In stru ctio ns fo r Use IntelliVue Patient Monitor MP2 Rel ease J with Software Rev ision J.xx .
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 2 Basic Operation Introducing the IntelliVue MP2 Controls, Indicators and Connectors Extending Measurements Operating and Navigating Operating Modes Understanding Screens Usi
What's New in Release F.
About Arrhythmia Monitoring Switching Arrhythmia Analysis On and Off Choosing an ECG Lead for Arrhythmia Monitoring Understanding the Arrhythmia Display Arrhythmia Relearning Arrhythmia Alarms About ST Monitoring Switching ST or STE On and Off Understanding the ST Display and Windows Updating ST Baseline Snippets About the ST Measurement Points ST Alarms STE Alarms Viewing ST Maps About QT/QTc Interval Monitoring QT Alarms Switching QT Monitoring On and Off 8 Monitoring Pulse Rate Entering the Setup Pulse
Perfusion Change Indicator Setting SpO2/Pleth as Pulse Source Setting Up Tone Modulation Setting the QRS Volume 11 Monitoring NBP Introducing the Oscillometric NBP Measurement Preparing to Measure NBP Starting and Stopping Measurements Enabling Automatic Mode and Setting Repetition Time Enabling Sequence Mode and Setting Up The Sequence Choosing the NBP Alarm Source Switching Pulse from NBP On/Off Assisting Venous Puncture Calibrating NBP 12 Monitoring Temperature Making a Temp Measurement Calculating Tem
16 Enhancing Telemetry Monitoring with the Monitor Monitor and Telemetry Transceiver Requirements 17 Trends Viewing Trends Setting Up Trends Documenting Trends Trends Databases Screen Trends 18 Recording Starting and Stopping Recordings Overview of Recording Types Creating and Changing Recordings Templates Recorder Status Messages 19 Printing Patient Reports Starting Report Printouts Stopping Reports Printouts Setting Up Reports Setting Up Individual Print Jobs Checking Printer Settings Printing a Test R
22 Maintenance and Troubleshooting Inspecting the Equipment and Accessories Inspecting the Cables and Cords Maintenance Task and Test Schedule Troubleshooting Disposing of the Monitor Disposing of Empty Calibration Gas Cylinders 23 Accessories ECG/Resp Accessories Invasive Pressure Accessories 5-Electrode One Piece Cables Set Combiners and Organizers NBP Accessories SpO2 Accessories Temperature Accessories Mainstream CO2 Accessories Sidestream CO2 Accessories Mainstream CO2 Accessories (for M3016A) Microst
Alarm and Measurement Default Settings Alarm Default Settings ECG, Arrhythmia, ST and QT Default Settings Pulse Default Settings Respiration Default Settings SpO2 Default Settings NBP Default Settings Temperature Default Settings Invasive Pressure Default Settings CO2 Default Settings Index 313 313 314 316 317 317 318 319 319 321 323 9
1 1 Installation 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 Step Task Check Box when Task Done 5 Perform Safety Tests, if required by local laws and regulations (see “Checking Out the Monitor” on page 15). 6 Check/set the time and date (see “Setting the Date and Time” on page 17).
1 Installation Repacking Retain the original packing carton and material, in case you need to return equipment to Philips for service. If you no longer have the original packing materials, Philips can advise you on alternatives. 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.
1 Installation 1 MSL Cable connects to power supply (M8023A) 1 AC power cord. Connect to AC mains socket. 2 Connect LAN cable here. For connection to a PC or Information Center. 3 Measurement Link (MSL) cable. Supplies AC input power to the monitor for AC operation and for battery charging. When there is a LAN connection to a PC or Information Center, the MSL cable also carries this data to and from the monitor. 4 Power-on LED.
1 Installation earthing may result in enclosure leakage currents equal to the sum of the individual earth leakage currents, so exceeding allowable limits. • Do not connect any devices that are not supported as part of a system. • Any non-medical device placed and operated in the patient's vicinity must be powered via an approved isolation transformer that ensures mechanical fixing of the power cords and covering of any unused power outlets.
1 Installation 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. 16 • Switch on the monitor. After start-up the 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.
1 Installation Setting the Date and Time To set the date and time: to enter the SmartKeys window. 1 Press the SmartKeys key 2 Select the Main Setup SmartKey to enter the Main Setup menu. 3 Select Date, Time 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 If you are handing over the monitor to the end-users directly after configuration, make sure that it is in Monitoring mode. WARNING Users must be adequately trained to use the monitor before monitoring a patient.
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 monitor and its functions. It tells you how to perform tasks that are common to all measurements (such as entering data, switching a measurement on and off, setting up and adjusting wave speeds, working with profiles). The alarms section gives an overview of alarms.
2 Basic Operation The monitor stores data in trend databases. You can see tabular trends (vital signs) and document them on a central printer. You can view measurement trend graphs, including horizon trends, to help you identify changes in the patient's physiological condition. The monitor can be powered by a rechargeable battery, or from AC mains using the external power supply (M8023A). For battery charging, care and status information, refer to the chapter “Using Batteries” on page 245.
2 Basic Operation MP2 Controls and Indicators 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. 6 Active INOP alarm lamp in light blue.
2 Basic Operation MP2 Patient Connectors, Right Side 1 Pressure (option) 2 Temperature (option) 3 Noninvasive blood pressure 4 SpO2 5 ECG sync pulse output (See “Monitor Performance Specifications” on page 282 for specifications) 6 ECG/Respiration 7 CO2 (option) MP2 Left Side 1 Loudspeaker 2 MSL Connector. Connects to the external power supply via the MSL cable for AC mains operation, battery charging, and communication with a network.
2 Basic Operation MMS Extension M3014A attached to the MP2 The MMS extensions connect to the monitor and use the monitor's settings. Trend data and measurement settings from the measurements in the extensions are stored in the monitor. WARNING • Measurements from an MMS extension are only available when the extension is connected to the monitor, and the monitor is running on external power.
2 Basic Operation M3014A, M3015A, M3015B and M3016A Capnography MMS Extensions The optional M3014A Capnography extension adds mainstream capnography or sidestream capnography, and optionally one pressure plus either a pressure or a temperature, Cardiac Output and Continuous Cardiac Output to the MMS.
2 Basic Operation The optional M3016A Mainstream CO2 extension adds mainstream capnography and optionally either pressure or temperature to the MMS.
2 Basic Operation Using the Battery Extension To provide enough power for the use of an MMS Extension during transport, you can use the Battery Extension (865297). The Battery Extension provides additional battery power for situations when no mains power is available and can typically power the monitor with MMS Extension for at least 6 hours.
2 Basic Operation red flashing (short on phase) Battery maintenance required. red flashing (long on phase) Battery Extension malfunction. off No battery inserted in the Battery Extension. External power not available yellow flashing (short on phase) Battery Extension is charging the monitor battery (monitor is switched off). red flashing (short on-phase) If the monitor is running, this indicates very low battery charge (<10 minutes running time left).
2 Basic Operation 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. The typical operator's position is in front of the monitor. There are also four keys to the right of the screen (see also “” on page 20).
2 Basic Operation MP2 Screen Elements Item Description 1 Alarm volume off indicator Comments 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. If red and yellow alarms are active at the same time, they rotate in the alarm field. 3 Patient category and bed label / INOP message field Patient category and bed label can be covered by INOP messages.
2 Basic Operation Using the Touchscreen Touch a screen element to get to the actions linked to that element. For example, touch a measurement numeric and the setup menu for that measurement opens. Touch a wave to enter the setup menu for that wave. Measurement Setup Menus Each measurement has a setup menu where you can change settings. Typically, the setup menu window covers the whole screen, except the INOP and alarm message fields, which are always displayed at the top.
2 Basic Operation Main Setup Menu There is usually more than one way to enter a setup menu for a measurement, to change a setting or to execute a task. Some routes are more direct than others. You can use whichever method you find most convenient. Which routes are available to you, however, can vary depending on your monitor’s configuration.
2 Basic Operation lock touchscreen operation set alarm limits change alarm volume change screen brightness (not for independent displays) change QRS volume change amplitude (size) of ECG wave review beat labels (annotate arrhythmia wave) re-learn arrhythmia - start/stop manual NBP measurement - start auto series - stop current automatic measurement within series start NBP STAT measurement stop automatic or STAT NBP measurement and measurement series start NBP measurement and measurement series
2 Basic Operation Using the On-Screen Keyboard Use this as you would a conventional keyboard. Enter the information by selecting one character after another. Use the Shift and capital Lock keys to access uppercase letters. Use the Back key to delete single characters, or use the Clr key to delete entire entries. Select Enter to confirm what you have entered and close the on-screen keyboard. Operating Modes When you switch the monitor on, it starts up in monitoring mode.
2 Basic Operation To resume monitoring, • Select anything on the screen or press any key. When monitoring is resumed, alarms are paused for 1 minute to allow time to finish plugging in the measurement cables. Understanding Screens Your monitor comes with a set of pre-configured Screens, optimized for common monitoring scenarios such as OR adult, or ICU neonatal. A Screen defines the overall selection, size and position of waves, numerics and other elements on the monitor screen when you switch on.
2 Basic Operation also operate the monitor from the external display. The XDS must be connected to the same Local Area Network (LAN) as the monitor. It is also possible to use an existing PC, connected to the same LAN, to host the XDS Application software. For more details, including limitations and restrictions, refer to the IntelliVue XDS Application Instructions for Use.
2 Basic Operation WARNING If you switch to a different profile, the patient category and paced status normally change to the setting specified in the new profile. However some profiles may be set up to leave the patient category and paced status unchanged. Always check the patient category, paced status, and all alarms and settings, when you change profiles. When you leave Demonstration Mode, the monitor uses the default profile.
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 • Global Speed, for all waves not included in the other group. 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 and then select User Interface 2 Select Global Speed or RespiratorySpeed, as required 3 Select a value from the list of available speeds.
2 Basic Operation Depending on your configuration, the monitor will either • display the Measurement Selection window automatically for you to resolve the conflict • take no action, you must enter the Measurement Selection window (using the measurement selection key) 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 – – De- Activate: to disable the conflicting measurement. It retains its label for future use but becomes invisible to the monitor, as though it had been unplugged. Setup : to enter the Setup menu for the measurement and change the conflicting device’s label to a different label.
2 Basic Operation WARNING Short Range Radio connections are subject to interruption due to interference from other radio sources in the vicinity, including microwaves, bluetooth devices, WLAN devices (802.11b,g,n) and cordless phones. Depending on the strength and duration of the interference, the interruption may occur for an extended period.
2 Basic Operation If your monitor is connected to an Information Center, the date and time are automatically taken from this. Once it is set, the internal clock retains the setting even when you switch off the monitor. Checking Your Monitor Revision 1 Select Main Setup then select Revisions to open the Monitor Revision menu. 2 Select the correct device from the device pop-up keys. 3 From the Monitor Revision menu, select the monitor component for which you need revision information.
2 Basic Operation Power On/Power Off Behavior The general rules determining the behavior of the monitor when connected to, or disconnected from power are as follows: • A monitor that was switched on prior to a temporary power loss switches on again when power is restored. • A monitor that was switched off prior to a temporary power loss remains off when power is restored. • When AC mains power is lost, a battery powered monitor continues to run without interruption on battery power.
2 Basic Operation Monitoring After a Power Failure If external power is disconnected or there is a power failure, the monitor continues to run on its rechargeable battery. If the monitor is without any power (no external power or the battery is empty) for less than one minute, monitoring will resume with all active settings unchanged. If the monitor is without power for more than one minute, the behavior depends on your configuration. If Automat.
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 J.
3 What's New? • Pause Alarms / Alarms Off key can be removed from the screen - a configuration setting removes the permanent key from the screen to avoid unintentional switching off of alarms. Alarms can still be switched off or paused, in the Alarms menu, under Main Setup. • Alarms paused after Standby mode - alarms are automatically paused for 1 minute after Standby mode to allow time for patient connection.
3 What's New? background. Additionally special regard was given to improved usability and compatibility with standard software products. 12 Lead ECG Enhancements You can now preview the 12-Lead ECG at the bedside before you send it to the Information Center. A new dedicated 12-Lead ECG Report can be printed in diagnostic quality from the bedside.
3 What's New? • QT View window - shows current wave and baseline wave with Q and T points marked so that you can verify that the QT algorithm detects correct Q and T points. 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.
3 What's New? New Smart Keys A SmartKey is available for New Lead Setup when a new ECG lead set with fewer leads than previously is being used. Better Visibility Of Gridlines The brightness of the gridlines on the realtime waves has been increased for better visibility.
3 What's New? 50
4 4 Alarms The alarm information here applies to all measurements. Measurement-specific alarm information is discussed in the sections on individual measurements. The monitor has two different types of alarm: patient alarms and INOPs. Patient Alarms Patient Alarms are red and yellow alarms. A red alarm indicates a high priority patient alarm such as a potentially life threatening situation (for example, asystole).
4 Alarms Alarm Delays There is a delay between a physiological event at the measurement site and the corresponding alarm indication at the monitor. This delay has two components: • The general measurement delay time is the time between the occurrence of the physiological event and when this event is represented by the displayed numerical values. This delay depends on the algorithmic processing and, for certain measurements (SpO2, EEG and BIS), on the configured averaging time.
4 Alarms Bright Alarm Limits If the alarm was triggered by an alarm limit violation, the corresponding alarm limit on the monitor screen is shown more brightly if Show ALarmLimits is enabled and there is sufficient room on the screen. Alarm Lamp A lamp on the monitor's front panel flashes. The alarm lamp is divided into two sections. The right one flashes for a patient alarm, except for short yellow alarms where the lamp will light for approximately six seconds.
4 Alarms Traditional Audible Alarms (HP/Agilent/Philips/Carenet) • Red alarms and red INOPs: A high pitched sound is repeated once a second. • Two-star yellow alarms and yellow INOPs: A lower pitched sound is repeated every two seconds. • One-star yellow alarms (short yellow alarms): The audible indicator is the same as for yellow alarms, but of shorter duration. • Standard INOPs: an INOP tone is repeated every two seconds.
4 Alarms Acknowledging Alarms To acknowledge all active alarms and INOPs, press the Silence key. This switches off the audible alarm indicators and alarm lamps. A check mark beside the alarm message indicates that the alarm has been acknowledged monitor is configured to re-alarm, a dashed check mark will be shown . If the .
4 Alarms Pausing or Switching Off Alarms If you want to temporarily prevent alarms from sounding, for example while you are moving a patient, you can pause alarms. Depending on your monitor configuration, alarms are paused for one, two, or three minutes, or infinitely. Infinite alarm pause is equivalent to switching the alarms off. To view the alarm pause setting chosen for your unit, 1 Select Main Setup, Alarms, then Alarm Settings 2 Check the Alarms Off setting.
4 Alarms The alarms off symbol is shown beside the measurement numeric. While Alarms are Paused or Off When red alarms are paused or off: • The red Alarms Paused lamp on the monitor front panel is lit. In the alarm field, the monitor displays the message Al. Paused x:yy or Alarms Off, together with the alarms paused symbol or the alarms off symbol. When yellow alarms are paused or off: • The yellow Alarms Paused lamp on the monitor front panel is lit.
4 Alarms Alarm Limits The alarm limits you set determine the conditions that trigger yellow and red limit alarms. For some measurements (for example, SpO2), where the value ranges from 100 to 0, setting the high alarm limit to 100 switches the high alarm off. In these cases, the alarms off symbol is not displayed. WARNING Be aware that the monitors in your care area may each have different alarm settings, to suit different patients.
4 Alarms To open the Alarm Limits window, either select one of the alarm fields then select the Alarm Limits pop-up key, or select the Alarm Limits SmartKey, if configured. 1 2 3 Graphic view of current yellow and red alarm limits and currently monitored measurement value.
4 Alarms Alternatively, you can use the keys in the measurement alarm limits window, which you access by selecting the measurement label in the Alarm Limits window. 1 Parameter label 2 High red alarm (view only) 3 High yellow alarm field.
4 Alarms non-pathological range, limits must be changed manually, based on the clinician's judgment about the specific patient. 1 Wide alarm limits 2 Narrow alarm limits 3 Alarm Limits 4 Measurement value Limits Narrow sets limits close to the currently measured values for situations where it is critical for you to be informed about small changes in your patient's vital signs.
4 Alarms Review Alarms Window The Review Alarms window contains a list of the most recent alarms and INOPs with date and time information. If configured to do so, each alarm is shown with the alarm limit active when the alarm was triggered and the maximum value measured beyond this limit.
4 Alarms Alarm Latching Behavior Red & Yellow Measurement Alarms Non-latching alarms Alarm has not been acknowledged. Alarm tone on. Alarm lamp on. Alarm tone on. Alarm lamp Alarm message. Flashing on. Alarm message. Flashing numerics. numerics. Alarm condition still present. Alarm has been acknowledged. Visual and audible latching Visual latching, audible non-latching Alarm tone on. Alarm lamp on. Alarm message. Flashing numerics. Alarm condition All audible and visual alarm no longer present.
4 Alarms Alarm Recordings You can set up your monitor so that it automatically triggers alarm recordings locally or at the Information Center, or if configured, to a printer as a realtime report. 1 Press the Main Setup SmartKey. 2 Select Alarms from the Main Setup menu. 3 Select Alarm Recording from the Alarms menu to open the Alarm Recordings menu. 4 Select a measurement from those listed for which you want to change the alarm condition that triggers an alarm recording. This opens a pop-up list.
5 5 Patient Alarms and INOPs This chapter lists patient alarms alphabetically, and technical alarms (INOPs) arranged by the source of the INOP and then alphabetically, irrespective of their priority. All alarms and INOPs are listed here; the ones which can appear on your monitor will depend on the model and the individual options. 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 Alarm Message From Condition Indication ** CCO High ** CCI High CCO Continuous Cardiac Output or CC Index is above the high alarm limit. numeric flashes and high alarm limit is highlighted, yellow alarm lamp, alarm tone ** CCO Low ** CCI Low CCO Continuous Cardiac Output or CC Index is below the low alarm limit. numeric flashes and low alarm limit is highlighted, yellow alarm lamp, alarm tone ** CPP High CPP The CPP value has exceeded the high alarm limit.
5 Patient Alarms and INOPs Alarm Message From Condition Indication * HR High ** HR High ECG The heart rate has risen above the high alarm limit. 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 switched on. * HR Low ** HR Low ECG The heart rate has fallen below the low alarm limit. numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone.
5 Patient Alarms and INOPs Alarm Message From Condition Indication * Pair PVCs ECG/Arrhythmia A non-ventricular contraction, followed by two numeric flashes, yellow alarm lamp, ventricular contractions, followed by a nonshort yellow audible alarm ventricular contraction has been detected. * Pause ECG/Arrhythmia No beat detected for a period greater than the pause threshold.
5 Patient Alarms and INOPs Alarm Message From Condition Indication ** RR Low RESP The respiration rate has dropped below the low numeric flashes and low limit is alarm limit. highlighted, yellow alarm lamp, alarm tone * Run PVCs High ECG/Arrhythmia A run of PVCs greater than 2 was detected. numeric flashes, yellow alarm lamp, short yellow audible alarm ** High SvO2/SO2 The the measured intravascular oxygen saturation has exceeded the high limit.
5 Patient Alarms and INOPs Alarm Message From Condition Indication ** tcpO₂ High ** tcpCO₂ High tcGas The tcpO2 or tcpCO2 value has exceeded the high alarm limit. numeric flashes, high alarm limit is highlighted, yellow alarm lamp, alarm tone ** tcpO₂ Low ** tcpCO₂ Low tcGas The tcpO2 or tcpCO2 value has fallen below the low alarm limit.
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. The measurement labels and abbreviations for pressure, temperature and SpO2 INOP messages are explained in the individual measurement chapters.
5 Patient Alarms and INOPs INOP Message, Indication What to do Check Screen Res. INOP tone 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. Check Settings INOP tone If this INOP appears, check the monitor and patient settings before you resume monitoring.
5 Patient Alarms and INOPs INOP Message, Indication What to do No Central Monit. INOP tone There is a problem with the communication to the network. Central monitoring is currently not possible (no patient alarms or information). Check the connection. In case the connection is via a telemetry device, the current telemetry use model does not support central monitoring. Contact your service personnel.
5 Patient Alarms and INOPs INOP Message, Indication What to do Unsupported LAN INOP tone There is a problem with the communication to the network and central monitoring is currently not possible. Check the connection. If the INOP persists, switch off the monitor and contact your service personnel. Unsupported WLAN There is a problem with the communication to the network and central monitoring is currently not possible. Check the wireless connection.
5 Patient Alarms and INOPs INOP Message, Indication What to do Batteries Incompat Batt 1 Incompat. Batt 2 Incompat. INOP tone The indicated battery or batteries cannot be used with this monitor. Replace with the correct battery or batteries as specified in this book. Batteries Low Batt 1 Low Batt 2 Low INOP tone The estimated battery-powered operating time remaining is less than 20 minutes.
5 Patient Alarms and INOPs MMS, MMS Extensions and FMS INOPs INOP Message, Indication What to do MMS Ext. Unplugged INOP tone The MMS extension has been disconnected from the Multi-Measurement Module. MMS Ext. Unpowered INOP tone The MMS extension cannot operate while the Multi-Measurement Module is running on battery power. MMS Ext. Unsupp INOP tone The MMS extension is not supported by your monitor. Contact your service personnel. MMS Ext.
5 Patient Alarms and INOPs INOP Message, Indication What to do Lead Off !! Lead Off !!! Lead Off Numeric is replaced by -?INOP tone Not all the required leads for ECG monitoring are connected. Check the ECG connections and make sure that the electrode indicated by [RA, LA, LL, RL, V or C] electrodes is attached. In EASI mode, all 5 electrodes must be connected.
5 Patient Alarms and INOPs Resp INOPs INOP Message, Indication What to do Resp Equip Malf Numeric is replaced by -?INOP tone Contact your service personnel. The RESP hardware is faulty. Resp Erratic Numeric is replaced by -?- The monitor has detected too many artifacts in the measured Resp signal. Check that the RA and LL electrodes are correctly attached and have not dried out. Resp Leads Off Numeric is replaced by -?INOP tone Not all the required leads for Resp monitoring are attached.
5 Patient Alarms and INOPs Temperature INOPs INOP Message, Indication What to do T1, T2, T3, T4 INOPs See INOPs Tamb INOPs See INOPs Tart INOPs See INOPs Tcereb INOPs See INOPs Tcore INOPs See INOPs Deactivated INOP tone A Temp measurement label in the measurement device has been deactivated, either by connecting a Pressure transducer in the shared Press/Temp socket, or by deactivating the label in the Measurement Se
5 Patient Alarms and INOPs SpO2 INOPs INOP Message, Indication What to do Chk Sensor The condition of the signal at the SpO2 sensor is not as expected. Accuracy may be compromised. Check proper application of the sensor in accordance with the Instructions for Use. If the INOP persists, consider exchanging the sensor. Deactivated The SpO2 measurement label in the measurement device has been deactivated by deactivating the label in the Measurement Selection window.
5 Patient Alarms and INOPs INOP Message, Indication What to do Unkn.Sensor Numeric is replaced by -?- The connected sensor or adapter cable is not supported by the SpO2 measurement. Use only specified sensors and cables. Unplugged Numeric is replaced by -?INOP tone An SpO2 measurement label has been deactivated, either by unplugging a module, or by deactivating the label in the Measurement Selection window. The measurement automatically disappears from the display.
5 Patient Alarms and INOPs INOP Message, Indication What to do Deactivated A Pressure measurement label in the measurement device or extension has been deactivated, either by INOP tone connecting a Temp transducer in the shared Press/Temp socket, or by deactivating the label in the Measurement Selection window. The measurement automatically disappears from the display.
5 Patient Alarms and INOPs CO2 INOPs INOP Message, Indication What to do CO₂ Auto Zero Numeric is replaced by -?if the Autozero lasts >15 sec, INOP tone sounds. The automatic zero calibration is in progress. This typically takes 10 seconds. During this time the CO2 values may not be updated, or they may be replaced by -?-. Wait until the zero calibration is complete to resume monitoring. CO₂ Cal Failed Numeric is replaced by -?INOP tone Make sure that the Cal cell was changed between CAL1 and CAL2.
5 Patient Alarms and INOPs INOP Message, Indication What to do CO₂ Upgrade FW Numeric is replaced by -?INOP tone The software in the Measurement Extension does not match the software in the MMS. Contact your service personnel. CO₂ Wait Cal2 Numeric is replaced by -?- Calibration on the first calstick cell is complete. Place the transducer on the other calstick cell and start the CAL2 calibration cycle.
5 Patient Alarms and INOPs INOP Message, Indication What to do CCO No Numeric is replaced by -?INOP tone may sound CCO/CCI cannot be calculated. Make sure that the pressure chosen in the Setup CCO menu under CCO From matches the pressure measured with the arterial catheter for CCO measurement. A pressure from an external device cannot be used. Select another pressure label, either ABP, Ao, ART, BAP, FAP, or UAP. CCO No Press at Information Center CCO/CCI cannot be calculated.
5 Patient Alarms and INOPs INOP Message, Indication What to do No ECG Source A telemetry device is paired with the monitor but the Information Center is not detecting a valid ECG signal from either of them. !! Repl. Tele Batt !!!Repl. Tele Batt Severe yellow/red INOP tone The battery in the telemetry device is almost empty and must be replaced. During this INOP, alarms cannot be paused or switched off. Tele Battery Low The battery in the Telemetry device is low and must be replaced soon.
5 Patient Alarms and INOPs INOP Message, Indication What to do cl SpO₂ Batt Incmp INOP tone The battery in use with the SpO2 Pod is incompatible. Replace it with one approved for use with the SpO2 Pod. cl SpO₂ Batt Low INOP tone The remaining battery time of the SpO2 Pod is below 2 hours. cl SpO₂ Batt Malf INOP tone There is a malfunction in the SpO2 Pod's battery system. Contact your service personnel. cl SpO₂ Batt Temp INOP tone The temperature of the battery in the SpO2 Pod is critically high.
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6 Managing Patients and Equipment 6 When the monitor is used together with an IntelliVue Information Center, a variety of services are provided to manage the interconnections between patients, equipment, hospital beds, caregivers, and so on. Many services can be used both at the monitor and at the Information Center, resulting in a more efficient workflow. Which services are available will depend on which Information Center you have.
6 Managing Patients and Equipment Additionally there are mechanisms to automatically free up equipment that is no longer used. This prevents unnecessary patient mismatches when the equipment is used for the next patient and avoids data of different patients getting mixed. PIIC iX When connected to PIIC iX, equipment states are tracked by the system. When the equipment is not assigned to a patient or no patient is admitted at a monitor, the equipment is considered as free equipment in the system.
6 Managing Patients and Equipment – – – First Name: Enter the patient's first name. Middle Name (if configured to appear): Enter the patient's middle name. Lifetime ID, Encounter ID: Whether these fields appear and how they are labeled can be configured for your hospital. One or both fields may be displayed and the labels may read: MRN, Case ID, Visit Number, or other alternatives. Enter the appropriate data for the fields displayed. – – Patient Cat.
6 Managing Patients and Equipment 5 Select Confirm to complete the admission or transfer. Patient Category and Paced Mode The patient category setting determines the algorithm the monitor uses to process and calculate some measurements, the safety limits that apply for some measurements, and the alarm limit ranges. The paced mode setting determines whether the monitor shows pacemaker pulses or not. When Paced Mode is set to Off, pace pulses are filtered and therefore do not show in the ECG wave.
6 Managing Patients and Equipment details as soon as possible to fully identify the patient on the network, on the monitor and on printed reports. To complete the details, open the Patient Demographics window and complete all required fields. Editing Patient Information To edit the patient information after a patient has been admitted, select the patient name field on the Main Screen to open the Patient Demographics window, and make the required changes.
6 Managing Patients and Equipment Removing the Monitor Removing a monitor stops using the monitor for the current patient and frees up the monitor and all devices assigned to that monitor. Removing the monitor: – – – – clears the patient demographics in the monitor. erases all patient measurement data (such as trend, event, and calculation data) from the monitor and devices assigned to the monitor. This ensures that data from a previous patient are not mixed with data from a new patient.
6 Managing Patients and Equipment Transferring Patients with IntelliVue Information Center iX PIIC iX There are several ways to transfer a patient from or to another bed. When a patient is transferred to the destination bed, Information Center monitoring continues in the destination bed and equipment that is not transferred with the patient is freed up.
6 Managing Patients and Equipment Transferring Patients with IntelliVue Information Center Transferring a Centrally-Monitored Patient with the Monitor Scenario: A centrally-monitored patient is moved with the monitor to another monitoring location on the same Information Center database server without interrupting the collection of patient trend information. 1 Select the patient name field or select the Patient Demogr. SmartKey to open the Patient Demographics window, then select the Transfer pop-up key.
6 Managing Patients and Equipment Manually Resolving Patient Mismatch The source of the patient mismatch is indicated by question marks (???) and displayed in the status line at the bottom of the screen (Patient ???, Patient Category ??? or Paced Mode ???). The Select Patient window automatically opens so you can decide which patient data to use. You do not have to resolve the mismatch immediately, but the indicators remain until you do.
6 Managing Patients and Equipment Patient Mismatch - If Neither Patient Data Set is Correct A patient mismatch where neither set of patient data is correct might occur if you connect a new MMS to a monitor in order to prepare for a new patient, before you actually start measuring. Select New Patient if you are sure that none of the information is correct.
6 Managing Patients and Equipment • PIIC iX only - equipment has been configured for use in a specific unit, but is now being used in a different unit. • Equipment has an equipment label but has not been configured at the Information Center and therefore cannot be managed. If a monitor or a companion device is in one of these situations, a Check Equipment INOP will appear and the equipment status will be shown in the Equipment window.
6 Managing Patients and Equipment Changing Caregiver Assignment When a caregiver is assigned, the caregiver name may appear next to the caregiver symbol in the Equipment window (depending on your network connection). Whether the name is shown or not, when you select this area of the window, a menu opens offering the following functions: PIIC iX • • Select Caregiver - you can select a different caregiver from a list.
6 Managing Patients and Equipment Own Patient Overview Window The measurements from other monitoring devices and telemetry devices are shown combined in the own patient overview window on the monitor, together with related information derived by the Information Center, such as alarms. 1 Current alarm and INOP generated by another device. 2 Own patient overview window 3 Delayed - indication that data in the window is delayed.
6 Managing Patients and Equipment Assigning a Telemetry Transceiver with an SRR Adapter to a Monitor Monitors which have this capability have a short range radio symbol on the model label. A telemetry device with a short range radio adapter can be assigned to a monitor directly. To assign a telemetry device to a monitor: 1 Press the Check button on the telemetry device. The measurement selection key on the monitor will change to show the "add cableless" symbol 2 Select the symbol.
6 Managing Patients and Equipment Controlling Other Devices from the Bedside You can change ECG settings for the current ECG source from the patient monitor. 1 Select the own patient overview window. 2 Select the Setup Equip pop-up key. A setup menu will appear with the settings available for the current ECG source.
6 Managing Patients and Equipment ECG Source Tracking at the Information Center The Information Center continuously checks whether a valid ECG signal is coming from the monitor or from another assigned device. If you unplug the ECG patient cable from the monitor and plug it into another device, the Information Center will automatically switch to monitoring the ECG from the other device. At the monitor, its own ECG measurement will be deactivated and the Setup ECG menu will no longer be accessible.
6 Managing Patients and Equipment PIIC iX With the IntelliVue Information Center iX, the following additional measurement settings can be synchronized: ECG/Arrhythmia Hexad Reconstruction Mode, Some ECG Alarms INOP On/Off ST STE On/Off, STE Alarm On/Off NBP Sys/Dia/Mean Alarm Limits, Alarms On/ Off, Alarm Source Resp Apnea Time, Alarm Limits, Detection Mode, Alarm On/Off, Resp On/Off SpO2 SpO2 Alarms on/off, SpO2 Alarm limits, SpO2 Low Alarm delay, SpO2 High Alarm delay, Desat Alarm Limit, NBP Ala
6 Managing Patients and Equipment Information Center Compatibility The functionality available for managing patients and equipment depends on the IntelliVue Information Center being used. In the following table the main differences between the PIIC and PIIC iX are shown. PIIC PIIC iX Not available Find Patient - searching for a patient in the Information Center or other connected hospital systems.
7 ECG, Arrhythmia, ST and QT Monitoring 7 The electrocardiogram (ECG) measures the electrical activity of the heart and displays it on the monitor as a waveform and a numeric. This section also tells you about arrhythmia monitoring (see “About Arrhythmia Monitoring” on page 127), ST monitoring (see “About ST Monitoring” on page 137) and QT monitoring (see “About QT/QTc Interval Monitoring” on page 148).
7 ECG, Arrhythmia, ST and QT Monitoring Selecting the Primary and Secondary ECG Leads The monitor uses the primary and secondary lead to compute HR and to analyze and detect cardiac arrhythmias. They are also available for recordings and for display on the Information Center. The secondary lead is only used if your monitor is configured for multi-lead (instead of single-lead) arrhythmia analysis.
7 ECG, Arrhythmia, ST and QT Monitoring Understanding the ECG Display Your display may be configured to look slightly different. 1 Lead label of the displayed wave 2 1 mV calibration bar 3 Pacer spikes 4 Pace pulse markers 5 Current heart rate 6 Current heart rate alarm limits and paced mode symbol 7 EASI lead placement label (located here when present) 8 ECG Filter label ECG HR numeric: This is the heart rate derived from the monitored ECG.
7 ECG, Arrhythmia, ST and QT Monitoring Monitoring Paced Patients An ECG optimized for monitoring a paced patient should look like this: 1 Normal Beats 2 Pace Pulses/Pace Beats You should choose a lead as primary or secondary lead that has these characteristics: • the normal QRS complex should be either completely above or below the baseline and it should not be biphasic. For paced patients, the QRS complexes should be at least twice the height of pace pulses.
7 ECG, Arrhythmia, ST and QT Monitoring Avoiding Pace Pulse Repolarization Tails Some unipolar pacemakers display pace pulses with repolarization tails. These tails may be counted as QRSs in the event of cardiac arrest or other arrhythmias. If you note a visible repolarization tail, choose a lead that decreases the size of the repolarization tail.
7 ECG, Arrhythmia, ST and QT Monitoring Changing the Volume of the QRS Tone The QRS tone is derived from either the HR or Pulse, depending on which is currently selected as the alarm source. The QRS volume can be set from 0 to 10 (0 means off). To change the QRS volume, in the Setup ECG menu select QRS Volume and then select the appropriate volume from the pop-up list. Changing the ECG Filter Settings The ECG filter setting defines how ECG waves are smoothed.
7 ECG, Arrhythmia, ST and QT Monitoring 3 Select Vb Lead and select the position used from the list. Choosing EASI or Standard Lead Placement You must enable either standard lead placement or EASI lead placement. • In the Setup ECG menu, select Placement and then Standard or EASI. EASI is shown beside the 1mV calibration bar on the ECG wave on the display, and EASI is marked on any printouts. See the section on “EASI ECG Lead Placement” on page 122 for electrode placement diagrams.
7 ECG, Arrhythmia, ST and QT Monitoring ECG Lead Fallback If fallback is configured on and there is a leads off INOP in the primary lead (and in the secondary lead, if you are using multi-lead monitoring) for longer than 10 seconds, and if another lead is available, this available lead automatically becomes the primary lead. This is known as lead fallback. When the Leads Off condition is corrected, the leads are automatically switched back. This setting can only be changed in Configuration Mode.
7 ECG, Arrhythmia, ST and QT Monitoring 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 1 RA placement: directly below the clavicle and near the right shoulder 2 LA placement: directly below the clavicle and near the left shoulder 3 RL placement: on the right lower abdomen 4 LL placement: on the left lower abdomen 5 V placement: on
7 ECG, Arrhythmia, ST and QT Monitoring Chest Electrode Placement V1 on the fourth intercostal space at the right sternal border V2 on the fourth intercostal space at the left sternal border V3 midway between the V2 and V4 electrode positions V4 on the fifth intercostal space at the left midclavicular line V5 on the left anterior axillary line, horizontal with the V4 electrode position V6 on the left midaxillary line, horizontal with the V4 electrode position V3R -V6R on the right side of the chest in posi
7 ECG, Arrhythmia, ST and QT Monitoring Conventional 12-Lead ECG 1 V1 - V6 2 LA 3 RA 4 RL 5 LL In conventional 12-Lead ECG using 10 electrodes, an electrode is placed on the right arm, left arm, right leg, and left leg. Six V- electrodes are placed on the chest. The right leg electrode is the reference electrode. Limb electrodes: – – Place arm electrodes on the inside of each arm, between the wrist and the elbow. Place leg electrodes inside of each calf, between the knee and the ankle.
7 ECG, Arrhythmia, ST and QT Monitoring Modified 12-Lead ECG 1 LA 2 V1-V6 3 LL 4 RL 5 RA 6 Angle of Lewis If your institution uses modified 10 Lead ECG electrode placement (the Mason-Likar Lead System), place the four limb electrodes close to the shoulders and lower abdomen. The six V electrodes are placed on the chest in the same position as the conventional 12-lead placement.
7 ECG, Arrhythmia, ST and QT Monitoring Capture 12-Lead You can view a 12-Lead ECG on the screen, capture a 12-Lead ECG episode, preview the captured ECG data and then store it and send it to a connected Information Center for analysis. You can download the resulting analysis from the Information Center and also other 12-Lead captures for review at the monitor. A 12-Lead report can be printed that also includes the downloaded analysis results and an ST Map.
7 ECG, Arrhythmia, ST and QT Monitoring Changing Settings for a Captured 12-Lead ECG Select the Setup 12 Lead pop-up key to choose settings for filter, gain, etc., if changes are needed. All changes apply to both the display and the printed 12-Lead report. The changes are only applied temporarily and will not be stored. If you want to change the default settings, see “Setting Up the 12Lead ECG” on page 122. High Pass Filter Sets the high pass filter for the waveforms. Choices are 0.05Hz, 0.15Hz and 0.5Hz.
7 ECG, Arrhythmia, ST and QT Monitoring Printing the 12-Lead ECG Print a dedicated 12-Lead ECG report by selecting the Print Report pop-up key. When you are working with an Information Center iX that provides 12-Lead analysis, the report contains the 12-Lead analysis results as well as measurement values (e.g. ST values, QT values, HR) which are also downloaded from the Information Center iX.
7 ECG, Arrhythmia, ST and QT Monitoring Pop-up Keys Selecting this pop-up key lets you Store & Send store the captured 12-Lead ECG in the monitor and send it to the Information Center. Review 12 Lead view a list of 12-Lead captures available at the monitor or at the IntelliVue Information Center, and select one for review.
7 ECG, Arrhythmia, ST and QT Monitoring EASI Electrode Placement 1 E (V) - on the lower sternum at the level of the fifth intercostal space 2 A (LL) - on the left midaxillary line at the same level as the E electrode 3 S (LA) - on the upper sternum 4 I (RA) - on the right midaxillary line at the same level as the E electrode 5 N - reference electrode - can be anywhere, usually below the sixth rib on the right hip ECG and Arrhythmia Alarm Overview The ECG and arrhythmia alarms available depend on
7 ECG, Arrhythmia, ST and QT Monitoring Cardiotach Alarms Additional Alarms with Basic Additional Alarms with Arrhythmia Option Enhanced Arrhythmia Option ***Asystole ***Ventricular Tachycardia **Afib ***Ventricular Fibrillation/ Tachycardia **Pacer Not Capture **End Afib **Pacer Not Pacing **Supraventricular Tach ***Extreme Bradycardia **PVCs/min HIGH (PVC > limit/min) **Missed Beat ***Extreme Tachycardia **Pause **High heart rate **Irregular HR **Low heart rate **End Irregular HR **Vent
7 ECG, Arrhythmia, ST and QT Monitoring ECG Alarms Off Disabled Be aware that your hospital department may have decided to disable the Alarms Off setting for ECG in the monitor's Configuration Mode. In this case, HR alarms cannot be switched off in Monitoring Mode. If you try to switch off the HR alarms, you will see the message To activate enter Config and enable Alarms Off.
7 ECG, Arrhythmia, ST and QT Monitoring During surgery: Use the appropriate orange electrode ECG safety cable, or lead cable with an orange connector, for measuring ECG in the operating room. These cables have extra circuitry to protect the patient from burns during cautery, and they decrease electrical interference. This also reduces the hazard of burns in case of a defective neutral electrode at the HF device. These cables cannot be used for measuring respiration.
7 ECG, Arrhythmia, ST and QT Monitoring About Arrhythmia Monitoring Arrhythmia analysis provides information on your patient's condition, including heart rate, PVC rate, rhythm, and ectopics. The monitor uses the user-selected primary and secondary ECG leads for singlelead or multi-lead arrhythmia analysis. During arrhythmia analysis, the monitor continuously • optimizes ECG signal quality. This is important for arrhythmia analysis.
7 ECG, Arrhythmia, ST and QT Monitoring For paced patients, in addition to the above, the pace pulse should be: – – – not wider than the normal QRS the QRS complexes should be at least twice the height of pace pulses large enough to be detected, with no re-polarization. To prevent detection of P-waves or baseline noises as QRS complexes, the minimum detection level for QRS complexes is set at 0.15 mV, according to AAMI-EC 13 specifications.
7 ECG, Arrhythmia, ST and QT Monitoring Intermittent Bundle Branch Block Bundle branch and the other fascicular blocks create a challenge for the arrhythmia algorithm. If the QRS during the block changes considerably from the learned normal, the blocked beat may be incorrectly classified as ventricular, causing false PVC alarms. You should always select a lead where the bundle branch block beats have an R-wave that is as narrow as possible to minimize incorrect calls.
7 ECG, Arrhythmia, ST and QT Monitoring Arrhythmia Beat Labels Arrhythmia beat labels tell you how the monitor is classifying beats. N = Normal V = Ventricular Ectopic S = Supra-ventricular Premature P = Paced ' = Pacer spike " = Biventricular Pacer Spike L = Learning patient's ECG A = Artifact (noisy episode) ? = Insufficient information to classify beats I = Inoperative condition (e.g.
7 ECG, Arrhythmia, ST and QT Monitoring Rhythm Status Message Description B or E Paced Rhythm A dominant rhythm of paced beats B, E Irregular HR Consistently irregular rhythm E Sinus Brady Sinus Rhythm Sinus Tach A dominant rhythm of SV beats preceded by P-waves B, E SV Brady SV Rhythm SV Tach A dominant rhythm of SV beats not preceded by P-waves B, E Unknown ECG Rhythm Rhythm cannot be determined B, E Learning ECG Algorithm is learning the ECG beat morphology B, E Learning Rhythm Algo
7 ECG, Arrhythmia, ST and QT Monitoring Arrhythmia Relearning During a learning phase: • Alarm timeout periods are cleared • Stored arrhythmia templates are cleared • Asystole, Vfib, and HR alarms (when there are enough beats to compute the HR) are active. No other alarms are active. Initiating Arrhythmia Relearning Manually To initiate relearning manually, in the Setup Arrhy menu, select Relearn Arrhy.
7 ECG, Arrhythmia, ST and QT Monitoring • respond to any INOP messages (for example, if you are prompted to reconnect electrodes) • be aware that a disconnected EASI electrode triggers an arrhythmia relearn on all leads • always ensure that the arrhythmia algorithm is labeling beats correctly. Arrhythmia Alarms Arrhythmia alarms can be switched on and off and the alarm settings changed just like other measurement alarms, as described in the Alarms section.
7 ECG, Arrhythmia, ST and QT Monitoring Switching All Yellow Arrhythmia Alarms On or Off All yellow arrhythmia alarms can be switched on and off together. To do this, • In the Setup Arrhy menu, select All Yellow Off or All Yellow On. Adjusting the Arrhythmia Alarm Limits Some arrhythmia alarms have limits which can be individually adjusted: VTach HR, VTach Run, PVCs/min, Vent Rhythm, SVT HR, SVT Run, Asystole Thresh., Pause Threshold, Afib/IHR End Dly.
7 ECG, Arrhythmia, ST and QT Monitoring Alarm Condition Example Short yellow alarm tone sounds Alarm message displayed Single alarm instance Non-sustained Vtach when alarm condition is initially detected for 3 minutes (latching time) Continuous alarm condition PVCs/min HIGH when alarm condition is initially detected and - as an alarm reminder - every time the configured timeout period has expired until the alarm condition stops, plus a maximum of three minutes latching time Same intermittent alarm
7 ECG, Arrhythmia, ST and QT Monitoring Examples of Alarm Chaining Logic – – 136 If there is an active Vent Bigeminy alarm, a PVCs > xx/min will not be triggered because it is lower on the same chain. However, a high HR alarm will become active because it is on a different chain. Higher priority alarms supersede previous alarms. For example, if a Vent Trigeminy alarm is active and a Pair PVCs occurs, the Pair alarm will be activated.
7 ECG, Arrhythmia, ST and QT Monitoring Understanding PVC-Related Alarms PVC-related alarms are detected on the basis of the current ventricular heart rate and the number of consecutive PVCs counted (referred to as PVC Runs). Example: This diagram illustrates the conditions under which PVC alarms would be generated if the Vent Rhythm Run limit is set to 12, the V-Tach Run Limit is set to 8, and the V-Tach HR Limit is set to 100.
7 ECG, Arrhythmia, ST and QT Monitoring WARNING Some clinical conditions may make it difficult to achieve reliable ST monitoring, for example: • if you are unable to get a lead that is not noisy • if arrhythmias such as atrial fib/flutter are present, which may cause an irregular baseline • if the patient is continuously ventricularly paced • if the patient has left bundle branch block. You should consider switching ST monitoring off if these conditions are present.
7 ECG, Arrhythmia, ST and QT Monitoring To change the order in which ST leads are displayed, 1 In the Setup ST Leads menu, choose a lead from the list. 2 Select the Sort Up or Sort Down key to move the lead up or down in the list. Understanding the ST Display and Windows Your monitor screen may be configured to look slightly different from the illustrations.
7 ECG, Arrhythmia, ST and QT Monitoring ST View Window The ST View Window shows a current ST snippet and numeric with a baseline snippet and numeric. The two snippets are in different colors, so that you can differentiate between them easily and see at a glance which numerics belong to which snippet. In the upper left corner the current lead and the ISO/ J-Point mode for current and baseline snippets is shown. On the right side all available ST numerics are shown.
7 ECG, Arrhythmia, ST and QT Monitoring STE View Window The STE View window shows a current ST snippet and STE numeric with an ST baseline snippet. The two snippets are in different colors, so that you can differentiate between them easily. In the upper left corner the current lead is shown. On the right side all available STE numerics are shown. The date and time of the ST baseline snippet is shown at the bottom of the window.
7 ECG, Arrhythmia, ST and QT Monitoring About the ST Measurement Points The ST value for each beat complex is the vertical difference between the ISO point and the ST point, as shown in the diagram below. The isoelectric (ISO) point provides the baseline, the ST point is at the midpoint of the ST segment. The J point is where the QRS complex changes its slope; as it is a fixed distance away from the ST point, it can be useful to help you position the ST point correctly.
7 ECG, Arrhythmia, ST and QT Monitoring 3 Select the ST point you need to adjust by touching the appropriate point on the screen. The current choice is highlighted (ISO point -80 in the screen example). 1 ST label and the ST numeric that would apply using the current points 2 1mV calibration bar 3 Cursors for adjusting ST points 4 Highlighted ST point The ISO-point cursor (1) positions the isoelectric point relative to the R-wave peak. The relation is shown beside the ISO-point in milliseconds.
7 ECG, Arrhythmia, ST and QT Monitoring To position the ST-point (3) relative to the J-point: select either J+60 or J+80. Select J Point and use the arrow keys to move the J-Point and position the ST-point at the midpoint of the ST segment. To position the ST-point directly: select ST Point and use the left and right arrow keys to position the ST point at the midpoint of the ST segment. 4 Select the Apply Changes pop-up key to activate the new ST measurement points and recalculate all ST values.
7 ECG, Arrhythmia, ST and QT Monitoring The ST Elevation measurements with automated J-point determination generate ST Elevation alarms, in addition to the ST measurements at the user-defined ST point (J+offset), which may be useful for ST depression alarms. When ST and STE analysis are both in use, this may result in redundant alarms for ST elevations. Because of the different measurement points, there may be different values obtained.
7 ECG, Arrhythmia, ST and QT Monitoring 4 ST index (for EASI) 5 ST label, value and polarity of corresponding lead 6 ST map If an ST lead is switched off, its axis is not shown in the map. If a lead is in INOP (the value is being measured but is invalid or unavailable because, for example, the corresponding ECG electrode is off), the area formed by the remaining ST leads is left open.
7 ECG, Arrhythmia, ST and QT Monitoring 1 Limb Leads 2 Chest Leads 3 current ST values 4 trending interval 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. 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 Displaying an ST Reference Baseline You can display an ST reference baseline for the current view, or for the trended view. The baseline is shown in yellow. However, if the ECG color is yellow, the baseline is shown in green. Use this baseline to detect ST changes. The baseline is derived automatically whenever the monitor relearns arrhythmia and also on user request. Select Show Baseline/Hide Baseline to toggle between baseline display on and off.
7 ECG, Arrhythmia, ST and QT Monitoring The QT interval (1) has an inverse relationship to heart rate. Faster heart rates shorten the QT interval and slower heart rates prolong the QT interval. Therefore there are several formulas used to correct the QT interval for heart rate. The heart rate corrected QT interval is abbreviated as QTc. The monitor uses as a default the Bazett correction formula and the alternative Fridericia formula can be selected in Configuration Mode.
7 ECG, Arrhythmia, ST and QT Monitoring Because normal beats followed by ventricular beats are not included in the analysis, no QT measurement will be generated in the presence of a bigeminy rhythm. If the heart rate is extremely high (over 150 bpm for adults and over 180 bpm for pediatrics and neonates) QT will not be measured. When the heart rate changes, it can take several minutes for the QT interval to stabilize.
7 ECG, Arrhythmia, ST and QT Monitoring The current waves are shown in the upper half of the window and the baseline waves in a different color below. The Q and T points are marked with a vertical line. By selecting one of the lead labels at the top of the window you can highlight the corresponding wave; the other waves are shown in gray. The underlined lead labels are the leads used for the QT calculation. By selecting the numeric area you can highlight all underlined leads.
7 ECG, Arrhythmia, ST and QT Monitoring Recording The QT Waves To start a recording, • Select Record QT. QT Alarms There are two QT alarms, QTc high limit alarm and QTc high alarm. The QTc high limit alarm is generated when the QTc value exceeds the set limit for more than 5 minutes. The QTc alarm is generated when the difference between the current value and the baseline value exceeds the set limit for more than 5 minutes.
7 ECG, Arrhythmia, ST and QT Monitoring 3 Select ΔHighLimit. 4 Select the appropriate setting. Switching QT Monitoring On and Off To switch all QT monitoring on or off, in the Setup QT Analysis menu, select QT Analys. to switch between On and Off.
7 ECG, Arrhythmia, ST and QT Monitoring 154
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 “Monitoring Invasive Pressure” chapter for an explanation of the pressure labels). The displayed pulse numeric is labeled and colorcoded to match its source wave.
8 Monitoring Pulse Rate Switching Pulse On and Off To switch a particular pulse numeric on or off, enter the Setup Pulse menu via the measurement setup menu or wave menu of the pulse source. For example, to switch an SpO2 pulse numeric on or off, 1 Enter the Setup Pulse menu by selecting the Pulse numeric or by selecting Pulse in the Setup SpO₂ menu. 2 In the Setup Pulse menu, select the correct pulse label, e.g. Pulse (SpO₂), to toggle between On and Off.
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 123, including Asystole, Vfib and Vtach alarms, and the heart rate alarms. This is indicated by the message ECG/Arrh AlarmsOff (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 158
9 Monitoring Respiration Rate (Resp) 9 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) 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.
9 Monitoring Respiration Rate (Resp) • the detection level (a dotted line) is not displayed on the waveform, • the algorithm expects a heart rate and therefore needs at least 3 electrodes attached to the patient. If you are monitoring respiration with only two electrodes, the detection algorithm becomes less sensitive which may result in reduced breath detection performance.
9 Monitoring Respiration Rate (Resp) Changing the Speed of the Respiration Wave Resp waveforms are usually viewed at a slower speed than other waveforms. For this reason, the Resp measurement has its own speed control and is not affected by the wave speed settings of the other measurements. • Select the Resp wave to enter the Resp Wave menu, then select Change Speed. Choose the required speed from the pop-up list.
9 Monitoring Respiration Rate (Resp) This is because of the higher internal impedance of the OR cable set, required for use if electrosurgery is being performed. 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) 164
10 10 Monitoring SpO2 Philips pulse oximetry uses a motion-tolerant signal processing algorithm, based on Fourier artifact suppression technology (FAST). It provides four measurements: • Oxygen saturation of arterial blood (SpO2) - percentage of oxygenated hemoglobin in relation to the sum of oxyhemoglobin and deoxyhemoglobin (functional arterial oxygen saturation). • Pleth waveform - visual indication of patient's pulse. • Pulse rate (derived from pleth wave) - detected pulsations per minute.
10 Monitoring SpO2 4 When using the M1195A Infant Finger Sensor, select a finger or toe with a diameter of between 7 and 8 mm (0.27" and 0.31"). When applying a M1193A neonatal sensor do not overtighten the strap. 5 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 Proper Sensor Fit: If a sensor is too loose, it might compromise the optical alignment or fall off.
10 Monitoring SpO2 – has not changed in its thickness (for example, due to edema), causing an improper fit of the sensor.
10 Monitoring SpO2 Understanding the SpO2 Numerics 1 Measurement Mode (only with the IntelliVue CL SpO2 Pod, in Auto or Manual mode) 2 Repeat time (only with the IntelliVue CL SpO2 Pod, in Auto mode) 3 Timestamp for numerics (only with the IntelliVue CL SpO2 Pod or a telemetry device) 4 Pulse numeric 5 Perfusion Numeric 6 Alarms off indicator (here for Pulse alarms) 7 SpO2 numeric 8 SpO2 alarm limits 9 Signal Quality indicator In automatic mode, you may see the time until the next measure
10 Monitoring SpO2 Assessing a Suspicious SpO2 Reading Traditionally, pulse rate from SpO2 was compared with heart rate from ECG to confirm the validity of the SpO2 reading. With newer algorithms, such as FAST-SpO2, this is no longer a valid criteria because the correct calculation of SpO2 is not directly linked to the correct detection of each pulse.
10 Monitoring SpO2 NOTE To ensure there is no gap in SpO2 measurements when moving from standard telemetry transmission to short range radio transmission, the measurement mode will always be set to continuous in this situation unless manual mode is set in both the telemetry device and the monitor. Making a Manual Measurement When the measurement mode is set to manual, • In the Setup SpO₂ menu, select Start SpO₂, or use the Start SpO₂ SmartKey.
10 Monitoring SpO2 • The time between the displayed numerical values crossing an alarm limit and the alarm indication on the monitor. This delay is the sum of the alarm delay time configured for SpO2, plus the system alarm delay. The system alarm delay is the processing time the system needs for any alarm to be indicated on the monitor, after the measurement has triggered the alarm. See the performance specifications in the Specifications chapter for the system alarm delay specification.
10 Monitoring SpO2 This diagram shows the relationship between the alarm delay and the deviation from the alarm limit. The shaded areas on the diagram show the area in which SpO2 values can violate the alarm limit without causing an alarm to be indicated. The area is smallest for the Short mode, and is extended for the Medium and Long modes by the corresponding areas shown above.
10 Monitoring SpO2 Example With Medium Mode Alarm Limit Deviation from violated Alarm Limit Resulting Alarm Delay This diagram shows the area for Medium mode, with two examples of hypoxia. Progressive hypoxia scenario: SpO2 value (C) - the values drop steadily and after 11 seconds a value leaves the shaded area. An alarm is indicated immediately.
10 Monitoring SpO2 Progressive hypoxia scenario: SpO2 value (E) - the values drop steadily and after 16 seconds a value leaves the shaded area. An alarm is indicated immediately. Recovery scenario: SpO2 value (F) - the values stay within the shaded area for 98 seconds, deviating from the alarm limit by 1% to 3%, before rising again above the alarm limit. No alarm is indicated because the SpO2 values never leave the shaded area below the alarm limit.
10 Monitoring SpO2 Adjusting the Desat Limit Alarm The Desat alarm is a high priority (red) alarm notifying you of potentially life threatening drops in oxygen saturation. 1 In the Setup SpO₂ menu, select Desat Limit. 2 Adjust the limit. Pleth Wave The Pleth wave is autoscaled to maximum display size. It decreases only when the signal quality becomes marginal. It is NOT directly proportional to the pulse volume. If you need an indication of change in pulse volume, use the perfusion indicator.
10 Monitoring SpO2 Setting Up Tone Modulation If tone modulation is on, the QRS tone pitch lowers when the SpO2 level drops. Remember, the QRS tone is derived from either heart rate or pulse depending on which is currently selected as the active alarm source. • In the Setup SpO₂ menu, select Tone Mod. to toggle between Yes (for on) and No (for off). Tone modulation is licensed under US patent US 4,653,498 from Nellcor Puritan Bennett Incorporated.
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 Unattended measurement: Use clinical judgement to decide whether to perform frequent unattended blood pressure measurements in cases of severe blood clotting disorders because of the risk of hematoma in the limb fitted with the cuff. CAUTION If you spill liquid onto the equipment or accessories, particularly if there is a chance that it can get inside the tubing or the measurement device, contact your service personnel.
11 Monitoring NBP Preparing to Measure NBP 1 Connect the cuff to the air tubing. 2 Plug the air tubing into the red NBP connector. Avoid compression or restriction of pressure tubes. Air must pass unrestricted through the tubing. 3 Make sure that you are using a Philips-approved correct sized cuff and that the bladder inside the cover is not folded or twisted. A wrong cuff size, and a folded or twisted bladder, can cause inaccurate measurements.
11 Monitoring NBP be set in Configuration mode. In Auto mode the measurement values may disappear more quickly (to be replaced by new measurement values), if the repeat time is set to less than one hour. NBP and SpO2 numerics from intermittent measurements can be configured to be grayed out or to disappear from the screen after a set time. This avoids older numerics being misinterpreted as current data. The time can be set individually for SpO2 and NBP in Configuration mode.
11 Monitoring NBP Action to be performed NBP Setup menu Start manual measurement Start/Stop SmartKeys Start Auto series Start/ Stop Start NBP Start STAT measurement NBP STAT NBP STAT Start STAT Stop Manual measurements Start/Stop Start/ Stop Stop NBP Stop current Auto measurement Start/Stop Start/ Stop Stop NBP Stop current STAT measurement and end series Start/Stop Start/ Stop NBP STAT NBP STAT Stop NBP Stop Auto, Manual or STAT measurement AND series Stop All Stop All 181
11 Monitoring NBP CAUTION Use clinical judgment to decide whether to perform repeated series of STAT measurements because of the risk of purpura, ischemia and neuropathy in the limb with the cuff. Enabling Automatic Mode and Setting Repetition Time 1 In the Setup NBP menu, select Mode and select Auto from the pop-up menu. 2 For an automatic measurement, select Repeat and set the time interval between two measurements.
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.
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12 12 Monitoring Temperature WARNING Measurements from an MMS extension connected to the monitor are not available when the monitor is running on its own battery power. They are only available when the monitor is powered by the external power supply (M8023A) or the Battery Extension (865297). You can measure temperature using the built-in temperature measurement (optional), or one of the MMS extensions. The Temp measurement automatically switches on when you connect a probe.
12 Monitoring Temperature Temp non-specific temperature label Trect rectal temperature Tart arterial temperature Tskin skin temperature Tcore core temperature Tven venous temperature Tesoph esophageal temperature Tnaso nasopharyngeal temperature Extended Temperature Label Set The following additional labels are available if Label Set is set to Full. This setting can only be changed in Configuration Mode.
13 13 Monitoring Invasive Pressure WARNING Measurements from an MMS extension connected to the monitor are not available when the monitor is running on its own battery power. They are only available when the monitor is powered by the external power supply (M8023A) or the Battery Extension (865297). CAUTION Do not use a monitor with an M1006A pressure module as an additional monitor for your patient. This may cause interference on the respiration or invasive pressure measurements.
13 Monitoring Invasive Pressure WARNING If measuring intracranial pressure (ICP, IC1 or IC2) with a sitting patient, level the transducer with the top of the patient's ear. Incorrect leveling may give incorrect values. Selecting a Pressure for Monitoring Tell the monitor the source of the pressure you want to monitor by selecting an appropriate pressure label. The label is a unique identifier for each type of pressure.
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. 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 CAUTION When using high frequency ventilation, ensure that the tubing from the ventilator does not touch the arterial line, or connect with it indirectly, while zeroing the pressure. This could cause small pressure variations which can interfere with the zero procedure. Zeroing All Pressures Simultaneously WARNING Before zeroing all pressures, make sure that all pressure transducers are vented to atmospheric pressure.
13 Monitoring Invasive Pressure 2 To confirm you want to use the new calibration factor, select the Confirm pop-up key. Displaying a Mean Pressure Value Only Use this when you want to see only the mean pressure. In the pressure's setup menu, select Mean only. Toggle between On to display mean pressure value only, and Off to display all pressure values (systolic, diastolic and mean).
13 Monitoring Invasive Pressure 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 Select and set the High Limit and Low Limit for the pressure(s) you have selected.
13 Monitoring Invasive Pressure • standard sphygmomanometer. • sterile 10cc syringe with heparinised solution. • 3-way stopcock. • approximately 25 cm of tubing. Making the Pressure Calibration WARNING Never perform the invasive pressure calibration while a patient is being monitored. 1 Zero the transducer. 2 Connect the syringe and manometer. a. Attach the tubing to the manometer. b.
13 Monitoring Invasive Pressure 7 When the monitor displays mercury calibr. 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. Factor field in the pressure's setup menu. 9 Reconnect the patient and start measuring again.
14 14 Monitoring Carbon Dioxide WARNING Measurements from an MMS extension connected to the monitor are not available when the monitor is running on its own battery power. They are only available when the monitor is powered by the external power supply (M8023A) or the Battery Extension (865297). CAUTION 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 can cause lower than actual etCO2 readings. Even with combined nasal oral cannulas, the etCO2 readings may be slightly lower than actual in patients breathing through the mouth only. Measurement Principles For both mainstream and sidestream measurements, the measurement principle is infrared transmission, where the intensity of infrared light passing the respiratory gas is measured with a photo detector.
14 Monitoring Carbon Dioxide WARNING Altitude Setting: The monitor is not equipped with automatic barometric pressure compensation. Before the CO2 measurement is used for the first time, the altitude must be set to the correct value. An incorrect altitude setting will result in incorrect CO2 readings. The CO2 readings will typically deviate 5% for every 1000 m difference. CAUTION Use the CO2 measurement with Philips approved accessories only.
14 Monitoring Carbon Dioxide – 4 When you see the message CO₂ calibration done at on the status line, the zero calibration is finished and you can begin monitoring. Install the airway adapter at the proximal end of the circuit between the elbow and the ventilator Ysection. WARNING To prevent stress on the endotracheal tube, support the sensor and airway adapter. Position sensor cables and tubing carefully to avoid entanglement or potential strangulation.
14 Monitoring Carbon Dioxide 3 To zero the sensor: – expose the sensor to room air and keep it away from all sources of CO2 including the ventilator, the patient's breath and your own. – in the setup menu for the CO2, select Start Zero Cal. – 4 when you see the message CO₂ calibration done at on the status line, the zero calibration is finished and you can begin monitoring.
14 Monitoring Carbon Dioxide CAUTION Always disconnect the cannula, airway adapter or sample line from the sensor when not in use. Using the Sidestream Sensor Holder The holder delivered with the sensor can be used to clamp the sensor onto an IV pole or a shelf. 1 Push the sensor into the holder until it clicks into position. 2 Clamp the holder onto an IV pole, a shelf or another appropriate location. To remove the sensor from the holder, release the clip and pull the sensor out of the holder.
14 Monitoring Carbon Dioxide Preparing to Measure Mainstream CO2 1 Attach the transducer connector to the CO2 connector on the M3016A extension. 2 Wait 20 minutes, allowing the transducer to reach its operating temperature and a stable thermal condition. 3 Perform an accuracy check and then, if necessary, calibrate the transducer. Checking Transducer Accuracy WARNING Check transducer accuracy at least once a week or if you doubt the CO2 readings. 1 In Setup CO₂ menu, select Cal.
14 Monitoring Carbon Dioxide Attaching and Removing the CO2 Transducer 1 Open the latch and place the transducer (B) onto the airway adapter (A). Place the airway adapter in the patient's breathing circuit between the endotracheal tube and the Y-piece. You may see the CO₂ Sens Warmup message until the transducer reaches operating temperature. Wait until this disappears before starting the measurement. 2 To remove the transducer from the airway adapter, open the latch and pull out the airway adapter.
14 Monitoring Carbon Dioxide Measuring Microstream CO2 using M3015A/B The M3015A/B 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. WARNING When using the IPI numeric (available for adult and pediatric patients), always ensure that the patient's date of birth is entered correctly and that the monitor is displaying the current date.
14 Monitoring Carbon Dioxide 3 Change the FilterLine if a CO₂ Occlusion INOP appears on the monitor or if the readings become extremely erratic. Disconnect the FilterLine during suctioning and nebulizing therapies or suppress sampling by turning off the pump as described in “Suppressing Sampling (not Mainstream CO2)” on page 205. Check the table in the Microstream CO2 Accessories section of the Accessories chapter for typical usage times for the different Microstream accessories.
14 Monitoring Carbon Dioxide Correction Altitude (M3014A only) Altitude is set during installation. The monitor automatically applies an appropriate correction. O2 (M3014A only) In the Setup CO₂ menu, select Oxy. Corr and select a value between 20% and 100%, the default value is 20%. If you are not measuring the expired O2, estimate it by subtracting 5% from the inspired O2 then select the nearest value from the list.
14 Monitoring Carbon Dioxide Changing the Apnea Alarm Delay This determines the time limit after which the monitor alarms if the patient stops breathing. 1 In the Setup CO₂ menu, select awRR. 2 In Setup awRR menu, select Apnea Time. 3 Choose the apnea alarm delay time. WARNING Safety and effectiveness of the respiration measurement method in the detection of apnea, particularly the apnea of prematurity and apnea of infancy, has not been established.
14 Monitoring Carbon Dioxide The value of the Integrated Pulmonary Index given in the IPI numeric is associated with the patient status as follows: IPI Patient Status 10 Normal 8-9 Within normal range 7 Close to normal range; requires attention 5-6 Requires attention and may require intervention 3-4 Requires intervention 1-2 Requires immediate intervention. NOTE The interpretation of the patient's IPI score may change in different clinical environments.
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15 Using a Telemetry Device and a Monitor (PIIC only) 15 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 Using a Telemetry Device and a Monitor (PIIC only) Own Patient Overview Window The measurements from the telemetry device are shown in the own patient overview window on the monitor when there is no direct connection via short range radio link. See “Own Patient Overview Window” on page 101.
15 Using a Telemetry Device and a Monitor (PIIC only) • A tone sounds at the telemetry device and the Leads Off indicators light • The ECG wave appears on the monitor To confirm that the correct telemetry device has been assigned, open the ECG Setup menu. The title of the menu contains the equipment label of the telemetry device; check that this is the correct label. If a telemetry device is already assigned to a monitor, you cannot assign a further telemetry device to that monitor.
15 Using a Telemetry Device and a Monitor (PIIC only) or use the Unpair function at the Information Center. NOTE The SmartKeys and pop-up keys for unpairing appear only on the monitor which is directly involved in pairing. Temporarily Stopping the Short Range Radio Connection To temporarily disable the SRR connection for this device, for example, in case of interference: 1 Open the Equipment window - either directly in Main Setup or by selecting the bed label in the information line.
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.
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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 Trends Pop-Up Keys When you open the graphic, tabular or histogram trends window, a selection of pop-up keys appears to let you navigate through the stored trend data and carry out trends-related tasks. Pop-Up Keys Selecting this pop-up key lets you.... Select Group see a pop-up list of trend groups and select a group for viewing. Select Interval see a pop-up list of available data resolution settings and select the level of detail shown in the trend view.
17 Trends Viewing Graphic Trends 1 Scroll to view more pop-up keys A cursor spanning all measurements in the trend group helps you to navigate through the trends database and shows you your current position in the database. When the cursor is moved across the time line, the values measured at the cursor time are shown in the right hand column. In graphical trends, aperiodic measurement trends are shown as an asterisk, NBP has a special symbol.
17 Trends Viewing Vital Signs Trends 1 Aperiodic values are shown with a timestamp 2 Scroll to view more pop-up keys The currently-selected column is highlighted. The values can be configured to display in the same colors as the waves and numerics on the realtime display. Any values available for display before the next scheduled update are shown in the right hand column, with a timestamp in brackets.
17 Trends • select the left hand column of the segment, where the measurement label is displayed. Expanded View To expand the segment to fill the Graphical Trends window, • in the Segment menu, select Expand to have that segment enlarged to fill the window. 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).
17 Trends between dotted line separators are displayed overlapping. The trend group All contains all available measurements, you cannot change the order or selection of this group. To change the selection of measurements in a trend group, either use the Change Group setting in the Segment menu or: 1 Select Main Setup, Trends, then Trend Groups. 2 Select the Trend Group you want to change and use the pop-up keys to Add, Change, or Delete the selection of measurements trended.
17 Trends Graphical Trend Presentation Graphical trends and screen trends for measurements with compound values (for example ABP or CO2) can be viewed in line or band form. To change the presentation style, 1 Select Main Setup then select Trends. 2 Select Global Style and choose • Line to display the trends as a continuous line • Band to fill the area between the trend lines, for example, between the systolic and diastolic pressures, with color.
17 Trends with arrows. This indicates that for this time period, more values were available and the most recent one is shown. Example database configuration In this example, we see that the monitor stores the most recent data at the highest resolution, older data are stored at a lower resolution. "4 hours @ 12 second resolution" means that the monitor stores trend data every 12 seconds, for the most recent four hours.
17 Trends To set a different ScreenTrend Time for a screen trend or a group of aligned screen trends, 1 Select a screen trend. 2 Select Change TrendTime. 3 Select the required trend time. Selecting Global leaves the trend time set to the global screen trend time. Changing the Selection of Screen Trends Displayed 1 Select the screen trend. 2 Select Change Trend and select the required trend from the list of available trends. Select Blank to remove the selected trend from the Screen.
17 Trends 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: • a horizon, drawn in white, as a reference point or baseline to help you visualize changes in your patient's condition. The horizon can be set to represent your patient's current condition, or a target condition and can be a single value or a range.
17 Trends 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. Setting the Time Period for the Trend Indicator Arrow The time period for which the trend indicator arrow is displayed can be set in the Trends window.
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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. Recordings made on the M3160A may look slightly different to those described here. See the documentation supplied with the Information Center for information on the 4-Channel Recorder.
18 Recording Overview of Recording Types Delayed Alarm Realtime (RT) manual automatic, triggered by defined alarm conditions manual Recording Destination central central printer central Information recorded from the start trigger minus the delay time from the start trigger minus the delay time n/a from the start trigger up to 2 n/a up to 2 Type of recording Number of waves up to 2 Speed 50, 25, 6.25 mm/sec 25 mm/sec n/a 50, 25, 6.
18 Recording • 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 “Overview of Recording Types” on page 228. This setting can only be changed in Configuration Mode. • Run Time: see how long this type of recording is configured to run. This setting can only be changed in Configuration Mode.
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19 19 Printing Patient Reports Starting Report Printouts Most patient reports can be printed by selecting Main Setup then Reports (or the Print Reports SmartKey) and then selecting the report name in the top half of the Reports menu. Report names are shown only for reports that have been correctly set up. Data from the time of the print request is printed, even if the print job is delayed in the printer queue.
19 Printing Patient Reports Starting the Different Types of Report Report types Report contents How to start printing reports Vital Signs Report Depends on selected trend group, data resolution, and period. In the Vital Signs window, select Print/ Record, then select Print. In the Graphical Trends window, select Print. Graphic Trends Report Select the ECG Report A, or ECG Report B SmartKeys, if configured, or the Print Reports SmartKey followed by ECG Report A or ECG Report B.
19 Printing Patient Reports 2 Select ECG Gain and set the required ECG gain to define how ECG waves will appear on the ECG report printouts. 3 Select Speed and select the report print speed. 4 Select Annotation and switch to On if the printed ECG wave should be annotated with beat labels. See the “ECG, Arrhythmia, ST and QT Monitoring” chapter for a list of beat labels. Pace pulse marks are automatically printed beside the wave for paced patients.
19 Printing Patient Reports Be aware that the monitor's memory for reports is limited. If the memory is full, Auto Reports cannot be printed and the information may be lost. Setting Up Individual Print Jobs To adjust the appearance of individual print jobs, in the Reports menu, Select Main Setup, Reports, then Setup Reports to enter the Setup Reports menu. 1 Select Report and then select the report you want to set up.
19 Printing Patient Reports Switching Printers On or Off for Reports You can enable or disable printer status to switch individual printers on or off for report printouts. 1 In the Setup Printers menu, select Printer and then select the name of the device you want to switch on or off for Reports printing from the pop-up list. 2 Select Printer Status to switch between the settings Enabled and Disabled. If you set this to Disabled, no reports will be printed to the named printer.
19 Printing Patient Reports Checking Report Status and Printing Manually A list of all print requests which are waiting, printing or stored can be viewed in the Reports Job List. To view the list, in the Reports menu, select Reports Job List.
19 Printing Patient Reports Printer Status Messages Printer Status Message Possible causes and suggested action Print job queued for The report has been placed in the queue for the named printer. Print job can't queue;resources? The printer queue is full and the monitor cannot accept another report request.
19 Printing Patient Reports Sample Report Printouts Each report header contains the patient's bed label, last name and first name, middle name (if there is enough space) the patient ID, the date and time, and the name of the report. The report footer contains the hospital label and page number, and the last page contains a note to mark the report end. The monitor may be configured to leave a space on the top left or right of the report printout to enable you to stick a patient address label on it.
19 Printing Patient Reports ECG Reports 1 Patient information 2 Numeric block 3 Wave area Below the header on ECG Reports, the numeric block shows the current HR, PVC, and ST values. The wave area shows the printed waves for all available ECG leads. A 1 mV calibration bar is printed at the beginning of each wave. With the 3X4, 6X2, and 2X4 formats, a rhythm stripe prints a longer section of the ECG wave from the primary ECG lead for ECG rhythm evaluation.
19 Printing Patient Reports 12-Lead ECG Report 1 Patient data 2 Analysis data from the Information Center (PIIC iX only) 3 12-Lead wave area 4 Data related to the wave presentation 5 ST Map with related ST numerics (optional) 6 Administrative data - including optional custom text fields 7 Hospital ID data - Institution, facility and department, if configured Other Reports See the sections on Trends for other example reports.
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 Clean with a lint-free cloth, moistened with warm water (40°C/104°F maximum) and soap, a diluted non-caustic detergent, tenside, ammonia- or alcohol-based cleaning agent. Do not use strong solvents such as acetone or trichloroethylene. Take extra care when cleaning the screen of the monitor because it is more sensitive to rough cleaning methods than the housing. Do not permit any liquid to enter the monitor case and avoid pouring it on the monitor while cleaning.
20 Care and Cleaning Product Name Product Type Ingredients Carpe DiemTM/MC Tb spray 0.5% accelerated hydrogen peroxide Carpe DiemTM/MC Tb Wipes wipes 0.5% accelerated hydrogen peroxide Super Sani-Cloth wipes isopropanol 55% quaternary ammonium chlorides 0.5% wipes isopropanol 15% quaternary ammonium chlorides 0.25% wipes isopropanol < 0.15% quaternary ammonium chlorides 0.
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21 21 Using Batteries The Lithium Ion batteries used in your monitor store a large amount of energy in a small package. This allows reliable battery-operated monitoring but also requires care in use and handling of the batteries. Follow the instructions in this chapter and refer for further details to the Application Note Lithium Ion Battery Management and Safety Practices included on your Documentation DVD.
21 Using Batteries 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 LED The battery LED on the front panel of the monitor is indicated by a battery symbol.
21 Using Batteries Battery Extension, the battery gauge shows the remaining power for the battery in the Battery Extension. Battery status/malfunction indicator: Normal battery function is indicated by the battery power gauge, together with the remaining operating time, on the Main Screen. However, if there are problems or changes in the status of the battery this is indicated by the battery status/malfunction indicator on the Main Screen. This consists of a blank battery gauge containing a symbol.
21 Using Batteries 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). TimeToFull is shown in place of TimeToEmpty if the monitor is connected to mains power via a host monitor or the M8023A external power supply, and tells you how much time is left until the battery is charged to 90%.
21 Using Batteries Replacing a Battery To replace the battery, 1 Press the battery eject button (1). This releases the battery. The INOP !! Insert Battery is suppressed for 15 seconds, allowing you sufficient time to insert 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. WARNING Do not insert your fingers or any objects into the open battery compartment.
21 Using Batteries Replacing the Battery in the Battery Extension To replace the battery, 1 Push the battery cover downwards, so that it opens. 2 Remove the battery from the compartment. 3 Slide the new battery firmly into position with the label facing downwards. 4 Close the battery cover and push it upwards, so that it remains closed. Optimizing Battery Performance The performance of rechargeable batteries may deteriorate over time.
21 Using Batteries Display Brightness Setting In the Main Setup menu, select User Interface, Brightness, then Optimum. This selects a level of brightness suitable for most monitoring locations that uses less battery power than brighter settings. Ensure that the current level of brightness is suitable for your monitoring location. Charging a Battery A battery can be charged in a monitor during monitoring. You can also use the 865432 Smart Battery Conditioner (previously M8043A) to charge batteries.
21 Using Batteries Storing a Battery A battery should not remain inside the monitor or Battery Extension if it is not used for a longer period of time. Batteries should be charged to a maximum of 50% for storage. NOTE The battery will discharge over time if it is stored inside the monitor or Battery Extension when not connected to AC power via the external power supply (M8023A).
22 Maintenance and Troubleshooting 22 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 Inspecting the Cables and Cords 1 Examine all system cables, the power plug and cord for damage. Make sure that the prongs of the plug do not move in the casing. If damaged, replace it with an appropriate Philips power cord. 2 Inspect the patient cables, leads and their strain reliefs for general condition. Make sure there are no breaks in the insulation. Make sure that the connectors are properly engaged at each end to prevent rotation or other strain.
22 Maintenance and Troubleshooting If you suspect an intermittent, system-wide problem call your service personnel. You may be asked for information from the status log. To view the status log, In the Main Setup menu, select Revisions. 1 Select Status Log.
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23 23 Accessories This chapter lists Philips-approved accessories for use with patient monitors as described in this document. 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.
23 Accessories For use with: Part No. Length 5-Electrode Cable Set, OR 989803170181 2.7 m 6-Electrode Cable Set M1667A 2.7 m 10-Electrode Cable set (5+5) M1663A 2.7 m 10-Electrode Cable set (6+4) M1665A 2.7 m 3-Electrode Cable Sets Description Length AAMI Part No. IEC Part No. OR Grabber shielded 1.0 m M1675A M1678A ICU Grabber shielded 1.0 m M1671A M1672A ICU snap shielded 1.0 m M1673A M1674A ICU Clip non-shielded 0.45 m M1622A -- ICU Clip non-shielded 0.
23 Accessories 6-Electrode Cable Sets Description Length AAMI Part No. IEC Part No. OR Grabber 1.0 m/1.6 m M1684A M1685A ICU Grabber 1.0 m/1.6 m M1680A M1681A ICU Snap 1.0 m/1.6 m M1682A M1683A Description Length AAMI Part No. IEC Part No. ICU Grabber, chest, shielded 1.0 m M1976A M1978A ICU Snap, chest, shielded 1.0 m M1602A M1604A OR Grabber, chest, shielded 1.0 m M1979A M1984A Description Length AAMI Part No. IEC Part No. ICU Grabber, chest, shielded 1.
23 Accessories Description Part No. Set organizer for non-shielded lead sets - miniclip 3-electrode M1636A 5-electrode M1638A Bedsheet clip M1509A Replacement red cover for trunk cable (for 5-electrode cable sets) 989808148861 Supported Cables Trunk Cables Length 3-Electrode Cable Set 5-Electrode Cable Set AAMI Part No. IEC Part No. AAMI Part No. IEC Part No. 0.9 m M1540C M1550C M1560C M1570C 2.
23 Accessories Invasive Pressure Accessories These transducers and accessories are designed to have special protection against electric shocks (particularly regarding allowable leakage currents), and are defibrillator proof. Transducer, accessories, sensor kits Part No Reusable pressure transducer 5 mV/.
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 Reusable Comfort Cuffs Patient Category Limb Circumference Part No. Tubing Adult (Thigh) 42 to 54 cm M1576A Large Adult 34 to 43 cm M1575A Adult 27 to 35 cm M1574A M1598B (1.5 m) or M1599B (3 m) Small Adult 20.
23 Accessories Adult/Pediatric Single Patient, Soft Cuffs Patient Category Limb Circumference Part No. Tubing Adult (Thigh) 44 - 56 cm M4579B Large Adult X-Long 35 - 45 cm M4578B Large Adult 35 - 45 cm M4577B M1598B (1.5 m) or M1599B (3 m) Adult X-Long 27.5 - 36 cm M4576B Adult 27.5 - 36 cm M4575B Small Adult 20.5 - 28.5 cm M4574B Pediatric 14.0 - 21.5 cm M4573B Infant 10 - 15 cm M4572B Neonatal/Infant Single Patient Cuffs Cuffs Limb Circumference Part No.
23 Accessories Order Number Description 989803163201 Bladder Width Contents Mobile CL Single-Patient Adult 26.0 - 34.5 cm Cuff 13.0 cm 20 cuffs 989803163221 Mobile CL Single-Patient Large 33.5 - 45.0 cm Adult Cuff 16.0 cm 20 cuffs 989803163251 Mobile CL NBP Cradle Kit - - 20 cradles 989803163131 Mobile CL Extension Air Hose, 1.
23 Accessories Product Number Description Comments Philips reusable sensors. M1191A/B Adult sensor (2m cable), for patients over 50 kg. Any finger, except thumb. M1191AL/BL M1191A/B with longer cable (3 m) M1192A Small adult, pediatric sensor (1.5 m cable) for patients between 15 kg and 50 kg. Any finger except thumb. M1193A Neonatal sensor (1.5 m cable) for patients between 1kg and 4 kg. Hand or foot. M1194A Ear sensor (1.5 m cable) for patients more than 40 kg. M1195A Infant sensor (1.
23 Accessories Product Number Description Comments NELLCOR disposable sensors (must be ordered from Nellcor) OxiMax MAX-A Adult finger sensor (patient size > 30 kg). Use adapter cable M1943A or M1943AL. OxiMax MAX-AL OxiMax MAX-A with long cable. OxiMax MAX-P Pediatric foot/hand sensor (patient size 10-50 kg). OxiMax MAX-I Infant foot/hand sensor (patient size 3-20 kg). OxiMax MAX-N Adult finger or neonatal foot/hand sensor (patient size > 40 kg or < 3 kg).
23 Accessories Product Number Description Philips Part Number LNOP Adtx Adult Sensor (> 30 kg) n/a LNOP Pdt Pediatric Sensor (10 - 50 kg) n/a LNOP Pdtx Pediatric Sensor (10 - 50 kg) n/a LNOP Inf-L Infant Toe Sensor (3 - 20 kg) n/a LNOP Neo-L Neonatal Sensor (< 3 kg) or Adult adhesive Sensor (> 40 kg) n/a LNOP NeoPt-L Neonatal Pre-Term Sensitive Skin Sensors (< 1 kg) n/a MASIMO LNCS® disposable adhesive sensors.
23 Accessories Order Number Description Contents 989803165941 Mobile CL 20 single patient SpO2 Sensors and Cradles for use on pediatric and adult patients >10 kg 20 Single-Patient Mobile CL DSpO2-1A Sensors 20 Single-Patient Wristbands 20 Single-Patient Cradles pre-assembled 989803165921 Mobile CL 20 single patient SpO2 Sensors 20 Single-Patient Mobile CL DSpO2-1A for use on pediatric and adult patients >10 kg Sensors 9898031659311 Mobile CL reusable SpO2 sensor and Cradles 1 Reusable Mobile CL RS
23 Accessories Mainstream CO2 Accessories Description Part No. CO2 Sensor M2501A Adult/Pediatric Airway Adapter (reusable) M2513A Infant Airway Adapter (reusable) M2516A Adult Airway Adapter (single-patient use) M2533A Infant Airway Adapter (single-patient use) M2536A Sidestream CO2 Accessories Description Part No.
23 Accessories Mainstream CO2 Accessories (for M3016A) Description Part No. CO2 Sensor M1460A Standard Airway Adapter (reusable) M1465A Small Airway Adapter (reusable) 14363A Microstream CO2 Accessories • "FilterLine Set" is a combination of a FilterLine with an Airway Adapter. • "H" in the accessory name indicates suitability for humidified ventilation and longer usage due to the active removal of humidity from the sample line. • "Smart CapnoLine" is a combined oral-nasal FilterLine.
23 Accessories Description Part Number Part Number for Long Version Smart CapnoLine® O2 Adult M2522A 989803160281 Smart CapnoLine® H O2 Adult 989803177951 989803177961 Smart CapnoLine® O2 Pediatric M2520A 989803160271 Smart CapnoLine® H O2 Pediatric 989803177971 989803177981 Smart CapnoLine® Adult M2526A 989803160301 Smart CapnoLine® Pediatric M2524A Accessories for Endoscopic Procedures Smart CapnoLine® Guard 989803178031 Smart CapnoLine® Guard O2 989803178041 Hook and Loop Strap
23 Accessories 272
24 24 Specifications The specifications in this section apply to the MP2 patient monitor. Indications for Use The monitor is indicated for use by healthcare professionals whenever there is a need for monitoring the physiological parameters of patients. 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.
24 Specifications WARNING The monitor is not intended for use in an MRI environment or in an oxygen-enriched environment (for example, hyperbaric chambers). Restricted Availability Following new features and functionality may not be available in all geographies: • Integrated Pulmonary Index for Microstream CO2 • Smart Alarm delays • IntelliVue Information Center iX Manufacturer's Information You can write to Philips at this address Philips Medizin Systeme Boeblingen GmbH Hewlett-Packard-Str.
24 Specifications Symbols These symbols can appear on the monitor and its associated equipment (depending on options).
24 Specifications Symbols Followed by two alphanumeric characters, indicates ingress protection grade Indicates location of serial number Indicates location of catalog number Indicates location of service number SmartKeys Main Screen Electrical input indicator Electrical output indicator (In some cases gas output indicator) LAN connection indicator for connection to a wired network (In some cases gas input indicator) Non-ionizing radiation symbol Installation Safety Information WARNING If multip
24 Specifications Monitor Mounting Precautions Mount the monitor using either the Philips Quick Mount or Fix Mount solution or another approved mounting solution. Select the mounting equipment and the mounting position so that no patient, operator or other person can be harmed by a monitor removed intentionally or released accidentally from the mount.
24 Specifications EMC And Radio Regulatory Compliance This ISM device complies with Canadian ICES-001. Cet appareil ISM est conforme à la norme NMB001 du Canada. The MP2 including IntelliVue Instrument Telemetry WMTS (US only)) The MP2 including IntelliVue Instrument Telemetry WMTS complies with part 15 of the FCC Rules. Operation is subject to the condition that this device does not cause harmful interference.
24 Specifications The radio component contained in this device is in compliance with Council Directive 1999/5/EC (Radio Equipment and Telecommunications Terminal Equipment Directive) In addition the product complies with: ETSI EN 300 328; ETSI EN 301 893; AS/NZS 4771+A1; ARIB STD-T66.
24 Specifications • Free Fall Test according to EN1789 (covers also IEC TR 60721-4-7 and Class 7M3). Test procedure according to EN 60068-2-32 (height 0.75 m). • Specification for degrees of protection provided by enclosures according to IEC/EN 60529: IP 32. • EN 1789 +A1:2003 Medical vehicles and their equipment - Road ambulances (chapter 6 - Medical Devices). • Radiated susceptibility 20 V/m according to EN ISO 9919 (SpO2) and EN ISO 21647 (CO2).
24 Specifications M8023A External Power Supply Weight and Dimensions Maximum Weight 700 g ±10% (1.5 lb ±10%) Size (W x H x D) 207 x 70 x 113 mm 8.1 x 2.8 x 4.4 in 865297 Battery Extension Weight and Dimensions Maximum Weight 1.4 kg ±10%, including battery (3.1 lb ±10%) Size (W x H x D) 190 x 140 x 135 mm 7.5 x 5.5 x 5.3 in Environmental Specifications The monitor may not meet the performance specifications given here if stored or used outside the specified temperature and humidity ranges.
24 Specifications Item Condition Range Ingress Protection Monitor IP32 (protected against ingress of water when the water is dripping vertically and the monitor is tilted up to 15°) External Power Supply (M8023A) IP31(protected against the ingress of solid foreign objects 2.5 mm in diameter or larger, and the ingress of water when the water is dripping vertically) when rested on its rubber feet on a flat, level surface.
24 Specifications Performance Specifications Alarm signal System alarm delay less than 4 seconds The system alarm delay is the processing time the system needs for any alarm to be indicated on the monitor, after the measurement has triggered the alarm. Delay for alarm availability on the network less than 4 seconds This is the time needed after alarm indication on the monitor until the alarm signal is available on the network, to the IntelliVue Information Center or for transmission to other systems.
24 Specifications Monitor Interface Specifications Monitor Interface Specifications Measurement Link (MSL) ECG Sync Pulse Output1 Connectors Female ODU (Proprietary) Power 30 V to 60 V input Power Sync. RS-422 compliant input 78.125kHz (typical) LAN signals IEEE 802.
24 Specifications Monitor Interface Specifications Internal WMTS Adapter Technology compatible with Philips IntelliVue Telemetry System (ITS), cellular infrastructure Frequency Band WMTS, 1395-1400 MHz and 1427-1432 MHz IntelliVue Instrument Telemetry Wireless Network Internal ISM Adapter Technology compatible with Philips IntelliVue Telemetry System (ITS), cellular infrastructure Frequency Band 1 2.
24 Specifications M4607A Battery Specifications One battery is required for battery operation of the monitor. The battery lifetime is 3 years from manufacturing date or 500 charge/discharge cycles. M4607A Battery Specifications Physical Specifications WxDxH 66 mm (2.36 in) x 80 mm (3.15 in) x 20 mm (0.79 in) Weight 160 g ±5% Performance Specifications Nominal Voltage 10.
24 Specifications M4605A Battery Specifications Battery Type Smart Battery 10.8 V, 6000 mAh, Lithium Ion Safety complies with UL 2054 Electromagnetic Compatibility (EMC) complies with the requirements for FCC Type B computing Device, and EN 61000-4-2 and EN 61000-3-2 Communication Standard complies with the SMBus specification v 1.1 Measurement Specifications See the Appendix on Default Settings for a list of the settings the monitor is initially shipped with.
24 Specifications ECG/Arrhythmia/ST Performance Specifications Sinus and SV Rhythm Ranges Bandwidth Bandwidth Brady Adult: 15 to 59 bpm Pedi: 15 to 79 bpm Neo: 15 to 89 bpm Normal Adult: 60 to 100 bpm Pedi: 80 to 160 bpm Neo: 90 to 180 bpm Tachy Adult: >100 bpm Pedi: >160 bpm Neo: >180 bpm Diagnostic Mode Adult/neo/pedi: 0.05 to 150 Hz Extended Monitoring Mode Adult/neo/pedi: 0.5 to 150 Hz Monitoring Mode Adult: 0.5 to 40 Hz Neo/pedi: 0.5 to 55 Hz Filter Mode Adult/neo/pedi: 0.
24 Specifications ECG/Arrhythmia/ST/QT Alarm Specifications Range Adjustment SVT Run 3 to 99 SV beats 1 SV beat ST High -19.8 to +20 mm 0.2 mm ST Low -20 to +19.8 mm 0.2 mm STE Limit -20 to +20 mm 0.2 mm QTc High 200 ms to 800 ms 10 ms steps QTc High 30 ms to 200 ms 10 ms steps ECG/Arrhythmia/ST Supplemental Information as required by AAMI EC11/13, IEC 60601-2-27 Respiration Excitation Waveform Sinusoidal signal, 260 A, 40.5 kHz Noise Suppression RL drive gain 44 dB max., max.
24 Specifications Respiration Respiration Performance Specifications Respiration Rate Range Adult/pedi: 0 to 120 rpm Neo: 0 to 170 rpm Accuracy at 0 to 120 rpm ±1 rpm at 120 to 170 rpm ±2 rpm Resolution 1 rpm Bandwidth 0.3 to 2.5 Hz (-6 dB) Noise Less than 25 m (rms) referred to the input Respiration Alarm Specifications Range Adjustment Delay High Adult/pedi: 10 to 100 rpm Neo: 30 to 150 rpm under 20 rpm: 1 rpm steps over 20 rpm: 5 rpm steps max.
24 Specifications SpO2 Performance Specifications SpO2 Range 0 to 100% The specified accuracy Accuracy is the root-meansquare (RMS) difference between the measured values and the reference values Philips Reusable Sensors: M1191A, M1191AL, M1191B, M1191BL, M1192A, = 2% (70% to 100%) M1193A, M1194A, M1195A, M1196A = 3% (70% to 100%) M1191T, M1192T, M1193T (Adult), M1196T = 3% (70% to 100%) M1193T (Neonate) = 4% (70% to 100%) Philips Disposable Sensors with M1943A(L): M1132A, M1133A (adult/infant), M1134A
24 Specifications SpO2 Alarm Specifications Range Adjustment Tachycardia Difference to high limit 0 to 50 bpm 5 bpm steps Clamping at 150 to 300 bpm 5 bpm steps Difference to low limit 0 to 50 bpm 5 bpm steps Clamping at 30 to 100 bpm 5 bpm steps Bradycardia SpO2 Alarm Specifications (cont.
24 Specifications NBP Complies with IEC 60601-2-30:1999/EN60601-2-30:2000. NBP Performance Specifications Measurement Ranges Systolic Adult: 30 to 270 mmHg (4 to 36 kPa) Pedi: 30 to 180 mmHg (4 to 24 kPa) Neo: 30 to 130 mmHg (4 to 17 kPa) Diastolic Adult: 10 to 245 mmHg (1.5 to 32 kPa) Pedi: 10 to 150 mmHg (1.5 to 20 kPa) Neo: 10 to 100 mmHg (1.5 to 13 kPa) Mean Adult: 20 to 255 mmHg (2.5 to 34 kPa) Pedi: 20 to 160 mmHg (2.5 to 21 kPa) Neo: 20 to 120 mmHg (2.
24 Specifications representative patient population. For the auscultatory reference the 5th Korotkoff sound was used to determine the diastolic pressure. In neonatal mode, the blood pressure measurements determined with this device comply with the American National Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP10 1992 and AAMI/ANSI SP10A -1996) in relation to mean error and standard deviation, when compared to intra-arterial measurements in a representative patient population.
24 Specifications Invasive Pressure Alarm Specifications Invasive Pressure Alarm Range Specifications Pressure -40 to 360 mmHg (-5.0 to 48 kPa) Adjustment Delay -40 to 50 mmHg 2 mmHg (0.5 kPa) max. 12 seconds >50 mmHg 5 mmHg (1 kPa) Extreme High Difference to high limit 0 to 25 mmHg Extreme Low Pulse 5 mmHg steps (0.5 kPa) Clamping at -40 to 360 mmHg 5 mmHg steps (1.0 kPa) Difference to low limit 0 to 25 mmHg 5 mmHg steps (0.5 kPa) Clamping at -40 to 360 mmHg 5 mmHg steps (1.
24 Specifications CO2 The CO2 measurement in the monitor, M3014A and M3015A complies with EN ISO 21647:2004 + Cor.1:2005 (except alarm system; alarm system complies with IEC 60601-2-49:2001). M3015A Microstream CO2 Performance Specifications CO2 AwRR IPI Range 0 to 150 mmHg (0 to 20 kPa), or 20% CO2, whichever is lower Accuracy Up to 5 minutes during warmup: ±4 mmHg or 12%, whichever is greater After 5 minutes warmup: 0 to 40 mmHg (0 to 5.3 kPa):±2.2 mmHg (±0.3 kPa) Above 40 mmHg (5.3 kPa):±(5.
24 Specifications M3014A Mainstream CO2 Performance Specifications CO2 awRR Range 0 to 150 mmHg (0 to 20.0 kPa) Accuracy after 2 minutes warmup: For values between 0 and 40 mmHg: ±2.0 mmHg (±0.29 kPa) For values from 41 to 70 mmHg: ±5% of reading For values from 71 to 100 mmHg: ±8% of reading The specifications are valid for standard gas mixtures, balance air, fully hydrated at 35°C, Pabs = 760 mmHg, flow rate = 2 l/min. Resolution Numeric: 1.0 mmHg (0.1 kPa) Wave: 0.1 mmHg (0.
24 Specifications M3016A Mainstream CO2 Performance Specifications CO2 awRR Range –4 to 150 mmHg (-0.5 to 20.0 kPa) Accuracy after 20 minutes warmup and calibration: For values between 0 and 40 mmHg: ±2.2 mmHg (±0.29 kPa) For values between 40 and 76 mmHg: ±5.5% of reading The specifications are valid for 45% O2 and N2 or N2O balance. Outside these conditions the accuracy reaches at a minimum the requirements of EN864/ISO9918. Resolution Numeric: 1.0 mmHg (0.1 kPa) Wave: 0.1 mmHg (0.
24 Specifications Interfering Gas and Vapor Effects On CO2 Measurement Values The specified deviations for M8102A/M3014A are valid when the appropriate corrections are switched on and set correctly.
24 Specifications Electromagnetic Emissions The monitor is suitable for use in the electromagnetic environment specified in the table below. You must ensure that it is used in such an environment. Emissions test Compliance Avoiding Electromagnetic Interference Radiofrequency (RF) emissions Group 1 The monitor uses RF energy only for its internal function.
24 Specifications Electromagnetic Immunity The monitor is suitable for use in the specified electromagnetic environment. The user must ensure that it is used in the appropriate environment as described below. IEC 60601-1-2 test level Compliance level Electromagnetic environment guidance Electrostatic discharge (ESD) IEC 61000-4-2 ±6 kV contact ±8 kV air ±6 kV contact ±8 kV air Floors should be wood, concrete, or ceramic tile.
24 Specifications Interference may occur in the vicinity of equipment marked with this symbol: Immunity test IEC 60601-1-2 test level Conducted RF IEC 61000-4-6 3 Vrms 150 kHz to 80 MHz Compliance level Electromagnetic environment guidance 3 Vrms Recommended separation distance: (1 Vrms for respiration) d = 1.2√P for respiration: d = 3.5√P Radiated RF IEC 61000-4-3 3 V/m 80 MHz to 2.
24 Specifications Recommended separation distances from portable and mobile RF communication equipment The monitor is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled. The customer or user of the monitor can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment and the monitor as recommended below, according to the maximum output power of the communications equipment.
24 Specifications 304
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 pre-configured to your requirements, the settings at delivery will be different from those listed here.
25 Default Settings Appendix Country-Description Line Frequency 50/60 [Hz] Units Weight Units Height kg, lb in, cm ECG Cable Color IEC, AAMI Bahamas 60 kg cm AAMI Bahrain 50 kg cm AAMI Bangladesh 50 kg cm IEC Barbados 50 kg cm AAMI Belarus 50 kg cm IEC Belgium 50 kg cm IEC Belize 60 lb in AAMI Benin 60 lb in AAMI Bermuda 60 kg cm AAMI Bhutan 60 lb in AAMI Bolivia 60 kg cm AAMI Bosnia and Herzegovina 50 kg cm IEC Botswana 50 kg cm IEC B
25 Default Settings Appendix Country-Description Line Frequency 50/60 [Hz] Units Weight Units Height kg, lb in, cm ECG Cable Color IEC, AAMI Cook Islands 60 lb in AAMI Costa Rica 60 kg cm AAMI Côte d'Ivoire 50 kg cm IEC Croatia 50 kg cm IEC Cuba 60 kg cm IEC Cyprus 50 kg cm IEC Czech Republic 50 kg cm IEC Denmark 50 kg cm IEC Djibouti 50 kg cm IEC Dominica 50 kg cm AAMI Dominican Republic 60 kg cm AAMI Ecuador 60 kg cm AAMI Egypt 50 kg c
25 Default Settings Appendix Country-Description Line Frequency 50/60 [Hz] Units Weight Units Height kg, lb in, cm ECG Cable Color IEC, AAMI Guam 60 lb in AAMI Guatemala 60 kg cm AAMI Guernsey 50 kg cm IEC Guinea 60 lb in AAMI Guinea-Bissau 60 lb in AAMI Guyana 60 kg cm AAMI Haiti 60 kg cm AAMI Heard Island and McDonald Islands 60 lb in AAMI Holy See, Vatican City State 60 lb in AAMI Honduras 60 kg cm AAMI Hong Kong 50 kg cm IEC Hungary 50 kg
25 Default Settings Appendix Country-Description Line Frequency 50/60 [Hz] Units Weight Units Height kg, lb in, cm ECG Cable Color IEC, AAMI Lebanon 50 kg cm AAMI Lesotho 50 kg cm IEC Liberia 50 kg cm IEC Libyan Arab Jamahiriya 60 lb in AAMI Liechtenstein 60 lb in AAMI Lithuania 50 kg cm IEC Luxembourg 50 kg cm IEC Macao 50 kg cm IEC Macedonia, The former Yugoslavian Republic of 50 kg cm IEC Madagascar 50 kg cm IEC Malawi 50 kg cm IEC Malaysia
25 Default Settings Appendix Country-Description Line Frequency 50/60 [Hz] Units Weight Units Height kg, lb in, cm ECG Cable Color IEC, AAMI New Caledonia 60 lb in AAMI New Zealand 50 kg cm AAMI Nicaragua 60 kg in AAMI Niger 50 kg cm IEC Nigeria 50 kg cm IEC Niue 60 lb in AAMI Norfolk Islands 60 lb in AAMI Northern Mariana Islands 60 lb in AAMI Norway 50 kg cm IEC Oman 50 kg cm AAMI Pakistan 50 kg cm IEC Palau 60 lb in AAMI Palestinian Terr
25 Default Settings Appendix Country-Description Line Frequency 50/60 [Hz] Units Weight Units Height kg, lb in, cm ECG Cable Color IEC, AAMI Senegal 50 kg cm IEC Serbia 50 kg cm IEC Serbia & Montenegro 50 kg cm IEC Seychelles 60 lb in AAMI Sierra Leone 50 kg cm IEC Singapore 50 kg cm IEC Slovakia 50 kg cm IEC Slovenia 50 kg cm IEC Solomon Islands 60 lb in AAMI Somalia 50 kg cm IEC South Africa 60 lb in AAMI South Georgia and the South Sandwich I
25 Default Settings Appendix Country-Description Line Frequency 50/60 [Hz] Units Weight Units Height kg, lb in, cm ECG Cable Color IEC, AAMI Uganda 60 lb in AAMI Ukraine 60 lb in AAMI United Arab Emirates 50 kg cm AAMI United Kingdom 50 kg cm IEC United States 60 lb in AAMI United States Minor Outlying Islands 60 lb in AAMI Uruguay 50 kg cm AAMI Uzbekistan 60 lb in AAMI Vanuatu 60 lb in AAMI Venezuela 60 lb in AAMI Viet Nam 50 kg cm IEC Virgin I
25 Default Settings Appendix Alarm and Measurement Default Settings The default wave speed for all measurements except Respiration is 25 mm/sec. For Respiration the default wave speed is 6.25 mm/sec. In the following tables, settings may be entered only once per table row if they are the same for all patient categories. Alarm Default Settings H30 (deviations from H10/H20/ H40) Alarm Settings Factory Default H10/H20/H40 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 Settings Factory Defaults Adult Pedi Neo High Limit 120 bpm 160 bpm 200 bpm Low Limit 50 bpm 75 bpm 100 bpm ECG/Arrhy Alarms On On On Alarm Source Auto Auto Auto ECG On On On QRS Volume 1 1 1 Primary Lead II II II Secondary Lead V V V Analysis Mode Multi Lead Multi Lead Multi Lead Lead Placement Standard Standard Standard Mod.
25 Default Settings Appendix Arrhythmia Settings Factory Defaults Adult Pedi Neo Vent Rhythm 14 14 14 SVT HR 180 200 210 SVT Run 5 5 5 PVCs/min 10 5 5 Non-Sustain On On On Vent Rhythm On On On Run PVCs On On On Pair PVCs On On On R-On-T PVCs On On On V.Bigeminy On On On V.Trigeminy On On On PVCs/min On On On Multif.PVCs On On On Pacer N.Cap On On On Pacer N.
25 Default Settings Appendix Lead I, II, III, V, aVR, aVL, V1-6, MCL Settings Factory Defaults Adult Pedi Neo ST Analysis On Off Off ST (Label) High +2.0 mm +2.0 mm +2.0 mm ST (Label) Low -2.0 mm -2.0 mm -2.0 mm ST (Label) High +1.0 mm +1.0 mm +1.0 mm ST (Label) Low +1.0 mm +1.0 mm +1.
25 Default Settings Appendix Factory defaults H10/H20/H40 Pulse Alarm Settings Adult Pedi Neo Δ ExtrBrady 20 bpm 20 bpm 20 bpm Brady Clamp 40 bpm 40 bpm 50 bpm Δ ExtrTachy 20 bpm 20 bpm 20 bpm Tachy Clamp 200 bpm 220 bpm 240 bpm Pulse alarms use the settings of the currently selected Pulse alarm source.
25 Default Settings Appendix SpO2 Alarm Default Settings Setting Adult Pedi Neo Desat Limit 80 80 80 Low Limit 90 90 85 High Limit 100 100 95 Desat Delay 20 sec 20 sec 20 sec High Alarm Delay 10 sec 10 sec 10 sec Low Alarm Delay 10 sec 10 sec 10 sec SmartAlarmDelay (SAD) Off Off Off High Alarm Delay (SAD) Short Short Short Low Alarm Delay (SAD) Short Short Short Label SpO₂ SpO₂ SpO₂ On On On Pulse settings Pulse (SpO₂) For all other Pulse default settings, re
25 Default Settings Appendix Temperature Default Settings Factory Defaults Temp Settings Adult Pedi Neo Low Limit 36 36 36 High Limit 39 39 39 Alarms On On On Unit °C °C °C Range 35...43 35...43 35...43 Color Green Green Green Invasive Pressure Default Settings ABP, ART, Ao, BAP, FAPP,P P1, P2, P3, P4, UAP Settings Factory Defaults Adult Pedi Neo Alarms from Sys. Sys. Sys.
25 Default Settings Appendix CVP, RAP, LAP, UVP Settings Factory Defaults Adult Pedi Neo Δ Extreme Low 5 5 5 Mean High Clamp 20/10 (15) 15/5 (10) 15/5 (10) Mean Low Clamp 0/-5 (-5) 0/-5 (-5) 0/-5 (-5) Scale 30 30 30 Mean only Yes Yes Yes Filter 12 Hz 12 Hz 12 Hz Mercury Cal Yes Yes Yes Artifact Suppr. 60 sec 60 sec 60 sec Unit mmHg mmHg mmHg Color Cyan (light blue) Cyan (light blue) Cyan (light blue) Adult Pedi Neo Alarms from Dia. Dia. Dia.
25 Default Settings Appendix ICP, IC1, IC2 Settings Factory Defaults Adult Pedi Neo Δ Extreme Low 10 10 10 Mean Low Clamp 20/10 (-5) 15/5 (-5) 15/5 (-5) Mean High Clamp 0/-5 (0) 0/-5 (0) 0/-5 (0) Scale 30 30 30 Mean only Yes Yes Yes Filter 12 Hz 12 Hz 12 Hz Mercury Cal Yes Yes Yes Artifact Suppr.
25 Default Settings Appendix 322
1 # 10-lead placement (ECG) 116 12-lead placement (ECG) 116 3-lead placement (ECG) 115 5-lead placement (ECG) 115 A AAMI ECG lead labels 114 abdominal breathing 160 and Resp electrode placement 160 aberrantly conducted beats 128 accessories 10-electrode cable sets 259 3-electrode cable sets 258, 260 5-electrode cable sets 258, 260 5-electrode one piece cables 261 6-electrode cable sets 259 CO2 201, 202, 203 CO2 (mainstream) 269, 270 ECG 107 NBP 177 adult cuffs 263 comfort cuffs 262 disposable cuffs 263 mu
charge status 248 conserving power 251 indicators 51 malfunction indicator 246 monitoring time 246 safety information 125, 162 status indicator 246 symbol 275 time to empty 247 time to full 247 battery eject symbol 275 battery performance 250 optimizing 250 beat labels 130 arrhythmia 127 blood pressure.
FAST 165 Fourier artefact suppression technology 165 FilterLine 203 CO2, microstream accessory 203 flushing invasive pressure accessories 187 functional arterial oxygen saturation 165 fusion beat pacemakers 125 and ECG monitoring 125 G gas cylinder empty, disposing of 255 getting started 42 global trend time 222 H horizon trend 222 trend time 222 HR = RR (Resp) 160 HR alarms 125 when arrhythmia off 125 HR alarms off (Config Mode) 125 HR and pulse alarm source selection 157 humidity correction 204 CO2 201,
O on-screen keyboard 33 operating room ECG cable 125 orange ECG cable 125 organizers 259, 261 oscillometric NBP measurement method 177 overlapping screen trends 223 P pace pulse rejection (ECG) 108, 110 about 36 switching on/off 60 paced patients 111, 125, 127 arrhythmia monitoring 125 repolarization tails 111 safety information 125, 162 setting status 125 paced status checking 58 pacemaker failure 125 parameter scales 220 patient 177 category, NBP 177 patient alarm messages 65 patient reports 238 contents
alarms specific to SpO2 170 arterial pulsation 165 assessing suspicious reading 169 FAST technology 165 perfusion indicator 165, 166, 175 pleth wave 175 pleth waveform 165 pulse numerics 166 signal quality 169 site inspection 166 site selection 165 SpO2 desat alarm 175 ST 137 adjusting alarm limits 134 alarms 51 ensuring diagnostic quality 137 filtering 137 measurement points, adjusting 142 snippets 139 ST display 139 ST map 145 report, printing printing 231 ST map report 148 scale, changing 148 scale 111,
Part Number 453564306381 Published in Germany 03/2012 *453564306381*
