactions. See the Instructions for Use supplied with the sensors for more information. M1901B, M1902B, M1903B and M1904B disposable sensors are not available in USA from Philips.
35 Accessories Product Number Description M1191T Adult sensor (0.45 m cable), for patients over 50 kg. Any finger, except thumb. Compatible with Opt. A01 Opt. A02 yes no M1192T Small adult, pediatric sensor (0.45 m cable) for yes patients between 15 kg and 50 kg. Any finger except thumb. no M1193T Neonatal sensor (0.9 m cable) for patients between 1 kg and 4 kg. Hand or foot. yes no M1196T Adult clip sensor (0.9 m cable) for patients over yes 40 kg. Any finger except thumb.
35 Accessories Product Number Description MAX-FAST Forehead sensor Compatible with Opt. A01 Opt.
35 Accessories Product Number Description M1943A Compatible with Comments Opt. A01 Opt. A02 Adapter cable (1.1 m cable) yes no M1943AL Adapter cable (3 m cable) yes no M1943NL OxiMax adapter cable (3 m cable) no yes Adapter cable for Philips disposable/ Nellcor disposable and reusable sensors. OC-3 Adapter Cable for OxiCliq sensors yes yes Available from Nellcor only. Product Number Description Compatible with Opt. A01 Opt.
35 Accessories Product Number Description LNCS Neo Compatible with Philips Part Number Opt. A01 Opt. A02 Neonatal Foot Sensor, 18 inch (< 3 kg) or Adult Finger Sensor 18 inch(> 40 kg) yes no n/a LNCS Neo-3 Neonatal Foot Sensor, 3 feet (< 3 kg) or Adult Finger Sensor, 3 feet(> 40 kg) yes no n/a LNCS NeoPt Neonatal pre-term sensitive skin Sensor 18 inch yes (< 1 kg) no n/a yes no n/a LNCS NeoPt-3 Neonatal pre-term sensitive skin Sensor 3 feet (< 1 kg) Adapter Cable for MASIMO sensors.
35 Accessories Temperature Probes Part No. Minimum measurement time for accurate readings 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.
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 Critical Care OR, EMS, ED Procedural Sedation, Critical Care, EMS, ED Critical Care, Sleep Critical Care, Sleep Procedural Lab, Long-term Lab Sedation, Critical Pain Management Care, EMS, ED EMS, ED Philips part numbers (A = Adult, P= Pediatric, I = Infant, N = Neonate) FilterLine Set: FilterLine H Set: A/P: M1920A FilterLine Set Long: A/ P:989803160241* FilterLine: M1925A* CapnoLine HO2: CapnoLine H: Smart CapnoLine: NIV Line: A/P: M1921A
35 Accessories tcGas Accessories This symbol indicates that the specified transducer (but not its membranes) is designed to have special protection against electric shocks (particularly regarding allowable leakage currents), and is defibrillator proof. Description Part No.
35 Accessories BIS Accessories Use only Aspect BIS sensors with the BIS module. The sensor is a silver/silver chloride electrode array that uses Aspect's patented ZipPrep technology and a proprietary connector. The sensor/electrodes are for single patient use only. Check shelf-life before use. The patient interface cable (Philips Ordering No. M1034-61630, Aspect Part No. 186-0131) has an estimated lifetime of one year. Do not scrap it when disposing of the BIS sensor.
35 Accessories SO2 Accessories for M1011A Contact your local PULSION or Edwards representative for information on accessories. They are not available from Philips.
35 Accessories 388
36 Specifications 36 Specifications The specifications in this section apply to the MX800 patient monitor. The monitor is not user installable. It 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 2010. 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) connectors, type RJ45 2 AC power input 3 Protective earth screw hole 4 Equipotential ground connector 5 Main measurement links (MSL) 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 (digital/analog) The following connectors are only present with the iPC 11 USB rear connectors (for keyboard, pointing devices, pr
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) The radio device used in this product complies with part 15 of the FCC Rules. Operation is subject to the condition that these devices do not cause harmful interference. Operation of this equipment requires the prior coordination with a frequency coordinator designated by the FCC for the Wireless Medical Telemetry Service.
36 Specifications 398 Product Max Weight WxHxD 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 3.8 in M1018A Transcutaneous Gas Module 350 g (11.3 oz) 72.5 x 99.6 x 97.5 mm, 2.9 x 3.9 x 3.8 in M1020B SpO2 Module <250 g 0.55 lb 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 Multi-measurement Module M3001A, MMS Extensions M3016A M3015A, M3014A, M3012A, Measurement Modules, and Flexible Module Rack M8048A Item Condition Range Temperature Range Operating 0 to 45°C (32 to 113°F) Non-operating -40 to 70°C (-40 to 158°F) Operating 95% Relative Humidity (RH) max. @ 40°C (104°F). M3015A only non-condensing. Non-operating 90% Relative Humidity (RH) max.
36 Specifications Performance Specifications MX800 Performance Specifications Power Specifications Indicators Power Consumption <200 W average Line Voltage 100 to 240 V Current 1.9 to 0.
36 Specifications MX800 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 Power co
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 Interface Specifications MX800 Interface Specifications Network MIB/RS232 USB Interface (4 ports) RS232 (Standard) Standard Connector RJ45 (8 pin) Isolation basic insulation (reference voltage: 250 V; test voltage: 1500 V) 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 MX800 Interface Specifications Short Range Radio Interface Measurement Link (MSL) Video Interface (standard) Type Internal SRR interface Technology IEEE 802.15.4 Frequency band 2.4 GHz ISM (2.400 - 2.483 GHz) Modulation technique DSSS (O -QPSK) Effective radiated power max. 0 dBm (1 mW) 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.
36 Specifications MX800 Interface Specifications Analog ECG Output (ring, tip) Full scale on display signal gain x measured ECG voltage Gain error <15 % Baseline offset <100 mV Bandwidth 1 to 100 Hz Output voltage swing ±4 V (min) Signal delay <22 ms Signal delay with older versions of the M3001A MMS <30 ms [identifiable with the serial number prefix DE227 or DE441 and option string #A01] Digital Pulse Output (ring) Pacemaker Pulse filtered and included in ECG output signal Output low volta
36 Specifications X2 (M3002A) Interface Specifications ECG Sync Pulse Cable detection Output (rectangular Marker In pulse) Wave Output Yes No No Connector Binder Series 709/719 Output levels Output low <0.8 V @ I = -4 mA Isolation None Pulse Width 100 +/- 10 ms (high) Delay from R-wave peak to start of pulse 20 ms maximum per AAMI EC13 Minimum required Rwave amplitude 0.5 V Wireless Network Device Interface Signals RD+/-, TD+/-: IEEE 802.3 10Base-T, PWR, GND 12.5 V ±20%, 3.
36 Specifications Display Specifications 19" WSXGA Type 482 mm active matrix color LCD (TFT) Resolution 1680 x 1050 (WSXGA+) Refresh frequency 58 Hz Useful screen 409,5 mm x 255.9 mm Pixel size 0.244 mm x 0.244 mm Measurement Specifications See the Appendix on Default Settings for a list of the settings the monitor is initially shipped with.
36 Specifications ECG/Arrhythmia/ST Performance Specifications Sinus and SV Rhythm Ranges Bandwidth Bandwidth Brady Adult: 15 to 59 bpm Pedi: 15 to 79 bpm Neo: 15 to 89 bpm Normal Adult: 60 to 100 bpm Pedi: 80 to 160 bpm Neo: 90 to 180 bpm Tachy Adult: >100 bpm Pedi: >160 bpm Neo: >180 bpm Diagnostic Mode Adult/neo/pedi: 0.05 to 150 Hz Extended Monitoring Mode Adult/neo/pedi: 0.5 to 150 Hz Monitoring Mode Adult: 0.5 to 40 Hz Neo/pedi: 0.5 to 55 Hz Filter Mode Adult/neo/pedi: 0.
36 Specifications ECG/Arrhythmia/ST/QT Alarm Specifications Range Adjustment Vent Rhythm Run 3 to 99 PVCs/minute 1 PVC SVT HR 120 to 300 bpm 5 bpm SVT Run 3 to 99 SV beats 1 SV beat ST High -19.8 to +20 mm 0.2 mm ST Low -20 to +19.8 mm 0.2 mm QTc High 200 ms to 800 ms 10 ms steps ΔQTc High 30 ms to 200 ms 10 ms steps ECG/Arrhythmia/ST Supplemental Information as required by AAMI EC11/13, IEC 60601-2-27 Respiration Excitation Waveform Sinusoidal signal, 260 μA, 40.
36 Specifications Respiration Respiration Performance Specifications Respiration Rate Range Adult/pedi: 0 to 120 rpm Neo: 0 to 170 rpm Accuracy at 0 to 120 rpm ±1 rpm at 120 to 170 rpm ±2 rpm Resolution 1 rpm Bandwidth 0.3 to 2.5 Hz (-6 dB) Noise Less than 25 mΩ (rms) referred to the input Respiration Alarm Specifications Range Adjustment Delay High Adult/pedi: 10 to 100 rpm Neo: 30 to 150 rpm under 20 rpm: 1 rpm steps over 20 rpm: 5 rpm steps max.
36 Specifications SpO2 Performance Specifications SpO2 Range The specified Option #A01 accuracy is the root- Accuracy mean-square (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 SpO2 70% to 100% Range Adjustment Delay Adult: 50 to 100% Pedi/Neo: 30 to 100% 1% steps (0, 1,
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 Resulting alarm delay alarm limit 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 Auto Mode Repetition Times 1, 2, 2.
36 Specifications Invasive Pressure Performance Specifications Measurement Range Pulse Rate -40 to 360 mmHg Range 25 to 350 bpm Accuracy ±1% Full Range Resolution 1 bpm Input Sensitivity Sensitivity: 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.
36 Specifications Invasive Pressure Alarm Specifications Invasive Pressure Alarm Specifications Pressure Range Adjustment Delay -40 to 360 mmHg (-5.0 to 48 kPa) -40 to 50 mmHg 2 mmHg (0.5 kPa) max. 12 seconds >50 mmHg 5 mmHg (1 kPa) Extreme High Difference to high limit 0 to 25 mmHg 5 mmHg steps (0.5 kPa) Clamping at -40 to 360 mmHg 5 mmHg steps (1.0 kPa) Difference to low limit 0 to 25 mmHg 5 mmHg steps (0.5 kPa) Clamping at -40 to 360 mmHg 5 mmHg steps (1.
36 Specifications M3015A Microstream CO2 Performance Specifications CO2 awRR Range 0 to 150 mmHg (0 to 20 kPa), or 20% CO2, whichever is lower Accuracy Up to 5 minutes during warmup: ±4 mmHg or 12%, whichever is greater After 5 minutes warmup: 0 to 40 mmHg (0 to 5.3 kPa):±2.2 mmHg (±0.3 kPa) Above 40 mmHg (5.3 kPa):±(5.5% + (0.
36 Specifications M3014A Mainstream 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 The specifications are valid for standard gas mixtures, balance air, fully hydrated at 35°C, Pabs = 760 mmHg, flow rate = 2 l/min. Resolution Numeric: 1.0 mmHg (0.1 kPa) Wave: 0.1 mmHg (0.
36 Specifications Either BTPS or ATPD can be selected as the humidity correction factor for the CO2 readings. The formula for the correction calculation is: where: PBTPS = partial pressure at body temperature and pressure, saturated PATPD = partial pressure at ambient temperature and pressure, dry Pabs = absolute pressure PH2O = 42 mmHg @35°C and 100% RH M3016A Mainstream CO2 Performance Specifications CO2 awRR Range -4 to 150 mmHg (-0.5 to 20.
36 Specifications CO2 Alarm Specifications Range etCO2 High 20 to 95 mmHg (2 to 13 kPa) 1 mmHg (0.1 kPa) etCO2 Low 10 to 90 mmHg (1 to 12 kPa) imCO2 High 2 to 20 mmHg (0.3 to 3.0 kPa) steps of 1 mmHg (0.1 kPa) M3002A/M3014A/M3016A: less than 14 seconds M3015A: less than 21 seconds. awRR High Adult/pedi: 10 to 100 rpm Neo: 30 to 150 rpm M3002A/M3014A/M3016A: less than 14 seconds M3015A: less than 21 seconds.
36 Specifications Spirometry The following specifications apply for 760 mmHg ambient pressure and patient gas: room air at 35°C, unless otherwise noted Spirometry Performance Specifications Flow Wave (AWF) Range ±25 l/min (neonatal) ±100 l/min (pediatric) ±180 l/min (adult) Accuracy ±3% or 0.125 l/min (neonatal) 0.25 l/min (pediatric) 0.
36 Specifications Spirometry Performance Specifications Inspired Volume numeric (TVin) Range 5 to 100 ml (neonatal) 30 to 400 ml (pediatric) 200 to 3000 ml (adult) Resolution 1 ml (neonatal/pediatric) 10 ml (adult) Range 5 to 100 ml (neonatal) 30 to 400 ml (pediatric) 200 to 3000 ml (adult) Resolution 1 ml (neonatal/pediatric) 10 ml (adult) Lung Compliance numeric Range 0 to 500 ml/cmH2O Resolution 1 ml/cmH2O Airway Resistance numeric Range 0 to 500 cmH2O/l/s (neonatal) 0 to 250 cmH2O/l/s (
36 Specifications Cardiac Output / Continuous Cardiac Output C.O./CCO Performance Specifications C.O. (right heart) Range 0.1 to 20.0 l/min Accuracy Instrument Specification (electrical): ±3% or 0.1 l/min System Specification: ±5%.or 0.2 l/min Repeatability Instrument Specification (electrical): ±2% or 0.1 l/min System Specification: ±3%.or 0.1 l/min C.O. (transpulmonary Range ) Accuracy EVLW ITBV CCO Blood Temperature 0.1 to 25.0 l/min Instrument Specification (electrical): ±4% or 0.
36 Specifications tcGas Performance Specifications tcpO2 Drift, including transducer Typically 1.25%/h tcpO2 response time, including transducer Typically 30 s tcpCO2 Range 5 to 200 mmHg (0.7 to 26.7 kPa) Resolution 1 mmHg (0.1 kPa) Overall Accuracy (incl. transducer) 5 to 76 mmHg (0.7 to 10.1 kPa) better than +5 mmHg(+0.7 kPa) Above 76 mmHg (10.1 kPa) better than +10% of reading tcpCO2 Test Signal 40 mmHg (5.3 kPa) tcpCO2 Drift, including transducer Typically 2.
36 Specifications Alarm Specifications Range Adjustment Delay SO2, SvO2, ScvO2 10% to 100% 1% max. 15 +4 seconds after value exceeds the set limit range EEG Complies with IEC 60601-2-26:1994/EN60601-2-26:1994. EEG Performance Specifications Leakage Current <=10 mA @ 110 Vac Input Signal Range 1 mVp-p Differential Input Impedance >15 MΩ @ 10 Hz Max.
36 Specifications BIS Performance Specifications BIS, BISx M1034A Bandwidth 0.25 - 100 Hz (-3 dB) High Pass Filters 0.25 Hz, 1 Hz, 2 Hz (-3 dB) Low Pass Filters 30 Hz, 50 Hz, 70 Hz, 100 Hz (-3 dB) Notch Filters (for line frequency) 50 Hz, 60 Hz Impedance Measurement Range 0 to 999 kΩ BIS Alarm Specifications Range Adjustment Alarm Delay BIS High/Low Alarm 1 Max.
36 Specifications Emissions test Compliance Avoiding Electromagnetic Interference Radio Frequency (RF) emissions Group 1 The monitor uses RF energy only for its internal function.
36 Specifications Immunity test Voltage dips, short interruptions and voltage variations on power supply input lines IEC 61000-4-11 IEC 60601-1-2 test level Compliance level <5% UT (>95% dip in UT) for 0.5 cycles <5% UT (>95% dip in UT) for 0.
36 Specifications Immunity test Conducted RF IEC 61000-4-6 IEC 60601-1-2 test level Compliance level 3 VRMS 3 VRMS 150 kHz to 80 MHz (1 VRMS for respiration and BIS) Electromagnetic environment guidance Recommended separation distance: d = 1.2√P for respiration and BIS: d = 3.5√P Radiated RF IEC 61000-4-3 3 V/m 3 V/m Recommended separation distance: 80 MHz to 2.5 GHz (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.
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.
36 Specifications 432
37 37 Default Settings Appendix This appendix documents the most important default settings of your monitor as it is delivered from the factory. For a comprehensive list and explanation of default settings, see the Configuration Guide supplied with your monitor. The monitor's default settings can be permanently changed in Configuration Mode. Note: If your monitor has been ordered pre-configured to your requirements, the settings at delivery will be different from those listed here.
37 Default Settings Appendix 434 Country-Description Line Frequency Units Weight Units Height ECG Cable Color Bahamas, The 60 kg cm AAMI Bahrain 50 kg cm AAMI Bangladesh 60 lb in AAMI Barbados 50 kg cm AAMI Belarus 50 kg cm IEC Belgium 50 kg cm IEC 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
37 Default Settings Appendix Country-Description Line Frequency Units Weight Units Height ECG Cable Color Cook Islands 60 lb in AAMI Costa Rica 60 kg cm AAMI Côte d'Ivoire 50 kg cm IEC Croatia 50 kg cm IEC Cuba 60 kg cm IEC Cyprus 50 kg cm IEC 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 AAM
37 Default Settings Appendix 436 Country-Description Line Frequency Units Weight Units Height ECG Cable Color Guatemala 60 kg cm AAMI Guernsey 50 kg cm IEC Guinea 60 lb in AAMI Guinea-Bissau 60 lb in AAMI Guyana 60 kg cm AAMI Haiti 60 kg cm AAMI 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 I
37 Default Settings Appendix Country-Description Line Frequency Units Weight Units Height ECG Cable Color Liberia 50 kg cm IEC Libyan Arab Jamahiriya 60 lb in AAMI Liechtenstein 60 lb in AAMI Lithuania 50 kg cm IEC Luxembourg 50 kg cm IEC Macao 60 lb in AAMI 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 IE
37 Default Settings Appendix 438 Country-Description Line Frequency Units Weight Units Height ECG Cable Color Niger 50 kg cm IEC Nigeria 50 kg cm IEC Niue 60 lb in AAMI Norfolk Islands 60 lb in AAMI Northern Mariana Islands 60 lb in AAMI Norway 50 kg cm IEC 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
37 Default Settings Appendix Country-Description Line Frequency Units Weight Units Height ECG Cable Color Sierra Leone 50 kg cm IEC Singapore 50 kg cm IEC Slovakia 50 kg cm IEC Slovenia 50 kg cm IEC Solomon Islands 60 lb in AAMI Somalia 50 kg cm IEC 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 6
37 Default Settings Appendix Country-Description Line Frequency Units Weight Units Height ECG Cable Color United States Minor Outlying Islands 60 lb in AAMI Uruguay 50 kg cm AAMI Uzbekistan 60 lb in AAMI Vanuatu 60 lb in AAMI Venezuela 60 lb in AAMI 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
37 Default Settings Appendix Alarm Settings Factory Default H10/H20/H40 Yel.Al. Interval 20 sec Alarm Low 4 2 Red Alarm Volume AlarmVol. +2 Yell.AlarmVolume AlarmVol. +0 Inop Volume AlarmVol. +0 AutoIncrease Vol 2 Steps IncreaseVolDelay 20 sec 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 H30 (deviations from H10/H20/H40) Adult Pedi Neo Adult Pedi Neo Δ ExtrBrady 20 bpm 20 bpm 20 bpm Brady Clamp 40 bpm 40 bpm 50 bpm 40 bpm 60 bpm 80 bpm ECG AL. OFF Inop Cyan Cyan Cyan Fallback On On On Alarms Off Enabled Enabled Enabled AlarmSource Sel.
37 Default Settings Appendix Respiration Default Settings Factory defaults H10/H20/H40 H30 (deviations from H10/H20/H40) Adult Pedi Neo Adult Pedi Neo High Limit 30 rpm 30 rpm 100 rpm Low Limit 8 rpm 8 rpm 30 rpm Off Off Off White White White Respiration Settings Apnea Time 20 sec 20 sec 20 sec Alarms On On On Resp On On On Detection Auto (Trigger Mode) Auto (Trigger Mode) Auto (Trigger Mode) Color Yellow Yellow Yellow SpO2 Default Settings SpO2 Settings Factory
37 Default Settings Appendix SpO2 Alarm Default Settings Setting Adult Pedi Neo High Alarm Delay 10 sec 10 sec 10 sec Low Alarm Delay 10 sec 10 sec 10 sec SmartAlarmDelay (SAD) Off Off Off High Alarm Delay (SAD) Short Short Short Low Alarm Delay (SAD) Short Short Short Label SpO₂ SpO₂ SpO₂ On On On Pulse settings Pulse (SpO₂) For all other Pulse default settings, refer to the Pulse Default Settings table.
37 Default Settings Appendix Temperature Default Settings Factory defaults H10/H20/H40 H30 (deviations from H10/H20/H40) Adult Pedi Neo Adult Pedi Neo Low Limit 36 36 36 35 35 35 High Limit 39 39 39 Alarms On On On Unit °C °C °C Range 35...43 35...43 35...43 Color Green Green Green Light Green Light Green Light Green Temp Settings Invasive Pressure Default Settings ABP, ART, Ao, BAP, Factory defaults H10/H20/H40 FAP, P, P1, P2, P3, P4, Adult Pedi Neo UAP Settings Sys.
37 Default Settings Appendix CVP, RAP, LAP, UVP Settings Factory defaults H10/H20/H40 H30 (deviations from H10/H20/H40) Adult Pedi Neo Adult Pedi Alarms from Mean Mean Mean High Limit 14/6 (10) 10/2 (4) 10/2 (4) Low Limit 6/-4 (0) 2/-4 (0) 2/-4 (0) Alarms On On On Extreme Alarms Enabled Enabled Enabled Δ Extreme High 5 5 5 Δ Extreme Low 5 5 5 Mean High Clamp 20/10 (15) 15/5 (10) 15/5 (10) Mean Low Clamp 0/-5 (-5) 0/-5 (-5) 0/-5 (-5) Scale 30 30 30 Mean only
37 Default Settings Appendix Factory Defaults ICP, IC1, IC2 Settings Adult Pedi Neo Alarms from Mean Mean Mean High Limit 14/6 (10) 10/2 (4) 10/2 (4) Low Limit 6/-4 (0) 2/-4 (0) 2/-4 (0) Alarms On On On Extreme Alarms Enabled Enabled Enabled Δ Extreme High 10 10 10 Δ Extreme Low 10 10 10 Mean Low Clamp 20/10 (-5) 15/5 (-5) 15/5 (-5) Mean High Clamp 0/-5 (0) 0/-5 (0) 0/-5 (0) Scale 30 30 30 Mean only Yes Yes Yes Filter 12 Hz 12 Hz 12 Hz Mercury Cal Yes
37 Default Settings Appendix CCO High Limit 8.5 l/min 3.7 l/min 1.3 l/min CCO Low Limit 4.0 l/min 2.6 l/min 0.3 l/min Alarms On On On CCI High Limit 4.3 l/min/m2 4.3 l/min/m2 5.2 l/min/m2 CCI Low Limit 2.0 l/min/m2 2.6 l/min/m2 1.
37 Default Settings Appendix Spirometry Default Settings Spirometry Settings Factory Adult Factory Pedi Factory Neo Apnea Time 20 20 20 MVexp Low 4.0 l/min 2.5 l/min 0.4 l/min MVexp High 8.0 l/min 4.0 l/min 0.
37 Default Settings Appendix SO2 Default Settings SO2 Settings Factory Adult Factory Neo Factory Pedi Low Limit 70% 70% 70% HR 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 SvO2 Default Settings SO2 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 Entr
37 Default Settings Appendix EEG Default Settings EEG Settings Factory Adult Factory Pedi Factory Neo TP, SEF On On On MDF, PPF, Delta, Theta, Alpha, Beta Off Off Off SEF Threshold 90% 90% 90% Numeric Average 8 sec 8 sec 8 sec Wave Scale 100µV (or +/- 50µV if Show Gridlines is configured to Yes) Show Gridlines No No No Low Filter 0.5 Hz 0.5 Hz 0.
37 Default Settings Appendix VueLink Default Settings 452 Device Alarms Ignored Color Green
Index 1 # 10-Electrode (5+5)Cable Sets 370 10-Electrode (6+4)Cable Sets 371 10-Lead Placement 118 3-Electrode Cable Sets 370, 372 3-Electrode One Piece Cables 372 5-Electrode Cable Sets 370, 372 5-Electrode One Piece Cables 373 6-Electrode Cable Sets 370 6-Lead Placement 117 A Abdominal Breathing 158 Aberrantly-Conducted Beats 129 About Arrhythmia Monitoring 127 About Automatic Alarm Limits 57 About Compressed Spectral Arrays (CSA) 250 About ECG Leads 114 About Electrode-to-Skin Impedance 249 About Label
C.O./CCO Curve Alert Messages 205 C.O./CCO Prompt Messages 207 C.O./CCO Safety Information 208 C.O.
Centers 100 Data Upload from an MMS 100 Default Profile 34 Default Settings Appendix 433 Defining the Column Interval Using the NBP Measurement 275 Deriving Alarms From awRR 222 Determining a Pressure's Most Recent Zero 183 Devices for Acquiring Measurements 14 Direct Connection - Automatic Pairing 264 Disabling the tcGas Site Timer 233 Disabling Touchscreen Operation 24 Discharging a Patient 95 Disconnecting from Power 43 Disinfecting the Monitor 362 Display INOPs 73 Displaying A Clock On The Main Screen 3
How Can You Combine Devices? 263 HR Alarms When Arrhythmia Analysis is Switched Off 126 Hypotension Evaluation 310 Invasive Pressure and Pulse 415 Invasive Pressure Default Settings 445 ISO/IEC Standard Audible Alarms 50 L I Ice-Bath Setup for RH Thermodilution C.O.
N NBP 414 NBP Accessories 373 NBP Default Settings 444 NBP INOPs 75 NBP Timestamp 174 Neonatal and Pediatric Modes 227 Neonatal/Infant Cuffs (Disposable, nonsterile) 375 Networked Monitoring 44 New Patient Check 96 New/Dried Out Transducers 233 No.
Measurements 200 Screen Trends 277 ScvO2 Default Settings 450 Selecting a Measurement Label 240 Selecting a Pressure for Monitoring 182 Selecting a Temperature for Monitoring 179 Selecting Leads for ST Analysis 138 Selecting Positions of Va and Vb Chest Leads (for 6-lead placement) 114 Selecting Screen Elements 23 Selecting the Active Alarm Source ECG or Pulse? 154 Selecting the Primary and Secondary ECG Leads 110 Selecting The QT Leads 148 Selecting the tcGas HeatPowerDisplay Mode 236 Sepsis Management Bun
tcGas INOPs 84 Technical Alarm Messages (INOPs) 68 Telemetry Data Window 264 Telemetry INOPs 89 Temp 417 Temperature Accessories 380 Temperature Correction for tcpCO2 236 Temperature Default Settings 445 Temperature INOPs 76 Testing Alarms 60 The Events Database 296 Timer Counting Direction 353 Timer Label 352 Timer Setup Pop-up Keys 352 Timer Types 351 Timer Volume 353 To Change the Size of all the ECG Waves 113 To Change the Size of an Individual ECG Wave 113 To Discharge a Patient 95 To Pause All Alarms
W Weight 204 What is a Timeout Period? 135 Where Can I Find More Information? 128, 148 While Alarms are Paused or Off 53 Working in the ST Map Task Window 146 X X1 Connectors and Symbols 17 X1 Multi-Measurement Module (M3001A) 16 X2 Controls and Indicators 18 X2 Left Side 19 X2 Multi-Measurement Module (M3002A) 17 X2 Overview 18 X2 Patient Connectors, Right Side 19 Y Yellow Arrhythmia Alarms 134 Z Zero Calibration 226 Zeroing a Pressure Measurement 183 Zeroing All Pressures Simultaneously 184 Zeroing IC
