I N S TR U C TI O N S F O R U S E IntelliVue MP2 Patient Monitor Release G.0 with Software Revision G.0x.
Printed in Germany 09/08 *M8102-9001B* Part Number M8102-9001B 4512 610 28821 S
M8102-9001B 1 Table Of Contents 1 Installation Installation Checklist Unpacking and Checking the Shipment Mounting the Monitor Mounting the External Power Supply (M8023A) Connecting the Monitor to AC Mains Checking Out the Monitor Operating the Monitor Setting the Date and Time Checking Country-Specific Default Settings Handing Over the Monitor 1 1 2 3 3 3 5 6 7 7 7 2 Basic Operation Introducing the IntelliVue MP2 Controls, Indicators and Connectors Extending Measurements Operating and Navigating Opera
Pausing or Switching Off Alarms Alarm Limits Reviewing Alarms Latching Alarms Testing Alarms Alarm Behavior at On/Off Alarm Recordings 43 45 49 50 51 51 51 5 Patient Alarms and INOPs Patient Alarm Messages Technical Alarm Messages (INOPs) 53 53 59 6 Managing Patients Admitting a Patient Quick Admitting a Patient Editing Patient Information Discharging a Patient Transferring Patients 83 83 85 85 85 86 7 ECG, Arrhythmia, ST and QT Monitoring Skin Preparation for Electrode Placement Connecting ECG Cables
Switching ST On and Off Understanding the ST Display and Windows Updating ST Baseline Snippets About the ST Measurement Points ST Alarms Viewing ST Maps About QT/QTc Interval Monitoring QT Alarms Switching QT Monitoring On and Off 117 118 119 120 122 122 127 130 131 8 Monitoring Pulse Rate Entering the Setup Pulse Menu System Pulse Source Switching Pulse On and Off Using Pulse Alarms 133 133 133 134 134 9 Monitoring Respiration Rate (Resp) Lead Placement for Monitoring Resp Understanding the Resp Displa
Starting and Stopping Measurements Enabling Automatic Mode and Setting Repetition Time Enabling Sequence Mode and Setting Up The Sequence Choosing the NBP Alarm Source Switching Pulse from NBP On/Off Assisting Venous Puncture Calibrating NBP 154 154 154 154 155 155 156 12 Monitoring Temperature Making a Temp Measurement Calculating Temp Difference 157 157 158 13 Monitoring Invasive Pressure Setting up the Pressure Measurement Zeroing the Pressure Transducer Adjusting the Calibration Factor Displaying a
18 Recording Starting and Stopping Recordings Overview of Recording Types Creating and Changing Recordings Templates Recorder Status Messages 199 199 200 200 201 19 Printing Patient Reports Starting Report Printouts Stopping Reports Printouts Setting Up Reports Setting Up Individual Print Jobs Checking Printer Settings Printing a Test Report Switching Printers On Or Off for Reports Dashed Lines on Reports Unavailable Printer: Re-routing Reports Checking Report Status and Printing Manually Printer Status M
Invasive Pressure Accessories SpO2 Accessories Temperature Accessories Mainstream CO2 Accessories Sidestream CO2 Accessories Mainstream CO2 Accessories (for M3016A) Microstream CO2 Accessories Battery Accessories 234 235 239 239 240 240 240 241 24 Specifications Intended Use Manufacturer’s Information Symbols Installation Safety Information Altitude Setting Monitor Safety Specifications EMC And Radio Regulatory Compliance Out-Of-Hospital Transport - Standards Compliance Monitor Performance Specifications
1 Installation 1 Installation should be carried out by qualified service personnel, either by the hospital’s biomedical department, or by Philips Support. If you have purchased a “customer-installable bundle”, it is assumed that your own hospital personnel will install and, if necessary, configure the monitor. You can contact Philips Support for assistance if required; any assistance will be associated with additional costs.
1 Installation Unpacking and Checking the Shipment Step Task Check Box when Task Done 6 Check/set the time and date (see “Setting the Date and Time” on page 7). 7 Check that the country-specific default settings are appropriate (see “Checking Country-Specific Default Settings” on page 7) 8 Perform System Test as necessary (see the Service Guide) ❏ ❏ ❏ Unpacking and Checking the Shipment The monitor and any supporting options ordered are supplied packed in protective shipping cartons.
Mounting the Monitor 1 Installation Mounting the Monitor The monitor can be rested on a flat, level surface, hung on the bed rail, or mounted on a wall or on a rollstand. See the Service Guide for details. Mounting the External Power Supply (M8023A) The external power supply (M8023A) can be rested on its rubber feet on a flat, level surface, or mounted as described in the Service Guide. The following pictures show examples of correct ( power supply.
1 Installation Connecting the Monitor to AC Mains The monitor has a wide-range external power supply (M8023A) that allows you to operate the monitor from an AC (alternating current) power source of 100 V to 240 V (± 10%) and 50/60 Hz (± 5%). The external power supply also charges the monitor’s battery. MSL Cable connects to power supply (M8023A) 4 1 2 3 1 2 3 4 AC power cord. Connect to AC mains socket. Connect LAN cable here. For connection to a PC or Information Center.
Checking Out the Monitor 1 Installation • Do not use AC mains extension cords or multiple portable socket-outlets. If a multiple portable socket-outlet without an approved isolation transformer is used, the interruption of its protective earthing may result in enclosure leakage currents equal to the sum of the individual earth leakage currents, so exceeding allowable limits. • Do not connect any devices that are not supported as part of a system.
1 Installation Operating the Monitor Operating the Monitor To complete installation you will need to operate the monitor to check basic functionality. Here is a quick introduction to the monitor. 6 1 Switch on the monitor. After start-up the 2 monitor display will become active. You operate the monitor using the touch screen. Touch something on the screen (numerics, waves, other screen items) to enter the corresponding menu. Touching the NBP numeric, for example, brings you to the Setup NBP menu.
Setting the Date and Time 1 Installation Setting the Date and Time To set the date and time: 1 Press the SmartKeys key 2 Select the Main Setup SmartKey to enter the Main Setup menu. 3 Select the Date, Time screen element from the monitor’s info line to enter the Date, Time menu. 4 Select, in turn, the Year, Month, Day, Hour (in 24 hour format, only) and Minute as necessary. Select the correct values from the pop-up list. 5 Select Store Date, Time to change the date and time.
1 Installation Handing Over the Monitor Users must be adequately trained to use the monitor before monitoring a patient. To achieve this, they should have access to, and read, the following documentation delivered with the monitor: • Instructions for Use (this book) - for full operating instructions • Quick Guide - for quick reminders during use Additionally, we recommend working through the Training Guide for self-training on the monitor before use (not available in all languages).
2 2 Basic Operation These Instructions for Use are for clinical professionals using the IntelliVue MP2 (M8102A) patient monitor. This basic operation section gives you an overview of the device and its functions. It tells you how to perform tasks that are common to all measurements (such as entering data, switching a measurement on and off, setting up and adjusting wave speeds, working with profiles). The alarms section gives an overview of alarms.
2 Basic Operation Introducing the IntelliVue MP2 Introducing the IntelliVue MP2 The Philips IntelliVue MP2 monitor provides a comprehensive set of basic physiological measurements: ECG (including ST analysis and optional 10-lead ECG), NBP, SpO2, and optionally invasive blood pressure, temperature and CO2. Through networking it provides information integration, documentation and information access.
Controls, Indicators and Connectors 2 Basic Operation MP2 Controls and Indicators 6 7 8 1 On/Standby switch 2 On/Standby LED. Green when monitor is on. Red indicates an error. 3 Battery status LED. Yellow when charging. Flashing red when battery is empty, or a battery malfunction is detected. 4 External power LED. Green when monitor is powered from an external power source. 5 Alarms off indicator. When alarms are suspended, the lamp is red, and the ALARMS OFF message appears on the screen.
2 Basic Operation Controls, Indicators and Connectors MP2 Patient Connectors, Right Side Symbols (International) Text (English versions only) 1 2 1 1 2 7 2 3 3 3 6 4 4 5 5 4 5 1 Pressure (option) 2 Temperature (option) 3 Noninvasive blood pressure 4 SpO2 5 ECG sync pulse output (See page 252 for specifications) 6 ECG/Respiration 7 CO2 (option) 1 Loudspeaker 2 MSL Connector.
Extending Measurements 2 Basic Operation Extending Measurements Your monitor is compatible with Philips measurement extensions for use with other IntelliVue patient monitoring devices. These allow you to add specific measurements to those already integrated into your monitor. These measurement extensions are referred to as MMS extensions. MMS Extension M3014A attached to the MP2 The MMS extensions connect to the monitor and use the monitor’s settings and power.
2 Basic Operation Extending Measurements M3014A, M3015A and M3016A Measurement Extensions The optional M3014A Capnography extension adds mainstream capnography, and optionally one pressure plus either a pressure or a temperature to the monitor. Cardiac Output and Continuous Cardiac Output are not available when used with the MP2. The optional M3015A Microstream CO2 extension adds microstream capnography and optionally either pressure or temperature to the monitor.
Extending Measurements 2 Basic Operation M3012A Hemodynamic MMS Extension MSL Connector to MP2 Pressure connectors (red) Cardiac Output (orange; optional) Temperature connectors (brown) When attached to the MP2 connected to the external power supply, the optional M3012A Hemodynamic extension adds temperature, pressure, and an additional pressure or a temperature to the monitor. Cardiac Output and Continuous Cardiac Output are not available when used with the MP2.
2 Basic Operation Operating and Navigating Operating and Navigating The principle method of operating your monitor is via the touchscreen. Almost every element on the screen is interactive. Screen elements include measurement numerics, information fields, alarms fields, waveforms and menus. There are also four keys to the right of the screen (see also “MP2 Controls and Indicators” on page 11).
Operating and Navigating 2 Basic Operation A typical main screen looks like this: 3 2 4 5 6 Bed9 Adult HR 1 Doe, John SpO2 7 Sinus Rhythm M 8 1mV NBP Sys. 9 11 All Sett. reset Profile Adult 10 MP2 Screen Elements Item Description Comments 1 Alarm volume off indicator is displayed when the alarm volume is set to zero (0). 2 Patient name / alarm message field Patient name can be covered by alarm messages or alarms On/Off/Paused message.
2 Basic Operation Operating and Navigating MP2 Screen Elements Item Description Comments 7 Measurement numeric/values Touch the numeric to enter the measurement setup menu. 8 Measurement wave Touch the wave to enter the measurement setup menu. 9 Status line Shows information and messages prompting you for action. 10 Battery status indicator Gives information about remaining battery charge, estimated operating time, maintenance requirements and malfunctions.
Operating and Navigating 2 Basic Operation Key to measurement setup menu: Item Description Comment 1 INOP and alarm message field. These are always displayed at the top of the screen. 2 Wave/numerics window. The main measurement numeric and wave (if applicable) are shown in this window so that you do not lose sight of the current measurement while making changes in the menu. 3 Status/prompt message. Status/prompt messages related to the measurement menu are displayed below the wave/numerics.
2 Basic Operation Operating and Navigating No Central Monit. ** NBPs HIGH SmartKeys Start/ Stop Measmt. Select. Admit/ Dischrge Alarm Limits Vitals Trend Profiles Alarm Volume QRS Volume Monitor Standby Touch to view more SmartKeys Main Setup is one of the SmartKeys. 20 enter Main Setup menu - you can get to all setup windows using this key enter standby mode - suspends patient monitoring. All waves and numerics disappear from the display.
Operating and Navigating 2 Basic Operation start veni puncture (inflate cuff to subdiastolic pressure) stop current NBP measurement set the NBP repeat time access patient reports switch CO2 pump off zero invasive pressure transducer new lead setup set standard or EASI lead placement review vital signs trend review graph trend unpair equipment and continue central monitoring with the monitor unpair equipment and continue central monitoring with the telemetry device start 12-Lead Capture (only a
2 Basic Operation Operating Modes Operating Modes When you switch the monitor on, it starts up in monitoring mode. To change to a different mode: 1 Select the Main Setup menu. 2 Select Operating Modes and choose the mode you require. Your monitor has four operating modes. Some are passcode protected. • Monitoring Mode: This is the normal, every day working mode that you use for monitoring patients. You can change elements such as alarm limits, patient category and so forth.
Understanding Screens 2 Basic Operation STANDBY Press any key or select any field on the screen to resume monitoring The monitor enters Standby mode automatically after the End Case function is used to discharge a patient. Standby suspends patient monitoring. All waves and numerics disappear from the display but all settings and patient data information are retained. A special Standby screen is displayed.
2 Basic Operation In the Change Screen menu, the changed Screen is shown linked to the original Screen and marked with an asterisk. Using the XDS Remote Display Change Screen 1 Wave B Up to three modified Screens can be accessed via the Change Screen menu. Vital Signs B To recall Screens, select the name of the Screen in the Change Screen menu 2 Waves A After a patient discharge, the monitor’s default Screen is shown. Modified Screens are still available in the Change Screen menu.
Understanding Profiles 2 Basic Operation Understanding Profiles Profiles are predefined monitor configurations. They let you change the configuration of the whole monitor so you can adapt it to different monitoring situations. The changes that occur when you change a complete profile are more far reaching than those made when you change a Screen. Screens affect only what is shown on the display. Profiles affect all monitor and measurement settings.
2 Basic Operation Understanding Settings WARNING If you switch to a different profile, the patient category and paced status normally change to the setting specified in the new profile. However some profiles may be setup to leave the patient category and paced status unchanged. Always check the patient category, paced status, and all alarms and settings, when you change profiles. When you leave Demonstration Mode, the monitor uses the default profile.
Changing Measurement Settings 2 Basic Operation Monitor settings, including settings that affect more than one measurement or Screen and define general aspects of how the monitor works, for example, alarm volume, reports and recordings, and display brightness. You must be aware that, although many settings can be changed in Monitoring Mode, permanent changes to settings can only be done in the monitor’s Configuration Mode.
2 Basic Operation Using Labels Changing the Wave Group Speed The wave speed group setting defines the speed of all the waves in the group. To change the wave speed of a wave speed group, 1 Select Main Setup -> User Interface 2 Select Global Speed or RespiratorySpeed, as required 3 Select a value from the list of available speeds. Changing Wave Speed for a Channel To change the wave speed of an individual wave channel, 1 Enter the Wave menu for a measurement by selecting its wave.
Using Labels 2 Basic Operation • display the Measurement Selection window automatically for you to resolve the conflict • take no action, you must enter the Measurement Selection window and resolve the conflict measurement selection key All the currently available measurements are depicted in the Measurement Selection window. Any measurement labels causing a label conflict are shown in red.
2 Basic Operation Changing Monitor Settings Label Compatibility When a new measurement is introduced, or new labels for an existing measurement, these labels will not be shown on older Information Centers, and consequently not on the Overview screen sourced from the Information Center. When a patient is transferred from a monitor with these new labels to one with an older software revision, the labels will be replaced with a generic label for that measurement.
Getting Started 2 Basic Operation 3 From the Monitor Revision menu, select the monitor component for which you need revision information. Getting Started Once you understand the basic operation principles, you can get ready for monitoring. Inspecting the Monitor WARNING If the monitor is mechanically damaged, or if it is not working properly, do not use it for any monitoring procedure on a patient. Contact your service personnel.
2 Basic Operation 2 Disconnecting from AC Mains Power Connect the required patient cables and sensors. The connectors are color-coded to the patient cables and sensors for easy identification. WARNING When connecting devices for acquiring measurements, always position cables and tubing carefully to avoid entanglement or potential strangulation. Starting Monitoring After you switch on the monitor, 1 Admit your patient to the monitor.
Capturing Alarm Reports and Printing 2 Basic Operation If your monitor is connected to a network, a network symbol is displayed in the upper left corner next to the bed label. To see details about the monitoring equipment and technical information about the network, select the Main Setup SmartKey to enter the Setup menu, then select Bed Information. Be aware that some network-based functions may be limited for monitors on wireless networks in comparison to those on wired networks.
2 Basic Operation 34 Capturing Alarm Reports and Printing
3 3 What’s New? This section lists the most important new features and improvements to the monitor and its user interface introduced with each release. Further information is provided in other sections of this book. You may not have all of these features, depending on the monitor configuration purchased by your hospital. What’s New in Release G.0? Short Range Radio Interface for MP2 A short range radio interface is now available for the MP2 monitor.
3 What’s New? What’s New in Release F.0? What’s New in Release F.0? QT/QTc Interval Monitoring QT interval monitoring is used to assist in the detection of prolonged QT interval syndrome. The QT interval is measured and the heart-rate corrected QT value, QTc, is calculated. The monitor also provides a 'QTc value which tracks variation in the QT interval in relation to a baseline value. High alarm limits can be set for QTc and 'QTc enabling alarm notification.
What’s New in Release F.0? 3 What’s New? New Patient Check The monitor can be configured to ask you in certain situations: after a specified power-off period, after a specified standby period and when no basic vitals (HR, RR, Pulse, SpO2, NBP) have been measured for a specified period, whether a new patient is now being monitored. By selecting the Yes pop-up key you can discharge the previous patient and reset settings.
3 What’s New? 38 What’s New in Release F.
4 Alarms 4 The alarm information here applies to all measurements. Measurement-specific alarm information is discussed in the sections on individual measurements. The monitor has two different types of alarm: patient alarms and INOPs. Patient Alarms are red and yellow alarms. A red alarm indicates a high priority patient alarm such as a potentially life threatening situation (for example, asystole).
4 Alarms Visual Alarm Indicators The monitor sounds an audible indicator for the highest priority alarm. If more than one alarm condition is active in the same measurement, the monitor announces the most severe. Your monitor may be configured to increase alarm indicator volume automatically during the time when the alarm is not acknowledged. Visual Alarm Indicators Alarm message: An alarm message text appears in the alarm status area at the top of the screen indicating the source of the alarm.
Audible Alarm Indicators 4 Alarms Audible Alarm Indicators The audible alarm indicators configured for your monitor depend on which alarm standard applies in your hospital. Audible alarm indicator patterns are repeated until you acknowledge the alarm by switching it off or pausing it, or until the alarm condition ceases (if audible alarm indication is set to non-latching). WARNING • Do not rely exclusively on the audible alarm system for patient monitoring.
4 Alarms Acknowledging Alarms ♦ If you want to see a numerical indication of the current alarm volume on a scale from zero to 10, or change the setting, select the Alarm Volume SmartKey. The volume scale pops up. The current setting is indented. To change the setting, select the required number on the scale. Any settings that are inactive (“grayed out”) have been disabled in the monitor’s Configuration Mode. Alarm Volume When the alarm volume is set to zero (off), the alarm volume symbol reflects this.
Pausing or Switching Off Alarms 4 Alarms Acknowledging Disconnect INOPs Acknowledging an INOP that results from a disconnected transducer switches off the associated measurement. The only exception is ECG/Resp: acknowledging a disconnect INOP for ECG leads does not switch off the ECG and Resp measurements. Acknowledging a disconnect INOP at the Information Center switches off the audible INOP indicator but does not switch off the measurement.
4 Alarms Pausing or Switching Off Alarms ♦ Press the Alarms key. Pausing alarms infinitely is the same as switching them off. To Switch Individual Measurement Alarms On or Off 1 Select the measurement numeric to enter its setup menu. 2 Select Alarms to toggle between On and Off. The alarms off symbol is shown beside the measurement numeric. While Alarms are Paused or Off • The red Alarms Paused lamp on the monitor front panel is lit.
Alarm Limits 4 Alarms 1 Select one of the alarm fields. This calls up the Review Alarms window. 2 Select either the pop-up key Pause Al. 5 min or the pop-up key Pause Al. 10 min. Each time you select one of these pop-up keys, the Alarm Pause Time is reset to five (or 10) minutes. Alarm Limits The alarm limits you set determine the conditions that trigger yellow and red limit alarms.
4 Alarms Alarm Limits 1 Alarm Limits 'QTc Off 2 SpO2 NBPs ABPs All Lim. All Lim. Narrow Wide 3 1 Graphic view of current yellow and red alarm limits and currently monitored measurement value Off indicates the measurement is switched off 2 Measurement labels, with alarms off symbol where appropriate 3 Set narrow or wide alarm AutoLimits for all measurements ♦ Select Show ST Limits to expand the list of ST leads and view the currently set alarm limits.
Alarm Limits 4 Alarms Alternatively, you can use the keys in the measurement Change Limits window, which you access by selecting the measurement label in the Alarm Limits window.
4 Alarms Alarm Limits When an ST measurement is in the Change Limits window there are also two pop-up keys available labeled All ST Narrow/All ST Wide. With these keys you can set Auto Limits for all ST Leads. About Automatic Alarm Limits (AutoLimits) The monitor can automatically set alarm limits suited to your individual patient, using the Automatic Alarm Limits function. This tells the monitor to adapt the alarm limits of selected measurements to the measured vital signs within a defined safe limit.
Reviewing Alarms 4 Alarms Documenting Alarm Limits To print a list of all current alarm limit settings on an available printer: 1 Select the Main Setup SmartKey. 2 Select Reports from the Main Setup menu. 3 Select Alarm Limits. Reviewing Alarms You can see which alarms and INOPs are currently active in the respective alarms and INOPs fields at the top of the screen. To review the history of alarms and INOPs, select the alarms or INOPs field to open the Review Alarms window.
4 Alarms Latching Alarms The Review Alarms window pop-up keys appear when the window is opened. If alarm pause extension is disabled, the pause pop-up keys are inactive. Alarm Limits Pause Al. Pause Al. 5 Min. 10 Min. Latching Alarms The alarm latching setting for your monitor defines how the alarm indicators behave when you do not acknowledge them. When alarms are set to non-latching, their indicators end when the alarm condition ends.
Testing Alarms 4 Alarms Testing Alarms When you switch the monitor on, a selftest is started. You must check that the alarms lamps light, one after the other, and that you hear a single tone. This indicates that the visible and audible alarm indicators are functioning correctly. For further testing of individual measurement alarms, perform the measurement on yourself (for example SpO2 or CO2) or use a simulator. Adjust alarm limits and check that appropriate alarm behavior is observed.
4 Alarms 52 Alarm Recordings
5 5 Patient Alarms and INOPs This chapter lists patient alarms and technical alarms (INOPs) alphabetically, irrespective of their priority. INOPs start on page 59. All alarms and INOPs are listed here; the ones which can appear on your monitor will depend on the model and the individual options. Patient Alarm Messages The measurement labels and abbreviations for pressure, temperature, SpO2, and anesthetic agent alarms are explained in the individual chapters.
5 Patient Alarms and INOPs Patient Alarm Messages Alarm Message From Condition **BIS LOW BIS The Bispectral Index value has dropped numeric flashes and low limit below the low alarm limit. is highlighted, yellow alarm lamp, alarm tone. ***BRADY/P xxx
Patient Alarm Messages 5 Patient Alarms and INOPs Alarm Message From Condition Indication **HR HIGH ECG The heart rate high alarm limit has been exceeded. numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone. If configured to short yellow, the sound switches off after 5 seconds if Arrhythmia is On. **HR LOW ECG The heart rate has fallen below the low numeric flashes and low limit alarm limit. is highlighted, yellow alarm lamp, alarm tone.
5 Patient Alarms and INOPs 56 Patient Alarm Messages Alarm Message From Condition Indication *** DISCONNECT PRESS The pressure is non-pulsatile and the numeric flashes, red alarm mean pressure is continuously less than lamp, alarm tone. 10mmHg (1.3kPa). This alarm occurs only with arterial pressures (P, ABP, ART, Ao, BAP, FAP, PAP, UAP, P1, P2, P3, P4). *** HIGH PRESS The measured pressure value is above numeric flashes, high limit is the extreme high alarm limit.
Patient Alarm Messages 5 Patient Alarms and INOPs Alarm Message From Condition Indication **RR LOW RESP The respiration rate has dropped below numeric flashes and low limit the low alarm limit. is highlighted, yellow alarm lamp, alarm tone. */**RUN PVCs HIGH ECG/ Arrhythmia A run of PVCs greater than 2 was detected. ** HIGH SvO2/SO2 The the measured intravascular oxygen numeric flashes and high alarm saturation has exceeded the high limit.
5 Patient Alarms and INOPs Patient Alarm Messages Alarm Message From Condition */**/***TELE ALARM Telemetry This is a generic alarm from the yellow or red alarm lamp and telemetry system. The specific alarm alarm tone cause is indicated in the alarm message in the Telemetry Data Window. ** HIGH TEMP The temperature has exceeded the high numeric flashes and high limit alarm limit. is highlighted, yellow alarm lamp, alarm tone.
Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) If an INOP interrupts monitoring and alarm detection, the measurement numeric will be replaced by -?-. If an INOP may lead to unreliable measurement values, a ? appears next to the numeric. INOP Message, Indication Source What to do ABP INOPS PRESS See INOPS (under Pressure). ALL ECG ALARMS OFF ECG/ All ECG alarms have been switched off, or the HR alarm Arrhythmia source is not ECG.
5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication Source What to do BATTERIES LOW or BATT 1/ BATT 2 LOW Batteries The estimated battery-powered operating time remaining is less than 20 minutes. Batteries The monitor cannot determine the battery status. If this INOP persists, replace the faulty battery or batteries. If the condition persists and the monitor is not connected to mains power, this INOP is re-issued two minutes after you acknowledge it.
Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication Source What to do BIS ENGINE MALFUNC BIS Malfunction in the BIS engine hardware. Disconnect and reconnect the BIS engine. If the INOP persists, replace BIS engine. BIS There is a malfunction in the BIS hardware. Unplug and replug the BIS module. If the INOP persists, contact your service personnel. BIS Impedance of one or more electrode(s) is above the valid range, most often caused by bad skin preparation.
5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication Source What to do BIS SENSOR USAGE BIS Excessive sensor usage. Replace sensor. A Cyclic Impedance Check will start automatically. BIS If the signal quality is below 50%, BIS numerics cannot be reliably derived. If the signal quality is below 15%, no BIS numerics can be derived. This may occur as a result of artifacts such as those generated from motion or the presence of electrocautery devices.
Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication Source What to do CCO NO numeric is replaced by -?INOP tone may sound C.O. CCO/CCI cannot be calculated. Make sure that the pressure chosen in the Setup CCO menu under CCO From matches the pressure measured with the arterial catheter for CCO measurement. A pressure from an external device cannot be used. Select another pressure label, either ABP, Ao, ART, BAP, FAP, or UAP.
5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication Source What to do CHARGER MALFUNC Batteries There is a problem with the battery charger in the monitor. Connect the monitor to mains power and contact your service personnel. Check Alarm Lamps INOP tone. Monitor Perform a visual check of the alarm lamp to establish whether there is a problem. Contact your service personnel to check the internal connections to the alarm lamps.
Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication Source What to do Check Screen Res INOP tone Monitor The Screen you have selected uses a resolution which is not supported by the display. The monitor will show a generic Screen instead until you select a different Screen. Contact your service personnel if you want the Screen deleted from the Profile(s) to avoid this in future.
5 Patient Alarms and INOPs 66 Technical Alarm Messages (INOPs) INOP Message, Indication Source What to do CO2 DEACTIVATED INOP tone. CO2 The CO2 measurement label in the measurement device has been deactivated by deactivating the label in the Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, reactivate the measurement label in the Measurement Selection window. C.O. DEACTIVATED INOP tone. C.O.
Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication Source What to do C.O. UNPLUGGED numeric is replaced by -?INOP tone. C.O. Plug in the C.O. module. Silencing this INOP switches off the measurement. CO2 UPDATE FW Numeric is replaced by a -?INOP tone. CO2 The software in the Measurement Extension does not match the software in the MMS. Contact your service personnel.
5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication Source What to do DEVICE REAL DATA INOP tone IntelliBridge The monitor is in DEMO mode but the device connected to the IntelliBridge module reports data that are not flagged as demo data. UNPLUGGED INOP tone. IntelliBridge The IntelliBridge module has been unplugged from the rack, or the whole rack has been disconnected. Silencing this INOP switches off the measurement.
Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication Source What to do EEG LEAD OFF [X = channel] at Information Center EEG One or more electrodes are not connected. Check in the EEG Impedance/Montage window on the monitor which electrode(s) are affected and reconnect the electrodes. EEG LEADS OFF [X = channel] EEG Two or more electrodes are not connected. Check in the EEG Impedance/Montage window which electrodes are affected and reconnect the electrodes.
5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication Source What to do LA LEAD OFF Numeric is replaced by -?- for 10 seconds; INOP tone. ECG The LA electrode has become detached from the patient or the lead set has been changed. Reattach the electrode or select New Lead Setup in the Setup ECG menu to confirm the new lead set. LAP INOPs PRESS See INOPS (under Pressure).
Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication Source What to do NBP Deactivated INOP tone. NBP 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.
5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication Source What to do PPV BAD SIGNAL at Information Center PPV The arterial pressure source selected for PPV is not providing a pulsatile signal. PPV CHK SOURCES PPV The arterial pressure source selected for PPV is unplugged or switched off. When this INOP has displayed for 1 minute PPV will be switched off.
Technical Alarm Messages (INOPs) INOP Message, Indication 5 Patient Alarms and INOPs Source What to do CHECK PROBE Predictive Numeric is replaced by -?Temp INOP tone. Check that the probe holder is correctly installed and that a compatible probe is in use. If the INOP does not clear, remove the probe from the holder then replace it. If the INOP still does not clear, disconnect and reconnect the probe. DEACTIVATED Predictive INOP tone.
5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication Source What to do !!/!!! REPLACE BATTERY T Telemetry The battery in the telemetry device is almost empty and must be replaced. RESP EQUIP MALF Numeric is replaced by -?INOP tone. RESP Contact your service personnel. The RESP hardware is faulty. RESP ERRATIC Numeric is replaced by -?- RESP The monitor has detected too many artifacts in the measured Resp signal.
Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication Source What to do LIGHT INTENS SO2 The intensity changed considerably since the last light intensity calibration. This may indicate that the catheter tip is positioned against a blood vessel wall or that there is low blood flow. Reposition the catheter (and perform a Light Intensity Calibration). SO2 The optical signal levels are too low.
5 Patient Alarms and INOPs INOP Message, Indication Source What to do SPIRO NO BREATH Spirometry No breath was detected for more than 25 seconds. Breath derived numerics are not available. SPIRO GAS COMPENS? Spirometry Gas compensation is set to “gas analyzer” but not all gases necessary for compensation are measured by a gas monitor. Some of the fall-back values provided by the user are used. Measurement accuracy might be reduced. SPIRO PATIENT CAT.
Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication Source What to do PULSE? SpO2 The detectable pulsations of the SpO2 signal are outside the specified pulse rate range. SpO2 SpO2 is analyzing the patient signal to derive Pulse, SpO2 and Perf values. Please wait until the search analysis is complete. SENSOR MALF Numeric is replaced by -?INOP tone. SpO2 The SpO2 sensor or adapter cable is faulty. Try another adapter cable and sensor.
5 Patient Alarms and INOPs 78 Technical Alarm Messages (INOPs) INOP Message, Indication Source What to do Tblood NO TRANSDUC Numeric is replaced by -?INOP tone C.O. No transducer attached to the module or catheter disconnected. Tblood OVERRANGE Numeric is replaced by -?- C.O. Tblood out of range 17°C - 43°C. Tcereb INOPS TEMP See INOPs (under Temp) Tcore INOPs TEMP See INOPs (under Temp). tcpO2 (or tcpCO2 or tcGas) CAL FAILED Numeric is replaced by -?INOP tone.
Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication Source What to do !!/!!!TELE DISCONNECT INOP tone Telemetry Telemetry transceiver was disconnected or short range radio link was lost. For cable connections; check Telemetry interface, cable connection and setup.
5 Patient Alarms and INOPs Technical Alarm Messages (INOPs) INOP Message, Indication Source What to do OVERRANGE Numeric is replaced by -?INOP tone. TEMP Try changing the application site of the transducer. Tesoph INOPS TEMP TEXT UPLOAD FAILED INOP tone IntelliBridge Incoming text from the IntelliBridge modules exceeds the maximum limit. Try unplugging one of the IntelliBridge modules. If the INOP occurs repeatedly contact your service personnel; a software upgrade may be necessary.
Technical Alarm Messages (INOPs) 5 Patient Alarms and INOPs INOP Message, Indication Source What to do CHECK SETUP INOP tone. VueLink No information was received from the external device. The device may be switched off or disconnected. VueLink INOP abbreviations may differ slightly depending on the device category. VueLnk EQUIP MALF INOP tone. VueLink Malfunction in the VueLink module. If this message appears repeatedly, the module must be replaced. Contact your service personnel.
5 Patient Alarms and INOPs 82 Technical Alarm Messages (INOPs)
6 6 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. Admitting a Patient The monitor displays physiological data and stores it in the trends as soon as a patient is connected.
6 Managing Patients Admitting a Patient 2 Clear any previous patient data by selecting the Dischrge Patient or End Case pop-up key and then Confirm. If you do not discharge the previous patient, you will not be able to distinguish data from the previous and current patients, for example, in the trend database. 3 Select Admit Patient. 4 5 Enter the patient information: select each field and use the on-screen keyboard or choose from the pop-up list of alternatives to input information.
Quick Admitting a Patient 6 Managing Patients If you do not fill in all patient information required by the Information Center, the Information Center may reject the admission. Complete all the required fields and try again to admit the patient. Quick Admitting a Patient Use Quick Admit only if you do not have the time or information to fully admit a patient. Complete the rest of the patient demographic details later. 1 Select the Quick Admit SmartKey.
6 Managing Patients 2 Transferring Patients Select the pop-up key for either: – End Case - to print any configured end case reports or vital signs recording, discharge the patient and clear the patient database, then enter standby mode. If an End Case SmartKey is configured for your monitor, you can also select this instead and then confirm. To see which end case reports are set up for your monitor, select Main Setup -> Reports -> Auto Reports.
Transferring Patients 6 Managing Patients Data Exchange Between Information Centers You can transfer demographic data and trend data from one IIC to another by selecting Transfer on the patient monitor. Trend data is not shared between Information Centers and monitors.
6 Managing Patients Transferring Patients Gender, date of birth, height, weight, and nursing notes do not generate a mismatch. If these fields are different on different devices, the monitor resolves them itself. For example, it may take date of birth from the Information Center, whilst taking gender from the monitor. Always check the Patient Demographics after combining patients, to ensure that you are satisfied with the results. Change them if necessary.
7 7 ECG, Arrhythmia, ST and QT Monitoring The electrocardiogram (ECG) measures the electrical activity of the heart and displays it on the monitor as a waveform and a numeric. This section also tells you about arrhythmia monitoring (see page 105), ST monitoring (see page 117) and QT monitoring (see page 127). Skin Preparation for Electrode Placement Good electrode-to-skin contact is important for a good ECG signal, as the skin is a poor conductor of electricity.
7 ECG, Arrhythmia, ST and QT Monitoring Selecting the Primary and Secondary ECG Leads 1 - ECG Connector 1 3 Attach the electrode cable to the patient cable. 4 Plug the patient cable into the white ECG connector on the monitor. An ECG waveform and numeric appears on the monitor display. CAUTION To protect the monitor from damage during defibrillation, for accurate ECG information and to protect against noise and other interference, use only ECG electrodes and cables specified by Philips.
Understanding the ECG Display 7 ECG, Arrhythmia, ST and QT Monitoring WARNING Pace pulse rejection must be switched on for paced patients by setting “Paced” to Yes. Switching pace pulse rejection off for paced patients may result in pace pulses being counted as regular QRS complexes, which could prevent an asystole event from being detected. When changing profiles, and at admission/discharge, always check that paced status is correct for the patient. Some pace pulses can be difficult to reject.
7 ECG, Arrhythmia, ST and QT Monitoring 1 Monitoring Paced Patients Pacer spikes configured to have a fixed size 1 Defibrillator synchronization marks: If an HP/Agilent/Philips defibrillator is connected, the synchronization marks (vertical lines on the ECG wave) are shown on the ECG wave. The synchronization marks will be shown in yellow, unless the ECG wave is yellow, then they will be green.
Changing the Size of the ECG Wave 7 ECG, Arrhythmia, ST and QT Monitoring Setting the Paced Status (Pace Pulse Rejection) ♦ In the Setup ECG menu, select Paced to toggle between Yes and No. Paced You can also change the paced status in the Patient Demographics window. When Paced is set to Yes: – Pace Pulse Rejection is switched on. This means that pacemaker pulses are Non-Paced not counted as extra QRS complexes.
7 ECG, Arrhythmia, ST and QT Monitoring Changing the Volume of the QRS Tone In the lead menu, select Size Up to increase wave size or Size Down to decrease the size. Selecting AutoSize lets the monitor choose the optimal adjustment factor for all displayed ECG waves. 2 To Change the Size of all the ECG Waves To change the size of all the ECG waves on the screen by a fixed adjustment factor, In the Setup ECG menu, select Adjust Size.
Selecting Positions of Va and Vb Chest Leads (for 6-lead placement) 7 ECG, Arrhythmia, ST and QT Monitoring – Diag: Use when diagnostic quality is required. The unfiltered ECG wave is displayed so that changes such as R-wave notching or discrete elevation or depression of the ST segments are visible. The setting Diag selects the highest available ECG bandwidth which is 0.05 to 150 Hz for the Adult, Pedi and Neo patient category.
7 ECG, Arrhythmia, ST and QT Monitoring ECG Lead Fallback 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
ECG Lead Placements 7 ECG, Arrhythmia, ST and QT Monitoring Electrode labels AAMI Electrode colors EASI IEC AAMI IEC 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 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 2 1 3 Standard 5-Lead Placeme
7 ECG, Arrhythmia, ST and QT Monitoring ECG Lead Placements 6-Lead Placement For a 6-lead placement use the positions from the 5-lead diagram above but with two chest leads. The two chest leads, Va and Vb, can be positioned at any two of the V1 to V6 positions shown in the chest electrode diagram below. The Va and Vb lead positions chosen must be selected in the ECG Setup Menu to ensure correct labeling.
ECG Lead Placements 7 ECG, Arrhythmia, ST and QT Monitoring 10-Lead Placement When monitoring 12-leads of ECG, using a 10-Electrode Lead Placement, it is important to correctly place electrodes and to label all 12-lead ECG reports with the correct lead placement. Conventional 12-Lead ECG In conventional 12-Lead ECG using 10 electrodes, an electrode is placed on the right arm, left arm, right leg, and left leg. Six Velectrodes are placed on the chest. The right leg electrode is the reference electrode.
7 ECG, Arrhythmia, ST and QT Monitoring Capture 12-Lead Modified 12-Lead ECG 1 - LA 2 - V1 - V6 6 3 - LL 5 1 4 - RL 5 - RA 6 - Angle of Lewis 2 4 3 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.
EASI ECG Lead Placement 7 ECG, Arrhythmia, ST and QT Monitoring EASI ECG Lead Placement Using a standard 5-electrode set in EASI lead placement you can monitor up to 12 standard ECG leads simultaneously and continuously at the bedside. EASI provides a monitoring method for trending ST segment changes that can provide an early indication of ischemia. WARNING EASI-derived 12-lead ECGs and their measurements are approximations to conventional 12-lead ECGs.
7 ECG, Arrhythmia, ST and QT Monitoring ECG and Arrhythmia Alarm Overview ECG and Arrhythmia Alarm Overview The ECG and arrhythmia alarms available depend on which measurements are switched on, and the arrhythmia option enabled for your monitor.
Using ECG Alarms 7 ECG, Arrhythmia, ST and QT Monitoring Using ECG Alarms ECG alarms can be switched on and off and the high and low alarm limits changed just like other measurement alarms, as described in the Alarms section. Special alarm features which apply only to ECG are described here.
7 ECG, Arrhythmia, ST and QT Monitoring ECG Safety Information ECG Safety Information CAUTION Interference from instruments near the patient and ESU interference can cause problems with the ECG wave. See the monitor specifications for more information. WARNING Defibrillation and Electrosurgery: Do not touch the patient, or table, or instruments, during defibrillation.
About Arrhythmia Monitoring 7 ECG, Arrhythmia, ST and QT Monitoring External pacing electrodes: When a pacemaker with external pacing electrodes is being used on a patient, arrhythmia monitoring is severely compromised due to the high energy level in the pacer pulse. This may result in the arrhythmia algorithm’s failure to detect pacemaker noncapture or asystole.
7 ECG, Arrhythmia, ST and QT Monitoring Switching Arrhythmia Analysis On and Off Switching Arrhythmia Analysis On and Off 1 In the Setup Arrhy menu, select Arrhythmia to toggle between On and Off. 2 Select the Confirm pop-up key which appears at the bottom of the screen.
Understanding the Arrhythmia Display 7 ECG, Arrhythmia, ST and QT Monitoring • PR interval deviation must be large • P-wave region must not match well Atrial fibrillation analysis is only available for adult patients and atrial fibrillation detection cannot be performed on PVCs or Paced beats. Since most atrial flutters have regular RR intervals, they cannot be detected by the atrial fibrillation algorithm.
7 ECG, Arrhythmia, ST and QT Monitoring 4 PVC Numeric 5 HR Numeric 6 Ectopic status message 7 Delayed arrhythmia wave Understanding the Arrhythmia Display Viewing Arrhythmia Waves ♦ To review arrhythmia beat labels, in the Setup Arrhy menu, select Annotate Arrhy. The wave showing the primary ECG lead will be delayed by six seconds and shown on a grey background. Beat labels will be annotated above the ECG wave and Delayed will be written beside it.
Understanding the Arrhythmia Display 7 ECG, Arrhythmia, ST and QT Monitoring Arrhythmia Status Messages The monitor displays two types of status messages: • Rhythm Status Messages -- to indicate the 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.
7 ECG, Arrhythmia, ST and QT Monitoring Arrhythmia Relearning Ectopic Status Messages The label B or E indicates basic (B) or enhanced (E) arrhythmia capability.
Arrhythmia Alarms 7 ECG, Arrhythmia, ST and QT Monitoring Automatic Arrhythmia Relearn Arrhythmia relearning is initiated automatically whenever: • ECG monitoring is switched on • The ECG Lead or Lead Label of the primary/secondary lead is changed manually, or when fallback occurs • A Leads Off INOP condition (that has been active for > 60 seconds) ends. If you are monitoring multi-lead arrhythmia and there is a change in one lead only, relearning happens only in the affected lead.
7 ECG, Arrhythmia, ST and QT Monitoring Arrhythmia Alarms Yellow Arrhythmia Alarms Yellow arrhythmia alarms are short yellow alarms specific to arrhythmia-related patient conditions. Depending on your monitor and Information Center configuration, they may be shown with one or two stars. The heart rate alarms (High HR and Low HR) can be configured as short yellow or standard yellow alarms.
Arrhythmia Alarms 7 ECG, Arrhythmia, ST and QT Monitoring Arrhythmia Alarm Timeout Periods Normally, an arrhythmia alarm is announced when an alarm condition is detected. However, there are certain situations that can inhibit the audible and visible indications of the alarm even though the alarm condition was detected.
7 ECG, Arrhythmia, ST and QT Monitoring Arrhythmia Alarms If you silence a yellow arrhythmia alarm and the alarm condition still exists, the visual indicators continue until the condition stops. You will get an alarm reminder every time the configured timeout period has expired. If you silence a yellow arrhythmia alarm and the alarm condition has stopped, the visual indicators are immediately cleared.
Arrhythmia Alarms 7 ECG, Arrhythmia, ST and QT Monitoring Red Arrhythmia Alarms Asystole Vent Fib/Tach V-Tach Extreme Tachy/Extreme Brady Yellow Arrhythmia Alarms higher priority PVC Alarms Chain Beat Detection Alarms Chain Non-sustain VT/ Vent Rhythm Pause SVT Pacer Not Captured/ Pacer Not Pacing/ Missed Beat HR High/ HR Low* Run PVCs Pair PVCs lower priority Rate Alarms Chain AFib First level timeout period (TimeOut 1st) R-on-T PVCs Second level timeout Irregular HR (occurs only if no oth
7 ECG, Arrhythmia, ST and QT Monitoring Arrhythmia Alarms Ventricular Heart Rate V-Tach Run Limit **Pair PVCs PVC = 2 ** Non-Sustain VT PVC Run < 8 HR > 100 ***V-Tach PVC Run t 8 HR > 100 V-Tach Heart Rate Limit 100 ** Run PVCs PVC Run > 2 but d 12 ** Vent Rhythm PVC Run > 12 HR d 100 HR d 100 1 2 3 4 5 6 7 8 9 10 11 12 Number of Consecutive PVCs (PVC Run) 14 15 Ventricular Rhythm Run Limit You will see that • if both the V-Tach Heart Rate Limit and the V-Tach Run Limit are exceeded
About ST Monitoring 7 ECG, Arrhythmia, ST and QT Monitoring About ST Monitoring The monitor performs ST segment analysis on normal and atrially paced beats and calculates ST segment elevations and depressions. This information can be displayed in the form of ST numerics and snippets on the monitor. All available leads can be monitored continuously. The ECG waveform does not need to be displayed on the monitor for ST Segment analysis.
7 ECG, Arrhythmia, ST and QT Monitoring 2 Understanding the ST Display and Windows Choose a lead from the list for ST monitoring. This closes the Choices window and adds the selected lead to the list of chosen leads. To disable ST monitoring for a lead: NOTE 1 Choose a lead from the list in the Setup ST Leads window. 2 Select the Delete key. This removes this lead from the list.
Updating ST Baseline Snippets 7 ECG, Arrhythmia, ST and QT Monitoring ST Snippets ST snippets show a one second wave segment for each measured ST lead. The most recent snippet is drawn in the same color as the ECG wave, usually green, superimposed over the stored baseline snippet, drawn in a different color. The comparison shows any deviation in the measurement since the baseline snippet was stored, for example as a result of a procedure carried out on the patient.
7 ECG, Arrhythmia, ST and QT Monitoring About the ST Measurement Points About the ST Measurement Points The ST value for each beat complex is the vertical difference between the ISO point and the ST point, as shown in the diagram below. The isoelectric (ISO) point provides the baseline, the ST point is at the midpoint of the ST segment. The J point is where the QRS complex changes its slope; as it is a fixed distance away from the ST point, it can be useful to help you position the ST point correctly.
About the ST Measurement Points 3 7 ECG, Arrhythmia, ST and QT Monitoring Select the ST point you need to adjust by touching the appropriate point on the screen. The current choice is highlighted (ISO point -80 in the screen example). ST label and the ST numeric that would apply using the current points Adjust ST Points ST-I 0.
7 ECG, Arrhythmia, ST and QT Monitoring 5 ST Alarms To update the ST snippet shown in the Adjust ST Points window, select the Update popup key. ST Alarms ST alarms are yellow alarms. Each ST lead has its own alarm limit. ST alarms are triggered when an ST value exceeds its alarm limit for more than one minute. Switching ST alarms off switches off alarms for all ST leads.
Viewing ST Maps 7 ECG, Arrhythmia, ST and QT Monitoring SBed10 ST-II HIGH Adult ST Map (Current) ST map Chest Leads Limb Leads ST label and polarity of corresponding lead Size Up Size Down Trend View Select Interval Show Show Baseline Values Scroll to view more pop-up keys Print If an ST lead is switched off, its axis is not shown in the map.
7 ECG, Arrhythmia, ST and QT Monitoring Viewing ST Maps Additionally, when both ST maps are displayed, you can view the currently available ST values in the ST Map window (Current or Trend) at any time. To do this, select the Show Values pop-up key. The ST values are shown in place of the second ST map, and the pop-up key text changes to Hide Values. Select the Hide Values pop-up key and the display shows both ST maps again.
Viewing ST Maps 7 ECG, Arrhythmia, ST and QT Monitoring In this diagram, V4 was either temporarily switched off, or in INOP, for around 30 seconds. No data was recorded. Consequently, the affected maps are not closed. Viewing an ST Map To display an ST map, ♦ In the Setup ST Analysis menu, select ST Map. Working in the ST Map Task Window You may need to activate the ST map task window to see all the data, and to access the pop-up keys. Select the map view on screen to activate its task window.
7 ECG, Arrhythmia, ST and QT Monitoring Viewing ST Maps 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, 126 1 Select Main Setup - > Reports. 2 Select ST Map. 3 Press Print.
About QT/QTc Interval Monitoring 7 ECG, Arrhythmia, ST and QT Monitoring About QT/QTc Interval Monitoring The QT interval is defined as the time between the beginning of the Q-wave and the end of the T-wave. It measures the total duration of the depolarization (QRS duration) and repolarization (ST-T) phases of the ventricular action potential. QT interval monitoring can assist in the detection of prolonged QT interval syndrome.
7 ECG, Arrhythmia, ST and QT Monitoring About QT/QTc Interval Monitoring Indications For Use Of QT Interval Monitoring Of special concern for QT monitoring is the administration of QT prolonging drugs to patients identified with risk factors for Torsade de Pointe. Females, older patients and patients with bradycardia, impaired left ventricular function (ischemia, left ventricular hypertrophy), hypokalemia and hypomagnesemia are in this increased risk category.
About QT/QTc Interval Monitoring 7 ECG, Arrhythmia, ST and QT Monitoring Changing the lead(s) used for QT measurements will not cause the baseline to be reset. QT View In the QT View window you can verify that the QT algorithm detects correct Q and T points. The current waves are shown in the upper half of the window and the baseline waves in a different color below. The Q and T points are marked with a vertical line.
7 ECG, Arrhythmia, ST and QT Monitoring QT Alarms If no baseline has been set for this patient, the first five minute value after the start of monitoring is automatically set as baseline. If you set a new baseline the previous baseline is discarded. As the 'QTc alarm is based on the difference between the baseline and the current value, setting an inappropriate new baseline may prevent a 'QTc alarm from being generated. Discharging a patient clears the baseline.
Switching QT Monitoring On and Off 7 ECG, Arrhythmia, ST and QT Monitoring Switching Individual QTc Alarms On and Off Each QTc alarm can be switched off individually. ♦ To switch an alarm on or off, in the Setup QT Analysis menu, select QTc Alarm or 'QTc Alarm to toggle between On and Off. Changing QTc Alarm Limits Set the high alarm limits based on your assessment of the patient's clinical condition, unit protocols, physician orders or medication specified limits.
7 ECG, Arrhythmia, ST and QT Monitoring 132 Switching QT Monitoring On and Off
8 8 Monitoring Pulse Rate The pulse numeric counts the arterial pulsations that result from the mechanical activity of the heart in beats per minute (bpm). You can display a pulse from any measured SpO2 signal (pleth wave), or any arterial pressure (P, ABP, ART, Ao, PAP, UAP, FAP, BAP: see the pressure section for an explanation of the pressure labels). The displayed pulse numeric is labeled and color-coded to match its source wave.
8 Monitoring Pulse Rate Switching Pulse On and Off Switching Pulse On and Off To switch a particular pulse numeric on or off, enter the Setup Pulse menu via the measurement setup menu or wave menu of the pulse source. For example, to switch an SpO2 pulse numeric on or off, 1 Enter the Setup Pulse menu by selecting the Pulse numeric or by selecting Pulse in the Setup SpO2 menu. 2 In the Setup Pulse menu, select Pulse (Pulse Source) to toggle between On and Off.
Using Pulse Alarms 8 Monitoring Pulse Rate WARNING Selecting Pulse as the active alarm source for HR/Pulse switches off the arrhythmia alarms listed in the section “ECG and Arrhythmia Alarm Overview” on page 102, including Asystole, Vfib and Vtach alarms, and the heart rate alarms. This is indicated by the message ECG/ARRH ALARM OFF (unless this has been configured off for your monitor), and the crossed-out alarm symbol beside the ECG heart rate numeric.
8 Monitoring Pulse Rate 136 Using Pulse Alarms
9 9 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).
9 Monitoring Respiration Rate (Resp) Understanding the Resp Display Lateral Chest Expansion Some patients, especially neonates, expand their chests laterally. In these cases it is best to place the two respiratory electrodes in the right midaxillary and left lateral chest areas at the patient’s maximum point of breathing movement to optimize the respiratory wave. Abdominal Breathing Some patients with restricted chest movement breathe mainly abdominally.
Changing the Size of the Respiration Wave 9 Monitoring Respiration Rate (Resp) • the algorithm expects a heart rate and therefore needs at least 3 electrodes attached to the patient. If you are monitoring respiration with only two electrodes, the detection algorithm becomes less sensitive which may result in reduced breath detection performance.
9 Monitoring Respiration Rate (Resp) Changing the Speed of the Respiration Wave Changing the Speed of the Respiration Wave Resp waveforms are usually viewed at a slower speed than other waveforms. For this reason, the Resp measurement has its own speed control and is not affected by the wave speed settings of the other measurements. ♦ Select the Resp wave to enter the Resp Wave menu, then select Change Speed. Choose the required speed from the pop-up list.
Resp Safety Information 9 Monitoring Respiration Rate (Resp) Rate adaptive pacemakers: Implanted pacemakers which can adapt to the Minute Ventilation rate may occasionally react on the Impedance measurement used by patient monitors for the determination of the Resp value and execute pacing with the maximum programmed rate. Switching off the Resp measurement can prevent this.
9 Monitoring Respiration Rate (Resp) 142 Resp Safety Information
10 10 Monitoring SpO2 Philips pulse oximetry uses a motion-tolerant signal processing algorithm, based on Fourier artefact suppression technology (FAST). It provides four measurements: • Oxygen saturation of arterial blood (SpO2) - percentage of oxygenated hemoglobin in relation to the sum of oxyhemoglobin and deoxyhemoglobin (functional arterial oxygen saturation). • Pleth waveform - visual indication of patient’s pulse. • Pulse rate (derived from pleth wave) - detected pulsations per minute.
10 Monitoring SpO2 4 Connecting SpO2 Cables Check that the light emitter and the photodetector are directly opposite each other. All light from the emitter must pass through the patient’s tissue. WARNING Loose Sensor: If a sensor is too loose, it might compromise the optical alignment or fall off. If it is too tight, for example because the application site is too large or becomes too large due to edema, excessive pressure may be applied.
SpO2 Signal Quality Indicator (Fast SpO2 only) 10 Monitoring SpO2 WARNING Inspect the application site every two to three hours to ensure skin quality and correct optical alignment. If the skin quality changes, move the sensor to another site. Change the application site at least every four hours. CAUTION • Injected dyes such as methylene blue, or intravascular dyshemoglobins such as methemoglobin and carboxyhemoglobin may lead to inaccurate measurements.
10 Monitoring SpO2 Changing the Averaging Time Changing the Averaging Time Depending on the monitor configuration, you may be able to change the averaging time for the SpO2 values. The averaging time represents the approximate time period used for the calculation. The exact averaging algorithm depends on the SpO2 technology (option) used and on the signal conditions. The longer the averaging time, the longer the time needed until the SpO2 value reflects the physiological event.
Pleth Wave 10 Monitoring SpO2 CAUTION If you measure SpO2 on a limb that has an inflated NBP cuff, a non-pulsatile SpO2 INOP can occur. If the monitor is configured to suppress this alarm there may be a delay of up to 60 seconds in indicating critical patient status, such as sudden pulse loss or hypoxia. Alarm Delays There is a delay between a physiological event at the measurement site and the corresponding alarm at the monitor.
10 Monitoring SpO2 Perfusion Numeric minimum size for reliable SpO2 value Perfusion Numeric The perfusion numeric (Perf) gives a value for the pulsatile portion of the measured signal caused by the pulsating arterial blood flow. As pulse oximetry is based on the pulsatile nature of the signal, you can also use the perfusion numeric as a quality indicator for the SpO2 measurement. Above 1 is optimal, between 0.3-1 is acceptable. Below 0.3 is marginal; reposition the sensor or find a better site.
Setting the QRS Volume 10 Monitoring SpO2 Tone modulation is licensed under US patent US 4,653,498 from Nellcor Puritan Bennett Incorporated. Setting the QRS Volume ♦ In the Setup SpO2 menu, select QRS Volume and set the appropriate QRS tone volume.
10 Monitoring SpO2 150 Setting the QRS Volume
11 11 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.
11 Monitoring NBP Preparing to Measure NBP CAUTION If you spill liquid onto the equipment or accessories, particularly if there is a chance that it can get inside the tubing or the measurement device, contact your service personnel. Measurement Limitations Measurements are impossible with heart rate extremes of less than 40 bpm or greater than 300 bpm, or if the patient is on a heart-lung machine.
Preparing to Measure NBP 11 Monitoring NBP 2 Plug the air tubing into the red NBP connector. Avoid compression or restriction of pressure tubes. Air must pass unrestricted through the tubing. 3 Make sure that you are using a Philips-approved correct sized cuff and that the bladder inside the cover is not folded or twisted. A wrong cuff size, and a folded or twisted bladder, can cause inaccurate measurements. The width of the cuff should be in the range from 37% to 47% of the limb circumference.
11 Monitoring NBP Starting and Stopping Measurements During measurements the cuff pressure is displayed instead of the units and the repeat time. An early systolic value gives you a preliminary indication of the systolic blood pressure during measurement. Starting and Stopping Measurements Use the Setup menu or SmartKeys to start and stop measurements.
Switching Pulse from NBP On/Off 11 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.
11 Monitoring NBP Calibrating NBP Venous puncture measurement mode Cuff pressure NBP VP 01:45 Time left in venous puncture mode (60) Calibrating NBP NBP is not user-calibrated. Cuff-pressure transducers must be verified and calibrated, if necessary, at least once every two years by a qualified service professional. See the Service Guide for details.
12 Monitoring Temperature 12 WARNING Measurements from an MMS extension connected to the monitor are not available when the monitor is running on battery power. They are only available when the monitor is powered by the external power supply (M8023A). You can measure temperature using the built-in temperature measurement (optional), or one of the MMS extensions. Temp measurement automatically switches on when you connect a probe. You can switch the measurement off manually.
12 Monitoring Temperature Calculating Temp Difference WARNING Make sure you set alarm limits for the correct label. The alarm limits you set are stored for that particular label only. Changing the label may change the alarm limits. Selecting a Temperature for Monitoring Tell the monitor which temperature you want to monitor by selecting its temperature label. The label is a unique identifier for each type of temperature.
13 13 Monitoring Invasive Pressure WARNING Measurements from an MMS extension connected to the monitor are not available when the monitor is running on battery power. They are only available when the monitor is powered by the external power supply (M8023A). CAUTION Do not use the MP2 in combination with other monitors using an M1006A pressure module and the HP1290A pressure transducer. This may cause interference on the respiration or invasive pressure signals.
13 Monitoring Invasive Pressure Setting up the Pressure Measurement 4 Connect the pressure line to the patient catheter. 5 If you are using an infusion pressure cuff with the pressure line, attach the pressure cuff to the fluid to be infused. Inflate it according to your standard hospital procedure, then start the infusion. 6 Position the transducer so that it is level with the heart, approximately at the level of the midaxillary line.
Zeroing the Pressure Transducer 13 Monitoring Invasive Pressure Zeroing the Pressure Transducer To avoid inaccurate pressure readings, the monitor requires a valid zero. Zero the transducer in accordance with your hospital policy (at least once per day). You must perform a zero: • when you use a new transducer or tubing • every time you reconnect the transducer cable to the monitor • if you think the monitor’s pressure readings are not correct.
13 Monitoring Invasive Pressure Adjusting the Calibration Factor Zeroing All Pressures Simultaneously WARNING Before zeroing all pressures, make sure that all pressure transducers are vented to atmospheric pressure. If you are measuring pressures with more than one measuring device, using the Zero Press SmartKey to initiate the zeroing calls up a list of all active pressures. Select the pressure you want to zero or select All Press to zero all pressures simultaneously.
Changing the Pressure Wave Scale 13 Monitoring Invasive Pressure Changing the Pressure Wave Scale 1 Select the label of the pressure wave whose scale you want to set to enter the Setup menu. 2 In the Setup menu, (for example ABP) select Scale. 3 Select a value from the pop-up list: – a positive value sets the top gridline. The bottom gridline is set at zero. – a negative value sets the bottom gridline. The middle gridline is set at zero.
13 Monitoring Invasive Pressure Choosing the Pressure Alarm Source Extreme Alarm Limits The extreme pressure alarms, Extreme High and Extreme Low, can be made available for your monitor in Configuration Mode and are additional to the standard High and Low limit alarms. They are generated by the active pressure alarm source, and are setup in Configuration Mode by adding a set value (the ' value) to the high and low alarm limits. This value can be set for each pressure label individually.
Calibrating Reusable Transducer CPJ840J6 13 Monitoring Invasive Pressure Calibrating Reusable Transducer CPJ840J6 Depending on your monitor’s configuration, you may be able to perform a calibration in monitoring mode. Perform a mercury calibration when you use a new transducer, and at regular intervals according to your hospital policy. You require: • standard sphygmomanometer. • sterile 10cc syringe with heparinised solution. • 3-way stopcock. • approximately 25cm of tubing.
13 Monitoring Invasive Pressure Calculating Cerebral Perfusion 5 Select the calibration pressure from the list, for example 200 mmHg. 6 Select Confirm to recalculate the calibration factor using the applied pressure. 7 When the monitor displays calibration done at , remove the manometer tubing, syringe and extra stopcock. We recommend you replace the transducer dome and tubing with sterile ones. 8 Label the transducer with the calibration factor shown in the Cal.
14 14 Monitoring Carbon Dioxide WARNING • Measurements from an MMS extension connected to the monitor are not available when the monitor is running on battery power. They are only available when the monitor is powered by the external power supply (M8023A). • Only one CO2 measurement at a time is supported. Use the CO2 measurement to monitor the patient’s respiratory status and to control patient ventilation.
14 Monitoring Carbon Dioxide Measuring CO2 using the CO2 Option or M3014A Depending on the Max Hold setting configured for your monitor, the etCO2 numeric shows either the highest CO2 value measured within the configured time period (Max Hold set to 10 sec or 20 sec) or the etCO2 numeric shows breath-to-breath value (Max Hold set to Off).
Measuring CO2 using the CO2 Option or M3014A 14 Monitoring Carbon Dioxide 2 Wait 2 minutes, allowing the sensor to reach its operating temperature and a stable thermal condition. 3 Choose the appropriate airway adapter and connect it to the sensor head. The airway adapter clicks into place when seated correctly. 4 To zero the sensor: – expose the sensor to room air and keep it away from all sources of CO2 including the ventilator, the patient’s breath and your own.
14 Monitoring Carbon Dioxide Measuring CO2 using the CO2 Option or M3014A – expose the sensor to room air and keep it away from all sources of CO2 including the ventilator, the 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.
Measuring Mainstream CO2 using M3016A 14 Monitoring Carbon Dioxide Removing Exhaust Gases from the System WARNING Anesthetics: When using the sidestream CO2 measurement on patients who are receiving or have recently received anesthetics, connect the outlet to a scavenging system, to avoid exposing medical staff to anesthetics. Use an exhaust tube to remove the sample gas to a scavenging system. Attach it to the sidestream sensor at the outlet connector.
14 Monitoring Carbon Dioxide Measuring Mainstream CO2 using M3016A 3 Enter the calibration value printed on the calstick then press Confirm to start calibration. 4 When the message CO2 CAL1 done;Start CAL2 cal appears, put the transducer on the other cell and select Start CAL2 then press Confirm. 5 When you see the message CO2 cal done;leave Cal. Mode, calibration is complete. 6 Select Cal. Mode to switch calibration mode off. You cannot monitor in calibration mode.
Measuring Microstream CO2 using M3015A 14 Monitoring Carbon Dioxide Measuring Microstream CO2 using M3015A The M3015A Microstream CO2 Extension measures the partial pressure of carbon dioxide in a patient’s expired gas using Microstream technology. The measurement is equipped with an automatic barometric pressure compensation.
14 Monitoring Carbon Dioxide Setting up all CO2 Measurements Disconnect the FilterLine during suctioning and nebulizing therapies. Check the table in the Microstream CO2 Accessories section of the Accessories chapter for typical usage times for the different Microstream accessories. CO2 values for non-intubated patients using Microstream accessories will always tend to be lower than for intubated patients.
Setting up all CO2 Measurements 14 Monitoring Carbon Dioxide 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. Humidity At installation, the monitor is configured to automatically apply either Body Temperature Pressure Saturated (BTPS) or Ambient Temperature Pressure Dry (ATPD).
14 Monitoring Carbon Dioxide Setting up all CO2 Measurements To change the imCO2 high limit: ♦ Select imCO2 High and choose the high alarm limit from the pop-up list that opens. Changing the Apnea Alarm Delay This determines the time limit after which the monitor alarms if the patient stops breathing. 2 In the Setup CO2 menu, select awRR. In Setup awRR menu, select Apnea. 3 Choose the apnea alarm delay time.
15 15 Assigning Two Devices to One Patient It is possible to assign a monitor and a telemetry device to the same patient, resulting in the information from both devices being combined in one sector at the Information Center. This is called “pairing” and when a telemetry device and a monitor are paired, the measurement data from the telemetry device will be displayed on the monitor screen. A telemetry device can be: • any Philips telemetry device (only for indirect connections, see below).
15 Assigning Two Devices to One Patient TELE INOP Delayed * TELE ALARM ** HR 140>120 SOME ECG ALRMS OFF %SpO2T HR NBP How Can You Combine Devices? Auto 10 min Sys. Telemetry data window etCO2 imCO2 WARNING All data presented in the telemetry data window are delayed for several seconds. If you need realtime data, for example for defibrillation, always use the monitor ECG instead of telemetry.
How Can You Combine Devices? 15 Assigning Two Devices to One Patient • Controls on the Telemetry Device (e.g. nurse call) will be inactive when the device is directly connected to the monitor except in the case when the monitor has no network connection and data are transferred via the telemetry device. See the "Enhancing Telemetry Monitoring with the Monitor" chapter.
15 Assigning Two Devices to One Patient How Can You Combine Devices? Correct channel configuration is important, refer to the Configuration Guide for details. If a TELE DISCONNECT INOP occurs when the telemetry device goes out-of-range, the INOP will disappear (without being silenced) as soon as the ECG signal from the telemetry device is available at the Information Center via standard telemetry transmission.
Functions Available When the Telemetry Data Window is Displayed 15 Assigning Two Devices to One Patient Functions Available When the Telemetry Data Window is Displayed Controlling the Telemetry Device from the Bedside You can change settings for a paired telemetry device at the monitor: 1 Select the telemetry data screen element 2 Select the Setup Tele pop-up key The Setup Telemetry menu will appear with the settings available for the telemetry device.
15 Assigning Two Devices to One Patient Functions Available For Devices Connected Via SRR Functions Available For Devices Connected Via SRR Telemetry Device Tele 1 The Telemetry Device window can be opened from the Measurement Selection window, by selecting the Tele pop-up key, or via Main Setup -> Telemetry Device.
General Telemetry-related Functions 15 Assigning Two Devices to One Patient ECG Source Tracking at the Information Center The Information Center continuously checks whether a valid ECG signal is coming from the monitor or the telemetry device. If you unplug the ECG patient cable from the monitor and plug it into the telemetry device, the Information Center will automatically switch to monitoring the ECG from the telemetry device.
15 Assigning Two Devices to One Patient General Telemetry-related Functions If later the patient is disconnected from the telemetry device, and reconnected to the monitor again, any changes in the settings made in the meantime will be passed on to the monitor. In this way, settings continuity is preserved when the ECG source changes. Settings synchronization can only take place when there is no patient information mismatch between the monitor and the Information Center.
16 Enhancing Telemetry Monitoring with the Monitor 16 You can use a monitor without a network connection to view measurement data from a telemetry transceiver at the bedside. You can also use the monitor to make additional measurements and send this measurement data to the Information Center via the telemetry transceiver. The monitor can so be used as a mobile viewer and measurement device, and is set up to simplify the assign/unassign procedures when used with short range radio.
16 Enhancing Telemetry Monitoring with the Monitor 186
17 17 Trends Trends are patient data collected over time and displayed in graphic or tabular form to give you a picture of how your patient’s condition is developing. Trend information is stored in the trends database for continuously-monitored measurements, such as ECG, as well as for aperiodicallymeasured parameters, such as Cardiac Output. Viewing Trends Trend information can be viewed embedded as a screen element on specially-designed Screens, or you can open a trend window over the current Screen.
17 Trends Viewing Trends 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. Print print a graphic trends report of the data in the current window. The report will use the current trend interval settings.
Setting Up Trends 3 17 Trends Place the cursor at a specific time by touching the graph. Viewing Vital Signs Trends Vital Signs: Standard HR SpO2 etCO2 imCO2 RR awRR Aperiodic values are shown with a timestamp Select Interval Select Group Graph Trend Scroll to view more pop-up keys Print The currently-selected column is highlighted. The values can be configured to display in the same colors as the waves and numerics on the realtime display.
17 Trends Setting Up Trends In the expanded view, you can also highlight a measurement to make it more easily visible (for example when multiple ST trends are in one segment). To highlight a measurement, ♦ in the Segment menu, select Highlight repeatedly until the highlight is on the required measurement. To return the segment to its original size, ♦ in the Segment menu, select Expand again.
Setting Up Trends 17 Trends 1 Select Main Setup -> Trends -> Trend Groups 2 Select the Trend Group you want to change and use the pop-up keys to Add, Change, or Delete the selection of measurements trended. To temporarily change the order in which the measurements are displayed in a group, 1 Select Main Setup -> Trends -> Trend Groups 2 Select the Trend Group and then the measurement you want to move and use the Sort Up/ Sort Down pop-up keys.
17 Trends Documenting 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. This sample ABP trend shows the continuouslymeasured values for the systolic, diastolic and mean pressures displayed in band form.
Screen Trends 17 Trends - 48 hours - 24 hours -4 hours now time 4 hours @12 second resolution 24 hours @ 1 minute resolution 48 hours @ 5 minute resolution Aperiodic Trends Database Aperiodic trends do not count toward the maximum number of trends allowed by the trend configuration. Trend data for aperiodic measurements is stored in a separate database and timestamped with the measurement time.
17 Trends Screen Trends SBed9 HR Adult SpO2 ALARMS OFF Perf Arrhythmia Off Measurement wave M NBP 1mV Auto 15 min Measurement numerics Temp Sys. NBPs 65 -60min -30min NBPs 65 -30min -60min NBP graphical screen trend ABP 240 50 Example of other graphical screen trends: ABP SBed9 HR Adult Pulse ALARMS OFF SpO2 Arrhythmia Off Measurement wave M NBP 1mV Auto 15 min Temp NBP Sys.
Screen Trends 17 Trends Setting the Screen Trend Time To set the ScreenTrend Time for all graphical, histogram and horizon screen trends (“global” trend time), 1 Select a screen trend then select Setup Trend, or select Main Setup -> Trends. 2 Select ScreenTrend Time and select the required time: 30 minutes, one, two, four, eight, or twelve hours. This is now the Global screen trend time and defines the period of trend information shown for all screen trends.
17 Trends Screen Trends NBP Sys. Horizon View The horizon view presents trend information superimposed over a defined baseline or base range. This helps you visualize changes in your patient’s condition since the baseline was set. The horizon view is made up of: 1 2 • a horizon, drawn in white, as a reference point or baseline to help you visualize changes in your patient’s condition.
Screen Trends 17 Trends 2 Select Set Scale Delta and select a value to define the distance between the horizon and the upper and lower scale limits. Be aware that changing the horizon trend scale can change the angle of the trend indicator, without the patient’s condition having changed. If a measurement exceeds the outer limits of the scale, the wave will be clipped and you must either reset the horizon or the horizon trend scale to display the values outside the scale limits.
17 Trends 198 Screen Trends
18 18 Recording Central For central recording from the bedside, your monitor must be connected via a network to an Recording Information Center. You can use either the M1116B 2-Channel Recorder or the standalone M3160A 4-Channel Recorder. See the documentation supplied with the Information Center for information on the 4-Channel Recorder. Starting and Stopping Recordings The recordings pop-up keys let you start and stop recordings.
18 Recording Overview of Recording Types Overview of Recording Types Delayed Type of recording manual Alarm Realtime (RT) automatic, triggered by defined alarm conditions manual central Recording Destination central central printer Information recorded from the start trigger minus the delay time from the start trigger minus the delay time N/A from the start trigger Number of waves up to 2 up to 2 N/A up to 2 Speed 50, 25, 6.25 mm/sec 25 mm/sec N/A 50, 25, 6.
Recorder Status Messages 18 Recording – Secondary Lead will always record the current secondary lead in the chosen recorder channel • Overlap: define whether the recorded waveforms will be printed overlapping or beside each other. • Speed: choose the recording print speed. • Delay Time: Delayed recordings start documenting on the recorder strip from a pre-set time before the recording is started. This interval is called the “Delay Time” and can be set as specified in the table on page 200.
18 Recording 202 Recorder Status Messages
19 19 Printing Patient Reports Starting Report Printouts Most patient reports can be printed by selecting Main Setup - > Reports (or the Reports SmartKey) and then selecting the report name in the top half of the Reports menu. Report names are shown only for reports that have been correctly set up. Data from the time of the print request is printed, even if the print job is delayed in the printer queue.
19 Printing Patient Reports Stopping Reports Printouts Report types Report contents How to start printing reports Alarm Limits Report Graphic and numeric report of all current alarm limits In the Alarm Limits window, select Print Realtime Reports Patient data and numerics, and either: all displayed waves OR all measured waves OR all measured RT waves Limits Select the Realtime Reports SmartKey, if configured In the Battery Status window, select Print Status.
Setting Up Individual Print Jobs 19 Printing Patient Reports To set up Vital Signs and Graphic Trend reports, 1 Select Main Setup -> Reports -> Vital Signs Rep. or Graph Trend Rep. 2 Select Trend Group and select the group you want to print on the report. The groups available depend on your monitor’s trend configuration. 3 Select Period and select the period of time for which trend data should be printed on the report.
19 Printing Patient Reports Checking Printer Settings 2 Select Report and then select the report you want to set up. 3 Select Report Type and then select the reports template you want the report selected in Step 2 to use. The selection of templates listed depends on the report type selected. Each template includes patient demographic data, and each Realtime Report also includes alarm and INOP information.
Dashed Lines on Reports 2 19 Printing Patient Reports Select Printer Status to toggle between the settings Enabled and Disabled. If you set this to Disabled, no reports will be printed to the named printer. If the monitor detects that no printer of a particular type is available, the Enabled/Disabled setting will automatically be set to Disabled and “grayed out”.
19 Printing Patient Reports Printer Status Messages • Request date and time • Report paper format • Job status: Preparing, Printing, Waiting, In Database, In Companion, Retry, Cancelling, Error Individual reports can be deleted from the list with the Delete Report key, and all reports with the Delete All Reps key. CAUTION The reports job list includes privacy information, in the form of the patient name with the related report title and date.
Sample Report Printouts Printer Status Message 19 Printing Patient Reports Possible causes and suggested action NoPrinter ;job susp printing when the printer becomes available. Print Database full->job suspnd. The requested report does not fit into the print database.
19 Printing Patient Reports Sample Report Printouts Alarm Limits Report Doe, John NBed6 Alarm Limits 123456789-P1 19 Apr 07 15:59:37 HR ST-aVF ST-V6 ST-I ST-V1 SpO2 ST-II ST-V2 NBPs ST-III ST-V3 ABPs ST-aVR ST-V4 RR ST-aVL ST-V5 Apnea Time 20 sec Measurement labels, with alarms off symbol where alarms are switched off Graphic view of current alarm limits in relation to currently monitored measurement value Realtime Report Patient demographic information, time stamp Active Alarms an
Sample Report Printouts 19 Printing Patient Reports ECG Reports Patient information Numeric block Wave area Below the header on ECG Reports, the numeric block shows the current HR, PVC, and ST values. The wave area shows the printed waves for all available ECG leads. A 1 mV calibration bar is printed at the beginning of each wave. With the 3X4, 6X2, and 2X4 formats, a rhythm stripe prints a longer section of the ECG wave from the primary ECG lead for ECG rhythm evaluation.
19 Printing Patient Reports 212 Sample Report Printouts
20 20 Care and Cleaning Use only the Philips-approved substances and methods listed in this chapter to clean or disinfect your equipment. Warranty does not cover damage caused by using unapproved substances or methods. Philips makes no claims regarding the efficacy of the listed chemicals or methods as a means for controlling infection. Consult your hospital’s Infection Control Officer or Epidemiologist.
20 Care and Cleaning Cleaning the Monitor 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.
Cleaning, Sterilizing and Disinfecting Monitoring Accessories 20 Care and Cleaning Cleaning, Sterilizing and Disinfecting Monitoring Accessories To clean, disinfect and sterilize reusable transducers, sensors, cables, leads, and so forth, refer to the instructions delivered with the accessory. Cleaning Batteries and the Battery Compartment Wipe with a lint-free cloth, moistened with warm water (40°C/104°F maximum) and soap. Do not use strong solvents. Do not soak the battery.
20 Care and Cleaning 216 Cleaning Batteries and the Battery Compartment
21 21 Using Batteries When monitoring a patient, one Philips M4607A rechargeable Lithium Ion battery must always be inserted into the battery compartment on the right side of the monitor. This applies even when you are running the monitor from the external power supply. The battery seals the battery compartment, thereby preventing the ingress of fluids or foreign bodies.
21 Using Batteries Battery Power Indicators Battery Power Indicators The battery LED and battery status information on the Main Screen, in combination with INOP messages and prompts, help you keep track of the battery power status. The indicators always show the remaining capacity in relation to the battery’s actual maximum capacity, which may lessen as the battery ages. You can see the actual capacity in the Battery Status window.
Battery Power Indicators 21 Using Batteries Battery status/malfunction indicator: Normal battery function is indicated by the battery power gauge, together with the remaining operating time, on the Main Screen. You are informed of problems or changes in the status of the battery by the battery status/malfunction indicator. This consists of a blank battery gauge containing a symbol. If the symbol is red, this indicates a critical situation.
21 Using Batteries Checking Battery Charge TimeToEmpty tells you approximately how long you can continue to use the monitor with this battery. Note that this time fluctuates depending on the system load (the display brightness and how many measurements you carry out), the age of the battery, and the remaining capacity of the battery.
Optimizing Battery Performance 21 Using Batteries Battery eject button The INOP !!INSERT BATTERY is suppressed for 15 seconds, allowing you sufficient time to load a new battery. 2 Remove the battery from the compartment. 3 Slide the new battery into position with the contacts facing downwards. It should ‘click’ into position when it is fully inserted. Click! Optimizing Battery Performance The performance of rechargeable batteries may deteriorate over time.
21 Using Batteries Battery Safety Information Charging a Battery A battery can be charged in a monitor during monitoring. You can also use the M8043A Smart Battery Charger to charge batteries. 1 Insert the battery into a monitor connected to the external power supply (M8023A). 2 Charge the battery until it is full, the battery LED goes out, and the battery power gauge is filled. In certain situations, internal temperature conditions may mean that the battery will not charge.
Battery Safety Information 21 Using Batteries Dispose of used batteries promptly and in an environmentally-responsible manner. Do not dispose of the battery in normal waste containers. Consult your hospital administrator to find out about local arrangements. CAUTION Do not disassemble, heat above 100°C (212°F) or incinerate the batteries, to avoid the risk of fire and burns. Keep batteries out of the reach of children and in their original package until you are ready to use them.
21 Using Batteries 224 Battery Safety Information
22 22 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.
22 Maintenance and Troubleshooting Maintenance Task and Test Schedule Maintenance Task and Test Schedule The following tasks are for Philips-qualified service professionals only. All maintenance tasks and performance tests are documented in detail in the service documentation supplied on the monitor documentation CD. Ensure that these tasks are carried out as indicated by the monitor’s maintenance schedule, or as specified by local laws.
Troubleshooting 22 Maintenance and Troubleshooting Troubleshooting If you suspect a problem with an individual measurement, read the Instructions for Use and doublecheck that you have set up the measurement correctly. If you suspect an intermittent, system-wide problem call your service personnel. You may be asked for information from the status log. To view the status log, 1 In the Main Setup menu, select Revision. 2 View the status log by selecting Status Log from the Monitor Revision window.
22 Maintenance and Troubleshooting 228 Disposing of Empty Calibration Gas Cylinders
23 23 Accessories 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.
23 Accessories ECG/Resp Accessories 3-Electrode Cable Sets Description Length AAMI Part No. IEC Part No. OR Grabber shielded 1.0m M1675A M1678A ICU Grabber shielded 1.0m M1671A M1672A ICU snap shielded 1.0m M1673A M1674A ICU Clip non-shielded 0.45m M1622A -- ICU Clip non-shielded 0.7m M1624A M1626A 5-Electrode Cable Sets Description Length AAMI Part No. IEC Part No. OR Grabber shielded 1.0m/1.6m M1973A M1974A ICU Grabber shielded 1.0m/1.
ECG/Resp Accessories 23 Accessories One-piece Cables Description Length AAMI Part No. IEC Part No. 3-lead Grabber, ICU 1.0m 989803143181 989803143171 5-lead Grabber, ICU 1.0m 989803143201 989803143191 Radio-translucent Cables Pack of five single wires, radio-translucent, 0.9m, M1649A Set Combiners and Organizers Set combiners and organizers Part No.
23 Accessories ECG/Resp Accessories 3-Electrode Cable Sets Description Length AAMI Part No. IEC Part No. OR 1.0m M1601A M1611A ICU Grabber shielded 1.0m M1603A M1613A ICU snap shielded 1.0m M1605A M1615A ICU Clip non-shielded 0.45m M1608A M1618A ICU Clip non-shielded 0.7m M1609A M1619A 5-Electrode Cable Sets Description Length AAMI Part No. IEC Part No. OR Grabber shielded 1.0m/1.6m M1621A M1631A ICU Grabber shielded 1.0m/1.6m M1623A M1633A ICU Snap shielded 1.0m/1.
NBP Accessories 23 Accessories NBP Accessories These cuffs and tubings are designed to have special protection against electric shocks (particularly regarding allowable leakage currents), and are defibrillator proof. You can use them during electrosurgery. Adult/Pediatric Multi-Patient Comfort Cuffs and Disposable Cuffs Patient Category Limb Bladder Circumference Width Disposable cuff Part No. Reusable cuff Part No.
23 Accessories Invasive Pressure Accessories Adult/Pediatric Soft Single Patient Single-Hose Disposable Cuffs Patient Category Limb Circumference Bladder (cm) Width Part No. Tubing Adult (Thigh) 45 - 56.5 cm 20.4 cm M4579A Large Adult X-Long 35.5 - 46 cm 16.4 cm M4578A M1598B (1.5m) or Large Adult 35.5 - 46 cm 16.4 cm M4577A M1599B (3m) Adult X-Long 27.5 - 36.5 13.1 cm M4576A Adult 27.5 - 36.5 cm 13.1 cm M4575A Small Adult 20.5 - 28.5 cm 10.4 cm M4574A Pediatric 15.0 - 21.
SpO2 Accessories 23 Accessories SpO2 Accessories Some Nellcor sensors contain natural rubber latex which may cause allergic reactions. See the Instructions for Use supplied with the sensors for more information. M1901B, M1902B, M1903B and M1904B disposable sensors are not available in USA from Philips. Purchase Nellcor sensors and adapter cables directly from Tyco Healthcare. Do not use more than one extension cable with any sensors or adapter cables.
23 Accessories SpO2 Accessories Product Number Description M1191T Adult sensor (0.45m cable), for Requires M1943 patients over 50 kg. Any finger, except (1 m) or M1943AL thumb. (3 m) adapter cable M1192T Small adult, pediatric sensor (0.45m cable) for patients between 15 kg and 50 kg. Any finger except thumb. M1193T Neonatal sensor (0.9m cable) for patients between 1kg and 4 kg. Hand or foot. M1196T Adult clip sensor (0.9m cable) for patients over 40 kg. Any finger except thumb.
SpO2 Accessories 23 Accessories Product Number Description Comments M1132A Infant finger or toe sensor, 0.9m cable Use adapter cable M1943A or (patient size 3 - 10 kg) M1943AL. M1133A Use adapter cable Adult/Infant/Neonatal, 0.9m cable M1943A or Foot or hand for neonates < 3 kg Big toe or thumb for patients between M1943AL.
23 Accessories SpO2 Accessories Product Number Description Comments OC-3 Adapter Cable for OxiCliq sensors Available from Nellcor only. Product Number Description Philips Part Number MASIMO LNOP reusable sensors. LNOP DC-I LNOP DC-IP LNOP YI LNOP TC-I Adult Finger Sensor (> 30 kg) Pediatric Finger Sensor (10 - 50 kg) Multi-site Sensor (> 1 kg) Ear Sensor (> 30 kg) MASIMO LNCS reusable sensors.
Temperature Accessories 23 Accessories The monitor uses Masimo certified pulse oximetry for reduced noise and low perfusion performance with Masimo Sensors under the Masimo NR&LP protocol available from Masimo Temperature Accessories Temperature Probes Part No.
23 Accessories Sidestream CO2 Accessories Sidestream CO2 Accessories Description Part No.
Battery Accessories 23 Accessories • “Smart CapnoLine O2” is a combined oral-nasal-O2-CO2 FilterLine. • “NIV Line” is a nasal FilterLine suitable for mask ventilation (for example, C-PAP). • “Single purpose” means CO2 measurement only, “dual purpose” means CO2 measurement and O2 delivery. • The accessories are supplied in packs of 25.
23 Accessories 242 Battery Accessories
24 24 Specifications Intended Use The monitor is intended to be used for monitoring and recording of, and to generate alarms for, multiple physiological parameters of adults, pediatrics, and neonates in a hospital environment and during patient transport inside and outside of the hospital environment. The monitor is intended for use by health care professionals. The monitor is only for use on one patient at a time. It is not intended for home use. Not a therapeutic device. Rx only: U.S.
24 Specifications Symbols Philips Medizin Systeme Boeblingen GmbH Hewlett-Packard-Str. 2 71034 Boeblingen Germany Visit our website at: www.philips.com. © Copyright 2002 - 2008. Koninklijke Philips Electronics N.V. All Rights Reserved. Trademark Acknowledgement The following are trademarks of Nellcor Puritan Bennett Incorporated: Nellcor®, Durasensor®, DuraY®, Oxiband®, Oxicliq®, OxiMax®. MAX-FAST® is a trademark of Mallinckrodt Inc.
Installation Safety Information 24 Specifications Symbols Silence Alarms ECG connector LAN connection indicator for connection to a wired network Monitor supports 12lead ECG Alarms Alarms Off Error LED IntelliVue Instrument Telemetry wireless network 200206 Identifies year and month of manufacture Always use separate collection for waste electrical and electronic equipment (WEEE) built-in short range radio interface built-in wireless network Installation Safety Information WARNING If multiple
24 Specifications Altitude Setting • Always connect the ECG sync cable first to the external device and then to the monitor. Wherever possible, pre-install the cable before the patient is brought into the vicinity of the equipment. Altitude Setting Altitude affects CO2 measurements. The monitor must be configured at installation to the correct altitude. Monitor Safety Specifications 0366 The monitor complies with the Medical Device Directive 93/42/EEC.
Out-Of-Hospital Transport - Standards Compliance 24 Specifications The MP2 including the Wireless IntelliVue Adapter - FCC and Industry Canada Radio Compliance: This device complies with Part 15 of the FCC Rules and RSS-210 of Industry Canada. Operation is subject to the following two conditions: (1) this device may not cause harmful interference, and (2) this device must accept any interference received, including interference that may cause undesired operation.
24 Specifications Out-Of-Hospital Transport - Standards Compliance can be used in a transport environment such as a road ambulance, airplane or helicopter. For this purpose the monitor fulfils the following additional mechanical, EMC and environmental requirements: • Shock Tests according to IEC TR 60721-4-7, Class 7M3. Test procedure according to IEC/EN 60068-2-27 (peak acceleration up to 100 g). • Random Vibration according to IEC TR 60721-4-7, Class 7M3.
Out-Of-Hospital Transport - Standards Compliance 24 Specifications Physical Specifications Specification Comments Maximum Weight 1.25 kg including battery, without options (2.8 lb) Size (W x H x D) 188 x 99 x 86 mm 7.4 x 3.9 x 3.4 in without handle and options M8023A External Power Supply Weight and Dimensions Maximum Weight 700 g ±10% (1.5 lb ±10%) Size (W x H x D) 207 x 70 x 113 mm 8.1 x 2.8 x 4.
24 Specifications Monitor Performance Specifications Item Condition Range Altitude Range Operating -500 m to 3000 m (10000 ft) Storage including transportation -500 m to 4600 m1 (15000 ft) Monitor IP32 (protected against ingress of water when the water is dripping vertically and the monitor is tilted up to 15°) Ingress Protection External Power Supply IP31(protected against the ingress of solid foreign objects 2.
Monitor Performance Specifications 24 Specifications Performance Specifications Alarm signal Review Alarms Real Time Clock Buffered Memory System delay less than 3 seconds Pause duration 1,2,3 minutes or infinite, depending on configuration Extended alarm pause 5 or 10 minutes Information all alarms / inops, main alarms on/off, alarm silence and time of occurrence Capacity 300 items Range from: January 1, 1997, 00:00 to: December 31, 2080, 23:59 Accuracy <4 seconds per day (typically) Ho
24 Specifications Monitor Performance Specifications Monitor Interface Specifications Wireless Network Device Interface (integrated, for compatible network options see below) Signals RD+/-, TD+/-: IEEE 802.3 10Base-T, PWR, GND 12.5 V ±20%, 3.5 W continuous Frequency Band USA: 2.400 – 2.483GHz, 5.15 ~ 5.35Ghz, 5.725 ~ 5.825Ghz Europe: 2.400 – 2.483GHz, 5.15~ 5.35Ghz, 5.47 ~ 5.725Ghz Japan: 2.400 – 2.483GHz, 4.90 – 5.091GHz, 5.15 – 5.25GHz China: 2.400 – 2.483GHz, 5.725 ~5.
M4607A Battery Specifications 24 Specifications Compatible Devices IntelliVue Instrument Telemetry Wireless Network (USA only) Internal WMTS Adapter Technology compatible with Philips Cellular Telemetry System (CTS), cellular infrastructure Frequency Band WMTS, 1395-1400 MHz and 1427-1432 MHz IntelliVue Instrument Telemetry Wireless Network (except USA) Internal ISM Adapter Technology compatible with Philips Cellular Telemetry System (CTS), cellular infrastructure Frequency Band 2.
24 Specifications Measurement Specifications Measurement Specifications See the Appendix on Default Settings for a list of the settings the monitor is initially shipped with. ECG/Arrhythmia/ST/QT Complies with IEC 60601-2-25:1993 + A1:1999 /EN60601-2-25:1995 + A1:1999, IEC 60601-227:2005/EN60601-2-27:2006, IEC 60601-2-51:2003 /EN 60601-2-51:2003 and AAMI EC11/ EC13:1991/2002.
Measurement Specifications 24 Specifications ECG/Arrhythmia/ST Performance Specifications Bandwidth Diagnostic Mode when the ECG is Extended transmitted from a Monitoring Mode telemetry device via short Monitoring Mode range radio Filter Mode Adult/neo/pedi: 0.05 to 40 Hz Neo/pedi: 0.5 to 40 Hz Adult: 0.5 to 40 Hz Neo/pedi: 0.5 to 40 Hz Adult/neo/pedi: 0.
24 Specifications Measurement Specifications ECG/Arrhythmia/ST Supplemental Information as required by AAMI EC11/13 Time to Alarm for Tachycardia Gain 0.5, Range 6.5 to 8.4 seconds, Average 7.2 seconds Vent Tachycardia 1 mVpp,206 bpm Gain 1.0 Range 6.1 to 6.9 seconds, Average 6.5 seconds Gain 2.0, Range 5.9 to 6.7 seconds, Average 6.3 seconds Gain 0.5, Range 5.4 to 6.2 seconds, Average 5.8 seconds Vent Tachycardia 2 mVpp,195 bpm Gain 1.0, Range 5.7 to 6.5 seconds, Average 6.1 seconds Gain 2.
Measurement Specifications 24 Specifications Respiration Alarm Specifications Range Adjustment Delay High Adult/pedi: 10 to 100 rpm Neo: 30 to 150 rpm under 20 rpm: 1 rpm steps max. 14 seconds over 20 rpm: 5 rpm steps Low Adult/pedi: 0 to 95 rpm Neo: 0 to 145 rpm under 20 rpm: 1 rpm steps for limits from 0 to 20 rpm: over 20 rpm: 5 rpm steps max. 4 seconds for limits above 20 rpm: max.
24 Specifications Measurement Specifications SpO2 Complies with EN ISO 9919:2005 (except alarm system; alarm system complies with IEC 60601-249:2001). Measurement Validation: The SpO2 accuracy has been validated in human studies against arterial blood sample reference measured with a CO-oximeter. Pulse oximeter measurements are statistically distributed, only about two-thirds of the measurements can be expected to fall within the specified accuracy compared to CO-oximeter measurements.
Measurement Specifications SpO2 Alarm Specifications 24 Specifications Range Adjustment Delay SpO2 Adult: 50 to 100% Pedi/Neo: 30 to 100% 1% steps (0, 1, 2, 3,... 30) +4 seconds Desat Adult: 50 to Low alarm limit Pedi/Neo: 30 to Low alarm limit 1% steps Pulse 30 to 300 bpm Adult: max.
24 Specifications Measurement Specifications NBP Performance Specifications Cuff Inflation Time Typical for normal adult cuff: Less than 10 seconds Typical for neonatal cuff: Less than 2 seconds Initial Cuff Inflation Pressure Adult: 165 ±15 mmHg Pedi: 130 ±15 mmHg Neo: 100 ±15 mmHg Auto Mode Repetition Times 1, 2, 2.
Measurement Specifications 24 Specifications Invasive Pressure and Pulse Complies with IEC 60601-2-34:2000/EN60601-2-34:2000. Invasive Pressure Performance Specifications Measurement Range Pulse Rate –40 to 360 mmHg Range 25 to 350 bpm Accuracy ±1% Full Range Resolution 1 bpm Input Sensitivity Sensitivity:5 μV/V/mmHg (37.
24 Specifications Measurement Specifications Invasive Pressure Alarm Specifications Range Tachycardia Adjustment Difference to high limit 0 to 5 bpm steps 50 bpm Bradycardia Clamping at 150 to 300 bpm 5 bpm steps Difference to low limit 0 to 50 bpm 5 bpm steps Delay max. 14 seconds max. 14 seconds Clamping at 25 to 100 bpm 5 bpm steps Temp Complies with EN 12470-4:2000. Specified without transducer. Temp Performance Specifications Temp Range –1 to 45qC (30 to 113qF) Resolution 0.1qC (0.
Measurement Specifications 24 Specifications M3015A Microstream CO2 Performance Specifications Rise Time 190 ms for neonatal mode (measured with FilterLine H for neonatal) 240 ms for adult mode (measured with FilterLine H for adult) Sample Flow Rate 50 + 15/-7.
24 Specifications Measurement Specifications M3014A Sidestream CO2 Performance Specifications Warm-up Time 2 minutes with CO2 sensor attached for full accuracy specification Sample Flow Rate 50 ±10 ml/minute Total System Response Time 3 seconds Operating Temperature 0 to 40°C (32 to 100°F) M8102A/M3014A Mainstream and Sidestream CO2 Humidity Correction Factor Either BTPS or ATPD can be selected as the humidity correction factor for the CO2 readings.
Measurement Specifications 24 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 mHg (1 to 12 kPa) imCO2 High 2 to 20 mmHg (0.3 to 3.0 kPa) steps of 1 mmHg (0.1 kPa) M8102A/M3014A/M3016A: less than 14 seconds M3015A: less than18 seconds. awRR High Adult/pedi: 10 to 100 rpm Neo: 30 to 150 rpm M8102A/M3014A/M3016A: less than 14 seconds M3015A: less than18 seconds.
24 Specifications Safety and Performance Tests Safety and Performance Tests You must observe any national regulations on the qualification of the testing personnel and suitable measuring and testing facilities. See the maintenance section for a list of required tests. Safety and performance tests, and what to do if the instrument does not meet these specifications are described in the Installation and Service guide.
Safety and Performance Tests 24 Specifications WARNING The monitor should not be used next to or stacked with other equipment. If you must stack the monitor, you must check that normal operation is possible in the necessary configuration before you start monitoring patients. Electromagnetic Immunity The monitor is suitable for use in the specified electromagnetic environment. The user must ensure that it is used in the appropriate environment as described below.
24 Specifications Safety and Performance Tests Portable and mobile RF communications equipment should be used no closer to any part of the monitor, including cables, than the recommended separation distance calculated from the equation appropriate for the frequency of the transmitter. Field strengths from fixed RF transmitters, as determined by an electromagnetic site survey, should be less than the compliance level in each frequency range.
Safety and Performance Tests 24 Specifications Recommended separation distances from portable and mobile RF communication equipment The monitor is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled.
24 Specifications 270 Safety and Performance Tests
25 25 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 preconfigured to your requirements, the settings at delivery will be different from those listed here.
25 Default Settings Appendix Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Islands Cocos Keeling Islands Colombia Comoros Congo Congo, Democratic Republic of the Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic
Country-Specific Default Settings Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia, The Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See, Vatican City State Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People’s
25 Default Settings Appendix Liberia Libyan Arab.
Country-Specific Default Settings Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Serbia & Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen
25 Default Settings Appendix Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine UK United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands (British) Virgin Islands (US) Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe 276 Country-Specific Default Settings 50 60 60 60 60 60 50 50 50 60 60 50 60 60 60 50 50 60 60 50 50 60 60 kg lb kg lb lb lb kg kg kg lb lb kg lb lb lb kg kg lb lb kg
Alarm and Measurement Default Settings 25 Default Settings Appendix Alarm and Measurement Default Settings Settings are only entered once per table row if they are the same for all patient categories1. Alarm Default Settings Alarm Settings Factory Default Alarm Volume 5 Alarms Off 2 min. Pause Al. 5min Enabled Pause Al.
25 Default Settings Appendix ECG, Arrhythmia, ST and QT Default Settings ECG, Arrhythmia, ST and QT Default Settings Factory Defaults ECG Settings Adult Pedi Neo 120 bpm 160 bpm 200 bpm Low Limit 50 bpm 75 bpm 100 bpm Alarms On Alarm Source Auto High Limit ECG On QRS Volume 1 Primary Lead II Secondary Lead V Analysis Mode Multi-lead Lead Placement Standard Mod.
ECG, Arrhythmia, ST and QT Default Settings 25 Default Settings Appendix Factory Defaults Arrhythmia Settings Adult Vent Rhythm 14 SVT HR 180 SVT Run 5 PVCs/min 10 Non-Sustain On Vent Rhythm On Run PVCs On Pair PVCs On R-On-T PVCs On V.Bigeminy On V.Trigeminy On PVCs/min On Multif. PVCs On Pacer N. Cap On Pacer N.
25 Default Settings Appendix ECG, Arrhythmia, ST and QT Default Settings Factory Defaults Lead-independent ST Settings Adult ST Alarm Mode Single ST Alarms On ST Analysis On ST-Index On ISO Point -80 ms J Point 48 ms ST Point J+60 Lead I, II, III, V, aVR, aVL, aVF, V1-6, MCL Settings ST(Label) Pedi Neo Off Factory Defaults Factory Adult Factory Pedi On Off Factory Neo For Alarm Mode = Single-ST ST(Label) High +2.0 mm ST(Label) Low -2.
Pulse Default Settings 25 Default Settings Appendix Pulse Default Settings Factory Defaults Pulse Settings Adult Alarms Source Pedi Neo Pedi Neo Auto Pulse (Label) On System Pulse SpO2 Alarms Off Enabled Alarm Source Sel.
25 Default Settings Appendix SpO2 Default Settings SpO2 Default Settings Factory Defaults SpO2 Settings Adult Alarms On QRS Volume 1 Tone Modulation Yes Tone Mod. Type Enhanced Pedi Speed 25 mm/s Perfusion On Average 10 sec NBP Alarm Suppr. On Extd.
NBP Default Settings 25 Default Settings Appendix NBP Default Settings Factory Defaults NBP Settings Adult Mode Pedi Auto Neo Manual Alarms from Sys.
25 Default Settings Appendix Invasive Pressure Default Settings Factory Defaults ABP, ART, Ao, BAP, FAP, P, P1, P2, P3, Adult P4, UAP Settings Pedi Neo 'Extreme High 15 10 5 'Extreme Low 15 10 5 High Clamp 190/100 (125) 140/80 (100) 105/75 (75) Low Clamp 80/45 (65) 60/35 (45) 45/15 (30) Scale 150 100 100 Speed 25 mm/s Mean Only No Filter 12 Hz Mercury Cal. Yes Artifact Suppr.
Invasive Pressure Default Settings PAP Settings 25 Default Settings Appendix Factory Defaults Adult Pedi Neo Alarms from Dia. High Limit 34/16 (20) 60/4 (26) 60/4 (26) Low Limit 10/0 (0) 24/-4 (12) 24/-4 (12) Alarms On Extreme Alarms Enabled Enabled Enabled 'Extreme High 5 5 5 'Extreme Low 5 5 5 High Clamp 45/20 (25) 65/5 (35) 65/5 (35) Low Clamp 5/-5 (-5) 15/-5 (5) 15/-5 (5) Scale 30 Speed 25 mm/s Mean Only No Filter 12 Hz Mercury Cal. Yes Artifact Suppr.
25 Default Settings Appendix CO2 Default Settings CO2 Default Settings Factory Defaults 286 CO2 Settings Adult etCO2 low 30 etCO2 high 50 imCO2 high 4 CO2 Alarms on Unit mmHg Scale 40 mmHg ImCO2 on N2O Corr (only M3015A/M3016A) Off Oxygen Corr (only M3014A) 16% Pedi Neo Gas Corr (only M3014A) Off Humidity Corr BTPS Max Hold Off AwRR On AwRR Alarms On AwRR high limit 30 100 AwRR low limit 8 30 Apnea time 20 secs Color Yellow
1 # 10-lead placement (ECG) 99 12-lead placement (ECG) 99 3-lead placement (ECG) 97 5-lead placement (ECG) 97 A AAMI ECG lead labels 96 abdominal breathing and Resp electrode placement 138 aberrantly conducted beats 106 accessories 10-electrode cable sets 230 3-electrode cable sets 230, 232 5-electrode cable sets 230, 232 5-electrode one piece cables 232 6-electrode cable sets 230 CO2 173 CO2 (mainstream) 239, 240 CO2 (microstream) 240 ECG 229 NBP adult cuffs 234 comfort cuffs 233 disposable cuffs 233 mul
chaining 114 latching 112 multiple 114 pvc-related alarms 115 sinus and SV rhythm ranges 257, 260 switching on/off 112 timeout periods 113 arrhythmia monitoring and defibrillation 104 arrhythmia options 102 arrhythmia relearning with EASI INOP 101 arterial pressure source 166 arterial pulsation 143 artifact suppression (pressure) 163 atrial fibrillation and flutter 106 audlatching (arrhythmia alarms) 112 auto alarm limits switching on/off 48 using 48 auto detection mode (Resp) 138 autofilter 94 automatic ar
damage claims 2 date, setting 7, 30 DC power symbol 245 default profile 26 default settings 271 checking country-specific 7 defibrillation and arrhythmia monitoring 104 and ECG monitoring 104 synchronization marks 91 defibrillator proof symbol 245 defibrillator synch maintenance interval 226 delay time recording 201 demonstration mode 22 desat alarm, SpO2 147 detection modes (Resp) 138 diagnostic (ECG filter setting) 95 discharging a patient 85 disconnect INOPs silencing 43 disinfecting infection control 21
cleaning 213 disinfecting 213 sterilizing 213 Information Center central recording 199 transferring patients 86 INOPs indicators 39 message field 17 silencing 43 installation checklist 1 connectors 246 personnel 1 Instructions for Use intended audience 9 IntelliVue Instrument Telemetry System (IIT) 32 intermittent bundle branch block 107 intermittent mandatory ventilation (Resp) 139 interruption symbol 245 intravascular dyshemoglobins (SpO2) 145 intrinsic rhythm 104 ISO point (ST) 120 J J point (ST) 120 K
cuff pressure 154 cuff, applying 153 cuff, selecting 153 cuff, tightness 153 disposable cuffs 233 how the measurement works 151 measurement correction 153 measurement limitations 152 measurement methods, auto 152 measurement methods, manual 152 measurement methods, sequence 152 measurement methods, stat 152 measurement, starting 154 measurement, stopping 154 neonatal cuffs (disposable) 234 numerics 153 oscillometric method 151 pediatric cuffs 234 preparing to measure 152 repeat time 153 repeat time for auto
QT monitoring limitations 128 QT/QTc monitoring 127 quick admit 85 R radiated field immunity Resp 140 rate adaptive pacemakers and ECG monitoring 105 realtime report 210 realtime reports content 206 recorder status messages 201 recording central 199 changing recording type 200 channels 200 choosing central recorder 200 choosing recording speed 201 creating templates 200 preventing fading ink 201 runtime 201 setting the runtime 201 setup menu 200 starting and stopping 199 wave overlap 201 recording alarms 5
pleth as alarm source 148 pleth wave 147 pleth waveform 143 pulse numerics 144 QRS tone 148 signal quality 145 site inspection 145 site selection 143 tone modulation 148 SpO2 desat alarm 147 SpO2 limit alarms 147 ST adjusting alarm limits 122 alarms 102, 122 baseline, updating 119 ensuring diagnostic quality 117 filtering 117 measurement points, adjusting adjusting 120 multi-lead alarms 122 numerics in ECG wave 92 snippets 119 ST display 118 ST map baseline, updating 125 current view 122 report, printing pr
scale (pressure) 163 size (CO2) 174 size (pressure) 163 wave channel speed 28 wave group speed 28 wave size Resp 139 wave size (ECG) changing 93 wave speed eeg speed wave speed global speed 27 respiratory speed 27 wave speed (Resp) 140 what’s new 35 wide alarms limits 48 wired network connection symbol 245 Z zero effect on pressure alarms 161 zeroing pressure transducer 161 viii
