H E A R T S TA R T X LT I N STR UCTION S F OR US E M3500B
Instructions for Use 0 % +HDUW6WDUW ;/7 'HILEULOODWRU 0RQLWRU
1RWLFH About This Edition Edition 3 Printed in the USA Publication number M3500-91900 The information in this guide applies to the M3500B HeartStart XLT, release Main 35 and earlier. This information is subject to change without notice. Philips Medical Systems shall not be liable for errors contained herein or for incidental or consequential damages in connection with the furnishing, performance, or use of this material.
Conventions This guide uses the following conventions: WARNING Warning statements describe conditions or actions that can result in personal injury or loss of life. CAUTION Caution statements describe conditions or actions that can result in damage to the equipment or loss of data. NOTE Notes contain additional information on usage.
Contents Introduction Overview ............................................................................................................................... 1-1 Intended Use ......................................................................................................................... 1-3 Defibrillation Therapy .......................................................................................................... 1-3 Indications for AED Therapy ................................................
Contents Defibrillating in AED Mode Overview ............................................................................................................................... 3-3 Defibrillation (with the default configuration) ............................................................... 3-3 Defibrillation (with a modified configuration) ............................................................... 3-4 Preparation ............................................................................................
Contents Discontinuing SpO2 Monitoring .......................................................................................... 5-9 Caring for Sensors ................................................................................................................ 5-9 Troubleshooting .................................................................................................................. 5-10 Defibrillating in Manual Mode Enabling Manual Mode .......................................................
Contents Setting Up and Configuring the HeartStart XLT Connecting/Disconnecting Patient Cables .......................................................................... 10-1 This section describes how to connect and disconnect the: .......................................... 10-1 Connecting the Pads Patient Cable ............................................................................... 10-2 Disconnecting the Pads Patient Cable ..........................................................................
Contents Loading Printer Paper ....................................................................................................... 11-10 Cleaning Instructions ........................................................................................................ 11-12 Cleaning the HeartStart XLT ...................................................................................... 11-12 Cleaning the Carrying Case ........................................................................................
Contents Specifications & Safety Specifications ...................................................................................................................... 13-2 Defibrillator .................................................................................................................. 13-2 Manual Mode .......................................................................................................... 13-2 AED Mode .........................................................................
1 Introduction 1 The M3500B HeartStart XLT Defibrillator/Monitor is designed to meet your resuscitation and monitoring needs. This guide provides instructions for safe and proper operation, set-up, configuration, and care of your HeartStart XLT. In this chapter, you’ll find general information that you should become familiar with before using the defibrillator/monitor. Overview The HeartStart XLT is a lightweight, portable, semi-automatic external defibrillator.
Overview Defibrillation is performed through multifunction defib electrode pads. In addition, both AED and Manual Mode offer monitoring through pads, 3-lead ECG monitoring electrodes, or optional 5-lead ECG monitoring electrodes. Optional pulse oximetry (SpO2) monitoring is available in both modes, as well. While monitoring ECG or SpO2, you may set heart rate and/or SpO2 alarms to alert you when these parameters are outside the limits defined.
Intended Use Intended Use The M3500B HeartStart XLT Defibrillator/Monitor is for use by emergency personnel trained in the operation of the device and qualified by training in basic life support, advanced cardiac life support, defibrillation, or other physician-authorized emergency medical response. It must be used by or on the order of a physician.
Defibrillation Therapy Contraindications for AED Therapy An AED is not to be used on patients that exhibit one or any combination of the following: z z z Responsiveness Spontaneous breathing Palpable pulse Precautions for AED Therapy The AED algorithm is not designed to handle erratic spiking problems caused by a properly or improperly functioning pacemaker. In patients with cardiac pacemakers, the HeartStart XLT may have reduced sensitivity and not detect all shockable rhythms.
Noninvasive Pacing Therapy Contraindications for Manual Defibrillation Therapy Asynchronous defibrillation therapy is contraindicated in patients that exhibit one or any combination of the following: z z z Responsiveness Spontaneous breathing Palpable pulse Precautions for Manual Defibrillation Therapy Defibrillating asystole can inhibit the recovery of natural pacemakers in the heart and completely eliminate any chance of recovery. Asystole should not be routinely shocked.
SpO2 Monitoring SpO2 Monitoring A pulse oximeter is a noninvasive device that indicates the oxygen saturation (SpO2) of arterial blood. This measurement is obtained through a probe that directs red and near infrared light through arterial beds. Hemoglobin absorbs these lights differently when it is bound with oxygen. Pulse oximetry measures this difference and translates the measurement into a saturation percentage that is displayed as an SpO2 reading.
Learning to Use the HeartStart XLT Learning to Use the HeartStart XLT The HeartStart XLT comes with: z z 1 Using the HeartStart XLT Defibrillator/Monitor, a videotape, and About Sealed Lead Acid Batteries, an application note on battery maintenance. For additional training materials, please visit our website at: www.medical.philips.com/cms. Safety Considerations General warnings and cautions that apply to use of the HeartStart XLT are provided in Chapter 13.
2 Getting Started Your HeartStart XLT is shipped to you in its carrying case with most of the accessories in their compartments. All you need to do before getting started is: z z z connect cables, connect to power, and insert the Data Card (if desired). This chapter will acquaint you with the HeartStart XLT and then guide you through these activities.
Getting Acquainted Basic Orientation The figure below shows the general layout of the controls, where the patient cables connect, and where to insert the battery and Data Card.
Getting Acquainted - Powers on the HeartStart XLT. - Powers off the HeartStart XLT. Defibrillation Controls - softkeys that perform the defibrillation function displayed in the softkey label above each button; control both AED and Manual Mode defibrillation. Manual Mode Controls - provide access to Manual Mode and control of synchronized cardioversion and pacing (if the option is present). Audiovisual Controls: 2 Adjusts the display contrast.
Getting Acquainted Manual Mode Controls The figure below shows the Manual Mode controls. These controls are accessed by lifting the door labeled "Manual." Figure 2-2 Manual Mode Controls Manual Sync Pacer Rate Start Stop Mode Output LEDs indicating the function is active (green light) or inactive (no light) NOTE 2-4 Synchronized cardioversion and pacing controls only function when Manual Mode is enabled.
Getting Acquainted Manual Sync Pacer Toggles between Manual Mode and AED Mode. Manual Mode is enabled when the green LED next to the key is lit. A password may be required for Manual Mode entry. Enables synchronized cardioversion when first pressed, as indicated by the green LED; disables synchronized cardioversion when pressed again. Activates the pacing function buttons (as indicated by the green LED), allowing you to use the buttons below to define pacing rate, mode, and current output.
Getting Acquainted Figure 2-3 AED Mode Display Layout (ECG and SpO2 disabled) System Message Momentary Message ECG Gain ECG User Message 150J Shocks: 0 00:15:02 Defibrillation Soft Keys NOTE PAUSE ANALYZE Current Charge Shocks Delivered Incident Timer SHOCK In its default configuration, the HeartStart XLT powers on in AED Mode where voice prompts and user messages are active. The Incident Timer shows the elapsed time since the HeartStart XLT was turned on.
Getting Acquainted Figure 2-4 AED Mode Display Layout (ECG and SpO2 Enabled) Lead Displayed Heart Rate HR Alarm HR ALARM LEAD SELECT 132 Lead II SpO2 value SPO2 86 PR 130 System Message Momentary Message SpO2 alarm Pleth Bar Pulse Rate ECG 2 User Message Selected Energy Defibrillation Soft Keys 150J PAUSE 114J Shocks: 0 00:15:02 ANALYZE Current Charge Shocks Delivered Incident Timer SHOCK User messages accompany voice prompts to guide you through the defibrillation process.
Getting Acquainted Figure 2-5 Manual Mode Display Layout Lead Displayed HR ALARM Heart Rate HR Alarm 132 LEAD SELECT Lead II SpO2 value SPO2 86 PR 130 System Message Momentary Message SpO2 alarm Pleth Bar Pulse Rate ECG 114J Selected Energy Defibrillation Softkeys Shocks: 0 00:15:02 150J ENERGY SELECT CHARGE Current Charge Shocks Delivered Incident Timer SHOCK LCD Backlight Under normal operation, the HeartStart XLT reads the ambient light and turns on the LCD back light when low light condit
Connecting to Power Connecting to Power The HeartStart XLT is powered by the M3516A battery. Prior to inserting the battery, make sure that the battery is charged and has been properly maintained (See “Battery Maintenance” on page 11-8). A fully charged battery will last for about two hours. A second spare charged battery should be kept in the carrying case at all times. The HeartStart XLT can also be powered by the M3517A AC Power Module or the M3518A DC Power Module.
Connecting to Power Removing the Battery Before removing the battery, make sure the HeartStart XLT is powered off. Then, to remove the battery, press the black battery eject button and pull the battery out, as shown in Figure 2-7. Figure 2-7 Removing the Battery Low Battery Warning The message /RZ %DWWHU\ is displayed on the HeartStart XLT when the battery is low and needs recharging.
Using a Data Card Using a Data Card Use of a Data Card is optional; the defibrillator will power up without a Data Card inserted. If you would like to collect patient information on a Data Card, the card must be inserted into the HeartStart XLT before the device is turned on. CAUTION Inserting or removing the data card while the defibrillator is on can corrupt the Data Card and prevent the unit from powering on again. If this occurs, see Table 12-3, Troubleshooting Tips.
Using a Data Card Inserting a Data Card To insert a Data Card: 1. Make sure the HeartStart XLT is powered off. 2. Press up on the release latch to open the door to the Data Card compartment. 3. If a Data Card is already in the compartment, press the black button inside the compartment to eject the card (see Figure 2-8). Then pull the card out. 4. With the yellow label facing up and the pointing towards the HeartStart XLT, slide the Data Card into the compartment. 5. Close the Data Card compartment door.
Using a Data Card Removing a Data Card To remove the Data Card: 1. Make sure the HeartStart XLT is powered off, (wait 2 seconds). 2. Press the black eject button (see Figure 2-8). 3. Pull the Data Card from the compartment.
3 Defibrillating in AED Mode The HeartStart XLT’s AED Mode is designed to guide you through standard treatment algorithms for cardiac arrest, including those provided by the American Heart Association and the European Resuscitation Council. Configuration choices allow you to customize AED Mode to better follow a specific treatment algorithm and to meet the unique needs of your life-saving team. This chapter describes how to use the HeartStart XLT to defibrillate in AED Mode.
Figure 3-1 AED Mode Overview If Patient is: z Unresponsive z Not Breathing z Pulseless Attach Pads Insert Data Card (Optional) Press On If Instructed, Press $1$/<=( No Shock Advised Shock Advised Press 6+2&.
Overview Overview An overview of the AED Mode defibrillation process is shown in Figure 3-1. The process begins only after you have: z z assessed that the patient is unresponsive, not breathing, and pulseless, and prepared for defibrillation by attaching pads and inserting a Data Card (if desired). Then you are ready to turn the HeartStart XLT on. The defibrillation process is dependent upon the configuration of your HeartStart XLT, as described in the following paragraphs.
Overview Defibrillation (with a modified configuration) Chapter 10 describes, in detail, the configurable parameters for AED Mode. Three parameters significantly impact the defibrillation process. They are: Device Initiated Analysis - initiates ECG analysis when the HeartStart XLT is first turned on. The default configuration setting is On. If you choose to set this parameter to 2II, you need to press $1$/<=( to initiate analysis in step 2 of the defibrillation process.
Preparation Preparation If the patient is: z z z unresponsive not breathing pulseless Then: 1. Apply multifunction defib electrode pads to the patient, as directed on the package. Use the anterior-anterior electrode placement. 2. Connect the pads to the pads patient cable, as shown in Figure 3-2. 3. If needed, insert a Data Card (as described in “Using a Data Card” on 211).
Defibrillating Defibrillating Follow the voice and screen prompts as they guide you through the following steps: 1. Press On. In this first step of the defibrillation process, the HeartStart XLT checks to see if the pads patient cable and the pads are connected. If they are, it proceeds to step 2. If the pads patient cable is not properly attached, you are prompted to &RQ QHFW 3DGV &DEOH.
Defibrillating If the pads have not been applied or are not making proper contact with the patient, you are prompted to $SSO\ 3DGV and &KHFN &RQQHFWLRQV.
Defibrillating 2. If instructed, press $1$/<=( . If device-initiated analysis is off, the HeartStart XLT monitors the rhythm (provided Rhythm Monitoring is on) and prompts you to press $1$/<=( if a potentially shockable rhythm is detected.
Defibrillating If device initiated analysis is on, you do not need to press $1$/<=( ; ECG analysis begins automatically. Figure 3-6 Analyzing Display Analyzing Do Not Touch Patient Shocks: 0 00:00:08 STOP ANALYSIS WARNING Handling or transporting the patient during ECG analysis can cause incorrect or delayed diagnosis. 3 If a shockable rhythm is detected, as indicated by the message 6KRFN $GYLVHG, analysis stops and the XLT automatically charges to 150J.
Defibrillating 3. If shock advised, press 6+2&. . Once charging is complete, the charge tone becomes continuous. Make sure no one is touching the patient or anything connected to the patient. Call out "Clear." Then press 6+2&. to deliver a shock to the patient. Figure 3-8 Press SHOCK Display Stand Clear! Press SHOCK 150J Shocks: 0 00:00:14 SHOCK WARNING Defibrillation current can cause operator or bystander injury.
Defibrillating Delivery of the shock is confirmed by the message 6KRFN 'HOLYHUHG and the shock counter is updated. Figure 3-9 Shock Delivered Display Shock Delivered Shocks: 1 00:00:40 Automatic Re-analysis On If Automatic Re-analysis is on, the HeartStart XLT analyzes the ECG following delivery of the shock. You are prompted to press 6+2&. , if an additional shock is advised. This cycle repeats until the rhythm converts or a shock series is complete.
Pausing for CPR Pausing for CPR At the completion of a shock series or when no shock is advised, the HeartStart XLT prompts you to &KHFN 3DWLHQW &KHFN 3XOVH . It allows eight seconds for you to check the pulse, then prompts you as follows: Figure 3-10 Press Pause Display If Needed Press PAUSE And Begin CPR PAUSE Shocks: 1 00:00:50 ANALYZE If CPR is needed, press 3$86( . While paused, the Pause Timer indicates the elapsed time and the total duration of the Pause state, in seconds.
Pausing for CPR Figure 3-11 Pause Display Paused Timer: 21 / 60 RESUME Shocks: 3 00:01:40 Elapse Time Total Pause Duration ANALYZE The pause state ends when the Pause Timer reaches the preconfigured Pause state duration, or if you press 5(680( or $1$/<=( . At the completion of the pause state, the defibrillation process begins again. If instructed, press $1$/<=( . If you do not press 3$86( , the HeartStart XLT begins monitoring the ECG rhythm (provided Rhythm Monitoring is on).
Monitoring Rhythm Monitoring Rhythm When the HeartStart XLT is not analyzing, defibrillating, or paused, Rhythm Monitoring alerts you to potentially shockable rhythms (provided Rhythm Monitoring is set to the default configuration, 2Q). The message 0RQLWRULQJ 5K\WKP appears on the display to let you know this feature is active and remains on the display for the duration of the monitoring.
Monitoring Rhythm If Rhythm Monitoring detects a shockable rhythm, you are prompted as follows: Figure 3-13 Shockable Rhythm Check Patient If No Pulse Press ANALYZE PAUSE Shocks: 3 00:00:55 ANALYZE This prompt is repeated periodically, as configured, until $1$/<=( or 3$86( is pressed. If you press $1$/<=( , the defibrillation process starts again. If you press 3$86( , rhythm monitoring is suspended for the duration of the pause. 3$86( is used when administering CPR, as noted earlier.
ERC Protocol ERC Protocol The HeartStart XLT can be configured to support the European Resuscitation Council (ERC) Guidelines for Resuscitation (1998). If (XURSHDQ 3URWRFRl is configured to 2Q, the defibrillation process described in this chapter is the same, with the exception of how the Pause state functions (see “Pausing for CPR” on 3-12).
ERC Protocol If CPR is needed, press 3$86( . While paused, a timer indicates the elapsed time and the total duration of the Pause state, as shown: Figure 3-15 Paused Timer: 35 / 60 RESUME Shocks: 3 00:01:40 Elapsed Time Total Pause Duration ANALYZE The total pause duration depends on the event preceding the Pause state.
Troubleshooting Troubleshooting When the HeartStart XLT detects a problem, it provides display and/or voice prompts to guide you to resolution. The table below lists the prompts you may encounter in AED Mode, the cause, and the suggested corrective action. Prompts related to the battery and Data Card are discussed in Chapter 12. Table 3-1 AED Mode Prompts Prompt Possible Cause Corrective Action Pads Off The multifunction defib electrode pads are not properly applied to the patient.
4 Monitoring the ECG The HeartStart XLT can be used for short or long-term ECG monitoring. The ECG monitoring function allows you to monitor through: z z multifunction defib electrode pads, or 3- or 5-lead ECG monitoring electrodes, as configured. When the HeartStart XLT is turned on, the ECG acquired through pads is shown on the display. ECG monitoring allows you to continue to monitor through the pads or to select a lead from an alternate ECG source (3- or 5lead).
Applying Monitoring Electrodes Applying Monitoring Electrodes Proper application and placement of electrodes is essential for reliable monitoring. Good contact between the electrode and the skin reduces the effects of motion artifact and signal interference. To apply electrodes: 1. Identify the appropriate electrode sites. (See Figure 4-1.) 2. Shave the electrode sites or clip hair, if necessary. 3. Clean and abrade the skin at the electrode sites. 4. Dry the skin at the electrode sites. 5.
Applying Monitoring Electrodes Electrode Placement Figure 4-1 shows typical electrode placement for the limb leads of a 3- or 5lead patient cable. The V/C lead of the 5-lead cable can be placed in any of the precordial lead positions (V1/C1 through V6/C6) shown in Figure 4-2. Figure 4-1 Limb Lead Electrode Placement AHA Labels RA/R LA/L RL/N* LL/F IEC Labels RA Right Arm R Right LA Left Arm L Left RL Right Leg* N Negative* LL Left Leg F Foot * Not used for 3-lead.
Applying Monitoring Electrodes Figure 4-2 Precordial Lead Electrode Placement Electrode 1 2 3 5 4 6 Location V1 C1 forth intercostal space, at right sternal margin V2 C2 forth intercostal space, at left sternal margin V3 C3 midway between V2/C2 and V4/C4 V4 C4 fifth intercostal space, at left midclavicular line V5 C5 same level as V4/C4, on anterior axillary line V6 C6 same level as V4/C4, at left mid axillary line Table 4-2 5-Lead ECG Lead Formation Lead I LA - RA II LL - RA
Selecting the Lead Selecting the Lead Available monitoring leads are dependent upon your device configuration: Table 4-3 Lead Select Choices Lead Select Choices are: If Configured for a: Pads, Lead I, Lead II, Lead III 3-lead ECG cable Pads, Lead I, Lead II, Lead III, aVR, aVL, aVF, V lead. 5-lead ECG cable /($' until To select a lead to monitor, cycle through the choices by pressing 6(/(&7 the desired lead is displayed.
Setting the Heart Rate Alarm Setting the Heart Rate Alarm The computed heart rate (number of detected QRS complexes per minute) is displayed below the +5 $/$50 sofkey, next to the . The heart rate represents the number of QRS complexes detected in a minute. A QRS beeper, if configured to on, indicates each QRS complex detected. If desired, a HR alarm may be set to alert you when the heart rate is outside the specified limits. Limit choices are listed in Table 4-4.
Disabling the HR Alarm Disabling the HR Alarm If the heart rate is outside the HR alarm limits, an alarm sounds. To disable the alarm, press +5 $/$50 . appears to indicate that the alarm is disabled. Adjusting the ECG Size To increase or decrease the size of the ECG, press trol, or on the gain con- . Troubleshooting Table 4-5 provides troubleshooting tips for ECG Monitoring.
Troubleshooting Table 4-5 Troubleshooting Tips (Continued) Situation 4-8 Cause Solution Poor ECG signal quality z The monitoring electrodes are not making proper contact with the patient. z The monitoring electrodes are outdated or dried-out. z Radio frequency interference (RFI) is causing artifact. z Check that the monitoring electrodes are properly applied. If necessary, prepare the patient’s skin and apply new electrodes. z Check the date code on the electrodes.
5 Monitoring SpO2 Pulse oximetry is a noninvasive method of continuously measuring oxygen saturation (SpO2) in arterial blood. The resultant SpO2 reading indicates the percentage of hemoglobin molecules in the arterial blood which are saturated with oxygen. SpO2 monitoring is one of the tools available to assist in assessing a patient’s cardiac and respiratory systems. This chapter explains how pulse oximetry works and describes how to use the HeartStart XLT to monitor SpO2.
Understanding Pulse Oximetry Understanding Pulse Oximetry A pulse oximetry sensor sends light through patient tissue to a receiver on the other side of the sensor. As Figure 5-1 shows, light emitting diodes transmit red and infrared light through peripheral areas of the body, such as a finger. Figure 5-1 Pulse Oximetry Sensor LED Photodetector A photodetector positioned opposite the light emitting diodes compares light absorption before and after pulsation.
Selecting a Sensor Selecting a Sensor Table 5-1 shows the SpO2 sensors that may be used with the HeartStart XLT.
Selecting a Sensor The most important factor when selecting a sensor is the position of the light emitting diodes in relation to the photodetector; when a sensor is applied, the diodes and the photodetector must be opposite each other. Sensors are designed for patients within a specific weight range and for specific sites. Be sure to: z z z Select a sensor appropriate for the patient’s weight. Select a sensor site with adequate perfusion. Avoid application to sites with edematous tissue.
Applying the Sensor Applying the Sensor Follow the manufacturer’s directions for applying and using the sensor, making sure to observe any warnings or cautions. For the best results: z z z z z z Make sure the sensor is dry. If the patient is moving, secure the sensor cable loosely to the patient. Avoid excessive pressure at the sensor site; ensure that circulation is not obstructed. Keep power cables away from the sensor cable and connection.
Connecting the Sensor Cable Connecting the Sensor Cable To connect a sensor cable: 1. Hold the connector with the flat side up so that the part number is visible. 2. Insert the connector into the receptacle and push until the blue portion of the connector is no longer visible.
Monitoring Monitoring To monitor SpO2: 1. 2. 3. 4. If the HeartStart XLT is not on, press On. Apply the appropriate sensor to the patient. Make sure the sensor cable is connected to the HeartStart XLT. Press 6S2 to turn on SpO2 monitoring. A dashed line (---) is displayed under 6S2 , while the oxygen saturation is measured and an SpO2 value is calculated. In a few seconds the SpO2 value is displayed in place of the dashed line.
Setting Alarms Setting Alarms An alarm may be set to alert you if the SpO2 value falls below a specified lower limit. Lower limit alarm choices are (no alarm), 90, 85, or 80. Press 6S2 repeatedly to cycle through the choices. Stop when the desired choice is displayed. A appears in three seconds, indicating that the selected alarm is active. To review the alarm limit, press 6S2 .
Discontinuing SpO2 Monitoring Discontinuing SpO2 Monitoring To shut off SpO2 monitoring, press 6S2 repeatedly until nothing appears below the 6S2 softkey. Figure 5-5 SpO2 Monitoring Off HR ALARM LEAD SELECT 78 Pads SpO2 Monitoring Rhythm Shocks: 3 00:00:49 PAUSE ANALYZE Caring for Sensors Refer to the manufacturers instructions for care and cleaning of sensors. To get the best results from your SpO2 reusable sensors, always handle the sensor and cable with care and protect them from sharp objects.
Troubleshooting Troubleshooting The table below lists system messages that you may encounter when monitoring SpO2. Table 5-2 System Messages Problem or Message 6S2 1RQ 3XOVDWLOH Possible Cause Corrective Action z Pulse absent or too z Check the sensor is weak to be detected. applied properly. z Make sure the sensor site has a pulse. z Relocate the sensor to z 6S2 /RZ 6LJQDO z SpO2 signal is too low to give an accurate reading. a site with improved circulation. Try another sensor type.
Troubleshooting Table 5-2 System Messages (Continued) Problem or Message 6S2 &DEOH 2II Possible Cause z The SpO2 cable is not connected to the device. 6S2 6HQVRU )DLO z The transducer is broken. 6S2 )DLOXUH z There is a hardware failure in the SpO2 subsystem. Corrective Action z Attach the cable to the HeartStart XLT. z Apply a new transducer. z Remove device from active use and call for service.
6 Defibrillating in Manual Mode 6 In Manual Mode you assess the ECG, decide if defibrillation is indicated, select the discharge energy level, and deliver the shock. The defibrillation process is under your control. There are no voice prompts, however, system and momentary messages provide relevant information throughout the process. It is important to be attentive to these messages. This chapter describes how to access Manual Mode and use it for defibrillation.
Enabling Manual Mode Enabling Manual Mode From AED Mode, press Manual to enable Manual Mode. If prompted, use the softkeys above the display to enter the password. Figure 6-1: Manual Password Display 1 2 3 4 Enter Password Shocks: 3 00:00:49 EXIT PASSWORD (;,7 To return to AED Mode, without entering a password, press 3$66:25' . Once Manual Mode is enabled, the green LED next to Manual is lit. In its default configuration, the HeartStart XLT powers on into AED Mode.
Preparation Preparation In preparation for defibrillation: 1. Apply multifunction defib electrode pads as directed on the package. Use either the anterior-anterior or anterior-posterior electrode placement, as appropriate. 2. Connect the pads to the pads patient cable, as shown in Figure 6-2. 3. If needed, insert a Data Card (as described in “Using a Data Card” on 211). 4. Press On. 5. Enter Manual Mode, if AED Mode is active.
Defibrillating Defibrillating The defibrillation process is as follows: 1. Select Energy The default energy setting is 150 joules. To change the energy setting, press (1(5*< 6(/(&7 repeatedly to cycle through the energy level choices. Stop when the desired energy is displayed. The choices are 5, 10, 25, 50, 70, 100, 150, or 200 joules. Figure 6-3 Energy Select Display HR ALARM LEAD SELECT 78 Pads 150 J ENERGY SELECT SpO2 Shocks:0 00:00:8 CHARGE 2. Charge Press &+$5*( .
Defibrillating Figure 6-4 Charging Display HR ALARM LEAD SELECT 78 Pads 6 87 J 150 J ENERGY SELECT SpO2 Current Charge Shocks:0 00:00:8 DISARM If desired, you may increase or decrease the selected energy level after pressing the &+$5*( button. To do so, press (1(5*< 6(/(&7 repeatedly until the desired energy level is displayed. The defibrillator charges to the selected energy automatically. Wait until the current charge reaches the selected energy level before proceeding. 3.
Returning to AED Mode Returning to AED Mode To enable AED Mode, from Manual Mode, press next to Manual Manual . The green LED goes out, indicating Manual Mode is no longer active. If ECG and/or SpO2 monitoring are enabled in AED Mode, alarms set in Manual Mode remain active when you switch to AED Mode.
7 Performing Synchronized Cardioversion Synchronized cardioversion is a Manual Mode function that allows you to synchronize the defibrillator shock with the R-wave of the ECG being monitored. During synchronized cardioversion, the ECG being monitored is shown on the display and may be derived from: z z the multifunction defib electrode pads, or the 3- or 5-lead monitoring electrodes. When selecting a lead, choose the best lead that displays a large QRS complex.
Preparing for Synchronized Cardioversion Preparing for Synchronized Cardioversion In preparation for synchronized cardioversion: 1. Apply multifunction defib electrode pads as directed on the package. Use either the anterior-anterior or anterior-posterior placement, as appropriate. 2. Connect the pads to the patient cable. (See Figure 6-2.) 3. Apply monitoring electrodes, if desired. (See “Applying Monitoring Electrodes” on page 4-2.) 4.
Delivering a Synchronized Shock Figure 7-1: Charging in Sync Mode HR ALARM LEAD SELECT 78 Pads SpO2 87 J 150 J ENERGY SELECT Sync Shocks:0 00:00:8 7 DISARM If desired, you may increase or decrease the selected energy level after pressing &+$5*( , by pressing (1(5*< 6(/(&7 repeatedly until the desired energy level is displayed. The defibrillator charges to the modified energy level automatically. Wait until the current charge reaches the selected energy level before proceeding. 5.
Disabling Sync Mode Delivering Additional Synchronized Shocks If additional synchronized shocks are indicated, make sure Sync Mode is still enabled and repeat steps 2-5. In its default configuration, the HeartStart XLT remains in Sync Mode after a shock is delivered, as indicated by the message 6\QF on the display and the lighted green LED next to Sync . The HeartStart XLT can be configured to exit Sync Mode after each shock is delivered. Disabling Sync Mode To disable Sync Mode, press Sync .
8 Pacing Noninvasive transcutaneous pacing is a Manual Mode function that is used to deliver paced pulses to the heart. Paced pulses are delivered through multifunction defib electrode pads applied to the patient’s bare chest. This chapter explains the pacing options and describes how to perform pacing.
Demand Mode Versus Fixed Mode Demand Mode Versus Fixed Mode The HeartStart XLT can deliver paced pulses in either demand or fixed mode. In demand mode, the pacer only delivers paced pulses when the patient’s heart rate is lower than the selected pacing rate. In fixed mode, the pacer delivers paced pulses at the selected rate. Monitoring During Pacing Multifunction defib electrodes pads can not be used to monitor the ECG and deliver paced pulses simultaneously.
Preparing for Pacing Preparing for Pacing In preparation for pacing: 1. Apply multifunction defib electrode pads as directed on the package. Use either the anterior-anterior or anterior-posterior placement, as appropriate. 2. Connect the pads to the patient cable. (See Figure 6-2.) 3. If needed, insert a Data Card (as described in “Using a Data Card” on 211). 4. Press On. 5. Enable Manual Mode. (See “Enabling Manual Mode” on page 6-2.) In addition, for demand mode pacing: 1. Apply monitoring electrodes.
Pacing Pacing To perform pacing: 1. Press Pacer . The green LED next to logue box appears. Pacer lights up and the dia- Figure 8-1 Pacing Display HR ALARM LEAD SELECT 78 Lead II SpO2 Pacer Stop Demand Mode 70ppm 30mA 150 J ENERGY SELECT Shocks:0 00:00:8 CHARGE The message 6WRS indicates that the pacing function is on but paced pulses are not being delivered. The pacer turns on in the mode last used. 2. Verify that the dot markers appears near the middle of the QRS complexes of the ECG.
Pacing 4. Adjust the rate to the desired number of paced pulses per minute (ppm). Press up, , or down, , on ber of paced pulses per minute. 5. Press Start Stop Rate to increase or decrease the num- to start pacing. The message 3DFLQJ indicates that paced pulses are being delivered in the selected mode at the rate and output level displayed.
Changing Pacing Modes 6. Increase the output until cardiac capture occurs. Press up on Output to increase the output in increments of 10 mA. 7. Decrease the output to the lowest level that still maintains capture. Press on Output to decrease the output in increments of 5 mA. Start Press Stop to stop pacing. Press Pacer to exit the pacing function. The green LED next to the button goes out, indicating pacing is no longer active.
Troubleshooting Troubleshooting The table below lists the pacing-related system and momentary messages that you may encounter during pacing. Table 8-1 Pacing System Messages Message Possible Cause Corrective Action /HDGV 2II z The selected monitoring lead is not making proper contact with the patient. z Pacing was attempted in demand mode without monitoring electrodes attached. z Check that the monitoring electrodes are properly applied.
9 Storing, Retrieving & Printing This chapter describes how the HeartStart XLT creates a patient record, called an Event Summary, for later retrieval and printing. It covers how to mark events for storage in the Event Summary, as well as how to print individual events as they occur. Overview The HeartStart XLT automatically creates an Event Summary for each patient. The Event Summary is stored in the HeartStart XLT’s internal memory and on a Data Card (if one is used).
Marking Events Marking Events Mark The Event button allows you to annotate the ECG strip at the point in time the button is pressed. In AED Mode, when monitoring is disabled, the event is marked with a . In Manual Mode, or when monitoring is enabled in AED Mode, you use the softkeys to select the annotation from the choices displayed (See Figure 9-1)*. If no selection is made, the event is marked with a .
Events Recorded Events Recorded The following events and related information are stored in the Event Summary: Table 9-1 Event Information Event Related Information Stored Power Change Power on, Power off, Continued use, Battery low. Pads Change Pads on, Pads off. AED Mode Analysis Analyzing, Analysis Stopped, Artifact Detected, Cannot Analyze, Shock Advised, No Shock Advised. Mode Change AED Mode or Manual Mode. Rhythm Monitoring Check Patient, Pause, Resume.
Events Recorded Table 9-1 Event Information (Continued) Event Related Information Stored SpO2 Violation SpO2 value and SpO2 alarm limit. Mark ECG waveform with annotation ( , Epi, Atro, Lido, or Other). 9-4 Print Strip ECG waveform. Sync Sync on, Sync off, Sync marker. Pacing Pacer start, Pacer stop, Pacer settings.
Creating a Patient Record Creating a Patient Record The HeartStart XLT creates an Event Summary patient record for each new patient. Each record is assigned a unique incident number. The HeartStart XLT keeps the Event Summary in its internal memory until you begin caring for a new patient. It assumes that: Table 9-2 Patient Record Summary If: Then: Power is off for more than 2 minutes and a new event is recorded You are caring for a new patient.
Printing the Internal Event Summary Printing the Internal Event Summary To print the internal Event Summary, press the complete summary is printed, press Print Summary. To stop printing before Print Summary again or press Print Strip . The Event Summary includes the following information, in the order listed: z z z a header with a place for you to write in the patient’s name and the operator’s name. a directory list of events that occurred during the incident and the time of their occurrence.
Printing the Internal Event Summary The Event Summary also includes waveforms and the appropriate annotation for each of the following events: Table 9-3 Event Waveform Information Event Waveform Description Shock Advised 11 seconds of ECG just prior to the message 6KRFN $GYLVHG No Shock Advised 11 seconds of ECG just prior to the message 1R 6KRFN $GYLVHG Cannot Analyze 11 seconds of ECG just prior to the message &DQQRW $QDO\]H Shock Delivered 11 seconds; 3 seconds prior to the shock, plus 8 s
Printing Events Printing Events The HeartStart XLT can be configured to print automatically when certain events occur. The table below lists these events and the length of the strip printed, depending on whether the printer is configured to print real-time or with a 6-second delay. Table 9-4 Printing Events Event Real-Time Strip Length Delayed Strip Length Defibrillator charges continuous 6 seconds just prior to charging, plus continuous printing throughout the charge duration.
10 Setting Up and Configuring the HeartStart XLT This chapter describes how to set-up and configure your HeartStart XLT.
Connecting/Disconnecting Patient Cables Connecting the Pads Patient Cable To connect the pads patient cable to the defibrillator: 1. Align the white pointer on the pads patient cable with the white arrow on the defibrillator’s pads connector, as shown in Figure 10-1. 2. Insert the patient cable into the pads connector. Push until you hear it click in place.
Connecting/Disconnecting Patient Cables Disconnecting the Pads Patient Cable To disconnect the pads patient cable: 1. Rotate the green locking mechanism on the patient cable in the direction (clockwise), of the blue arrow on the defibrillator until it stops (as shown in Figure 10-2). 2. Hold the locking mechanism in this position as you pull the patient cable away from the defibrillator.
Connecting/Disconnecting Patient Cables Connecting the ECG Patient Cable To connect a 3- or 5-lead ECG patient cable: 1. Align the keyed patient cable plug with the slot on the ECG connector, as shown in Figure 10-3. 2. Push the patient cable firmly into the ECG connector, until the white portion is no longer visible.
Connecting/Disconnecting Patient Cables Connecting the SpO2 Patient Cable To connect the SpO2 patient cable: 1. Hold the connector with the flat side up, as shown in Figure 10-4. 2. Insert the connector into the receptacle and push until the blue portion of the connector is no longer visible. Figure 10-4 Connecting the SpO2 Patient Cable Disconnecting the SpO2 Patient Cable To disconnect the SpO2 patient cable, gently pull it out of the SpO2 connector.
Arranging Accessories in the Carrying Case Arranging Accessories in the Carrying Case The HeartStart XLT carrying case is designed to hold your essential defibrillation and monitoring accessories. Figure 10-5 shows the recommended placement for each of these accessories.
Configuring the HeartStart XLT Configuring the HeartStart XLT Configuration options allow you to customize the HeartStart XLT to best meet your needs. This section describes: z z z z z z How to access the configuration menu. Configurable items and their setting options. How to change the configuration. How to save the configuration to a Data Card. How to load the configuration from a Data Card. How to print the configuration.
Configuring the HeartStart XLT To turn the HeartStart XLT on in Configuration Mode: 1. If the device is already on, press Off. 2. While holding down softkeys 4 & 5, press 1. The configuration menu appears as shown in Figure 10-7. The menu lists the categories of settings that may be configured.
Configuring the HeartStart XLT Table 10-1 General Settings Parameter Setting Choices Description 'DWH GG PPP \\\\ Current date, where GG is the day, PPP is the month, and \\\\ is the year. any valid date 7LPH KK PP Current time, where KK is the hour and PP is the minutes. Time is based on a 24 hour clock. any valid time 3ULQW RQ 0DUN 3ULQW RQ &KDUJH Prints a 3 second strip when pressed. Mark Event On / Off is Prints a continuous strip during charging.
Configuring the HeartStart XLT Table 10-1 General Settings (Continued) Parameter 10-10 Description Setting Choices 3ULQWHU 'HOD\ Captures what you just saw. All printed strips, including those generated by an event (mark, charge, shock or alarm), include an additional 6 seconds of information - the 6 seconds of information that occurred just prior to printing being initiated.
Configuring the HeartStart XLT Table 10-2 AED Settings: Parameter Description Setting Choices $(' 6KRFN 6HULHV Defines the maximum number of shocks to deliver before prompting &KHFN 3DWLHQW &KHFN 3XOVH ,I 1HHGHG %HJLQ &35. 2, 3, 4 6KRFN 6HULHV 7LPHU Defines the number of seconds that must pass before the next shock is considered the first shock of a new shock series, rather than the next shock of the current shock series.
Configuring the HeartStart XLT Table 10-2 AED Settings: (Continued) Parameter 16$ 7LPHU Description Defines the duration of the Pause time (in seconds) when 3$86( is pressed and the time since the last shock is greater than the 6KRFN 6HULHV 7LPHU setting - typically when 1R 6KRFN $GYLVHG Setting Choices 30, 60, 120, 180 If (XURSHDQ 3URWRFRO is set to Off, the following configuration choice appears: ´3DXVHµ 7LPHU Defines the duration of the pause time (in seconds), when 3$86( is pressed (when (XU
Configuring the HeartStart XLT Table 10-3 Manual Settings Parameter Description Choices 0DQXDO 0RGH 6HFXULW\ Requires entry of a password to access Manual Mode. On, Off 6\QF $IWHU 6KRFN Determines if the Sync function stays on after a synchronized shock is delivered. On, Off Setting the Manual Mode Password When Manual Mode Security is set to On (see “Modifying the Configuration” on page 10-15), the password entry screen is displayed.
Configuring the HeartStart XLT Table 10-4 ECG Filter Settings Item 10-14 Description Setting Choices $& /LQH )LOWHU Selects the setting used to filter out AC line noise. 60 Hz, 50 Hz 3DGV (&* IRU 'LVSOD\ Selects the display filter frequency for the pads ECG. Monitor (.15-40Hz), EMS (1-30 Hz) 3DGV (&* IRU 3ULQWHU Selects the printer filter frequency for the pads ECG. Monitor (.
Configuring the HeartStart XLT Modifying the Configuration To modify the configuration, from the main menu: 1. Use and 2. Press (17(5 . to highlight the desired category of settings. 3. Use and to highlight the item you want to change. &+$1*( 4. Press . 5. Use the softkeys ( 1(;7 , , or ,) to select the desired setting. To 6(7 select the default setting, press '()$8/7 . 6. Press 6$9( to save the change. To exit without making the change, press &$1&(/ . 7. Press 0$,1 to return to the main menu.
Configuring the HeartStart XLT Saving Settings to a Data Card Configuration settings may be saved to a Data Card and used to load the same configuration into other HeartStart XLTs or to restore the configuration, if necessary. To save the configuration: 1. Make sure a Data Card is in the HeartStart XLT before turning the unit on. 2. Select 6DYH 6HWWLQJV WR 'DWD &DUG from the main configuration menu. 3. Press 6$9( in response to the question 6DYH 6HWWLQJV WR 'DWD &DUG".
11 Maintaining the HeartStart XLT 11 This chapter describes how to care for your HeartStart XLT Defibrillator/ Monitor and its accessories. It provides: z z z z z z z Operational checks, Battery maintenance procedures, Instructions on loading printer paper, Cleaning instructions, Instructions for removing and replacing the carrying case, A list of approved supplies and accessories, and Instructions for disposal of the device.
Operational Checks Operational Checks The following operational checks are intended to quickly verify the proper operation of the HeartStart XLT. Perform these checks regularly, at the intervals specified, along with visual inspection of the device and all cables, controls, accessories and supplies. Also regularly check expiration dates of all supplies, such as multifunction defib electrode pads and monitoring electrodes.
Operational Checks Every Shift Perform a “Shift/System Check” every shift (see “Shift/System Check” on page 11-4) to verify that the HeartStart XLT is functioning properly and to ensure that necessary supplies and accessories are present and ready for use. Every Month Check expiration dates on multifunction defib electrode pads and monitoring electrodes every month. Replace them if the expiration date has passed.
Operational Checks Shift/System Check To perform the Shift/System Check: 1. Turn the HeartStart XLT off. 2. Connect a 50 ohm test load to the pads patient cable (instead of pads). 3. If a Data Card is routinely used, insert a Data Card into the HeartStart XLT. 4. If a power module is used, unplug the power module. 5. Insert a charged battery. 6. While pressing Print Strip , press On to start the test. 7. Follow the prompts on the display to proceed with the test.
Operational Checks The report also lists additional checks that you should do. Perform each of these checks and record the results. The guidelines for completing the checks are as follows: Defibrillator Inspection - make sure the HeartStart XLT is clean, clear of objects on top and has no visible signs of damage. Cables/Connectors - make sure there are no cracks, broken wires, or other visible signs of damage. Make sure the connectors engage securely.
Operational Checks Power Supply Battery - make sure: z z z a charged battery is in the HeartStart XLT another battery is charged or being charged the batteries have no visible signs of damage AC/Power Module 1. Make sure a battery is in the HeartStart XLT. 2. Plug the power module into a power outlet and connect it to the HeartStart XLT. 3. Verify that the power and charging indicators on the power module are lit. 4.
Operational Checks Battery Capacity Test (CT) To perform a Battery Capacity Test: 1. Turn the HeartStart XLT off. 2. Place a "Test in Progress" label on the HeartStart XLT to indicate to others that it may not be used. 3. Insert a charged battery. 4. If an AC power module is connected, unplug the power module from the Mark HeartStart XLT. While pressing Event , press On to start the test. 5. Allow the test to proceed to completion.
Battery Maintenance Battery Maintenance The HeartStart XLT uses the M3516A Battery Pack. It is a rechargeable sealed lead acid battery. Battery maintenance begins when you receive a new battery and continues throughout the life of the battery. Detailed information on battery care is provided in the application note “About Sealed Lead Acid Batteries,” that came with your HeartStart XLT. Table 11-2 lists battery maintenance activities and when they should be performed.
Battery Maintenance Battery Capacity A fully charged M3516A battery, operating at room temperature, provides greater than 2.7 hours of monitoring or more than 50, 200-joule charge-shock cycles. Battery Life-Expectancy Life-expectancy of a battery depends on the frequency and duration of use. When properly maintained and stored, the life-expectancy of a battery is about 2 years. For more aggressive use models, life-expectancy may be less.
Loading Printer Paper Loading Printer Paper To load printer paper: 1. Slide the printer door to the right until the paper roller pops up. 2. If there is an empty or low paper roll in the printer, pull up on the plastic removal tab to remove the roll.
Loading Printer Paper 3. Place a new roll of printer paper (40457C/D) into the printer paper well, positioning the roll so that the end of the roll is on the top and the grid faces down. Be sure to push the roll down so that it is firmly seated in the paper well. 4. Pull the end of the paper past the paper roll. 5. Slide the printer door to the right and hold it open. Press the roller down over the paper and release the door.
Cleaning Instructions Cleaning Instructions Following are recommendations for cleaning the HeartStart XLT and its associated case, cables, etc.
Cleaning Instructions Cleaning the Printer Printhead If the printout has light or varying density printing, clean the printhead to remove any buildup of paper residue. To clean the printhead: 1. Slide the printer door to the right until the paper roller pops up. 2. Pull up on the plastic removal tab to remove the roll of paper. 3. Clean the printhead surface (above the brush) with a cotton swab dipped in rubbing alcohol. 4. Replace the roll of paper (see “Loading Printer Paper” on page 11-10).
Cleaning Instructions Cleaning Pads, Electrodes & Cables Defibrillation pads and monitoring electrodes are single use and do not require cleaning.
Removing & Replacing the Carrying Case Removing & Replacing the Carrying Case To remove the carrying case from the HeartStart XLT, follow steps 1 through 7 in Figure 11-4. After loosening the screws (step 6), lay the unit flat and lift the defib up off the metal mounting plates to disengage it from the two metal pins at the rear of the case. Then slide the defib out of the case as shown in step 7.
Removing & Replacing the Carrying Case To put the carrying case on the HeartStart XLT, follow the steps 1 through 7 in Figure 11-5. Slide the unit into the case as shown in step 1, then lower it onto the two metal pins at the rear of the case before tightening the screws (step 2).
Putting On the Manual Door Putting On the Manual Door To put on the manual door, align the door with the door hinges as shown in Figure 11-6. Then push, as shown in Figure 11-7, until the door snaps in place.
Supplies & Accessories Supplies & Accessories Approved supplies and accessories for the HeartStart XLT are listed in Table 11-3 . To order: z z In the USA, call 1-800-225-0230 (electrodes, cables, paper, etc.) or 1-800-934-7372 (HeartStart Pads adapters only). Outside the USA, contact your local Philips Medical Systems Sales Office, your authorized Philips Medical Systems Dealer or Distributor, or visit our online store at www.medical.philips.com/cms and follow the Supplies link.
Supplies & Accessories Table 11-3 Supplies and Accessories (Continued) Part Number Description 11 Defibrillation Pads, Pads Cables, Adapters and Test Load (gray flat connector) M3713A Multifunction Adult Plus Pads - Adult Plus multifunction defib pads (general use). M3716A Multifunction Adult Radiolucent Pads - Adult Radiolucent multifunction defib pads (special purpose - for X-ray and special procedures). M3717A Multifunction Pediatric Plus Pads - Pediatric multifunction defib pads (general use).
Supplies & Accessories Table 11-3 Supplies and Accessories (Continued) Part Number Description ECG Cables M1733A 3-lead ECG Trunk cable, AAMI (8-pin). M1734A 5-lead ECG Trunk cable, AAMI (8-pin). M1735A 3-lead ECG Trunk cable, IEC (8-pin). M1736A 5-lead ECG Trunk cable, IEC (8-pin).
Supplies & Accessories Table 11-3 Supplies and Accessories (Continued) Part Number Description 11 Battery/Power Modules/ Adapter M3516A Sealed Lead Acid Battery. M3517A AC power module. M3518A DC Power Module M3506A Battery charger adapter. Extension Cable M4748A Adapter extension cable Carrying Case M3509A M3500B HeartStart XLT Defibrillator/Monitor Carrying case. (If a new Quick Reference Card is needed for the carrying case, it must be ordered separately.
Disposing of the HeartStart XLT Prior to disposing of the HeartStart XLT, remove the battery. Then dispose of the device and its accessories in accordance with local standards. WARNING Disposal of the device with the battery inserted presents a potential shock hazard.
12 Troubleshooting If the HeartStart XLT detects an error or potential problem during use, it displays a system or momentary message. In AED Mode, these messages are often accompanied by a voice prompt. This chapter describes the messages and what you should do in response. In addition, this chapter provides general troubleshooting tips and information on calling for service. NOTE For instructions for repair, or for further technical information, refer to the service manual, part number M3500-90900.
System Messages System Messages System messages remain on the display until the specified action is taken or no longer relevant. Each message is accompanied by a three second beep to alert you. Table 12-1 lists system messages. Table 12-1 System Messages Message Description Corrective Action $WWDFK 3DGV &DEOH The pads cable is not properly attached to the device. Check the cable connection. &RQILJXUDWLRQ /RVW The configuration is reset to the default settings. z Reconfigure the HeartStart XLT.
System Messages Table 12-1 System Messages (Continued) Message Description Corrective Action 1R 3DGV The multifunction defib electrode pads are not properly connected to the HeartStart XLT. Check the pads cable connection. 3DGV &DEOH 2II The pads cable is not connected to the defibrillator. Check pads connector is locked in place. 3DGV 2II The pads are not making proper contact with the patient. Make sure the pads are properly applied to the patient.
System Messages Table 12-1 System Messages (Continued) Message Description Corrective Action 6S2 &DEOH 2II The SpO2 cable is not connected to the device. Attach the SpO2 cable to the HeartStart XLT. 632 )DLOXUH A failure has occurred in the SPO2 circuitry. Remove the device from active use and call for service. 6S2 /LJKW ,QWHUI The level of ambient light is so high that the sensor cannot obtain an SpO2 reading or the sensor or cable is damaged. z Cover the sensor with an opaque material.
System Messages Momentary Messages Momentary messages are temporary and only appear on the display for a few seconds. Each message is accompanied by a three second beep to alert you. Table 12-2 lists momentary messages. Table 12-2 Momentary Messages Message Possible Cause Corrective Action The multifunction defib electrode pads are not making proper contact with the patient. z Check the pads are applied to the patient, as directed on the pads’ package. z Replace the pads if the prompt continues.
System Messages Table 12-2 Momentary Messages (Continued) Message Possible Cause Corrective Action 'DWD &DUG )XOO z The incident is more than 2 hours in duration, causing the Data Card to fill. z An empty Data Card was not inserted for the incident, causing the Data Card to fill sooner. z None. A new Data Card can not be inserted during an incident. z Use one Data Card per incident/ patient to decrease the chance of the card filling.
Troubleshooting Tips Troubleshooting Tips Table 12-3 lists some situations that you may encounter, causes, and actions to take. Table 12-3 Troubleshooting Tips Situation Cause Possible Solution There is no power. OR z Insert a fully charged battery. z Attach AC Power cord. A corrupt Data Card may prevent the unit from powering on. OR z Remove the Data Card z Insert a new Data Card, if available z Turn on the device Hardware failure. z Remove this unit from clinical use and call for service.
Troubleshooting Tips Table 12-3 Troubleshooting Tips (Continued) Situation Cause Possible Solution There is a dashed (----) line on the display instead of an ECG. ECG data is not being acquired. z Check the patient cable is connected. z Check the pads or electrodes are properly applied. z Check that the desired lead is selected. The HeartStart XLT does not appear to be functioning properly. z The battery is low. z There is a system failure. z Change the battery.
Calling for Service Calling for Service For telephone assistance, call the Response Center nearest to you, or visit our website at: www.medical.philips.com/cms and follow the link for service.
Calling for Service Other International Areas Australia Tel: 131147 France Tel: 0803 35 34 33 Germany Tel: 0180 5 47 50 00 Netherlands Tel: 31 20 547 2555 Fax: 31 29 547 2949 Belgium (for Dutch) Tel: 32 2 525 7102 Fax: 32 2 525 71 91 Spain Tel: 34 902 30 40 50 Fax: 34 91 326 39 66 Austria Tel: 43 1 60101 820 Switzerland Tel: 0800 80 10 23 12-10 Italy Tel: 800-825087 United Kingdom Tel: 00 44 7002 432584 Belgium (for French) Tel: 32 2 525 710 3 Fax: 32 2 525 71 91 Poland Tel: 48 22 5710499 Finl
13 Specifications & Safety This section provides: z z z z z Specifications for the HeartStart XLT, Symbol definitions for symbols appearing on the HeartStart XLT, A clinical performance summary, Safety related information, and Electromagnetic compatibility information.
Specifications Specifications Defibrillator Waveform: Biphasic Truncated Exponential. Waveform parameters adjusted as a function of patient impedance. Shock Delivery: Via multifunction defib electrode pads. Charge Time: Less than 3 seconds to 200 Joules with a new, fully charged M3516A SLA battery pack at 25oC. Less than 15 seconds to 200 Joules when powered by a M3517A or M3518A power module with no battery installed. Patient Impedance Range: 25 to 180 Ohm.
Specifications Defibrillator (cont.) AED Mode AED Energy Protocol: Fixed Energy (150 Joules). AED Shock Series: 2, 3, or 4. Shock Series Timer: off, 30, 60, 90, 120, 150, 180, or 210 seconds. Text and Voice Prompts: Extensive text audible messages guide user through protocol. Protocol: Follows pre-configured settings. Can be configured to meet American Heart Association and European Resuscitation Council guidelines.
Specifications ECG Monitoring Inputs: Single channel ECG may be viewed on display and printed. PADS ECG is obtained through two multifunction defibrillation electrode pads. Lead I, II, or III is obtained through the 3-lead ECG cable and separate monitoring electrodes. With a 5-lead cable, lead aVR, aVL, aVF, or V can also be obtained. Lead Fault: LEADS OFF message and dashed line appear on the monitor if a lead electrode or wire becomes disconnected.
Specifications Display Display Size: 96 mm x 72 mm. Display Type: Transflective active matrix LCD with LED backlight. Display Resolution: 320 x 240 pixels. Sweep Speed: 25 mm/s nominal (stationary trace; sweeping erase bar). Viewing Time: 4 seconds. Thermal Array Printer Continuous Real Time Strip: User starts and stops the print strip.
Specifications Thermal Array Printer (cont.) Auto Printing: The printer can be configured to automatically print on Mark, Charge, Shock and Alarm. Delayed Printing: The printer can be configured to run real time or with a six second delay. Reports: The following can be printed: Event Summary, Configuration, Extended Self Test, System Log. + _ Speed: 25 mm/s with an accuracy of Amplitude Accuracy: + _ 10% or + _ 5%. 50 uV, whichever is greater. Paper Size: 50 mm by 30 m (100 ft).
Specifications Noninvasive Pacing Waveform: Monophasic Truncated Exponential. Current Pulse Amplitude: 10 mA to 200 mA (5 mA resolution); accuracy 10 mA - 50 mA +_ 5 mA, 50 mA - 200 mA +_ 10%. Pulse Width: 20 ms with accuracy +0, -5 ms. Rate: 30 ppm to 180 ppm (10 ppm increments); accuracy + _ 1.5%. Modes: Demand or Fixed Rate. Refractory Period: 340 msec (40 to 80 ppm); 240 msec (90 to 180 ppm). SpO2/Pulse Oximetry Accuracy with: M1191A sensor - 1 standard deviation 70% to 100%, +_ 2.5%.
Specifications Event Storage Internal Event Summary: The internal Event Summary stores up to 300 events and up to 50 waveforms. Events can be marked with a Mark Event symbol and, if configured for drug annotation, the following labels can be added: Epinephrine, Atropine, Lidocaine, or Other. The Print Summary key on the front panel is used to print the internal Event Summary. Data Card Event Summary: One Data Card can store approximately 2 hours of continuous ECG waveforms and events.
Specifications Environmental Temperature: 0o to 50oC operating, -20o to 70oC storage. Thermal paper may darken above 55oC. Charging the battery at temperatures above 35oC may degrade battery life. z Storing the battery for extended periods at temperatures above 40oC will reduce battery capacity and degrade battery life. z Operating and storage specifications for electrodes may vary. Refer to the manufacturer’s specifications for details.
Symbol Definitions Symbol Definitions The following table lists the meaning of each symbol shown on the HeartStart XLT and the M3516A battery. Table 13-1 Defibrillator and Battery Symbols Symbol Definition On. Off. Shock hazard. ! Attention - See operating instructions in user’s guide. Power module input.
Symbol Definitions Table 13-1 Defibrillator and Battery Symbols (Continued) Symbol Definition Meets IEC type BF leakage current requirements and is defibrillator protected (Patient Applied Part is isolated and defib-proof suitable for direct patient contact except the heart or major arteries.) Meets IEC type CF leakage current requirements and is defibrillator protected (Patient Applied Part is isolated and defib-proof suitable for direct patient contact including the heart and major arteries).
Symbol Definitions The following table lists the symbols that appear on the HeartStart XLT shipping carton. Table 13-2 Shipping Carton Symbols Symbol Definition Atmospheric pressure range. Temperature range. Relative humidity range. Recyclable paper product. Fragile. Right side up. Do not get wet.
Symbol Definitions Table 13-2 Shipping Carton Symbols (Continued) Symbol Definition Shelf life. Long-term storage conditions. Short-term transport storage.
Clinical Performance Summary - Defibrillation Clinical Performance Summary - Defibrillation An international, multicenter, prospective, randomized, clinical study was conducted to assess the effectiveness of the SMART Biphasic waveform in out-of-hospital sudden cardiac arrests (SCAs), as compared to monophasic waveforms.
Clinical Performance Summary - Defibrillation Table 13-3 Clinical Summary - Defibrillation Biphasic Patients Number/(Percent) Monophasic Patients Number/(Percent) P Value (chi-square) Defibrillation Efficacy Single shock only <2 shocks <3 shocks 52/54 (96%) 52/54 (96%) 53/54 (98%) 36/61 (59%) 39/61 (64%) 42/61 (69%) <0.0001 <0.0001 <0.0001 Patients Defibrillated 54/54 (100%) 49/58 (84%) 0.003 Return of Spontaneous Circulation 41/54 (76%) 33/61 (54%) 0.
Clinical Performance Summary - Cardioversion Clinical Performance Summary - Cardioversion An international, multicenter, prospective, double-blinded, randomized, clinical trial was conducted to assess the effectiveness of the SMART Biphasic waveform in treatment of atrial fibrillation (AF), as compared to monophasic waveforms. The primary objective of the study was to determine the required energy for cardioversion of AF using the SMART Biphasic waveform, as compared with a monophasic damped sine waveform.
Clinical Performance Summary - Cardioversion The 150J SMART Biphasic waveform successfully converted far more patients with an initial 100J shock (60% compared with 22% for the monophasic waveform), and successfully converted patients at least as well with a maximum energy of 200J as the monophasic did with its maximum energy of 360J (91% compared to 85% for the monophasic waveform). Overall, the biphasic waveform required fewer shocks (1.7, compared to 2.
Clinical Performance Summary - Cardioversion Conclusion The SMART Biphasic waveform cardioverted at higher rates than the monophasic damped sine waveform at each step of the protocol, although the cumulative biphasic rate after 4 shocks was not significantly different from the monophasic rate. Tissue damage was more pronounced in the monophasic population.
Safety Considerations Safety Considerations The following general warnings and cautions apply to use of the HeartStart XLT. Additional warning and cautions specific to a particular feature are provided in the appropriate section. WARNING The HeartStart XLT is not intended to be deployed in settings or situations that promote use by untrained personnel. Operation by untrained personnel can result in injury or death. WARNING Remain attentive to the patient during the delivery of therapy.
Safety Considerations WARNING Do not allow multifunction defib electrode pads to touch each other or to touch other ECG monitoring electrodes, lead wires, dressings, etc. Contact with metal objects may cause electrical arcing and patient skin burns during defibrillation and may divert current away from the heart. WARNING During defibrillation, air pockets between the skin and multifunction defib electrode pads may cause patient skin burns.
Safety Considerations WARNING Avoid contact between the patient and conductive fluids and/or metal objects, such as the gurney. Contact with metal objects could cause unintentional current pathways. WARNING Operating the HeartStart XLT or its accessories in conditions outside the environmental specifications can result in device or accessory malfunction. WARNING Avoid exposing the display to direct sunlight on a hot day.
Electromagnetic Compatibility Electromagnetic Compatibility When using the M3500B defibrillator/monitor (with or without the M3517A AC Charger), electromagnetic compatibility with surrounding devices should be assessed. A medical device can either generate or receive electromagnetic interference. Testing for electromagnetic compatibility EMC) of the M3500B with and without the appropriate accessories has been performed according to the international standard for EMC for medical devices (IEC 60601-1-2).
Electromagnetic Compatibility Once the source is located, attempt to attenuate the EMC coupling path by distancing the defibrillator from the source as much as possible. If assistance is needed, call your local service representative. Restrictions for Use Artifact on the ECG caused by electromagnetic interference should be evaluated by a physician or physician authorized personnel to determine if it will negatively impact patient diagnosis or treatment.
Index A AC Power Module.
Index C Cables checking 11-5 cleaning 11-14 connecting 2-2, 3-6 ECG 10-4 Pads 3-6, 10-2 SpO2 5-6, 10-5 Cal Pulse 2-3 Carrying case arranging accessories in 10-6 cleaning 11-12 ordering 11-21 removing & replacing 11-15 Check Patient Timer setting 10-11 Check Printer message 12-5 Cleaning carrying case 11-12 HeartStart XLT 11-12 pads, electrodes & cables 11-14 power modules 11-13 printer printhead 1113 Clinical Performance 1314, 13-16 ii Configuration 10-7 accessing menu 10-7 AED Mode 3-4 Automatic Reanaly
Index Device Initiated Analysis settings 3-4, 10-11 Display AED Mode 2-7 controls 2-2 layout 2-5 Manual Mode 2-8 specifications 13-5 troubleshooting 12-8 E ECG analysis. See Analysis ECG cables cleaning 11-14 connecting 10-4 ordering 11-20 See also Cables ECG electrodes.
Index HeartStart XLT 1-1 assessment of 1-3 cleaning 11-12 configuring 10-7 controls 2-2 operational checks 113, 11-4 safety precautions 1320 specifications 13-2, 13-8 symbols 13-10 training materials 1-7 training required 1-3 troubleshooting 12-7 HR alarm. See Heart rate alarm Hypothermia pacing 1-5 SpO2 monitoring 5-1 I Incident number.
Index Monitoring electrodes. See Electrodes Monitoring Rhythm. See Rhythm Monitoring Multifunction defib electrode pads. See Pads N Nellcor sensors 5-3 No Data Card Present message 12-6 No Pads message 12-3 No Shock Advised Timer 3-17, 10-12 No Shock Delivered message 3-18, 12-5 Non Pulsatile message 510, 5-11 Noninvasive transcutaneous pacing. See Pacing O Operational checks 11-2 Output Low message 8-7 Oxygen saturation.
Index Power modules 2-9 cleaning 11-13 electromagnetic compatibility 1322 ordering 11-21 specifications 13-2 Power supply checking 11-6 events recorded 9-3 interruption of power 9-5 overview 2-9 specifications 13-2 troubleshooting 12-7 See also Batteries vi Precautions 13-19 asystole 1-5 batteries 11-9 defibrillation current (shock) 3-10 ECG analysis 3-9 electrodes 4-2 electromagnetic compatibility 1322 heart rate alarms 4-6, 8-2 pacemakers 1-4, 4-6 rhythm monitoring 314 safety symbols 13-10 sensors 5-5,
Index RF interference 13-22 Rhythm Monitoring 3-4, 3-14 AED Mode 3-8 configuring 3-14, 1011 events recorded 9-3 S Safety precautions. See Precautions Saving settings to Data Card 10-16 Security (password) 1013 Semi-Automatic External Defibrillation. See AED Mode Sensors 5-3 applying 5-5 caring for 5-9 cleaning 11-14 ordering 11-20 selecting 5-3 troubleshooting 12-4 Service 12-9 Settings.
Index Sync control 2-5 Synchronized cardioversion 7-1 delivering shock 7-2 disabling Sync Mode 7-4 enabling 2-5 indications for use 1-4 preparation 7-2 selecting leads 7-1 synchronizer specifications 132 System Failure Service Unit message 12-3 System messages 2-7 list of 12-2 System tests. See Maintenance T Telephone assistance 12-9 Thermal Array Printer.
M3500-91900 Edition 3 Copyright © 2002 Philips Electronics North America Corporation Printed in the U.S.A.
