Operations Manual - Frank's Hospital Workshopfrankshospitalworkshop.com/equipment/documents/ecg/user... · 2018-10-04 · Ultraview Care Network Operations Manual i-i About This Manual

Ultraview Care Network™

Operations Manual070-1001-17 Rev. K

©2010 Spacelabs Healthcare

All rights reserved. Contents of this publication may not be reproduced in any form without the written permission of Spacelabs Healthcare. Products of Spacelabs Healthcare are covered by U.S. and foreign patents and/or pending patents. Printed in U.S.A. Specifications and price change privileges are reserved.

Spacelabs Healthcare considers itself responsible for the effects on safety, reliability and performance of the equipment only if:

• assembly operations, re-adjustments, modifications or repairs are carried out by persons authorized by Spacelabs Healthcare, and

• the electrical installation of the relevant room complies with the requirements of the standard in force, and

• the equipment is used in accordance with the operations manual.

Spacelabs Healthcare will make available, on request, such circuit diagrams, component part lists, descriptions, calibration instructions or other information which will assist appropriately qualified technical personnel to repair those parts of the equipment which are classified by Spacelabs Healthcare as field repairable.

Spacelabs Healthcare is committed to providing comprehensive customer support beginning with your initial inquiry through purchase, training, and service for the life of your Spacelabs Healthcare equipment.

CORPORATE OFFICES

U.S.A.

Spacelabs Healthcare, LLC5150 220th Ave SE

Issaquah, WA 98029

Telephone: 425-657-7200

Telephone: 800-522-7025

Fax: 425-657-7212

Authorized EC Representative UNITED KINGDOM

Spacelabs Healthcare, Ltd.1 Harforde Court

John Tate Road

Hertford, SG13 7NW

Hertfordshire, UK

Telephone: 44 (0) 1992 507709

Fax: 44 (0) 1992 501213

BirthNet, Clinical Browser, Data Shuttle, Flexport, Intesys, Mermaid, MOM, Multiview, PCIS, PCMS, PrintMaster, Quicknet, Sensorwatch, TRU-CAP, TRU-CUFF, TruLink, Ultralite, Ultraview, Ultraview Care Network, Ultraview Clinical Messenger, Ultraview Digital Telemetry, Ultraview SL, Uni-Pouch, UCW, Varitrend, Dynamic Network Access, DNA, and WinDNA are trademarks of Spacelabs Healthcare.

Other brands and product names are trademarks of their respective owners.

Caution:US Federal law restricts the devices documented herein to sale by, or on the order of, a physician.

Before use, carefully read the instructions, including all warnings and cautions.

Rx Only

!

About This Manual

Ultraview Care Network™ Operations Manual documents a complete range of patient monitoring functions for critical care. While each module may monitor one or more vital sign parameters, the operation of individual parameters stays the same throughout the system. This CD-ROM manual is organized by operating functions rather than by specific products. Monitor and parameter functions are presented in the CD-ROM titled Ultraview Care Network Operations Manuals (P/N 084-1101-xx).

Quick Information

At the beginning of each chapter you will find illustrations of the monitor keys that appear on all Ultraview monitors.

Brief troubleshooting information for each function is found at the end of each chapter. Troubleshooting tips suggest solutions to the most frequent problems.

Operating Instructions

Each vital sign chapter contains a clinical overview, a description of the screen display, operating instructions, error messages, and other pertinent information.

Product Compatibility

If your system does not contain a feature described in this manual:

• Your product may contain an earlier version of software. Refer to the original documentation that accompanied your system.

• Your system configuration, including options ordered, may be different from the configurations described in this manual. Refer to the notes in this manual describing features likely to be impacted by system configuration.

Before moving a component from one network to another, be certain that the component’s software version is compatible with that required by the second network. If in doubt, have a qualified field service engineer verify compatibility between the component and the network.

Use only Spacelabs Healthcare parts and accessories with your Spacelabs Healthcare components. Other parts may degrade performance or damage the components. Refer to the Spacelabs Healthcare Supplies Products Catalog (P/N 084-1201-xx) for the part numbers and descriptions of additional parts and accessories.

Ultraview Care Network Operations Manual i-i

Table of Contents

Contents Page

Quick Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i-iOperating Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i-iProduct Compatibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i-i

System Introduction and Network Basics

Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1System Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3Monitor Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-4Power Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-4Network Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-10Watching Alarms Remotely — Alarm Watch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-11Viewing Remote Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-11Full Bed Review — UCW and Ultraview 1700 Only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-13Reviewing Remote Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-14

Alarms

Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-3Default Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-3Setting Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-4Identifying Alarm Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-4Adjusting Alarm Tones/Key Tones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-6Controlling Alarms via the TONE RESET/ALM SUSPEND Key. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-7Alarm Watch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-8Automatic Recording of an Alarm. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-11Alarms Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-12

Admit/Discharge

Directory of Keys — Ultraview 1030/1050/1500/1600 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1Directory of Keys — UCW and Ultraview 1700 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-2Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3Entering New Patient Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3Changing Patient Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-9Discharging a Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-10Admit/Discharge Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-11

Printing

Directory of Keys — Monitor Setup Level. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1Directory of Keys — Biomed Level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-2Directory of Keys — Clinical Level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-3Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-5Bedside Printer Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-6System Printer Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-7Ultraview 1030/1050 Monitor Printers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-7PrintMaster . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-8Printing Priorities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-12Selecting Print Duration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-14Printer Key Functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-15Recording Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-16Selecting Recording Destination. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-16

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Table of Contents

Printing via Monitors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-17Defining Preselected Recording Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-19Loading Paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-20Paper Out Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-23Record Vitals Report (Ultraview 1030/1050 Only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-23Printing Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-26

Bedside/Transport Monitors

Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1Directory of Keys — UCW and Ultraview 1700 (Privileged Access). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-2Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-3Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-4Identifying Special Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-4Bedside and Transport Monitor Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-5Setting Up Priorities and Colors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-8Data Shuttle Option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-12Battery Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-15Wireless Network Interface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-17Outbound Parameters Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-17Ultraview 1030/1050 Connections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-20Ultraview 1030/1050 with Capnography (Option G, H, or M) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-23Maternal Obstetrical Monitor — 94000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-24Bedside/Transport Monitor Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-29

Central Monitors

Directory of Keys — UCW and Ultraview 1700 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-1Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-46-Trace Option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4Central Monitor Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5System Clock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-7Screen Saver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-8Data Communications Watch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-8Central Monitors Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-10

Module Configuration Manager

Directory of Keys — For Configurations with ECG. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1Directory of Keys — For Configurations without ECG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2Directory of Keys — For Telemetry Configurations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-5Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-6Setting User-Defined Default Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-7Storing Changed Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-7Selecting Alarm Attributes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-7Parameter Configurations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-8Transferring User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-39Retrieving User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-39Restoring Factory Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-40Restoring User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-41

ECG

Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-1Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3ECG Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-4Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-9Selecting Adult or Neonate Mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-11Monitoring Paced Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-11

Ultraview Care Network Operations Manual ii

Table of Contents

Setting and Adjusting Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-13Selecting ECG Leads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-15Displaying Additional Waveforms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-16Checking the ECG Amplitude. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-16Adjusting Waveform Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-17Adjusting Sweep Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-17Adjusting Tones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-18Changing the Display Resolution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-18Selecting Primary and Alternate Heart Rate Source . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-19Suspending/Resuming ECG Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-20Printing ECG Recordings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-21Restoring Default Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-22Power Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-22ECG Problem Solving. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-22ECG Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-24

Arrhythmia

Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-1Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-3Setting Up Arrhythmia Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-4Setting and Adjusting Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-7Reviewing Arrhythmias. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-9Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-10Controlling Arrhythmia Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-11Clearing a Class or Event . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-11Merging Classes/Trends. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-12Plotting Arrhythmia Trend Graphs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-13Printing Arrhythmia Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-16Arrhythmia Problem Solving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-17Arrhythmia Troubleshooting Guide. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-19

ST Analysis

Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-1Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-3Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-4Setting Up ST Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-5Adjusting Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-6Selecting Leads for ST Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-7Displaying Real-Time ST Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-8Reviewing ST Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-8Clearing ST Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-9Viewing ST Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-10Selecting the ST Trend Timebase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-11Printing ST Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-12ST Analysis Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-13

12-Lead Diagnostics

Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-1Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-3Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-4Initiating a 12-Lead Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-5Automatic Scheduling of 12-Lead Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-5Saving and Clearing 12-Lead Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-6Sending 12-Lead Reports. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-7Report Directory Display. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-7Patient Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-8

Ultraview Care Network Operations Manual iii

Table of Contents

Respiration

Directory of Keys — ECG. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-1Directory of Keys — Respiration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-2Directory of Keys — Varitrend 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-3Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-5Setting Up Respiration Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-6Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-7Selecting Adult or Infant Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-8Setting and Adjusting Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-8Turning Respiratory Waveform On/Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-9Adjusting Waveform Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-10Adjusting Sweep Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-10Adjusting Respiration Tone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-10Selecting Respiration Leads. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-11Adjusting Respiration Sensitivity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-12Using the Cardiovascular Artifact Filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-12Restoring User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-13Recording Respiration Waveforms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-14Configuring Varitrend 3 Graphs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-14Printing Varitrend 3 Graphs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-18Respiration Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-19

NIBP

Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-1Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-3Setting Up NIBP Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-4Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-6Setting and Adjusting Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-7Selecting Adult or Neonatal Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-8Displaying Heart (Pulse) Rate Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-8Initiating a Manual Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-9Setting Automatic Measurements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-9Stopping a Measurement in Progress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-10Recording Measurements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-11Reviewing Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-11Restoring User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-12Status Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-12NIBP Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-14

SpO2

Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-1Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-3Setting Up SpO2 Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-4Dual SpO2 Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-5Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-6Ensuring Accurate Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-7Using the Sensorwatch Feature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-7Setting and Adjusting Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-8Selecting Data Averaging Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-9Using SpO2 with Intra-Aortic Balloon Pumps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-9Adjusting Tone Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-10Modifying Waveform Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-10Viewing Pulse Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-11Restoring User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-11Suspending/Resuming SpO2 Processing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-12Recording SpO2 Waveforms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-13Error Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-13

Ultraview Care Network Operations Manual iv

Table of Contents

Sensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-15SpO2 Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-16

Fetal Monitoring

Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-1Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-3Fetal Display Detail. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-3Starting Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-5Ultrasound Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-7Uterine Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-9ECG Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-10Intrauterine Pressure Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-11Main Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-13Fetal Heart Rate Alerts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-13Bradycardia Alert . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-14Tachycardia Alert . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-16Recorder Operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-17Module Configuration Manager . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-24Telemetry Option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-27

Temperature

Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-1Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-3Setting Up Temperature Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-3Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-4Setting or Adjusting Temperature Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-4Recording Temperatures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-5Restoring User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-5Temperature Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-6

Digital Telemetry

Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-1Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-3Intended Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-5Digital Telemetry System Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-6Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-12Setting up Telemetry Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-14Enabling and Adjusting Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-15Discharging a Patient and Acknowledging Signal Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-16Controlling Patient-Initiated Recordings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-17Multiparameter Telemetry (NIBP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-17Status Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-22NIBP Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-24

Pressure

Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-1Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-3Setting Up Pressure Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-4Zeroing the Pressure Transducer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-5Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-5Setting and Adjusting Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-6Adjusting Waveform Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-7Selecting Numeric Display Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-7Adjusting Sweep Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-8Displaying Waveforms with Scales. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-8Freezing the Scaled Display. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-8Changing the Waveform Scale. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-9

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Selecting the Waveform Measurement Value . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-9Storing Values for Trending . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-10Recording Waveforms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-10Setting Artifact Rejection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-11Selecting a Filter Frequency. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-11Restoring User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-12Factory Default Pressure Alarm Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-13Invasive Pressure Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-14

Cardiac Output

Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-1Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-3Setup Procedure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-4Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-5Entering the Computational Constant. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-6Entering Patient Height/Weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-6Measuring Cardiac Output . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-7Averaging Cardiac Output . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-8Clearing Cardiac Output Curves. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-8Storing Cardiac Output Curves. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-9Stopping Curve Drawing and Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-9Selecting Index Normalization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-10Displaying Cardiac Index and Cardiac Output Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-10Displaying Calculations Table. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-11Editing Vital Sign Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-13View Additional Table Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-14Recording Cardiac Output Curves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-14Error Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-15Cables and Probes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-16Cardiac Output Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-17

SvO2

Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-1Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-3Setting Up SvO2 Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-4Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-5Preparing the Catheter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-5Performing Pre-insertion (in vitro) Calibration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-7Beginning SvO2 Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-7Performing Light Intensity Calibration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-8Performing In Vivo Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-8Displaying Intensity Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-9Setting Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-10Setting the Light Intensity Alarm. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-10Adjusting Trend Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-11Obtaining Oximetry Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-12Printing Oximetry Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-13Storing or Reading Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-13Correcting Out-of-Range Light Intensity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-13Correcting Insufficient Light Intensity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-14Correcting Calibration Errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-15Correcting Optical Module Errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-15Correcting SvO2 Display Error . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-15Ensuring Catheter Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-16SvO2 Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-17

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Capnography

Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-1Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-3Patient Connection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-4Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-6Setting Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-8Adjusting the Waveform Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-10Turning the Waveform Display On/Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-10Selecting a Unit of Measure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-10Selecting a Sweep Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-11Respiration Tone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-11Selecting a Text Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-12Freezing the Waveform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-12Recording Waveforms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-12Calibrating the Sensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-13Selecting Gas Compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-15Restoring Default Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-16Capnography Troubleshooting Guide. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-17

Multigas

Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22-1Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22-3Warnings and Cautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22-4Analyzer Controls and Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22-6Multigas Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22-7Patient Connection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22-8Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22-10Replacing the Water Trap. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22-12Replacing the Gas Analyzer Filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22-12Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22-13Setting Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22-15Waveform Display. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22-18Selecting a Text Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22-19Selecting a Unit of Measure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22-19Selecting an Agent ID. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22-20Selecting Stand By Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22-21Selecting a Pump Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22-22Initiating a Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22-22Suspending Sampling. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22-25Multigas Troubleshooting Guide. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22-26

BIS

Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23-1Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23-3Patient Preparation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23-6Initialization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23-7Normal Bedside Display Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23-8Remote View Display Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23-11Split Screen Display Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23-12Numeric Key Format. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23-12BIS Main Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23-13Status Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23-16Definitions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23-18Care and Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23-19

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EEG

Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24-1Directory of Keys — Processing Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24-2Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24-3Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24-5Setting Up the EEG Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24-6Configuring the EEG Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24-7Initial Setup. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24-7Storing a Setup. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24-14Recalling a Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24-15EEG Displays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24-16EMG Display. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24-24Archiving EEG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24-25Marking Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24-26Storing DSA/Trend Snapshots . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24-26Recalling DSA/Trend Snapshots . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24-27Erasing Snapshots . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24-28Printing EEG. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24-28Patient Preparation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24-29Remote Monitors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24-35

Calculations

Directory of Keys — Remote Calcs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-1Directory of Keys — Clinical Calcs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-2Directory of Keys — Drug Dosage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-3Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-5Setting Up Physiologic Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-5Setting Up Drug Dosage Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-6Accessing Calculation Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-6Updating Data Between Monitors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-6Display Detail — Physiologic Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-7Hemodynamic Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-12Respiration Calculations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-14Oxygenation Calculations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-16Renal Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-18Drug Dosage Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-20Display Detail - Drug Dosage Calculations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-21Configurable Drug Names (UCW and Ultraview 1700 Only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-30

Trends

Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26-1Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26-2Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26-3Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26-4Printing the Trend Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26-6Graphic Trends Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26-6Tabular Trends Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26-8Trends Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26-10

Remote Keypad

Directory of Keys — UCW and Ultraview 1700 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27-1Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27-3Setting Up the Remote Keypad . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27-3Setting Up the Receiver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27-4Selecting a Parameter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27-5Operating Menu Keys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27-5Recording a Waveform. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27-6

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Programming Access Codes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27-6Remote Keypad Troubleshooting Guide. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27-8

Remote Display

Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-1Setting Up the Secondary Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-1Copying Stored Values of the Primary Monitor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-2Restoring a Stored Value . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-3Copying Primary Attributes to the Secondary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-3Resetting Default Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-4Tracking or Locking Displays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-4Adjusting Scaled Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-6

Patient Data Logger

Directory of Keys — Bedside only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29-1Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29-3Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29-5Data Printouts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29-6Patient Data Logger Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29-7

DNA

Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30-1Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30-3

Ultraview Care Network Product Specifications

System Safety Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31-1Equipment Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31-3Equipment Maintenance Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31-4Ultraview Care Network Module Compatibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31-4

Cleaning and Sterilization

Monitors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32-1Cleaning Products Not Recommended for Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32-1Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32-2TruLink Noninvasive Blood Pressure Cuffs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32-2Cables and Lead Wires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32-3Pulse Oximetry Sensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32-4Capnography Sensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32-490518 Multigas Analyzer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32-5Ultrasound Transducers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32-6

Battery Use, Maintenance, and Disposal

Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33-1Sealed Lead-Acid Batteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33-2Nickel Metal Hydride Batteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33-2Ultraview 1030/1050/Maternal Obstetrical Monitor (MOM). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33-2Ultraview 1600/1700. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33-3Multigas Analyzer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33-4Ultraview Digital Telemetry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33-4Fetal Monitor Telemetry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33-5

Diagnostic Messages

Appendix A — Symbols

Ultraview Care Network Operations Manual ix


Contents

Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1System Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Monitor Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Power Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Network Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Watching Alarms Remotely — Alarm Watch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Viewing Remote Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Full Bed Review — UCW and Ultraview 1700 Only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Reviewing Remote Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Overview

This chapter gives an overview of the Ultraview Care Network products, provides basic system operating instructions, and describes network functions. Information regarding the operation of clinical information system products are contained under separate cover. Please refer to their respective operations manuals.

Ultraview Care Network Operations Manual 1-1


Figure 1-1: Ultraview Care Network monitor family

Caution:US Federal law restricts the devices documented herein to sale by, or on the order of, a physician.

Modules90491 Module Housing

module

90367 Ultraview 1030 Monitor90369 Ultraview 1050 Monitor

90385 UCW® Monitor90364 Ultraview 1600 Monitor90387 Ultraview 1700 Monitor

90363 Ultraview 1500 Monitor

adultNIBPNIBPSpO

2

P1-2

P3-4

CO

hlo2

hlo1

2

90496 Ultraview Command Module

90499 Module Housing

15:55 110/ 68( 84) mmHg HR= 69 (ECG)16:54 115/ 68( 77) mmHg HR= 69 (ECG)16:55 113/ 55( 88) mmHg HR= 69 (ECG)16:56 108/ 56( 82) mmHg HR= 69 (ECG)16:57 116/ 62( 83) mmHg HR= 69 (ECG)

ECG

ECG

RESP

SPO2

NIBP

LAST BP=16:5702/21

11662

97

20

69

68 bpm

%

( 83)mmHg

150100

10085

300

ROW 512040

RA-LA

V3ST=-0.16

♥ II MONST= 0.08

A=0

*

S

*

21 FEB 1994

?HELP

MONITORSETUP

SPECIALFUNCTIONS

R X

TONE RESETALM SUSPEND

RECORD

PREVIOUSMENUS

NORMALSCREEN

Color Display, CRT or flat panelwith Touchscreen

RxOnly



System Basics

Ultraview Care Network monitors provide a consistent operator interface across all bedside and central monitoring environments. Monitors installed on a network provide access from monitor to monitor and enable you to control the remote data.

Networked monitors enable you to view waveforms and numeric values of patient parameters, review vital sign and ECG arrhythmia and ST history, and record patient data automatically during alarm events. Refer to Network Basics on page 1-10 for more information.

• Central stations display patient specific parameters, remote alarms, and alarm limits that are based on the setting of the bedside as determined by the primary caregiver. Refer to Central Monitors on page 6-3 for detailed information on the system capabilities.

• The Remote View feature enables you to monitor two patients simultaneously. Remote views of waveforms and numerics are nearly identical in display and function to the parameter at the originating monitor. Alarms, trends, menu keys, and recordings are accessible through a Remote View. Refer to Viewing Remote Parameters on page 1-11 and Alarms on page 2-3 for more information.

• The Full Bed Review feature enables you to view multiple parameters on a UCW and Ultraview 1700 bedside monitor from any other bedside or central monitor on the network. Refer to Full Bed Review — UCW and Ultraview 1700 Only on page 1-13 for more information.

• The Alarm Watch feature notifies you when an alarm occurs on any other monitor on the network. Refer to Alarm Watch on page 2-8 for more information.

• Vital signs trending provides minute-by-minute recording of parameter data for review and for documentation in the patient record. You select the format and interval for trending. Refer to Trends on page 26-3.

• Optional calculations features provide automatic calculation and trending of advanced clinical variables including hemodynamic, renal, oxygenation, ventilation calculations, and drug dosage. Refer to Calculations on page 25-5.



Monitor Basics

Ultraview Care Network monitors use modules to monitor various clinical parameters. For example:

• Electrocardiograph (ECG). Refer to ECG on page 8-3.

• Noninvasive Blood Pressure (NIBP). Refer to NIBP on page 13-3.

• Cardiac Output (CO). Refer to Cardiac Output on page 19-3.

Remote module housing units may be used with Ultraview Care Network monitors to house additional modules. The 90385 Universal Clinical Workstation (UCW), 90363 Ultraview 1500, 90364 Ultraview 1600, and 90387 Ultraview 1700 monitors must use a remote module housing unit to house any of its modules.

• Each 90499 module housing holds up to two modules.

• Each 90491 module housing holds up to four modules.

An external power supply is needed whenever a module housing is used. A separate power supply is required for the 90491 and 90499 module housing.

Warning:Due to the potential for electromagnetic interference, portable communication transmitters and cellular phones should not be operated within 1.07 meters (3.5 feet) of the patient, patient leads, or associated patient monitoring equipment.

Note:

All references to the Universal Clinical Workstation or UCW include the Universal Clinical Workstation-Independent Display (UCW-ID), and all the available features of the UCW-ID.

Power Failure

Warning:• In the case of a power failure, the remote module housing (90491 or 90499) provides +5 volts of

power to maintain data integrity.

• If the power is interrupted to the remote module housing but not to the monitor, the module will remain active and the following will occur:

- Waveforms will go flat (as if the patient has no vital signs) or will be totally lost.

- Parameter values will go to the minimum limit or ??? (except for non-invasive pressure, which will display the last value before the power failure).

- Alarms may sound for low limit violations or for conditions such as Asystole, Leads Off, Loss of Signal, or Adapter Disconnected.

• If any of the above conditions occur, check to determine whether or not power has been interrupted to the remote module housing and re-establish AC power.

• Do not allow the Ultraview 1600, Ultraview 1700, or the 90499 module housing to be left turned ON without power applied for long periods of time or the memory backup batteries will be depleted.



Modules are designed with default settings for alarms and various other parameter settings (for example, NIBP reading frequency) which you may adjust to meet the needs of your patients. When events occur that might cause the selected limits or values to return to the monitor default settings, the monitor may display a CHECK SETUP key in the ECG zone combined with a low priority alarm tone (refer to Setting Alarm Limits on page 2-4 for details on alarm priorities). To cancel the message and the alarm, simply touch the CHECK SETUP key on the screen.

The following describes the events that will cause the CHECK SETUP key to appear.

Note:

Check Setup is an optional feature on the ECG channel. Contact your system administrator if your system does not have this feature.

Event Reason

Monitor power ON

Any time you power ON a monitor, all parameters are reset to their default values or to the values set the last time the monitor was in use. It is very important to review the parameter limits and/or their values and adjust them appropriately for the current patient.

When you insert an ECG module

Because the module values will come up with default settings, it is important to review and reset the limits and/or values for that particular patient.

An error is detected and the monitor resets

The monitor has detected an error that cannot be corrected through other means.



Inserting Modules

Insert a module into the bedside monitor (Ultraview 1030/1050) or into the remote module housing as shown below.

Figure 1-2: Ultraview Care Network module insertion

Patient Preparation

To prepare the patient for monitoring, attach the patient cable, and connect the patient cable to the module. Touch a parameter key, then touch the menu keys as needed to set up monitoring for a specific parameter.

remote module housing

Ultraview 1030/1050

right side view

patientmoduleslot

90499 Module Housing

patient moduleslot

Ultraview 1600 and Ultraview 1700 Monitors



Using the Monitor Screen

Ultraview Care Network monitors employ touchscreen technology for interaction with the system. To activate a menu or parameter key, simply touch the key on the screen.

Using the Screen Keys

The Ultraview Care Network monitors use keys on the screen to execute monitor functions. The monitor keys are located to the far right side of the screen and have standard functions regardless of the parameter being monitored. The menu keys appear along the bottom of the screen as menu items. The (physiological) parameter keys appear next to the parameter display. Some monitors (for example, the UCW) display these keys pictorially as icons, but the key names and functionality are the same for all Ultraview Care Network monitors.

Figure 1-3: Screen keys

monitorkeys (Icons)

monitorkeys

parameterkeys

menu keys

menuline

messagearea

PRINTERCONTROLS

11:3211:3311:3411:3511:36

110/ 69( 84)113/ 73( 88)113/ 69( 84)

82/ 51( 64)108/ 67( 83)

TEMP34.7



Menu and Parameter Keys

The menu and parameter keys appear on the monitor screen as displayed in Figure 1-3.

• Touch a parameter key to display a set of menu keys for that parameter

• Touch a menu key to control a monitoring function, for example, ALARM LIMITS

Keys that are currently active appear in bold lettering. Inactive keys appear in dim lettering. When you touch an inactive key an error tone will sound.

Touch the HELP key, and then the key in question, to display a description of its function in the system message area above the menu line.

Touch the MONITOR SETUP key to display a menu that enables you to adjust tones, enter patient data, modify the screen format, set time and date, adjust brightness, determine battery status (Ultraview 1030/1050 only), and specify printing characteristics.

The UCW and Ultraview 1700 enable you to display a digital clock, stopwatch, or timer in the lower right corner of the screen. Touch the clock to display the clock menu. The Ultraview 1030, 1050, 1500, and 1600 monitors display a digital clock at the bottom right of the screen. Refer to Bedside/Transport Monitors on page 5-3 and Central Monitors on page 6-3 for a detailed explanation of the functions that apply to your system.

Touch the SPECIAL FUNCTIONS key to display a menu that enables you to view remote parameters, activate automatic notification of remote alarms, view trends of vital sign data and clinical and drug calculations, and use other optional network applications.

When you touch the TONE RESET/ALM SUSPEND key once during an alarm condition it will silence the alarms for 45 seconds at the unit where the key was touched (bedside or central). Touching the key again during the initial 45-second suspension will silence the alarms for three minutes at the bedside only. Refer to Alarms on page 2-3 for more details.

To obtain help about a menu key:

• Touch HELP.• Touch the desired menu key.

To customize your monitor:

• Touch MONITOR SETUP.• Select any menu key.

To activate additional functions:

• Touch SPECIAL FUNCTIONS.• Select any menu key.



You may use either a system printer or a printer module for recording patient data. Recordings of monitored data can be generated by touching the RECORD key and then touching up to four flashing parameter keys (depending on the printer capacity). Refer to Printing on page 4-5 for more details.

Touch the PREVIOUS MENU key to move back one menu level. From the Main menu level, touch PREVIOUS MENU to remove the current menu from the display and close the application window.

Touch the NORMAL SCREEN key to close any active application window, and its menus, or to return to the basic display.

Using the Keyboard

A keyboard can be used for certain applications like Calculations and Admit/Discharge. An on-screen keyboard is provided for all local applications, but you may also use an external keyboard. Refer to Using the On-Screen Keyboard on page 3-4 for keyboard displays. Use the arrow keys and TAB key on the keyboard to move within an application window.

Using the Mouse

If your system is equipped with a mouse it may be used with selected functions in lieu of the keyboard or touchscreen. Click the left mouse button on a menu key to activate the key.

To temporarily silence alarm tones:

• Touch TONE RESET/ALM SUSPEND once to silence for 45 seconds.• Touch TONE RESET/ALM SUSPEND again (within 45 seconds) to suspend alarms for

three minutes (bedside only).

To record a parameter:

• Touch RECORD once.• Select up to four flashing parameter keys.

To change the screen display:

• Touch PREVIOUS MENU to return to last menu.• Touch NORMAL SCREEN to remove the menu from the screen.



Network Basics

To aid in understanding the concept of a network operation, consider your need to communicate between beds in a single care unit. While you are in the care unit at a bedside monitor, you can view parameter waveforms from another bed and control those parameters just as if you were at that remote bedside.

Advanced networking allows remote access and interaction with Clinical and Drug Calculations, Tabular Trends, Graphic Trends, and parameters from remote beds. Standard networking allows the remote viewing of single parameters from bedside to bedside, and bedside to central. The Full Bed Review feature on the UCW and Ultraview 1700 allows remote viewing of the entire bedside monitor.

If you need to review information from another unit on the network, you can do so by specifying the unit as well as the bed. For example, if you have a need for frequent communication between your care unit and another care unit, those units would be designated as subnets on your networked system. This identification typically appears on the keys in the appropriate menus.

The following figure illustrates a possible network configuration.

Figure 1-4: Network configuration

Although the presence of the network is invisible to you as you operate any monitor on the system, decisions were made during installation to configure the system according to your hospital’s specifications. Typically, hospitals designate a system administrator for this task. This manual directs you to refer questions to that individual where system operation may differ according to the decisions made by your hospital.

Subnet #1Intensive Care Unit

Subnet #2 Emergency Room

NETWORK



Watching Alarms Remotely — Alarm Watch

With the network Alarm Watch function enabled you will be notified of all alarms at all monitors. Once a monitor has been set up to Alarm Watch a bed, any alarm from that bed is reported.

Warning:• The Alarm Watch function is not automatically enabled. You must first select the bed that the

central or bedside monitor should Alarm Watch.

• Alarm conditions for parameters not currently displayed on the central monitor will only be reported at a central monitor when Alarm Watch is enabled at the central monitor.

Refer to Alarm Watch on page 2-8 for more information.

Viewing Remote Parameters

Each parameter on a bedside monitor can be independently viewed (Remote View) on any other bedside or central monitor on the network. Remote views of parameters can be identical in display and function to the local bedside, with the addition of the patient name and bed identification label.

If enabled by your system administrator alarms and menu keys operate the same at the remote monitor as they do at the local bedside.

Bedside monitors can have parameters remotely viewed by up to 16 other devices.

Note:

Your network protocol may not enable you to make remote alarm limit changes or to remotely control a parameter. If you have a question regarding this function, ask your system administrator.

To enable Alarm Watch:

• Touch SPECIAL FUNCTIONS.• Touch ALARM WATCH.• Select a bed or a subnet. • If you selected a subnet, then select a bed.• Touch ALARM WATCH.

To view remote parameters from a bedside monitor:

• Touch SPECIAL FUNCTIONS.• Touch REMOTE VIEW.• Select a bed or a subnet. • If you selected a subnet, then select a bed.• Select desired parameter.



Remotely viewed parameters occupy the lowest zone on the screen of a bedside monitor. On the central monitor each remote parameter is assigned a specific display position. Every Remote View zone is separated from other zones by a dividing line.

When a bedside monitor is set up to remotely view a parameter from another bedside, a one-second advisory tone sounds at the onset of the alarm condition. The remote alarm tones must be active at that bedside monitor.

Arrhythmia and ST segment review data can also be viewed from remote monitors if optional Arrhythmia and ST segment analysis software is part of your system.

Warning:Remote View and Alarm Watch are mutually exclusive functions on the bedside monitor. Selecting to remotely view a parameter at a bedside inactivates the Alarm Watch function at that monitor.

When you need to control or continually observe a parameter from a remote monitor, use the Remote View function. When you wish to have remote notification of alarms, use the Alarm Watch function.

Note:

Your network protocol may not allow you to control remotely viewed parameters. If you have a question regarding this function, ask your system administrator.

Figure 1-5: Remote View (UCW/Ultraview 1700)

To view remote parameters from a central monitor:

• Touch MONITOR SETUP.• Touch SCREEN FORMAT.• Select the destination display zone.• Select a subnet or bed as appropriate.• Select a parameter and color.



Full Bed Review — UCW and Ultraview 1700 Only

The Full Bed Review (FBR) key allows you to view several parameters from another monitor at your bedside or central station monitor. The monitor at which the Full Bed Review is enabled will display all available parameters from the remote monitor within the limitations of the capabilities of the displaying monitor.

Whenever a bedside or central monitor is displaying another monitor’s data, an FBR key appears in the lower left corner if no menus are displayed. Full Bed Review can be activated by touching this FBR key, then selecting one of the flashing parameter keys. If the monitor is not displaying another monitor’s data, Full Bed Review can be activated by touching the FBR key that follows the last parameter icon for the selected bed.

If more parameters are available from the remote bedside than FBR can display, keys for these additional parameters are displayed as numeric keys along the bottom of the screen. Selecting any of these numeric keys causes the selected parameter to replace the lowest parameter.

The parameter keys displayed by FBR are interactive. To access the controls for a parameter, touch that parameter’s key. Remote review of trended or calculated data for the selected monitor is available by touching the TRENDS/CALCS key found in the Special Functions menu.

Note:

Full Bed Review displays a single ECG lead if the remote bedside is configured to display ECG data using the Full View or Split View format.

To deactivate the FBR feature, touch NORMAL SCREEN.

To activate Full Bed Review at a bedside monitor when a remote view is not displayed:

• Touch SPECIAL FUNCTIONS.• Touch REMOTE VIEW.• Select one of the subnet icons, then select a bed icon.• Touch the FBR key displayed after the last parameter icon for that bed.

-OR-

• Select any parameter icon, then perform the steps in the following Quick Start.

To activate Full Bed Review when a remote parameter is already displayed:

• Touch NORMAL SCREEN, if needed, to display all parameters.• Touch FBR displayed in the lower left corner of the monitor.• Touch the flashing parameter key of the selected remote bed.



Reviewing Remote Trends

Retrospective vital sign review through either graphic or tabular trends provides minute-by-minute access to data from any monitor on the network.

To activate Full Bed Review at a central monitor without parameters already displayed:

• Touch MONITOR SETUP.• Touch SCREEN FORMAT.• Select one of the subnet icons, then select a bed icon. • Touch the FBR key displayed after the last parameter icon for that bed.

-OR-

• Select any parameter icon, and select a display zone to assign that parameter to that display zone.

• Follow the steps in the previous Quick Start.

To deactivate the Full Bed Review:

• Touch NORMAL SCREEN.

To display a trend from a remote monitor:

• Touch SPECIAL FUNCTIONS. • Touch REMOTE TRENDS/CALCS. • Select a bed or a subnet. • If you selected a subnet, then select a bed. • Touch GRAPHIC TRENDS or TABULAR TRENDS.


Alarms

Directory of Keys

Note:Based on features purchased, more or fewer keys may appear here than on your menu screens.

Adjusting Alarm Tones

TONEOFF

MONITORSETUP

TONES

REMOTEALARMS

ALARMWATCH

KEYTONE

LOCALALARMS

VOLUME VOLUME

MONITORSETUP

RECORDERCONFIG.

RECORDINGDURATION

ALARMPARAMS

MORE

Setting Up Automatic Alarm Recordings

MONITOR SETUP

MONITOR SETUP - Select type of tone to change

MONITOR SETUP - LOCAL ALARM TONE

MONITOR SETUP

RECORDER CONFIGURATION

Select parameters which require alarm recordings from BED X

RECORDINGDESTINATION

NETWORK BOTH

ALARM RECORDINGS TOTHIS

MONITOR12 SEC 20 SEC

On Central only - Select Bed

BED X ...

Select duration for recordingsinitiated from this monitor

1 2 4VITALSSETUP

Number of recorder channels

THIS NETWORKMONITOR

OTHER RECORDINGS TO

ON

ECGON OFF

RESPON OFF

...


Alarms

Directory of Keys


SPECIALFUNCTIONS

ALARMWATCH

RV/AWOFF

NET 02 NET 03 NET 04 MORE

SPECIAL FUNCTIONS

ALARM WATCH - Select bed(s) for ALARM WATCH

ALARM WATCH - Select bed(s) for ALARM WATCH in subnet NET03

1001ON OFF

1002ON OFF

1003ON OFF

1004ON OFF

3001ON OFF

3002ON OFF

3003ON OFF

3004ON OFF

3005ON OFF

3006ON OFF

3006ON OFF

Setting Up Alarm Watch (1030/1050/1500/1600)

Setting Up Alarm Watch (UCW/Ultraview 1700)

SPECIALFUNCTIONS

ALARMWATCH

RV/AWOFF

SPECIAL FUNCTIONS


Alarms

Contents

Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Default Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Setting Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Identifying Alarm Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Adjusting Alarm Tones/Key Tones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Controlling Alarms via the TONE RESET/ALM SUSPEND Key. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Alarm Watch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Automatic Recording of an Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Alarms Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Overview

This chapter describes how to use the Alarm Watch feature, set alarm limits, silence and suspend alarms, set alarm tones, and specify parameters for automatic alarm recordings.

When a parameter goes into alarm on a local bedside monitor, the corresponding parameter key flashes on the screen, an alarm message is displayed, and an alarm tone sounds (unless tones are disabled). You can also choose to automatically record the parameter in alarm on a bedside or network printer. Networked monitors enable you to monitor alarm conditions at both the central and bedside monitors simultaneously through the Alarm Watch feature.

Warning:Alarm conditions for which you want to be alerted must be set to ON or enabled at the location where you want to be alerted, bedside or central. You can enable them from the local bed, remote bed, or central.

Note:

Define your own default settings for alarm limits, alarm priorities, recordings, and other attributes with the Module Configuration Manager feature. Refer to Module Configuration Manager on page 7-5 for further details.

Default Alarm Limits

Factory default alarm limit settings are activated whenever the monitor is powered ON, whenever a module is inserted, or when a parameter is enabled. You can modify these settings to meet your own protocols.

Refer to the Alarm section of the appropriate parameter chapter in this manual for details concerning setting or adjusting alarm limits for a specific parameter.


Alarms

Setting Alarm Limits

You can change parameter alarm limits by using the parameter's Alarm Limits menu. The steps to the left illustrate the minimum procedure used to adjust high and low alarm limits for a parameter.

Note:

• Parameters may contain additional alarm limit features not listed here. Read the specific parameter chapter (for example, ECG or NIBP) in this manual for details.

• To set fetal alert limits, please refer to Fetal Monitoring on page 15-3 for further details.

Identifying Alarm Levels

Alarm conditions are visually and audibly prioritized as high, medium, or low.

* The repetition rate for the tone bursts on the High, Medium, and Low levels may be adjusted for all monitors by your system administrator.

To set alarm limits:

• Touch a parameter key (ECG, TEMP, etc.). • Touch ALARM LIMITS. • Ensure ALARMS ON is set.• Select HI = or LO =. • Use arrow keys to adjust.

Table 1: Bedside Alarms

Priority Tone Type* Visual Tone Duration

HighContinuous tone, or 2 bursts of 5 tones every 15 seconds

Flashing key; message appears in red on color monitors

Until the alarm condition is resolved, the alarm is suspended, or the tone is reset

Medium

Intermittent tone (one second ON, one second OFF), or burst of 3 tones every 30 seconds

Flashing key; message appears in yellow on color monitors


Low

Intermittent tone (one second ON, four seconds OFF), or 1 tone every 30 seconds




Alarms

Warning:Parameters shown in the ECG waveform zone in Enhanced Vital Signs mode do not alarm at the central station. Only parameters set via the Alarm Watch mode will alarm as set up by the system administrator.

* The repetition rate for the tone bursts on the High, Medium, and Low levels can be adjusted for all monitors by your system administrator.

Table 2: Alarm Watch and Remote View Alarms

Priority Tone Type* Visual Tone Duration

High

Centralcontinuous tone, or 2 bursts of 5 tones every 15 secondsBedsideone single tone

Flashing key; message appears in red on color monitors

Centraluntil the alarm condition is resolved or the tone is resetBedsideone second

Medium

Centralintermittent tone (one second ON, one second OFF), or burst of tones every 30 secondsBedsideone single tone



Low

Centralintermittent tone (one second ON, four seconds OFF), or one tone every 30 secondsBedsideone single tone




Alarms

Adjusting Alarm Tones/Key Tones

You can turn the alarm tone ON or OFF and adjust the tone volume for local alarms, Remote View alarms, or Alarm Watch alarms. While you are adjusting tone volume, a tone sounds briefly as an example of the new level.

Alarm tones refer to the sound associated with an alarm condition. Key tones sound each time you touch a screen key.

Volume adjustments affect only the monitor where the adjustment is made. The tone volume of an alarm notification at a remote monitor must be adjusted at that monitor. It cannot be adjusted remotely. A visual alarm notification is displayed until the condition is resolved, even if you disable the alarm tones at that monitor.

Alarm Watch tones sound when the Alarm Watch feature is active and an alarm condition exists on a watched monitor. The Alarm Watch feature must be enabled via the Special Functions menu for the Alarm Watch tone to sound.

The Remote View alarm tone only sounds when a remotely viewed parameter goes into alarm.

Warning:Disabling alarm tones via Monitor Setup at a bedside or at a central monitor eliminates alarm tones for all alarm conditions at that monitor, even in the case of life-threatening events.

To set local alarm tones or key tones:

• Touch MONITOR SETUP. • Touch TONES. • Select LOCAL ALARMS or KEY TONE.• Select TONES ON. • Use VOLUME and VOLUME keys to adjust.

To set alarm watch tones or remote view tones:

• Touch MONITOR SETUP. • Touch TONES. • Select ALARM WATCH or REMOTE ALARMS.• Select TONES ON. • Use VOLUME and VOLUME keys to adjust.


Alarms

Controlling Alarms via the TONE RESET/ALM SUSPEND Key

During an Alarm Condition

If you touch TONE RESET/ALM SUSPEND once at a monitor during an alarm condition:

• The alarm tone is silenced at that monitor for 45 seconds, but the alarm tone continues to sound at other monitors. If the alarm condition continues, the alarm tone resumes at that monitor at the end of the 45-second period. If another parameter goes into alarm during this period, or if the initial condition ends and then begins again, the alarm tone will again sound at that monitor.

• The message ALARM TONES SUSPENDED FOR 45 SECONDS is displayed only on that monitor.

• All flashing parameter keys continue to flash.

At a bedside monitor, when you touch the TONE RESET/ALM SUSPEND again within 45 seconds:

• All alarms and alarm recordings are suspended for three minutes. No alarms sound for any reason during this period, and no new alarm recordings are produced.

Note:

The ALM SUSPEND feature is only available at bedside monitors. If this feature has been disabled (set to OFF), the TONE RESET/ALM SUSPEND key does not suspend alarms.

• A message is displayed to indicate that all alarms are suspended.

• Trend data may not be collected. This feature can be enabled or disabled only by your system administrator.

Normal alarm operation can be resumed within the three-minute time period by touching the TONE RESET/ALM SUSPEND or RESUME ALARMS key again.

Note:

The ALM SUSPEND key is relabeled as RESUME ALARMS after the first key touch.

To silence an alarm tone for 45 seconds at any monitor, touch the TONE RESET/ALM SUSPEND key once.

To resume alarm tones at a central monitor, touch the TONE RESET/ALM SUSPEND key again.

To suspend all alarms at a bedside monitor for three minutes, touch the TONE RESET/ALM SUSPEND key again within 45 seconds.

Note: If alarms resume the second time the key is touched, your bedside monitor may be configured differently for this feature. Contact your system administrator for details.


Alarms

In the Absence of an Alarm Condition

Note:

The TONE RESET/ALM SUSPEND key is relabeled as ALARM SUSPEND after the first key touch.

Touching the TONE RESET/ALM SUSPEND key once when no parameters are in an alarm condition suspends the alarms at the bedside monitor. (Refer to During an Alarm Condition on page 2-7.)

To resume alarms at a bedside monitor, touch the TONE RESET/ALM SUSPEND key again.

Note:

You cannot suspend alarms from a central monitor. However, you can silence alarm tones for 45 seconds. Touching this key has no effect if it is touched at the central monitor when no alarm is sounding.

Alarm Watch

With the network Alarm Watch feature, you can be notified at a local bedside or central monitor of all alarms from a remote bed. The Alarm Watch feature defaults to its last setting when the monitor is turned ON. The local monitor displays the message ALARM WATCH ON when the Alarm Watch feature for a remote bed is active. On a central monitor, the message AW OFF also displays for each bed not selected for Alarm Watch.

Note:

A central monitor can be configured with the Central Alarm Watch Manager to automatically Alarm Watch every bed it is currently monitoring. Contact your system administrator about this feature.

Refer to Viewing Remote Parameters on page 1-11 for more information. The listed limits for the number of devices that can remotely view a monitor apply to Alarm Watch-initiated remote views.

When a parameter from a monitor that is under Alarm Watch goes into alarm, a message such as ALARM WATCH – BED 28 ECG CHANNEL IN ALARM displays on the message line of the alarm-watching monitor. A one-time advisory tone sounds at the watching bedside or central monitor. The corresponding waveform appears in the lowest zone on the screen of the alarm-watching monitor, unless:

• another alarm-watched parameter is in alarm and its waveform already occupies that zone at the watching monitor,

-OR-

• a parameter is displayed in the lowest zone of the monitor and its parameter key has been activated displaying a menu.

To resume normal alarm operation at a bedside monitor within the three-minute period, touch the TONE RESET/ALM SUSPEND or RESUME ALARMS (Ultraview 1030, 1050, 1500, and 1600 monitors) key again.

To suspend alarms at a bedside monitor when no alarm is sounding, touch the TONE RESET/ALM SUSPEND key once.


Alarms

When a waveform for an Alarm Watch parameter in alarm displays, the appropriate tone sounds at the bedside (once) and at the central monitors for the duration of the alarm.

Only one Alarm Watch waveform can be viewed at a time. When subsequent, concurrent alarms occur for one patient or other patients on Alarm Watch, a message displays and a one-second advisory tone sounds. Remember to enable Alarm Watch tones in the Monitor Setup menu to produce audible alarms.

If multiple alarms occur simultaneously, the messages displayed cycle from one to another every three seconds (up to a maximum of ten alarms) until all alarm conditions are resolved, or until you disable alarms at either the local monitor (through Remote View) or the remote monitor.

Warning:• Using the Alarm Watch feature, you can watch for alarms from 32 other monitors. However,

more than ten remote alarms cannot be reported simultaneously to any monitor using the Alarm Watch feature.

• Remote View and Alarm Watch are mutually exclusive features on bedside monitors. If you select to Remote View a parameter the Alarm Watch feature at that monitor is inactivated.

To resume Alarm Watch, touch the ALARM WATCH or ALARM WATCH ENABLE (on the UCW and Ultraview 1700) key. Alarm Watch is resumed for all previously selected patients. You can also add patients for Alarm Watch. The ALARM WATCH ON message displays in the message zone whenever one or more remote beds are selected for Alarm Watch from that local monitor.

If your hospital protocol requires remote monitoring of all alarms, you can activate Alarm Watch during the setup of your bedside or central monitors. Alarm Watch remains ON as long as you do not power down the monitor. Refer to Power Failure on page 1-4 for further information.

To enable Alarm Watch:

• Touch SPECIAL FUNCTIONS.• Touch ALARM WATCH.• Select a bed or a subnet.• If you selected a subnet, then select a bed.• Ensure that the key for the desired bed(s) has the ON segment highlighted or is

indented.• Touch ALARM WATCH ENABLE for the UCW and Ultraview 1700.

To disable Alarm Watch:

• Touch SPECIAL FUNCTIONS. • Select RV/AW OFF.

To de-select beds for Alarm Watch:

• Touch SPECIAL FUNCTIONS.• Touch ALARM WATCH.• Touch the bed to de-select.

-OR-

• Touch DESELECT ALL.


Alarms

Alarm Watch Rotation

On some monitors, your system administrator can configure the Alarm Watch feature to rotate the visible active alarms through the Alarm Watch display zone on the screen. Active alarms being monitored will rotate in and out of the display zone at an interval set by your system administrator. The Alarm Watch rotation time, signal tone, and rotation algorithm are set in the ALARM WATCH SETUP menu, accessed by touching the PRIVILEGED ACCESS key.

ROTATE ALARM WATCH — enables the system administrator to turn the rotation of alarms ON or OFF. If you select OFF, the ALARM WATCH ROTATION and the ROTATION TIME options are unavailable.

ALARM WATCH ROTATION — enables the system administrator to select either a rotation system allowing the higher priority alarms to rotate into the window more often (Priority) or a simple rotation system allowing all alarms equal time in the rotation regardless of the alarm priority.

ROTATION TIME — selects the interval between rotations in the Alarm Watch window.

Central Alarm Watch Manager

Your system administrator may have configured your central station monitor with the Central Alarm Watch Manager feature enabled. This feature automatically activates the Alarm Watch feature for all beds currently displayed on that central monitor.

Note:

• When the Central Alarm Watch Manager is activated, it displays alarms for each bedside that has the Alarm Watch feature enabled. The central monitor continues watching for alarm conditions from the selected bedside monitors until you disable Alarm Watch for that bedside monitor or disable the Auto Alarm Watch feature altogether.

• The factory default is Auto Alarm Watch ON with access to the Auto Alarm Watch feature DISABLED.

• The Central Alarm Watch Manager must be set by a system administrator with a Biomed level of privileged access.

ALARM WATCH SETUP

ROATATE ALARM WATCH

ALARM WATCH ROTATION

ROTATION TIME

ON OFF PRIORITY SIMPLE 15 SEC 30 SEC


Alarms

Alarm Tone Manager

The Alarm Tone Manager provides two levels of managing alarm notifications.

• If this feature is ENABLED, it will not allow individual alarm tones to be permanently disabled.

• The system administrator can set a minimum volume for alarm tones ensuring that they are always at a safe and audible level.

Note:

• The factory default for the Alarm Tone Manager is OFF, which inhibits access to the ALARM TONES keys in the Monitor Setup menu.

• The Alarm Tone Manager must be set by a system administrator with a Biomed level of privileged access.

Automatic Recording of an Alarm

Touch the ALARM PARAMS key to display a menu of parameters that can initiate alarm recordings on a bedside recorder and on a network printer if the parameter goes into an alarm condition. Recording on a network printer is configuration-dependent. See your system administrator for details.

If alarm recordings are disabled for a parameter, no alarm recording is produced on either the bedside or network printer. However, the designated alarm tones are still generated and alarm messages are displayed.

Alarm recordings print the last 12 or 20 seconds (selectable under RECORDING DURATION) of a waveform or print until the alarm stops or is suspended, whichever is longer. To stop a recording at the bedside printer, touch STOP or UNIT OFF on the printer module.

When a bedside recorder is present in the monitor and is selected and online, an alarm recording is automatically directed to that recorder.

Use the key labeled OTHER ON/OFF for any new parameter not yet on the alarm parameters menu.

Note:

• Spacelabs Healthcare strongly recommends verifying alarm parameter settings on the monitor once per shift and upon each admission.

• If a printer is not attached to the monitor, the recorder channel (1, 2, 4) keys do not appear in the menu.

To select parameters for alarm recording and generate automatic recordings on a bedside recorder:

• Touch MONITOR SETUP.• Touch RECORDER CONFIG.• Select RECORDING DESTINATION.• Select a destination for the alarm recording.• Touch PREVIOUS MENU.• Touch ALARM PARAMS. • Select parameter key(s) ON to initiate a recording in case of alarm. If the parameter

key is OFF, no alarm recording is produced for that parameter in an alarm condition.


Alarms

Alarms Troubleshooting Guide

Clinical Situation Possible Cause Solution

Duplicate alarm recordings print at the bedside and system printer

■ Alarm recording directed to both bedside and network printers under the RECORDING DESTINATION key.

■ Select THIS MONITOR or NETWORK for alarm recordings.

No alarm recordings are printed

■ Parameters for alarm recordings are set to OFF.

■ Select parameters for alarm recordings from the Alarm Parameters menu or Record Alarm Parameters menu.

■ Bedside printer is OFF.

■ The alarms have not been directed to the bedside printer.

■ ALARMS SUSPENDED for three minutes.

■ Turn bedside printer ON.

■ Ensure that THIS MONITOR or BOTH is selected.

■ Ensure that alarms are not suspended.

■ System printer is not identified as one of two network printers.

■ Have your system administrator verify configuration.

■ Printer is out of paper. ■ Load paper into printer.

Alarms continue to violate after touching TONE RESET

■ More than one alarm may be in violation.

■ Touch TONE RESET/ALM SUSPEND again.

No alarm notification occurs at a central monitor

■ The Alarm Watch function is not active.

■ Activate Alarm Watch for the desired beds at the central.

■ Parameters not displayed. ■ Display the desired parameters using SCREEN FORMAT under MONITOR SETUP.

CANNOT INTERACT WITH ALARM WATCH parameter displayed

■ The monitor may not be configured to allow interaction with remote parameters.

■ Contact your system administrator.


Alarms

CANNOT deselect ALARM WATCH

■ The Ultraview Central Monitor is configured with Central Alarm Watch Manager to prevent de-selection of automatically alarm watched beds.



Admit/Discharge

Directory of Keys — Ultraview 1030/1050/1500/1600To enter patient name, ID, or other data

MONITOR SETUP

ADMIT/DISCHARGE - Selection function

ADMIT - Purge existing data for this bed? DISCHARGE - Are you sure? (All data for the bed will be purged)

Select data you want to enter

ADMIT/DISCH. - Patient’s Date of Birth: DDMMMYYYY

Enter patient name/ID for bed xx

on-screen keypad

To enter height, weight, BSA (and calculations with Clinical Calculations feature)


MONITOR SETUP

ADMIT/DISCHARGE

ADMITCHANGE

DATADISCHARGE

YES NO YES NO

ID NAMEDATE OF

BIRTHHEIGHT

in/cmWEIGHT

lb/kgBSAm2

MALE FEMALE

ADULT NEONATE

on-screenkeyboard

MONTH DAY YEAR ENTER

HT 66.9

7 8 9REMOVE KEYPAD

CLEAR

4 5 6 RESTORE

1 2 3 ENTER

+/- 0 .

Note: HEIGHT keypad shown as an example


Admit/Discharge

Directory of Keys — UCW and Ultraview 1700

To enter patient name, ID, or other data

MONITOR SETUP

For central monitoring

ADMIT/DISCHARGE - Select function

Admit - Purge existing data for this bed? DISCHARGE - Are you sure? (All data for the bed will be purged)


TONESADMIT/

DISCHARGEMONITOR CONFIG.

RECORDER CONFIG.

PRIVILEGED ACCESS

ADMITCHANGE

DATADISCHARGE

YES NO YES NO

NICU

BED01BED01 BED02 BED03 BED04 BED05 BED06 BED07

ICU CCUMICU

MONITOR SETUP-Admit/Discharge: Select Bed

For bedsidemonitoring


Admit/Discharge

Contents

Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Entering New Patient Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Changing Patient Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Discharging a Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Admit/Discharge Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Overview

This chapter describes how to enter new patient data, change data for an existing patient, and delete patient data from a Ultraview Care Network monitor.

You can access the Admit/Discharge menu on either the central or bedside monitor. However, if you are accessing this menu at a central monitor, you must also select the patient's bed (this is not necessary at a bedside monitor).

Entering New Patient Information

The only information required when admitting a patient to the system is the patient's name (up to 40 characters). Entering the patient's ID number (up to 15 characters) is optional.

This section discusses how to enter the following patient information, depending on which monitor you have.

• Patient Name and ID (refer to Ultraview 1030/1050/1500/1600 on page 3-5 and UCW/Ultraview 1700 on page 3-6)

• Height, Weight, and BSA (body surface area) (refer to Entering Height, Weight, and BSA on page 3-7)

• Date of Birth (refer to Entering Patient Date of Birth on page 3-9)

• Patient Type and Gender (refer to Entering Patient Type and Gender on page 3-9)


Admit/Discharge

Using the On-Screen Keyboard

A keyboard is displayed on the monitor screen as you begin the process of admitting or changing data on a patient. The on-screen keyboard functions differently depending on the monitor model you have. You can also use the external computer keyboard to enter patient data into the selected field.

To enter new patient information (Ultraview 1030/1050/1500/1600):

• Touch MONITOR SETUP.• Touch ADMIT/DISCHARGE. • Touch ADMIT. • Select YES to purge the existing data. • Select ID and/or NAME.• Enter information using the on-screen keyboard. • Touch ENTER. • Touch PREVIOUS MENU (if necessary).• Select DATE OF BIRTH and enter MONTH, DAY, and YEAR.• Touch ENTER.• Touch PREVIOUS MENU.• Select HEIGHT, WEIGHT, or BSA and enter information using the on-screen keypad.• Touch ENTER. • Touch MALE/FEMALE until the correct gender is highlighted.• Touch ADULT/NEONATE until the relevant selection is highlighted.

To enter new patient information (UCW/Ultraview 1700):

• Touch MONITOR SETUP.• Touch ADMIT/DISCHARGE. • Select a subnet or a bed (central only).• If you selected a subnet, then select a bed.• Touch ADMIT. • Select YES to purge the existing data. • Select a field on the on-screen keyboard.• Enter information using the on-screen keyboard. • Touch ENTER after completing each field. • Select ADULT or NEONATE.• Select MALE or FEMALE.• Touch ACCEPT to store the new patient data.


Admit/Discharge

Ultraview 1030/1050/1500/1600

The keyboard shown in Figure 3-1 appears when you touch the NAME or ID key under the ADMIT and CHANGE DATA keys. Use this keyboard to enter or change the patient’s name or ID only.

Figure 3-1: Ultraview 1030/1050/1500/1600 on-screen keyboard

RESTART CLEAR BACKSPACE

!

1

@

2

#

3

$

4

%

5

^

6

&

7

*

8

(

9

)

0

_

-

Q W E R T Y U I O P“

‘

CAPSLOCK

A S D F G H J K L:

;

SHIFT Z X C V B N M<,

>.

?/

ENTER


Admit/Discharge

UCW/Ultraview 1700

The keyboard shown in Figure 3-2 appears when you touch the ADMIT or CHANGE DATA keys. You can use this keyboard to enter or change ALL patient information.

Figure 3-2: UCW/Ultraview 1700 on-screen keyboard

Character Keys — Each character key you touch displays above the keyboard on the 1030, 1050, 1500 and 1600. It displays in the selected field on the UCW and Ultraview 1700.

Function Keys —

DEL or BACKSPACE deletes the character to the LEFT of the cursor.

moves the cursor left one position.

moves the cursor right one position.

RESTART redisplays the last name or value stored and deletes all earlier changes.

CLEAR deletes the currently displayed name or value.

ENTER stores the data displayed in the selected field into system memory.

TAB moves the cursor to the next field.

CAPS LOCK locks the keyboard in all caps mode.

SHIFT toggles the shift mode on and off.

INS inserts the selected data in the current space.

SPACE BAR inserts a space.

ACCEPT enters the data into the system and completes the admit.


Admit/Discharge

Entering Height, Weight, and BSA

Table 1 lists the default values and valid ranges for height, weight, and BSA (body surface area). You can adjust the values up or down within the valid range. The values last set for height, weight, and BSA remain until manually changed.

The parameter value can be displayed in either U.S or metric units (see your system administrator for details). The system automatically computes BSA from the values entered for height and weight and uses this BSA value to obtain indexed values for physiologic calculations such as Cardiac Output.

Toggle the ADULT/NEONATE key to display the respective adult and neonatal default values for height, weight, and BSA.

Note:

On central monitors, the ADULT/NEONATE key appears dotted if the remote monitor where the admit/discharge occurs does not support the patient type selection.

Table 1: Height, Weight, BSA Default Value

Label Name Units

Default Value(1030, 1050, 1500, 1600 only)

Valid Range Adult Neonatal

BSABody Surface

Aream2 1.81 0.11 0.03 to 3.69

HT Heightcm

in

170

66.9

35

13.8

20 to 215

7.9 to 84.6

WT Weightkg

lb

70.000

154.324

1.500

3.307

0.2 to 250.0

0.441 to 551.156


Admit/Discharge

Using the On-Screen Keypad (Ultraview 1030/1050/1500/1600 only)

When you select either the HEIGHT, WEIGHT, or BSA parameter key, an on-screen keypad will appear displaying the selected parameter in the upper left corner (Figure 3-3). The current parameter value is displayed in the upper right corner. You can change this parameter value up or down using the arrow keys, or you can use the keypad numbers to enter up to seven digits, including a decimal point. The system recognizes any value within the range that displays immediately below the keypad. The default values for height, weight, and BSA are displayed if other values are not available.

Figure 3-3: Ultraview 1030/1050/1500/1600 on-screen keypad

Numeric Keys — The 0 to 9 and decimal point keys allow you to enter numeric data.

Function Keys —

increases or decreases the displayed parameter value by 1.0, 0.1, 0.01, or 0.001 depending on the resolution of the input value.

ENTER stores the value displayed in the top right corner of the keypad in system memory. The ENTER key must be touched to store the value.

CLEAR sets the value in the top right corner of the keypad to 0.

RESTORE returns the previous value or displays the stored value.

REMOVE KEYPAD clears the keypad from the screen and restores the previously displayed value.

+/- This key is disabled.

HT 66.9

7 8 9 REMOVEKEYPAD

CLEAR

4 5 6 RESTORE

1 2 3

ENTER+/- 0 .


Admit/Discharge

Entering Patient Date of Birth

Ultraview 1030/1050/1500/1600

To enter the patient’s date of birth, touch the DATE OF BIRTH key and enter the month, day, and year. Touch ENTER to store the information in the monitor’s memory.

UCW/Ultraview 1700

To enter the patient’s date of birth, use the TAB key to move to the Birthdate field on the on-screen keyboard and enter the Day, Month, and Year. Touch ENTER and ACCEPT to store the information in the monitor’s memory.

Entering Patient Type and Gender

To select the patient type, touch the ADULT/NEONATE key. Once the selection has been made, it is stored in the monitor’s memory and either ADULT or NEONATE is highlighted. If you use one patient type exclusively, your system administrator may set the selection to that specific type.

To select the patient gender, touch the MALE/FEMALE key. Once the selection has been made, it is stored in the monitor’s memory and either MALE or FEMALE is highlighted.

Changing Patient Information

To alter any existing patient information, use the CHANGE DATA key. This key does not function when there is no patient name or ID number stored in the system.

To change patient information:

• Touch MONITOR SETUP.• Touch ADMIT/DISCHARGE.• Select a subnet or a bed (central only).• If you selected a subnet, then select a bed.• Touch CHANGE DATA.• Make desired changes as described under Entering New Patient Information on

page 3-3.


Admit/Discharge

Discharging a Patient

To clear the bedside monitor of existing patient information, touch the DISCHARGE key. You can now purge the existing patient data.

To discharge a patient:

• Touch MONITOR SETUP.• Touch ADMIT/DISCHARGE.• Select a subnet or a bed (central only).• If you selected a subnet, then select a bed.• Touch DISCHARGE.• Select YES to purge the existing data.


Admit/Discharge

Admit/Discharge Troubleshooting Guide


Patient name incorrect as entered on keyboard menu

■ Name exceeds 40 character maximum and system has written over some characters.

■ Re-enter name using 40 characters or less.

■ No patient name or ID number stored in system.

■ Enter name or ID number.


Printing

Directory of Keys — Monitor Setup Level


RECORDERCONFIG.

RECORDINGDURATION

ALARMPARAMS

RECORDALL

RECORDPRESELECTED A

RECORDPRESELECTED B

CONTINUOUSRECORD

PRINTER(1 - 8)

STOPRECORDING

CONVERT TOCONTINUOUS

To set up the printer:

To obtain recordings from the monitor:

Touch RECORD once

Touch this key, then touch

RECORDER MENU

Touch RECORD twice

the desired parameter key(up to four), for each parameterto be continuously recorded

PRINTER (1 - 8 ) CONTROL MENU

1 42

Number of Recorder Channels

RECORDINGDESTINATION

NETWORK BOTH

ALARM RECORDINGS TO:THIS

MONITOR

OTHER RECORDINGS TO:

VITALSSETUP

RECORD

PRINTVITAL SIGNS

SYSTEM PRINTER MODULE

To control recordings from the monitor using the system printer module:

12 SEC

PRIVILEGEDACCESS

See following pages

MONITOR SETUP

RECORDER CONFIGURATION

Select durationof recordingsinitiated fromthis monitor

Select parametersthat requirealarm recordingfrom bed x

20 SEC

ECGONOFF

...

ONOFF

NETWORKTHIS

MONITOR

SLOWON OFF

PRINTERON OFF


Printing

Directory of Keys — Biomed Level


SELECT

BIOMED LEVEL: Select Parameter

ACCESS

Enter BIOMED password

RECORDERNAMES

RECORDERSETUP

RECORDERSALARM EXTENDEDDURATION SETTING

RECORDER SETUP - Select Parameter

Select recorder name to change

Selecting a key displays keyboard for renaming printer.

RECORDER A RECORDER B

Select priority of recorder to be assigned to bed x

Select RECORDER x recorder for bed x

Laz1

PRIVILEGED

ALARM EXTENDED DURATION SETTING

SELECTIONAUTO BACKUP

0 SECONDS 6 SECONDS 12 SECONDS

Laz1


Printing

Directory of Keys — Clinical Level

Refer to To obtain recordings from the monitor and To control recordings from the monitor using the system printer module on page 4-1 for more UCW and Ultraview 1700 keys.


PRIVILEGEDACCESS

Enter CLINICAL password

PRESELECTED RECORDINGS - Select configuration to change

Select option to change - X: (current selection displays)

SELECTTYPE

SELECTBED

Select recording type - X: Beds = (current selection displays)

ALL BEDSIDEBEDSIDE PARAM(S)

CONFIGUREDPARAMETERS

Select beds/subnets - X: (current selection displays)

ALLSUBNETS

THISSUBNET

THISMONITOR

ALL BEDS ONTHIS MONITOR

PRESELECTED A PRESELECTED B

PRESELECTEDRECORDINGS


Printing

Contents

Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Bedside Printer Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6System Printer Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Ultraview 1030/1050 Monitor Printers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7PrintMaster . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Printing Priorities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Selecting Print Duration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Printer Key Functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Recording Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Selecting Recording Destination. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Printing via Monitors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Defining Preselected Recording Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Loading Paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Paper Out Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Record Vitals Report (Ultraview 1030/1050 Only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Printing Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Overview

This chapter documents the printing functions of the following printing components:

• 90449 bedside printer module

• 90469 (two- and four-channel) system printer module

• Record Vitals Report

• Ultraview 1030/1050 printer

• 90838 PrintMaster™ laser printer

The chapter reviews each printer and includes information and instructions about its features.

Printers can provide strip chart recordings of the following:

• Automatic recordings of any parameter in an alarm condition (if configured in the MCM and if the Record Alarms Parameters function is enabled for that parameter).

• Parameter data such as:

- Patient name, bed name, time and date of recording

- Vital signs, edgeprint annotation, and scaling information

- Waveform data (including timing tick marks and a grid)

- Arrhythmia/ST segments

• Non-waveform data displayed on the screen such as graphic trends, data tables, hemodynamic calculations, and cardiac output.


Printing

Bedside Printer Module

The 90449 bedside printer module is a two-channel printer that provides automatic and manual recordings of parameter data on 50 mm fanfold paper.

Figure 4-1: 90449 bedside printer module

The bedside printer module prints recordings of parameters in alarm conditions, requested waveforms, and non-waveform data such as:

• tabular trends

• hemodynamic calculations

• drug dose calculations

• graphic trends waveform data

Note:

The bedside printer is not designed for use as a system printer and will not function correctly if used in this manner.


Printing

System Printer Module

The 90469 system printer module is a two- or four-channel printer that provides automatic and manual recordings of parameter data on 50 mm or 120 mm fanfold paper.

Figure 4-2: 90469 system printer module

The Ultraview Care Network system printer module prints recordings of parameters in alarm conditions, requested waveforms, and non-waveform data such as:

• tabular trends

• hemodynamic calculations

• drug dose calculations

• graphic trends waveform data

Ultraview 1030/1050 Monitor Printers

The printers in the Ultraview 1030/1050 monitors are two-channel printers that provide automatic and manual recordings of parameter data on 50 mm roll paper. The printers print recordings of parameters in alarm conditions, requested waveforms, and non-waveform data.


Printing

PrintMaster

The 90838 PrintMaster is a four-channel, network printer that provides automatic and manual recordings of parameter data on 8 1/2 × 11 or A4 paper.

Figure 4-3: PrintMaster

� Display panel

� Top cover release

� Top printout tray

� Rear cover release

� Central processing unit

� Paper drawer

� Front cover release

The PrintMaster printer functions the same as the bedside and system printer modules in that it prints recordings of parameters in alarm conditions, requested waveforms, and non-waveform data.

��

�

�

� �

�


Printing

Clearing Paper Jams (PrintMaster)

If a paper jam occurs, a message will indicate the location of the jam. Once the jam is cleared, the cover closed, and the printer warmed up, the printer will print all the pages affected by the jam.

One of three paper jam messages may appear on the printer display:

Terminating a Print Job (PrintMaster)

To terminate an undesired multi-page print job that is currently printing, power the printer OFF (until the front panel lights go out) then turn it back ON. This cancels any print job in process.

Replacing the Toner Cartridge (PrintMaster)

When the TONER LOW message appears on the printer display:

1 Open the top cover.

2 Lift and pull the toner cartridge out at an angle.

3 Insert the new cartridge.

4 Close the top cover.

Table 1: PrintMaster Paper Jam Messages

Message Text Solution

PAPER INPUT JAM

1 Pull out the paper drawer.

2 Remove the sheet that did not feed.

3 Inspect remaining sheets to ensure they are not wrinkled or stuck together.

4 Close the paper drawer.

5 Open and close the top cover to clear the paper jam message.

PAPER FEED JAM

1 Open the top cover.

CAUTION! THE FUSING UNIT IS HOT.

2 Lift out the image drum cartridge.

3 Carefully remove the jammed paper.

4 Replace the image drum cartridge.

5 Close the top cover.

PAPER EXIT JAM

1 Open the top cover and the rear cover to release the roller pressure.

CAUTION! THE FUSING UNIT IS HOT.

2 Pull the paper out from the rear or inside of the printer.

3 Close the top and rear covers.


Printing

PrintMaster Display Messages

Table 2: Printer Display Messages

Message Text Reason

ON-LINE Ready to receive data.

OFF-LINE Not ready to receive data.

DATA PRESENT Print data is in buffer.

PRINTING Data is being received and printed.

POWER SAVING Power saving mode is active.

LOW TONER Toner is running out. 100 more pages can be printed when this message is first displayed.

TONER EMPTY REPLACE TNR CART

Toner cartridge is empty. Printer will stop receiving printing until toner cartridge is replaced.

TONER SENSOR Malfunction of toner sensor is detected.

RESETManual reset was initiated. All temporary fonts and macros are deleted.

PRINT FONTS Font page is printing.

DRUM CLEANING Drum cleaning page is printing.

PRINT DEMO PAGE Demo page is printing.

PRINT MENU Menu page is printing.

CHANGE DRUMDrum near 90% of life. Change drum and reset drum counter.

FUSER LIFE Fuser near end of life. Contact a field service engineer.

COPY nnn/mmmIndicates number of copies printed. nnn = page being printed.mmm = total copies requested.

STACKER FULLREMOVE THE PAPER

Paper exit bin is full. Printing is stopped until paper is removed.

mmmmm MANUAL PAPER REQUEST

Insert requested paper. Printing is stopped until paper is provided or RECOVER is pressed. mmmmm = requested size.


Printing

mmmmm ttttttt PAPER REQUESTPaper size mmmmm requested at tray ttttttt. Printing is stopped until paper is provided or RECOVER is pressed.

PAPER OUT tttttttPaper is out at tray ttttttt. Printing is stopped until paper is provided.

ERROR MEMORY OVERFLOW

Page data exceeds available memory. Press RECOVER to continue. Adjust RASTER BUFFER, RECEIVE BUFFER, and/or FONT PROTECT in menu, and resend job.

ERROR RECEIVE BUFFER OVERFLOW

Received buffer overflow. Data was lost. Press RECOVER to continue, and resend job.

ERROR PRINT OVERRUNData too complex for current RASTER BUFFER setting. Increase RASTER BUFFER value and resend job or add memory. Press RECOVER to continue.

ERROR HOST I/FHost interface error. Data was lost. Press RECOVER to continue, and resend job.

CARD NOT FOUND PLEASE REINSERT

Font card removed. Reinstall card. Press RECOVER to continue, and resend job.

ERROR PAPER SIZE CHECK tttttttIncorrect paper size detected for tray ttttttt. Provide correct paper size and press RECOVER to continue.

PAPER INPUT JAM CHECK tttttttPaper jammed while being supplied from tray ttttttt. Clear jam and open/close top cover.

PAPER FEED JAM CHECK ttttttttPaper jammed during feeding from tray tttttttt. Clear jam and open/close top cover.

PAPER EXIT JAM REMOVE THE PAPER

Paper jammed during exit. Clear jam and open/close top cover.

COVER OPEN Close cover.

EEPROM RESETTINGEEPROM resetting to factory defaults; returns to ON-LINE.

ERROR CARD FORMAT CHECKInstalled font card has invalid data. Turn off printer to clear error.

ERROR CARD REMOVED ON-LINEFont card removed while ON-LINE. Turn off printer to clear error.

Table 2: Printer Display Messages (continued)

Message Text Reason


Printing

The PrintMaster will beep every 15 seconds under the following conditions:

• paper jam

• missing toner cartridge

• top cover or back door open

• power to printer is OFF

• power cord is disconnected

• printer cable is disconnected

• printer in Not Ready mode

Printing Priorities

Each Spacelabs Healthcare network-connected patient monitor is capable of sending recordings to two network printers. With two printers available to monitors on the network, printer selection rules are used to strike the best possible balance to:

• generate the most timely output of high-priority recordings;

• ensure that subsequent recordings from one patient over a short time span are processed by one printer; and

• use paper as efficiently as possible.

When the printing load is heavy, these objectives may conflict. The factors that are taken into consideration when a print request occurs include:

• Are either of the two printers outputting, holding in memory queue, or loading in queue a print job from this monitor?

• Are either of the printers idle?

• Is the record request a high-priority request (alarm vs. manual)?

• Are either of the printers currently printing a continuous recording?

ERROR CONTROLLER nn On -aaaaaaaa

Controller error, nn = error type. Power off printer to clear error. If error continues, contact your field service engineer.

8888888888888888

Displayed when power is turned ON. This is done to test all LEDs and LCD segments.

INITIALIZING Controller is being initialized at power ON.

RESET TO SAVEPress RESET to save menu changes. Menu changes cannot be reset automatically because data is present in buffer.

Table 2: Printer Display Messages (continued)

Message Text Reason


Printing

• Are either of the printers’ queues full?

• Which of the printers is the preferred size for this request (1, 2, or 4 channels)?

At the time of a printing request, the monitor from which the request is coming evaluates both of the available printers one at a time, leading to a score for each of the two printers. Each printer’s evaluation passes all the way through the priority tree from the top score to the score at the bottom of the tree. The printer generating the highest score gets the job. If the evaluation produces the same score for each printer, the print job is sent to the printer designated as the primary printer for that monitor.

The printing rules mentioned work best when the two printers are sharing the printing load. The monitor automatically determines which printer is best for each type of recording. Another configuration designates one printer as the primary printer and the other as the backup printer. All recordings are sent to the primary printer unless it is unable to print for the following reasons:

• Offline

• Out of paper

• Disconnected from network

• Powered OFF

• All print queues full

• Unable to accept recording type

If the primary printer is unable to print, the recordings are then sent to the backup printer unless it is also unable to print for the reasons listed above.

Some networks are configured so that recordings from a given monitor are directed to only one of the printers on the network. In this case only one printer will be available instead of two during possible times of simultaneous multiple bed alarms. The selection rules will not be applicable, and print performance will be affected.

The following list defines recording priorities in descending order:

Highest

• Alarm recording or a manual recording request via a monitor

• RECORD ALL request via a bedside monitor

• RECORD ALL request via a central monitor

• Non-waveform recordings

Lowest

• All Arrhythmia/ST classes

In all network printing cases:

• High-priority print jobs bump lower-priority jobs. For instance, an alarm recording will bump graphic trends to a lower position in the print queue.

• A fully loaded printer will bump graphic trends out of the queue.

• A high-priority request erases as many lower-priority requests as needed to make room for the data it contains.

Note:

A status message is not displayed when a print request replacement occurs.


Printing

Selecting Print Duration

Waveform Data

In the absence of an alarm condition, the print request origin determines the length of time that waveform data (ECG, ART, RESP, etc.) is recorded.

Recordings requested via the monitor are either 12 or 20 seconds in duration. This is selectable via the RECORDING DURATION key. Recordings start with a few seconds of data received just prior to the print request, followed by real-time data.

Note:

The RECORDING DURATION key will not display if the recording duration has been preset by your system administrator.

Non-Waveform Data

The length of time the printer requires to record non-waveform data, such as graphs and data tables, depends on the complexity of the data and cannot be pre-determined.

To select print duration from the monitor:

• Touch MONITOR SETUP. • Touch RECORDER CONFIG.• Touch RECORDING DURATION to change length of time for printing.


Printing

Printer Key Functions

Ultraview 1030/1050 Monitor, Bedside, and System Printer Modules

Printer control keys for the bedside and system printer modules are located on the module front. The printers can also be controlled by keys on the monitor itself.

Table 3: Key Descriptions

Key Function

SLOWON/OFF

Changes the print speed of waveform recordings to 6.25 mm/second. Pressing SLOW a second time returns the printer to the current system sweep speed. SLOW has no effect on the print speed of non-waveform recordings (data tables, graphics, etc.).

CONTINUE

• When the printer is offline, press this key to feed roll paper at 25 mm/second or to feed one sheet of perforated paper through printer module.

• When the printer is online and currently printing a 12- or 20-second waveform recording, press CONTINUE to convert to a continuous recording. If you press CONTINUE, the 12- or 20-second recording completes, followed by a horizontal line, and then the current data. The horizontal line appears even on recordings that are not in a queue, but are the only request.

STOP RECORDING

• Stops any printing currently in progress and moves to the next print request in the queue.

• Stops any roll paper advance currently in progress.

PRINTERON/OFF

Takes the printer offline without turning the power OFF. Alarms and print requests are now ignored. An LED (located either in the key or on the front panel of system printer) illuminates when this function is selected.

To access printer control keys from the monitor:

• Touch NORMAL SCREEN.• Touch RECORD.• Select the desired key.


Printing

Recording Alarms

An alarm recording may be triggered whenever a parameter enters an alarm condition. Recordings in the process of printing cannot be interrupted or delayed by a new alarm condition.

Note:

Parameter alarm recordings can be set to OFF so that a printer will not respond to an alarm condition (the alarm tone and accompanying alarm message are unaffected). Refer to Automatic Recording of an Alarm on page 2-11 for more details.

Selecting Recording Destination

The Recording Destination menu contains keys that direct alarm recordings to a bedside recorder, a network printer, or both. All other recordings may be directed only to a bedside printer or a network printer, but not both.

Alarm recordings begin with several seconds of pre-alarm waveform data and continue for as long as the alarm condition exists (a minimum of 12 seconds).

Note:

12-lead ECG reports will always print to the 90838 printer, if available, regardless of the destination settings for the recording.

To select parameters for alarm recording and generate automatic recordings on a bedside recorder:

• Touch MONITOR SETUP.• Touch RECORDER CONFIG.• Select RECORDING DESTINATION.• Select a destination for the alarm recording.• Touch PREVIOUS MENU.• Touch ALARM PARAMS. • Select parameter key(s) ON to initiate a recording in case of alarm. If the parameter

key is OFF, no alarm recording is produced for that parameter in an alarm condition.


Printing

Printing via Monitors

Non-Waveform Data

Whenever you display non-waveform data on either the central or bedside monitors, a PRINT key displays. The RECORD key is not functional for printing non-waveform data. As a result, non-waveform data must be displayed before it can be recorded.

Non-waveform data usually occupies a minimum of two slots in the printer's queue due to the volume of information being sent. This means that a single non-waveform recording may take up as much room on the strip chart as two simultaneous waveform recordings.

If the data cannot fit on the strip at one time, it is separated horizontally, printing first the top half and then the bottom half of the data.

Waveform Data

Waveform data is recorded using the RECORD key on the monitor.

Note:

• Requests for recording waveform data are limited to only those waveform parameters that are currently displayed on the screen (except ECG where all leads print).

• If a parameter menu is left on the screen, the CONTINUOUS RECORD key is not displayed.

Each time you touch RECORD on the monitor, the CONTINUOUS RECORD key displays and waveform parameter keys flash for up to four seconds. You must make your key selection within this four-second window. This window stays open for an additional two to four seconds each time a key is selected. Once the parameter keys stop flashing, any waveforms that have been selected are automatically sent to the printer for recording.

Touch the RECORD key twice to display the Recording menu. From the Recording menu you can:

• Record all parameters currently on this screen by touching RECORD ALL.

• Initiate a preselected group of recordings by touching PRESELECTED A or PRESELECTED B.

• Select PRINT VITAL SIGNS to manually print the vital signs you have selected (refer to Record Vitals Report (Ultraview 1030/1050 Only) on page 4-23 for more information).

RECORD ALL and PRESELECTED A OR B recordings are eight seconds in duration.

To start a manual recording via the monitor:

• Touch RECORD.• Touch up to four flashing parameter keys.• Touch CANCEL RECORD SELECTION(S) to terminate.

-OR-

• Touch STOP RECORDING in the PRINTER CONTROLS menu to terminate.


Printing

Group Recordings

The printers record all the requested parameters on one patient before beginning on the parameters of the next patient. Under no circumstances will the printer combine the parameters of different patients onto the same strip chart. Recordings in the process of being printed cannot be interrupted or delayed by additional print requests.

To print group recordings via the monitor:

• Touch RECORD twice.• Touch RECORD ALL.

-OR-

• Touch RECORD PRESELECTED A or B.

To start a continuous recording via the monitor:

• Touch RECORD.• Touch CONTINUOUS RECORD, then touch the desired parameter key (up to four, for

each parameter to be continuously recorded. • Touch CANCEL RECORD SELECTION to restart the selection process.

To stop a continuous recording via the monitor:

• Touch RECORD.• Touch STOP CONT. RECORD.

-OR-

• Touch STOP RECORDING in PRINTER CONTROLS.


Printing

Defining Preselected Recording Keys

The Preselected Recordings function enables you to define which beds and parameters will be automatically recorded. The preselected group is established by the system administrator. For UCW and Ultraview 1700 monitors this is set up through the Clinical level of the Privileged Access menu.

To define the PRESELECTED A and B parameters (UCW and Ultraview 1700):

• Touch MONITOR SETUP. • Touch PRIVILEGED ACCESS.• Enter Clinical password.• Touch PRESELECTED RECORDINGS.• Touch key to be defined (A or B).• Touch SELECT TYPE.• Touch FIRST 2 BEDSIDE PARAM(S) and use arrow keys to cycle through parameter

selections: ALL BEDSIDE PARAM(S) or FIRST n BEDSIDE PARAM(S) (where n is 1, 2, 4 or 8).

-OR-

• Touch CONFIGURED PARAMETERS and toggle desired parameters ON or OFF.• Touch PREVIOUS menu twice to define the remaining PRESELECTED key.

To define the PRESELECTED A and B beds (UCW and Ultraview 1700):

• Touch MONITOR SETUP. • Touch PRIVILEGED ACCESS.• Enter Clinical password.• Touch PRESELECTED RECORDINGS.• Touch key to be defined (A or B).• Touch SELECT BEDS.• Select ALL SUBNETS.

-OR-

• Select THIS SUBNET.

-OR-

• Select THIS MONITOR. • Touch PREVIOUS menu twice to define the remaining PRESELECTED key.


Printing

Loading Paper

Bedside Printer Module

The small black rectangular cue mark on the bedside printer paper must face out and be at the bottom of the tray when loading paper into the tray.

Figure 4-4: Bedside printer module paper tray

Each recording starts at the Z-fold perforation and blank sheets are not placed between successive print requests.

To load paper in a bedside printer module (2-channel only):

• Press eject button next to PAPER OUT light.• Withdraw plastic paper tray.• Discard old cardboard retainer inside tray.• Remove label from new paper but keep cardboard retainer in place around one end.• Start inserting paper into tray, beginning with cardboard retainer end.• With paper halfway into tray, lift up spring-loaded roller.• Bring out top fold of paper from under top end of cardboard retainer.• Bring top fold over top of spring-loaded roller.• Release spring-loaded roller onto remainder of paper.• Insert stack fully.• Unfold paper and position over top of black roller at end of tray.• Slide tray completely back into printer module.

Note orientation of small cue mark


Printing

System Printer Module

The system printer module has a slide-out plastic tray that accepts packets of Z-fold paper. The two-channel printer uses 50 mm wide by 27 m long paper. The four-channel printer uses 120 mm wide by 45.7 m long paper. Each sheet has a small black rectangular cue mark located along the edge used to load the paper into the tray.

Figure 4-5: System printer module paper trays (top view)

To load paper in a system printer module (2- or 4-channel):

• Press eject button next to PAPER OUT light.• Withdraw plastic paper tray.• Discard old cardboard retainer inside tray (2-channel only).• Remove label from new paper but keep cardboard retainer in place around one end

(2-channel only).• Discard 4-channel container.• Start inserting paper into tray, beginning with cardboard retainer end (2-channel only).• Make sure black squares are in the top left corner of the pages (4-channel).• Insert stack fully.• Unfold paper and position over top of black roller at end of tray.• Slide tray completely back into printer module.

four-channel two-channel

paper roller paper roller

cue mark cue mark


Printing

Ultraview 1030/1050 Printers

The Ultraview 1030/1050 monitor’s printer uses 50 mm wide by 30 m long rolls of thermal paper. The printer has an automatic self-feed mechanism for threading the paper through the rollers.

Figure 4-6: Loading printer paper

PrintMaster

The PrintMaster printer has a slide-out paper drawer that accepts up to 500 pages of letter or A4-sized copy paper. Slide the drawer out of the printer, place the paper (according to orientation) into the cassette, and place the cassette back into the printer.

To load paper in the Ultraview 1030/1050 printer:

• Press release button on door.• Open paper tray door all the way.• Snap new roll into place.• Pull out 6 to 12 inches of paper.• Close door.


Printing

Paper Out Conditions

Warning:While printers are offline, or out of paper, they will ignore any new alarm that would normally start a recording, and no alarm or requested recordings will go into a queue.

All printers signal a paper out condition by periodically sounding a tone. The PrintMaster will beep every 15 seconds when there is no paper in the cassette, or the cassette is not loaded. In addition, the PrintMaster and the bedside printer module flash the PAPER OUT light, while the two-channel and four-channel system printer modules display a LOCAL PRINTER PAPER OUT message. On the Ultraview 1030/1050 monitor’s printer, the PAPER OUT tone does not sound if the local alarm tone key is set to OFF.

After reloading paper in the system printer module, the paper-feed mechanism ejects a sheet to verify proper paper feeding. For the paper-feed mechanism to work, you must leave the printer power ON while you are loading paper.

Caution:Removing a bedside or system printer module from the monitor to load paper causes an immediate loss of pending print requests.

Record Vitals Report (Ultraview 1030/1050 Only)

The Record Vitals Report:

• provides manual recordings of parameter data on 50 mm roll paper

• only prints to the monitor’s internal recorder

Figure 4-7: Vitals Setup menu keys

STARTTIME

PRINTVITAL SIGNS

Configure parameters or start vitals recordingSELECT

VITALSSETUP

DATAINTERVAL PARAMETERS


Printing

Data Interval

You may choose a time interval ranging from one minute to 60 minutes, specifically, 1-, 2-, 3-, 5-, 10-, 15-, 30-, and 60-minute intervals. You can also select NIBP ON/OFF and other parameter data from that reading time. If you select NIBP ON, you are not required to select an interval. NIBP readings appear in the report based on the time that you take the readings. If you do not choose an interval or NIBP ON before printing, the message VITALS REPORT ERROR prints.

Start Time

You may print vital sign measurements ranging from those taken in the past hour to those taken in the last 24 hours, specifically, 1, 2, 4, 8, 12, and 24 hours.

Select Parameters

You may choose the parameters you wish to have included in the report. If you choose a vital sign for which no data is available, ??? appears on the report.

The following is an example of a vitals report. A blank space to enter notes is standard in every report.

Figure 4-8: Vitals report

To define the details of a report:

• Touch MONITOR SETUP.• Touch RECORDER CONFIG.• Touch VITALS SETUP.• Touch DATA INTERVAL and select an interval for report history.• Touch PREVIOUS MENU.• Touch START TIME and select a time period for report history.• Touch PREVIOUS MENU.• Touch SELECT PARAMETERS and select the parameters you wish to include in the

report.• Touch PREVIOUS MENU.

Time HR BPM Resp RPM Temp °C Notes

07:50 74 18 37.8

07:52 74 18 37.8

07:54 54 13 37.8

07:56 54 13 37.8


Printing

Print Vital Signs

To print the report, touch PRINT VITAL SIGNS or touch RECORD twice and then touch PRINT VITAL SIGNS.

Note:

Be sure to choose the data interval, the start time, and the parameters you wish to include on the report before printing.

To print a manual report with the Record Vitals Report option:

• Touch VITALS SETUP, PRINT VITAL SIGNS.

-OR-

• Touch RECORD twice and touch PRINT VITAL SIGNS.


Printing

Printing Troubleshooting Guide


Printer displays PAPER OUT message

■ Printer is out of paper. ■ Load paper (refer to Loading Paper on page 4-20).

■ Printer door is open.

■ Paper was loaded improperly.

Printer fails to print self-test strip

■ Failed internal diagnostics. ■ Notify qualified field service engineer.

Message UNABLE TO RECORD THE REQUESTED CHANNEL is displayed

■ Printer not active.

■ Printer not selected by a system administrator.

■ Printer is out of paper.

■ Toggle PRINTER ON/OFF key.

■ Check with your hospital biomed or system administrator.

■ Load paper.

CONTINUOUS RECORD key not displayed

■ Menu is at the bottom of the screen.

■ Touch NORMAL SCREEN, then RECORD.



Directory of Keys


ADMIT/DISCHARGE

TONES MONITORCONFIG.

RECORDERCONFIG.

MONITOR SETUP

MONITOR CONFIGURATION

Refer to System Introduction chapter

Refer to

SPECIAL FUNCTIONS

ENERGY SAVING MODE

ON

REMOTEVIEW

PARAMETERCONFIG

SCREEN BRIGHTNESS

NORMAL

SPECIALFUNCTIONS

Refer to Setting up Priorities and Colors in this chapter

BRIGHTNESSCONTRAST

REMOTETRENDS/CALCS

ALARMWATCH

RV/AWOFF

LOCALTRENDS/CALCS

PRIVILEGEDACCESS


NORMALSCREEN

RECORD

PREVIOUSMENU

MINORGRATICULE

Refer toAlarms chapter

Refer toAlarms chapter

Refer toSystem

Introduction chapter Refer to

Trends or Calcs chapter

Select bed

MINOR GRAT

ON OFF

MINOR GRATICULE - 2 divisionsMONITOR SETUP: DISPLAY BRIGHTNESS AND CONTRASTBRIGHTNESS CONTRAST

UCW, Ultraview 1500, 1600, and 1700

OFF DIM

Refer to Alarms chapter

Refer toAdmit chapter

Printing chapter

OUTBOUNDPARAMETERS

DATALOGGER

Refer to

Refer to

Refer to

System Introductionchapter

Printing chapter

Alarms chapter

Refer toPatient Data Logger

chapter

Ultraview 1030 and 1050 only

MONITORSETUP

HELP

DC Power AC Power

Refer to the next page

CLOCKON OFF

ACTIVATESCREEN SAVER

UCW and Ultraview 1700 only

Ultraview 1030/1050



Directory of Keys — UCW and Ultraview 1700 (Privileged Access)


ROTATE ALARM WATCHALARM WATCH SETUP - Select parameter to change


RESETMONITOR

CHANGE CLINICALPASSWORD

CLINICAL LEVEL - Select Parameter

UNITS OFMEASURE

USERACCESS

ALARMSETUP


TIME/DATE

TIMEDATE

24 HOURS HOURS ENTER

USER ACCESS - Enable user access to functions

PRESELECTEDA

PRESELECTEDB


PRIORITY

MINUTES

mmHgkPa

inchescm

lbkg

MONITOR SETUP - Time/Date 10:06 AM/PM

ROTATION TIME

15 S 30 SSIMPLEON OFF

AMPM

ALARM WATCHSETUP

Restart monitor after selectingunits of measurement

Enter clinical level password

ALARM SETUP - Select parameter

ADMIT/DISCHARGE

TONES MONITORCONFIG.

RECORDERCONFIG.

MONITOR SETUP

PRIVILEGEDACCESS


MORE

REMOTE ACCESS

ON OFF

ALARM SUSPEND

ON OFF

TREND SUSPEND

ON OFFALARMRELAY

MORE

QRS/SPO2 TONE ENABLE

ALWAYS DURING ALARM

ALARM WATCH TONE

SINGLE TRIPLE

PATIENT TYPE

ON OFF

PARAMETER CONFIG

ON OFF

RECORDING DURATION

ON OFF

SUBNET ACCESS

ON OFF

REMOTE KEYPADSTATION ADDRESS



Contents

Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Identifying Special Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Bedside and Transport Monitor Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Setting Up Priorities and Colors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Data Shuttle Option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Battery Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Wireless Network Interface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Outbound Parameters Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Ultraview 1030/1050 Connections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Ultraview 1030/1050 with Capnography (Option G, H, or M) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Maternal Obstetrical Monitor — 94000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Bedside/Transport Monitor Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Overview

This chapter describes the functions and features of bedside and transport monitors. Refer to the Bedside/Transport Monitors on page 5-1 for help in locating functions not described in this chapter.

The Ultraview Care Network family of monitors and modules have built-in error detection and recovery circuitry. This circuitry, together with special software, enables the monitor to re-initialize and continue to function if an error occurs.

When the system detects an error that cannot be corrected through other means, the bedside monitor re-initializes or resets (blanks). Normally, a reset involves very little loss of patient monitoring time (approximately five seconds) and, with few exceptions, all operator set inputs (alarm limits, pressure labels, transducer offsets, etc.) are retained. The entire process of restoring the bedside monitor following a reset, takes approximately 20 seconds, depending upon the number of parameters being monitored.

In some cases, stored trend data will be lost when the monitor resets. If this occurs, the lost data may indicate a hardware condition that requires corrective action. The system will then initiate the start-up diagnostics to check the monitor's operation and fully recover the data. This process takes approximately 10 seconds longer.

If a bedside monitor resets, the bedside monitor displays CHECK SETUP in the ECG zone to alert you to check all limits and values and ensure that the monitor has restored all preset values. (Refer to Power Failure on page 1-4 for more information.) This also occurs when the monitor is turned ON or when an ECG module has been inserted. Your system administrator may disable the CHECK SETUP feature.

Warning:Due to the potential for electromagnetic interference, portable communication transmitters and cellular phones should not be operated within 1.07 meters (3.5 feet) of the patient, patient leads, or associated patient monitoring equipment.



Display Detail

All monitoring data originates at the bedside. Parameter modules plug into the monitor itself or into a remote module housing to obtain patient information, including waveforms and numeric displays.

The bedside screen may (optionally) display up to eight full waveform zones. If more than eight zones are used, zones 9 through 24 appear at the bottom of the screen as numeric values. When you activate a numeric value key, that parameter is displayed in the lowest priority display zone.

Figure 5-1: Bedside and transport monitors

Identifying Special Applications

If your monitor has access to Special Applications, additional keys identifying those functions appear in the Special Functions menu. Touch the SPECIAL FUNCTIONS key to access the applications.

Special applications include:

• Patient Data Logger (refer to Patient Data Logger on page 29-3)

• Dynamic Network Access (DNA) (refer to DNA on page 30-3) (UCW and Ultraview 1700 only)

UCW/Ultraview 1500/1600/1700 Ultraview 1030/1050



Bedside and Transport Monitor Features

Adjusting Screen Brightness and Contrast

Using the Monitor Setup menu you may increase or decrease the monitors’ screen contrast and brightness.

Ultraview 1030/1050 monitors contain a SCREEN BRIGHTNESS key for monitors operating on AC power enabling you to set the screen to NORMAL or DIM. Setting the screen to DIM also enables the power saving features such as shutting off the LEDs and disabling the mouse and keyboard. The screen will also dim approximately 30 seconds after the last time a key is touched or after the final alarm ends. Ultraview 1030/1050 monitors operating on DC (battery) power contain an ENERGY SAVING MODE ON/OFF key that enables and disables the power saving features.

Setting QRS Tones

Your monitor can be configured to sound a tone whenever an R-wave (QRS tone) or SpO2 pulse (SpO2 tone) is detected. The pitch of the QRS tone can be modulated with the current SpO2 value. Refer to Adjusting Tones on page 8-18 and Adjusting Tone Volume on page 14-10 for more information.

Your monitor has two options for how the QRS or SpO2 tone sounds if it has been enabled via either parameter’s TONE ON/OFF key. Your monitor can be configured to always sound this tone (default setting) or to only sound this tone when an alarm is occurring.

On UCW and Ultraview 1700 monitors, this selection is available to any user with the Clinical level of “privileged access.” On Ultraview 1030, 1050, 1500, and 1600 monitors, this selection is only available to your system administrator.

To adjust screen clarity:

• Touch MONITOR SETUP.• Touch MONITOR CONFIG.• Touch BRIGHTNESS.

-OR-

• Touch CONTRAST.

-OR-

• Touch BRIGHTNESS/CONTRAST (for Ultraview 1500 only).• Use arrow keys to adjust.



Using Scaled Displays

Bedside monitors display up to four scaled pressures simultaneously.

Monitors optionally display minor graticule lines that may be adjusted. Minor graticules are small dashed line segments that appear between the full scale graticule lines.

Setting the Time and Date

The TIME/DATE key controls both the time and date menus. The current time or date displays above the menu.

The time displays in either 12- or 24-hour format. Network monitors display the network time; standalone monitors display the internal system time.

Touch ENTER to make the time/date change permanent in the system.

Note:

Setting the time on any networked monitor sets the time for all monitors on that network.

To set the QRS tones (UCW and Ultraview 1700):

• Touch MONITOR SETUP.• Touch PRIVILEGED ACCESS.• Enter Clinical password.• Touch ALARM SETUP.• Touch MORE.• Select QRS/SPO2 TONE ENABLE ALWAYS

-OR-

• Select QRS/SPO2 TONE ENABLE DURING ALARM.

To adjust the scaled display:

• Touch MONITOR SETUP.• Touch MONITOR CONFIG.• Touch MINOR GRATICULE.• Select MINOR GRATICULE ON.• Use arrow keys to adjust.



Using the System Clock

A system clock can be continually displayed in the lower right corner of the screen. The clock feature may also be used as a stopwatch or timer.

Figure 5-2: Clock display formats

Note:

• The digital clock is available for all monitors.

• The stopwatch and timer are only available for the UCW and Ultraview 1700.

To change the network or internal system time and date (UCW and Ultraview 1700 only):

• Touch MONITOR SETUP.• Touch PRIVILEGED ACCESS.• Enter Clinical password.• Touch TIME/DATE.• Select TIME.

-OR-

• Select DATE.• Select 24 HOURS or AM/PM (12 hours).

-OR-

• Select MONTH, DAY, and YEAR.• Use arrow keys to set time or date.• Touch ENTER.

To access the clock menu (UCW and Ultraview 1700 only):

• Touch MONITOR SETUP.• Touch MONITOR CONFIGURATION.• Select CLOCK ON.• Touch the clock that appears in the lower right of the screen.• Select DIGITAL, STOPWATCH, or TIMER.

digital timer

02 DEC 08 02 DEC 08 02 DEC 08

Elapsed Remaining

stopwatch



Activating the Screen Saver

Activating the screen saver blanks the screen (displaying only the Spacelabs Healthcare logo). You may also disable the screen saver by touching the screen, clicking (or dragging) the mouse, or pressing any key on the keyboard.

Note:

• The screen will automatically be restored by an incoming alarm condition.

• This feature is only available for the UCW and Ultraview 1700.

Setting Up Priorities and Colors

Table 1 lists default priorities and colors for each screen parameter.

To activate the screen saver:

• Touch MONITOR SETUP.• Touch MONITOR CONFIG.• Touch ACTIVATE SCREEN SAVER.

To change a parameter priority or color:

• Touch MONITOR SETUP.• Touch MONITOR CONFIG.• Touch PARAMETER CONFIG.• Select a parameter.• Select the destination priority.• Select a color.• Select the parameter key to be colored (the key and waveform will appear in the

chosen color).• Touch STORE to store local color and priority settings.

Table 1: Parameter Priorities and Colors

Channel Type Name Priority Color

ECG1 Electrocardiogram (first lead) 1 Green

ECG2 Electrocardiogram (second lead) 2 Green

RESP Respiration 3 Cyan

VARI Varitrend 4 White



ART Arterial Pressure 5 Red

UA Umbilical Artery Pressure 6 Red

PA Pulmonary Arterial Pressure 7 Yellow

UV Umbilical Vein Pressure 8 Blue

CVP Central Venous Pressure 9 Blue

RAP Right Atrial Pressure 10 Blue

ICP Intracranial Pressure 11 Magenta

LAP Left Atrial Pressure 12 Red

PRS Other Pressure (general) 13 Magenta

UNLP Unlabeled Pressure 14 Blue

EtCO2 End Tidal CO2 (Capnography) 15 White

SpO2 (SaO2) Pulse Oximetry (O2 Saturation) 16 Green

NIBP Noninvasive Blood Pressure 17 Red

SvO2 Venous O2 Saturation 18 Magenta

TCP Partial Pressure of Transcutaneous O2 19 White

EEG Electroencephalogram 20 Blue

GAS Gas Analyzer Flexport® Interface 21 White

CO Cardiac Output 22 Magenta

TEMP Temperature 23 White

INCUB WARMR

Incubator/Warmer 24 White

PO + ET SpO2 and EtCO2 Flexport Interface 25 White

IV Infusion Flexport Interface 26 White

VENT Ventilator Flexport Interface 27 White

OTHER 28 White

Table 1: Parameter Priorities and Colors (continued)

Channel Type Name Priority Color



On the UCW and Ultraview 1700 Parameter Configuration screen, you can touch ALL to display all color configurations (Figure 5-3) or touch LOCAL to display the local color configurations (Figure 5-4).

Figure 5-3: UCW and Ultraview 1700 parameter configuration (ALL selected)

Figure 5-4: UCW and Ultraview 1700 parameter configuration (LOCAL selected)



Figure 5-5: Ultraview 1050, 1500, 1600 parameter configuration

Note:

Your monitor or workstation may not be configured to allow changes to parameter priorities or colors. Contact your system administrator for details.

The Parameter Configuration screen enables you to change the monitor’s default priorities and colors.

Each parameter is displayed in order, and is based upon its assigned priority. The highest priority appears at the top of the screen.

Blank parameter keys enable you to insert a space above, between, or below other parameters. Blanks of any priority can be inserted into a template by selecting the blank and putting it into the desired location. This causes a blank zone to be inserted into the corresponding display area and pushes down all active parameters with a lower priority.

For the UCW and Ultraview 1700, the DISPLAY PRIORITIES key displays a list of the currently active parameters, or all possible parameters, ordered by priority. Touch LOCAL to display only this bed’s currently active parameters.

STORE — causes the currently displayed parameter priorities and colors to be stored in memory.

RESTORE — causes the last stored local priority and color settings to be restored from memory.

FACTORY DEFAULTS — causes the factory default priority and color settings to be restored.

Not available on Ultraview 1030

monitors

ART CO CVP ECG1 WHITE1

ECG12

ECG23

RESP4

VARI

ECG2 EEG ETCO2 GAS RED5

ART6

UA7

PA8

UV

ICPINCUB

WARMRIV LAP GREEN

9CVP

10RAP

11ICP

12LAP

NIBP OTHER PA PO+ET BLUE13

PRS14

UNLP15

ETCO216

SPO2

PRS RAP RESP SPO2 YELLOW17

NIBP18

SVO219

TCP20

EEG

SVO2 TCP TEMP UA CYAN21

GAS22CO

23TEMP

24INCUB

UNLP UV VARI VENT MAGENTA25

PO+ET26IV

27VENT

28OTHER

INSBLANK

DELBLANK

29 30 31 32

STORE RESTOREFACTORYDEFAULTS



Data Shuttle Option

The Data Shuttle option enables you to transfer patient admit data (e.g., age, gender, name, and BSA) and up to 24 hours of trend and episodic data from one monitor to another using a 90496 Ultraview Command Module.

You can transfer data acquired through any Ultraview Care Network module or Flexport interface. Before you shuttle data from one monitor to another, you must first transfer the data from the source monitor into a 90496 module. When you remove the module from the source monitor and insert it into the receiving monitor, data can be transferred to the receiving monitor.

Note:

The time and date set on both the sending and receiving monitors must be identical for the data transfer to be successful.

Transferring Data to the Module

If your monitor and module support the Data Shuttle option, the monitor displays a TRANSFER DATA key in your ECG Setup menu. When you wish to transfer data (for example when transporting a monitored patient from one unit to another), touch the TRANSFER DATA key to initiate data transfer into the module. The monitor will then display the message TRANSFERRING PATIENT DATA INTO MODULE.

Note:

• The Data Shuttle option is only available in bedside or transport monitors. Central monitors do not display keys and messages related to data transfer.

• If you insert a module that supports the Data Shuttle option into a monitor that does not have the option, the monitor will not display data transfer messages and keys.

Once the data is completely transferred, the monitor sounds a tone and displays the message DATA TRANSFER COMPLETED below the UPDATE TRANSFER and CANCEL TRANSFER keys. The module is now ready to be removed from that monitor.

To transfer data:

• Touch ECG.• Touch SETUP.• Select TRANSFER DATA.• Remove module after DATA TRANSFER COMPLETED is displayed.• Insert module into a monitor to retrieve the data.• Touch RETRIEVE DATA.• Touch YES.



Figure 5-6: Data Transfer Completed display

If you do not transfer the module to the receiving monitor immediately, the source monitor will be storing new data, but the module's transfer data is not automatically updated.

After two minutes, a tone will sound once each minute to remind you to update the module with the newly acquired data and the monitor will display the message DATA TRANSFER COMPLETED.

The message DATA IS XX MINUTES OLD displays the amount of time that has elapsed since you last transferred the data. The monitor updates this message each minute.

Updating the Data Transfer

If time has elapsed between data transfer into the module and module removal, you may wish to update the transferred data before you remove the module. To update this data, touch UPDATE TRANSFER.

While the data is being updated, the monitor re-displays the message TRANSFERRING PATIENT DATA INTO MODULE.

Note:

• Parameter information acquired between the time you transfer data and the time you remove the module is lost. The monitor indicates this lost information as a gap in the trends of the parameters involved when you retrieve the data.

• To provide seamless trend information, remove the module and insert it into the receiving monitor within 30 to 45 seconds after you transfer the data. If there is a delay in completing the data shuttle, update the transfer data just before you remove the module.

• If the module has been out of the monitor for 10 or more minutes, all data will be lost.

To update transfer data:

• Touch UPDATE TRANSFER.

ECG

CANCEL TRANSFERUPDATE TRANSFER

DATA TRANSFER COMPLETED



Canceling the Data Transfer Before Module Removal

Touch the CANCEL TRANSFER key to clear all data transfer messages and keys from the ECG display zone and purge previously transferred data from the module. The monitor will then reactivate the TRANSFER DATA key in the ECG Setup menu.

Retrieving Transfer Data

When you insert the module into the receiving monitor, the monitor displays the RETRIEVE DATA and CANCEL TRANSFER keys and sounds a low priority alarm tone every five seconds until you either cancel the data transfer or retrieve the data. The monitor also displays the patient name associated with the data to be transferred and, if applicable, the patient name associated with the data that currently resides in the monitor.

When you touch the RETRIEVE DATA key, the monitor displays YES and NO keys along with the following message:

YES purges the monitor's data and retrieves data from the module.

NO cancels this action.

Touch NO to return to the previous screen. Touch YES to transfer the data from the module into the receiving monitor and purge any data previously stored in that monitor.

Figure 5-7: Retrieving Transfer Data display

Once you initiate data retrieval, the monitor removes all data transfer-related keys from the ECG display zone and displays the message TRANSFERRING PATIENT DATA INTO MONITOR. When the data retrieval into the monitor is complete, the monitor displays the message DATA TRANSFER COMPLETED for one minute.

To cancel data transfer:

• Touch CANCEL TRANSFER.

To receive transferred data:

• Touch RETRIEVE DATA.• Touch YES.

C ST

ECG

CANCEL TRANSFER

Module: Jones, BMonitor: Adams, S

RETRIEVE DATA



When you insert a module loaded with transfer data, you cannot purge a prior patient's data (while data is being transferred) using the monitor’s Admit or Discharge menus. If you attempt to purge patient data in this manner, the monitor will display the following message:

Purge is not allowed during transport.

Canceling the Data Transfer After Module Insertion

To cancel a data transfer, touch the CANCEL TRANSFER key. The monitor displays YES and NO keys along with the following message:

YES purges data previously transferred into the module.

NO cancels this action.

Touch YES to confirm the cancellation of the data transfer and reactivate the TRANSFER DATA key in the ECG Setup menu. Touch NO to return to the previous screen.

Battery Status

Battery status conditions are indicated as follows:

Solid Green LED

A solid green LED indicates the external power supply is connected to the AC mains power and does not indicate the battery charge level. Only a charging cycle or a faulty battery will cause the green LED to flash, and these conditions only occur when a battery is installed in the monitor.

Flashing Green LED — Battery Charging

A flashing green LED indicates a battery, or batteries, installed in the monitor are being charged and are not ready to be used.

A flashing LED turns on and off in a constant pattern with no delays. It functions with the monitor powered ON or OFF. The flashing is different than the battery fault detection flash.

Note:

The green LED will stop flashing and glow solid when the charging cycle is complete.

To cancel data transfer:

• Insert module into receiving monitor.• Touch CANCEL TRANSFER.• Touch YES.



Intermittent Flashing Green LED — Battery Fault Detected

An intermittent flashing green LED indicates that either battery A or battery B is faulty. Faulty batteries are determined to be batteries which do not hold a charge or batteries which attempt to charge too long.

The intermittent signal will display a solid green LED for one second and then display a flashing LED for one second in a repeating pattern. An error message is also added to the error log for review by your system administrator.

To determine whether one battery, or both, are faulty, power the monitor ON using the front panel switch and observe the display message. The message will display along the bottom of the monitor indicating whether one, or both, of the batteries are faulty. Replace the faulty battery with the same battery type.

Battery Gauge

The battery gauge is always present in the lower right corner of the display when the monitor is operating on batteries (powered ON and not plugged into AC power). This gauge indicates the approximate battery capacity. For example, the gauge will display:

• a fully charged battery

• 3/4 battery charge remaining



• minimum battery charge remaining

Note:

• Recordings are automatically inhibited when the battery power reaches 1/2 battery charge remaining.

• Recordings drain large amounts of power and could cause the monitor to power OFF without warning.

• When the battery power becomes critically low (approximately 1/4 battery charge remaining), the entire battery gauge flashes to emphasize this warning. The monitor may power OFF at any time, depending on monitor loading.

• Upon power OFF, the monitor will cease to function.



Wireless Network Interface

The Wireless Network Interface (WNI) provides Ultraview 1030/1050 monitors equipped with the wireless option to communicate with the Spacelabs Healthcare Ethernet network. This enables the wireless bedside monitor to communicate with a central station and other networked devices.

The WNI provides wireless transmission of up to five waveforms along with associated numerics, alarms, trends, arrhythmia, ST, and Flexport Interface Systems data.

Alarm Watch and Remote Trends are not restricted. Bed-to-bed communications enable a bedside to use the Remote View or Alarm Watch features to view data from other beds on the wireless or hard-wired network.

Outbound Parameters Menu

To view the Outbound Parameters menu, touch the OUTBOUND PARAMETERS key in the Monitor Setup menu.

When a parameter key is ON, the parameter is available for selection in another monitor’s Remote View menu and Select Outbound Parameters menu. If two parameters have identical labels, both parameters will display. The maximum number of parameters that can be set depends upon the monitor’s specific configuration for wireless networking. When the maximum number of parameters is reached, the remaining parameters that were not selected become unavailable. The monitor’s default outbound parameter selection is ECG1 when turned ON.

All parameters, including the parameters that are set to OFF in this menu, are displayed by other monitors that are set to ALARM WATCH this monitor. If an outbound parameter is set to OFF, all existing remote views for that parameter will be dropped.

Note:

Setting OTHER to ON selects any unlisted channel types such as VARI, CO, and unlabeled pressures.

To select parameters for display at remote monitors:

• Touch MONITOR SETUP.• Touch OUTBOUND PARAMETERS.• Select the parameters you wish to display (up to five).

To change parameters for display at remote monitors:

• Touch MONITOR SETUP.• Touch OUTBOUND PARAMETERS.• Deselect the parameter key that you wish to stop displaying.• Select the parameter you wish to display.



Wireless Ethernet Connection

Ultraview 1030/1050 Monitors (Option Z)

In wireless mode, the monitor maintains network communication with a central station through the Wireless Network Interface (WNI) that is connected to the standard Spacelabs Healthcare hard-wired Ethernet network. Wireless communication is automatically disabled when the monitor is directly hard-wired to the network using its network port, and enabled when the hard-wired port is disconnected.

Figure 5-8: Rear panel Ultraview 1030/1050



Optional Model 90310 Wireless Network Interface

Figure 5-9: 90310 Wireless Network Interface

rack mounting

power LED

hardware(single or double)

90310 front panel

antenna

ã

status LEDs

channel selection thumbwheel

connectors

connects to AUI multiport for wireless network

90310 rear panel



Ultraview 1030/1050 Connections

External Power Supply Connection

The connection for the external power supply is shown in Figure 5-10. The green LED on the front panel will display ON whenever the unit is powered by an external power supply.

Figure 5-10: Ultraview 1030/1050 external power supply connection

The Ultraview 1030/1050 also provides an external Flexport System Interface connection (Figure 5-11).

J1 - externalpower supplyconnection

external powersupplyDC outlet

cable



Figure 5-11: Ultraview 1030/1050 external Flexport connection — interface connector option F or G

To connect to an external power supply (Ultraview 1030 and 1050 only):

Note: Charging takes place only when plugged into an AC outlet.

• Attach the DC outlet cable to J1.• Connect the power cord of the external power supply to an AC outlet.

SDLC cable

SDLCterminator

SDLCconnection

Flexportinterface

modular cable

externaldevice

transitionconnector

P/N 012-0182-xx

P/N 012-0152-xx



Ethernet Connection — Options F or G for Ultraview 1030/1050

Figure 5-12: Ultraview 1030/1050 10BaseT network connection

To connect to the 10BaseT port for network communication:

• Plug either end of cable assembly P/N 175-0951-xx into the modular jack connection on the back of the monitor.

Network communication is done through the 10BaseT cable assembly only.

• Plug the other end of the cable into the wall in a wall plate with an eight pin modular jack connector.

10BaseTcable assembly

modular jack connection

P/N 175-0951-xxpatientmoduleslot

J1 - externalpower supplyconnection

remote alarmconnection



Ultraview 1030/1050 with Capnography (Option G, H, or M)

Options G and H add mainstream EtCO2 and O2 monitoring to the Ultraview 1030/1050. Option M includes EtCO2 monitoring only.

Figure 5-13: Ultraview 1030/1050 rear panel with option G or H

Note:

Option M (not pictured) does not include the O2 port.

O2

EtCO2

endotracheal

mainstream airway

ventilator

humidifier

adapterO2 sensor

capnographypanel

inspiratory circuit

expiratory circuit

O2 adaptercable

O2 airway adapter

tube

cablesensorhead

sensor

ventilatorcircuit



Maternal Obstetrical Monitor — 94000

The Maternal Obstetrical Monitor (MOM) is a fetal monitor which, when used with an Ultraview Command Module or other Ultraview modules, provides the optional ability to monitor maternal ECG, NIBP, temperature, and SpO2. The multiple trace screen enables simultaneous display of real-time fetal and maternal ECG and maternal SpO2. Both internal and external fetal monitoring capabilities are provided.

The monitor provides networking capabilities to Spacelabs Healthcare monitors through an Ethernet network, BirthNet®, and other manufacturers’ fetal data management systems.

Data for the fetal heart rate and uterine activity can be captured using telemetry.

Warning:• Shock hazards may exist if this instrument is not properly grounded. Protection against

electrical shock is provided by grounding the chassis with a three-wire cable and plug. The grounding wire must not be removed or defeated. Grounding reliability can only be assured if connected to a receptacle marked Hospital Only or Hospital Grade.

• To reduce the risk of electric shock, do not remove the protective covers. Only qualified Spacelabs Healthcare personnel should service the instrument.

• There is a risk of explosion if the instrument is operated in the presence of flammable anesthetics.

To start capnography monitoring (Ultraview 1030 and 1050 only):

• Plug the mainstream EtCO2 sensor cable into the EtCO2 receptacle on the capnography panel.

• Perform sensor calibration, if necessary.• For option H or M, place the sensor on the zero cell and wait for the completion

message to display on the screen. Sensor cells are located on the sensor cable and are labeled “O” and “REF”.

• For option H or M, place the sensor on the reference cell and wait for the completion message to display on the screen.

• Prepare the patient according to hospital procedures.• Select the appropriate airway adapter (neonate or adult).• Verify that the windows are clean and dry.• Place the sensor head over the airway adapter and perform an adapter calibration, if

necessary.• Remove the airway adapter from the sensor head.• Insert the airway adapter into the ventilator circuit and Ballard style tracheal suction

system (if present) as shown.• Attach the sensor head to the airway adapter.• Make the other connections as shown.• Ensure that the sensor head is always positioned above the ventilator circuit so that

moisture will not enter the adapter.



• Always inspect the transducer face, housing, cable, and power cord before using the instrument. If the transducer is cracked or chipped, or if the power cord is frayed, broken, or otherwise damaged, call a qualified technician. Do not use the transducer or the monitor on a patient.

• Always disconnect the instrument from the power supply prior to cleaning the monitor.

• The total system chassis risk current should not exceed 300 A @ 120 V, 500 A @ 240 V.

• Do not operate this instrument if it is wet or if condensation is present.

• During recharging, the wireless transducers may become hot or warm to the touch. Allow the wireless transducers to cool prior to using them on a patient.

• An intentional reset will occur if the processors lose communication with each other. Under these circumstances, the main processor will self-reset and the communication will be re-established after the startup sequence. A solid triangle is printed on the 60-bpm line of the FHR scale to differentiate this type of reset from others. A small gap in the heart rate tracing will result.

Caution:• Excessive bending or twisting of a transducer cable may cause failure or intermittent operation

of the transducer.

• Do not sterilize a transducer using gas, heat, or liquid methods. Do not autoclave a transducer. These sterilization methods may permanently damage the transducer.

• This instrument is not intended for use with defibrillators.

• Disposal of these devices and all accessories must be in accordance with local and federal laws.

• Due to the potential for electromagnetic interference, electronic devices (for example, portable communication transmitters, cellular telephones, personal computers, electronic toys, and other medical devices) should not be operated within 1.07 meters (3.5 feet) of the patient, patient leads, or associated patient monitoring equipment until evaluated by the Biomedical Engineering staff.

• If the integrity of the external protective earth conductor is in doubt, the equipment must be operated from its internal power source.

• The fetal module is an IEC 601-1 Class I device with type B, BF, and CF patient connectors. Type B equipment provides a particular degree of protection against electric shock, particularly regarding allowable leakage current (not to exceed 0.1 mA) and reliability of the protective earth connection (if present). Type BF equipment meets the criteria above for B with an F-type applied part. An F-type applied part is isolated from all other parts of the equipment to such a degree that the patient leakage current allowable in single fault condition is not exceeded with a voltage equal to 1.1 times the highest rated mains voltage applied between the applied part and earth. Type CF equipment provides a degree of protection higher than that for type BF against electroshock, particularly regarding allowable leakage currents (not to exceed 0.01 mA), and having an F-type applied part.



• Water ingress for the fetal module is IPX0.

• The MOM unit is not approved for transport applications.

Front Panel

� Power ON/OFF

� Recorder drawer release button

� Fetal chart recorder

� FHR 1 connector (either ultrasound or ECG)

� UA connector

� FHR 2 connector (ultrasound only)

� Battery charging light

��

� �

�

�

�



Right Side Panel

� Telemetry antenna connector (optional)

� Ultraview Module (optional)

� J1 — External power supply connector

Left Side Panel

� Maternal chart recorder (optional)

� Event marker connector

� Ethernet connector (Ultraview Care Network)

� Battery compartment door

�

�

�

�

�

� �



Rear Panel

� J4 — Other I/O

� J3 — RS-485 port - BirthNet

� J2 — External device port - RS-232

Warning:• The use of accessory equipment that does not comply with the monitor’s safety requirements

may lead to a reduced level of safety. Consideration should be given to the use of the accessory in the vicinity of a patient. The safety certification of the accessory must be performed in accordance with the appropriate IEC 601-1 and/or IEC 601-1-1 harmonized national standard.

• EMC compliance may be compromised by the connection of accessory and/or peripheral equipment. Compliance of accessory and/or peripheral equipment must be considered to ensure continued EMC compliance.

� � �



Bedside/Transport Monitor Troubleshooting Guide


Cannot change parameter priority or colors

■ Monitor may not be set up to allow the user to change priority or colors.


Changed parameter priority or colors are lost

■ The STORE key was not touched after the selection was made.

■ Touch the STORE key to make changes permanent.

Transport monitor has no DC power

■ The monitor was not plugged into an AC outlet while not in use.

■ No batteries installed.

■ Plug the monitor into an AC outlet to recharge the batteries.

■ Install one or two batteries.


Central Monitors



SCREENFORMAT

TONESADMIT/

DISCHARGEMONITORCONFIG.

BRIGHTNESS

Select waveformzone

Select bed(or subnet, then bed)

Select parameter

Refer to

Refer to

CLOCK

ON OFF

PRIVILEGEDACCESS

Refer to Selecting Waveforms for Display in this chapter

MONITOR SETUP

MONITOR CONFIGURATION

ACTIVATESCREEN SAVER

the next page

RECORD

Refer to

chapterAlarms

ALARMWATCH

GRAPHICTRENDS

TABULARTRENDS CALCS

DRUGCALCS

AWOFF

REMOTETRENDS/CALCS

TRENDS/CALCS for BED XXX

Select bed

SPECIAL FUNCTIONS

RECORDERCONFIG.

CONTRAST

Refer to

Admit/Discharge

MONITOR SETUP -

BRIGHTNESS CONTRAST

Ultraview UCW

DNA

DISPLAY BRIGHTNESS AND CONTRAST

and 1500 only

chapterRefer to

Printing chapter

Refer toPrinting chapter

Alarms chapter


Central Monitors

Directory of Keys — Privileged Access


Enter clinical password

SCREENFORMAT

TONESADMIT/

DISCHARGEMONITORCONFIG

PRIVILEGEDACCESS

MONITOR SETUP

RECORDERCONFIG

ROTATE ALARM WATCHALARM WATCH SETUP - Select parameter to change


RESETMONITOR



UNITS OFMEASURE

USERACCESS

ALARMSETUP


TIME/DATE

TIMEDATE

24HOURS ENTER

USER ACCESS - Enable user access to functions

PRESELECTED A PRESELECTED B


PRIORITY

MINUTES

mmHgkPa

inchescm

lbkg

MONITOR SETUP - Time/Date 10:06 AM/PM

ROTATION TIME

15 S 30 SSIMPLEON OFF

AMPM

ALARM WATCHSETUP

Restart monitor after selectingunits of measurement

ALARM SETUP - Select parameter


MORE

REMOTE ACCESS

ON OFF

ALARMRELAY

QRS/SPO2 TONE ENABLE

ALWAYS DURING ALARM

ALARM WATCH TONE

SINGLE TRIPLE

PATIENT TYPE

ON OFF

PARAMETER CONFIG

ON OFF

RECORDING DURATION

ON OFF

SUBNET ACCESS

ON OFF

HOURS



Central Monitors

Contents

Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46-Trace Option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Central Monitor Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5System Clock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Screen Saver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Data Communications Watch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Central Monitors Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Overview

The central monitor provides full monitoring control of remote parameters including display and alarms, with both visual and audible annunciation. All waveform and current numeric data, arrhythmia, ST segment, and trends are available with central monitoring.

The Ultraview Care Network family of monitors and modules have built-in error detection and recovery circuitry. This circuitry, together with special software, allows the central to re-initialize and continue to function if an error occurs.

When the system detects an error that cannot be corrected through other means, the central monitor re-initializes or resets (blanks). Normally, a reset involves very little loss of patient monitoring time (approximately five seconds) and, with few exceptions, all operator set inputs (for example, alarm limits, pressure labels, transducer offsets, etc.) are retained. The entire process of restoring the central display following a reset takes approximately 20 seconds, depending on the number of parameters being monitored.

In some cases, stored trend data will be lost when the monitor resets. Typically, this is indicative of a hardware condition that requires corrective action. In this case, the system initiates the start-up diagnostics to check the monitor's operation so that full recovery takes approximately 10 seconds longer.

If a bedside monitor has reset, the central and bedside monitors display CHECK SETUP in the ECG zone to alert you to check all limits and values and ensure that the monitors have restored all preset values. Refer to Power Failure on page 1-4 for more information. This also occurs when the monitors are turned ON or when an ECG module has been inserted. However, your system administrator may disable this CHECK SETUP feature.

Caution:Due to the potential for electromagnetic interference, electronic devices (for example, portable communication transmitters, cellular telephones, personal computers, electronic toys, and other medical devices) should not be operated within 1.07 meters (3.5 feet) of the patient, patient leads, or associated monitoring equipment until evaluated by the Biomedical Engineering staff.


Central Monitors

Display Detail

UCW and Ultraview 1700 central monitor screens can display up to eight full waveform zones. The split screen option allows for a maximum of 12 or 16 zones to be displayed.

Figure 6-1: Split screen display

6-Trace Option

The 6-trace mode feature includes automatic screen formatting that increases the font and zone size for alphanumeric text.

The larger font and zone size always appears on central monitors configured for 4-, 5-, 6-, and 12-trace operation because no more than 6 full zones can have parameters assigned.

24 Dec 05


Central Monitors

Central Monitor Features

Selecting Parameters for Display

Use the SCREEN FORMAT key in the Monitor Setup menu to assign remote parameters to specific display zones and to choose the color of those zones. Names of the subnet and bedside keys are assigned by your system administrator.

One to eight screen zones can be viewed across the entire screen. Split-screen central monitors can accommodate up to 16 screen zones, with zones 1 through 8 displayed on the left and zones 9 through 16 displayed on the right.

Figure 6-2: Central display — Screen Format menu

To select remote parameters for display:

• Touch MONITOR SETUP.• Touch SCREEN FORMAT.• Select a bed (or a subnet, then a bed).• Select the parameter(s) to be displayed.• Select a zone.

To assign color to a zone:

• Touch MONITOR SETUP.• Touch SCREEN FORMAT.• Touch the desired color.• Touch the zone to be colored.


Central Monitors

RESTORE COLORS — restores the last stored color settings from memory.

FACTORY DEFAULTS — restores the zone colors to the factory color setting of white.

OVERWRITE ZONE — replaces a zone that has already been assigned a parameter. Select the new parameter and then touch OVERWRITE ZONE to drop the previously assigned parameter channel and replace it with the new parameter.

INSERT ZONE — moves the assigned zone and all other zones immediately adjacent to the assigned zone down one zone, and the new zone is inserted above them. If this causes an assigned zone to disappear from the screen, a warning box appears, prompting you to complete or cancel the insert.

CLEAR ZONE — clears the zone assignment and returns the zone to an unassigned state. Touch CLEAR ZONE, then touch the zone from which you wish to remove an assignment.

Setting the Time and Date

The TIME/DATE key controls both the time and date menus. The current time or date is displayed above the menu.

Time is displayed in either 12- or 24-hour format. Network monitors display the network time and stand-alone monitors display the internal system time.

The system will not make any time/date change permanent until you touch ENTER.

Note:

Setting the time on any networked monitor sets time for all monitors on that network.

To change the network or internal system time and date:

• Touch MONITOR SETUP.• Touch PRIVILEGED ACCESS.• Enter Clinical password.• Touch TIME/DATE.• Select TIME.

-OR-

• Select DATE.• Select 24 HOURS or AM/PM (12 hours).

-OR-

• Select MONTH, DAY, and YEAR.• Use arrow keys to set time or date.• Touch ENTER.


Central Monitors

System Clock

A system clock can be continually displayed in the lower right corner of the screen. The clock feature can also be used as a stopwatch or timer.

Figure 6-3: Clock display formats

Note:

• The digital clock is available for all monitors.

• The stopwatch and timer are only available for the UCW and Ultraview 1700.

To enable/disable the clock:

• Touch MONITOR SETUP.• Touch MONITOR CONFIGURATION.• Select CLOCK ON to enable the clock.

-OR-

• Select CLOCK OFF to disable the clock.

To access the clock menu:

• Touch MONITOR SETUP.• Touch MONITOR CONFIGURATION.• Select CLOCK ON.• Touch the clock that appears in the lower right of the screen.• Select DIGITAL, STOPWATCH, or TIMER.

digital stopwatch timer

02 DEC 08 02 DEC 08

Elapsed Remaining

02 DEC 08


Central Monitors

Screen Saver

Activating the screen saver blanks the screen (displaying only the Spacelabs Healthcare logo). You may also disable the screen saver by touching the screen, clicking (or dragging) the mouse, or pressing any key on the keyboard.

Note:

The screen will automatically be restored by an incoming alarm condition.

Data Communications Watch

The Data Communications Watch (DCW) feature displays a Data Communications Interrupted (DCI) message on the central when the central’s communication link to a bedside/remote monitor is interrupted.

A bedside monitor may drop from the central display because of a power interruption at the bedside, Ethernet failure, or other circumstance. As soon as a communication loss is detected by the central monitor, a DCI notification will be displayed on the screen in place of each channel that lost communication, and an alarm tone will sound if enabled (refer to Enabling Alarms (Optional) on page 6-9).

Keys will be displayed in the waveform zone of the interrupted channel to permit disabling of the alarm tone associated with the interruption, and to remove the zone from the display.

The DCI notification shows the bed name, patient name and the parameter key label of the lost channel, as shown in Figure 6-4.

Figure 6-4: DCI notification display

Note:

The Data Communications Watch feature is enabled only through the system administrator menu.

The parameter key (ECG in the above example) will also flash (if DCW alarms are enabled) when the DCI notification is displayed on the screen. Touch this key to display a status message at the bottom of the screen noting the time and date that communication with the lost channel was interrupted.

To activate the screen saver:

• Touch MONITOR SETUP.• Touch MONITOR CONFIGURATION.• Touch ACTIVATE SCREEN SAVER.

REMOVE PATIENT ZONE?

YES

E

C

GBED 01 JONES, B NO

DATA COMMUNICATIONS INTERRUPTED


Central Monitors

Press YES to remove all DCI notifications associated with the same bedside from the central display. Unless the zone is re-assigned by the user, the central will continue to attempt communication with the remote monitor. Once communication is restored, the patient data is displayed in the zones again.

Press NO to silence the alarms (if enabled), but to continue display of the DCI notification. All alarms for that bedside monitor are silenced simultaneously. The NO key becomes dithered (inactive) after it is pressed.

Enabling Alarms (Optional)

When activated, this option causes an alarm to sound and the parameter key to flash when the DCI notification is displayed. This option must be enabled through the Biomed menu.

A flashing parameter key and low level alarm tone, signifying an alarm condition, will occur as soon as the central detects a communication loss. Alarm conditions will continue until either YES or NO is pressed on the DCI notification, a new parameter is assigned to the zone, or communication is restored.

Enabling Detection for Admitted Patients (Optional)

If ADMIT REQUIRED is ON, communication will be watched for only those remote monitors having admitted patients. If ADMIT REQUIRED is OFF, communications will be watched for all patients on the central monitor.

To enable Data Communications Watch (must have system administrator menu access):

• Touch MONITOR SETUP.• Touch PRIVILEGED ACCESS.• Enter Biomed password.• Touch MORE.• Touch DATA COMM WATCH.• Select COMM WATCH ON.• Select ALARM ON to enable DCW alarms.• Select ADMIT REQUIRED ON to enable DCW for admitted patients only.


Central Monitors

Central Monitors Troubleshooting Guide


Cannot assign color to a zone

■ Monitor may not be set up to allow you to assign colors.


Cannot assign a parameter to a zone

■ Zone may not have been cleared of previous assigned waveforms.

■ Select CLEAR ZONE, then touch the zone in which to display the new parameter. Repeat the initial SCREEN FORMAT steps.

Cannot access the clock menu

■ Clock may have been left in STOPWATCH or TIMER mode.

■ Touch the clock/timer display, then touch PREVIOUS MENU to restore the clock.

Cannot deselect Alarm Watch

■ The Ultraview Central Monitor is configured with Central Alarm Watch Manager to prevent de-selection of automatically alarm-watched beds.




Directory of Keys — For Configurations with ECG


ECG MENU

ALARMLIMITS

SIZE SETUPLEAD

CONTROLDISPLAYFORMAT

SUSPENDPROCESSING REVIEWPRINTRELEARN

ECG - SETUP

SWEEPSPEED

RATESOURCE

MONITOR

EXTENDEDQRS

TONERESTORESETTINGS

HIDDENKEY

ECG - CONFIG

INFANT

DEFAULT STORAGE MENU

USERSETTINGS

TRANSFERSETTINGS

RETRIEVESETTINGS

FACTORYDEFAULTS

STORE

CONFIG

YES NO

See your systemadministrator foraccess to this key

TRANSFERDATA

NIBP TEMP

E

C

G

PACED

YES NO

ADULT ARR

ON OFF

USER SETTINGS - CHANNEL SELECT

ECG RESP VARITREND

SELECT PARAMETER

CURSOR CURSOR

User Settings screens appear here (Refer to Display Detail)

CHANGE VALUE PAGE X OF X

PRES SPO2

YES NO

YES NO

PRINT PAGE

NEXT PAGE

PREV PAGE



Directory of Keys — For Configurations without ECG



USERSETTINGS

TRANSFERSETTINGS

RETRIEVESETTINGS

FACTORYDEFAULTS

TEMP MENU

ALARMLIMITS

RESTORESETTINGS

HIDDENKEY


TEMP

USER SETTINGS - CHANNEL SELECT

PRES SPO2 TEMP

User Settings screens appear here (Refer to Display Detail)

YES NO

STORE

SELECT PARAMETER

CURSOR CURSOR


YES NO

PRINT PAGE

NEXT PAGE

PREV PAGE



Directory of Keys — For Telemetry Configurations


ECG MENU

ALARMLIMITS

SIZE SETUPLEAD

SELECTCHANNELFORMAT


ECG - SETUP

SWEEPSPEED

MONITOR

EXTENDEDQRS

TONERESTORESETTINGS

HIDDENKEY

ECG - CONFIG

INFANT


USERSETTINGS

TRANSFERSETTINGS

RETRIEVESETTINGS

FACTORYDEFAULTS

CONFIG

YES NO


TMSETUP

E

C

G

PACED

YES NO

ADULT ARR

ON OFF

YES NO

PRINTPAGE STORE

SELECT PARAMETER

CURSOR CURSOR NEXT PAGE

PREV PAGE


YES NO



Contents

Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Setting User-Defined Default Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Storing Changed Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Selecting Alarm Attributes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Parameter Configurations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Transferring User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39Retrieving User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39Restoring Factory Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40Restoring User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Overview

The Module Configuration Manager feature provides the capability to define and store all user-configurable options within your module. Once a module has been configured, these settings will control its operation whenever the module is powered ON.

To ensure standardization of multiple modules, settings may be transferred from one configured module to another. Settings are first transferred from a configured module to the monitor (using the TRANSFER SETTINGS key), then retrieved from the monitor into other modules (using the RETRIEVE SETTINGS key).

The Restore Settings feature changes all the module’s parameter user-configurable options to the defaults previously stored as user settings.

Note:

• User-configurable parameters are available based on the options in your module. For example, if your module does not have the Arrhythmia Processing feature (Multiview™ I), parameters related to arrhythmia detection and alarms will not be available.

• User-defined settings which have been transferred to the monitor’s memory are available for retrieval into other modules until (1) the monitor is powered OFF or (2) a patient is admitted or discharged with a purge of data.

Depending on the parameter configuration of the module, the Module Configuration Manager feature is accessible through either the ECG or TEMP parameter key. For module configurations without ECG, use the TEMP key. For module configurations with ECG, use the ECG key. (Refer to Module Configuration Manager on page 15-24 for more information.)

Note:

The TEMP key will only be displayed if a temperature probe is connected to the module.



Display Detail

The User Settings screens list all user-configurable options for ECG, respiration, Varitrend 3, temperature, invasive pressure, non-invasive blood pressure, and SpO2. From these screens you can change and store the options in your module.

Figure 7-1 illustrates the ECG User Settings screen which is used to change and store ECG rate alarm limits. In this example, LEARNED has been chosen as the adult rate alarms type.

The parameter configuration tables in this chapter list all available options, the available user settings, and the factory defaults for each parameter.

Figure 7-1: ECG user settings

� CURSOR AND CURSOR keys scroll through the two columns of parameters on the screen.

� and keys scroll the list of valid settings for the highlighted parameter.

� PREV PAGE key returns to the previous screen.

� NEXT PAGE key advances to the next screen.

� PRINT PAGE key prints the current screen.

� STORE key stores the currently selected settings as defaults.

PARAMETER DESCRIPTION VALUE PARAMETER DESCRIPTION VALUE

ECG RATE ALARMS (ADULT) ECG RATE ALARMS (INFANT)

• TYPE LEARNED • TYPE LEARNED

• HIGH RATE 180 • HIGH RATE 220

• LOW RATE 40 • LOW RATE 100

• HIGH RATE OFFSET 50 • HIGH RATE OFFSET 50

• LOW RATE OFFSET 50 • LOW RATE OFFSET 50

• DELAY 3

Set ECG alarm type to LEARNED or FIXED limits

��

STORE

SELECT PARAMETERCURSOR CURSOR

CHANGE VALUE PAGE X OF XPRINTPAGE

NEXT PAGE

PREV PAGE



Setting User-Defined Default Values

Use the User Settings screens to change and store settings. If the setting for the selected parameter cannot be changed, the message THIS SETTING CANNOT BE CHANGED will be displayed.

The ability to access the Module Configuration Manager screens can either be visible to all users or remain hidden. The factory default setting is Invisible. Adjust the SYSTEM SETUP key to the Visible setting in the ECG configuration table to enable user access to this function.

Storing Changed Settings

Touch the STORE key after entering configuration changes for any parameter in the module. This action stores only the currently selected settings for all parameters in that module.

The Patient Admit/Discharge function (available in the ECG configuration screen) allows you to SAVE the changes in the alarm limit settings as the default settings for future patients, or RESTORE the original default settings upon discharge of that patient or admission of a new patient.

The Save setting is commonly used in environments where multiple patients are monitored for short periods of time, for example, the operating room. Selecting SAVE allows you to save specific settings from patient to patient until the module is removed or the monitor is powered OFF.

The Restore setting is more commonly used in environments where it is desirable to initialize alarm limit settings for each patient, for example, the critical care unit or the intensive care unit. Selecting RESTORE returns the module to the default settings upon patient admission or discharge.

Your selection on the ECG Configuration screen applies to all parameters.

Selecting Alarm Attributes

Alarms can be independently configured for all parameters including: tone types (high, medium, low, or none), whether a specific alarm condition triggers an automatic recording, or alarms are watched under the Alarm Watch feature.

In the Monitor Setup menu, individual parameters may be selected for automatic alarm recording. If alarm recording is enabled for a particular parameter, for example ECG, you can further specify which alarms will generate a recording.

You can also specify which alarms will be watched using the Alarm Watch feature. For example, if you have selected a patient for Alarm Watch, but you do not want to be alerted to LEAD OFF conditions remotely, select Alarm Watch OFF for that condition in the corresponding Alarm Attributes screens. Refer to the Alarm Attributes tables in this chapter for available user-defined settings and factory defaults for the individual parameters.



Parameter Configurations

ECG

Heart rate alarms can be set to fixed values or based upon the patient's learned heart rate. The learned heart rate is known as a result of ECG monitoring. If the learned option is selected, you must specify high and low offset values. The high and low rate alarm limits specify boundaries of the maximum available settings.

To automatically set heart rate alarms to:

• 40 beats above and 40 beats below the patient's learned heart rate

• not to exceed a high rate of 200 and a low rate of 30

Adjust the default settings as follows:

When selecting the fixed option, you only need to adjust the high and low rate settings.

Heart rate alarms can be set independently for the adult mode and the infant mode.

In the infant mode, you can select a delay between the time of initiation of monitoring and alarm activation (0 to 3 minutes). This provides a period of time for the patient to calm down after electrode application.

ST alarms can be set to identify regional and global changes. Specific leads can be selectively included or excluded to provide more specific information.

The Check Setup feature provides a visual and audible prompt for you to assess the patient setup before initiating monitoring or following a monitor reset or ECG module change. You can disable this feature by setting it to OFF.

If you do not want to suspend ECG processing or disable ECG alarms, set the CONTROL setting to OFF.

Note:

• For telemetry, some settings may or may not be available, depending on whether the module is used in a central or bedside monitor.

• For Ultraview Digital Telemetry (multiparameter), default settings for SpO2 and NIBP may be found as part of the ECG channel. Telemetry ECG parameter configuration and alarm attributes are found in separate tables in this chapter following the tables for the hard-wired (non-telemetry) products. Refer to Table 1 and Table 2 for non-telemetry products. Refer to Table 3 and Table 4 for telemetry products.

Type Learned

HIGH RATE 200

LOW RATE 30

HIGH RATE OFFSET 40

LOW RATE OFFSET 40



To review or change settings:

• Touch ECG.• Touch SETUP.• Touch CONFIG.• Touch the hidden key 3 times.• Touch USER SETTINGS.• Select ECG.

-OR-

• Select RESP.

-OR-

• Select VARITREND.

-OR-

• Select PRESSURE.

-OR-

• Select SPO2.

-OR-

• Select NIBP.

-OR-

• Select TEMP.• Use CURSOR and CURSOR to scroll through the parameter description list.• Use and to change the settings.• Touch NEXT PAGE to continue to next screen of parameters.• Touch STORE to save the new settings.• Touch YES when the STORE ALL CHANNEL DEFAULTS message is displayed.

Table 1: ECG Parameter Configuration

Parameter Available User SettingsFactory Defaults

User Settings

ECG Rate Alarms (Adult)

Rate Alarm Type Learned or fixed limits Learned

High Rate Alarm Limit 5 to 300 BPM 180 BPM

Low Rate Alarm Limit 0 to 200 BPM 40 BPM

High Rate Offset(only applies to learned limits)

5 to 80 BPM 50 BPM

Low Rate Offset(only applies to learned limits)

5 to 80 BPM 50 BPM



ECG Rate Alarms (Infant)

Rate Alarm Type Learned or fixed limits Fixed

High Rate Alarm Limit 5 to 300 BPM 220 BPM

Low Rate Alarm Limit 0 to 200 BPM 100 BPM


5 to 80 BPM 50 BPM


5 to 80 BPM 50 BPM

Infant Alarm Delay (for ECG and Resp alarms)

0 to 3 minutes 3 minutes

ECG Mode Adult/Infant Adult

Sweep Speed 50, 25, or 12.5 mm/sec 25 mm/sec

Respiration ON/OFF On

Varitrend ON/OFF Off

QRS Tone (local only) ON/OFF Off

QRS Volume (local only) 1 (soft) to 8 (loud) 4

SpO2 Pitch Modulation of QRS Tone

ON/OFF OFF

Display Resolution Monitor/Extended Monitor

Arrhythmia Processing ON/OFF ON

Abnormals in a Row 2 to 10 or OFF 5

Abnormals/Minute 1 to 99 or OFF Off

Review ON/OFF ON

1st Lead Selection Limb, V, or augmented lead V2

1st Lead Waveform Size 2.00 to 0.10 mV/cm 0.50 mV/cm

2nd Lead Selection Limb, V, or augmented lead II

2nd Lead Waveform Size 2.00 to 0.10 mV/cm 0.50 mV/cm

ST Alarm (single lead) 0.00 mm (OFF) to 9.00 mm 1.0 mm

Table 1: ECG Parameter Configuration (continued)


User Settings



ST Alarm (multi-lead) 0.00 mm (OFF) to 8.75 mm 0.50 mm

ST Alarm (I) ON/OFF ON

ST Alarm (II) ON/OFF ON

ST Alarm (III) ON/OFF ON

ST Alarm (AVR) ON/OFF ON

ST Alarm (AVL) ON/OFF ON

ST Alarm (AVF) ON/OFF ON

ST Alarm (V1) ON/OFF ON






Automatic Lead Switch ON/OFF ON

Single Lead Alarm ON/OFF OFF

Primary Rate Source ECG/ART/SPO2/UA ECG

Alternate Rate Source (ECG) ON/OFF ON

Alternate Rate Source (ART) ON/OFF ON

Alternate Rate Source (SPO2) ON/OFF ON

Alternate Rate Source (UA) ON/OFF ON

Enhanced Vital Signs ON/OFF OFF

Display FormatFull view, Split view, 2-lead,

1-lead, or Cascade1-lead

Save ST Time IntervalOFF, 5, 10, 15, 30, or

60 minutes15 minutes



User Settings



ST Trend Scale

-5 to 0 mm

0 to 5 mm

-2 to 0 mm

0 to 2 mm

-1 to 1 mm

-2 to 2 mm

-5 to 5 mm

-10 to 10 mm

±2.0 mm

ST Trend Timebase 1.5, 3, 6, 12, or 24 hours 6 hours

Real-Time ST Trend ON/OFF OFF

Real-Time Trend Timebase 15 or 30 minutes 30 minutes

Auto ReportOFF; 30 minutes; 1, 2, 4, 8,

24 hoursOFF

Auto Print ON/OFF OFF

Report FormatStandard-1, Cabrera-1, Standard-3, Cabrera-3

Standard-1

Send ECG Report Auto/Manual Auto

Check Setup ON/OFF ON

Line Frequency 50 Hz, 60 Hz 60 Hz

Control ON/OFF ON

Default Storage Key Visible/Invisible Invisible

Patient Admit/Discharge Save/Restore Restore

Select HLO ParametersECG1/P1, ECG1/RESP,

ECG1/ECG2, P1/P2ECG1/P1



User Settings



Table 2: ECG Alarm Attributes

Alarm Type

Tone Type Alarm Recording Alarm Watch

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Asystole H H H Y Y Y Y Y Y

VFIB H H H Y Y Y Y Y Y

High Rate H,M,L,N H Y,N Y Y,N Y

Low Rate H,M,L,N H Y,N Y Y,N Y

Run H,M,L,N H Y,N Y Y,N Y

Couplet H,M,L,N M Y,N Y Y,N Y

Tach H,M,L,N M Y,N Y Y,N Y

ABN/MIN H,M,L,N M Y,N Y Y,N Y

ST Single-lead H,M,L,N M Y,N Y Y,N Y

ST Multi-lead H,M,L,N M Y,N Y Y,N Y

Classes Full H,M,L,N L N N N Y,N N

CH 1 & 2 Lead Off H,M,L,N M N N N Y,N Y

CH 1 Lead Off H,M,L,N M N N N Y,N Y


Low Voltage H,M,L,N M N N N Y,N Y

Noisy Signal H,M,L,N L N N N Y,N N

HR Unavailable H,M,L,N M N N N Y,N Y

H = High; M = Medium; L = Low; N = None; Y = Yes; N = No



Note:

• Alarm attributes for asystole and ventricular fibrillation cannot be changed.

- If ECG alarms are enabled, episodes of asystole and ventricular fibrillation will always trigger a high alarm tone.

- If ECG alarm recording is enabled, asystole and ventricular fibrillation will always trigger a recording.

- If Alarm Watch is enabled for a patient, asystole and ventricular fibrillation will always trigger an alarm notification.

• Setting tone type to NONE automatically sets alarm recording and alarm watch to NO for that alarm. Changing tone type from NONE to any other setting returns alarm recording and alarm watch to factory defaults.

• Setting tone type to NONE for high rate, low rate, ABN/MIN, or run causes the affected alarm limit to be displayed in reverse video in the ECG display zone.

Table 3: ECG Parameter Configuration (Telemetry Only)

Parameter Available User Settings Factory DefaultsUser

Settings

ECG Rate Alarms (Adult) ON ON ON

Rate Alarm Type Learned/Fixed Learned

High Rate Alarm Limit 5 to 300 bpm 180 bpm

Low Rate Alarm Limit 0 to 200 bpm 40 bpm


5 to 80 bpm 50 bpm


5 to 80 bpm 50 bpm

ECG Rate Alarms (Infant) ON ON ON

Rate Alarm Type Learned/Fixed Learned

High Rate Alarm Limit 5 to 300 bpm 220 bpm

Low Rate Alarm Limit 0 to 200 bpm 100 bpm


5 to 80 bpm 50 bpm


5 to 80 bpm 50 bpm

Infant Alarm Delay(for ECG and Resp alarms)

0 to 3 minutes 3 minutes



2nd Lead Display ON/OFF OFF

ECG Mode Adult/Infant Adult

Sweep Speed 50, 25, or 12.5 mm/second 25 mm/second

Enhanced Vital Signs ON/OFF OFF

ST Trend Timebase 1.5, 3, 6, 12, or 24 hours 6 hours

QRS Tone (local only) ON/OFF OFF

QRS Volume (local only) 1 (soft) to 8 (loud) 4

SpO2 Pitch Modulation of QRS Tone ON/OFF OFF

Display Resolution Monitor/Extended Monitor

Arrhythmia Processing ON/OFF ON

Abnormals in a Row 2 to 10 or OFF 5

Abnormals/Minute 1 to 99 or OFF OFF

Review ON/OFF ON

1st Lead Selection Limb, V, augmented or

MCL leadVI

1st Lead Waveform Size 2.00 to 0.10 mV/cm 0.5 mV/cm

2nd Lead Selection Limb, V, augmented or

MCL leadII

2nd Lead Waveform Size 2.00 to 0.10 mV/cm 0.5 mV/cm

ST Level Alarm (channel 1) ON/OFF OFF

ST Level Alarm Type Learned/Fixed Learned

High Level Alarm Limit (only applies to fixed limits)

-8.75 to 9.00 mm 1.00 mm

Low Level Alarm Limit (only applies to fixed limits)

-9.00 to 8.75 mm -1.00 mm

High Level Offset (only applies to learned limits)

0.25 to 9.00 mm 1.00 mm

Low Level Offset(only applies to learned limits)

0.25 to 9.00 mm 1.00 mm

Table 3: ECG Parameter Configuration (Telemetry Only) (continued)


Settings



ST Change Alarm (channel 1) ON/OFF OFF

Max-Min. Change Within 5-Minutes (delta)

0.25 to 9.00 mm 1.00 mm

ST Level Alarm (channel 2) ON/OFF OFF

ST Level Alarm Type Learned/Fixed Learned

High Level Alarm Limit(only applies to fixed limits)

-8.75 to 9.00 mm 1.00 mm

Low Level Alarm Limit(only applies to fixed limits)

-9.00 to 8.75 mm -1.00 mm

High Level Offset(only applies to learned limits)

0.25 to 9.00 mm 1.00 mm

Low Level Offset(only applies to learned limits)

0.25 to 9.00 mm 1.00 mm

ST Change Alarm (channel 2) ON/OFF OFF

Max-Min. Change Within 5 Minutes (delta)

0.25 to 9.00 mm 1.00 mm

Check Setup Key ON/OFF ON

Line Frequency 50 Hz, 60 Hz 60 Hz

Control (controls ALARM ON/OFF and SUSPEND PROCESSING keys)

ON/OFF ON

Automatic Lead Switch ON/OFF ON

Single Lead Alarm ON/OFF OFF


Low Battery Alarm ON/OFF ON

Patient Record ON/OFF OFF

Telemetry Bed Assignment Temporary/Permanent Temporary




Settings



Frequency Band

North America UHF, North America VHF, European

Telecom, United Kingdom, Australia, Spain, Sweden,

Finland, New Zealand, Norway, Singapore,

South Africa

North America UHF

Primary Heart Rate Source ECG/ART/SPO2/UA ECG

Alternate Rate Source (ECG) ON/OFF ON

Alternate Rate Source (ART) ON/OFF ON

Alternate Rate Source (SPO2) ON/OFF ON

Alternate Rate Source (UA) ON/OFF ON

Multiparameter Telemetry ON/OFF ON

Telemetry SpO2 Alarms(only if multiparameter is ON)

ON ON ON

SpO2 High Limit(only if multiparameter is ON)

51% to 100% 100%

SpO2 Low Limit(only if multiparameter is ON)

50% to 99% 85%

SpO2 Limit Alarm Delay(only if multiparameter is ON)

0 to 30 seconds 15 seconds

SpO2 Message Alarm Delay(only if multiparameter is ON)

0 to 60 seconds 20 seconds

Telemetry NIBP Alarms(only if multiparameter is ON)

ON ON ON

NIBP Systolic High Limit(only if multiparameter is ON)

35 to 260 mmHg 150 mmHg

NIBP Systolic Low Limit(only if multiparameter is ON)


NIBP Diastolic High Limit(only if multiparameter is ON)




Settings



Note:

Multiparameter telemetry displays ECG, SpO2, and NIBP data all in the ECG channel. Alarm messages are displayed in order of priority.

NIBP Diastolic Low Limit(only if multiparameter is ON)


NIBP Mean High Limit(only if multiparameter is ON)


NIBP Mean Low Limit(only if multiparameter is ON)


Table 4: ECG Alarm Attributes (Telemetry Only)

Alarm Type


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Asystole H H H Y Y Y Y Y Y

VFIB H H H Y Y Y Y Y Y

High Rate H,M,L,N H Y,N Y Y,N Y

Low Rate H,M,L,N H Y,N Y Y,N Y

Run H,M,L,N H Y,N Y Y,N Y

Couplet H,M,L,N M Y,N Y Y,N Y

Tach H,M,L,N M Y,N Y Y,N Y

ABN/MIN H,M,L,N M Y,N Y Y,N Y

ST High/Low H,M,L,N M Y,N Y Y,N Y

ST Change H,M,L,N M Y,N Y Y,N Y



Settings



Classes Full H,M,L,N L N N N Y,N N

CH 1 & 2 Lead Off H,M,L,N M N N N Y,N Y



Low Voltage H,M,L,N M N N N Y,N Y


Squelch H,M,L,N L N N N Y,N N

Signal Interference H,M,L,N L N N N Y,N N

Low Battery H,M,L,N L N N N Y,N N

SpO2 Monitor Fail H,M,L,N L N N N N

SpO2 High Limit H,M,L,N L Y,N N Y,N N

SpO2 Low Limit H,M,L,N L Y,N N Y,N N

SpO2 Faulty Sensor H,M,L,N L N N N N

SpO2 Sensor Disconnected

H,M,L,N L N N N N

SpO2 Ambient Light Intf. H,M,L,N L N N N N

SpO2 Sensor Off Patient H,M,L,N L N N N N

SpO2 Insufficient Signal H,M,L,N L N N N N

SpO2 Noisy Signal H,M,L,N L N N N N

NIBP Cable Disconnected H,M,L,N L N N N N

NIBP Unavailable (xx) H,M,L,N L N N N N

Table 4: ECG Alarm Attributes (Telemetry Only) (continued)

Alarm Type


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Note:

• Messages and alarms beginning with “SPO2” or “NIBP” apply only when the Ultraview Multiparameter Digital Telemetry transmitter is used and multiparameter operation is enabled by the MCM Multiparameter Telemetry ON setting. Refer to Multiparameter Telemetry (NIBP) on page 17-17 for more information.

• Alarm attributes for asystole and ventricular fibrillation cannot be changed.

- If ECG alarms are enabled, episodes of asystole and ventricular fibrillation will always trigger a high alarm tone.

NIBP Reading Failure (xx) H,M,L,N L N N N N

NIBP Air Leak H,M,L,N L N N N N

NIBP Loose or No Cuff H,M,L,N L N N N N

NIBP Patient Cancelled H,M,L,N L N N N N

NIBP Low Battery H,M,L,N L N N N N

NIBP Low Battery Backup H,M,L,N L N N N N

NIBP Kinked Hose H,M,L,N L N N N N

NIBP Event Code (xx) H,M,L,N L N N N N

NIBP Sys High Limit H,M,L,N L Y,N N Y,N N

NIBP Sys Low Limit H,M,L,N L Y,N N Y,N N

NIBP Dia High Limit H,M,L,N L Y,N N Y,N N

NIBP Dia High Limit H,M,L,N L Y,N N Y,N N

NIBP Mean High Limit H,M,L,N L Y,N N Y,N N

NIBP Mean Low Limit H,M,L,N L Y,N N Y,N N


Table 4: ECG Alarm Attributes (Telemetry Only) (continued)

Alarm Type


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- If ECG alarm recording is enabled, asystole and ventricular fibrillation will always trigger a recording.

- If Alarm Watch is enabled for a patient, asystole and ventricular fibrillation will always trigger an alarm notification.


• Setting tone type to NONE for high rate, low rate, ABN/MIN, or run causes the affected alarm limit to be displayed in reverse video in the ECG display zone.

Respiration

Respiration alarms can be set independently for the adult and infant mode. In the adult mode, respiratory rate alarms can be set as determined following initiation of respiratory monitoring. If you select the learned option, the high rate alarm limit is set at 1.5 times the learned rate. The low rate alarm limit is set to 0. The high limit is never automatically set above 150 breaths per minute (BPM) or lower than 30 BPM in the learned model.

Note:

Respiratory rate and apnea alarms cannot be disabled in the infant mode.

To review or change Respiration settings:

• Touch ECG.• Touch SETUP.• Touch CONFIG.• Touch the hidden key three times.• Touch USER SETTINGS.• Select RESP.• Use CURSOR and CURSOR to scroll through the parameter description list.• Use and to change the settings.• Touch NEXT PAGE to continue to next screen of parameters.• Touch STORE to save the new settings.• Touch YES when the STORE ALL CHANNEL DEFAULTS message is displayed.

Table 5: Respiration Parameter Configuration

Parameter Available User Settings Factory Defaults User Settings

Rate Alarms (Adult) ON/OFF OFF

High Rate Alarm Type Learned/Fixed Learned

High Rate Alarm Limit(only applies to fixed limits)

1 to 200 breaths/min. 50 breaths/min.



Low Rate Alarm Limit(only applies to fixed limits)

0 to 195 breaths/min. 0

Apnea Alarm ON/OFF OFF

Apnea Duration 5 to 40 seconds 20 seconds

Breathing Pattern Shallow/Normal Normal

Rate Alarms (Infant) ON ON ON

High Rate Alarm Type Learned/Fixed Fixed

High Rate Alarm Limit 1 to 200 breaths/min 100 breaths/min

Low Rate Alarm Limit 0 to 195 breaths/min 10 breaths/min

Apnea Alarm ON ON ON

Apnea Duration 5 to 40 seconds 20 seconds

Breathing Pattern Shallow/Normal Shallow

Waveform Display ON/OFF ON

Waveform Size 2.00 to 0.10 ohms/cm 1.00 ohms/cm

CVA Filter ON/OFF ON

Lead SelectionRA-LA, RL-LA, RA-LL,

RL-LLRA-LA

Sweep Speed25,12.5, 6.25 or 1.56 mm/sec.

12.5 mm/sec.

Breath Tone (local only) ON/OFF OFF

Breath Tone Volume (local only)

1 (soft) to 8 (loud) 3

Table 5: Respiration Parameter Configuration (continued)

Parameter Available User Settings Factory Defaults User Settings



Note:

• Alarms attributes for apnea cannot be changed.

- If RESP alarms are enabled, episodes of apnea will always trigger a high alarm tone.

- If RESP alarm recording is enabled, apnea will always trigger a recording.

- If Alarm Watch is enabled for a patient, apnea will always trigger an alarm notification.


• Setting tone type to NONE for high rate or low rate alarms causes the affected alarm limit to be displayed in reverse video in the RESP display zone.

Table 6: Respiration Alarm Attributes

Alarm Type


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Apnea H H H Y Y Y Y Y Y

High Rate H,M,L,N M Y,N Y Y,N Y

Low Rate H,M,L,N M Y,N Y Y,N Y

Loss of Signal H,M,L,N M N N N Y,N Y




Varitrend® 3

Default settings and individual parameter scales for the Varitrend timebase and display are adjustable. Definitions for up to five events can be pre-selected to describe concurrent changes in heart rate, respiration rate, or saturation level that may be of specific clinical interest.

To review or change Varitrend 3 settings:

• Touch ECG.• Touch SETUP.• Touch CONFIG.• Touch the hidden key 3 times.• Touch USER SETTINGS.• Select VARITREND.• Use CURSOR and CURSOR to scroll through the parameter description list.• Use and to change the settings.• Touch NEXT PAGE to continue to next screen of parameters.• Touch STORE to save the new settings.• Touch YES when the STORE ALL CHANNEL DEFAULTS message is displayed.

Table 7: Varitrend 3 Parameter Configuration


User Settings

Trend Timebase 1.5 minutes or 3.0 minutes 1.5 minutes

Resp Display Rate or waveform Waveform

Resp Waveform Size

±0.3 ohms

±0.5 ohms

±1.0 ohms

±2.0 ohms

±6.0 ohms

±2.0 ohms

Resp Rate Scale

AUTOSCALE

0 to 50

0 to100

0 to150

0 to 200

AUTOSCALE



Heart Rate Scale

AUTOSCALE

0 to100

0 to150

50 to150

0 to 200

100 to 200

0 to 250

100 to 250

0 to 300

100 to 300

AUTOSCALE

SpO2 Scale

AUTOSCALE

0 to100

25 to100

50 to100

75 to100

AUTOSCALE

Auto Alarm Recording ON/OFF OFF

Bradycardia Limit (event 1) 0 to150 bpm or OFF OFF

Tachycardia Limit (event 1) 100 to 300 bpm or OFF OFF

Apnea Limit (event 1) 10 to 40 seconds or OFF OFF

SpO2 Limit (event 1) 25% to 95% or OFF OFF

Bradycardia Limit (event 2) 0 to150 bpm or OFF OFF




Bradycardia Limit (event 3) 0 to 150 bpm or OFF OFF





Table 7: Varitrend 3 Parameter Configuration (continued)


User Settings



Non-Invasive Blood Pressure

Non-invasive blood pressure (NIBP) alarms can be set independently for the adult and infant modes. Default settings for systolic, diastolic and mean alarm limits are fully adjustable within the specified ranges.

To have measurements automatically initiated at regular intervals, you can select from the list of AUTO INTERVALS. After connecting a cuff to the patient, set AUTO to ON in the NIBP menu and NIBP measurements will be automatic.








To review or change NIBP settings:

• Touch ECG.• Touch SETUP.• Touch CONFIG.• Touch the hidden key 3 times.• Touch USER SETTINGS.• Select NIBP.• Use CURSOR and CURSOR to scroll through the parameter description list.• Use and to change the settings.• Touch NEXT PAGE to continue to next screen of parameters.• Touch STORE to save the new settings.• Touch YES when the STORE ALL CHANNEL DEFAULTS message is displayed.

Table 7: Varitrend 3 Parameter Configuration (continued)


User Settings



Table 8: NIBP Parameter Configurations

ParameterAvailable User

SettingsFactory Defaults

User Settings

Systolic Alarm (Adult) ON/OFF OFF

High Alarm Limit 45 to 260 mmHg 150 mmHg

Low Alarm Limit 40 to 255 mmHg 100 mmHg

Diastolic Alarm (Adult) On/off Off



Mean Alarm (Adult) ON/OFF OFF



Systolic Alarm (Infant) ON/OFF OFF



Diastolic Alarm (Infant) ON/OFF OFF



Mean Alarm (Infant) ON/OFF OFF



NIBP Mode Adult/Neonate Adult

Display Pulse Rate Yes/No Yes

Auto Interval1 to 10 minutes by 115 to 55 minutes by 5

1, 2, 4, or 8 hours15 minutes



Temperature

Default settings for high and low temperature alarm limits are adjustable, as well as the settings for the delta temperature.

Table 9: NIBP Alarm Attributes

Alarm Type


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Systolic H,M,L,N M Y,N N Y,N N

Diastolic H,M,L,N M Y,N N Y,N N

Mean H,M,L,N M Y,N N Y,N N

No Reading H,M,L,N N Y,N N Y,N N

System Fault H,M,L,N L Y,N N Y,N N

Remove Cuff H,M,L,N H Y,N N Y,N Y




To review or change Temperature settings:

Module Configurations with ECG

1 Touch ECG.

2 Touch SETUP.

3 Touch CONFIG.

4 Touch the hidden key three times.

5 Touch USER SETTINGS.

6 Select TEMP.

7 Use CURSOR and CURSOR to scroll through the parameter description list.

8 Use and to change the settings.

9 Touch STORE to save the new settings.

10 Touch YES when the STORE ALL CHANNEL DEFAULTS message is displayed.

Module Configurations without ECG

• Touch TEMP.• Refer to steps 4 through 10 above.

Table 10: Temperature Parameter Configuration



User Settings

Temperature 1 Alarms ON/OFF OFF

High Alarm Limit 0.1° to 50.0° C 37.5° C

Low Alarm Limit 0.0°to 49.9° C 36.5° C

Temperature 2 Alarms ON/OFF OFF


Low Alarm Limit 0.0° to 49.9° C 36.5° C

Delta Alarms ON/OFF OFF


Low Alarm Limit 0.0° to 49.9° C 0.0° C





Note:

Setting the tone type to NONE automatically sets the alarm recording and alarm watch to NO for that alarm. Changing the tone type from NONE to any other setting returns the alarm recording and alarm watch to the factory defaults.

Invasive Pressure

Invasive pressure parameters can be independently configured for each of two or four pressure channels. The alarm type must be set to Fixed for the user-defined alarm limit settings to be functional for high and low pressure alarm limits. If the alarm type is set to the Learned mode, high and low alarm limits are set according to the patient’s learned pressure.

The factory default label is:

• ART for the first pressure channel label

• PA for the second pressure channel

• PRS for the third channel

• CVP for the fourth channel

The associated alarm limit defaults correspond to typical pressure values for the respective catheter site.

Table 11: Temperature Alarm Attributes

Alarm Type


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T1 High Limit H,M,L,N L Y,N N Y,N N

T1 Low Limit H,M,L,N L Y,N N Y,N N

T2 High Limit H,M,L,N L Y,N N Y,N N

T2 Low Limit H,M,L,N L Y,N N Y,N N

DT High Limit H,M,L,N L Y,N N Y,N N

DT Low Limit H,M,L,N L Y,N N Y,N N




To review or change Invasive Pressure settings:


1 Touch ECG.

2 Touch SETUP.

3 Touch CONFIG.



6 Select PRESSURE.



9 Touch NEXT PAGE to continue to next screen of parameters.


11 Touch YES when the STORE ALL CHANNEL DEFAULTS is displayed.


• Touch TEMP.• Refer to steps 4 though 10 above.

Table 12: Pressure Parameter Configuration Table (Channel 1)


Settings

Label (P1)ICP, LAP, RAP, CVP, PA,

ART, UA, UV, PRSART

Scales ON/OFF OFF

Top of Scale 10 to 500 mmHg or Auto 200 mmHg

Filter Frequency3, 8, 12, 15, 18, 21, 25, 30,

35, 40 Hz12 Hz

Sweep Speed50, 25, 12.5, 6.25 mm/sec.,

or same as ECGsame as ECG

Artifact Rejection ON/OFF OFF

Numeric SizeSys/Dia LargeMean Large

All Large

Sys/DiaLarge

Alarm Type Learned/Fixed Learned

Systolic Alarm ON/OFF OFF



High Alarm Limit -45 to 300 mmHg or OFF 180 mmHg

Low Alarm Limit -50 to 295 mmHg or OFF 100 mmHg

Diastolic Alarm ON/OFF OFF



Mean Alarm ON/OFF OFF



CPP Alarm ON/OFF OFF





User Settings

Label (P2)ICP, LAP, RAP, CVP, PA, ART, UA, UV,

or PRSPA

Scales ON/OFF/Auto OFF

Top of Scale 10 to 500 mmHg 50 mmHg

Filter Frequency 3, 8, 12, 15, 18, 21, 25, 30, 35, 40 Hz 12 Hz

Sweep Speed50, 25, 12.5, 6.25 mm/sec., or

same as ECGSame as ECG

Artifact Rejection ON/OFF ON

Numeric SizeSystolic/Diastolic Large

Mean LargeAll Large

Systolic/DiastolicLarge



Table 12: Pressure Parameter Configuration Table (Channel 1) (continued)


Settings














Table 14: Invasive Pressure Parameter Configuration (Channel 3)


Settings

Label (P3)ICP, LAP, RAP, CVP, PA, ART, UA,

UV, or PRSPRS



Filter Frequency3, 8, 12, 15, 18, 21, 25, 30,

35, 40 Hz12 Hz

Sweep Speed50, 25, 12.5, 6.25 mm/sec., or




Mean LargeAll Large



Table 13: Pressure Parameter Configuration Table (Channel 2) (continued)


User Settings

















Settings

Label (P4)ICP, LAP, RAP, CVP, PA, ART, UA,

UV, or PRSCVP



Filter Frequency 3, 8, 12, 15, 18, 21, 25, 30, 35, 40 Hz 12 Hz

Sweep Speed50, 25, 12.5, 6.25 mm/sec, or




Mean LargeAll Large



Table 14: Invasive Pressure Parameter Configuration (Channel 3) (continued)


Settings















Table 16: Invasive Pressure Alarm Attributes

Alarm Type


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CH1 Systolic H,M,L,N H Y,N Y Y,N Y

CH1 Diastolic H,M,L,N H Y,N Y Y,N Y

CH1 Mean H,M,L,N H Y,N Y Y,N Y

CH1 CCP H,M,L,N H Y,N Y Y,N Y




Settings



Note:

Setting the tone type to NONE automatically sets the alarm recording and alarm watch to NO for that alarm. Changing the tone type from NONE to any other setting returns the alarm recording and alarm watch to the factory defaults.













Table 16: Invasive Pressure Alarm Attributes (continued)

Alarm Type


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SpO2

Default settings can be adjusted for high and low SpO2 alarm limits and settings for alarm priority.

To review or change SpO2 settings:


1 Touch ECG.

2 Touch SETUP.

3 Touch CONFIG.



6 Select SPO2.



9 Touch NEXT PAGE to continue to next screen of parameters.



• Touch TEMP. • Refer to steps 4 though 10 above.

Table 17: SpO2 Parameter Configuration



User Settings

SpO2 Alarms ON ON

High Alarm limit 51 to 100% 100%

Low Alarm limit 50 to 99% 85%

Limit Alarm Delay 0 to 30 seconds 15 seconds

Message Alarm Delay 0 to 60 seconds 20 seconds

Data Averaging Time 4, 8, or 16 seconds 8 seconds

Pulse Tone (local only) ON/OFF OFF



Note:


• Ultraview Digital Telemetry SpO2 default settings are described in Setting Up SpO2 Monitoring on page 14-4.

Pulse Tone Volume (local only) 1 (soft) to 8 (loud) 4

Pulse Rate Display ON/OFF ON

Motion Detection ON/OFF ON

Table 18: SpO2 Alarm Attributes

Alarm Type


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High Limit H,M,L,N H Y,N Y Y,N Y

Low Limit H,M,L,N H Y,N Y Y,N Y

Adapter Disconnected H,M,L,N L N N N Y,N N

Sensor Disconnected H,M,L,N L N N N Y,N N

Sensor Off Patient H,M,L,N L N N N Y,N N

Insufficient Signal H,M,L,N L N N N Y,N N

Light Interference H,M,L,N L N N N Y,N N


Low Signal Strength H,M,L,N N N N N Y,N N


Table 17: SpO2 Parameter Configuration (continued)



User Settings



Transferring User-Defined Settings

Once you have configured the settings on your module you may transfer these settings to the monitor for subsequent retrieval into other modules. (Refer to Retrieving User-Defined Settings on page 7-39.)

When the transfer of settings into the monitor is complete, the transfer successful message will be displayed.

Note:

User-defined default settings that have been transferred to the monitor’s memory are available for retrieval into other modules until (1) the monitor is powered OFF or (2) a patient is admitted to or discharged from that monitor with a Purge Data/Yes.

Retrieving User-Defined Settings

To standardize the user-configurable options for similar modules, you can configure a single module and transfer its settings to the monitor for subsequent retrieval into other modules.

First, transfer the settings from the configured module into the monitor. Insert a second module or remote module housing into the monitor and retrieve the settings.

When the retrieval of data into the module is complete, a RETRIEVAL SUCCESSFUL message will be displayed. If settings have not been previously transferred into the monitor, a RETRIEVAL FAILED message will be displayed.

Note:

• User-defined default settings that have been transferred to the monitor’s memory are available for retrieval into other modules until (1) a monitor is powered OFF or (2) a patient is admitted to or discharged from that monitor with a Purge Data/Yes.

• Once retrieved, alarm ON/OFF status and alarm limits for all parameters will be reset according to the newly retrieved settings.

To transfer user-defined settings from the module into the monitor:


1 Touch ECG.

2 Touch SETUP.

3 Touch CONFIG.


5 Touch TRANSFER SETTINGS.

6 Select YES.





Restoring Factory Settings

The Factory Default feature changes the user-configurable settings for all parameters in the module to the factory default settings.

Note:

Alarm ON/OFF status and alarm limits for all parameters are reset to the factory default settings.

To retrieve user-defined settings from the monitor into another module:


1 Touch ECG.

2 Touch SETUP.

3 Touch CONFIG.


5 Touch RETRIEVE SETTINGS.

6 Select YES.



To restore factory settings:


1 Touch ECG.

2 Touch SETUP.

3 Touch CONFIG.


5 Touch FACTORY DEFAULTS.

6 Select YES.


• Touch TEMP.• Refer to steps 4 though 6 above.



Restoring User-Defined Settings

The Restore Settings feature changes the user-configurable settings for all parameters in the module to the defaults previously stored as user settings.

Note:

Once restored, alarm ON/OFF status and alarm limits for all parameters in the module are reset to the previously stored user settings.

To restore user-defined settings:


1 Touch ECG.

2 Touch SETUP.

3 Touch RESTORE SETTINGS.

4 Select YES.


• Touch TEMP.• Refer to steps 3 and 4 above.


ECG

Directory of Keys


ECG

2 LEADON OFF

VARITRENDON OFF

SPLIT VIEWON OFF

RATESOURCE

SWEEP SPEED

QRS MONITOR PACEDYES NO

CONFIGTONE EXTENDED

ADULTINFANT

50 mm/sec

12.5 mm/sec

25 mm/sec

TONEON OFF

SPO2 PITCHON OFFVOLUME VOLUME

SIZE SIZE1 mV

1 mV/cmCAL

ECG - DISPLAY FORMAT

ECG - SETUP

ECG - CONFIG

ECG - SWEEP SPEED

ECG - SIZE

ECG - QRS TONE

ALARMLIMITS

SIZE SETUPDISPLAYFORMAT

SUSPENDPROCESSING

RELEARN PRINT

ECG MENU

REVIEW

ALARMS

ON OFF

HI=130

LO=40

ABN INROW=5

ABN PERMIN=OFF

SINGLEST = 1.00

MULTIST = 0.50

ECG - ALARM LIMITS

1st LEADxx

ARR ON OFF

TRANSFERDATA

FULL VIEWON OFF

STLEADS

CASCADEON OFF

ECG - LEAD CONTROL

RESTORESETTINGS

Select primary heart rate source

ECG ART UA SPO2

Enable alternate rate source(s)

UA ON OFF

ART ON OFF

SPO2 ON OFF

ECG ON OFF

LEADCONTROL

NEXTVIEW

ARRCLASSES

STSEGMENTS

ALLLEADS

PRINTALL

PRINT MENU

AUTO LEAD SWITCHON OFF

2nd LEADxx

SINGLE LEAD ALARMON OFF

CANCELPRINT

STREVIEW

ARRHYTHMIAREVIEW

ECG - REVIEW

CLEARMEMORY

SAVEMEMORY

ECG - RELEARN

ECG - SUSPEND PROCESSING

YES NO

RESTORE all user settings within this module

RESPON OFF

REPORT

REVIEW

REAL TIMEST TREND

TREND DISPLAY

ON OFF

TREND TIMEBASE

15 MIN / 30 MIN

YES NO


ECG

Contents

Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3ECG Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Selecting Adult or Neonate Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Monitoring Paced Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Setting and Adjusting Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Selecting ECG Leads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Displaying Additional Waveforms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Checking the ECG Amplitude . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Adjusting Waveform Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Adjusting Sweep Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Adjusting Tones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Changing the Display Resolution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Selecting Primary and Alternate Heart Rate Source . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Suspending/Resuming ECG Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Printing ECG Recordings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Restoring Default Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Power Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22ECG Problem Solving. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22ECG Troubleshooting Guide. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Overview

Note:

Some of the telemetry features described in this chapter may not be available.

When used in conjunction with a Spacelabs Healthcare Ultraview Care Network monitor, the ECG function provides a means for continuous monitoring of electrocardiographic signals. It can detect abnormal cardiac rhythms, including life-threatening arrhythmias such as asystole, ventricular fibrillation, and ventricular tachycardia.

The basic ECG software provides alarms for high and low heart rates, ventricular fibrillation, and asystole.

The Multiview I option provides enhanced arrhythmia detection and alarm capability. Multiview I detects ventricular tachycardia, couplets, and single abnormal beats in addition to the detection and alarm capabilities of the basic ECG software.

The Multiview II option expands arrhythmia detection to include pauses and tachycardias of a supraventricular origin. This option also offers storage capabilities so that trends of arrhythmia episodes, as well as dominant, ventricular-paced and AV-paced rhythms, can be reviewed, edited, and printed. Refer to Arrhythmia on page 9-3 for detailed information about the Multiview options.

The diagnostic ECG feature, which meets all of the requirements and standards for electrocardiographic devices, provides the capability to obtain a diagnostic 12-lead report as a function of the monitoring system. The 12-lead report is a set of diagnostic-quality electrocardiographic waveforms that accurately represent both the detailed cardiac cycle and the cardiac rhythm.


ECG

The ECG function:

• detects and displays a waveform representing each cardiac cycle

• determines lead configuration options

• displays heart rate (heart rate is computed from an average of eight beats with a provision for immediately updating the heart rate should the rate slow suddenly)

• detects pacemaker pulses

• initiates ECG-related alarms when limits are violated

• acquires, displays, and prints diagnostic-quality 12-lead reports

ECG traces for multiple leads can be displayed, however, ECG monitoring is always performed on two leads. Lead faults are identified by a message on the screen. If automatic lead switching is enabled, the system automatically switches to another appropriate lead to continue monitoring in the event of a lead fault.

Warning:Following a lead switch and until the patient’s rate and morphology are learned, some ECG alarms are not active. Alarms for ventricular fibrillation and asystole continue to be active. However, ECG alarms for high rate, low rate, run, couplet, abnormal per minute, and tachycardia are not.

Note:

• Monitor input circuits are protected for electrosurgical equipment and defibrillator use.

• Cardiac pacemakers or other electrical stimulators do not affect and are not affected by operation of this unit.

• You can define your own default settings for such characteristics as alarm limits and display configuration. Refer to Module Configuration Manager on page 7-5 for further information.

ECG Setup

The ECG waveform area displays the CHECK SETUP key and sounds an alarm when the monitor is powered ON, following a monitor reset, and after an ECG module is inserted. Touch the ECG key to dismiss the CHECK SETUP key and silence the alarm. Verify that the system configuration (for example, alarm limits, lead selection, etc.) is appropriate before you begin, or resume, monitoring.

Warning:Signals resulting from devices such as Automatic Implantable Cardiac Defibrillators (AICD) may momentarily blank the ECG trace rather than display an out-of-range signal. In such cases, it may not be apparent that the AICD has fired and the condition of the patient should be checked. In all instances of AICD firing, the monitor will redisplay the ECG waveform within five seconds.

Note:

When the Check Setup feature is disabled, the CHECK SETUP key will not display and its associated alarm tone will not sound. Contact your system administrator to enable this feature.


ECG

Accessories

Warning:Use only monitoring cables and safety lead wires to protect against accidental connection to electrical power cords or outlets. Failure to do so may result in adverse health consequences or death.

Use silver/silver-chloride electrodes or their equivalent, and always connect all electrodes required for a particular lead. Missing electrodes may result in the loss of ECG tracing.

Caution:• Visually inspect each lead wire for obvious damage and replace them as needed.

• When placing a telemetry transmitter on the patient, make sure the front of the transmitter is always facing away from the patient.

• Use only patient cables and lead wires specified by Spacelabs Healthcare. Other cables and lead wires may degrade performance and may damage the monitor during defibrillation or high frequency electrosurgery. Non-Spacelabs Healthcare cables and lead wires may also change the required input impedance and DC offset voltage, affecting monitor performance.

• Do not use stainless steel electrodes.

• Place the electrodes as far away from the electrosurgery site as possible because considerable high frequency current may flow into the electrodes. This can cause patient burns, especially if a defect is present in the neutral cable of the electrosurgical unit. Placing electrodes too close to the electrosurgery site can also cause a noisy ECG trace.

• Do not allow conductive parts of electrode leads or connectors, including the neutral electrode, to contact other conductive parts, including the ground.

• Poor cable dress or improper electrode preparation may cause line isolation monitor transients to resemble actual cardiac waveforms and thus inhibit heart rate alarms. Refer to Patient Preparation and Electrode Application on page 8-5 for details on proper electrode preparation and application.

Note:

Use only Spacelabs Healthcare recommended electrodes. Some electrodes may polarize, creating large offset potentials which can compromise recovery time after application of defibrillator pulses. Squeeze bulb electrodes, commonly used for diagnostic ECG recording, may be particularly vulnerable to this effect.

Patient Preparation and Electrode Application

To set up for ECG monitoring, first attach lead wires to the patient cable or telemetry transmitter. Match the color-coding on the patient cable or telemetry transmitter to the lead wire color.

Next, attach each electrode to its lead wire before applying the electrodes to the patient. Figure 8-1 displays the correct procedure for applying electrodes to a patient. Be sure to press firmly around the entire edge of the adhesive surface. Do not apply pressure over the gel column itself as this may trap air or displace the conductive gel, which may degrade the signal significantly. Gel displacement arising from attaching the electrode to the lead wire after applying the electrode to the patient may also degrade the signal.


ECG

Electrodes should be placed over flat, non-muscular areas of the body to minimize muscle artifact (refer to Figure 8-2 and Figure 8-3). This is particularly important for telemetry patients who are commonly ambulatory. If necessary, after the electrodes and lead wires have been attached, tape a stress loop (a loop of lead wire close to the electrode that minimizes stress or pulling on the electrode itself. Stress-looping significantly improves ECG signal quality, particularly for ambulatory patients.

ECG monitoring begins when the module detects a signal via connection of an ECG patient cable to the module or by installation of a battery in a telemetry transmitter.

ECG monitoring requires the following minimum conditions:

• ECG electrodes must be properly attached the patient and lead wires must be properly attached to the patient cable or telemetry transmitter.

• The patient cable must be connected to the module or telemetry transmitter.

• The module must be connected to a monitor that is powered ON.

Telemetry ECG monitoring requires the following additional minimum conditions:

• The telemetry transmitter must have a functional battery.

• The telemetry receiver module must be tuned to the telemetry transmitter’s frequency (channel number).

• The telemetry receiver module must be connected to a Spacelabs Healthcare diversity antenna.

• Refer to Setting up Telemetry Monitoring on page 17-14 for more information.

Figure 8-1: Electrode application

1 Attach electrode to lead wire. 2 Apply electrode to skin.

To prepare the patient:

• Wash the area where you plan to place an electrode with soap and water.• If necessary, shave the area where you plan to position the electrodes.• Clean the skin with alcohol.• Dry the skin thoroughly.• Abrade the skin.

To apply ECG electrodes:

• Attach electrode to lead wire.• Apply electrode to patient skin.


ECG

V

R

Table 1 lists electrode color and identifier codes.

Figure 8-2: Adult electrode placement

Table 1: Electrode Color and Identifier Codes

AHA Electrode Identifier

AHA Color Code

Electrode PlacementIEC Electrode

IdentifierIEC Color

Code

RA White Right Arm R Red

LA Black Left Arm L Yellow

LL Red Left Leg F Green

RL Green Right Leg N Black

V1 Brown/Red 4th Intercostal - Right Sternum C1 White/Red

V2 Brown/Yellow 4th Intercostal - Left Sternum C2 White/Yellow

V3 Brown/Green Midway Between V2 and V4 C3 White/Green

V4 Brown/Blue 5th Intercostal - Left Midclavicular C4 White/Brown

V5Brown/Orange

Left Anterior Axillary Line at V4 C5 White/Black

V6 Brown/Violet Left Midaxillary Line at V4 C6 White/Violet

C Brown Chest C White

LARA

LLRL

LARA

LL

Chest electrodes must beappropriately relocated onpatient’s chest to view alternateprecordial leads.

Chest electrodesmust be appropriatelyplaced on the patient’schest to view precordialleads.

5 ElectrodesI, II, III, aVR, aVL, aVF,

V1 - V6

4 ElectrodesI, II, III, aVR, aVL, aVF

3 ElectrodesI, II, III

10 Electrodes

LARA

1 (C1)

LLL

LARA

V1 (C1)

LLRL

V6 (C6)

V2 (C2)V3 (C3)V4 (C4)V5 (C5)

V6 (C6)

V2 (C2)V3 (C3)V4 (C4)V5 (C5)


ECG

Figure 8-3: Neonate electrode placement

LARA

LL

Alternate Method:

Position RA and LA electrodes at the 2nd intercostal space, midclavicular line. Position LL below the diaphragm, preferably below the umbilicus.

RALA

LL

Maximum Impedance Change:

Position RA and LA electrodes at the nipple level, midaxillary line. Position LL below the diaphragm, preferably below the umbilicus.


ECG

Display Detail

Note:

For telemetry display information refer to Display Detail on page 17-12.

Your ECG display may differ from the one shown here depending on: 1) the type of monitor you are using, 2) the options in your module, 3) which functions you have enabled, and 4) which patient type you have selected.

The illustrations below show the displays with arrhythmia and ST analysis ON.

Figure 8-4: Bedside monitor display (full view)

Figure 8-5: Central monitor display (split screen)

� � � � �

�

*

*ECG

II

A=3

A/M 10ROW 4

120

4070AVR

AVL

AVF

V4

V5

V6

V1

V2

V3

III

II

I

IIIIIIV1V2V3

AVRAVL AVFV4V5V6

0.160.001.44

-1.442.881.44

0.16

0.16-0.16-0.16-0.16

0.24

ST=0.00* **MON PACED

�

�

�

�

�

ECG

HR=70 SPO2=99% 123/90 25/12

BED 01 DANIELS,R

RR=23 NIBP=155/100

� � �

� ��

�


ECG

Figure 8-6: Central monitor display

� ECG trace for first lead

� bed name

� ECG key for first lead

� QRS indicator (flashes once per detected beat)

� ECG lead designator

� display resolution (monitor or extended)

� paced operation indication (pacemaker detection is enabled)

abnormals per minute alarm limit *

ST segment level for first lead** (the asterisk indicates ST alarms are enabled)

� abnormals in a row alarm limit *

ECG rate alarm limits. Split-screen central monitors display a bell symbol when alarms are enabled; bedside monitors display the rate alarm limits (120/40)

� abnormals per minute counter *

� current heart rate

� arterial pressure

� pulmonary artery pressure

� SpO2 level

� respiration rate

� non-invasive blood pressure (systolic/diastolic)

� ECG Full View display

� ST Segment levels for Full View Display

* Only appears with the Multiview I or II option in the adult mode with Arrhythmia detection enabled.

** Only appears in adult mode with the ST segment analysis option.

Note:

If the enhanced vital sign display feature is enabled, you can view SpO2, respiration rate, and non-invasive pressure in the ECG zone on central or remote bedside monitors. However, no alarms are active.

ECG

II MON PACED

ST=0.00A=3

A/M 10ROW 4

120

4070

123/90 25/12

* ***

*BED 01 DANIELS,R

RR=23 NIBP=155/100 SPO2=99%

� � � � �

�

�

*

��


ECG

Selecting Adult or Neonate Mode

The ECG function provides both adult and neonate operational modes. When you select adult or infant, ECG alarm limits are adjusted based on your selection.

Warning:When the system is in the neonate mode, ECG and respiration alarm activation can be delayed from 0 to 3 minutes. The factory default setting for alarm delay is 3 minutes. Closely observe the patient during this period.

Monitoring Paced Patients

When you monitor pacemaker patients, use the Paced feature to automatically enhance pacemaker spikes for display and eliminate them from the heart rate counter.

To prevent pacemaker pulses from being counted as actual beats, specialized circuitry removes the pacemaker pulses from the ECG signal and replaces them with pacemaker flags.

If the interval between the pacemaker pulse and the QRS complex is greater than 150 milliseconds, the beat is considered to have originated in the atria, and is not classified as a paced beat.

Warning:• ECG detection circuitry may continue to count the pacemaker rate during occurrences of

cardiac arrest or some arrhythmias. Do not rely entirely upon ECG rate alarms. Keep pacemaker patients under close surveillance.

• During electrosurgical activity, the system may not accurately detect paced beats due to the electrical interference.

To specify the patient type:

• Touch ECG.• Touch SETUP.• Touch CONFIG.• Select ADULT or INFANT.

To monitor paced patients:

• Touch ECG.• Touch SETUP. • Select PACED YES.


ECG

• The system may insert pacemaker flags into the ECG signal in response to signals that are not pacemaker pulses. Therefore, if you use a Spacelabs Healthcare monitor to observe pacemaker performance, you must take into account all possible sources of pacemaker flags.

• Use the pacemaker manufacturer's performance analyzer as the primary means of evaluating pacemaker operation.

• Operation of some pacemaker programs may suppress the ECG waveform, preventing QRS detection and rate counting. This may result in an erroneous asystole alarm.

• Signals resulting from devices such as Automatic Implantable Cardiac Defibrillators (AICD) may momentarily blank the ECG trace rather than display an out-of-range signal. In such cases, it may not be apparent that the AICD has signaled and the condition of the patient should be checked. In all instances of AICD signaling, the bedside or central will redisplay the ECG waveform within five seconds.

Note:

• The optimal leads for monitoring paced patients may vary. To select an optimal trace, sequence through the available leads. If pacemaker spikes are not detected or if the heart rate is incorrectly counted, select another lead or change electrode position.

• In telemetry monitoring, pacemaker spikes are detected on lead II.

When using temporary transvenous pacemakers, you may want to check the pacemaker capture threshold on a regular basis (refer to your hospital protocol for frequency and procedure). Since the pacemaker flag substituted by the monitor does not represent the true amplitude of the detected pacemaker pulse, you will need to temporarily deactivate the Ultraview Care Network pacemaker software to check the capture threshold. In addition, placing the display in the extended mode and changing the sweep speed to 50 mm/sec will enhance the resolution and improve visualization of the pacemaker pulse amplitude. Remember to return to the monitor mode, reactivate pacemaker detection, and reset desired sweep speed after checking the capture threshold.

Permanent transvenous pacemakers employing a bipolar lead system are capable of obtaining capture of the cardiac muscle at a much lower current than those with unipolar lead systems. For optimal paced rhythm detection, the pacemaker pulse and QRS complex must be of sufficient voltage. To determine if the monitor is correctly detecting the pacemaker pulses, verify that the Paced mode is activated. Each paced beat should have a pacemaker flag superimposed on the ECG trace at the appropriate point prior to the QRS complex. If flags are not consistently observed, sequence through the available leads for a better lead, or reposition electrodes, to optimize pacemaker detection. Check the amplitude of the QRS complex by inserting a 1 mV calibration pulse in the ECG trace as described in Checking the ECG Amplitude on page 8-16.


ECG

Setting and Adjusting Alarms

ECG alarms default to the ON position when the module is inserted into a monitor that is powered ON. Events that can cause an ECG alarm include:

• High or low rate

• Ventricular fibrillation (VFIB)

• Asystole

Warning:• If ECG monitoring is interrupted and subsequently resumed during an asystole event, five to six

seconds will elapse prior to the monitor sounding and displaying the Asystole alarm.

• If ECG monitoring is initiated during an asystole event, 10 to 11 seconds will elapse prior to the monitor sounding and displaying an Asystole alarm.

Additional conditions which can cause an alarm with the Multiview I or II options include:

• Abnormals in a row (couplets or runs)

• Abnormals per minute

• Tachycardia (of supraventricular origin)

Note:

If the alarm limit for high rate, low rate, abnormals per minute (A/M) or abnormals in a row (ROW) is displayed in reverse video, this is an indication that alarm tone, alarm recording, and alarm watch have been disabled for the indicated alarm.

To check capture threshold:

• Touch ECG.• Touch SETUP.• Select PACED NO.• Select EXTENDED.• Touch SWEEP SPEED.• Select 50 mm/sec.• Perform capture threshold verification procedure according to your protocol.• Touch ECG.• Touch SETUP.• Select PACED YES.• Select MONITOR.• Touch SWEEP SPEED.• Select desired speed.


ECG

Refer to Arrhythmia on page 9-3 for details concerning arrhythmia alarms or to ST Analysis on page 10-3 for details concerning ST alarms.

Initial Alarm Limits for Heart Rate

At the completion of a learn sequence (refer to Learning the Dominant Waveform on page 9-5), the rate alarm limits are initialized using fixed or learned criteria.

When you change the adult/neonate configuration, the system changes the alarm limits accordingly. You can adjust these limits up or down as needed.

Alarms

Table 2 displays the conditions for which an alarm may be initiated.

To set or adjust rate alarms:

• Touch ECG.• Touch ALARM LIMITS.• Touch ALARMS ON.• Touch HI = or LO = key.• Use arrow keys to adjust.

Table 2: ECG Alarms

Alarm Cause Of Alarm Display Indication

VFIB Ventricular fibrillation detected VFIB

Asystole>5 seconds with no QRS detected

Heart rate 0; flashing low rate limit; ASYSTOLE

High Heart Rate High limit violatedFlashing high limit and HI RATE ALARM

Low Heart Rate Low limit violatedFlashing low limit and LO RATE ALARM

Chan 1 and 2 — Leads OFFOne or more of the electrodes for both ECG leads are off or loose

No ECG trace and CHAN 1 & 2 LEADS OFF

Chan 1 — Lead OFFOne or more of the electrodes for the first ECG lead are OFF or loose

No ECG trace and CHAN 1 - LEADS OFF

Chan 2 — Lead OFFOne or more of the electrodes for the second ECG lead are OFF or loose

No ECG trace and CHAN 2 - LEADS OFF


ECG

Selecting ECG Leads

When you select a precordial lead, a help message appears that describes the proper location for the chest electrode. For example, if you select V1, the message (C) 4TH INTERCOSTAL SPACE, RIGHT STERNAL BORDER is displayed.

No message appears when you choose to display a limb or augmented lead (for example, I, II, III, AVR, AVL, or AVF).

Note:

Changing your selection for the first lead may change the selection for the second lead.

When you change lead selections, the new waveform is displayed and the learn sequence is automatically initiated. If you change lead selections while processing is suspended, the module initiates the learn sequence when you resume processing.

Warning:Following a lead switch and until the patient’s rate and morphology are learned, some ECG alarms are not active. Alarms for ventricular fibrillation and asystole continue to be active; however, some ECG alarms (high rate, low rate, run, couplet, abnormal per minute, and tachycardia) are not.

Rate Source UnavailableHeart rate is not available from either the primary or any alternate heart rate source

HR UNAVAILABLE

Noisy SignalExcessive noise, artifact or baseline shift

NOISY SIGNAL

Low ECG VoltageQRS amplitude is between 0.16 and 0.20 mV (adult only)

ECG VOLTAGE TOO LOW

To change the lead selection:

• Touch ECG.• Touch LEAD CONTROL.• Touch 1ST LEAD or 2ND LEAD.• Select lead.

Table 2: ECG Alarms (continued)

Alarm Cause Of Alarm Display Indication


ECG

Displaying Additional Waveforms

Multiple ECG traces can be displayed by selecting either FULL VIEW, SPLIT VIEW, 2ND LEAD or CASCADE.

A second waveform zone can be used to display either a second ECG lead or a cascaded trace from the first ECG zone. However, you cannot display both a second ECG trace and a cascaded ECG trace at the same time.

Data in a cascaded ECG trace wraps from the first waveform zone into the second to display 12 seconds of data for the selected lead. While the cascaded trace is displayed, the text in the parameter key for the second zone displays STOP. Touching the STOP key freezes the trace for viewing. While the display is frozen, the text in the key displays START. Touching the key again unfreezes the trace.

Checking the ECG Amplitude

Touching the 1 mV CAL key inserts a 1 mV amplitude calibration pulse into all ECG tracings. Use this calibration pulse as a reference to determine whether the amplitude of the ECG waveform exceeds the minimum voltage threshold.

For ECG detection, the QRS amplitude must be at least 0.2 to 0.5 mV in an adult and 0.15 to 0.5 mV in a neonate.

To display six traces (requires a 12-lead cable):

• Touch ECG.• Touch DISPLAY FORMAT.• Select SPLIT VIEW ON.

To display twelve traces (requires a 12-lead cable):

• Touch ECG.• Touch DISPLAY FORMAT.• Select FULL VIEW ON.

To check the ECG amplitude:

• Touch ECG.• Touch SIZE.• Touch 1 mV CAL.


ECG

Adjusting Waveform Size

You can increase or decrease the display size of the ECG waveform. This changes the displayed size only and does not affect the signal gain.

When you touch the 1 mV/cm key, you set the ECG waveform size to 1 millivolt per centimeter. This standardizes the waveform to aid in accurately viewing QRS complexes for ST segment deviation. The factory default setting for ECG waveform size is 0.5 mV/cm.

Note:

When displaying multiple ECG leads in the split-view or full-view format, the waveform size of all leads is adjusted simultaneously.

Adjusting Sweep Speed

The sweep speed determines the speed at which the ECG traces move across the screen. When multiple ECG traces are displayed, changes to SWEEP SPEED affect all waveform traces. Available sweep speeds are 12.5, 25, or 50 mm/second. The factory default setting is 25 mm/second.

Note:

Changing the ECG sweep speed may also change the speed of the invasive pressure waveforms. Refer to Pressure on page 18-3 for more details.

To adjust waveform size:

• Touch ECG.• Touch SIZE.• Touch the arrow keys to adjust.

-OR-

• Touch the 1 mV/cm key to standardize.

To adjust the sweep speed:

• Touch ECG.• Touch SETUP.• Touch SWEEP SPEED.• Select the desired sweep speed.


ECG

Adjusting Tones

The QRS tone is the sound the monitor generates with each detected R wave. When you enable the QRS tone, you can adjust the volume and select whether to modulate the tone with the current SpO2 value. The factory default setting for QRS tone is OFF.

The factory default setting for SpO2 pitch is OFF. In this setting, the monitor uses the default pitch for the QRS tone. When you enable the SpO2 pitch tone, the monitor modulates the pitch of the QRS tone higher or lower depending on the current SpO2 value. When you disable the QRS tone, the system automatically turns SpO2 pitch modulation OFF.

Changing the Display Resolution

The MONITOR/EXTENDED key determines the display resolution of the ECG traces.

• The Monitor mode displays a reduced frequency range, but filters out more noise for better viewing.

• The Extended mode displays a broader frequency range, and also more noise.

Note:

Changing the display resolution does not change the waveform bandwidth used to analyze the ECG signals for arrhythmia and ST segment level.

The factory default setting for display resolution is monitor mode.

To set the QRS tone:

• Touch ECG.• Touch SETUP.• Touch QRS TONE.• Select TONE ON.• Use arrow keys to adjust volume.

Table 3: Display Resolution

Key Telemetry Non-telemetry

MONITOR 0.5 to 30 Hz 0.5 to 40 Hz

EXTENDED 0.05 to 30 Hz 0.05 to 150 Hz

To change the display resolution:

• Touch ECG.• Touch SETUP.• Select MONITOR or EXTENDED.


ECG

Selecting Primary and Alternate Heart Rate Source

You may select a primary rate source as well as enable alternate rate sources. Rate sources include ECG, ART (arterial pressure), UA (umbilical artery) and SpO2. If you enable one or more alternate sources, a heart rate will be displayed, if available, from either the primary or an alternate source. If you do not enable any alternate sources, a heart rate will only be displayed if the primary rate source is available.

If a heart rate is not available from any source, the message HR UNAVAILABLE is displayed in the ECG waveform zone, and ??? replace the rate numbers.

Caution:Cardiovascular Artifact (CVA) detection is disabled for the respiration channel when using an alternate heart rate source.

Note:

• If ART is to be used as an alternate heart rate source, Spacelabs Healthcare recommends setting up each monitor with only one arterial pressure channel.

• Use of SpO2 as the primary heart rate source is not recommended by Spacelabs Healthcare.

To select a primary heart rate source:

• Touch ECG.• Touch SETUP.• Touch RATE SOURCE.• Select the desired primary rate source (ECG, ART, UA, or SPO2).

To enable alternate rate sources:

• Touch ECG.• Touch SETUP.• Touch RATE SOURCE.• Set the desired alternate source(s) to ON (ECG, ART, UA, and/or SPO2).


ECG

Suspending/Resuming ECG Processing

When you touch YES in the Suspend Processing menu, ECG and respiration waveforms continue to be displayed, but no processing occurs. If you touch NO, the display returns to the ECG menu without affecting ECG and respiration processing.

When you suspend ECG processing:

• The message ECG PROCESSING SUSPENDED appears in the ECG waveform zone. In modules with the respiration option RESP PROCESSING SUSPENDED appears in the respiration waveform zone.

• Question marks replace the heart rate immediately and replace the ST segment value after 30 seconds. If an alternate heart rate source is available, the new heart rate is displayed. Question marks (???) will continue to display for the ST segment value.

• The message ECG ALM OFF replaces the alarm limits (if no alternate rate source is available).

• The keys in the ECG Alarm Limits menu display dotted outlines to indicate they are disabled (if no alternate rate source is available).

• The key SUSPEND PROCESSING changes to RESUME PROCESSING.

• For multiparameter telemetry, SpO2 and/or NIBP alarm surveillance is still active if already enabled by the user. Alarm messages related to NIBP and SpO2 prevent the ECG PROCESSING SUSPENDED message from displaying.

To suspend ECG processing:

• Touch ECG.• Touch SUSPEND PROCESSING.• Touch YES.

To resume ECG processing:

• Touch ECG.• Touch RESUME PROCESSING.• Touch YES.


ECG

Printing ECG Recordings

All printouts of ECG data are annotated with the following:

• Bed identification

• Time and date of the printout

• Lead designator

Depending on the printer model and software version, the ALL LEADS recording can be printed on a single page or as consecutive two- or four-channel recordings. For these recording formats, 6.25 seconds of waveform data will be printed for all available leads.

If you are using a 90838 PrintMaster and if all the leads are connected, touching the STAT REPORT key will provide a 12-lead report. For this recording format, 2.5 seconds of waveform data will be printed for each lead plus 10 seconds of waveform data for a rhythm lead.

A 12-lead report can be scheduled to print at regular time intervals using the AUTO REPORT and AUTO PRINT features. Available intervals are 30 minutes, 1 hour, 2 hours, 4 hours, 8 hours, and 24 hours.

Note:

• A printer (with 1.10.04 version software or greater) is required for the STAT REPORT feature.

• A 12-lead report cannot be printed using the 90449 printer module.

To print recordings of all leads:

• Touch ECG.• Touch PRINT.• Touch ALL LEADS.

To print a 12-lead report:

• Touch ECG.• Touch REVIEW.• Touch REPORT REVIEW.• Touch STAT REPORT.• Touch PRINT.

To print a 12-lead report at pre-selected intervals:

• Touch ECG.• Touch REVIEW.• Touch REPORT REVIEW.• Select AUTO REPORT of 30 minutes, 1 hour, 2 hours, 4 hours, 8 hours, or 24 hours.• Touch AUTO PRINT ON.


ECG

Restoring Default Settings

Using the Module Configuration Manager feature, you can restore all default settings. User-configurable settings are described in Setting User-Defined Default Values on page 7-7.

After the default settings are restored, the system initiates a learn sequence. Following the learn sequence, rate and ST alarm limits are reset.

Note:

RESTORE SETTINGS changes the user-configurable settings for all parameters in the module.

Power Failure

In the case of a power failure, the remote module housing (90499) provides +5 V of power to maintain data integrity. If the power is interrupted to the remote module housing but not to the monitor, the following will occur:

• all parameters will display ??? in the numeric zone

• ECG will display Channel 1 & 2 Leads Off

• Respiration will display Loss of Signal

• Cardiac output will display Catheter Fault and Probe Fail

• SpO2 will display Adapter Disconnected

ECG Problem Solving

In general, if ECG signal quality is poor (as evidenced by wandering baseline, excessive noise, or muscle or respiration artifact), try the following solutions:

• Ensure that the patient's skin was properly prepared.

• Ensure that all electrodes are firmly attached and in good condition.

• Ensure that the electrodes are positioned on a flat, non-muscular area.

• Ensure that lead wires are properly fastened and in good condition.

If this fails to resolve the problem, select a different lead.

To restore default settings:

• Touch ECG.• Touch SETUP.• Touch RESTORE SETTINGS.• Select YES.


ECG

By following the instructions provided in this chapter and discussed during in-service education, you can avoid most common monitoring problems. If a problem occurs, consult the ECG Troubleshooting Guide on page 8-24. The following additional information should help you resolve a few of the more complex problems.

Lead Fault Indication

If a lead fault occurs, the message CHECK XX is displayed in the ECG waveform zone, where XX identifies the failed or missing electrode. If automatic lead switching is enabled, the module selects another lead automatically so that monitoring is uninterrupted. If automatic lead switching is disabled, a LEAD OFF message is displayed.

Noise Detection

Upon detection of noise, a NOISY SIGNAL message is displayed in the ECG waveform zone. If both the 1st and 2nd leads are noisy, the module suspends processing temporarily. If the noise persists for 10 seconds, the system sounds a tone. When the noise disappears, the message and tone cease.

Note:

• If monitoring is interrupted due to overload or saturation of the input amplifiers, including overload caused by a defibrillator discharge, the ECG trace is displayed as an out-of-range signal accompanied by a NOISY SIGNAL or an HR UNAVAILABLE message, or both. If the overload or saturation condition persists, the ECG trace is displayed as a flat line signal accompanied by an ASYSTOLE message.

• If the displayed waveform does not appear noisy, but the NOISY SIGNAL message persists, check all leads for noise before calling a qualified service person.

False Alarms

Careful attention to skin preparation and electrode application, especially during setup, will reduce false alarms. Should false alarms occur, check for the following:

• There may be excessive noise on the signal (the most common cause of false alarms). Electrodes misplaced over muscles or a poor lead connection can cause significant noise when the patient moves.

• Heart rate limits may be set too close to patient's heart rate. Check to see if this is the case and adjust the limits as necessary.

• The ECG amplitude may have dropped below the R-wave detector threshold level causing false low rate alarms. Reposition the electrodes to obtain a QRS amplitude of at least 0.20 mV (adult) and 0.15 mV (neonate).

• QRS frequency components and shape may be unsatisfactory for accurate beat detection and classification. Make necessary changes in electrodes, electrode sites or lead selection to restore a good signal.

• In some cases, VFIB may resemble previously classified abnormal beats which may cause VFIB to be detected as a RUN. If this occurs, use the waveform display as the primary indication of condition.

• The module may not recognize some beats as morphologically different from the learned dominant beat. You may be able to improve performance by changing electrode positions or switching to a lead setting that provides better differentiation between the dominant and abnormal beats.


ECG

ECG Troubleshooting Guide


AC noise ■ Display resolution set to extended mode (0.05 to 150 Hz).

■ Select monitor mode (0.5 to 40 Hz).

■ Electrodes dry. ■ Repeat skin preparation and apply new moist electrodes.

■ Patient cable entwined with other electrical devices.

■ Separate patient cable from all other cables.

Baseline wanders ■ Patient moving excessively. ■ Use stress loops to secure lead wires and cable to the patient.

■ Respiration artifact. ■ Select another lead or reposition the electrodes.

■ Electrodes dry. ■ Repeat skin preparation and apply new moist electrodes.

Low amplitude ECG ■ Skin improperly prepared. ■ Abrade skin and reapply electrodes.

■ Lead selected not showing QRS complex with greatest amplitude.

■ Check 12-lead ECG to determine better monitoring lead and reposition electrodes.

■ Electrodes could be positioned too near bone or muscle mass.

■ Select another lead or reposition electrodes.

Module won’t learn ■ ECG signal too noisy for initialization.

■ Improve signal quality by repeating skin preparation and/or repositioning electrodes.

■ ECG voltage below threshold. ECG VOLTAGE TOO LOW message may be displayed.

■ Perform the following steps as needed.

a Check cables, lead wires and electrodes, then relearn patient rhythm.

b Change lead or reposition electrodes.

No ECG trace ■ Improper attachment of ECG connector cable to the module/or leads off.

■ Remove, then re-plug the connector into the module or reconnect the leads.

■ Module is not seated into the monitor or remote housing.

■ Remove, then reinsert the module or exchange the module.


ECG

Excessive alarms ■ Electrodes dry. ■ Repeat skin preparation and apply new moist electrodes.

■ Alarm limits set too close to patient's normal heart rate.

■ Readjust alarm limit.

■ Excessive interference: patient cable or wires routed too close to other electrical devices.

■ Reroute cables and leads.

■ Excessive patient movement or muscle tremor.

■ Reposition electrodes and use stress loops to secure lead wires and cable to the patient.



Arrhythmia

Directory of Keys


ECG

ECG MENU

ALARMLIMITS

SIZE SETUPLEAD



ARRCLASSES

STSEGMENTS

ALLLEADS

PRINTALL

CANCELPRINT

ECG - PRINT

CLEARMEMORY

SAVEMEMORY

ECG - RELEARN

STREVIEW

ARRHYTHMIAREVIEW

REPORTREVIEW

REAL TIMEST TREND

ECG REVIEW

TREND DISPLAY

OFFON

RUN1 TACHDOM

CPL0

ABN3

PAUSE8

PACED8

REVIEW

MERGECLASSTREND

LEAD

IIVI

ALARM

NOYESCLEAR

GROUPTREND

PRIORCLASS

NEXTCLASS

PRINT

ARRHYTHMIA REVIEW

ENTIRECLASS

LASTEVENT

Do you wish to clear the entireclass or the most recent occurrence?

MERGECLASSES

MERGETRENDS

PRIORCLASS

NEXTCLASS

Merge these classes or select another class.

TIMEBASE6 HOURS

INCLUDE

NOYES

CURSOR

RLPRIORCLASS

NEXTCLASS

PRINT

CLASS TREND

TIMEBASE6 HOURS

CURSOR

RLPRIORCLASS

NEXTCLASS

PRINT

GROUP TREND

ALARMS

OFFONHI=130

LO=40

ABN INROW=5

ABN PERMIN=OFF

SINGLEST = 1.00

MULTIST = 0.50

STLEADS

ECG - ALARM LIMITS

TREND TIMEBASE

15/MIN/30MIN


Arrhythmia

Contents

Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Setting Up Arrhythmia Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Setting and Adjusting Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Reviewing Arrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Controlling Arrhythmia Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Clearing a Class or Event . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Merging Classes/Trends. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Plotting Arrhythmia Trend Graphs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Printing Arrhythmia Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Arrhythmia Problem Solving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Arrhythmia Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Overview

Two levels of arrhythmia detection and review are available in Spacelabs Healthcare monitors.

The Multiview I option provides enhanced arrhythmia detection and alarms for ventricular tachycardia, couplets, and single abnormal beats in addition to the detection and alarm capabilities for high and low heart rates, ventricular fibrillation, and asystole.

The Multiview II option expands arrhythmia detection to include pauses and tachycardias of a supraventricular origin. This option also offers storage capabilities so that trends of arrhythmia episodes as well as dominant and paced rhythms can be reviewed, edited and printed.

Note:

• No arrhythmia detection system can correctly detect and classify all arrhythmias 100% of the time. Use sound clinical judgement when monitoring patients with arrhythmias.

• You can define your own default settings for such characteristics as alarm limits and display configuration. Refer to Module Configuration Manager on page 7-5 for further details.


Arrhythmia

Setting Up Arrhythmia Monitoring

With the Multiview I or II option, the ARR ON/OFF key (located in the Config menu under Setup) can be used to selectively enable or disable arrhythmia detection functions. Arrhythmia detection must be enabled if you wish to establish a new dominant waveform (refer to Relearning the Dominant Waveform on page 9-6 for more details).

Note:

The Arrhythmia ON/OFF key is only available in modules with the Multiview I or II options.

When you turn arrhythmia detection ON

• IN LEARN appears above the ECG tracing in the first zone

• the RELEARN key is present in the ECG menu

• ABN IN ROW and ABN PER MIN keys are present in the Alarm Limits menu

• ECG alarms are momentarily deactivated until the learn sequence completes

• Rate and ST alarm limits are initialized

• Abnormals in a Row and Abnormals per Minute alarm limits are initialized

When you turn arrhythmia detection OFF

• IN LEARN appears above the ECG tracing in the first zone

• no arrhythmia detection features or menus are displayed

• ECG alarms are momentarily deactivated until the learn sequence completes

• Rate and ST alarm limits are initialized

To set up arrhythmia monitoring:

• Set up system and patient for standard ECG monitoring.• Touch ECG.• Touch SETUP.• Touch CONFIG.• Ensure ADULT is selected.• Select ARR ON.

To disable arrhythmia detection:

• Touch ECG.• Touch SETUP.• Touch CONFIG.• Select ARR OFF.


Arrhythmia

Learning the Dominant Waveform

During the learn sequence, IN LEARN is displayed on the monitor while the system establishes the heart rate and begins to classify each beat. Rate alarms are set based on this learned heart rate (if they have not been previously set to Fixed in the Module Configuration Manager). The first non-premature beat that occurs ten times is established as the dominant class. When the learn sequence is completed, the IN LEARN message disappears.

Examples of actions that initiate a learn sequence are:

• power ON

• module insertion

• changing patient type (adult/infant)

• enabling/disabling arrhythmia detection

• patient admission via the Admit/Discharge menu

The system will not classify a paced beat as the dominant class. If the patient is 100% paced and there is no dominant class at the end of the learn sequence, the first single, non-paced beat detected five times becomes the dominant class.

Detecting Abnormal Beats

The system compares each incoming beat with the dominant class. It examines morphology and the intervals between both the previous and following beats to determine whether the beat does or does not match the dominant. If the system determines the beat is abnormal, it compares the new beat with each of the abnormal shapes categorized since the learn sequence was completed. If the current beat fails to match any of the existing shapes (and after five occurrences), the system classifies it as a new abnormal class.

Detecting Pauses

The system classifies an R-R interval that is 1.8 times (or 80%) longer than the average R-R interval as a pause.

The last beat detected preceding the pause is displayed to the left of center in the pause class. The system does not count two consecutive, long R-R intervals both in the pause class. Instead, it assumes that a sudden rate change occurred and updates the heart rate immediately.

Detecting Paced Beats

If the Paced mode is enabled in the ECG Setup menu and the system does not detect a paced beat during the learn sequence, a paced class will be created once the system detects the first paced beat.

The system identifies two different types of paced beats:

• paced

• AV-paced


Arrhythmia

The paced class is created for ventricular-paced beats defined as a QRS complex which is preceded by a single pacemaker pulse.

The AV-paced class is created for beats that are preceded by two pacemaker pulses.

The QRS complex must follow the pacemaker pulse within 150 msec for the beat to be classified into either paced class. If the pacemaker pulse precedes the QRS complex by more than 150 msec, the beat may be triggered by an atrial pacemaker and is not classified in either paced class.

Relearning the Dominant Waveform

You can relearn the dominant rhythm and establish a new dominant at any time during monitoring. After touching the RELEARN key, you can either clear the memory or save the memory. Once a selection is made, the relearn sequence is initiated during which ECG alarms are suspended. The old dominant is labeled as exdominant and stored as an abnormal class.

Warning:Until the patient’s rate and morphology are learned, ECG alarms for high rate, low rate, run, couplet, abnormal per minute, and tachycardia are not active.

Selecting CLEAR MEMORY clears all arrhythmia and ST segment data and resets the Abnormals per Minute, Abnormals in a Row, and ST segment alarms. Upon completion of the learn sequence, ECG alarms are enabled and rate alarms limits are reset.

Selecting SAVE MEMORY saves all previously acquired arrhythmia and ST segment data. Once the learn sequence is completed, ECG alarms are enabled and rate alarms are reset. The Abnormals per Minute and Abnormals in a Row alarms remain unchanged. If ST segment level alarms were enabled prior to the relearn sequence, they will be reset.

Automatic Dominant Class Update

The system uses the following rules to update the dominant class:

• An abnormal class that occurs more frequently than 50% of all beats in the previous 60 seconds, and occurs three beats more frequently than the current dominant during that period, automatically becomes the new dominant class.

• The old dominant is put into an abnormal class and given the status EXDOMINANT. This class can become dominant again and has the same characteristics as any other active class.

The message NEW DOMINANT is displayed above the ECG trace for 60 seconds after the new dominant is established.

To relearn the dominant waveform:

• Touch ECG.• Touch RELEARN.• Select SAVE MEMORY or CLEAR MEMORY.


Arrhythmia


In addition to the alarms described in ECG on page 8-3, the Multiview I or II options provide alarms for these additional conditions.

Abnormals in a Row Alarm

Following the learn sequence, the Abnormals in a Row alarm limit is set based on either factory defaults or user-defined settings. You can adjust the alarm limit from two to ten or you can deactivate it.

• Setting the Abnormals in a Row alarm limit to three or greater will initiate a RUN ALARM message when three or more consecutive abnormal beats (at a rate greater than 90 bpm) occur.

• Setting the Abnormals in a Row alarm limit to two will initiate a COUPLET ALARM message when two consecutive abnormal beats occur.

The factory default setting for the Abnormals in a Row limit is five.

Abnormals per Minute Alarm

Following the learn sequence, the Abnormals per Minute alarm limit is set based on either factory defaults or user-defined settings. You can adjust the alarm limit from 1 to 99, or it can be deactivated.

The factory default setting for the Abnormals per Minute limit is OFF.

Note:

If the alarm limit for high rate, low rate, ABN/MIN, or ABN IN ROW is displayed in reverse video, this is an indication that alarm tone, alarm recording, and alarm watch have been disabled for the indicated alarm.

Table 1 describes the arrhythmias detected with the Multiview I or II options (with arrhythmia detection enabled).

To set or adjust alarms for abnormal beats (arrhythmia detection must be enabled):

• Touch ECG.• Touch ALARM LIMITS.• Touch ALARMS ON.• Select ABN IN ROW = or ABN PER MIN =.• Use arrow keys to adjust.


Arrhythmia

* Prematurity is defined as an instantaneous R-R interval that is (1) 15% premature as compared to the average R-R interval and, (2) 666 msec for couplets and runs, and 500 msec for tachycardias of a supraventricular origin.

** Template-forming classes.

Table 1: Classification of Events

Type of ClassDefining

CharacteristicsPrematurity

Required

Max # of Classes Allowed

Type of Waveform Storage

ABNORMAL **One beat of abnormal morphology

No

12

Qualifying occurrence (5th) + most recent

COUPLET **Two consecutive beats of abnormal morphology

No for the first beat; Yes for the

second beat *

Qualifying occurrence (3rd) + most recent

RUN

Three or more consecutive beats of abnormal morphology

No for the first beat; Yes for each subsequent beat *

32

Six seconds of each occurrence. First in, first out. Saves longest Run and Pause

PAUSEAn R-R interval that is 1.8 × (or 80%) longer than normal

No

ASYSTOLEAbsence of QRS for five seconds or more

No NA

Six seconds of last occurrence stored as a pause when following normal beats

PACEDOne pacemaker flag followed by a QRS (within 150 msec)

No 1First paced beat occurrence each minute (PACED key must be set to YES)

AV PACEDTwo pacemaker flags followed by a QRS

No 1First paced beat occurrence each minute (PACED key must be set to YES)

TACH (SUPRA VENTRICULAR)

5 or more premature dominant beats in a row

Yes * 1Six seconds of last occurrence

VFIB NA No 1Six seconds of last occurrence

DOMINANT ** NA NA 1Qualifying occurrence (10th) + the most recent each minute


Arrhythmia

Reviewing Arrhythmias

Note:

Arrhythmia Review and Edit functions are only available in modules with the Multiview II option in the ADULT mode, and with both arrhythmia detection and review enabled.

Selecting Arrhythmia Classes

The numerical value for each arrhythmia key indicates the number of occurrences that the system has stored. If none have been detected, the numerical value inside the key is 0 and the key outline is dotted. For classes that only store the last occurrence of that type of arrhythmia (for example, tachycardias of a supraventricular origin), a value is not displayed. The system updates the menu as new classes are created.

Selecting Leads for Review

When you access the Arrhythmia Review menu, the LEAD key text changes to indicate which leads were being monitored the last time the displayed event occurred. The lead associated with the currently displayed waveform is highlighted. You can change the lead selection by touching the LEAD key.

Multiple Arrhythmia Classes

The system distinguishes between classes of the same type that have different morphologies by assigning numbers to each class. The class number is displayed to the right of the class type; for example, ABNORMAL 1.

The system will display, in sequence, up to 32 different runs and/or pauses. However, the system always keeps the longest run or pause. If the system detects one more pause and/or run than it can store, it replaces the oldest run or pause with the new one (that is, first in, first out).

Updating Classes

The system updates the review waveform once each minute for the dominant, paced and AV paced classes. Otherwise, it updates with each occurrence.

To review arrhythmias:

• Touch ECG.• Touch REVIEW.• Select an arrhythmia class type for review.• Select NEXT CLASS or PRIOR CLASS keys to progress through the review.


Arrhythmia

Display Detail

The system stores and displays arrhythmia review data in two categories: non-template forming classes and template-forming classes.

The non-template forming class displays a waveform that is 6.25 seconds long and is representative of the most recent occurrence.

The template-forming class displays two waveforms. The waveform on the left is 1.25 seconds long; the arrhythmia that originated the class is centered. The waveform on the right is 4.5 seconds in length and the most recent occurrence of the class is centered.

The lead, frequency, and time and date of last occurrence appear to the right of each presentation.

Figure 9-1: Arrhythmia waveforms

Non-template Forming Class Example

Template Forming Class Example

Lead II

Last MINUTE: 1

Last HOUR: 1

Last OCCURRENCE:

04:44AM

2 Dec 2008

Lead VI

Last MINUTE: 2

Last HOUR: 6

Last OCCURRENCE:

04:40PM

2 Dec 2008

(Tachycardia)

(Couplet)


Arrhythmia

Controlling Arrhythmia Alarms

Touch ALARM YES or NO to enable or disable alarms for couplets, single abnormals, or tachycardia. Disabling alarms for a specific arrhythmia prevents alarm generation for subsequent detection of that arrhythmia class. At least one episode of the class must be stored before the alarm can be disabled.

Clearing a Class or Event

When you clear a class, the system removes it from memory. Touch the ENTIRE CLASS key to clear the displayed class and template from memory and from the trend buffer. When the system finishes clearing the class, the Arrhythmia Review menu appears and displays the next class.

Touch the LAST EVENT key to remove only the most recent occurrence of the displayed class from memory. The LAST EVENT key is only active for abnormal and couplet classes.

When you clear the most recent event:

• the system removes the most recent occurrence of that class from memory.

• the system displays the message The last occurrence of this class was deleted in place of the cleared waveform.

• the system updates the frequency and last occurrence totals. The system does not redisplay the updated information until you redisplay the class.

To control arrhythmia alarms:

• Touch ECG.• Touch REVIEW.• Touch ARRHYTHMIA REVIEW.• Select CPL, ABN or TACH.• Select ALARM YES or NO.

To clear a class or the most recent event in a class:

• Touch ECG.• Touch REVIEW.• Touch ARRHYTHMIA REVIEW.• Select an arrhythmia class.• Touch CLEAR.• Select ENTIRE CLASS or LAST EVENT.


Arrhythmia

Merging Classes/Trends

Merging enables you to take two different classes or trends from the same group and merge them together into a single class, combining the trend history and time of last occurrence. When the module is frequently storing a single morphology as two different classes, merging the classes opens up storage for new classes while saving all arrhythmia data.

Merging Classes

Two classes may be merged when the system interprets two abnormal beats as different classes but the clinician sees them as the same class. This could occur if a patient's dominant beat is experiencing frequent changes in polarity or when the electrodes have been repositioned.

At the start of merging two classes, one class appears on the left side of the screen and the second class appears on the right side. The message Merge these classes or select another class appears at the bottom of the screen.

If the two classes look clinically the same, they can be merged by touching the MERGE CLASSES key. Once merged, the first beat will be displayed as a template on the left side of the screen with the message (M1) following the class title. Any subsequent beat that fits any of the merged templates will then be stored in that class.

You can merge a maximum of two classes into a third class. The following constraints apply to merging classes:

• Two single templates can be merged into a class with one template.

• One class of two (previously merged) templates can be merged with one additional template.

• If a class has been merged once, then (M1) follows the class number, for example, ABNORMAL 12 (M1).

• If a class has been merged twice, then (M2) follows the class number, for example, ABNORMAL 12 (M2).

Merging Trends

There is no limit to the number of trends that you can merge. Merging trends of arrhythmia data deletes the template for the class that has been merged. If an arrhythmia event occurs that matches the merged class, a new class will be created.

If you want to combine the data for two routinely recurring arrhythmia classes, merge the classes rather than merge the trends. Merging classes permits the two classes to be stored and trended together on an ongoing basis.

If you want to combine an active arrhythmia class with an inactive class, merge the trends. An example of an inactive arrhythmia class is the dominant morphology associated with a previous lead selection.


Arrhythmia

Merge Constraints

The following additional constraints apply to merging individual classes or trends:

• If the system cannot merge any of the existing classes or trends, the MERGE key is disabled (the key will appear dotted) in menus for those classes/trends.

• Only classes/trends that the system can merge are presented.

• Single abnormal classes/trends can be merged with each other, or with the dominant, paced, or AV paced classes/trends.

• Couplets can only be merged with couplets.

• Runs and pauses cannot be merged.

Plotting Arrhythmia Trend Graphs

When you plot trend graphs the display area consists of:

• 1.5-second segment of the selected class waveform on the left (individual class trends only).

• Trend graph of the selected class, or group of classes, on the right. Refer to Figure 9-2.

When you select CLASS TREND, the trend graph plots occurrences of events that match that particular class. The total number of events that occurred during the time period between the cursors appears below the trend graph.

Figure 9-2: Abnormal class trend

To merge class or trend data:

• Touch ECG.• Touch REVIEW.• Touch ARRHYTHMIA REVIEW.• Select an arrhythmia class.• Touch MERGE.• Use PRIOR CLASS or NEXT CLASS to display the two classes you wish to merge.• Select MERGE CLASSES or MERGE TRENDS.

100

0From 12:18 to 18:17 18:17

0

20

50

HR

10

12:17 Total = 612

PER

1

MIN

ABNORMAL 1


Arrhythmia

When you select GROUP TREND, the trend graph plots occurrences of all events in that group of classes along with the average heart rate. For example, the group trend for abnormals plots the occurrences of all single abnormals regardless of the class in which they were stored.

• The dominant group trend graph displays the total of all abnormal beats, including beats in runs, over the selected timebase.

• A total of all events specific to the selected class over the selected timebase is displayed for all other trended classes.

Each trend graph is displayed with two scales:

• the scale on the left represents heart rate.

• the scale on the right displays the number of arrhythmias over the trended period.

Scales are automatically selected, based on the heart rate and arrhythmia values.

Selecting a Timebase

You can also select the time period over which the system trends arrhythmia data. The factory default setting is six hours. Resolution for each timebase is shown below.

To display a trend graph:

• Touch ECG.• Touch REVIEW.• Touch ARRHYTHMIA REVIEW.• Select an arrhythmia class for review.• Select CLASS TREND or GROUP TREND.

Resolution Timebase

1 minute = 6-hour trend graph

2 minutes = 12-hour trend graph

4 minutes = 24-hour trend graph

To select a timebase for class or group trends:

• Touch ECG.• Touch REVIEW.• Touch ARRHYTHMIA REVIEW.• Select an arrhythmia class.• Select CLASS TREND or GROUP TREND.• Select TIMEBASE (6 ,12 , or 24 hours).


Arrhythmia

Excluding Classes from Trends

Use this function to exclude specific classes from the group trend for that class as well as from the dominant trend graph (only valid with CPL and ABN classes). This function defaults to YES indicating that all classes will be included. When you select a class, the template for that class displays on the screen. It is followed by a trend graph that plots all of the occurrences of that class over the selected trend graph timebase.

Positioning the Cursors

The cursors are small, bright lines that move along the bottom of the trend display and allow you to view the number of trended events that occurred between any two points in time displayed on the trend graph.

Initially, the left (L) cursor is located flush with the left edge of the trend graph, and the right (R) cursor is located flush with the right edge of the trend graph. The number of trended events between, and inclusive of, the cursor points appear below the trend graph. If the cursors move past each other, the L cursor becomes the R cursor and vice versa. The highlighted L or R portion of the CURSOR key changes accordingly.

To exclude a class in a group trend:

• Touch ECG.• Touch REVIEW.• Touch ARRHYTHMIA REVIEW.• Select an arrhythmia class.• Touch CLASS TREND.• Select INCLUDE NO.

To position the cursors on the trend graph:

• Touch the CURSOR to highlight either the L or R portion.• Touch the trend plot to position the cursor near the desired point.• Use the arrow keys for adjustment of the cursor.


Arrhythmia

Printing Arrhythmia Data

All printouts of ECG or arrhythmia data are annotated with the following data:

• Bed identification

• Time and date of the printout

• Lead designator

You can print all arrhythmia data for all classes or individually selected classes. You can also print individually selected arrhythmia trend plots.

Selecting PRINT ALL prints all ST events and all arrhythmia classes. PRINT ALL also prints all leads.

To print recordings of ALL arrhythmia events:

• Touch ECG.• Touch PRINT.

-OR-

• Touch PRINT ALL.• Touch ARR CLASSES.

To print selected arrhythmia classes:

• Touch ECG.• Touch REVIEW.• Touch ARRHYTHMIA REVIEW.• Select an arrhythmia class.• Touch PRINT.

To print selected arrhythmia trends:

• Touch ECG.• Touch REVIEW.• Touch ARRHYTHMIA REVIEW.• Select an arrhythmia class.• Select CLASS TREND or GROUP TREND.• Touch PRINT.


Arrhythmia

Arrhythmia Problem Solving

Refer to ECG on page 8-3 for additional monitoring tips.

False Alarms

Careful attention to good monitoring techniques, especially during setup, will reduce false alarms. When false alarms occur, check the following:

• Multiple classes with atrial fibrillation or flutter waveforms. Either 1) merge these classes with the dominant or another abnormal class, 2) deactivate the alarms for these classes, -OR- 3) consider deactivating the Abnormals per Minute alarm.

• Repetitive artifact mimicking QRS complexes. Review the morphology of abnormal classes that are triggering alarms. Either merge these abnormal classes together or deactivate the alarm for these classes.

• In some cases VFIB may resemble previously classified abnormal beats which may cause VFIB to be detected as a RUN. If this occurs, use the waveform display as the primary indication of condition.

• Some beats may not be recognized as morphologically different from the learned, dominant beat. You may be able to improve performance by changing electrode positions or switching to a lead setting that provides better differentiation between the dominant and abnormal beats.

Abnormal Beats Mis-classified

There are a number of possible situations that might cause beats to be improperly classified (either too many or too few).

• If the message NOISY SIGNAL is displayed, too much noise is present on either one, or both, ECG channels.

• If the message ECG VOLTAGE TOO LOW is displayed, the signal level is below the threshold for QRS detection.

• Some beats are not recognized as being different from the learned dominant beat.

You may be able to improve performance in these cases by changing electrode positions or by switching to a lead setting that provides a better signal or allows abnormal beats to be more clearly differentiated from dominant beats.

No Couplet or Run Alarms

If alarms do not occur as expected, check the following:

• Abnormal in a Row alarm limit may be set too high to generate alarm for couplets. When you wish to be alerted for couplets, set Abnormal in a Row alarm limit to 2.

• Abnormal beat(s) may not meet the classification criteria of 15% prematurity (for the second beat in a couplet or subsequent beats — at 90 BPM — in a run) and R-R intervals of less than or equal to 666 msec. No action is indicated. An Abnormal in a Row alarm (COUPLET or RUN) will not be generated unless both criteria are met.

• Processing may have been suspended or the signal quality may be poor. Resume processing or check electrodes for other causes of a poor signal.


Arrhythmia

Previous Abnormal Classes Missing in Arrhythmia Review

If you find that previously classified abnormal beats are no longer stored for review, one of the following conditions have occurred:

• The class has been cleared.

• Memory was cleared using the RELEARN key or data was purged during the Admit/Discharge function.

• A module error recovery reset occurred.

Classes Full

The total number of abnormal and couplet classes that can be stored is 12. When the system detects the 13th class, the message CLASSES FULL is displayed with an alert tone (if tone is set to ON). All subsequent alarm events will initiate an alarm, even if classes are full.

A “classes full” condition can be cleared by:

• merging one or more classes

• merging one or more trends

• deleting one or more abnormal or couplet classes

Note:

All alarm events occurring when classes are full will initiate an appropriate alarm.


Arrhythmia

Arrhythmia Troubleshooting Guide


Abnormal beat not detected

■ Inadequate signal: NOISY SIGNAL or ECG VOLTAGE TOO LOW messages appear. Noise level is over allowable range, or signal level is below QRS detection threshold.

■ Make the necessary adjustments to restore good signal.

■ Check all leads to determine a better monitoring lead or select another lead.

■ Remove the cause of the noise.

■ Some beats not recognized as morphologically different from the learned dominant beat.

■ No action required; some events that may be diagnosed as abnormal by a skilled clinician may not meet the module's criteria for abnormality.

■ System has not seen five abnormals or three couplets of like morphology to generate a class.

■ No action is required.

■ Arrhythmia detection is not enabled.

■ Enable arrhythmia detection through the ECG Setup menu.

False Alarms Note: Careful attention to good monitoring technique, especially setup, will keep false alarms at a low level. If false alarms do occur, however, check the following.

■ Noise on the signal caused by poor electrode application is the most common cause of false alarms.

■ Remove the cause of the noise.

■ Deactivate alarm for the classes that fill up with repetitive artifact; do not clear these classes.

■ Multiple abnormal classes with atrial fibrillation or flutter waveforms.

■ Merge the class with the dominant or another abnormal class.

■ Deactivate alarm for these classes, or consider deactivating the ABN PER MIN alarm.

■ Atrial fibrillation continually triggering TACH alarm.

■ Consider deactivating TACH alarm.

■ Limits set too close to patient's heart rate.

■ Check and adjust the alarm limits.

■ Amplitude of ECG signal has dropped below threshold of R-wave detector.

■ Reposition electrodes and relearn patient's rhythm.


ST Analysis

Directory of Keys


I II III V1 V2 V3 V4 V5 V6 AVF

Highlighted leads are included in ST alarms. Touch to include or exclude.

AVL AVR

ECG

ECG MENU

ALARMLIMITS

SIZE SETUPLEAD



STREVIEW

ARRHYTHMIAREVIEW

REPORTREVIEW

REAL TIMEST TREND

ECG REVIEW

TREND TIMEBASE15 MIN/30 MIN

TREND DISPLAY

OFFON

STTREND

TIME SAVE

NOYESCLEAR

PRIORSET

PRINTNEXTSET

SAVESET

TIMEBASE6 HOURS

PRINTST

SCALE

ST REVIEW - ST SEGMENT LEVELS at HR:MIN DAY-MONTH-YEAR

TREND OF ST SEGMENT LEVEL

Do you wish to clear the displayed ST data?

YES NO

ALARMS

OFFONHI=130

LO=40

ABN INROW=5

ABN PERMIN=OFF

SINGLEST = 1.00

MULTIST = 0.50

STLEADS

ECG - ALARM LIMITS


ST Analysis

Contents

Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Setting Up ST Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Adjusting Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Selecting Leads for ST Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Displaying Real-Time ST Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Reviewing ST Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Clearing ST Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Viewing ST Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Selecting the ST Trend Timebase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Printing ST Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12ST Analysis Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Overview

The ST analysis function monitors changes to the ST segment level.

Note:

• The significance of ST changes can only be determined by a clinician.

• The value of ST segment measurements may be affected by:

- wide complex QRSs (for example, bundle branch block).

- Wolff-Parkinson-White (WPW) syndrome.

- fusion beats classified as dominants.

Since the ST segment is composed of frequencies at the lower end of the frequency range (0.05 Hz), the system automatically analyzes the ST segment at 0.05 Hz regardless of whether the display mode is set to monitor or extended.

ST segment analysis starts during the ECG learn sequence. Based on the dominant waveform, the PR (isoelectric), J, and ST points are automatically identified for each beat. The amplitude difference between the ST point and the PR point is referred to as the ST segment level.

Note:

You can define your own default settings for alarm limits. Refer to Default Alarm Limits on page 2-3 for further details.


ST Analysis

Display Detail

The current ST segment level is displayed for all leads to the right of the ECG parameter key in the split view and the full view modes. Question marks (???) are displayed when the current ST segment level is not available, or as OFF when the lead is not connected.

Figure 10-1: ST segment display (full view)

Figure 10-2: ST segment display (split view)

I 0.16 AVR 0.16

II 0.00 AVL 0.24

III 1.44 AVR 0.16

V1 -1.44 V4 0.16

V2 2.88 V5 0.16

V3 4.32 V6 0.16

�

�

ECG

II MON

A=0A/M 10ROW 4

1204070

AVR

AVL

AVF

V4

V5

V6

V1

V2

V3

III

II

I�

�

ECG

II MON

A=0A/M 10ROW 4

1204070

V4

V6

V1

V2

V3

V5

�

�

�

�

ECG

I 0.16 AVR 0.16

II 0.00 AVL 0.24

III 1.44 AVR 0.16

V1 -1.44 V4 0.16

V2 2.88 V5 0.16

V3 4.32 V6 0.16


ST Analysis

Figure 10-3: Real-time ST trend display


� Abnormals per minute counter

� Current heart rate

� ST segment levels (updates at 30-second intervals)

� ST segment level (single lead); asterisk indicates ST alarms are enabled

� Real-time ST trend

� Amplitude scale in millivolts

Time scale — either 15 or 30 minutes

Setting Up ST Monitoring

ST analysis is performed on all available ECG leads, even if they are not currently displayed. Setup for ST monitoring is the same as for ECG monitoring. Refer to ECG on page 8-1 for setup details.

Note:

ST Analysis and Review functions are only available in the adult mode in modules with the ST option.

To set up ST monitoring:

• Set up system and patient for standard ECG monitoring.• Touch ECG.• Touch SETUP.• Touch CONFIG.• Select ADULT.

ECG ST = X.XX70

�

�V2

5.0030 MIN0.00

�

�

�


ST Analysis

Adjusting Alarms

You can adjust alarm limits in increments of 0.25 mm as needed for both single lead ST and multiple lead ST.

ST alarms can be activated manually or automatically once the system has acquired an ST segment measurement. Typically, the system acquires this data within 30 to 60 seconds after completion of the learn sequence.

Note:

Disabling ECG alarms also disables ST alarms.

The SINGLE ST alarm allows you to monitor for localized changes that may only be detectable in a single lead. An ST alarm for a SINGLE LEAD will activate if the ST level for any one lead exceeds the SINGLE ST alarm limit, with respect to its current reference level.

The factory default setting for the single lead ST alarm limit is 1.00 mm.

The MULTI ST alarm allows you to monitor for global changes that may be detectable in multiple leads. An ST alarm for MULTIPLE LEADS will activate if the ST level for three or more leads exceeds the MULTI ST alarm limit, with respect to each lead’s current reference level.

The factory default setting for the multi-lead ST alarm limit is 0.50 mm.

Note:

The MULTI ST alarm limit cannot be set above the SINGLE ST alarm limit if both alarms are enabled.

At the time that ST monitoring is initiated, the current reference level for all leads is set to 0.00 mm (isoelectric). A SINGLE ST alarm will activate if any lead has an initial ST level that exceeds the SINGLE ST alarm limit. Or, a MULTI ST alarm will activate if three or more leads have initial ST levels that exceed the MULTI ST alarm limit.

Whenever a SINGLE or MULTI ST alarm is activated, the reference level for all leads is automatically reset based on each lead’s current ST level. This allows changes in ST levels to be dynamically tracked throughout the patient’s course of treatment.

As shown in Figure 10-4, when the patient’s ST segment trend line rises and violates the first alarm threshold, a new baseline and a new upper alarm threshold are established (the amount of change needed to set off another alarm is denoted by Delta). The lower alarm threshold remains unchanged. Though the patient’s ST segment continues to climb, it does not reach the new alarm threshold, so a new upper limit is not set. When the ST level declines, the alarm threshold also declines until the original alarm thresholds are re-established. As the patient’s ST level continues to decline, a new threshold is established when an alarm condition occurs.

To set or adjust ST alarms:

• Touch ECG.• Touch ALARM LIMITS.• Select SINGLE ST or MULTI ST.• Use arrow keys to adjust.


ST Analysis

Figure 10-4: ST segment alarm function

As a second example, assume the SINGLE ST alarm is set at 1.00 mm. The initial ST amplitude for a particular lead is +0.60 mm. Based on the initial reference level of 0.00 mm, an alarm would activate if the ST level exceeds +1.00 mm. Therefore, no alarm occurs. Instantaneously, the ST level increases to +1.20 mm. SINGLE ST alarm occurs and the new reference level for the lead is set to +1.20 mm. The next ST alarm for that lead, assuming no changes are made in other leads, would be activated at +2.20 mm.

Selecting Leads for ST Alarms

Touching the ST LEADS key allows you to select which leads are to be used to generate ST alarms. Leads that are not clinically relevant for a patient can be disabled to allow tighter limits to be placed on more clinically significant leads.

All highlighted leads will be used to generate ST alarms.

The factory default setting is all leads included.

To select or deselect leads for ST alarms:

• Touch ECG.• Touch ALARM LIMITS.• Touch ST LEADS.• Select or deselect leads.

Thick line is the measured ST level.Solid line is the ST alarm baseline.Dashed line is the alarm threshold.


ST Analysis

Displaying Real-Time ST Trends

To facilitate the assessment of short-term changes in ST-segment levels, measurements for a single lead can be displayed as a real-time trend.

The amplitude scale for the trend display is dynamically adjusted to show the maximum and minimum values for the selected time scale.

The time scale for the trend display is user-selectable — either 15 minutes or 30 minutes.

Trend data is continuously updated at three-second intervals.

Reviewing ST Data

Use the ST Review menu to display and review ST segment data. A snapshot of ST segments for all available leads is displayed. The time and date of the ST snapshot is displayed on the menu prompt line. Touch the PRIOR SET or NEXT SET key to display ST data at other time points. Figure 10-5 is an example of a ST segment snapshot.

Nine ST snapshots can be stored for display. The oldest ST snapshot, not marked as SAVED, will be deleted to make room to store a new snapshot. To save an ST snapshot, touch the SAVE SET key.

ST snapshots are automatically stored whenever an ST alarm occurs or at pre-selected time intervals. To store the ST snapshots at periodic intervals, select TIME SAVE YES. Available intervals are 5, 10, 15, 30 or 60 minutes (only available in the Module Configuration Manager).

The factory default setting for the time save interval is 15 minutes.

Figure 10-5: ST segment display

To display a real-time ST trend:

• Touch ECG.• Touch REVIEW.• Touch REAL TIME ST TREND.• Select ON.• Select TREND TIMEBASE of 15 or 30 minutes.

AVR

AVF

V4

V6

V1

V2

V3III

II

I-0.16 mm

-0.16 mm

0.16 mm

2.88 mm

4.32 mm

0.16 mm

0.16 mm

0.16 mm

0.00 mm

1.44 mm

AVL0.24 mm


ST Analysis

Clearing ST Data

Touching the CLEAR key and then confirming your choice by selecting YES clears the currently displayed data for all leads from memory. Data is also cleared from the trends.

To review ST data:

• Touch ECG.• Touch REVIEW.• Touch ST REVIEW.

To set the ST collection time interval:

• Touch ECG.• Touch REVIEW.• Touch ST REVIEW.• Touch TIME SAVE.• Select OFF, 5, 10, 15, 30, or 60 minutes.

To clear the displayed ST data:

• Touch ECG.• Touch REVIEW.• Touch ST REVIEW.• Touch CLEAR.• Select YES.


ST Analysis

Viewing ST Trends

Trends showing deviations in ST segment level are displayed for each lead monitored in the past 24 hours. Touching the trend graph or one of the arrow keys in the menu produces a cursor on the baseline of the trend plot. Position this cursor at a point of interest in the trend to determine the ST segment level for all displayed leads at that time. A measurement for each lead is displayed in the table to the right of the trend display.

Figure 10-6 shows an example of a trend display. The graph plots deviations in ST segment level over time.

Figure 10-6: ST trend display

To view ST trends:

• Touch ECG.• Touch REVIEW.• Touch ST REVIEW.• Touch ST TREND.• Touch the trend plot near the desired data point. Then use arrow keys to adjust the

cursor position.

AVRV4

AVLV5

AVFV6

IV1

IIV2

IIIV3

00:00 06:0000:00 06:00

SCALE -2 mm to 2 mm

I 0.16 AVR 0.16

II 0.00 AVL 0.24

III 1.44 AVR 0.16

V1 -1.44 V4 0.16

V2 2.88 V5 0.16

V3 4.32 V6 0.16

ST VALUES at 03:38


ST Analysis

Selecting the ST Trend Timebase

You can select the time period over which the ST data is displayed in a trended format. Resolution for each timebase is shown below.

Available timebases are 1.5, 3, 6, 12, or 24 hours. The factory default setting for the ST trend timebase is six hours.

Resolution Timebase

30 seconds 1.5 hours

1 minute 3 hours

2 minutes 6 hours

4 minutes 12 hours

8 minutes 24 hours

To select a timebase:

• Touch ECG.• Touch REVIEW.• Touch ST REVIEW.• Touch ST TREND.• Select TIMEBASE of 1.5, 3, 6, 12, or 24 hours.


ST Analysis

Printing ST Data

Printouts of ST segment data are annotated with the following:

• bed identification

• time and date of the printout

• lead designator

ST segment waveforms can be printed from either the Print or ST Review menu.

To print all the available ST segment waveforms, use the Print menu.

To print only selected ST segment waveforms or ST trends, use the ST Review menu.

Note:

ST Segment data cannot be printed with the 90449 printer module.

To print all ST segment data:

• Touch ECG.• Touch PRINT.• Touch ST SEGMENTS.

To print selected ST segments:

• Touch ECG.• Touch REVIEW.• Touch ST REVIEW.• Touch PRINT.

To print the current trend data:

• Touch ECG.• Touch REVIEW.• Touch ST REVIEW.• Touch ST TREND.• Touch PRINT.


ST Analysis

ST Analysis Troubleshooting Guide


No access to ST analysis functions

■ The system must learn the ST segment level before it can provide access to ST analysis functions.

■ Wait until the system analyzes sufficient QRS complexes to calculate the ST segment level (approximately one minute).

ST = ?? is displayed ■ Infrequent occurrence of dominant beats.

■ ST analysis not performed on paced, premature dominant or abnormal beats.

■ ECG amplitude may be insufficient to detect QRS complexes.

■ Check QRS amplitude.


12-Lead Diagnostics

Directory of Keys


CLEAR

Do you wish to clear

ECG - REVIEW

STREVIEW

REPORTREVIEW

ALARMLIMITS

SIZE SETUPLEAD


SUSPENDPROCESSING

RELEARN PRINT

ECG MENU

REVIEW

MORETEXT

ECG

ARRHYTHMIAREVIEW

ECG - REPORT REVIEW HR:MN DAY-MONTH-YEAR

PRINTSAVESTAT

REPORT

AUTO REPORTXX MIN

DIR

DISPLAY

ECG - REPORT DIRECTORY

AUTO PRINTOFF

REAL TIMEST TREND

the displayed ECG report?

TREND DISPLAYON OFF

TREND TIMEBASE15 MIN / 30 MIN

ON

YES NO

REPORTSETUP

SENDECG*

*This box will onlydisplay if the ModuleConfiguration ManagerSend ECG Reportsetting is set to manual


12-Lead Diagnostics

Contents

Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Initiating a 12-Lead Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Saving and Clearing 12-Lead Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Sending 12-Lead Reports. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Report Directory Display. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Patient Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Overview

The 12-lead report function acquires and displays 12 ECG vectors in the same format as an electrocardiograph.

Diagnostic electrocardiographic devices obtain conventional ECG signatures that accurately represent both the detailed waveforms in each cardiac cycle and the beat-to-beat variability to determine cardiac rhythm. Prior to analysis, the ECG data is split into two different paths: one to the module’s monitoring functions and the other to the diagnostic functions. The ANSI/AAMI specifications for diagnostic electrocardiographic devices, as required by the data in the diagnostic path, is acquired at 500 samples per second.

The output from both the monitoring and diagnostic functions are combined and transferred to the bedside monitor for display and distribution to the Ultraview Care Network.

Note:

• No automated analysis is completely reliable. A physician should read all ECG results.

• Special problems exist with pediatric ECGs because of the considerable differences in the signal characteristics of adult and infants and because of the evolution of the ECG patterns from birth to adolescence.

• Digital systems produce a noticeable modulating effect from one cycle to the next, particularly in pediatric ECGs. This phenomenon, which is not physiologic, is due to the asynchronism between data acquisition sample rate and the peak of the QRS waveform.


12-Lead Diagnostics

Display Detail

The 12-lead report display shows 2.5 seconds of waveform data per lead. Presentation of the leads may be in a standard format (refer to Figure 11-1) or the Cabrera format. When analysis is complete, measurements and diagnostic statements are displayed above the waveform data (requires option D).

Figure 11-1: 12-lead report display

� Measurement and interpretation data (requires Option D)

� ECG traces for 12 leads (2.5 seconds/lead)

�

�

Vent. rate: 60 BPM SINUS BRADYCARDIAPR interval: 162 ms NORMAL ECGQRS duration: 88 msQT/QTc: 360/360 msP-QRS-T axes: 50 44 51

I AVR V1 V4

II AVL V2 V5

III AVF V3 V6


12-Lead Diagnostics

Initiating a 12-Lead Report

You can acquire a 12-lead report by touching STAT REPORT. Initiating a STAT REPORT will not affect the automatic schedule.

Note:

• When monitoring paced patients, ECG processing and the pacepulse detection function will be suspended for 10 seconds whenever acquisition of an ECG report is in process. Temporarily suspending these functions allows the actual pacepulse to be displayed/printed in the 12-lead report without interfering with arrhythmia analysis.

• If the STAT REPORT key is labeled LEADS OFF, one or more of the 12 leads is disconnected. Check all electrode connections before proceeding.

Automatic Scheduling of 12-Lead Reports

12-lead reports can be acquired automatically by selecting an interval time using the AUTO REPORT key. User-selectable intervals include 30 minutes or 1, 2, 4, 8, or 24 hours. Selecting OFF will disable this feature.

12-lead reports can be printed as they are acquired by selecting AUTO PRINT ON, or saved in memory for review and printing at a later time by selecting AUTO PRINT OFF.

Touching the PRINT key at any time will print the displayed diagnostic report.

Note:

Automatic 12-lead reports are inhibited whenever the ECG signal is not of sufficient quality to produce a diagnostic report.

To initiate a 12-lead ECG report:

• Touch ECG.• Touch REVIEW.• Touch REPORT REVIEW.• Touch STAT REPORT.


12-Lead Diagnostics

Saving and Clearing 12-Lead Reports

All 12-lead reports are stored in the module’s memory. The module can store multiple 12-lead reports (the exact number depends upon the ECG waveforms). When the module’s report memory is full, the oldest report that has not been saved is replaced by the newest report.

To retain the currently displayed report in memory indefinitely, touch the SAVE key.

To clear the currently displayed report from memory, touch the CLEAR key and then confirm your choice by selecting YES.

Note:

If your monitoring system is interfaced to an ECG Management System and you are using a single module to acquire 12-lead reports at multiple bedsides, clear the 12-lead report(s) from memory before proceeding to the next patient’s bedside.

To schedule 12-lead ECG reports:

• Touch ECG.• Touch REVIEW.• Touch REPORT REVIEW.• Touch REPORT SETUP.• Select AUTO REPORT of 30 minutes, 1 hour, 2 hours, 4 hours, 8 hours, or 24 hours.• Touch AUTO PRINT ON or OFF.

To automatically print 12-lead ECG reports:

• Touch ECG.• Touch REVIEW.• Touch REPORT REVIEW.• Touch REPORT SETUP.• Touch AUTO PRINT ON.

Note:

• Requires a 90838 PrintMaster to print 12-lead ECG reports.

• Once this selection is made, each 12-lead report that is generated will be automatically printed.


12-Lead Diagnostics

Sending 12-Lead Reports

12-lead ECG reports can be manually sent to an ECG Management System as they are acquired. To establish this as the default, use the Send ECG Report feature in the Module Configuration Manager and change the user setting to Manual. Refer to Table 1 on page 7-9 for more information.

If you select Manual, all reports are sent only to an ECG Management System when you touch SEND ECG.

Note:

• The SEND ECG key is not displayed if the Send ECG Report feature is set to Automatic.

• The default setting is Automatic.

Report Directory Display

Touching the DIR key will display a directory of 12-lead reports. The time and date of each report is shown with the summary diagnosis.

Use the arrow keys to select the report of interest, then touch the DISPLAY key to display the selected diagnostic report.

Reports that have been saved will be marked as YES in column three.

Note:

A summary statement (column 4) is only displayed if option D is present.

To save/clear a 12-lead ECG report:

• Touch ECG.• Touch REVIEW.• Touch REPORT REVIEW.• Touch SAVE (while the report is displayed).

-OR-

• Touch CLEAR (while the report is displayed).• Touch YES to confirm (for CLEAR only).

To manually send 12-lead ECG reports:

• Touch ECG.• Touch REVIEW.• Touch REPORT REVIEW.• Touch SEND ECG.


12-Lead Diagnostics

Figure 11-2: Report directory display

Patient Demographics

The patient’s gender, date of birth, height, and weight are required by the diagnostic ECG algorithm. This information is entered via the patient Admit function.

If patient demographic information is not entered, the diagnostic ECG algorithm will use the following defaults:

Note:

For an accurate diagnosis, the patient’s demographics must be entered correctly.

TIME DATE SAVED DIAGNOSIS

1:00 28 DEC YES ABNORMAL ECG

1:30 28 DEC NORMAL ECG



3:00 28 DEC YES ABNORMAL ECG

3:30 AM 28 DEC YES NORMAL ECG

To view directory of 12-lead ECG reports:

• Touch ECG.• Touch REVIEW.• Touch REPORT REVIEW.• Touch DIR.

Table 1: Patient Demographic Default Values

Demographic Default Value

Date of Birth 40 years

Gender Male

Height 5’10”

Weight 180 lbs


Respiration

Directory of Keys — ECG


ECG MENU

SUSPENDPROCESSING

ALARM LIMITS

SIZE SETUPLEAD


PRINT

FULL VIEW SPLIT VIEW RESP VARITREND NEXT

ECG - DISPLAY FORMAT

RELEARN REVIEW

ECG

Respiration Refer to

2 LEAD CASCADE

RESP

VIEW

VARI

Varitrend 3 Refer to

ECG - SETUP

ECG - CONFIG

ON OFF ON OFF ON OFF ON OFF ON OFF ON OFF

SWEEPSPEED

QRSTONE

MONITOREXTENDED

PACEDYES NO CONFIG

RATESOURCE

RESTORESETTINGS

TRANSFERDATA

ADULTINFANT

ARRON OFF


Respiration

Directory of Keys — Respiration


RESP - SWEEP SPEED

RESP - TONE

RESP - LEAD SELECT

RESP - ALARM LIMITS

RESP - SIZE

RESP MENU

RESP

ALARM LIMITS

SIZESWEEPSPEED

RESPTONE

LEADSELECT

SHALLOWNORMAL

CVA FILTERON OFF

WAVEFORMON OFF

RL - LA RA - LA RA - LL RL - LL

TONEON OFF VOLUME VOLUME

25mm/sec

12.5mm/sec

6.25mm/sec

1.56mm/sec

SIZE SIZE

HI/LOON OFF

HI =20

LO =10

APNEAON OFF

APNEA =OFF


Respiration

Directory of Keys — Varitrend 3


VARITREND MENU

VARI

SIZEEVENTTREND

1.5 MIN3.0 MIN

SPO2SCALE

RESP RATERESP WAVE PRINT

HRSCALE

RESP WAVESIZE

VARITREND - SIZE MENU

DEFINEEVENT

CLEAREVENT

PRIOREVENT

NEXTEVENT

TREND PRINT

VARITREND - EVENT TREND MENU

TIMEBASE6 HOURS

PRINT

VARITREND - TREND MENU

CLEAR THISEVENT

VARITREND - CLEAR MENU

CLEAR ALLEVENTS

ONOFF PRINT

TACHOFF

APNEA20 sec

SPO285%

VARITREND - DEFINE EVENT MENU

BRADYHR 100

ENTER


Respiration

Contents

Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Setting Up Respiration Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Selecting Adult or Infant Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Setting and Adjusting Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Turning Respiratory Waveform On/Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Adjusting Waveform Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Adjusting Sweep Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Adjusting Respiration Tone. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Selecting Respiration Leads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Adjusting Respiration Sensitivity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Using the Cardiovascular Artifact Filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Restoring User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Recording Respiration Waveforms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Configuring Varitrend 3 Graphs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Printing Varitrend 3 Graphs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Respiration Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Overview

The respiration function detects and displays a waveform that:

• represents each breath

• provides the respiration rate

• detects and rejects cardiovascular artifact

• initiates alarms when limits are violated for either the respiration rate or apnea

Changes in thoracic impedance during patient inspiration and expiration provide respiration data through the use of the ECG cable. Lead selection for respiration is independent of lead selection for ECG, even though both receive data from the same electrodes.

Varitrend 3, an optional feature in some modules, generates a graph that plots heart rate, SpO2, and respiratory rates. You can view this plot on the monitor or print it on a system or bedside printer.

The Event Trend feature of Varitrend 3 enables you to screen for apparent life threatening events such as bradycardia, with desaturation, or apnea accompanied by a change in heart rate. This feature plots bradycardia, tachycardia, apnea and desaturation trends for viewing and printing. A 24-hour trend of events is maintained and up to 48 events are stored in memory. Refer to Configuring Varitrend 3 Graphs on page 12-14 for more details.

Note:

You can define your own default settings for alarm limits and the display configuration. Refer to Setting User-Defined Default Values on page 7-7 for further details.


Respiration

Setting Up Respiration Monitoring

Refer to the Directory of Keys — Respiration on page 12-2 for a flow diagram of respiration keys and menus.

Caution:If you suspend ECG processing using the SUSPEND PROCESSING key in the ECG menu, you also suspend respiration processing.

Note:

• If the RESP ON/OFF key does not appear in the ECG Display Format menu, your module does not include the respiration option.

• The RESP key must be ON in the ECG Display Format menu to display the RESP parameter key.

To set up respiration monitoring:

• Set up system and patient for standard ECG monitoring.• Touch ECG.• Touch DISPLAY FORMAT. • Select RESP ON.• Touch RESP.• Select additional keys as necessary.


Respiration

Display Detail

Respiration appears on the monitor in the following format:

Figure 12-1: Respiration display

� Respiration trace

� Respiration parameter key

� Respiration indicator (flashes once per detected breath)

� Selected lead for respiration

� Apnea alarm limit in seconds

� High respiratory rate alarm limit

� Low respiratory rate alarm limit

Current respiratory rate

RESP

APN 15sRA-LA

2015

*18

2015

� � � � �

��


Respiration

Selecting Adult or Infant Mode

The respiration function provides both adult and infant operational modes to optimize monitoring accuracy.

When you select adult or infant, RESP alarm limits and breath detection sensitivity are adjusted based upon your selection.

Caution:When the system is in the infant mode, respiration alarm activation can be delayed for up to three minutes. (The factory default setting for alarm delay is three minutes.) Closely observe the patient during this period.


The factory default setting for respiratory rate alarms is OFF in the adult mode and ON in the infant mode. Once respiratory alarms are enabled, the factory default settings are as follows:

The factory default setting for apnea alarms is OFF in the adult mode and ON in the infant mode. When active, the factory default setting is 20 seconds in both modes. The apnea alarm setting is adjustable from 5 to 40 seconds, or the alarm can be disabled.

Refer to Setting Alarm Limits on page 2-4 for details on system alarm operation.

Note:

If the alarm limit for high rate or low rate is displayed in reverse video, the alarm tone, alarm recording, and alarm watch have been disabled.

To specify the patient type:

• Touch ECG.• Touch SETUP.• Touch CONFIG.• Select ADULT or INFANT.

High Rate Low Rate

Adult150% of learned rate; not below 30 breaths/minute

0 breaths/minute

Infant 100 breaths/minute 10 breaths/minute


Respiration

Apnea Alarms

Apnea alarm limit is the maximum duration allowed between breaths before the respiration rate is set to zero. The apnea alarm limit may be set from 5 to 40 seconds in 5-second increments.

• If the APNEA ALARM is turned ON, the APNEA ALARM will sound after the apnea limit is reached.

• If the APNEA ALARM is turned OFF, the respiration rate will be set to zero after 20 seconds or when the apnea alarm limit is reached, whichever is greater. If the low rate alarm is ON, it will sound 10 seconds after the rate is set to zero.

Turning Respiratory Waveform On/Off

You may choose to turn the respiration waveform OFF and display only the respiration numeric values.

The factory default setting for respiration waveform is ON.

To set or adjust rate alarms:

• Touch RESP.• Touch ALARM LIMITS.• Select HI/LO ON.• Select HI= or LO=.• Use arrow keys to adjust.

To set or adjust apnea alarms:

• Touch RESP.• Touch ALARM LIMITS.• Select APNEA ON.• Touch APNEA=.• Use arrow keys to adjust.

To turn the respiration waveform display ON or OFF:

• Touch RESP.• Select WAVEFORM ON/OFF.


Respiration


You can increase or decrease the size of the respiration waveform display. This changes the displayed size only, and does not affect the signal gain or breath detection sensitivity.


The sweep speed determines the rate at which the respiration waveform moves across the screen. Sweep speed selections are 25, 12.5 (factory default), 6.25, or 1.56 mm/sec.

Adjusting Respiration Tone

You can select an audible tone to sound with each respiratory cycle. The tone volume is adjustable or can be disabled.

The factory default setting for tone is OFF.

To adjust respiratory waveform size:

• Touch RESP. • Touch SIZE.• Adjust waveform size using SIZE or SIZE

To select a respiration sweep speed:

• Touch RESP. • Touch SWEEP SPEED. • Touch the appropriate mm/sec key.

To adjust the respiration tone volume:

• Touch RESP.• Touch RESP TONE.• Select TONE ON.• Adjust tone volume using VOLUME or VOLUME


Respiration

Selecting Respiration Leads

Respiration lead selections are RL-LA, RA-LA, RA-LL, and RL-LL.

• RA-LA represents the line of maximum respiratory effort in adults and chest-breathing infants.

• RA-LL represents the line of maximum respiratory effort in abdominal-breathing infants.

• The factory default setting for respiration lead selection is RA-LA.

Note:

When a good respiration signal cannot be attained from the selected lead, the message LOSS OF SIGNAL is displayed and ??? appears in place of the respiratory rate.

Figure 12-2: Infant electrode placement

To select respiration leads:

• Touch RESP.• Touch LEAD SELECT.• Select the appropriate lead configuration.

LARA

LL

Alternate Method:

Position RA and LA electrodes at the 2nd intercostal space, midclavicular line.Position LL below the diaphragm, preferably below the umbilicus.

RALA

LL

Maximum Impedance Change:

Position RA and LA electrodes at the nipple level, midaxillary line.Position LL below the diaphragm, preferably below the umbilicus.


Respiration

Adjusting Respiration Sensitivity

Two input sensitivities for respiration monitoring are available. You can set them based on the patient’s respiratory effort; shallow or normal. Use the shallow mode if the monitor has difficulty counting the respiratory rate and/or the waveform is difficult to read. Selecting the SHALLOW mode also lowers the detection sensitivity nearer to the low amplitude waveform of infants.

The factory default for sensitivity is NORMAL in the adult mode, and SHALLOW in the infant mode.

Using the Cardiovascular Artifact Filter

Respiration is monitored based on impedance changes which occur with the expansion and contraction of the chest. However, the physical action of the heart pumping blood and the flow of blood through the vasculature also creates changes in impedance known as cardiovascular artifact (CVA).

In the absence of respiration, for example, during episodes of apnea, it is possible for a waveform to appear in the respiration zone which represents CVA rather than true respirations. In such cases, the rate of the CVA would be the same as the heart rate.

The Spacelabs Healthcare CVA detection filter provides a method of discriminating between true respiratory effort and cardiac activity. The filter checks for coincidence between the respiratory and the heart rate. If the rates are the same, the digital display for respiratory rate changes to CVA, a CVA message appears in the waveform zone, and an apnea alarm is triggered if the apnea alarm has been enabled. This minimizes the possibility of apneic episodes being undetected due to CVA. Episodes of CVA will be reflected as a respiratory rate of zero in the trends.

To adjust respiration monitoring sensitivity:

• Touch RESP.• Select SHALLOW or NORMAL.


Respiration

If the patient’s respiratory and heart rates are actually identical, you may want to disable the CVA filter.

Warning:If you disable the CVA detection filter, you will not be alerted to the presence of CVA if it replaces the respiration waveform.


With the Restore Settings feature, you can restore the user-configurable settings to the defaults previously stored as user settings. User-configurable options are listed in Setting User-Defined Default Values on page 7-7.

Note:

• Module Configuration Manager is an optional feature for some modules. Your module may not contain this option.

• RESTORE SETTINGS changes the user-configurable settings for all parameters in the module.

• Once restored, alarm ON/OFF status and alarm limits are reset to the previously stored user settings.

To enable the CVA filter:

• Touch RESP. • Select CVA FILTER ON.

To disable the CVA filter:

• Touch RESP.• Select CVA FILTER OFF.




Respiration

Recording Respiration Waveforms

You can print Respiration waveforms and values. Refer to Printing on page 4-5 for additional information.

Configuring Varitrend 3 Graphs

In Varitrend 3, trends for heart rate and SpO2 are displayed in the upper half of the zone. Either the respiration rate trend or the compressed respiration waveform is displayed in the lower half of the zone.

Note:

If the VARITREND ON/OFF key does not appear in the ECG Display Format menu, then your module does not include the Varitrend option.

Setting the Time Scale

You can set the time scale for the horizontal axis at either 1.5 or 3.0 minutes.

To print Respiration waveforms:

• Touch RECORD.• Touch flashing RESP parameter key.

To turn Varitrend 3 ON or OFF:

• Touch ECG. • Touch DISPLAY FORMAT. • Select VARITREND ON or OFF.

To set the horizontal time scale:

• Touch VARI.• Select 1.5 MIN or 3.0 MIN.


Respiration

Selecting Respiratory Display Type

The lower graph displays the trend for either the respiration rate or the compressed respiration waveform.

• RESP RATE displays the current respiration rate trend.

• RESP WAVE displays a compressed respiration waveform.

Selecting Respiratory Rate Scale

You can adjust the scale for the respiration rate trend. Scale selections include 0–50, 0–100, 0–150, or 0–200 breaths/minute.

Selecting Respiratory Waveform Size

You can trend a compressed respiration waveform. In this mode, the message RESP WAVEFORM appears next to the vertical axis instead of scale values.

To select the type of respiratory display:

• Touch VARI.• Select RESP RATE or RESP WAVE.

To select respiration rate scale:

• Touch VARI.• Touch RESP RATE.• Touch SIZE.• Touch RESP RATE SCALE.• Use arrow keys to adjust.

To select a respiration waveform:

• Touch VARI.• Touch SIZE.• Touch RESP WAVE SIZE.• Use arrow keys to adjust.


Respiration

Selecting Heart Rate Scale

You can plot heart rate. Scale selections include 0–100, 0–150, 0–200, 0–250, 0–300, 50–150, 100–200, 100–250, and 100–300 beats/minute.

Selecting SpO2 Scale

You can plot SpO2. Scale selections include 0–100, 25–100, 50–100, and 75–100%.

Defining Events

The Event Trend feature of Varitrend 3 enables you to store events that represent a change in a patient’s condition based on multiple variables. You can define criteria for up to five different events. For example, you may want to store episodes where the heart rate drops to less than 100 bpm, apnea lasts for more than 20 seconds, or the SpO2 value drops to less than 85%.

The patient’s status will be continually checked against each event definition. If any of the criteria are violated, a snapshot of the Varitrend 3 display representing this deviation will be stored. The event will also be added to the event trend.

To select heart rate scale:

• Touch VARI.• Touch SIZE.• Touch HR SCALE. • Use arrow keys to adjust.

To select an SpO2 scale:

• Touch VARI.• Touch SIZE.• Touch SPO2 SCALE. • Use arrow keys to adjust.


Respiration

Displaying Event Trends

Events are trended according to their duration and frequency. Regardless of the defining criteria, all events are plotted (grouped) together in the event trend graph. You can select to view these trends in 6-, 12-, or 24-hour time periods. Resolution for each timebase is shown below (15 minutes for a 6-hour trend, 30 minutes for a 12-hour trend, 60 minutes for a 24-hour trend).

The top trend displays the duration of the longest event in each time period. The bottom trend displays the number of events that occurred during each time period. Scaling, for the vertical axis for each trend, is automatically adjusted based upon patient data.

Figure 12-3: Event trend graph

Note:

Events longer than four minutes will be reported as four-minute events.

To access Event Trend:

• Touch VARI.• Touch EVENT TREND.

To define an event:

• Touch VARI. • Touch EVENT TREND.• Touch DEFINE EVENT. • Select event(s) to define.• Use arrow keys to adjust.• Touch ENTER.

60

30

0

18:30 06:30 18:30

Eventbar graph

10

5

0

60-minuteresolution

LongestEVENT

(seconds)

Number ofEvents


Respiration

Clearing Events

If you choose to clear a single event the data that represents that episode will be removed from the event trends. You may also clear all events and trends. This will have no effect on the event definitions.

Printing Varitrend 3 Graphs

You may produce a recording of the currently displayed Varitrend 3 graph. Refer to Printing on page 4-1 for a complete overview of printer functions.

To display event trends:

• Touch VARI.• Touch EVENT TREND.• Touch TREND.

To clear events:

• Touch VARI.• Touch EVENT TREND.• Touch CLEAR EVENT.• Select CLEAR THIS EVENT or CLEAR ALL EVENTS.

To print events:

• Touch VARI.• Touch EVENT TREND.• Touch PRINT.

To print event trends:

• Touch VARI.• Touch EVENT TREND.• Touch TREND.• Touch PRINT.

To print a Varitrend 3 graph:

• Touch VARI.• Touch PRINT.


Respiration

Respiration Troubleshooting Guide


Inaccurate respiratory rate or 0 displayed. Question marks displayed instead of rate

■ Respiration too shallow for normal detection.

■ Touch the SHALLOW/NORMAL key to highlight SHALLOW.

■ ECG electrode contact or placement poor.

■ Apply new electrodes. Make sure to properly prepare the skin; position electrodes on the chest where the chest expansion is the greatest.

■ Incorrect lead selection for respiration.

■ Select the appropriate lead. Best lead selection is typically RA-LA for adults and RA-LL for infants.

■ CVA artifact. ■ Assess the patient for apnea. Reselect lead for better signal quality.

No respiration waveform. LOSS OF SIGNAL message is displayed

■ ECG electrodes or patient cable not attached.

■ Select another lead.

■ Reconnect the leads or the patient cable.

No respiration waveform is displayed

■ Channels have not been configured to display respiration.

■ Select RESP ON in the ECG Display Format menu.


NIBP

Directory of Keys


ADULT NIBP - ALARM LIMITS

NIBP - CHANGE CONFIGURATION

TIME INTERVAL for automatic readings = q xx yyy

NIBP

ADULT NIBP - MENU

ALARMLIMITS

TIMEINTRVL

CHANGECONFIG.

DISPLAY PRON OFF

ADULT

NEONATAL

ALARMSON OFF

HI=150

LO=100

SYS DIA MEAN

AUTO

ON OFFREVIEW

PRINT<< >> >><<


NIBP

Contents

Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Setting Up NIBP Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Setting and Adjusting Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Selecting Adult or Neonatal Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Displaying Heart (Pulse) Rate Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Initiating a Manual Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Setting Automatic Measurements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Stopping a Measurement in Progress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Recording Measurements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Reviewing Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Restoring User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Status Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12NIBP Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Overview

Note:


Noninvasive blood pressure (NIBP) uses oscillometric monitoring to measure systolic (S), diastolic (D), and mean (M) arterial blood pressures. The Ultraview Care Network monitor displays these readings and the time the measurement was initiated. You can also display heart rate. The monitor can display up to 10 readings at one time and store up to 120 readings.

Note:

• Blood pressure measurements determined with this module are equivalent to those obtained by a trained observer using the cuff/stethoscope auscultation method, within the limits prescribed by the American National Standard, Electronic or automated sphygmomanometers.

• Use only cuffs specified by Spacelabs Healthcare. Other cuffs may adversely affect performance and measurement accuracy.

• There are no hazards associated with using non-invasive blood pressure equipment during defibrillation or high-frequency electrosurgery because both the cuff and cuff tubing are non-conductive materials.

• You can define your own default settings for such characteristics as alarm limits and display configuration. Refer to Setting User-Defined Default Values on page 7-7 for further information.


NIBP

Setting Up NIBP Monitoring

Proper cuff selection and application is essential in ensuring the accuracy of NIBP readings. To select the proper cuff, first measure the circumference of the limb at its midpoint. Match the limb measurement to the range of appropriate circumferences (in centimeters) specified on each cuff. When applied, the index line on a correctly sized cuff will fall within the designated range markings on the cuff. If the cuff is too wide for the patient, the reading will be falsely lowered. If too narrow, the reading will be falsely elevated. The cuff results in the greatest chance of error, so a variety of cuff sizes should be available to accommodate your full patient population.

The cuff should be snugly applied. When the cuff is properly applied to an adult, you should be able to insert one finger between the cuff and the limb. If you can insert two fingers, the cuff is too loose which may result in falsely elevated readings. Ensure that the inflation tube is not kinked or occluded when the cuff is applied.

During blood pressure measurement, the inflated cuff reduces blood flow to the limb to which it is applied. Do not apply a cuff to a limb that has restricted blood flow. Check the patient periodically to ensure cuff application does not impair limb circulation.

Warning:• Do not apply the cuff to any extremity being used for intravenous infusion or catheterization.

• Do not apply the cuff to any area of breached or injured skin.

Caution:• Do not use extensions or adapters with the neonatal inflation tube, other than those specified.

• Do not apply the cuff to an extremity with restricted or otherwise compromised blood flow.

• Do not apply the cuff to a limb being monitored with a pulse oximetry sensor. SpO2 readings will be affected during NIBP monitoring.

To set up NIBP monitoring:

• Attach the cuff tube to the appropriate module front panel connector.• Attach the cuff to the patient.• Touch NIBP.• Touch additional screen keys as needed.


NIBP

Patient Factors Affecting Readings

Excess patient movement, speech, or muscle contractions (as a result of severe pain or shivering) can interfere with automated NIBP readings. Ensure that the patient is quiet and not moving during NIBP readings just as you would during manual readings. Avoid applying external pressure to the cuff during readings. Institute measures to minimize shivering and alleviate pain.

Some arrhythmias may cause beat-to-beat pressure fluctuations that can make obtaining NIBP readings more difficult. Increased variability of readings can result from these pressure variations. If it becomes difficult to obtain readings in the presence of arrhythmia, pressure should be temporarily verified using another method. Pressure also varies cyclically with normal respiration. With deep respirations, or in certain patients, this effect may be enhanced, increasing reading variability.

For patients in shock, indirect methods of measuring pressure (auscultatory, oscillometric, doppler) may not be reliable because of peripheral vascular changes. These changes include peripheral vasoconstriction and diminished peripheral circulation resulting from shunting of blood to central organs. In some cases, peripheral pulses or Korotkoff sounds may be diminished or disappear in spite of adequate blood pressure. In such cases, measuring a cuff pressure may be impossible or give misleading results. Direct (invasive) blood pressure measurements should be considered in patients with signs of shock or any patient who rapidly becomes unstable for unknown reasons.


NIBP

Display Detail

Figure 13-1 and Figure 13-2 illustrate typical NIBP displays. You can view NIBP readings from any Ultraview Care Network bedside or central monitor on a network. The NIBP display on a split-screen central monitor appears in a format slightly different from that of a bedside or full-screen central monitor.

Figure 13-1: Bedside monitor display

Figure 13-2: Central monitor, split-screen display

� STAT key initiates an immediate blood pressure measurement. While a measurement is in progress the key label changes to STOP.

� NIBP key.

� Last systolic and diastolic readings.

� NIBP alarm limits. Split-screen central monitors display a bell symbol when alarms are enabled. Bedside monitors display the high and low alarm limits for systole and diastole. The asterisk indicates alarms are enabled for mean pressure.

� Mean reading.

� Current interval for automatic readings (q 15 min). q’ in place of q indicates that the reduced delay of five seconds between readings is active (refer to Setting Automatic Measurements on page 13-9).

� NIBP measurement table.

Time and date of the last reading.

08:30 am 128/67 (80)

08:45 am 132/67 (83)

09:00 am 134/69 (85)

09:15 am 140/72 (89)

09:30 am 141/72 (91)

09:45 am 138/73 (88)

10:00 am 140/73 (90)

10:15 am 142/76 (92)

10:30 am 144/77 (95)

10:45 am 165/97 (120)

INTERVALq 15 min

10:4512/08

LAST BP =

NIBP

16597

mmHg

(120)

SD

150100100

60*

�

� � � � �

STAT

�

NIBP

165/97 10:4512/08

LAST BP = mmHg(120)

BED 01 DAVIS, J.

� � � �


NIBP

Bedside monitors show an NIBP table displaying a chronological listing of NIBP readings. The oldest data is at the top of the left column. Each reading contains the time of the measurement and the pressure values for systolic, diastolic, and mean. As new measurements are taken, the oldest data moves off the screen.

Note:

If you remove one NIBP module and insert another without purging data (via ADMIT/DISCHARGE), the NIBP table may display data for two patients.

Central monitors display the last NIBP reading only.

Setting and Adjusting Alarm Limits

You can define alarm limits for systolic, diastolic and mean values. The factory default setting for NIBP alarms is OFF. The default alarm limits settings for both the adult and the neonate modes are listed in Table 1.

Table 1: Alarm Limits

HIGH LOW

Neonatal Systolic 85 mmHg (11.5 kPa) 55 mmHg (7.5 kPa)

Diastolic 75 mmHg (10.0 kPa) 45 mmHg (6.0 kPa)

Mean 80 mmHg (10.5 kPa) 50 mmHg (6.5 kPa)

Adult Systolic 150 mmHg (20.0 kPa) 100 mmHg (13.5 kPa)

Diastolic 100 mmHg (13.5 kPa) 60 mmHg (8.0 kPa)

Mean 110 mmHg (14.5 kPa) 90 mmHg (12.0 kPa)

To set or adjust alarms:

• Touch NIBP.• Touch ALARM LIMITS.• Select SYS, DIA, or MEAN.• Select ALARM ON.• Select HI= or LO=.• Use arrow keys to adjust.


NIBP

Selecting Adult or Neonatal Mode

In modules that offer both adult and neonatal modes, you can determine the current mode by observing which key is highlighted or by reading the menu prompt in the NIBP menu. The factory default setting is adult.

The following events occur with each change of mode:

• The monitor erases current NIBP readings from the display but retains them in memory.

• Previous NIBP readings appear immediately if present in memory. If not, readings appear as the measurements are taken.

• Alarm limits and state (ON/OFF) are automatically changed for the new mode (adult or neonatal).

• Active NIBP alarms reset; alarms in violation terminate and suspended alarms end

Warning:.The mode (adult or neonatal) selected must correlate with the hose connected to the module and the patient type.

Displaying Heart (Pulse) Rate Data

Non-invasive pressure measurements may be displayed with or without a pulse rate. If you choose to display pulse rate, only five measurements may be displayed in the NIBP table. Otherwise, ten measurements may be displayed as shown in Figure 13-1. Pulse rate is obtained from ECG, arterial pressure (ART), SpO2, and NIBP (in that order), depending on the availability of these parameters.

To select the patient type:

• Touch NIBP.• Touch CHANGE CONFIG. • Select ADULT or NEONATAL.

To display heart rate on NIBP table:

• Touch NIBP.• Touch CHANGE CONFIG.• Select DISPLAY PR ON.


NIBP

Initiating a Manual Measurement

You can start a measurement at any time by touching the STAT key.

If an initial measurement attempt is not successful, a single retry will be initiated after a 5-second interval (short-term mode) or 30-second interval (long-term mode).

Note:

New measurements cannot be initiated if another measurement is already in progress.

Setting Automatic Measurements

The NIBP module always powers ON with automatic measurements set to OFF. The current time interval for automatic measurements is displayed on the message line above the arrow keys.

The factory default setting for automatic time interval is 15 minutes.

For automatic time intervals of less than five minutes, the module makes special allowances for a rapid succession of readings. For the first 15 minutes after you set up a reading (turn AUTO mode ON or select a new time interval), the minimum delay between readings is only five seconds. When this five-second delay is active, the interval message will appear with an apostrophe, after the q (q’). After the 15-minute period, the minimum delay between readings becomes 30 seconds.

Warning:During blood pressure readings the inflated cuff reduces blood flow to the limb to which it is applied. Consider this when selecting short time intervals.

To start an immediate measurement:

• Touch STAT.

To determine automatic measurement intervals:

• Touch NIBP.• Select AUTO ON.• Touch TIME INTRVL.• Use arrow keys to adjust interval.


NIBP

Measurement Intervals

Adult and neonatal measurement intervals are as follows:

• between 1 and 10 minutes in one-minute increments

-OR-

• between 10 and 60 minutes in five-minute increments

-OR-

• 1, 2, 4, or 8 hours.

Automatic Reading Times

Turning automatic mode ON or changing the interval initiates a new measurement schedule. When the selected interval is a multiple of five minutes, automatic readings will always begin at the next five-minute division. Selecting AUTO ON shortly before the desired five-minute division can be used to synchronize measurements to exact clock times.

For example, if at 8:03 you select a time interval of 15 minutes, automatic readings will occur at 8:05 and 8:20. If at 8:22 the interval is changed to seven minutes, the next automatic readings will occur at 8:29 and 8:36.

Note:

Touching STAT BP will take an immediate reading without affecting scheduled reading times.

Stopping a Measurement in Progress

To stop an NIBP measurement currently in progress, press the red Deflate button on the front of the module or the STOP key on the display. The next automatic reading will begin on schedule.

To stop an immediate measurement:

• Press the red Deflate button on the module.

-OR-

• Touch STOP.


NIBP

Recording Measurements

You can choose to print out either the complete NIBP display or only the numeric values of the last reading.

Reviewing Measurements

You can review a patient’s NIBP measurements by scrolling through the measurement table line-by-line or page-by-page. (A page is limited to five measurements if the pulse rate is displayed. Otherwise, a page is 10 measurements.)

To scroll line-by-line, touch the single arrow keys:

• To review earlier measurements, touch the key.

• To review later measurements, touch the key.

To scroll page-by-page, touch the double arrow keys:

• To review earlier measurements, touch the « key.

• To review later measurements, touch the » key.

To page to the earliest five (or ten) measurements, touch the«key.

To page to the latest five (or ten) measurements, touch the »| key.

Note:

The monitors display a full page of readings when more than five or ten NIBP measurements have been taken. For this reason, some readings may appear on multiple pages.

To print the NIBP measurements currently displayed:

• Touch NIBP.• Touch REVIEW.• Touch PRINT.

To print the most recent measurement (no table):

• Touch RECORD (monitor key).• Touch NIBP.

To review NIBP measurements:

• Touch NIBP.• Touch REVIEW.• Touch or to move backward or forward in time.


NIBP


With the Restore Settings feature, you can restore the user-configurable settings to the defaults previously stored as user settings. User-configurable settings are listed in Setting User-Defined Default Values on page 7-7.

Note:


Status Messages

At the beginning of a blood pressure measurement:

• The mean value of the previous reading disappears.

• The message READING IN PROGRESS replaces the diastolic value.

• A bleed step replaces the previously displayed systolic pressure.

If the system fails to complete an initial measurement reading, the message SECOND READING REQUIRED will be displayed along with a description of the cause of the failure. A second measurement automatically begins either 5 or 30 seconds later, depending on whether the short-term automatic mode is active. If the second attempt fails:

• The message NO READING is displayed.

• An alarm sounds (if alarms are turned ON).

• One of the following messages is displayed:

INFLATE ERROR

HW ERROR

NO DATA

If the Deflate button on the front of the module or the STOP key on the display is pressed during a reading, the reading will end and the messages NO READING and CUFF DEFLATE will be displayed.

If the system detects unstable beat-to-beat blood pressures during measurements, one of two messages will be displayed:

• In the neonatal mode, MOTION is displayed.

• In the adult mode, ARTIFACT is displayed.




NIBP

If an error status message is displayed and the system is unable to proceed with its current operation, you must correct the fault before the system can continue. If you are unable to correct the fault, contact a qualified service person.

If NIBP SYSTEM FAILURE ERROR NUMBER = XX (bedside only), or HW ERROR (bedside and remote) displays, it indicates that a hardware problem has caused the NIBP portion of the module to be inoperable. The module must be serviced by a qualified service person before NIBP measurements can be taken.

If the error message CUFF CAN NOT BE DEFLATED displays, it indicates that the deflate hardware is blocked and the cuff cannot be deflated. Remove the cuff from the limb immediately and have the module serviced. The module must be serviced by a qualified service person before NIBP measurements can be taken.

If either of the above messages are displayed, a RESET NIBP key will be present in the Change Config menu. Touch the RESET NIBP key to re-enable non-invasive blood pressure monitoring.

Note:

If these messages occur repeatedly, discontinue NIBP monitoring and contact a qualified service person.


NIBP

NIBP Troubleshooting Guide


No NIBP screen key is displayed

■ Module not inserted correctly. ■ Remove and re-insert the module.

No NIBP readings can be obtained

■ Incorrect or inoperative cuff in use.

■ Replace with the cuff known to be operative.

■ Cuff tubing is attached to an adult outlet, but monitor is configured in the neonatal mode (or vice versa).

■ Connect tubing to the correct outlet. Correlate monitor mode, cuff and patient type.

■ Tubing is kinked. ■ Locate kink and straighten tubing.

■ Some arrhythmias (for example, atrial fibrillation and frequent ventricular ectopy) may cause a single or repeated failure to obtain a reading (may be due to true beat-to-beat variations in pressure).

■ Document arrhythmia if present, verify pressure with another method, then follow hospital procedure for care of this type of patient.

■ Excessive patient motion or muscle contractions associated with shivering or severe pain.

■ Ensure that patient is quiet with minimal movement during NIBP readings. Minimize the patient’s shivering.

■ Blood pressure outside of measurement range.

■ Verify extremely high or low pressures with another method.

Intermittent or complete failure to operate

■ Hardware error (codes 10, 20, and 30) detected during previous measurement.

■ Check the presence of the RESET NIBP key in the CHANGE CONFIG menu. Touch RESET NIBP to re-enable monitoring.

■ Remove the module from service and call a qualified service person if this condition occurs repeatedly.


NIBP

Apparent incorrect value

■ Wrong size cuff for patient. ■ Measure patient’s limbs at the midpoint. Match limb measurement to the range specified on the cuff (undersizing the cuff results in the greatest degree of error).

■ Cuff is damaged. ■ Replace with a good cuff.

■ Excessive patient motion, shivering or severe pain.

■ Ensure the patient is quiet with minimal movement during NIBP readings. Minimize the patient’s shivering.

■ False high readings may be the result of venous congestion caused by frequent readings.

■ Reduce the frequency of the readings.

■ Cuff too loose or positioned incorrectly.

■ Tighten the cuff or reposition it appropriately.

Variable readings occur ■ Some arrhythmias may cause beat-to-beat pressure and NIBP readings.

■ Document the arrhythmia, if present. Verify the pressure using another method, then follow hospital procedure for care of this type of patient.

■ Larger than normal influence of respiratory phases on blood pressure (inspiratory fall in blood pressure; expiratory rise).

■ NIBP software usually compensates for normal variation.

No NIBP readings or questionable values in the presence of shock

■ Peripheral vascular changes experienced during shock may reduce the reliability of blood pressure readings obtained with any indirect method. Peripheral pulses may be diminished or absent.

■ Consider invasive pressure measurements in patients with symptoms of shock or in any patient who rapidly becomes unstable for unknown reasons.



SpO2

Directory of Keys


ALARM LIMITS

SETUPIABP

YES NO

PULSE RATE

ON OFF

SPO2

SPO2 MENU

SIZEWAVEFORM

ON OFFAVERAGING TONE

SPO2 - SETUP

SPO2 - ALARM LIMITS

ALARMS

ON OFF

HI =

100

LO =

85

ALM DELAY

15sMSG ALARMDELAY 30s

MSG ALARM KEY is displayedonly when its value is otherthan 20 seconds.

SIZE SIZE

TONE

ON OFFVOLUME VOLUME

SPO2 - WAVEFORM SIZESPO2 - DATA AVERAGING TIME XXs

SPO2 - TONE

SUSPENDPROCESSING

YES

SPO2 - SUSPEND PROCESSING

NO


SpO2

Contents

Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Setting Up SpO2 Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Dual SpO2 Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Ensuring Accurate Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Using the Sensorwatch Feature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Setting and Adjusting Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Selecting Data Averaging Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Using SpO2 with Intra-Aortic Balloon Pumps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Adjusting Tone Volume. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Modifying Waveform Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Viewing Pulse Rate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Restoring User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Suspending/Resuming SpO2 Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Recording SpO2 Waveforms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Error Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Sensors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15SpO2 Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Overview

Note:


Pulse oximetry allows continuous noninvasive monitoring of a patient's hemoglobin oxygen saturation. The oximetry sensor contains two light-emitting diodes (LEDs) that transmit specific wavelengths (typically 660 and 940 nanometers) of light that are received by a photo detector.

Oxygen saturated blood absorbs light differently compared to unsaturated blood. The amount of light absorbed by the blood can be used to calculate the ratio of oxygenated hemoglobin to total hemoglobin in arterial blood. The monitor displays this ratio as percent SpO2. Normal values range from 95 to 100%.

Warning:• A pulse oximeter should NOT be used as an apnea monitor.

• A pulse oximeter should be considered an early warning device. If a trend towards patient deoxygenation is indicated, blood samples should be analyzed by a laboratory co-oximeter to completely understand the patient’s condition.

• When used according to the manufacturers’ instructions, sensors have no adverse effect on tissues.


SpO2

Note:

• Pulse oximetry may interfere with magnetic resonance imaging (MRI) procedures. Refer to your hospital’s protocols for specific instructions.

• You can define your own default settings for such characteristics as alarm limits and display configuration. Refer to Setting User-Defined Default Values on page 7-7 for further information.

• The ECG lead wires of the 90343 telemetry transmitter must be connected to the patient in order to perform ECG and blood oxygen saturation monitoring.

Setting Up SpO2 Monitoring

When you connect the adapter cable to the module, the SPO2 key will be displayed. Attach the sensor to the patient and then to the adapter cable.

Caution: • Use only patient sensors specified by Spacelabs Healthcare. If you use sensors other than

those specified, it may degrade performance and could damage the monitor during defibrillation.

• Spacelabs Healthcare recommends the use of sensors repaired or remanufactured by the original manufacturer only.

• Check the sensor site frequently. Do not allow the sensor to remain on one site for a prolonged period of time, especially when monitoring neonates. Refer to the sensor manufacturer's instructions.

• Never attach an SpO2 sensor on a limb being monitored with a blood pressure cuff or a limb with restricted blood flow.

• A poorly applied sensor may give incorrect saturation values. The Sensorwatch signal strength indicator is used to identify a poorly applied sensor or a poorly chosen site. Re-apply the sensor. Refer to Using the Sensorwatch Feature on page 14-7 for further details.

• Choose a site with sufficient perfusion to ensure accurate oximetry values.

An adapter cable is required between the sensor and the module. Do not discard the adapter cable when you have finished using a disposable oximetry sensor. Disconnect the sensor cable from the adapter cable before discarding the sensor.

Connect the SpO2 adapter cable to the module or telemetry transmitter by aligning the cable with the notch on the SpO2 connector on the front of the module or telemetry transmitter. Push the cable straight into the connector. To remove the cable, press the latch release on the bottom of the cable and pull the cable straight out.


SpO2

Dual SpO2 Monitoring

Some modules support real-time monitoring of dual SpO2 sites. To employ this option, insert a second Spacelabs Healthcare SpO2 module into an available slot in the monitor. The new parameter will be displayed below the first SpO2 channel. Affix a label to the monitor’s bezel to indicate the sensor site location (for example, right hand, left foot) for each SpO2 parameter displayed on the monitor.

To set up SpO2 monitoring (non-telemetry):

• Connect the adapter cable to the module.• Attach the sensor to the patient and connect the sensor cable to the adapter cable.• Touch SPO2.

To set up SpO2 monitoring (telemetry):

• Connect the SpO2 adapter cable to the transmitter. • Attach the sensor to the patient and connect the sensor cable to the SpO2 adapter

cable. • Initiate ECG monitoring.• Touch ECG.• Touch CHANNEL FORMAT.• Touch SPO2 ON.


SpO2

Display Detail

Note:

For telemetry display information, refer to Display Detail on page 17-12.

These figures illustrate a typical SpO2 display. You can view oximetry values from any Ultraview Care Network bedside or central monitor on a network.

� Pulse plethysmographic waveform

� SPO2 key

� Sensorwatch signal strength indicator

Shaded area (waveform index, WFI) expands up proportionally to signal strength; horizontal line indicates minimum signal level.

No shading (lowest waveform index) corresponds to no detected signal strength or a faulty sensor.

� SpO2 pulse rate (asterisk flashes when pulse is detected - on bedside monitors only)

� Current SpO2 value (percent)

� High and low SpO2 alarm limits

� The bell indicates that alarms are enabled (on split screen central only)

99

109 bpm

%10085

*SPO2=99% PULSE RATE = 109 bpm

Figure 14-1: Split screen central monitor Figure 14-2: Bedside monitor

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SPO2

SPO2

Ultra
view Care Network Operations Manual 14-6

SpO2

Ensuring Accurate Monitoring

While each sensor requires site specific application procedures, the following general points aid in ensuring oximetry monitoring success.

• Choose a site that provides proper alignment of the LEDs and receiving photodetector.

• Reduce light interference when monitoring a neonate under bright light by using a diaper or other light block over the sensor.

• Select a site that has unrestricted blood flow and can remain as immobile as possible to reduce or eliminate movement artifact.

• Do not restrict blood flow when securing a sensor with tape.

• Do not select a site near potential electrical interference (electrical cords, for example).

• The Sensorwatch bar should be above the minimum signal level.

Using the Sensorwatch Feature

The Sensorwatch feature is a graphical presentation of the amplitude of the signal received from the sensor. It can be used to determine the best sensor site and application.

Changes in the displayed shaded level signify the changes in the patient’s perfusion or changes in the application of the sensor. The horizontal line near the bottom fourth of the graphic represents the minimum signal level that results in accurate saturation values. When the shading is just below this point, the message LOW SIGNAL STRENGTH - REPOSITION OR REPLACE SENSOR is displayed and SENSORWATCH flashes.

When the shading is below the line:

• Reposition the sensor to a different site to provide better perfusion.

• Reposition the sensor so that better contact is made with the skin and the LEDs and photodetector are aligned better.

• Replace a defective sensor.

• Wait for the patient to warm and the perfusion to increase.


SpO2

Setting and Adjusting Alarm Limits

Pulse oximetry alarm limits and delays are based either on factory default limits or user-defined limits. The factory default settings for alarm limits are 100% for high and 85% for low. For alarm delays, the factory default settings are 15 seconds for alarm limit delay and 20 seconds for message alarm delay. Refer to Alarms on page 2-3 for further information concerning Ultraview Care Network alarm operations.

Refer to SpO2 on page 7-37 for SpO2 parameter tables listing available user settings and factory defaults for this parameter. Refer to Table 3 on page 7-14 and Table 4 on page 7-18 for telemetry information.

Additional Information for Telemetry Products

When SpO2 alarms are enabled, a bell symbol is displayed immediately following the measured SpO2 saturation percentage (%).

To set or adjust SpO2 alarms (non-telemetry):

• Touch SPO2.• Touch ALARM LIMITS.• Touch ALARMS ON.• Touch HI=, LO=, ALM DELAY, or MSG ALARM DELAY (if present).• Use arrow keys to adjust.

To set or adjust SpO2 alarms (telemetry):

• Touch ECG. • Touch ALARM LIMITS.• Touch SPO2 ALARM LIMITS.• Select SPO2 ALARMS ON. • Select HI=, LO=, ALM DELAY, and MSG ALARM DELAY.• Use arrow keys to adjust.


SpO2

Selecting Data Averaging Period

Use this feature to smooth the oximetry saturation value by averaging patient input values over 4, 8, or 16 seconds. The default value is eight seconds.

• For non-telemetry products, the data averaging period is displayed in the menu prompt line of the AVERAGING menu.

• For telemetry products, refer to the 90343, 90347, 90478, 90479-A Ultraview Digital Telemetry Service Manual (P/N 070-0744-xx) for setting up the data averaging period.

Using SpO2 with Intra-Aortic Balloon Pumps

Enabling the intra-aortic balloon pump (IABP) feature informs the SpO2 software that an IABP is in use. The SpO2 software must differentiate between true arterial pulsations and those produced by the IABP. With the IABP feature enabled, the transmitter excludes the IABP-generated pulsations from the calculation for SpO2.

The IABP feature also may be useful with patients experiencing irregular heart rhythms. Enabling the IABP feature permits the transmitter to reject irregular pulses, providing a more accurate SpO2 measurement.

Note:

• When the IABP feature is enabled, the pulse rate obtained from SpO2 may not match the heart rate obtained from ECG.

• In cases of excessive patient motion or artifact, the accuracy of the SpO2 measurement may be compromised when the IABP feature is enabled.

• (90343 only) When the IABP operation is selected, the SPO2 status key in the Channel Format menu indicates IABP. The Service Manual describes how to configure the telemetry transmitter for use with an IABP.

To specify a data averaging period:

• Touch SPO2.• Touch SETUP.• Touch AVERAGING.• Use arrow keys to adjust.

To use with balloon pump (non-telemetry):

• Touch SPO2.• Touch IABP YES.


SpO2

Adjusting Tone Volume

Use this function to turn the pulse tone ON or OFF. The pitch varies according to the SpO2 value. The higher the oxygen saturation, the higher the pitch.

The default setting for the pulse tone is OFF.

Note:

This feature is not supported in telemetry products.

Modifying Waveform Display

Use this function to turn the plethysmographic waveform display ON or OFF. The default setting is ON.

Use the SIZE key to change the height of the displayed waveform as necessary for clarity. This changes the displayed size only and does not affect the signal gain.

Note:

• Amplitude of the displayed waveform is not proportional to the pulse amplitude.

• This feature is not supported in telemetry products.

To adjust tone volume (non-telemetry):

• Touch SPO2.• Touch SETUP.• Touch TONE.• Touch TONE ON.• Use arrow keys to adjust.

To modify display of the waveform (non-telemetry):

• Touch SPO2. • Touch SETUP.• Verify WAVEFORM ON.• Touch SIZE.• Touch SIZE or SIZE to adjust.


SpO2

Viewing Pulse Rate

You can obtain and view a pulse rate derived from the saturation data. The pulse rate is displayed within the range of 30 to 250 beats per minute ±3 beats per minute.

The default setting for the pulse rate display is ON for non-telemetry products.

For telemetry products, the heart rate for display is obtained directly from the acquired ECG leads or an alternate rate source. SpO2 can be used as the alternate source if the multiparameter telemetry transmitter is set for continuous measurement, but not when SpO2 is set for episodic measurement.



Note:

• RESTORE SETTINGS changes the user-configurable settings for all parameters in the module.


To modify the pulse rate display (non-telemetry):

• Touch SPO2.• Touch PULSE RATE ON/OFF.

To display heart rate from SpO2 sensor (multiparameter telemetry):

• Touch ECG. • Touch SETUP.• Touch RATE SOURCE.• Select SpO2 ON.• Select SpO2 as rate source.


SpO2

Suspending/Resuming SpO2 Processing

When you touch YES in the Suspend Processing menu, analysis and display of the SpO2 data is suspended. If you touch NO, the display returns to the SpO2 menu without affecting processing.

When you suspend SpO2 processing:

• The message SPO2 PROCESSING SUSPENDED appears in the SpO2 waveform zone.

• Question marks replace the SpO2 and pulse rate values.

• The message SPO2 ALM OFF replaces the alarm limits.

• The keys in the SpO2 Alarm Limits menu display outline to indicate they are disabled.

• The SUSPEND PROCESSING key changes to RESUME PROCESSING.

Note:



Configurations with ECG

• Touch ECG.• Touch SETUP.• Touch RESTORE SETTINGS.• Touch YES.

Configurations without ECG

• Touch TEMP.• Touch RESTORE SETTINGS.• Touch YES.

To suspend SpO2 processing:

• Touch SPO2.• Touch SUSPEND PROCESSING.• Touch YES.

To resume SpO2 processing:

• Touch SPO2.• Touch RESUME PROCESSING.• Touch YES.


SpO2

Recording SpO2 Waveforms

You can print SpO2 waveforms and values. Refer to Printing on page 4-5 for additional information.

Note:


Error Messages

Warning:Error messages indicate a problem or condition that may affect accurate monitoring values. Do not ignore these messages. Correct any fault before continuing.

When error messages are displayed, the saturation value and pulse rate immediately change to ??? and an alarm may occur if your module is configured to do so. If it occurs, this alarm does not begin until after the message alarm delay time has elapsed.

If your module has been configured for an alarm using the Module Configuration Manager feature, the parameter key flashes red for high-priority alarms or yellow for medium- and low-priority alarms. Refer to Module Configuration Manager on page 7-5 for more information.

Telemetry products use different text for their SpO2 error messages than non-telemetry products. Table 1 serves as a key for interpreting the telemetry messages. Telemetry products also display their error messages within ECG’s display zone, so the following ECG alarm messages take priority over other SpO2 messages.

• LEADS OFF

• NOISY SIGNAL

• ECG ALARMS SUSPENDED

To print SpO2 waveforms:

• Touch RECORD.• Touch flashing SPO2 parameter key.

Table 1: Telemetry Message Equivalent

SpO2 Message Equivalent Telemetry SpO2 Message

ADAPTER DISCONNECTED – CHECK CONNECTION AT MODULE

SPO2 UNAVAILABLE

FAULTY SENSOR – REPLACE SENSOR SPO2 FAULTY SENSOR

SENSOR DISCONNECTED – CHECK CONNECTION AT ADAPTER CABLE

SPO2 SENSOR DISCONNECTED


SpO2

ADAPTER DISCONNECTED — CHECK CONNECTION AT MODULE

• The module does not detect an adapter cable connected to the front panel. Check proper adapter cable connection.

• If the message persists and the adapter cable is secure, replace the adapter cable.

• The channel will drop and the alarm will stop after approximately 10 seconds.

• On remote view, there may be no audible alarm on the remote monitor before the channel drops.

SENSOR DISCONNECTED — CHECK CONNECTION AT ADAPTER CABLE

• The module does not detect a sensor. Check the proper connection of the sensor with adapter cable.

• If the message persists, replace the sensor and/or the adapter cable.

SENSOR OFF PATIENT — CHECK CONNECTION AT PATIENT

• The module does not detect a valid sensor input signal. Check the patient for proper sensor placement.

• The tissue between the LED and photodiode is too transmissive. If the sensor placement seems correct and the message persists, try a sensor site with a thicker tissue bed.

Note:

This message is not available with disposable SpO2 sensors or non-clip type sensors.

FAULTY SENSOR — REPLACE SENSOR

• The LED and/or photodiode have failed. Replace the sensor.

SENSOR OFF PATIENT – CHECK CONNECTION AT PATIENT

SPO2 SENSOR OFF PATIENT

INSUFFICIENT SIGNAL – REPOSITION OR REPLACE SENSOR

SPO2 INSUFFICIENT SIGNAL

AMBIENT LIGHT INTERFERENCE – COVER SENSOR AREA

SPO2 AMBIENT LIGHT INTF.

NOISY SIGNAL SPO2 NOISY SIGNAL

LOW SIGNAL STRENGTH – REPOSITION OR REPLACE SENSOR

SPO2 INSUFFICIENT SIGNAL

Table 1: Telemetry Message Equivalent (continued)

SpO2 Message Equivalent Telemetry SpO2 Message


SpO2

AMBIENT LIGHT INTERFERENCE — COVER SENSOR AREA

• The sensor is receiving external light interference from a bright light source near the sensor. Shield the sensor from the external light source.

• The sensor photodiode and LEDs are misaligned on flexible sensors thereby allowing light to enter. Realign the sensor photodiode with LEDs.

• If the message persists, replace the sensor.

INSUFFICIENT SIGNAL — REPOSITION OR REPLACE SENSOR

• Insufficient signal for proper operation as evidenced by a low deflection on Sensorwatch signal strength bar.

• Poor sensor application or site. Correctly re-apply or reposition to a better perfused site or massage site.


NOISY SIGNAL

• Sensor signal disturbed by motion or other interference. Eliminate sensor movement. Message disappears when the value is obtained.

• Sensor placement adjacent to power cords or other electrically noisy devices. Move the noisy device or move the sensor to another site.


LOW SIGNAL STRENGTH — REPOSITION OR REPLACE SENSOR

When this message appears the saturation and pulse rate continue to be displayed; however, the Sensorwatch flashes as a indication of a possible error condition.

• Insufficient blood flow between the sensor light emitter and detector. Move the sensor to an area of higher perfusion.

• Poor sensor application. Reposition to place active components closer to skin or locate to a better perfused site.

• Sensor site is below the blood pressure cuff. Move to another site.


Sensors

For further information about biocompatibility or sensor disposal, refer to the Spacelabs Healthcare Product Specification sheets and to the manufacturer's instructions enclosed with each sensor.


SpO2

SpO2 Troubleshooting Guide


No SpO2 parameter key is displayed

■ Module not inserted correctly. ■ Remove and reinsert the module.

■ Adapter cable not connected to module properly.

■ Correctly connect the adapter cable.

■ Sensor not connected to adapter cable.

■ Correctly connect the sensor.

■ SpO2 is not enabled at the 90343 transmitter.

■ Call a qualified field service technician to check transmitter DIP switch 1 and 2.

■ SpO2 is not enabled at the 90478 receiver.

■ Call a qualified field service technician to enable multiparameter telemetry in the Module Configuration Manager or to enable the SpO2 display in the Channel Format menu.

SpO2 value displays ???

■ Sensor not connected to patient. ■ Reattach the sensor.

■ Excessive patient motion. ■ Urge patient to remain still while reading is in progress.

■ Module is in the initialization phase (the first 15 seconds after sensor application).

■ Wait until the initialization is complete.

■ Adapter cable not connected to the module properly.

■ Correctly connect the adapter cable.

■ Sensor not connected to the adapter cable.

■ Correctly connect the sensor.

■ Low battery indicator constantly illuminated (telemetry only).

■ Call a qualified field service technician.


SpO2

Low signal strength ■ Sensor placement not optimum. ■ Move the sensor to a site which has better perfusion.

■ Align the LED with the sensor photo detector.

■ Sensor is placed below blood pressure cuff.

■ Move the sensor to an alternate limb.


■ Module error. ■ Call a qualified field service technician.

Factors which cause significant variances in sensor accuracy

■ Presence of dysfunctional hemoglobins (COHb, MetHb).

■ Follow hospital procedure for determining oxygenation in these patients.

■ Presence of intravascular dyes (indocyamine green, methylene blue) depending on their concentration in the blood stream.


■ High ambient light level. ■ Reduce light levels near the patient.

■ Electrosurgical interference. ■ Follow hospital procedure for determining oxygenation in these patients.

■ Patient is significantly anemic (Hb less than 5 g/dl) or patient has received large amounts of IV solutions.




SpO2

No SpO2 alarms are displayed (telemetry only)

■ ECG “Leads Off” condition exists. ■ Re-attach ECG lead wires to patient and resume ECG monitoring to clear pending ECG alarms.

■ Higher-priority alarm condition is present.

■ Clear current alarm condition and/or re-prioritize SpO2 alarms of interest in the Module Configuration Manager.

■ When SpO2 alarms are set to ON, all SpO2 alarm conditions will cause the parameter value (or ???) to blink according to the alarm priority set by using the Module Configuration Manager.



Fetal Monitoring

Directory of Keys

FETAL - MAIN MENU

FETAL SETUP MENU

FETAL - FETAL ECG MENU

FETAL - TOCO SENS MENU

FETAL - TWIN SHIFT MENU

FETAL - F-ALERT LIMITS MENU


FETAL

F-ALERTRESET

SETUPRECORDER PAPER

FEEDAUDIO X

XX% MARK UA REF

ON OFF

TWIN SHIFT

TOCO SENS

FETAL ECG

F ALERT LIMITS

PRINT PERIOD

RESTORE SETTINGS

HIDDEN KEY

TWINS

YES NO

SIZE SIZE X mm/sec

WAVEFORM ECG PLOT ECG HR EDIT

ON OFF ON OFF ON OFF

LOW MEDIUM HIGH

AUTO MANUAL NO SHIFT

F-ALERT HI= XXX

LO= XXX

ON OFF


Fetal Monitoring

Contents

Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Fetal Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Starting Operation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Ultrasound Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Uterine Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9ECG Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Intrauterine Pressure Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Main Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Fetal Heart Rate Alerts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Bradycardia Alert . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Tachycardia Alert . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Recorder Operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Module Configuration Manager . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Telemetry Option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Overview

This chapter describes the fetal monitor functionality of the Spacelabs Healthcare Maternal Obstetrical Monitor™ (MOM™). For instructions on optional maternal parameters such as ECG, SpO2, temperature, and NIBP refer to the appropriate chapter of this manual.

Fetal Display Detail

The fetal module automatically allocates a single display zone when it establishes communication with the Maternal Obstetrical Monitor. This zone consists of numeric values and messages. When an internal fetal ECG electrode is applied to the patient, a second zone displays the fetal ECG waveform from channel 1. This zone does not display when using ultrasound-monitoring technique.

For singleton births, this display will appear as follows:

Figure 15-1: Singleton birth display

FETAL67

FHR1 (US)

PATIENT’S NAMEROOM 1003

144UC (EXT)

ALERT ON

144FHR1 (US)

25UA (EXT)

✑✓✑✓TIME and DATE

PATIENT’S NAME RM 1003

PAPER OUT

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Fetal Monitoring

For a twin pregnancy, the display appears as follows:

Figure 15-2: Twin display

� Heart beat indicator (flashes once per detected beat)

� Channel 1 heart rate (beats per minute)

� FHR channel label

� Source of heart rate signal (US = ultrasound, ECG = spiral ECG)

� Signal indicator (full = good signal; half full = adequate; empty = poor or no signal)

� UA channel label

� Uterine activity measure (units for toco; mmHg or kPa for IUP)

Source (EXT for toco; mmHg, or kPa for IUP)

Channel 2 heart rate (beats per minute)

� Fetal parameter key

Status messages (appear when appropriate)

� Time, date, patient name, and room number

� Fetal ECG trace from spiral electrode

FETAL67

FHR1 (US)

PATIENT’S NAMEROOM 1003

144UC (EXT)

ALERT ON

FHR1 (ECG)

32UA (EXT)

125FHR2 (US)

136

TIME and DATE

PATIENT’S NAME RM 1003

PAPER OUT

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Fetal Monitoring

Starting Operation

Power ON

To prepare the monitor for operation:

1 Plug the appropriate end of the power supply cord into the monitor’s right side panel receptacle labeled J1.

2 Secure the connector with the screw that is provided.

3 Plug the other end of the power cord into a properly grounded three-wire outlet marked Hospital Grade or Hospital Only.

4 Press the main power switch ON. The monitor will perform a self-test.

Note:

If the MOM unit is powered OFF for a period of three minutes, all data, including the patient’s name, is purged from memory.

Standalone unit (not connected to BirthNet):

The patient’s name will flash on the display if all the following conditions are met:

• The patient’s name has been admitted through the monitor setup.

• The patient was not discharged from the monitor before powering OFF the monitor.

• The unit was not powered OFF for a period greater than three minutes.

If the flashing name is correct, the clinician should confirm the identity of the patient by touching the F-ALERT RESET key. Following confirmation, the patient’s name will print on the fetal strip and will continue to print every 20 minutes.

If incorrect, use the MONITOR SETUP/ADMIT DISCHARGE key to admit the new patient.

Under standalone conditions, the patient’s name will also flash if no fetal heart rate data has been received for a period of 10 minutes on channel 1. Touch the F-ALERT RESET key to confirm the patient’s name.

When connected to BirthNet, the patient’s name will flash the first time the monitor intercepts a name from BirthNet (after power ON) to inform the clinician of the identity of the patient. Touch the F-ALERT RESET key to confirm the information. The patient name will also automatically print on the fetal strip. Subsequent admission through BirthNet will not cause the name to flash if the monitor has not been powered OFF between patients.

Note:

The Admit/Discharge feature of the monitor is primarily a standalone feature. Use of this feature when connected to BirthNet might create a situation where the name of the patient entered under ADMIT in Monitor Setup will appear on the maternal strip while the fetal strip is identified with the patient’s name from BirthNet. If the hospital chooses to use the Admit/Discharge function, it is recommend that the monitor be powered OFF for three minutes between patients.

Under standalone or BirthNet connections, when the monitor is in fetal heart rate alert status, the clinician will have to first touch the F-ALERT RESET key to reset the alert, and again, to confirm the patient’s name.


Fetal Monitoring

Loading Chart Paper

To load chart paper:

1 Press the Recorder Release button and slide the drawer out to reveal the paper bin.

2 Pull out one or two sheets of paper from the top of a new packet and place the remaining packet of paper into the recorder drawer. Position the top of the paper (fetal heart rate scale) toward the left of the drawer with the printed side facing up.

3 Slide the recorder door back until it snaps securely in place. Make sure that the leading two sheets of paper hang out of the monitor.

Note:

For the protection and proper performance of the recorder, use only paper approved by Spacelabs Healthcare. Failure to use approved paper may result in a malfunction.

Calibration

Calibration provides a functional check of the equipment and helps ensure a reliable recording. Calibration should be performed before beginning a recording and can be done at any time during monitoring.

To calibrate:

1 Touch the FETAL key.

2 Touch the PAPER FEED key.

3 FHR 1–150, UA –50, and FHR 2–180 will be displayed and the recorder will print corresponding lines on the fetal strip chart.

Note:

Following calibration, check that the recorder printed a line at 150 and 180 to ensure the paper is the correct scale.

To advance and calibrate the fetal recorder paper:

• Touch PAPER FEED.


Fetal Monitoring

Ultrasound Monitoring

Channel 1

The ultrasound transducer sends sound waves into the uterine cavity and detects echoes returning from objects in the path. The monitor uses auto-correlation to analyze these echoes from moving objects, specifically the fetal heart. The rhythm of the motion is used to compute the fetal heart rate. To produce a reliable recording, the transducer must be positioned properly to send sound waves directly at the fetal heart.

Note:

To obtain consistent, reliable information, proper application of transducers is essential.

Ultrasound Transducer Preparation and Application

The transducer connections are color-coded and uniquely keyed.

1 Plug the ultrasound transducer (green) connector into the FHR1 (green) connector on the front of the monitor. The groove on the transducer connector must be aligned properly.

2 Apply a generous amount of gel over the face of the ultrasound transducer.

Note:

The gel is necessary to ensure that good signals are produced by the transducer. Use enough gel to cover the flat transducer face before it is placed on the mother’s abdomen. Add additional gel, if necessary, to improve the signal.

3 Adjust the volume as necessary to hear the fetal heart sounds while positioning the ultrasound transducer.

Note:

Remember to calibrate the monitor each time you begin a monitoring session. Refer to Calibration on page 15-6.

4 Place the transducer on the mother’s abdomen and gently move it along the abdomen to locate the sharpest and clearest fetal heart sounds.

Note:

Keep the transducer face in contact with the abdomen. Tilt the transducer to locate the clearest heart sounds, then reposition it in the direction of the tilt until you hear the best signal while the transducer is flat on the abdomen.

5 The transducer should be held securely in place with the transducer belts without causing discomfort to the patient.

6 Check the mother’s pulse. Be sure it does not coincide with the displayed heart rate. If it does, the transducer may be detecting the maternal blood flow, rather than the fetal heart beat. Reposition the transducer toward the fetal heart.


Fetal Monitoring

Channel 2

The monitor is equipped with a second FHR connector to provide simultaneous monitoring of twins. Both fetuses can be monitored using ultrasound transducers. Ultrasound transducer preparation and application for the second fetus is the same as for a single fetus. Volume controls for both channels are located on screen.

Note:

Make sure that both transducers are not directed at the same fetus. Review the information on Differentiation of Fetal Heart Rate on page 15-8 and Coincidence Recognition on page 15-9.

Twins Signal Processing

To display the second fetus heart rate, the TWINS YES/NO key must be set to YES. To prevent the second ultrasound transducer from producing signal noise from the FHR2 input, the factory default is TWINS NO.

Differentiation of Fetal Heart Rate

To aid in distinguishing twin fetal heart rates, you can select one of three modes for presentation of the fetal heart rate data for the second fetus. The three modes are:

• FHR2 prints on the same scale as FHR1

• FHR2 prints on a scale 30 bpm below FHR1 (twin shift manual setting)

• FHR2 shifts to a scale 30 bpm below FHR1 when the monitor detects the two FHRs to be in proximity to each other (auto setting). To differentiate twin FHRs on the fetal strip chart, the FHR2 trend prints in a light gray compared to the darker FHR1 trend. When twin fetal heart rates intersect, the FHR2 trend prints dots only, rather than a line, to enhance the distinction between the two. Finally, the recorder prints HR2 every 10 minutes with a dotted line pointing to the FHR2 trend. If the 30-bpm offset is activated, the message will read HR2, Add 30.

Note:

Once shifted, FHR2 will remain on this alternate scale until the monitor detects a consistent pattern of baseline separation between the two fetal heart rates. In many cases, this alternate scale may remain in effect throughout the delivery.

To set twins signal processing:

• Touch FETAL.• Touch SETUP.• Touch TWINS YES.

To set the twin FHR shift:

• Touch FETAL.• Touch SETUP.• Touch TWIN SHIFT.• Select MANUAL, AUTO, or NO SHIFT mode.


Fetal Monitoring

Coincidence Recognition

The system has a coincidence recognition feature to detect the same heart rates between FHR1 and FHR2 over a period of time. When a coincidence is suspected, the monitor prints a question mark (?) on the strip chart to notify the clinician.

Note:

• If these marks appear, the FHR1 and FHR2 signals may be from the same fetus. Re-check the ultrasound transducer positions. If necessary, reposition the transducers to capture the fetal heart rates from different fetuses.

• This detection may not occur if channel 1 is in ECG mode and channel 2 is ultrasound, because of the difference in signal processing.

• This detection may not occur if one or both of the ultrasound channels have a poor signal quality.

Uterine Activity

The toco transducer detects uterine activity by sensing changes in tension on the abdomen. Although absolute uterine pressure cannot be measured by this method, the toco transducer does provide a reliable indication of the timing and approximate duration of contractions.

Note:

Do not use any kind of gel on the toco transducer.

Toco Transducer Preparation and Application

1 Plug the toco transducer (yellow) connector into the UA (yellow) connector on the front of the monitor. The groove on the toco transducer connector must be aligned properly.

2 Position the transducer on the maternal abdomen. The best location is usually midline between the fundus and the umbilicus.

3 The transducer should be held securely in place with the transducer belts without causing discomfort to the patient.

4 To initialize, touch the UA REF key. The UA display will reset to 20 units momentarily.

Note:

Toco sensitivity can be set at three different levels enabling you to adjust the sensitivity to meet the specific needs of a particular patient.


Fetal Monitoring

ECG Monitoring

In addition to ultrasound, channel 1 is designed to monitor fetal heart rate using an invasive spiral electrode to obtain the fetal ECG and derive the heart rate. The ECG (internal) mode is generally considered the most accurate and reliable method to obtain a fetal heart rate.

Fetal ECG Electrode Preparation and Application

Warning:• Because the tip of the fetal spiral electrode is designed to penetrate the fetal skin, it may

present the possibility of trauma, hemorrhage, or infection. Therefore, these electrodes should only be used under aseptic conditions. Refer to contraindications and application instructions on the electrode manufacturer’s packaging.

• To apply the fetal ECG spiral electrode, the membranes must be ruptured.

Note:

If both the fetal heart rate and uterine activity are to be monitored using internal techniques, it is generally recommended that the intra-uterine catheter be inserted before the attachment of the spiral electrode.

1 Prepare an area on the patient’s upper thigh or, preferably, on the lower abdomen by cleaning with an alcohol swab. Allow to dry.

2 Apply a pre-gelled ECG skin electrode to the prepared area.

3 Plug the leg clip (green) connector into the FHR 1 (green) connector on the front of the monitor. The groove on the transducer connector must be aligned properly.

Note:

• To acquire ECG data, the leg clip must be connected to FHR channel 1.

• The leg clip does not work on FHR channel 2.

4 Apply the fetal spiral electrode according to the instructions on the manufacturer’s packaging.

To initialize uterine activity:

• Touch FETAL.• Touch SETUP.• Touch the UA REF key.• Touch YES to confirm.

To set the Toco sensitivity:

• Touch FETAL.• Touch SETUP.• Touch the TOCO SENS key.• Select LOW, MEDIUM, or HIGH sensitivity.


Fetal Monitoring

5 Once the spiral electrode has been attached, press the top of each push post on the leg clip to reveal a slot. Insert each wire (two) from the electrode into each slot on the leg clip. There are no color-coded requirements, either wire can be inserted into either post.

6 Gently pull the wires to make sure they are firmly attached to the leg clip. They should not disconnect.

7 Attach the leg clip to the pre-gelled skin ECG electrode on the patient’s thigh or abdomen.

8 Check that the monitor is receiving appropriate signals, and adjust the audio key to hear the tone (R-wave detection), as necessary.

Intrauterine Pressure Monitoring

Actual intrauterine pressure, including contraction frequency, duration, intensity, and uterine tone (pressure between contractions), is measured using an intrauterine catheter and pressure transducer. Application techniques for internal pressure catheters are considered to be beyond the scope of this manual. Consult the manufacturer’s instructions included with the package for proper application techniques.

Warning:When inserting the intrauterine pressure catheter, the membranes must be ruptured.

Pressure Transducer Preparation and Application: Reusable Pressure Transducer (Fluid Filled Catheter)

1 Follow manufacturer’s instructions on the preparation and insertion of the intrauterine catheter.

2 Level the pressure transducer with the maternal xiphoid or the top of the fundus.

3 Plug the pressure transducer (yellow) connector into the UA (yellow) connector on the front of the monitor. The groove on the transducer connector must be aligned properly.

4 Attach a three-way stopcock (from the intrauterine catheter kit) to the side port of the pressure transducer (strain gauge). Attach a pressure relief valve or dead-end stopper to the top port.

5 Once the intrauterine catheter has been inserted, remove the catheter guide, and attach the catheter to the three-way stopcock.

6 Fill a 20 cc syringe with sterile water and attach it to the three-way stopcock.

7 Turn the handle of the stopcock toward the pressure transducer and flush the catheter with at least 5 cc of sterile water.

Note:

• Check to ensure that all of the air bubbles have been removed.

• If there are still air bubbles in the dome, repeat the process.

8 Turn the handle of the stopcock toward the catheter.

9 Lift the cap on the pressure relief valve or remove the dead-end stopper on the top of the pressure transducer (strain gauge) dome to vent the dome. Flush the transducer with 1 to 2 cc of sterile water.


Fetal Monitoring

Caution:Do not attempt to force water into the transducer dome unless it is vented to the air. Permanent damage to the transducer may result.

10 Touch the RECORDER key to turn the recorder ON.

11 Touch the UA REF key to initialize.

12 Press Yes to confirm the initialization. The UA display should read 0 (zero). Release the cap on the pressure relief valve or replace the dead-end stopper to reseal the dome.

Note:

• Check to see that all of the air bubbles have been removed.

• If there are still air bubbles in the dome, repeat the process.

13 Turn the handle of the stopcock toward the syringe to begin recording uterine activity.

Note:

Between contractions, the UA channel should not return to zero. This is the measure of the uterine resting tone.

If, during monitoring, the UA channel does not appear to be accurately recording contractions or the tracing of the contractions looks jagged or angular, either the catheter has collected debris from the amniotic fluid or it contains air bubbles. If this happens, take the following steps:

14 Turn the three-way stopcock toward the pressure transducer.

15 Flush with 5 to 10 ml of sterile water.

16 Turn the handle of the stopcock toward the syringe.

17 Check the recording.

Transducer-Tipped Catheter Disposable

Application techniques for internal pressure transducers are considered to be beyond the scope of this manual. Consult the manufacturer’s instructions included with the package for proper application technique.

1 Plug the intrauterine pressure catheter (yellow) connector into the UA (yellow) connectors on the front of the monitor.

2 Touch the UA REF key to initialize.

3 Press Yes to confirm the initialization. The UA display on the monitor should read 0 (zero) and the strip chart should record 0 (zero).

4 Follow manufacturer’s instructions on the preparation and application of the intrauterine pressure catheter.

Note:

• To check that the system is operational, it is often helpful to ask the patient to cough. This should produce an artifact on the fetal strip chart recording.

• Utah Medical IPC 400 is the only catheter-tipped transducer recommended for use with this monitor.


Fetal Monitoring

Main Menu

When the FETAL key is touched, the menu will appear at the bottom of the screen. This menu will remain on screen during the monitoring session, unless the operator accesses another menu screen. To return the to Main menu, touch the FETAL key.

Fetal Heart Rate Alerts

The fetal module provides two alert conditions for fetal heart rate: operator-set limits and pattern recognition.

The fetal heart rate pattern recognition alert function activates if the bradycardia or tachycardia alert limits are violated for a preset period of time or if heart rate patterns described below occur. The alert function serves the purpose of notifying the care giver of a potential condition that might be developing and should not replace any of the care giver’s functions.

Note:

• When an alert condition occurs, the monitor provides several indications. Alert reset removes these indications.

• A message flashes Heart Rate F-Alert.

• The FETAL key will flash.

• A tone will sound if tones are enabled.

The monitor will generate an alert when twenty consecutive, one-second samples of fetal heart rate are below the operator-set limit. The factory default is 84 bpm.

To initialize uterine activity:

• Touch FETAL.• Touch SETUP.• Touch the UA REF key.• Press Yes to confirm.

To turn F-Alert ON or OFF:

• Touch FETAL.• Touch SETUP.• Touch the F-ALERT limits key.• Select F-ALERT ON or OFF.


Fetal Monitoring

Bradycardia Alert

Type 1

The heart rate is divided into eight groups of 20 seconds each. Group H represents the current 20 seconds.

An alert will activate if Groups G and H are below 90 bpm.

Figure 15-3: Type 1 bradycardia alert

Caution:• Any time the alert activates, the heart rate must return to normal before the Alert can be

reactivated. Reset the alert by pressing the F-ALERT RESET key on the screen.

• If a group of heart rates is less than 30 bpm, the algorithm considers this condition a loss of signal and a NO ALERT will occur.

Note:

All representations of fetal heart rates in this chapter are computer generated.

To set fetal alert limits:

• Touch FETAL.• Touch SETUP.• Touch the F-ALERT limits key.• Select F-ALERT ON.• Select the HI= or LO= key.• Use the arrow keys to adjust the limits.

To silence and reset the alert:

• Touch FETAL.• Touch SETUP.• Touch F-ALERT RESET.


Fetal Monitoring

Type 2

An alert will activate if:

• Group H is less than Group F; and

• Group G is less than Group E; and

• Group F is less than Group D; and

• Group E is less than Group C; and

• Group H is below Group C by more than 30 bpm.


Type 3

An alert will activate if the average of Groups G and H is lower than the average of Groups A, B, C, and D by more than 40 bpm.



Fetal Monitoring

Tachycardia Alert

The monitor analyzes the fetal heart rate for tachycardia using the following algorithms. The heart rate is divided into eight groups of 20 seconds each.

Type 1

An alert will activate if:

• Group C is less than 180 bpm, and

• Groups F, G, and H are each greater than or equal to 190 bpm.

Figure 15-6: Type 1 tachycardia alert

Note:

The most recent Heart Rate Group is H; Heart Rate Group A must not be zero.

Type 2

An alert will activate if Group A is less than the tachycardia limit set by the operator, and Groups B, C, D, E, F, G, and H are each greater than or equal to the tachycardia limit set by the operator. The example shown below has the limit set at 180 bpm.

Figure 15-7: Type 2 tachycardia alert


Fetal Monitoring

Recorder Operations

The monitor is automatically programmed to print predetermined data items on the fetal strip chart. The following two strips identify the data items and illustrate how twin FHRs print on the strip. The recorder will also print values from maternal monitoring parameters. When installed with the BirthNet Obstetrical Data Management System, designated data items entered in BirthNet will also print on the strip.

Figure 15-8: Twin fetal heart rates on the same scale


Fetal Monitoring

Figure 15-9: Twin fetal heart rates on same scale, then shifted to separate scales

These messages print according to the following schedule:

Table 1: Print Time Intervals

DATA ITEM TIME INTERVALS

� Time and Date Every 5 minutes

� Recorder Speed 5, 20, 35, and 50 minutes after the hour

� HR Mode 5, 20, 35, and 50 minutes after the hour

� Uterine contraction mode 5, 20, 35, and 50 minutes after the hour

� Monitor ID # 10, 25, 40, and 55 minutes after the hour

Twin Shift (when selected) Every 10 minutes “HR2 add 30” prints

? (for signal coincidence) Upon detection

� � �

�

�


Fetal Monitoring

Event Marker Functions

To mark an event on the strip chart recorder, touch the MARK key on the screen. The recorder will print a black bar at the top of the heart rate scale. The monitor is also equipped with an external Event Marker. When the external Event Marker is pressed, the recorder prints an arrow at the top of the heart rate scale.

Printing Heart Rates Over 240 bpm (ECG only)

When a spiral electrode is in use and the heart rate exceeds 240 bpm, the numeric value (up to 300) is displayed on the screen. On the fetal strip chart, the monitor will automatically plot the scale at half-rate when the heart rate is over 240 bpm (i.e., if the heart rate is 250 bpm, it plots at 125 bpm). A two-dot bar prints on the top of the fetal strip chart to indicate this half-rate scale is in effect. When the heart rate falls below 240 bpm, the monitor resumes normal plotting procedures.

Maternal Parameters

The maternal physiological data (such as SpO2, NIBP, etc.) from the Ultraview Command Module or other Spacelabs Healthcare modules are printed on the fetal strip at designated intervals (1 to 60 minutes).

Note:

Maternal SpO2 and heart rate values are printed on the strip as MSpO2 and MHR.

To mark an event on the fetal strip:

• Touch the MARK key.

To set the time interval for SpO2 and MHR parameters to print on the fetal strip:

• Touch FETAL.• Touch SETUP.• Touch PRINT PERIOD.• Select numeric value equal to the number of minutes to set the time interval for SpO2

and MHR parameters to print on the fetal strip.


Fetal Monitoring

ECG HR Edit

The fetal module can recognize and edit fetal heart rate changes between two consecutive heart beats that are greater than 30 bpm. If ECG edit is ON, connecting (slew) lines between consecutive heart rates are not plotted. Under these circumstances, the tracing appears to have gaps.

ECG Plots

When monitoring in the ECG mode (spiral electrode), the monitor can be set up to print short “rhythm strips.” If a change in heart rate greater than 20 bpm between two consecutive fetal ECG complexes is detected, this change triggers the monitor to plot the ECG rhythm strip, representing approximately four seconds of data: two seconds before and two seconds after the triggering event.

Note:

• The monitor does not recognize another triggering event until the rhythm plot is complete. Following completion, the monitor will recognize and plot the next event.

• Artifacts may also trigger the monitor to plot the fetal ECG.

The ECG rhythm strip feature can also be triggered manually. When the Event Marker is pressed (and the ECG HR is not plotting), a small arrow appears on the strip and the ECG rhythm strip plots.

The ECG data is presented at standard 25 mm/s, although the monitor runs at 3 cm/min. It will take about three and a half minutes at 3 cm/min for an entire ECG rhythm strip to print.

Note:

Arrows indicate the triggering event.

To set ECG HR Edit:

• Touch FETAL.• Touch SETUP.• Touch the FETAL ECG key.• Select ECG HR Edit ON or OFF.

To set ECG plot:

• Touch FETAL.• Touch SETUP.• Touch the FETAL ECG key.• Select ECG PLOT ON or OFF.


Fetal Monitoring

Figure 15-10: ECG rhythm strip

Figure 15-11: ECG rhythm strip

Variability Trend Plots

When operating in ECG mode, a trend of fetal heart rate variability is automatically calculated and plotted. This x-y graph, printed every 10 minutes, is computed by combining long-term and short-term heart rate variability. One point is plotted for each 128 heart beats.

The x-axis corresponds to time, and the y-axis corresponds to the value of variability for each measurement. The y-axis is divided into three levels of variability:

• above average

• average

• below average

The most recent data is represented at the right side of the graph and it takes approximately 100 minutes of monitoring for the variability plot to reach its full capacity.


Fetal Monitoring

Figure 15-12: Above-average variability plot

Figure 15-13: Average variability plot


Fetal Monitoring

Figure 15-14: Below-average variability plot

Note:

• The Variability Trend Graph is only generated in direct ECG mode from FHR channel 1.

• Variability data is not meant to indicate the status or well being of the fetus.

• Variability data is a mathematical expression of the variability of the fetal heart rate displayed in a convenient way.

Paper Out Memory

If the recorder runs out of chart paper, the screen flashes PAPER OUT in the dedicated status area on the screen.

When this condition occurs, the monitor continues to collect and store fetal heart rate and uterine activity data up to one hour (40 minutes if monitoring twins). Once the paper is replaced, the monitor prints the stored data at 12 times real time. A vertical line marks the start and end points, along with the messages MEM START and MEM END. When the stored data has been printed, normal (real-time) recording resumes.

Note:

• All collected data is erased when the recorder is powered OFF.

• If you wish to print the collected data, do not power OFF the recorder when replacing the paper.

• To terminate a print session on the fetal strip chart, select RECORDER OFF.

To disable the fetal recorder:

• Select RECORDER OFF.


Fetal Monitoring


The Module Configuration Manager feature provides the capability to define and store all user-configurable options for the fetal parameter. Once configured, these settings control its operation whenever the monitor is powered ON.

Display Detail

The User Settings screens list all user-configurable options. From these screens you can change and store the options in your monitor.

Figure 15-15 illustrates the User Settings screen which is used to change and store fetal rate alarm limits.

The parameter configuration table (Table 2 on page 15-25) lists all available options, the available user settings, and the factory defaults for each parameter.

Figure 15-15: User settings

� CURSOR and CURSOR keys scroll through the two columns of parameters on the screen.

� and keys scroll the list of valid settings for the highlighted parameter.

� PREV PAGE key returns to the previous screen.

� NEXT PAGE key advances to the next screen.

� PRINT PAGE key prints the current screen.

� STORE key stores the currently selected settings as defaults.

PARAMETER DESCRIPTION VALUE PARAMETER DESCRIPTION VALUE

FETAL RATE ALERT OFF TWIN SHIFT NO SHIFT

• HIGH RATE 180 TOCO SENSITIVITY MEDIUM

• LOW RATE 84 ECG PLOT ON

ECG EDIT OFF

FETAL ECG WAVEFORM ON EXTERNAL DEVICE NONE

• FECG WAVEFORM SIZE 1.00 PRINT PERIOD 10

• FECG SWEEP SPEED 25

Enable/Disable Fetal Rate Alert

��

STORE

SELECT PARAMETER

CURSOR CURSORCHANGE VALUE PAGE X OF X

PRINTPAGE

NEXTPAGE

PREVPAGE


Fetal Monitoring

Setting User-Defined Default Values

Use the User Settings screens to change and store settings. If the setting for the selected parameter cannot be changed, the message THIS SETTING CANNOT BE CHANGED will be displayed.

The ability to access the Module Configuration Manager screens can either be visible to all users or remain hidden. The factory default setting is INVISIBLE. Adjust the SYSTEM SETUP key to the VISIBLE setting to enable user access to this function.

Storing Changed Settings

Touch the STORE key after entering configuration changes for any page. This action stores the currently selected settings for all entries.

The Patient Admit/Discharge function allows you to SAVE the changes in the alarm limit settings as the default settings for future patients, or RESTORE the original default settings upon discharge of that patient or admission of a new patient.

Parameter Configurations

To review or change settings:

• Touch FETAL.• Touch SETUP.• Touch the hidden key three times.• Touch DEFAULT STORAGE.• Touch USER SETTINGS.• Use CURSOR and CURSOR to scroll through the parameter description list.• Use and to change the settings.• Touch NEXT PAGE to continue to next screen of parameters.• Touch STORE to save the new settings.• Touch YES when the Yes/No message is displayed.

Table 2: Fetal Parameter Configuration



User Settings

Fetal Rate Alert ON/OFF OFF

High Rate Limit 160–210 bpm 180 bpm

Low Rate Limit 70–130 bpm 84 bpm

FECG Waveform ON/OFF ON

FECG Waveform Size 0.10–2.00 1.00

FECG Sweep Speed 25 or 50 mm/s 25 mm/s

Twin Shift Auto/Manual/No shift No shift


Fetal Monitoring

Toco Sensitivity High/Medium/Low Medium

ECG Plot ON/OFF ON

ECG Edit ON/OFF OFF

External Device None/Nellcor FSpO2 None

Print Period 1 to 60 minutes 10 minutes

Chart Recorder ON/OFF ON

Speed 1, 2, or 3 cm/minute 3 cm/minute

Heat 1/2/3 2

Alignment 0–10 3

Scale USA/INTL USA

Variability Plot ON/OFF ON

FHR1 Audio Level OFF, 50% to 100% 75%

FHR2 Audio Level OFF, 50% to 100% 75%

Patient Name Source Auto/Manual Auto

Time/Date Format USA/INTL USA

CIM Protocol A/B A

CIM Baud Rate 9.6 k/19.2 k 9.6 k

Modem ID 0–255 0

Simulator ON/OFF OFF

Begin Address 0–127 0

End Address 0–127 0

Increment 1–63 0

System Setup Key Visible/Invisible Invisible

Fetal Heart Rate Alert Medium Medium

Table 2: Fetal Parameter Configuration (continued)



User Settings


Fetal Monitoring

Telemetry Option

Each fetal monitor can be equipped with a fetal telemetry system to provide continuous monitoring of an ambulatory patient. The patient carries a small transmitting device that transmits signals to the fetal monitor for recording. The fetal telemetry system transmits ultrasound, Toco, and nurse call information to a corresponding receiver connected to the fetal monitor.

Fetal Monitor Telemetry Operating Instructions

1 Open the battery compartment and install a fresh 9-volt alkaline battery.

2 Insert the antenna into the antenna jack on the transmitter.

3 Ensure that either the whip antenna or extended range antenna system is attached to the fetal monitor. The whip antenna should be extended at least two sections.

4 Power ON the transmitter.

5 Apply the ultrasound transducer and toco transducer. (Refer to Ultrasound Transducer Preparation and Application on page 15-7 and Toco Transducer Preparation and Application on page 15-9.) The data from the telemetry unit is transmitted to the fetal monitor for display and printing on the strip chart.

6 The unit is supplied with headphones that allow the patient to listen to the fetal heart sounds. The patient should continually hear fetal heart sounds through the earphones. She should be instructed to move the ultrasound transducer slightly if the sound quality diminishes. If unable to re-establish the heart sounds, the patient should notify her clinician.

Table 3: Fetal Alert Attributes

Alarm Type Tone Type Alarm Recording Alarm Watch

Ava

ila

ble

Us

er

Set

tin

gs

Fa

cto

ry D

efau

lts

Use

r S

ett

ing

s

Ava

ila

ble

Us

er

Set

tin

gs

Fa

cto

ry D

efau

lts

Use

r S

ett

ing

s

Ava

ila

ble

Us

er

Set

tin

gs

Fa

cto

ry D

efau

lts

Use

r S

ett

ing

s

Fetal Heart Rate Alert

Medium Medium N N Y/N N


Fetal Monitoring

7 When the red Nurse Call button on the transmitter is pressed, an audible tone emits from the fetal monitor. To cancel the tone, touch the F-ALERT RESET key on the Fetal Main menu.

Note:

• When the transmitter is powered ON, it should emit a short tone to indicate that the battery is good. If the battery is low, the transmitter emits a steady tone until depleted. Replace the battery if the transmitter is emitting a steady tone or is depleted.

• If the patient exceeds the receiving range, the signal may be weak or may drop out. The patient should return to within range of the fetal monitor.

• Certain locations may require that the whip antenna be fully extended to enhance reception.

• Each telemetry unit (transmitter) operates on a specific radio frequency and is uniquely paired with a receiver internal to the fetal module. These must remain together to operate properly.


Temperature

Directory of Keys


ALARMLIMITS

HI=OFF

LO=OFF

HI=OFF

LO=OFF TEMP 1 TEMP 2

DELTATEMP

TEMP - ALARM LIMITS

TEMP - ALARM LIMITS

TEMP MENU

ALARMS

ON OFF

ALARMS

ON OFF

RESTORESETTINGS

YES NO

RESTORESETTINGS

HI=OFF

LO=OFF TEMP 3 TEMP 4

DELTATEMP

ALARMS

ON OFF

Alternate key display

YES NO

keys may not be displayed



TEMP

ALARMLIMITS

TEMP MENU


ALARMLIMITS

TEMP MENU


TEMP

Two Temperatures (same module)


Temperature

Contents

Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Setting Up Temperature Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Setting or Adjusting Temperature Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Recording Temperatures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Restoring User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Temperature Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Overview

Either one or two temperature inputs can be monitored. Whenever two temperatures from the same module are monitored, a delta value (temperature difference between the two readings) is calculated.

Temperatures are displayed in degrees centigrade only. You can set independent high and low alarm limits for each temperature, and the delta temperature.

Setting Up Temperature Monitoring

Attach the temperature probe(s) to the patient and then to the module. The TEMP key and temperature values now appear on the monitor screen. Touch TEMP to display the Temperature menu.

Note:

You can define your own default settings for alarm limits. Refer to Setting User-Defined Default Values on page 7-7 for further details.

To set up temperature monitoring:

• Attach the temperature probe(s) to the patient.• Plug the temperature probe(s) into the module.• Touch TEMP.• Select additional keys as needed during monitoring.


Temperature

Display Detail

Temperature readings appear on the monitor screen as soon as you plug a temperature probe into the module.

Figure 16-1: Temperature display

� Temperature parameter key

� Single channel temperature reading

� Temperature label

� High and low temperature alarm limits

� Two temperatures (T1/T2 or T3/T4)

� Delta temperature (DT)

� Status of temperature alarms

Note:

When alarm limits are set on more than one temperature, the alarm limits for only one temperature will be displayed. To view the alarm limits, touch TEMP, then ALARM LIMITS, then select the TEMP 1, TEMP 2, TEMP 3, TEMP 4, or DELTA TEMP key.

Setting or Adjusting Temperature Alarm Limits

High and low alarm limits can be set for T1 (T3), T2 (T4), and the temperature difference (DT) between two temperatures.

The factory default settings for high and low temperature alarms are 37.5° C and 36.5° C. Refer to Default Alarm Limits on page 2-3 for details on system alarm operation.

To set or adjust alarm limits

• Touch TEMP.• Touch ALARM LIMITS.• Select TEMP 1, TEMP 2, TEMP 3, TEMP 4, or DELTA TEMP.• Select ALARMS ON. • Select HI= or LO=.• Use arrow keys to adjust limit.

38.0oC

38.537.5

TE

MP

��

TEMP

T1 ONT2 ONDT OFF

� �

38.0oC

35.1T1

T2

DT2.9

�T1

�


Temperature

Recording Temperatures

You can send currently displayed temperature readings to a bedside recorder or system printer. Refer to Printing on page 4-5 for an overview of system printing information.



Note:


To print a strip chart of current temperature readings:

• Touch RECORD.• Touch TEMP while it flashes.






• Touch TEMP.• Touch RESTORE SETTINGS.• Select YES.


Temperature

Temperature Troubleshooting Guide


Intermittent or no operation ■ Module error. ■ Call a qualified service person.

Temperature not displayed ■ Module not inserted correctly. ■ Reinsert the module.

■ Probe not connected to module.

■ Reconnect the probe.


Digital Telemetry

Directory of Keys


ECG

2nd LEADON OFF

ECG - CHANNEL FORMAT

ECG - SETUP

ALARMLIMITS SETUP

CHANNELFORMAT

ECG MAIN MENU - (Multi-Lead) (Multiview II option with Arrhythmia and Review ON - used with 90341/90343/90347/91341 transmitters)

TMSETUP

ASSIGNTM BED

PT RECORDYES NO

LO BATON OFF

SET TMCHAN

ECG - TM SETUP **Centralonly **

Bedsideonly **

SPO2ON OFF

NIBPON OFF

SpO2(IABP)(NEO)(RATE)(AVG)

90343 only

ECG ALMON OFF

ST LIMITSCH 1

ABN IN ROW=XX

ABN PER MIN=XX

ST LIMITSCH 2

HI=XXX

LO= XXX

SPO2 ALMON OFF

ALM DELAY=XXs

MSG ALMDELAY =XXs

HI=XXX

LO=XXX

NIBP ALMON OFF

HI=XXX

LO=XXX

NIBP ACTIVE(NO CABLE)

SPO2 ALARMLIMITS

NIBP ALARMLIMITSLIMITS90341,

90347, 91341 (and

90343with

SpO2 and

NIBP turned OFF)

90343

ECG ALARM

MPT=ON *

90343 only MPT=ON *

* Multiparameter Telemetry (MPT):required settings inModule Configuration Manager

DIA MEANSYS

Limit keys will flash on alarm

** Not shown in Remote Views

**

SCREENFORMAT

MONITOR SETUP MENU

select ECG 1

select bed(or subnet, then bed)

NOTE: Refer to Directory of Keys on page 8-1 for additional menu keys not shown here.


Digital Telemetry

Contents

Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Intended Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Digital Telemetry System Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Setting up Telemetry Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Enabling and Adjusting Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Discharging a Patient and Acknowledging Signal Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Controlling Patient-Initiated Recordings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Multiparameter Telemetry (NIBP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Status Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22NIBP Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Overview

The digital telemetry receiver module (90478), when used in conjunction with a Spacelabs Healthcare patient-worn telemetry transmitter, an Ultraview monitor, and telemetry receiver module housing (90479-A), provides continuous monitoring of electrocardiographic signals in order to detect abnormal cardiac rhythms, including asystole, ventricular fibrillation, and ventricular tachycardia.

When used with the multiparameter digital telemetry transmitter (90343) and/or the Ambulatory Blood Pressure (ABP) monitor (90217), monitoring of electrocardiographic signals is augmented by the availability of continuous or episodic SpO2 measurements and/or episodic noninvasive blood pressure (NIBP) measurements.

ECG monitoring in telemetry is identical to hard-wired ECG monitoring (refer to ECG Setup on page 8-4). For more information on SpO2 and NIBP monitoring, refer to Setting Up SpO2 Monitoring on page 14-4, and Multiparameter Telemetry (NIBP) on page 17-17.

Warning:• Medical telemetry spectrum allocations may be assigned to frequencies already allotted to

other priority users. Radio frequency interference from other products may disrupt or impede telemetry patient monitoring during the life of this equipment. You are urged to regularly consult with applicable local and federal regulatory agencies (e.g., FCC, FDA, etc.) regarding the locations and frequencies of other spectrum users in your geographic area. A Spacelabs Healthcare field service engineer may be able to assist you in reconfiguring your equipment frequencies to reduce the risk of interference. Spacelabs Healthcare cannot, and does not, guarantee interference-free telemetry operation.

• Telemetry systems may be more susceptible to interference than hard-wired systems; this may impact signal quality.


Digital Telemetry

• Operation of hand-held, wireless telephone equipment (cordless telephones, cellular telephones) near telemetry systems may cause interference and should be discouraged. While personal communication devices are turned on, a separation of >2 meters (>6.5 feet) should be maintained between personal communication devices and interior walls, the patient cables, and any electronic medical device to which the patient may be connected. Patients should not use any type of electronic communication equipment

Caution:• This device has a limited bandwidth range of 0.05 to 30 Hz, which may adversely affect the

recording of high frequency components in the ECG signal, especially when the morphology of the ECG changes rapidly.

• This device has a limited dynamic range of 4 mV, which may render the device vulnerable to saturation by ECG signals with amplitudes higher than 4 mV.

• Patients should not use any type of electronic equipment (e.g., portable radios, cellular telephones, pagers, personal computers, etc.) while connected to any medical electronic device without prior evaluation of that electronic equipment by the biomedical engineering staff.

Note:

• Spacelabs Healthcare’s telemetry equipment complies with Part 15 and Part 95 of the FCC Rules and with RSS-210 of Industry Canada and with requirements of other national spectrum management authorities. Repeated here are operational cautions for biomedical telemetry from the FCC Rules (47CFR15.242(f)):

- “Biomedical telemetry devices must not cause harmful interference to licensed TV broadcast stations or to other authorized radio services, such as operations on the broadcast frequencies under subpart G and H of part 74 of this chapter, land mobile stations operating under part 90 of this chapter in the 470-512 MHz band, and radio astronomy operation in the 608-614 MHz band. (See section 15.5). If harmful interference occurs, the interference must either be corrected or the device must immediately cease operation on the occupied frequency. Further, the operator of the biomedical telemetry device must accept whatever level of intereference is received from other radio operations. The operator, i.e., the health care facility, is responsible for resolving any interference that occurs subsequent to the installation of these devices.”

• Medical telemetry equipment is only for installation and use in hospitals and health care facilities. It is not permitted for use in vehicles that operate outside the medical facility premises. The user of this equipment is not authorized to make any changes or alterations that could compromise the national certifications.

• Operation of telemetry equipment in the 608 – 614 MHz, part of the Wireless Medical Telemetry Service (WMTS) and in authorized spectrum of each country, may be geographically restricted by government regulation. Operation of this equipment in all U.S. WMTS bands requires coordination and registration with the FCC designated frequency coordinator.

• Both the standard and limb lead modes for the 90341 and 91341 function correctly with or without the right leg electrode attached. However, for optimum performance, the right leg electrode should always be used.

• The RA lead wire for the 90341, 90343, and 90347 must be connected to the transmitter at all times. This lead wire also serves as the transmitter’s antenna.

• The ECG lead wires of the 90343 must be connected to the patient in order to perform ECG, SpO2, and NIBP monitoring.


Digital Telemetry

Intended Use

As an option on adult patients, additional abnormal cardiac rhythms, such as ventricular runs, tachycardia, and ST segment deviations, can be detected. The digital telemetry system also provides a means for the episodic monitoring of NIBP signals to detect abnormal events such as high and low blood pressure. Finally, it provides a means for both continuous and episodic monitoring of blood oxygen saturation signals in order to detect oxygen desaturation caused by abnormal pulmonary/circulatory functions.

Note:

Episodic monitoring of NIBP values and continuous and episodic monitoring of blood oxygen saturation values are only supported in conjunction with ECG monitoring. SpO2 and NIBP alarms are inhibited by ECG leads-off condition.

The patient-worn transmitters are intended for use with either adult or neonatal patients in a hospital environment. When the NIBP option is selected in the 90343 configuration, the NIBP feature is to be used with adult patients only.

Note:

Operation of this equipment may be subject to licensing requirements by your local telecommunications authority. Please check with your Spacelabs Healthcare field service engineer.


Digital Telemetry

Digital Telemetry System Components

The digital telemetry system consists of the transmitters, receiver module, and receiver housing.

Figure 17-1: Spacelabs Healthcare digital telemetry system

DiversityAntennaSystem

receiver module

Digital Telemetry Receiver Module Housing

SDLC cable

90479-A

90478-Q

90341/90347Digital Telemetry

Ultraview 1050

ECG Transmitters

90343 Digital TelemetryMultiparameter(ECG, SpO2, &

NIBP)Transmitter

Ultraview 1700

receiver module90478-Q/T/V

(only module available for use

in a bedisdemonitor)

Active

91341Digital TelemetryECG Transmitter


Digital Telemetry

Telemetry Transmitters

The patient-worn telemetry transmitters are small, battery-powered devices that monitor ECG activity and SpO2/NIBP (90343 only) data, and transmit this information to the telemetry receiver module.

• The 90341 and 91341 use up to five lead wires and transmit two leads of ECG. Two leads may be displayed simultaneously.

• The 90343 and 90347 use up to five lead wires and transmit four leads of ECG. Two leads may be displayed simultaneously.

• The 90343 is also capable of transmitting numerical NIBP and SpO2 data. This data is displayed simultaneously with that of the ECG waveform data.

Each telemetry channel requires its own transmitter operating on a unique radio frequency. Telemetry receivers are tuned from the Spacelabs monitor touchscreen to receive the available transmitter frequencies.

The front labels on the transmitters are color-coded to their compatible receivers.

• The 90341, 90343, and 90347 transmitter labels are blue.

• The 91341 transmitter label is green.

Up to five standard disposable silver/silver chloride chest electrodes are connected to the patient. The ECG lead wires are attached to these electrodes and connected to the transmitter. A patient-operated RECORD button initiates an ECG strip at the system printer if this feature is enabled at the central or bedside monitor.

Note:

Clean the transmitter after each use. The transmitter does not require any preventive maintenance other than cleaning.

Selecting Options for Lead Display

Refer to Patient Preparation and Electrode Application on page 8-5 for lead placement illustrations.

Note:

If one of the leads fails, a lead fault message displays in the upper left corner of the waveform zone. If there is no valid lead vector, the message LEADS OFF displays and an alarm tone sounds.

90343/90347 Multi-lead Transmitters

When all electrodes are connected to the patient, leads I, II, III, AVR, AVL, AVF, and Vx are available. When no chest electrode is applied, leads I, II, III, AVR, AVL, and AVF are available using the remaining connected electrodes.


Digital Telemetry

90341/91341 Dual-lead Transmitters

Table 1 indicates which leads are available when various electrodes are connected. Two operational modes are offered:

• Standard mode (chest electrode present) — Offers a choice of one V lead (V1-6), plus lead II.

• Limb lead mode — Offers choices of the leads I, II, III, AVR, AVL, or AVF.

Note:

For optimum performance, the right leg electrode should always be used. However, both modes work correctly with or without the right leg electrode attached.

Table 1: 90341/91341 Lead Options

Connected Electrodes (X) Valid Lead Vectors

C LA LL RA

X X X X V1-6 and II (standard mode)

X X X III (standard mode)

X X X I (standard mode)

X X total lead failure (standard mode)

X X X II (standard mode)

X X None (lead failure)

X X None (lead failure)

X None (lead failure)




None (lead failure)

X X III (limb lead mode)

X X I (limb lead mode)

X X II (limb lead mode)

X X X I, II, III, AVR, AVL, AVF (limb lead mode)


Digital Telemetry

Note:

The 91341 dual-lead transmitter has blue indicators near the ECG connector block. Each indicator provides the status of its respective lead wire and flashes if its lead wire is disconnected from the skin electrode or if the skin electrode makes poor electrical contact with the patient.

Figure 17-2: 91341 transmitter

Transmitter Batteries

A 9-volt alkaline battery is recommended for standard use in the digital telemetry transmitter. A 9-volt lithium battery may also be used for applications requiring more extended battery service life.

Always observe the battery position and polarity as illustrated at the bottom of the battery compartment. After battery installation, close and latch the compartment cover. The transmitter begins transmitting as soon as the battery is in place.

Note:

• Insert a battery only when the transmitter is being used with a patient. Remove the battery when the transmitter is not in use.

• The following description of transmitter operation is valid only for 9-volt alkaline and 9-volt lithium batteries and does not apply to any other type of battery.

- When the battery level falls below approximately 7.0 volts, the low battery LED on the transmitter will flash once every 15 seconds. The LOW BATTERY message may appear after the low battery LED on the transmitter begins to flash. When the battery level falls below 6.0 volts, the low battery LED flashes once every two seconds. When the battery level falls below 5.5 volts, the SpO2 and NIBP functions shut down.

- The LOW BATTERY message appears and an alarm tone sounds (if LO BAT is set to ON) when the transmitter battery voltage falls below approximately 7.0 volts. When this message appears, the transmitter has approximately three hours of operating time left, depending on transmitter type, selected options, and the type of battery.

Lead fault indicators(91341)


Digital Telemetry

Setting Battery Status Alarms

The telemetry battery alarm tone and a LOW BATTERY message displayed in the ECG zone alert you to a low battery condition in the transmitter. You can disable the low battery alarm tone if your bedside or central monitor is configured to do so.

Telemetry Receiver Module

The 90478 telemetry receiver module plugs into a bedside or transport monitor, or into a digital telemetry module housing. The receiver module receives patient vital signs data from the patient-worn transmitter. This data is reconstructed by the receiver module, displayed on the monitor and analyzed as described in ECG on page 8-3, Arrhythmia on page 9-3, and ST Analysis on page 10-3. Refer also to SpO2 on page 14-3.

A telemetry receiver module must be tuned to a transmitter’s assigned frequency before it can receive data from that transmitter. Qualified personnel can use the ECG TM SETUP menu to tune the receiver module at the monitor to which the receiver module is directly connected.

Caution:• Do not install a telemetry receiver module into a bedside monitor that is currently equipped with

any other ECG module, hard-wired or telemetry (or SpO2 module or NIBP module if the 90343 transmitter is operating with that specific receiver module). Doing so may cause inaccurate patient data displays at remote monitors.

• Only 90478-Q modules may be installed in bedside monitors.

Note:

• Telemetry transmitters may have preassigned channel frequencies (or numbers) that cannot be changed. The channel number is identified on the back of the transmitter’s case. The frequency of the 91341 transmitter can be changed by qualified field service technicians.

• Only qualified field service technicians should tune telemetry receiver modules to receive data from a telemetry transmitter. Telemetry receiver modules must be used with a transmitter on the same frequency.

• Qualified field service technicians should set the telemetry transmitter’s frequency band via the Module Configuration Manager feature.

To control low battery alarms:

• Touch ECG. • Touch SETUP. • Touch TM SETUP.• Select LO BAT / ON or OFF.


Digital Telemetry

Telemetry Receiver Module Housing

The telemetry receiver housing can hold up to eight separate telemetry receiver modules. Except for the ON/OFF switches, there are no operator controls on the module housing. For normal operation with AC mains power applied, the AC mains indicator light on the front panel of the module housing must be illuminated. The housing and eight modules retain the operating configuration for up to 10 minutes during an AC mains power interruption.

Warning:All system connections must be made by Spacelabs Healthcare personnel only. Changes or modifications not expressly approved by Spacelabs Healthcare will void the user’s authority to operate the equipment.

To tune a receiver module:

• Touch ECG. • Touch SETUP. • Touch TM SETUP.• Touch SET TM CHAN.• Select the digit to change. Use the keys to select the value for that digit.• Repeat for all digits as necessary.• Touch STORE.


Digital Telemetry

Display Detail

Signal detection is indicated on your monitor when an ECG signal appears next to the ECG parameter key in the zone assigned to receive the transmitted telemetry channel. The transmitter's channel number is always identified above the waveform, to the left of the ECG key.

Figure 17-3: Bedside monitor

Figure 17-4: Central monitor — split screen(with NIBP turned OFF and SpO2 turned ON)

Note:

• SpO2 does not display if it is turned OFF.

• A bell symbol follows the percent (%) symbol if the SpO2 alarm is enabled.

• The SpO2 time stamp (15:12) only displays when SpO2 mode is set as episodic.

Figure 17-5: Central monitor — split screen (with NIBP and SpO2 turned ON)

ECG

II MON PACED

ST=0.00A=3

A/M 10ROW 4

120

4070*

***

*BED 01

�

�

��

�

*

��

�

��

98% 15:12 120/68(94) 15:15

2241

�

ECG

HR= 70 A=3 II 98%15:12 2241

��

BED 01

�

� �

ECG

HR= 70 120/68(94) 15:15

98% 15:12

2241

��

BED 01

�

�


Digital Telemetry

Note:

• NIBP data replaces the count of abnormal events and lead information.

• The NIBP time stamp (15:15) always displays because NIBP is episodic, but the SpO2 time stamp (15:12) only displays when SpO2 mode is set as episodic.

• SpO2 does not display if it is turned OFF. SpO2 displays immediately above the bed and patient name if it is turned ON.

• A bell symbol follows the percent (%) symbol if the SpO2 alarm is enabled and follows the mean pressure value if NIBP alarms are enabled.

� ECG trace for first lead

� Patient/room ID

� ECG key for first lead

� QRS indicator (flashes once per detected beat)


� Display resolution (MONITOR or EXTENDED)

� Paced operation indication (pacemaker detection is enabled)

Abnormals per minute alarm limit*

ST segment level for first lead** (the asterisk indicates ST alarms are enabled)

� Abnormals in a row alarm limit*

ECG rate alarm limits. Split-screen central monitors display a bell symbol when alarms are enabled. Bedside monitors display the rate alarm limits (120/40).

� Abnormals per minute counter*

� Current heart rate

� Telemetry channel number

� Sensorwatch signal strength indicator

Shaded area (waveform index, WFI) expands up proportionally to signal strength; horizontal line indicates minimum signal level.

No shading (lowest waveform index) corresponds to no detected signal strength or a faulty sensor.

� SpO2 reading and time of last reading

� Non-invasive blood pressure systolic/diastolic (mean) reading and time of last reading

* Only appears with the Multiview I or II option in adult mode with arrhythmia detection enabled.

** Only appears in adult mode with the ST segment analysis option.


Digital Telemetry

The current (or latest) NIBP reading taken may be displayed when the NIBP parameter is enabled and the 90217 ABP monitor is set up correctly. The current systolic, diastolic, and mean values, along with the time of the reading, are displayed as shown in Figure 17-3 on page 17-12. The displayed values are replaced by ??? when no valid values have been acquired from the 90217.

Setting up Telemetry Monitoring

Assigning a Telemetry Channel

Note:

When connecting a new patient to a transmitter, make sure the prior patient’s information has been purged.

Your central monitor can only display a telemetry channel after that channel has been assigned a specific bed name. Refer to the following steps to assign a specific bed name to a telemetry channel and to assign the bed to a specific display zone.

Your central monitor can be configured to remember the bed name assigned to individual telemetry channels. These beds are permanently assigned until you unassign or reassign them. Refer to Module Configuration Manager on page 7-5 for more information.

Previous NIBP readings can be displayed using the tabular trend or graphic trend monitor functions. NIBP readings are collected by the system on a minute-by-minute basis and can be displayed in the same manner as any other monitored parameter. Refer to Trends on page 26-3 for more information.

To display the NIBP data:

• Touch ECG. • Touch CHANNEL FORMAT.• Select NIBP / ON.

To initiate telemetry ECG monitoring:

• Select a transmitter.• Note its channel number. • Attach lead wires to transmitter.• Attach lead wires to electrodes.• Apply electrodes to patient.• Install a transmitter battery.• Close the transmitter case.


Digital Telemetry

Enabling and Adjusting Alarms

Alarm limits for multiparameter telemetry are adjusted the same way as the alarm limits for other parameters. The only difference is that you must select the specific parameter to adjust for multiparameter telemetry. Once that selection is made, adjustments are made to ECG alarms, NIBP alarms, and SpO2 alarms as described in Setting and Adjusting Alarms on page 8-13, Setting and Adjusting Alarm Limits on page 13-7, and Setting and Adjusting Alarm Limits on page 14-8.

Refer to NIBP Messages on page 17-23 for status messages relating to NIBP alarms.

To set up the central for ECG (if bed name not remembered):

• Touch key label that matches transmitter's frequency.• Select bed/room number for transmitter channel.

To set up the central for ECG:

• Touch MONITOR SETUP.• Touch SCREEN FORMAT.• Select subnet and bed/room number.• Select ECG and then desired zone.

To set or adjust multiparameter telemetry alarms:

• Touch ECG. • Touch ALARM LIMITS. • Touch ECG ALARM LIMITS, NIBP ALARM LIMITS, or SPO2 ALARM LIMITS.• For ECG and NIBP — Touch HI = or LO = key.• For SpO2 — Touch HI=, LO=, ALM DELAY =, or MSG ALARM DELAY = (if present).• Use the arrow keys to adjust.


Digital Telemetry

Discharging a Patient and Acknowledging Signal Loss

When a telemetry signal is lost because the transmitter is out of range or the battery is depleted, return the patient into antenna range and check that the battery is functioning properly. The ECG waveform automatically displays when the lost signal returns.

After eight seconds of signal loss, the monitor displays the INTERMITTENT SIGNAL LOSS message in the waveform zone and initiates the signal loss alarm. Selecting NO to this message displays the IS SIGNAL LOSS PERMANENT message, and cancels the intermittent signal loss alarm.

Caution:SpO2 and NIBP data may not be displayed when the INTERMITTENT SIGNAL LOSS message is displayed.

The process of discharging a patient begins by removing the battery from the transmitter. All monitors displaying this telemetry channel display the message IS SIGNAL LOSS PERMANENT in the waveform zone. Only the monitor hosting this telemetry channel displays YES and NO keys below this message.

1 Touch YES to the IS SIGNAL LOSS PERMANENT message to display the message DISCHARGE THIS PATIENT. (Touch NO to cancel the discharge process and suspend the alarm.)

2 Touch YES to the DISCHARGE THIS PATIENT message to display the message PURGES DATA - ARE YOU SURE. (Touch NO to cancel the discharge process.)

3 Touch YES a third time to discharge the patient and erase all patient data from memory. (Touch NO to cancel the discharge process.)

To discharge a patient:

• Remove battery.• Disconnect the transmitter from the patient.• Touch YES to confirm signal loss is permanent. • Touch YES to discharge.• Touch YES to purge data.

To acknowledge signal loss, select NO.


Digital Telemetry

Controlling Patient-Initiated Recordings

If the Patient Record function is activated (PT RECORD is YES) in the ECG TM SETUP menu, the patient can initiate a recording by pressing the RECORD button on the front of the transmitter.

Multiparameter Telemetry (NIBP)

For more information on SpO2 monitoring, refer to Setting Up SpO2 Monitoring on page 14-4.

The 90343 digital telemetry multiparameter transmitter sends SpO2 data plus NIBP data acquired by the 90217 ambulatory blood pressure (ABP) monitor to the 90478 digital telemetry receiver. The 90478 displays the patient’s SpO2 data and episodic NIBP data, and triggers alarms based on thresholds set at the patient monitor.

Setting up the ABP Monitor

The 90217 ABP monitor is a small, lightweight, battery-powered unit designed to take blood pressure measurements. Refer to the 90207/90217 ABP Monitors Operations Manual (P/N 070-0137-xx) and the 90121 ABP Report Management System Operations Manual (P/N 070-0529-xx) for more detailed information on this product, its initialization by a direct PC interface, patient preparation, and event codes.

The 90217 ABP monitor must be initialized prior to the monitoring of each patient. Initialization is accomplished using the 90121 ABP Report Management System.

Caution:Failure to initialize the ABP monitor as specified may result in the display and storage of incorrect measurements or measurements acquired from a prior patient. The operator must initialize the ABP monitor before each patient use.

When used with the 90343 patient-worn transmitter, the ABP monitor purges its measurements as they are successfully sent. This operation differs from when the ABP monitor is used in a standalone manner and stores a maximum of 240 NIBP readings and event codes.

To control the transmitter's Patient Record function:

• Touch ECG.• Touch SETUP. • Touch TM SETUP.• Select PT RECORD / YES or NO.

90217 ABP Monitor


Digital Telemetry

Setting up NIBP Monitoring

NIBP uses oscillometric monitoring to measure systolic (S), diastolic (D), and mean (M) arterial blood pressures. The pressure readings are sent from the 90217 ABP monitor to the 90343 patient-worn transmitter by a connecting cable. The 90343 transmitter includes the NIBP readings in the communications to the 90478 receiver using the radio frequency data link. Valid measurements are displayed on the Spacelabs monitor and stored for trending. NIBP readings that are not successfully transmitted by the 90217 to the 90478 within 24 hours of their measurement are unavailable for display or trending.

After the monitor is initialized, prepare the patient for monitoring as follows:

1 Turn on the monitor and wait for the monitor to perform self-tests. When the LCD displays the current time, the monitor is ready for operation.

2 Strap the monitor to the patient’s hip opposite the side on which the cuff is worn. Secure the monitor using the patient's own belt or the ABP pouch strapped over the opposite shoulder. When using the shoulder strap, use the patient’s belt or the belt supplied with the monitor to provide additional security.

3 To select the proper cuff, measure the circumference of the limb at the point where the cuff is to be applied. Match the limb measurement to the range of appropriate circumferences (in centimeters) specified on each cuff (refer to Table 2).

To set up NIBP monitoring:

• Initialize the ABP monitor as described in the ABP manuals referred to previously.• Apply appropriate cuff to patient.• Attach cuff to ABP monitor.• Connect NIBP adapter cable (P/N 012-0588-xx) between ABP monitor and 90343

transmitter.• Touch ECG.• Touch CHANNEL FORMAT.• Select NIBP / ON.

Table 2: Cuff Size by Limb Circumference

Cuff Size Limb Circumference

Pediatric 13 to 20 cm

Small adult 17 to 26 cm

Average adult 24 to 32 cm

Large adult 32 to 42 cm

Extra-large adult 38 to 50 cm


Digital Telemetry

Caution:• Avoid compression or restriction of pressure in the NIBP patient connector tubes. Check that

operation of the equipment does not result in prolonged impairment of circulation.

• Do not apply cuff to areas of breached or injured skin.

• Cuff hose connections use luer fittings. Be careful not to connect the ABP monitor into an intravenous fluid line when working close to them.

• This product contains natural latex rubber components to which some people may be allergic. These components include the bladder and the first four inches of tubing extending from the cuff.

Note:

• Use only Spacelabs Healthcare cuffs with this monitor. Using other manufacturer’s cuffs may result in inaccurate readings, even if the manufacturer’s recommended size is observed.

• If the cuff is too small, pressure readings may be falsely high; a cuff that is too large produces a falsely low reading. The bladder can be positioned in the cuff for either the left or right arm.

• Use only single hose cuffs to ensure proper operation. Spacelabs Healthcare’s hoses are non-conductive with respect to defibrillator discharge effects.

• Leakage currents are not affected by the high-level output in the 90478. The patient is electrically isolated from the patient monitor by the RF link.

4 Position the cuff so that the center of the inflatable bladder is directly over the brachial artery. The center of the bladder location is marked on the outside of the cuff. Once the proper position is determined, the cuff must be tightened to ensure that it is equally snug at the top and bottom edges and that it is not kinked. This is especially important on larger arms. Insert a finger between the cuff and the limb to ensure it is not too tight. It may be necessary to wrap the cuff with its tail at an angle to achieve uniform tightness. If the cuff is not equally snug at the top and bottom edges, the number of readings available will be limited and the monitor may indicate that the cuff is improperly applied.

5 Relax the patient’s arm at their side once the cuff is applied. To avoid reading errors due to hydrostatic pressure differences, the level of the cuff on the arm should be near the level of the heart.

6 Lead the hose up the arm with the cuff and place it across the back of the patient. Drape the hose so it does not cause the patient discomfort and is not pinched shut by too tight a radius. Figure 17-6 displays the most common positions for the cuff hose.

7 Connect the hose to the monitor.

8 Take one or more blood pressure readings to verify proper monitor operation. Push the START/STOP key to begin a measurement.

9 Configure the 90343 transmitter for use with the 90217 ABP monitor by opening the battery compartment door, removing the battery, and setting DIP switches 5 to ON and 8 to OFF.


Digital Telemetry

10 Configure the 90478 receiver for operation with the 90343 transmitter and attached to the 90217 ABP monitor. The NIBP measurement displays in numeric format on the Spacelabs monitor. The values of the measurement are displayed as ??? until a valid NIBP measurement has been taken.

11 Interconnect the adapter cable between the communications port on the ABP monitor and the NIBP port on the 90343 transmitter as shown in Figure 17-7.

Figure 17-6: Common cuff hose positions

alternative #1

alternative #2


Digital Telemetry

Figure 17-7: Transmitter ECG, SpO2, and ABP monitor connections

Patient Factors Affecting Readings

Proper cuff selection and application is critical in ensuring the accuracy of NIBP readings. Measure the circumference of the limb at its midpoint. Match the limb measurement to the range of appropriate circumferences (in centimeters) specified on each cuff. If the cuff bladder is too wide for the patient, the reading will be falsely lowered; if it is too narrow, the reading will be falsely elevated. Undersizing the cuff results in the greatest chance of error, so a variety of cuff sizes should be available to accommodate your full patient population.

Apply the cuff snugly. When the cuff is properly applied to an adult, you should be able to insert one finger between the cuff and the arm. If you can insert two fingers, the cuff is too loose, which may result in falsely elevated readings. Ensure that the hose is not kinked when the cuff is applied.

SpO2 sensor

NIBP adapter cable

NIBP cuff

SpO2 adapter

90217 & 90343 mount in pouches to patient’s belt.


Digital Telemetry

During blood pressure measurement, the inflated cuff reduces blood flow to the limb to which it is applied. Do not apply a cuff to a limb that has restricted blood flow. Check the patient periodically.

Excessive patient movement, speech, or muscle contractions as a result of severe pain or shivering can interfere with automated NIBP readings. Ensure that the patient is quiet and not moving during NIBP readings just as you would manual readings. The patient must avoid applying external pressure to the cuff during readings. Institute measures to minimize shivering and alleviate pain.

Some arrhythmias may cause beat-to-beat pressure fluctuations that can make obtaining NIBP readings more difficult. If it becomes difficult to obtain readings in the presence of arrhythmia, pressure should be temporarily verified using another method (i.e., ausculatory, oscillometric, Doppler). Pressure also varies cyclically with normal respiration. With deep respirations or in certain patients, this effect may be enhanced, increasing reading variability.

For patients in shock, indirect methods of measuring pressure (auscultatory, oscillometric, Doppler) may not be reliable because of peripheral vascular changes. These changes include peripheral vasoconstriction and diminished peripheral circulation resulting from shunting of blood to central organs. In some cases, peripheral pulses or Korotkoff sounds may be diminished or disappear in spite of adequate blood pressure. In such cases, measuring a cuff pressure may be impossible or give misleading results. Direct blood pressure measurements (invasive) should be considered in patients with signs of shock or any patient who rapidly becomes unstable for unknown reasons.

Status Messages

Caution:Status messages indicate a problem or condition which may affect accurate monitoring values. Do not ignore these messages. Correct any fault before continuing.

Telemetry products use different text for status messages than non-telemetry products. Refer to Table 1 on page 14-13 for a key for interpreting the telemetry messages.

Telemetry Messages

The following are general telemetry messages that apply to the patient-worn transmitters.

INTERMITTENT SIGNAL LOSS

The intermittent signal loss message indicates that the patient may be out of antenna range or the battery is depleted. Return the patient into antenna range. Check that the battery is functioning properly. A low-priority alarm tone sounds after 10 seconds in this condition.

LOW BATTERY

A low battery message indicates that the battery is weak. After this message appears, the battery has approximately three hours of useful life left (depending on the type of battery used). Install a new battery. A low-priority alarm tone sounds if the SETUP menu’s LOW BAT ON/OFF key is set to ON.

SIGNAL INTERFERENCE

The signal interference message indicates, via the displayed triangle squelch waveform, that an interfering signal has been detected. A signal can no longer be detected because of interference from a stronger signal source lasting more than 0.5 seconds. A low-priority alarm tone sounds whenever this message is displayed in the waveform zone.


Digital Telemetry

IS SIGNAL LOSS PERMANENT?

The permanent signal loss message indicates that no RF signal is being detected.

NIBP Messages

The 90217 ABP monitor provides an extensive set of result codes that indicate the status of the monitor and the potential causes of an inability to take a valid reading.

When an error condition is detected, the NIBP parameter value immediately changes to ??? and an alarm is triggered. The alarm condition persists until a new NIBP reading is taken.

Telemetry products display their status messages within the ECG’s display zone, so the following ECG status messages take priority over other NIBP messages:

• LEADS OFF

• NOISY SIGNAL

• ECG ALARMS SUSPENDED

The monitor displays the following messages to provide ABP status information to the caregiver. These messages summarize the 90217 event codes. A complete list of event codes can be found in the 90207/90217 ABP Monitors Operations Manual (P/N 070-0137-xx).

NIBP UNAVAILABLE (xx)

Displays when the 90217 ABP monitor detects an internal error condition defined by the code (xx). Typically, this requires the transmitter to be removed from service.

NIBP READING FAILURE (xx)

Displays when the ABP monitor is unable to make a reading. The code (xx) defines the cause of failure.

NIBP AIR LEAK

Displays when an air leak is detected in the pneumatic system, preventing a reading from being taken.

NIBP LOOSE OR NO CUFF

Displays when the cuff inflates in a manner indicating that it is not attached to the patient correctly.

NIBP PATIENT CANCELLED

Displays when the patient presses the START/STOP button on the ABP monitor, halting a reading in progress.

NIBP LOW BATTERY

Displays when the primary (3×AA) battery voltage is low. Replace with fresh batteries.

NIBP KINKED HOSE

Displays when the pressure value increases too rapidly, indicating a kinked hose or other restriction.

NIBP EVENT CODE (xx)

Displays when the event code returned from the ABP monitor is not defined into one of the other messages.


Digital Telemetry

NIBP Troubleshooting Guide


No NIBP displays ■ Adapter cable is not inserted correctly.

■ Remove and re-insert adapter cable.

■ NIBP is not enabled on the 90343 or 90478.

■ Enable NIBP function by setting transmitter DIP switch 5 ON and setting DIP switch 8 OFF.

■ 90217 ABP is not properly initialized.

■ Re-initialize the 90217 ABP using 90121.

■ 90343 low battery indicator is constantly illuminated.

■ Call qualified service person.

No NIBP readings can be obtained

■ Incorrect or inoperative cuff in use.

■ Replace with cuff known to be operative.

■ Tubing is kinked. ■ Locate kink and straighten tubing.

■ Some arrhythmias (e.g., atrial fibrillation and frequent ventricular ectopy) may cause a single or repeated failure to obtain a reading (may be due to true beat-to-beat variations in pressure).

■ Document arrhythmia, if present, verify pressure with another method, then follow hospital procedure for care of this type of patient.

■ Excessive patient motion or muscle contractions associated with shivering or severe pain.

■ Ensure that patient is quiet with minimal movement during NIBP readings; minimize patient’s shivering.

■ Blood pressure is outside of measurement range.

■ Verify extremely high or low pressure with another method.


■ 90217 ABP error. ■ Remove 90217 ABP from service, record event code, and call qualified service person.


Digital Telemetry

Apparent incorrect value

■ Wrong size cuff for patient. ■ Measure patient’s limbs at the midpoint. Match limb measurement to range specified on cuff (undersizing the cuff results in the greatest degree of error).

■ Cuff is damaged. ■ Replace with good cuff.

■ Excessive patient motion, shivering, or severe pain.

■ Ensure patient is quiet with minimal movement during NIBP readings. Minimize patient’s shivering.

■ False high readings may be the result of venous congestion caused by frequent readings.

■ Reduce frequency of readings.

■ Cuff is too loose or positioned incorrectly.

■ Tighten cuff or reposition appropriately.

90217 ABP Display is incorrect

■ Data not retained. ■ Replace backup battery.

■ Low or no power. ■ Check the batteries for a full charge. If needed, replace or recharge the batteries.

■ May be one of the following: time-out, no reading due to air leak in the system, improper cuff size, cuff size not properly attached to the 90217 ABP.

■ Isolate cause and correct.

No NIBP alarms are displayed

■ ECG “Leads Off” condition exists.

■ Higher-priority alarm condition is present.

■ Re-attach ECG lead wires to the patient and resume ECG monitoring to clear pending ECG alarms.

■ Clear current alarm condition and/or re-prioritize NIBP alarms in the Module Configuration Manager.

■ When NIBP alarms are ON, all NIBP alarm conditions cause the parameter value (or ???) to blink according to the alarm priority set using the Module Configuration Manager.



Digital Telemetry

Variable readings occur

■ Some arrhythmias may cause beat-to-beat pressure and NIBP readings.

■ Document arrhythmia, if present, verify pressure using another method, then follow hospital procedure for care of this type of patient.

■ Larger-than-normal influence of respiratory phases on blood pressure (inspiratory fall in blood pressure; expiratory rise).

■ NIBP software usually compensates for normal variation.

No NIBP readings or questionable values in the presence of shock

■ Peripheral vascular changes experienced during shock may reduce the reliability of blood pressure readings obtained with any indirect method. Peripheral pulses may be diminished or absent.

■ Consider invasive pressure measurements in patients with symptoms of shock or in any patient who rapidly becomes unstable for unknown reasons.

90217 displays “LLL” and alarm sounds

■ Low main battery condition. ■ Turn off the 90217 unit and replace batteries within 60 seconds after removal to continue monitoring.

Cuff too tight ■ Cuff is placed on patient too tightly.

■ Reposition the cuff.

■ Air pump is staying on too long. ■ Return the unit to Spacelabs Healthcare for service.

Cuff too loose ■ Cuff is placed on the patient too loosely.

■ Reposition the cuff.

■ Air pump is not staying on long enough.

■ Return the unit to Spacelabs Healthcare for service.



Pressure

Directory of Keys


ALARMLIMITS

SELECTLABELSIZE SETUP SCALES ZERO

SCALESON OFF

FREEZEON OFF

SCALE0-180

SAVESYS

SAVEMEAN ZERO

SAVEDIA

ART PA CVP RAP LAP ICP UA UV PRS

SWEEP SPEED25 mm/sec.

FILTER12 Hz

ART REJON OFF

NUMERICSIZE

50mm/sec.

25mm/sec.

12.5mm/sec.

6.25mm/sec. SAME AS ECG

SYSHI=150

SYSLO=90

DIAHI=150

DIALO=90

MEANHI=OFF

MEANLO=OFF

ALARMOFF

ALLOFF

0 1 2 3 4 5 6 7 8 9 ENTER

PRESSURE MAIN MENU

PRESSURE SCALES Menu CURSOR = 95

PRESSURE Label Select Menu

PRESSURE Setup Menu

PRESSURE Waveform Size Menu

PRESSURE Alarm Limits Menu

The scale is now 0 - 180. Enter the new scale setting: 0

FILTER 12 HZ

This keybecomesSAVE PCWPwith PA

The pressure label you select will appear here

PRESSURE Sweep Speed Menu

SYS/DIALARGE

MEANLARGE

ALLLARGE

PRESSURE Numeric Size Menu

ON


Pressure

Contents

Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Setting Up Pressure Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Zeroing the Pressure Transducer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Setting and Adjusting Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Adjusting Waveform Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Selecting Numeric Display Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Adjusting Sweep Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Displaying Waveforms with Scales. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Freezing the Scaled Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Changing the Waveform Scale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Selecting the Waveform Measurement Value . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Storing Values for Trending . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Recording Waveforms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Setting Artifact Rejection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Selecting a Filter Frequency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Restoring User-Defined Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Factory Default Pressure Alarm Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Invasive Pressure Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Overview

A pressure key and waveform will automatically be displayed as soon as you connect a transducer to the module. Immediately after connection, you can relabel the catheter site or zero the system. Pressure labels may be pre-defined (refer to Selecting Alarm Attributes on page 7-7) or you can select from the following:

Pressure Label Description

ART arterial pressure

CVP central venous pressure

ICP intracranial pressure

LAP left atrial pressure

PA pulmonary artery pressure

RAP right atrial pressure

PRS generic pressure

UA umbilical artery pressure

UV umbilical vein pressure


Pressure

Disconnecting the pressure cable or the transducer will cause the pressure key and waveform to disappear from the display.

Systolic, diastolic, and mean pressure values are displayed for arterial, pulmonary artery, umbilical artery, umbilical vein and generic pressures. Only the mean value is displayed for other pressure types. Refer to the Display Detail on page 18-5 for a sample arterial pressure and intracranial pressure display on the bedside monitor.

Warning:Systolic and diastolic pressures displayed numerically for patients being treated with an Intra-Aortic Balloon Pump (IABP) therapy may not be accurate. Display the waveform with scales to verify or determine pressures for these patients.

Note:

With the Module Configuration Manager feature, you can define your own default settings for such characteristics as alarm limits and display configuration. Refer to the Module Configuration Manager on page 7-5 for further details.

Setting Up Pressure Monitoring

Connect the cable end of either a reusable or disposable transducer to the pressure connector located on the front of the module using a Spacelabs Healthcare pressure cable.

When setting up an invasive pressure system, take all measures to maintain system sterility and to prevent the introduction of air into the system. Air bubbles are the most common cause of inaccurate pressure readings. The transducer, stopcocks, connectors and tubing must be completely free of air to ensure maximum performance.

Note:

• Refer to the catheter, tubing, or transducer manufacturer’s instructions or your hospital’s protocol for specific instructions on removing air from the system.

• Invasive pressure systems specified by Spacelabs Healthcare are compatible with high-frequency electrosurgical and defibrillation equipment. No special precautions are required.


Pressure

Zeroing the Pressure Transducer

Before you can begin monitoring you must zero the system. Zeroing has two purposes: 1) to establish atmospheric pressure as zero, and 2) to compensate for the hydrostatic effect of fluid in the catheter-tubing system.

Note:

If after you have followed the instructions to zero the pressure transducer and a ZERO REJECTED message appears, you may have a transducer problem. Follow the transducer manufacturer's directions to correct this problem before you continue.

Display Detail

A pressure display appears once you select a pressure label and zero the transducer. Figure 18-1 shows an example of the display for ART and ICP. The system identifies the specific pressure type in the parameter key and menu title (PA, CVP, LAP, etc.).

Figure 18-1: Bedside monitor pressure display

� Pressure waveforms

� Pressure parameter keys

� Systolic pressure

To zero the pressure transducer:

• Touch the desired pressure parameter key.• Open stopcock to air/close to patient (at phlebostatic axis).• Touch ZERO.• Close stopcock to air/open to patient.• Begin monitoring after the pressure values appear.

13370

6CPP= 86

(92)150120

155

ART

M

ICP

SmmHg

12060

D

mmHg

CHECK CATHETER

� �

�

��

�

�

�


Pressure

� Mean pressure

� Systolic pressure alarm limits

� Diastolic pressure alarm limits

� Diastolic pressure

Cerebral perfusion pressure

Mean pressure alarm limits

� Mean pressure

CHECK CATHETER key (for UA pressures only)


Pressure alarm limits can be defined for systolic, diastolic, and mean values for ART, PA, UA, UV, and PRS. Alarm limits can only be set for the mean value for all other pressures.

The Alarm Limits menu for ICP provides a cerebral perfusion pressure key (CPP) used to set CPP alarm limits. CPP is computed as mean arterial pressure minus intracranial pressure (MAP-ICP). The value CPP=xxx displays at the top of the digital zone above the ICP value if ICP and at least one peripheral invasive arterial pressure are being monitored. If the system cannot compute a pressure (for example, no mean arterial pressure is available), then the message CPP=??? displays.

Alarms can be independently set for each pressure channel.

The CHECK CATHETER alarm may be set when umbilical artery pressure is being monitored. This alarm will sound whenever the pulse rate drops below 60 BPM or the pressure approaches 0 mmHg. Touching the CHECK CATHETER key will silence the alarm.

To set or adjust alarm limits:

• Touch the desired pressure parameter key.• Touch ALARM LIMITS.• Select desired alarm.• Select ALARM ON.• Use arrow keys to adjust a limit value.


Pressure


You can increase or decrease the size of the pressure waveform display. This only changes the displayed size and does not affect the signal gain. The waveform size may not be adjusted while the scales are displayed.

Selecting Numeric Display Size

You can select from three different display formats for pressure numerics (for ART, PA, PRS, UA and UV only). In each of the three display formats, mean pressure is 92, systolic pressure is 133 and diastolic pressure is 70.

Figure 18-2: Display formats

Note:

Specific alarm limits are not displayed in the All Large display format.

To change the waveform size:

• Touch the desired pressure parameter key.• Touch SIZE.• Select SIZE or SIZE

To change the numeric display size:

• Touch the desired pressure parameter key.• Touch SETUP.• Touch NUMERIC SIZE.• Select a display size.

13370

92(92)

70

13392

70133

mmHg

mmHg

mmHg

SYSTOLIC/ MEAN LARGE ALL LARGEDIASTOLIC LARGE


Pressure


The sweep speed determines the rate at which the pressure waveform moves across the screen. Sweep speed selections are: 50, 25, 12.5, 6.25 mm/second, or the same sweep speed as ECG.

Displaying Waveforms with Scales

You can superimpose a vertical reference scale over pressure waveforms. Up to four pressures can be scaled at one time.

Touching a parameter key and then the SCALES key displays scales when the pressure parameter key is activated. Selecting SCALES ON maintains the selected pressure display in scaled format until SCALES OFF is selected.

Freezing the Scaled Display

You can freeze a pressure waveform display to stabilize the waveform for obtaining measurements.

To unfreeze the waveform display, select FREEZE OFF or exit the pressure menu by touching either the PREVIOUS MENU or NORMAL SCREEN keys.

To select a pressure waveform sweep speed:

• Touch the desired pressure parameter key.• Touch SETUP.• Touch SWEEP SPEED.• Select a sweep speed.

To configure the display of pressure waveforms with a vertical scale:

• Touch the desired pressure parameter key.• Touch SCALES.• Select SCALES ON if the pressure is to remain in scales.

To freeze the pressure display:

• Touch the desired pressure parameter key.• Touch SCALES.• Select FREEZE ON.


Pressure

Changing the Waveform Scale

You can increase or decrease the pressure waveform scale. The bottom of the scale is always 0 (zero). You may set the top of the scale to be any value from 10 to 500 mmHg by typing in the desired value and touching ENTER.

Selecting the Waveform Measurement Value

You can obtain a measurement at any part of the pressure waveform by using the horizontal cursor. The measurement value displays as CURSOR = xx in the message line above the Pressure menu. The most common use of this function is to obtain a pulmonary capillary wedge pressure (PCWP) value from the pulmonary artery catheter.

To change the pressure waveform scale:

• Touch the desired pressure parameter key.• Touch SCALES.• Select SCALE 0-xxx.• Enter a new scale using the numerical keys.• Touch ENTER.

To obtain a pulmonary capillary wedge pressure (PCWP):

• Touch PA.• Inflate PA catheter balloon.• Touch SCALES.• Touch FREEZE ON.• Deflate PA catheter balloon.• Use arrow keys to position cursor.• Touch SAVE PCWP.


Pressure

Storing Values for Trending

You can store values into memory for pressure trend displays for use in clinical calculations.

Recording Waveforms

You can print pressure waveforms and values. Refer to Printing on page 4-5 for additional information.

Note:

The pressure scales should not be changed during a recording. This may lead to an annotation on the recorded strip that does not match the actual scale of the recording.

To store values in memory:

• Touch the desired pressure parameter key.• Touch SCALES.• Use arrow keys to position cursor.

For ART, PRS, UA and UV

• Select SAVE SYS, SAVE DIA or SAVE MEAN.

For CVP, RAP, LAP or ICP

• Touch SAVE MEAN.

For PA

• Touch SAVE PCWP.

To print pressure waveforms:

• Touch RECORD.• Touch flashing PRESSURE parameter key.


Pressure

Setting Artifact Rejection

Variations in intrathoracic pressures during the respiratory cycle can influence invasive pressures; especially PA, PCWP and CVP. The respiratory artifact rejection feature minimizes the impact of such variations by automatically selecting data from waveform peaks that have little change in amplitude from peak to peak. End-expiration is typically the time with the least variation. The artifact rejection feature works equally well in both mechanically-ventilated and spontaneously-breathing patients.

In patients with chronic obstructive pulmonary disease, intrathoracic pressures during respiration are different than those in patients with normal lung function. Disable artifact rejection when monitoring these patients.

The factory default for artifact rejection is ON for PA pressure only, and OFF for all other pressure labels.

Selecting a Filter Frequency

When noise and other interference appears on the pressure waveform, you can adjust the filter frequency to minimize its effect.

A higher filter frequency shows greater detail, but can also produce more artifact. A lower filter frequency smooths the waveform and may help diagnose transducer or catheter problems such as under damping or ringing.

The filter frequency may be set within the range of 3 to 40 Hz.

To activate respiration artifact rejection:

• Touch the desired pressure parameter key.• Touch SETUP.• Select ART REJ ON.

To adjust the filter frequency:

• Touch the desired pressure parameter key.• Touch SETUP.• Touch FILTER.• Touch the arrow keys to choose the desired setting.


Pressure



Note:

• RESTORE SETTINGS changes the user-configurable settings for all parameters.







• Touch TEMP.• Touch RESTORE SETTINGS.• Select YES.


Pressure

Factory Default Pressure Alarm SettingsArterial (ART), Generic Pressure (PRS), Umbilical Artery and Vein (UA and UV), Cerebral Perfusion (CPP-mean only)

Systolic *

mmHg High Low

-50 to 79 +30 -05

80 to 109 +30 -10

110 to 119 +30 -15

120 to 129 +25 -20

130 to 139 +20 -20

140 to 149 +15 -20

150 to 159 +10 -20

160 to 169 +10 -25

170 to 179 +10 -30

180 to 189 +10 -35

190 to 300 +10 -40

Systolic *

kPa High Low

-6.7 to 10.5 +4.0 -0.7

10.6 to 14.5 +4.0 -1.3

14.6 to 15.9 +4.0 -2.0

16.0 to 17.2 +3.3 -2.7

17.3 to 18.5 +2.7 -2.7

18.6 to 19.9 +2.0 -2.7

20.0 to 21.2 +1.3 -2.7

21.3 to 22.5 +1.3 -3.3

22.6 to 23.8 +1.3 -4.0

23.9 to 25.1 +1.3 -4.7

25.2 to 40.0 +1.3 -5.3

Mean

mmHg High Low

-50 to 69 +30 -05

70 to 79 +30 -10

80 to 99 +30 -15

100 to 109 +30 -20

110 to 119 +30 -25

120 to 129 +25 -30

130 to 139 +20 -30

140 to 149 +15 -30

150 to 179 +10 -30

180 to 300 +10 -35

Mean

kPa High Low

-6.7 to 9.2 +4.0 -0.7

9.3 to 10.5 +4.0 -1.3

10.6 to 13.2 +4.0 -2.00

13.3 to 14.5 +4.0 -2.7

14.6 to 15.8 +4.0 -3.3

15.9 to 17.2 +3.33 -4.0

17.3 to 18.5 +2.7 -4.0

18.6 to 19.8 +2.00 -4.0

19.9 to 23.8 +1.3 -4.0

23.9 to 40.0 +1.3 -4.7

* Example: If systolic is between 80 and 109 mmHg, then HI alarm defaults to 30 mmHg above actual value; LO alarm defaults to 10 mmHg below actual value.

Diastolic

mmHg High Low

-50 to 69 +30 -05

70 to 79 +20 -10

80 to 89 +20 -15

90 to 99 +15 -15

100 to 109 +10 -20

110 to 119 +05 -25

120 to 300 +05 -30

Diastolic

kPa High Low

-6.7 to 9.2 +4.0 -0.7

9.3 to 10.6 +2.7 -1.3

10.7 to 11.8 +2.7 -1.9

11.9 to 13.2 +2.00 -1.9

13.3 to 14.5 +1.3 -2.7

14.6 to 15.8 +0.7 -3.3

15.9 to 40.0 +0.7 -4.0

Pulmonary Artery (PA), Right Atrial (RAP), Central Venous (CVP), Left Atrial (LAP), and Intracranial (ICP-mean only)

Systolic, Diastolic, and Mean

mmHg High Low kPa High Low

-50 to 25 +05 -05 -6.7 to 3.3 +0.67 -0.67

26 to 300 +20% -20% 3.4 to 40.0 +20% -20%


Pressure

Invasive Pressure Troubleshooting Guide


Intermittent or no operation

■ Module error. ■ Call a qualified service person.

No pressure key appears ■ Module not inserted correctly. ■ Reinsert the module.

■ Transducer not connected. ■ Reconnect the transducer.

Numeric display does not settle

■ Respiration artifact too high. ■ Select ART REJ ON.

Pressure display disappears

■ Cable disconnected from the module.

■ Reconnect cable.

■ Cable disconnected from the transducer.

■ Reconnect cable.

Pressure shows NOT ZEROED

■ Pressure has not been zeroed. ■ Zero pressure with the ZERO key after opening transducer to air.

Shows constant pressure ■ Stopcock(s) are positioned incorrectly.

■ Reposition stopcock(s) to connect the patient to the transducer (a waveform will appear on the screen).

ZERO REJECTED message appears

■ Stopcock(s) are positioned incorrectly.

■ Reposition stopcock(s) to open the transducer to air. Zero pressure with the zero key.

■ Still unable to zero. ■ Follow transducer manufacturer's instructions to correct the problem.


Pressure

CHECK CATHETER key appears on the monitor

■ Stopcock(s) are positioned incorrectly.

■ Reposition stopcock(s) to connect the patient to the transducer (a waveform will appear on the screen).

■ UA catheter has become dislodged or occluded.

■ Check UA catheter.

■ Upon completion of the above, touch the CHECK CATHETER key to silence the alarm.



Cardiac Output

Directory of Keys


CARDIACOUTPUT

HEIGHT/WEIGHT CALCS

0.5 5 0

HEIGHT =170 CM

WEIGHT =70 KG

CLEAR CANCEL STORE CALCS PRINTAVERAGEALL

YES NOYES NO

YES NO

ENTER

ENTER

START

CO#1 BAD CURVE

5.8Inject when ready

Enter computational constant

BSA = ?.? Must enter patient height and weight for calculations

Inject when ready (if auto) Touch START then INJECT (if manual)

Press YES toPress YES to confirm

Press YES to confirm

CC =.550

CO

CO - MENU

confirm STORECLEAR

AVERAGE ALL

STOPCURVE

CO#2 CO#3

CO#4

TB XX.XoCTI X.XoC

5.8

5.8

data by pressing

the key

corresponding to

the day/time

desired

CO

CO/CI

Select a row ofDAY/TIME CO CI SV SV SVR PVR LVSW RVSW HR MAP CVP MPA PCWP

26/02:25p 5.1 2.9 70.8 40.4 1629 235 54.9 10.4 72 110 6 25 10

27/09:30p 4.9 2.8 65.3 37.8 1712 211 51.4 9.2 75 112 7 25 12

28/10:15p 4.5 2.5 56.2 32.1 1917 213 44.5 7.8 80 115 7 25 13

29/07:30a 4.0 2.2 47.0 26.8 2237 219 38.2 6.5 85 120 8 26 15

30/08:30a 4.0 2.2 47.0 26.8 2237 219 38.2 6.5 85 120 8 26 15

HEIGHT/WEIGHT

VITALSIGNS

SCROLLUP

SCROLLDOWN PRINT

MAP = xxx mmHg

CVP =xx mmHg

MPA =xx mmHg

PCWP =xx mmHg ENTER

VR INDEXON OFF

SW INDEXON OFF

CALCULATIONS

VITAL SIGNS - Adjust vital signs, then touch ENTER

HR = xxx

AUTO

MANUAL


Cardiac Output

Contents

Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Setup Procedure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Entering the Computational Constant. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Entering Patient Height/Weight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Measuring Cardiac Output . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Averaging Cardiac Output . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Clearing Cardiac Output Curves. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Storing Cardiac Output Curves. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Stopping Curve Drawing and Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Selecting Index Normalization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Displaying Cardiac Index and Cardiac Output Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Displaying Calculations Table. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Editing Vital Sign Values. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13View Additional Table Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Recording Cardiac Output Curves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Error Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Cables and Probes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Cardiac Output Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Overview

Cardiac output (CO) monitoring enables you to evaluate the patient's fluid status and the pumping ability of the heart, as well as calculate and display various hemodynamic values.

Cardiac output is calculated by the thermodilution technique using a variation of the Stewart-Hamilton formula. Thermodilution involves injecting a cooled fluid (injectate) through a flow-through housing into an intravascular catheter. The catheter delivers the injectate directly to the right atrium and monitors the temperature downstream from the delivery site at the pulmonary artery.

Cardiac output is determined by measuring the change in blood temperature downstream from the delivery site with respect to time. The change in temperature is inversely proportional to the flow of blood through the right heart. If the flow is large, the volume of blood that the injectate mixes with is large as well, so the monitor detects a small change in temperature. When a smaller flow of blood is diluted by the same volume of injectate, the change in temperature is larger. The injectate has a larger influence on the temperature as measured in the pulmonary artery.

The system displays cardiac output by plotting a curve for each injection. The vertical axis of the curve represents temperature and the horizontal axis represents time.

Spacelabs Healthcare’s cardiac output monitoring automatically captures vital sign values at the moment each CO curve is completed. This data is used to produce hemodynamic calculations.


Cardiac Output

Setup Procedure

The setup procedure that follows assumes that the pulmonary artery catheter has been placed. Follow your standard hospital procedure to properly place the pulmonary artery catheter in the patient.

Figure 19-1 illustrates the components used for CO monitoring. When using a reference solution injectate temperature probe, it should be inserted into the cardiac output cable in place of the in-line injectate temperature probe.

When you connect the thermistor connector port of the catheter to the cardiac output cable, the system monitors patient blood temperature (TB) and displays the value on the screen. When you connect the injectate temperature probe, the system detects the temperature of the injectate (TI) and displays it on the screen, but does not trend the data. The system displays a message instructing you to connect the probe or catheter, or to enter the computational constant (CC).

If you connect the cardiac output cable only to the catheter or only to the injectate probe, you can enter or adjust the computational constant but you cannot monitor cardiac output.

Figure 19-1: Cardiac output monitoring setup

To set up the system for monitoring cardiac output:

• Insert the cardiac output cable into the module.• Attach the thermodilution catheter to the cardiac output cable.• Connect either an in-line injectate temperature probe or a reference solution injectate

probe to the cardiac output cable.

In-line injectate temperature probe

Thermistor connector

Cardiac output cable

Thermodilution catheter

Injectate


Cardiac Output

Display Detail

The CO key is displayed once you connect the CO cable to the module. To display the CO main menu, touch the CO key and curves will appear as the system detects the flow for each injection. The message INJECT WHEN READY is displayed when the system is ready to plot a new output curve.

Figure 19-2 illustrates the cardiac output display when curves are being acquired, on a bedside monitor.

Figure 19-2: Cardiac output display

� Cardiac output curve

� Cardiac output (liters/minute)

� Curve ID number key (used to select a curve)

� Blood temperature

� Injectate temperature

� Cardiac output (average)

� Time and date of averaging

Stop curve key (only displayed during curve drawing)

Cardiac index value

� Cardiac index value (average)

CO#1 CO#2 CO#3

5.8 5.86.0

TB 36.5 oCTI

5.80.2 oC

01:07 P01/06

STOPCURVE

CO#1

5.8CO

CI 3.7

CI = 3.7

�

� �

�

�

�

�

�


Cardiac Output

Entering the Computational Constant

To generate calculations, you must first enter the computational constant (CC) and verify that the system is correctly configured. Refer to your thermodilution catheter package insert for current constants.

The temperature of the injectate changes due to contact with the catheter wall and the surrounding blood. To account for this interaction, the system includes a correction factor in the equation. The correction factor (K or CT) is a function of catheter and flow-through housing dimension, internal volume, and injectate temperature and differs among catheter models and manufacturers.

Once you enter a value for the computational constant, the value is displayed on the CC= key and remains in system memory. Until you enter the computational constant, the message CC REQUIRED is displayed, and ENTER COMPUTATIONAL CONSTANT is displayed on the message line after the CC= key is selected.

Entering Patient Height/Weight

To perform indexed hemodynamic calculations, you must enter the patient's height and weight before you generate CO curves. CO uses the patient's height and weight entered during the admit function.

The valid range for height is from 20 to 215 cm (8 to 84 inches). The valid range for weight is from 1 to 250 kg (2 to 551 pounds). After you enter both height and weight values, the system automatically calculates and displays the patient's body surface area (BSA).

To enter the computational constant:

• Touch CO.• Touch CC =. • Touch the appropriate keys (tenths, hundredths, and then thousandths) and use arrow

keys to adjust. • Touch ENTER.

To enter patient height and weight:

• Touch CO.• Touch HEIGHT/WEIGHT.• Select HEIGHT = and/or WEIGHT =.• Use arrow keys to adjust. • Touch ENTER.


Cardiac Output

Measuring Cardiac Output

To maintain the accuracy of the readings, you must allow the catheter to warm up between injections. When in AUTO mode, wait until the INJECT WHEN READY message appears between injections. When in MANUAL mode, wait until the TOUCH START THEN INJECT message appears.

Five curves can be displayed at one time. Some curves may automatically be classified as “bad,” in which case they are then labeled BAD CURVE and are automatically excluded from averaging. CO curves are numbered consecutively from 1 to 99.

Note:

To obtain all hemodynamic calculations remember to enter height and weight, and to store a PCWP prior to initiating measurement of CO.

A 15-minute timer begins after acquisition of the first good curve. After 15 minutes, the AUTO/MANUAL and START keys become invalid (dotted), and the messages MUST SELECT CURVES, AVERAGE, STORE, or CLEAR CO appear. Cardiac output injections are disabled until you perform one of these actions. Injections may resume as soon as the INJECT WHEN READY or TOUCH START, THEN INJECT message appears.

To obtain CO measurements:

• Touch CO.• Touch CARDIAC OUTPUT.• Select AUTO or MANUAL.• Wait for the INJECT WHEN READY or the TOUCH START THEN INJECT message

to display.

-OR-

• If in manual mode, touch START.• Inject the prepared injectate into the proximal lumen of the thermodilution catheter.


Cardiac Output

Averaging Cardiac Output

This function computes the average using the data from up to five, good, displayed curves. Curves labeled as “bad” are not included in the average.

You can perform cardiac output averaging as soon as the system has measured and displayed at least two acceptable curves.

When the cardiac output averaging is complete:

• The CO zone displays the curves used in the average, the averaged cardiac output, and cardiac index values.

• The time and date of the last curve displays.

Clearing Cardiac Output Curves

Occasionally you may want to delete a curve prior to averaging or storing. All curves, or only selected curves, can be cleared. If a “bad” curve is displayed when you select to average, store, or clear another displayed curve, the “bad” curve is also cleared.

When you clear an individual CO curve or all CO curves, the INJECT WHEN READY message is displayed in the first available curve position, so the curves displayed on the screen may not appear in numerical order.

To average all cardiac output curves:

• Touch CO. • Touch CARDIAC OUTPUT.• Touch AVERAGE ALL.• Touch YES.

To clear or store all curves:

• Touch CO.• Touch CARDIAC OUTPUT.• Select CLEAR or STORE.• Touch YES.


Cardiac Output

Storing Cardiac Output Curves

This feature enables you to store all of the acceptable, displayed curves at once or individually. The system stores the vital signs and cardiac output value it acquired at the end of curve acquisition, along with the time it displayed each curve. The curves clear from the screen as they are stored. The system does not store “bad” curves. After you store the acceptable curves, the system clears all curves from the screen.

Stopping Curve Drawing and Acquisition

This feature enables you to stop the curve drawing and data acquisition of a cardiac output curve in progress. The STOP CURVE key only appears during curve drawing. Touching this key will invalidate all curve data for that injection. Once the blood temperature is again stable, the INJECT WHEN READY message will appear if in AUTO mode. The TOUCH START THEN INJECT message will appear if in MANUAL mode.

To clear or store selected curves:

• Touch CO.• Touch CARDIAC OUTPUT.• Touch the CO# keys adjacent to the curves (up to 5) that you wish to clear or store.• Select CLEAR or STORE.• Touch YES.

To stop a curve in progress:

• Touch STOP CURVE.


Cardiac Output

Selecting Index Normalization

To individualize the values to the patient, the system calculates them with the BSA. Cardiac Index (CI) and Stroke Volume Index (SVI) are automatically displayed.

You can display either the Systemic Vascular Resistance (SVR) and the Pulmonary Vascular Resistance (PVR) or their indexed values (SVRI and PVRI), but not both simultaneously. Similarly, you can display the Left Ventricular Stroke Work (LVSW) and the Right Ventricular Stroke Work (RVSW) or their indexed values (LVSWI and RVSWI), but not both simultaneously.

Displaying Cardiac Index and Cardiac Output Values

The cardiac output or both cardiac output/index values can be displayed with the curves. If the CO portion of the CO|CO/CI key is highlighted, only the cardiac output value will be displayed. To activate the display for the cardiac output and cardiac index values, touch the CO|CO/CI key to highlight the CO/CI segment. If the cardiac index value is available, then it is displayed when the CO parameter is inactive.

To select indexing:

• Touch CO.• Touch CARDIAC OUTPUT.• Touch CALCS.• Select VR INDEX ON or SW INDEX ON.

To display both cardiac output and cardiac index values:

• Touch CO|CO/CI.


Cardiac Output

Displaying Calculations Table

You can view hemodynamic calculations after storing or averaging data. The table includes only those calculations that have been stored or averaged.

Table 1 shows an example of the hemodynamic calculations table displayed when you touch the CALCS key. Each horizontal row is one complete set of data. Each new value appears at the bottom of the table. The system defaults to VR INDEX OFF and SW INDEX OFF.

To display the calculations table:

• Touch CO.• Touch CALCS.

Hemodynamic Equations

BSA = Ht 0.725 × Wt 0.425 × 0.007184

CI = CO/BSA

SV = (CO/HR) × 1000

SVI = SV/BSA

SVR = 79.9 × [(MAP-CVP)/CO]

SVRI

= 79.9 × [(MAP-CVP)/CI]= 79.9 × [(MAP-CVP)]/[CO/BSA]= 79.9 × [(MAP-CVP)]/[CO × 1/BSA]= 79.9 × [(MAP-CVP)/CO] × BSA= SVR × BSA

PVR = 79.9 × [(MPA-PCWP)/CO]

PVRI

= 79.9 × [(MPA-PCWP)/CI]= 79.9 × [(MPA-PCWP)]/[CO/BSA]= 79.9 × [(MPA-PCWP)]/[CO × 1/BSA]= 79.9 × [(MPA-PCWP)/CO] × BSA= PVR × BSA

LVSW = 0.0136 × SV × (MAP - PCWP)

RVSW = 0.0136 × SV × (MPA - CVP)

LVSWI = LVSW / BSA

RVSWI = RVSW / BSA

* Assumes pressures are measured in mmHg


Cardiac Output

Note:

The vital sign values shown in Table 1 are typical if your monitor's UNITS OF MEASURE key is set to mmHg. Consult your system administrator if your display is different from that shown here.

The system automatically calculates and enters CO and CI values in the table. Values in the columns SV, SVI, SVR, PVR, LVSW, and RVSW are automatically calculated from the vital sign values entered in the columns HR, MAP, CVP, MPA, and PCWP.

The values under the columns HR, MAP, CVP, MPA, and PCWP are parameter values obtained from other channels in the bedside monitor at the time a CO value is calculated or those values you have entered manually. To enter values in these columns refer to Editing Vital Sign Values on page 19-13.

If you do not enter height and weight values prior to generating CO curves, the monitor displays any value that uses BSA (e.g., CI, SVI, LVSWI and RVSWI) as ?.?. If a calculated value is out of the displayable range, the monitor displays the value as ++++. If any of the vital signs in the hemodynamics table are negative, the system uses the value 0 (zero) in the calculations.

The equations used for the hemodynamics table are defined in the table to the left.

Table 1: Sample Calculations

DAY/TIME CO CI SV SVI SVR PVR LVSW RVSW HR MAP CVP MPA PCWP

26/02:25p 5.1 2.9 70.8 40.4 1629 235 54.9 10.4 72 110 6 25 10

27/09:30p 4.9 2.8 65.3 37.8 1712 211 51.4 9.2 75 112 7 25 12

28/10:15p 4.5 2.5 56.2 32.1 1917 213 44.5 7.8 80 115 7 25 13

29/07:30a 4.0 2.2 47.0 26.8 2237 219 38.2 6.5 85 120 8 26 15

30/08:30a 4.0 2.2 47.0 26.8 2237 219 38.2 6.5 85 120 8 26 15


Cardiac Output

Editing Vital Sign Values

Select a row of data in the hemodynamic calculations table to turn the vital signs keys ON.

Default values are supplied if you touch the VITAL SIGNS key and no prior value is available. When you edit a value, the system recalculates the hemodynamic calculation values using the new vital sign value.

A CVP value is used in calculations if it is available. If only a RAP value is available, then the RAP value is used in place of CVP. If neither CVP nor RAP pressure is available, the system cannot automatically calculate SVR, SVRI, RVSW, or RVSWI. A CVP or RAP value can be manually entered using this edit process.

Note:

To ensure that a RAP/CVP value can be registered, immediately reopen the stopcock to the patient after you inject the bolus so that flow is reinstated.

A PCWP value is used in calculations if the last stored PCWP value is less than 15 minutes old. If no such PCWP value is present, an LAP value is substituted. If neither PCWP nor LAP values are available, the system cannot automatically calculate PVR, PVRI, LVSW, nor LVSWI and the monitor displays the message NO PCWP VALUE AVAILABLE WITHIN THE LAST 15 MINUTES. You can add a PCWP value manually using this edit process.

Table 2: Hemodynamic and Vital Signs Values

Label Name UnitsDefault Value

Valid Range

HR Heart Rate beats/min 70 0 to 300

MAPMean Arterial Pressure

mmHg

kPa

80

10.7

0 to 300

0.0 to 40.0

CVPCentral Venous Pressure

mmHg

kPa

10

1.3

0 to 99

0.0 to 13.2

MPAMean Pulmonary Artery Pressure

mmHg

kPa

15

2.0

0 to 99

0.0 to 13.2

PCWPPulmonary Capillary Wedge Pressure

mmHg

kPa

10

1.3

0 to 99

0.0 to 13.2


Cardiac Output

View Additional Table Data

Five sets of values display at any one time. Additional sets of values can be displayed by scrolling through the data.

Thirty sets of values are saved in the monitor’s hemodynamic calculations table so you can remove and re-insert the module without losing hemodynamic values. You can erase these values by discharging a patient or by powering the monitor OFF.

Recording Cardiac Output Curves

If a bedside or system printer is installed, you can record all curves in the CO display area. You can also record the calculations table when it is displayed on the screen.

To edit vital sign values:

• Touch CO.• Touch CARDIAC OUTPUT.• Touch CALCS.• Touch DAY/TIME in the row you wish to select.• Touch VITAL SIGNS.• Select the vital sign you wish to edit.• Use arrow keys to edit the displayed value.• Press ENTER.

To view additional sets of data:

• Touch CO.• Touch CALCS.• Touch SCROLL UP to scroll the data up one row, touch SCROLL DOWN to scroll the

data down one row.

To record thermodilution curves:

• Touch CO.• Touch CARDIAC OUTPUT.• Touch PRINT.


Cardiac Output

Error Messages

Catheter Fault

There is a problem with the thermodilution catheter. Connect or replace the catheter.

TB Out Of Range

The blood temperature (TB) is unacceptable. The temperature must be between 17.2° and 43° C.

Probe Fault

There is a problem with the probe. Connect or replace the probe.

TI Too Warm

The injectate temperature (TI) is greater than 25.5° C. Cool down injectate.

Bad Curve

There are a number of different possible causes: unsteady baseline, irregular curve from shunts or poor injection, delayed curve, catheter or probe fault during curve recording. Delete the bad curves as necessary to perform additional cardiac output determination.

Injectate Temperature Error

The temperature difference between the injectate and body is less than 8° C. Cool the injectate down.


Cardiac Output

Cables and Probes

Refer to Spacelabs Healthcare Supplies Products catalog for part numbers and specifications for cables, probes, and injectate systems.

Computation Constants/Catheter Compatibility

Nominal resistance @ 37° C 14,004 ±15%

Refer to the instructions provided with your catheter for the computation constants for your specific catheter, setup injectate temperature, and injectate volume. Contact your local thermodilution catheter sales representative for further information.

Warning:For 3 cc injectate volumes, the 0° to 5° C injectate temperature is required for consistent results.

Note:

Cardiac output function is compatible with the Baxter Edwards Critical-Care REF and REF-Ox catheters for cardiac output measurement, but cannot perform the REF function.

Refer to Calculations on page 25-5 for hemodynamic and vital sign value tables.


Cardiac Output

Cardiac Output Troubleshooting Guide


Invalid pressure reading

■ Stopcock of the CVP or RAP line may not have been turned OFF quickly enough after injection was made.

■ Turn the stopcock off immediately after making the injection to provide the module with the correct pressure value at the time it obtains the curve.

Erroneous CO values using room temperature injectate

■ Injectate too warm. ■ Injectate temperature is above 25.5° C.

■ Injection rate too slow. ■ Administer bolus smoothly at a rate of 10 cc/4 seconds.

Unable to obtain indexed values for calcs

■ Did not enter height and/or weight prior to averaging curves.

■ Enter the height/weight and reinject the curves.

■ If the Calcs option is installed, enter the height/weight in hemocalcs to obtain index values without reinjecting curves.

Value of calcs variable displays as +++

■ Measured value is out of range. ■ Check computation constant (CC) values for validity.

Spontaneous CO curves drawn while in AUTO mode

■ Infusion of IV drips or medications through proximal port.

■ Turn off the IV solutions temporarily.

■ Mechanically ventilated patient causing shifts in PA temperature.

■ Use the Manual mode.

■ Cardiac arrhythmias causing blood flow variance.

■ Use the Manual mode and time the injection during stable ECG rhythm.


Cardiac Output

Substantial variance in CO values/irregular curves

■ Varied temperature in bolus.

■ Injection delivered at varying points in the respiratory cycle.

■ Standardize the temperature of bolus.

■ Use the Manual mode and time the injection at end expiration, if desired.

■ Movement. ■ Standardize the patient position during procedure.

■ Physiological problems. ■ Any of the following conditions can affect accurate readings: ventricular arrhythmias, low stroke volume, and/or valve insufficiency.

■ Injectate rate too slow. ■ Administer the bolus smoothly at a consistent rate.

No curve drawn after bolus injected

■ Insufficient time has elapsed between injections to allow blood temperature stabilization.

■ Wait 60 to 90 seconds between injections.



SvO2

Directory of Keys


SVO2 MENU

11:55 av DO2 = 4.61 Ca = 19.80 Cv = 15.20 ml/dl O2AV = 990 VO2 = 250 ml/min

SVO2

ALARMLIMITS

TIMEBASE2 HOURS

INTENSITYDISPLAY

CALIBRATE STOREREAD

PRINT SCALES CALCS

STORE READ

YES NO YES NO

SVO2TREND

CALCRESULTS

PRE-INSERTION

INVIVO

LIGHTINTENSITY

YES NO YES NO YES NO

ENTER

ENTER

1HOUR

2HOUR

4HOUR

8HOUR

16HOUR

ALARMSON OFF

HI =80

LO =80

LIGHT INTON OFF

PaO2 = PvO2 = CO = SaO2 = SvO2 = Hgb =


SvO2

Contents

Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Setting Up SvO2 Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Preparing the Catheter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Performing Pre-insertion (in vitro) Calibration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Beginning SvO2 Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Performing Light Intensity Calibration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Performing In Vivo Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Displaying Intensity Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Setting Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Setting the Light Intensity Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Adjusting Trend Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Obtaining Oximetry Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Printing Oximetry Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Storing or Reading Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Correcting Out-of-Range Light Intensity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Correcting Insufficient Light Intensity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Correcting Calibration Errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Correcting Optical Module Errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Correcting SvO2 Display Error . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Ensuring Catheter Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16SvO2 Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Overview

Measurements of venous oxygen saturation (SvO2) provide a status indicator of the oxygen transport system in the critically ill patient.

Low or rapidly decreasing saturation values indicate an imbalance between oxygen consumption and oxygen delivery. Normal values reflect a balance of the oxygen transport system or the patient’s ability to successfully compensate for alterations in oxygen supply or demand. Continuous SvO2 monitoring can reduce the frequency of additional invasive measurements and enhance the timeliness of intervention in the critically ill patient.

This system utilizes three-wavelength reflectance spectrophotometry to sense the amount of light absorbed by the blood. The use of three wavelengths compensates for changes in light reflectance from red blood cell surfaces, blood vessel walls, and for variations in hematocrit values. Digital filtering reduces vessel-wall artifacts.


SvO2

Data acquisition begins when a Hospira oximetry catheter is positioned at a site within the pulmonary artery. The catheter connects to a Hospira optical module which contains three LEDs emitting red and infrared wavelengths of light. The catheter returns reflected light through a second optical fiber to the optical module. Here the light is converted to an electrical signal which the SvO2 module recognizes and displays as a saturated venous oximetry value (percent SvO2).

Caution:• The Spacelabs Healthcare SvO2 module requires the use of a Hospira optical module and

Hospira oximetry catheter. Both items must be acquired directly from a Hospira representative. Refer to www.hospira.com for more information.

• The Hospira Optical Module provides patient isolation from the monitor system. Refer to Hospira accompanying documents for instructions on cleaning and maintenance.

• The Spacelabs Healthcare SvO2 module will not operate correctly with any other catheter for SvO2 monitoring.

Setting Up SvO2 Monitoring

In addition to the Spacelabs Healthcare module, venous oximetry monitoring requires a Hospira optical module, connecting cable, and a Hospira oximetry catheter. You must correctly connect all necessary cables, prepare the catheter and patient for this invasive procedure, and calibrate the catheter to begin monitoring.

The system provides two calibration methods. The patient’s current status determines the proper calibration method. You can calibrate the catheter:

• while in its sterile package

-OR-

• after it has been placed within the pulmonary artery, and you can verify adequate light intensity during monitoring.

Refer to Preparing the Catheter on page 20-5 and Performing Pre-insertion (in vitro) Calibration on page 20-7 for more details.

To set up SvO2 monitoring:

• Place the catheter’s optical connector into the optical module on the connecting cable.• Insert the connecting cable into the SvO2 module.


SvO2

Display Detail

Figure 20-1 provides a trend of oximetry values and the current light intensity value.

Figure 20-1: Typical venous oximetry display

� Current time base — 1HR

� Venous oximetry trend graph

� Event marks — I (in vivo calibration initiated), C (in vivo calibration complete)

� Light intensity display marks (vertical lines) superimposed over trend graph

� Light intensity bar graph (light meter)

� Real time intensity signal level (two vertical lines)

� Markers for normal intensity levels (two horizontal lines)

SvO2 parameter key

Current venous oximetry value — 76%

� Status or error message area

Current alarm limits — high 80, low 60

Preparing the Catheter

Each Hospira oximetry catheter is packaged in a sterile, disposable tray which includes a disposable optical reference. Inspect the catheter tray carefully. If you suspect damage to the tray DO NOT USE THE CATHETER.

Perform the catheter setup according to the instructions included with the catheter. Setup instructions are included here as a convenience.

1 Peel back the outer wrap. Do not break the seal of the inner wrap.

2 Peel back the lift tab to uncover the optical connector at the end of the tray.

3 Pull the optical connector slightly away from the tray. Place the optical module in the recess at the open end of the catheter tray.

� � � � �

��


SvO2

4 Open the end of the optical module by pulling straight out in the direction of the arrow (refer to Figure 20-2). The monitor will display an INSUFFICIENT LIGHT message.

Figure 20-2: Placing the optical module into the catheter tray

5 Place the optical connector into the optical module with the word TOP facing up. Close the module (refer to Figure 20-3).

Figure 20-3: Placing the optical connector into the optical module

6 With the inner wrap still in place, press down on the black optical reference at the point labeled PUSH. Listen for a click.

Note:

This step may not apply to all catheters. Check the Hospira package insert.

The catheter is now ready for pre-insertion calibration. After you complete the calibration, prepare the patient for catheter insertion.


SvO2

Performing Pre-insertion (in vitro) Calibration

This calibration procedure tales up to 72 seconds. When calibration is successful, the message PRE-INS CAL COMPLETE displays and the event mark P displays on the oximetry trend.

If the catheter fails calibration, verify the following:

• A secure cable connection exists between the optical and SvO2 modules.

• The catheter's optical connector is inserted properly within the optical module.

• You tested the catheter by replacing it with a known good catheter to ensure proper catheter function.

Repeated calibration failure with a known good catheter may indicate a defective optical module. Replace the optical module if necessary.

Beginning SvO2 Monitoring

Follow standard hospital procedure to prepare the patient for catheter insertion.

1 Using sterile procedures, peel back the remaining inner wrap from the catheter tray. Pull the retainer (white tab) to release the catheter.

2 Grasp the catheter at approximately the 5 cm mark and gently pull it straight out from the optical reference.

Caution:The optical fibers can be damaged if you do not draw the catheter out carefully.

3 Prepare the catheter and insert it into the patient according to hospital procedure. Oxygen saturation readings will immediately display on the bedside monitor.

4 When the catheter is positioned properly, verify the light intensity signal is within the correct operating range (i.e., the bars on the graph extend at least two vertical dots within the high and low range markers).

5 Perform a light intensity calibration.

Note:

Do not begin a light intensity calibration if the signal is out of range. If this occurs, refer to Correcting Out-of-Range Light Intensity on page 20-13.

6 Begin continuous mixed venous oxygen saturation monitoring.

To initiate pre-insertion calibration:

• Touch SVO2.• Touch CALIBRATE.• Touch PRE-INSERTION.• Touch YES.


SvO2

Performing Light Intensity Calibration

This procedure adjusts the optical module’s light intensity reference level to match the light intensity returned through the catheter from the patient’s blood. The SvO2 module stores this value and signals an alarm if the detected light differs significantly from the stored light levels.

Perform a light intensity calibration only when the catheter is in the proper position in the patient.

Performing In Vivo Calibration

In vivo calibration compares a drawn (measured) blood gas value with the value displaying on the monitor. The catheter manufacturer recommends that the oxygenation value be checked periodically. Several conditions may necessitate in vivo calibration.

• Catheter was placed without pre-insertion calibration.

• Catheter has been in place for an extended period of time.

• Decaying light intensity values indicate possible damage to the fiber optics (in this case, the catheter manufacturer recommends checking the oxygenation value every 12 hours).

• You believe the saturation reading is incorrect.

Note:

Use only measured oxyhemoglobin saturation values from a co-oximeter. Do not use values calculated from a laboratory blood gas analyzer. Oxyhemoglobin values calculated on the basis of PO2, pH, and temperature have been shown to be inaccurate.

To initiate light intensity calibration:

• Touch SVO2.• Touch CALIBRATE.• Touch LIGHT INTENSITY.• Touch YES.


SvO2

Perform an in vivo calibration only when the patient’s oxygen saturation is relatively stable and the intensity signal is within normal limits. When calibration begins, the optical module stores the preceding five seconds of oxygen saturation data.

Displaying Intensity Data

You can display a history of light intensity values superimposed over the saturation trend graph. This combined display can be valuable for troubleshooting because the quality of light passing the catheter tip directly affects the accuracy of the saturation value. Successful monitoring ensures light intensity values remain within the limits of the bar graph display.

Real time maximum and minimum intensity values display as vertical bars to each side of a vertical row of dots. This display updates every six seconds. Horizontal lines represent the recommended operating limits for light intensity.

Removing display of the intensity data does not affect storage of the data in monitor memory, and the current intensity continues to display in the intensity bar.

To initiate in vivo calibration:

• Touch SVO2.• Touch CALIBRATE.• Touch IN VIVO.• Touch YES.• Draw blood from the distal lumen when the message DRAW BLOOD is displayed and

send to lab for analysis.• Use arrow keys to adjust value if displayed value differs from lab value by more than

four saturation units.

To display a history of light intensity values:

• Touch SVO2.• Touch INTENSITY DISPLAY.


SvO2


The current limits for venous oximetry display to the right of the parameter key. You can set high or low saturation limits.

The alarm default is OFF. When you turn alarms ON:

• they default to a high of 80% and low of 60%

• the exceeded limit key flashes

• the limit value is displayed in the message area of the screen

Setting the Light Intensity Alarm

If the light intensity alarm is turned ON, a second-level alarm will sound in the event of an intensity alert.

To set or adjust alarm limits:

• Touch SVO2.• Touch ALARM LIMITS.• Select ALARMS ON.• Select HI= or LO=.• Use arrow keys to adjust.

To set the light intensity alarm:

• Touch SVO2.• Touch ALARM LIMITS.• Select LIGHT IN - ON or OFF.


SvO2

Adjusting Trend Display

The most recent minute of mixed venous oxygen saturation data is displayed as a point on the right side of the trend graph. As the module acquires new data, the older data points move left to create a record of data.

Select Timebase

The SvO2 module stores the most recent 16 hours of saturation trend data. You can view this data graphically in 1-, 2-, 4-, 8-, or 16-hour timebases. Data is displayed in one-minute increments on 1- to 4-hour graphs, in two-minute increments on the 8-hour graph, and in four-minute increments on the 16-hour graph.

Select Scale

You can select one of three sizes for the trend graph:

• 30% to 70%

• 40% to 80%

• 50% to 90% (default)

Event Marks

The system automatically displays event marks along the top of the trend graph to note the point when any of the following events occur:

P — pre-insertion calibration initiated

I — in vivo calibration initiated

C — in vivo calibration complete

L — light intensity calibration complete

F — calibration failure

R — light intensity range error

To select a timebase:

• Touch SVO2.• Touch TIMEBASE × HOURS.• Select hours.

To change trend graph size:

• Touch SVO2.• Touch SCALES.• Use arrows to adjust.


SvO2

Obtaining Oximetry Calculations

You can use the calculations feature to obtain specific values for the oximetry measurements listed below.

Arterial oxygen content — Ca

CaO2 = (1.34 × Hgb × SaO2/100) + (0.0031 × PaO2)

Venous oxygen content — Cv

CvO2 = (1.34 × Hgb × SvO2/100) + (0.0031 × PvO2)

Arterial-venous oxygen content difference

avDO2 = CaO2 – CvO2

Oxygen availability or oxygen delivery

O2AV = CaO2 × CO × 10

Oxygen consumption

VO2 = avDO2 × CO × 10

Values for cardiac output (CO), pulse oximetry (SpO2), and venous oxygen saturation (SvO2) are automatically displayed when data is available in the Ultraview Care Network system. You must manually enter laboratory values for PaO2, PvO2, and hemoglobin (Hgb) to obtain calculations.

Note:

If an SaO2 value is available, it may be used in place of the SpO2 value.

To obtain oxygenation calculations:

• Touch SVO2.• Touch CALCS.• Select a manually entered value(s) for PaO2, PvO2, Hgb.• Use arrow keys to adjust.• Touch ENTER.


SvO2

Printing Oximetry Data

You can print venous oximetry data in two formats: the current trend or the results of the most recent set of oxygenation calculations. Refer to Printing on page 4-5 for more details on system and bedside printers.

Storing or Reading Data

The last 15 minutes of data gathered by the SvO2 module may be stored in the optical module’s memory before disconnection. That data can be read back into the SvO2 module. The stored data includes the year, month, hour, and minute of collection.

Correcting Out-of-Range Light Intensity

Each time you perform a light intensity calibration, the oximetry module stores the intensity value and signals an alarm or error message if the current light level differs significantly from the stored level. Light intensity error messages serve as a reference to determine if the light at the catheter tip is adequate for accurate monitoring. Do not ignore these messages.

The module alerts you to this condition when:

• an INTENSITY ALERT or SVO2 DATA OUT OF RANGE message is displayed

-OR-

• a second level alarm begins.

When the monitor displays the SVO2 DATA OUT OF RANGE or INTENSITY ALERT message, select the intensity display feature to view a history of light intensity values. Refer to Figure 20-4 to identify the type of abnormal intensity. Refer to the following list of possible causes and solutions.

To print saturation data:

• Touch SVO2.• Touch PRINT.• Select SvO2 TREND or CALC RESULTS.

To read or store data in the optical module:

• Touch SVO2.• Touch STORE READ.• Select STORE or READ.• Touch YES.


SvO2

• High — check the position of the catheter as the tip may lie against the vessel wall. Reposition the catheter according to your hospital protocol.

• Low, dampened, or erratic — check the blood flow past the catheter as a clot may have formed over the catheter tip.

Figure 20-4: Abnormal intensities

Take the following actions:

• If a Spacelabs Healthcare invasive pressure module is being used, examine the pulmonary artery (PA) pressure waveform for spontaneous wedge indicating the catheter tip may lie against the vessel wall. If this occurs, reposition the catheter.

• If a Spacelabs Healthcare invasive pressure module is being used for pulmonary artery pressure monitoring, examine the pressure waveform for dampening, indicating clotting over the tip of the catheter. If this occurs, follow hospital procedure to flush the distal lumen. Reposition the catheter if necessary.

• Abnormal resistance when you push the catheter through the distal lumen indicates damage to catheter fiber optics. Reposition the catheter and replace if necessary.

• If connections between the catheter optical connector and the optical module appear loose, tighten the connections.

• If the catheter contains obvious kinks, the optical fibers may be damaged. Replace the catheter.

Correcting Insufficient Light Intensity

The message INSUFFICIENT LIGHT displays when an unusually small amount of light is being received during monitoring or during pre-insertion calibration.

Take the following actions:

• If this message displays while the catheter is exposed to room light during pre-insertion calibration, take no action. It disappears when the catheter is placed in the patient.

• If this message displays during pre-insertion calibration while the catheter is connected to the optical module, verify proper connection to the module.

• Check that the tip is fully inserted into the optical reference and firmly press PUSH on the optical reference until you hear a click. Do not use the catheter if the tip is pulled out of the optical reference when you receive the catheter tray.

• Disconnect the optical module from the catheter, close the optical module lid, and place the optical module in an area out of direct light. If the message disappears, replace the catheter. If the message remains, contact your system administrator.

• Examine the catheter for kinking. If optical fibers are damaged, replace the catheter.

correct intensityrange

lowintensity

highintensity

dampenedintensity

erraticintensity


SvO2

Correcting Calibration Errors

The message CALIBRATION REJECTED displays when pre-insertion or in vivo calibration is not successful.

Take the following action as indicated:

• Check for secure catheter connection to the optical module. Reconnect the catheter if necessary.

• Check the status message on the monitor screen to verify sufficient, stable light intensity. If the INSUFFICIENT LIGHT message displays, refer to the previous section which describes steps to correct this condition.

• Allow the optical module to warm up for one more minute, then retry.

The message NOT CALIBRATED displays and an alert sounds (if alarms are ON) if you begin monitoring before you calibrate the system. The message disappears after you complete a successful calibration.

Correcting Optical Module Errors

The SvO2 module performs constant memory checks to ensure data is not lost or changed erroneously. When the OPTICAL MODULE MEMORY ERROR message displays, replace the optical module with a known good unit.

Expect the NO OPTICAL MODULE message whenever you disconnect the optical module from the SvO2 module because this suspends SvO2 monitoring.

If this message appears when the optical module is not disconnected, replace the module or contact a qualified service person.

Correcting SvO2 Display Error

If the oxygen saturation value is out of the display range, the display changes from a percentage to ???.

Take the following action as indicated:

• Verify proper function of the optical module; no error messages display. Replace with a known good module if necessary.

• Display light intensity history to verify proper catheter function (refer to Correcting Insufficient Light Intensity on page 20-14).

• Perform in vivo calibration.


SvO2

Ensuring Catheter Function

The catheter fiber optics are sensitive to damage. Avoid kinking, excessive manipulation, or grasping with forceps or a hemostat. Damage to the fiber optics reduces transmission of light to and from the blood which significantly compromises oxygen saturation accuracy.

Damage is indicated by one or more of the following:

• low intensity display

• intensity error message displays

• intensity alarms begin if alarms are ON

• oxygen saturating values are inaccurate


SvO2

SvO2 Troubleshooting Guide

Note:

Catheters should be handled according to your hospital’s protocol.


INTENSITY ALERT or SVO2 DATA OUT OF RANGE message is displayed

■ Faulty catheter position within vessel.

■ Check for spontaneous wedge or balloon inflation; if present reposition the catheter.

■ Clot over catheter tip. ■ Flush distal lumen.

■ Loose connections between catheter optical connector and optical module.

■ Tighten the connections.

■ Kinked or damaged fiber optics in catheter.

■ Replace the catheter.

INSUFFICIENT LIGHT message is displayed

■ Catheter exposed to room light during pre-insertion calibration.

■ No action required; status message only.

■ Catheter is kinked. ■ Check the catheter.

■ Faulty connection between catheter and optical module.

■ Fully insert the tip into the optical reference.

CALIBRATION REJECTED message is displayed

■ Faulty connection between catheter and optical module.

■ Reconnect.

■ Optical module not warmed up. ■ Wait one minute and retry.

??? is displayed in place of SvO2 value

■ Value out of range. ■ If optical module error message also is displayed, replace optical module.

■ Poor light intensity. ■ Display light intensity history to verify.

■ Pre-insertion calibration insufficient.

■ Perform in vivo calibration.


Capnography

Directory of Keys


GAS - CAL MENU - O2 CAL

LIMITSALARM FREEZE

ON OFFSETUP CALVIEW

ALARMS PRINT

ROOM O2SPAN

100% O2 SPANZERO

TONESIZESWEEPSPEED

PERCENT

mmHg (kPa)

LARGE TXT

SMALL TXT

RESP TONE

ON OFFVOLUMEVOLUME

25mm/sec

12.5mm/sec

6.25mm/sec

3.12mm/sec

1.56mm/sec

WAVEFORM

ON OFF0-80 0-60 0-40

APNEA RR ETCO2 O2 MINCO2

APNEAON OFF

APNEA =OFF

APNEA

RR

APNEA

RRHI =OFF

LO =OFF

RR

ON OFF

GAS

GAS - ALARM LIMITS MENU - APNEA

GAS - ALARM LIMITS MENU - RR

GAS - ALARM LIMITS MENU

GAS - MAIN MENU

GAS - SETUP MENU

GAS - SETUP MENU - RESP TONE

GAS - SETUP MENU - SWEEP SPEED

GAS - SETUP MENU - SIZE

COMP

GAS - COMP

N2O

ON OFF

O2

AUTO MAN

O2

ON OFF

GAS - CAL MENU

O2CAL

CO2CHECK

GAS - CAL MENU - CO2 CHECK

CO2 = XX.X

NEXTREADING

BarPres = XXX

ADAPTERCAL

CANCELSTART

RESP

mmHg mmHg mmHg

RESTORESETTINGS

YES NO

GAS - CAL MENU - ADAPTER CAL

CAPNO

O2 ONLY

0-5.3 kPa0-10.7 kPa 0-8.0 kPa

HIDDENKEY


Capnography

Contents

Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Patient Connection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Setting Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Adjusting the Waveform Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Turning the Waveform Display On/Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Selecting a Unit of Measure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Selecting a Sweep Speed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Respiration Tone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Selecting a Text Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Freezing the Waveform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Recording Waveforms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Calibrating the Sensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Selecting Gas Compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Restoring Default Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Capnography Troubleshooting Guide. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Overview

The 90516 Ultraview Capnograph module is a mainstream gas analyzer, designed to measure the concentration of carbon dioxide in a gas mixture to aid in determining the patient’s ventilatory, circulatory, and metabolic status. The capnograph module has a small, lightweight sensor that continuously measures the end-tidal and minimum CO2 levels in the patient’s airway. Respiration can be monitored via airway and endotracheal or tracheostomy tubes. Both adults and neonates can be monitored with this type of capnograph (using separate adult and neonatal airway adapters).

The sensor head contains a small infrared transducer that accurately measures the CO2 in the airway. The sensor is connected to the airway by an airway adapter. These adapters may either be disposable or reusable and are available in adult and neonatal sizes.

The capnograph automatically compensates for the ambient barometric pressure to ensure accurate readings. A connector is included to allow measurement of O2 in the airway using a fuel cell type O2 sensor. A full calibration menu is provided to easily calibrate and use the O2 sensor. A separate adapter is used for O2 monitoring.

Caution:• Although the 90516 capnograph module detects and reports apnea conditions, it is not intended

to be a primary diagnostic apnea monitor and/or apnea recording device.

• Use only Spacelabs Healthcare sensors with this monitor. Other sensors may plug in, but will not operate.

• Use only Spacelabs Healthcare airway adapters with Spacelabs Healthcare sensors. The monitor may not function if other airway adapters are used, and sensor damage may result.


Capnography

• If the patient’s airway is configured with a closed suctioning system, make sure the airway adapter is placed close to the suctioning system (on the ventilator side). This will help ensure that the sampling adapter is not impaired during and after suctioning.

• U.S. Federal law restricts this device to sale by or on the order of a physician.

Note:

• Model 90516-xM does not include O2 capability.

• If your module is equipped with the Module Configuration Manager feature, you can define your own default settings for such characteristics as alarm limits and display configuration. Refer to Module Configuration Manager on page 7-5 for further details.

Patient Connection

Respiration can be monitored via an endotracheal or tracheostomy tube.

Mainstream capnography is a highly accurate method of measuring respiratory gas values. There are several variations of closed circuit tracheal suction systems that can be used with Spacelabs Healthcare capnography units. Spacelabs Healthcare recommends the Ballard style tracheal suction system.

Closed Circuit Tracheal Suction Systems

Closed circuit tracheal suction systems (such as those provided by Ballard) extend the life of the endotracheal tube and associated tubing by allowing the endotracheal tube to be periodically suctioned without detaching it from the ventilator circuit. Spacelabs Healthcare recommends use of Ballard Model #221 elbow closed tracheal suction systems, or similar systems, with Spacelabs Healthcare capnography units. Such a system allows the Spacelabs Healthcare airway adapter to be placed outside the tube through which fluids are being suctioned, reducing the chance of occluding the airway.

To start capnography monitoring:

• Plug the module into the monitor.• Plug the sensor connector into the monitor.• Perform sensor calibration, if necessary.• Prepare the patient according to hospital procedures.• Select appropriate airway adapter (neonate or adult).• Verify that windows are clean and dry.• Place sensor head over the airway adapter and perform an adapter calibration, if

necessary.• Remove the airway adapter from the sensor head.• Insert the airway adapter into the ventilator circuit and Ballard style tracheal suction

system (if present) as shown in Figure 21-1.• Attach the sensor head to airway adapter.• Ensure that the sensor head is always positioned above the ventilator circuit so that

moisture will not enter the adapter.


Capnography

Spacelabs Healthcare does not recommend use of traditional setups that require the airway adapter to be in line with the endotracheal tube. However, if you prefer a traditional setup such as the Ballard Model 2205 style, using the Ballard Model 112 adapter moves the airway adapter away from the suction catheter.

Figure 21-1 shows examples of setups using the Ballard Model #221 and Model 2205 style (with Model 112 adapter). Similar closed systems, such as the Concord Portex (not shown), must be placed in the ventilator circuit in the same positions as shown in Figure 21-1.

Figure 21-1: Ballard setups

When you first power on the module, the GAS parameter key is displayed adjacent to a flat waveform.

Note:

• Capnography is not analyzed during unit warm-up.

• The typical initial warm-up period is two to five minutes (five minutes is the maximum warm-up time). This time varies based upon the temperature of the sensor.

• The capnograph is protected against the effects of a cardiac defibrillation discharge and is safe to use on patients with a cardiac pacemaker or other electrical stimulation.

• The airway adapter may require regular cleaning or replacement if the capnograph is used on patients that emit excessive mucous.

suction catheterBallard Adapter #112

ventilator circuit

mainstream airway

endotracheal tube

Ballard closed tracheal suction system

endotracheal tube

ventilator circuit

suction catheter

with adapter (Model 2205/Adapter #112)Ballard elbow closed tracheal suction system (Model 221)-OR-

adapter adapter mainstream airway

sensor headsensor head


Capnography

Display Detail

When you connect the capnography device to a monitor, the waveform area is displayed in one of four formats, the large and small text formats in normal or view alarms modes. Instructions for choosing a format are detailed later in this manual.

The full screen, large text format is the default display for bedside monitors. The full screen, small text format in VIEW ALARMS is the only display format for the full screen remote view monitors. The split screen central format is available only for central monitors operating in split screen mode. Refer to Figure 21-2 through Figure 21-6.

Figure 21-2: Bedside screen in small text (waveform ON)

Figure 21-3: Bedside screen in large text (waveform OFF)

Figure 21-4: Bedside screen in large text during View Alarms (waveform OFF)

�

� �

�

�

ETCO2= 30 mmHg

MINCO2= 0 mmHgO2= 20%

RR= 6 BPM

�

GAS

� � � �

�

�

O2 COMP ONN2O COMP ON 6

RR

BPMMINCO2

mmHg0GAS

30ETCO2

mmHgO2

%20

� � �

�

�

�

O2 COMP ONN2O COMP ON

ETCO2

O2

450

8015

APNEA 3030

15

RR

MINCO2

30ETCO2

mmHgO2

%20GAS


Capnography

Figure 21-5: Full remote view (waveform OFF)

Figure 21-6: Split screen

� GAS key

� End tidal carbon dioxide data

� Oxygen data (if O2 monitoring capability is included)

� Alarms ON bell (refer to Table 1)

� Minimum inspired carbon dioxide data

� Respiratory rate

Table 1: Alarm Status and Display

Alarm Status Bell Display

At least one alarm ON Present

At least one alarm ON and violated

Flashing

All alarms OFF Replaced with GAS ALM OFF in reverse video

At least one alarm ON; alarms temporarily suspended by monitor

Replaced with GAS ALM SUSP in reverse video (flashes if any alarm is violated)

�

� �

�

�

�

O2 COMP ONN2O COMP ON

ETCO2

O2

450

8015

APNEA 303015

RR

MINCO2

ETCO2= 40 mmHg

MINCO2= 2 mmHgO2= 18%

RR= 12 BPM

GAS

�

� � �

�

ETCO2 = 3.2MINCO2= 0.5

O2= 21RR= 23

Numeric key

ETCO2= 40 mmHg

APNEA= 30 sO2= 18%

RR= 12 BPMMINCO2= 32 mmHg

GAS


Capnography


You can set high and low alarm limits for respiratory rate (RR), EtCO2, O2, minimum CO2 (high limit only), and the apnea alarm delay time.

When alarm limits for EtCO2 and RR are initially enabled, the limit values depend upon the patient’s current readings for those parameters (these limit values are learned). Alarm limits for all other monitored parameters, when enabled; always have the same fixed values.

You can modify limits for any of the monitored parameters. Factory-set default values appear for alarm limits when you initially power up the unit. Factory default settings and ranges for alarm limits are shown on the table below. Refer to Alarms on page 2-3 for additional information on alarms.

Note:

The VIEW ALARMS format with small text selected is the default display for all full screen remote. In this format, all text is cleared from the waveform zone and the labels and alarm limits of respiratory rate, EtCO2, O2, minimum CO2, and apnea are displayed. The View Alarms screen is the only format that displays the alarm limits.

To set gas alarm limits:

1 Touch GAS.

2 Touch ALARM LIMITS.

3 Select the parameter for which you wish to set alarm limits.

4 Touch ON for the parameter selected in step 3.

5 Select the HI=, LO=, or APNEA= alarm.

6 Use the arrow keys to set the high and/or low alarm limits or the apnea alarm delay time.

7 Touch PREVIOUS MENU to select another parameter for setting alarm limits.

8 Repeat steps 3 through 7 until all limits are set.

Table 2: Alarm Limit Ranges

Monitored Parameter Units

Low Alarm High Alarm

ResolutionMinimum Default Maximum Minimum Default Maximum

EtCO2 % 0.0 ** 9.9 * 0.1 ** 10.0 * 0.1

EtCO2 mmHg 0 ** 75 1 ** 76 1

EtCO2 kPa 0.0 ** 9.9 0.1 ** 10.0 0.1


Capnography

* The current barometric pressure measurement affects the maximum high and low alarm limits for EtCO2 when measured in %.

** Learned Alarm Limits.

The respiration rate alarm limits default as shown below:

Condition Limit

RR 12 LO = 1 BPM

RR >12 LO = RR* 0.5 (truncated to the next lower resolution)

RR 20 HI = 30 BPM

RR >20 HI = RR* 1.5 (rounded to the next higher resolution)

The EtCO2 high alarm limit defaults to the displayed value +15% and is rounded to the next higher resolution, when needed.

The EtCO2 low alarm limit defaults to the displayed value -15% and is truncated to the next lower resolution, when needed.

Note:

If the current EtCO2 reading is 0 when the alarms are first turned ON, special EtCO2 limits are defined. If mmHg is selected, the high and low limits are set to 0 and 1, respectively. If % or kPa is selected, the high and low limits are set to 0.0 and 0.1, respectively.

RR BPM 1 ** 145 15 ** 1501 for 1 to 30

5 for >30

APNEA sec - - - 20 30 45 5

MINCO2 % - - - 0.1 1.0 9.9 0.1

MINCO2 mmHg - - - 1 8 76 1

MINCO2 kPa - - - 0.1 1.0 9.9 0.1

O2 % 15 18 95 20 100 1001 for 1 to 30

5 for >30

Table 2: Alarm Limit Ranges (continued)

Monitored Parameter Units

Low Alarm High Alarm



Capnography

Adjusting the Waveform Size

The capnography waveform can appear on your monitor in three scale sizes: 0 to 40 mmHg (0 to 5.3 kPa), 0 to 60 mmHg (0 to 8.0 kPa), or 0 to 80 mmHg (0 to 10.7 kPa).

Turning the Waveform Display On/Off

You can turn the capnography waveform ON or OFF.

Selecting a Unit of Measure

You can monitor capnography values as a percentage or with the monitor’s selected units of measurement for pressures (mmHg or kPa).

To adjust the waveform scale size:

• Touch GAS.• Touch SETUP.• Touch SIZE.• Select the desired scale.

To turn the waveform display ON or OFF:

• Touch GAS.• Touch SETUP.• Touch SIZE.• Select WAVEFORM ON or OFF.

To select a measurement unit:

• Touch GAS.• Touch SETUP.• Select PERCENT or mmHg (kPa).


Capnography

Selecting a Sweep Speed

You can view capnography waveforms at any of the following sweep speeds: 25, 12.5, 6.25, 3.12, or 1.56 mm/second.

Respiration Tone

You can turn the respiration cycle tone ON or OFF, and adjust the volume of the respiration cycle tone that sounds at the peak of the respiration cycle.

To select a sweep speed:

• Touch GAS.• Touch SETUP.• Touch SWEEP SPEED.• Select desired sweep speed.

To turn tone OFF:

• Touch GAS.• Touch SETUP.• Touch RESP TONE.• Select RESP TONE OFF.

To adjust the tone volume:

• Touch GAS.• Touch SETUP.• Touch RESP TONE.• Select RESP TONE ON.• Use arrow keys to adjust the volume.


Capnography

Selecting a Text Format

You can change display formats for capnography by switching between large and small text (refer to Display Detail on page 21-6).

Freezing the Waveform

You can freeze the waveform display at any time. The waveform stays frozen until you press the FREEZE ON/OFF key again or until you press the NORMAL SCREEN key.

Recording Waveforms

You can print Capnography waveforms and values. Refer to Printing on page 4-5 for additional information.

To switch text formats:

• Touch GAS.• Touch SETUP.• Select LARGE TXT or SMALL TXT.

To freeze the gas waveform:

• Touch GAS.• Select FREEZE ON.

To print gas waveforms:

• Touch RECORD.• Touch flashing GAS parameter key.


Capnography

Calibrating the Sensors

Calibrating O2 (If Present)

A ZERO calibration establishes baseline values for the oxygen channel. You are prompted to perform a ZERO calibration if it is required.

Note:

To minimize patient disruptions, perform O2 zero and span procedures before the O2 adapter is placed in the ventilator circuit.

A room O2 span calibration calibrates the oxygen sensor using room air.

A 100% O2 span calibration sets the level for oxygen so that the display reads 100% when pure oxygen is input to the unit. For improved accuracy, a 100% O2 span calibration should be performed whenever the patient is receiving more than 60% O2.

Note:

Authorized service personnel also use the 100% O2 span calibration to calibrate the oxygen sensor’s response to 100% O2.

To calibrate O2 using room air:

• Touch GAS.• Touch CAL.• Touch O2CAL.• Disconnect O2 cell and touch ZERO.• Reconnect O2 cell.• Ensure that O2 cell is in room air.• Wait for the O2 reading to stabilize.• Touch ROOM O2 SPAN.

To calibrate O2 by performing a 100% O2 span:

• Touch GAS.• Touch CAL.• Touch O2 CAL.• Flow 100% O2 through the O2 airway adapter and wait for O2 readings to stabilize.• Touch 100% O2 SPAN.


Capnography

Calibrating the Airway Adapter

Adapter calibration compensates for the optical differences between the adult and neonatal airway adapters. Adapter calibration needs to be performed each time you switch from an adult airway adapter to a neonatal airway adapter.

Note:

During calibration, keep the sensor and airway adapter away from all sources of CO2 (including the patient’s and your own exhaled breath, and ventilator exhaust valves).

Calibrating the CO2 Sensor

The CO2 sensor does not require calibration at each power up. Calibration is only necessary the first time the sensor is connected, or when a CAL REQUIRED message is displayed.

Once calibrated, the sensor can be unplugged and reconnected without being recalibrated. However, a sensor calibration is required whenever the CO2 sensor is changed.

Note:

To maintain optimum performance of the sensor and capnograph, you should perform a calibration verification of the sensor at least once a week.

To calibrate the airway adapter:

• Touch GAS.• Touch CAL.• Select appropriate airway adapter (neonate or adult).• Place sensor head over the airway adapter.• Place the sensor and adapter away from all sources of CO2.• Touch ADAPTER CAL.• Touch START.


Capnography

Selecting Gas Compensation

The measurement of CO2 by infrared analysis is affected by the presence of oxygen and nitrous oxide. The module must be set up with the appropriate compensations turned on in order to obtain accurate end-tidal CO2 readings when increased levels of O2 (greater than 60%), or N2O (greater than 50%) are present in the airway.

Note:

• High concentrations of O2 will cause a lower than expected CO2 reading.

• High N2O level will cause a higher than expected CO2 reading.

To calibrate the CO2 sensor:

• Remove the airway adapter from the sensor head (if present).• Place the sensor on the zero cell.• When the message ZERO CAL COMPLETE appears, remove the sensor from the zero

cell and place it on the reference cell.• When the message CALIBRATION VERIFIED appears, remove the sensor from the

reference cell. (An airway adapter calibration may be required.)• Sensor is ready for use.

To verify the sensor calibration:

• Remove the airway adapter from the sensor head (if present).• Place the sensor on the reference cell.• When the message CALIBRATION VERIFIED appears, remove the sensor from the

reference cell. (An airway adapter calibration may be required.)• Sensor is ready for use.

To select gas compensation:

• Touch GAS.• Touch COMP.• Select N2O ON, if N2O is greater than 50%.• Touch O2 AUTO to automatically select COMP, if O2 cell is present.• Select O2 MAN, if no O2 cell is present.• Select O2 ON, if O2 is greater than 60%.


Capnography

Restoring Default Settings

With the Module Configuration Manager feature, you can restore all default settings. User-configurable options are listed in Setting User-Defined Default Values on page 7-7.

To restore default settings:

• Touch GAS.• Touch SETUP.• Touch RESTORE SETTINGS.• Select YES.


Capnography

Capnography Troubleshooting Guide

The capnography module displays error messages in the gas waveform zone. Many of these messages also trigger an alarm. If the menu line is available, the monitor displays messages there as well. The table below provides the text, meaning and suggested response to these messages.

Problem or Message Probable Cause(s) Suggested ResponseAlarm

Sounds

SERVICE REQUIRED - Send for repair

■ Incompatible or faulty sensor.

■ Barometric pressure reading error.

■ Module self-test failure.

■ Return to factory for repair or use compatible sensor.

■ Yes

SENSOR OVER TEMPERATURE

■ Sensor is exposed to extreme heat.

■ Remove the excessive heat source from the sensor. If problem persists, return to factory for repairs.

■ Yes

WARMING UP ■ Module or sensor was just plugged in.

■ Allow 2 to 5 minutes to warm up.

■ No

PLACE ADAPTER IN RM AIR

■ The adapter calibration menu is accessed.

■ Either place the sensor head and the airway adapter in room air and start an airway adapter calibration, or leave the adapter calibration menu.

■ No

ADAPTER CAL IN PROGRESS

■ An airway adapter calibration sequence is in progress.

■ Wait until adapter calibration is completed and message goes away.

■ No

ADAPTER CAL ERROR -Perform adapter calibration

■ An error was found during the airway adapter calibration.

■ Place the sensor head and the airway adapter in room air and away from any source of CO2 and perform an airway adapter calibration. If the problem persists, return to factory for repairs.

■ Yes


Capnography

NOT CALIBRATED -Place adapter in room air

■ An airway adapter calibration was started, but either the sensor was not ready, or the sensor was on the zero or reference cell, or some CO2 or a breath has been detected in the last 20 seconds.

■ Place the sensor head and the airway adapter in room air and away from any source of CO2 and perform an airway adapter calibration. If problem persists, return to factory for repairs.

■ Yes

ADAPTER ERROR -Check airway adapter

■ Airway adapter was removed from the sensor head.

■ Snap airway adapter back into the sensor head.

■ Yes

■ Optical blockage on airway adapter windows.

■ Clean or replace the airway adapter.

■ Yes

■ Adapter calibration was not performed.

■ Perform an airway adapter calibration.

■ Yes

CO2 CAL IN PROGRESS ■ A zero calibration of the CO2 sensor is in progress.

■ Wait for the message ZERO CAL COMPLETE to appear.

■ No

ZERO CAL COMPLETE -Place sensor on REF cell

■ A zero calibration of the CO2 sensor was completed successfully.

■ Remove the sensor head from the zero cell and place it over the reference cell.

■ No

CO2 ZERO CAL ERROR -Perform zero calibration

■ An error was found during the sensor zero calibration.

■ Perform a zero and a reference calibration. If the problem persists, return sensor to factory for repairs.

■ Yes

SENSOR ERROR -CO2 zero cal required

■ A drift of the source current is detected since the last time that the sensor was either plugged in or zeroed.

■ Perform a zero and a reference calibration. If the problem persists, return sensor to factory for repairs.

■ Yes


Sounds


Capnography

CHECKING CALIBRATION

■ A span or reference calibration of the CO2 sensor is in progress.

■ Wait for the CALIBRATION VERIFIED message to appear.

■ No

CALIBRATION VERIFIED -Remove sensor from cell

■ A reference calibration of the CO2 sensor was completed successfully.

■ Remove the sensor head from the reference cell and place it over the airway adapter.

■ No

Note:

The unit does not analyze patient data while the monitor displays the above messages.

Low or high CO2 values are observed

■ An airway adapter and/or sensor calibration is needed.

■ Perform a zero and a reference calibration, make sure an appropriate airway adapter is selected, and perform an airway adapter calibration. If problem persists, return to factory for repairs.

■ No

ADAPTER CALIBRATION ABORTED

■ The airway adapter calibration was aborted by the user.

■ Wait for the message to go away.

■ No

O2 ZERO COMPLETE ■ The zero calibration of the O2 sensor was completed successfully.


■ No

O2 ZERO REJECTED Zero value too high

■ O2 cell was connected during zero.

■ Disconnect O2 cell and repeat the O2 zero.

■ No

21% O2 SPAN COMPLETE ■ The span calibration of the O2 sensor in room air was completed successfully.


■ No


Sounds


Capnography

O2 SPAN REJECTED -Span value out of range

■ O2 cell was not functioning during the room O2 span.

■ Replace O2 cell perform room O2 span. If problem persists, return to factory for repairs.

■ No

■ O2 cell was not in room air. ■ Place the O2 sensor in room air and away from any source of higher level oxygen and perform room O2 span. If problem persists, return to factory for repairs.

■ No

100% O2 SPAN COMPLETE

■ The span calibration of the O2 sensor using 100% oxygen was completed successfully.


■ No

100% O2 SPAN FAILED -O2 cell bad or 100% O2 not present

■ O2 cell is wearing out. ■ Replace O2 cell and perform 100% O2 span. If problem persists, return to factory for repairs.

■ No

■ 100% oxygen was not present in the O2 sensor airway adapter.

■ Make sure 100% O2 is present in the O2 sensor airway adapter and perform 100% O2 span. If problem persists, return to factory for repairs.

■ No

O2 SPAN REQUIRED -Perform a ROOM O2 SPAN

■ O2 cell requires new span when initially plugged in.

■ Place the sensor in room air and away from any source of oxygen and perform room O2 span. If problem persists, return to factory for repairs.

■ No

■ A drift in the O2 cell output voltage level was detected.

■ Place the sensor in room air and away from any source of oxygen and perform room O2 span. If problem persists, return to factory for repairs.

■ No


Sounds


Multigas

Directory of Keys


GAS - CAL MENU

LIMITSALARM FREEZE

ON OFFSETUP CALVIEW

ALARMS PRINT

CHECK O2SENSOR

BAR. PRESS.

SIZESWEEPSPEED

LARGE TEXT

SMALL TEXT

25mm/sec

12.5mm/sec

6.25mm/sec

3.12mm/sec

1.56mm/sec

WAVEFORM

ON OFF0-80 mmHg 0-60 mmHg 0-40 mmHg

APNEA RR ETCO2 I CO2 FiO2 I N2O I AGNT

APNEA

ON OFFHI =OFF

APNEA

RR

APNEA

RRHI =OFF

LO =OFF

RR

ON OFF

GAS

GAS - ALARM LIMITS MENU - APNEA

GAS - ALARM LIMITS MENU - RR

GAS - ALARM LIMITS MENU

GAS - MAIN MENU

GAS - SETUP MENU

GAS - SETUP MENU - SWEEP SPEED

GAS - SETUP MENU - SIZE

0-5.0 kPa

SUSPENDSAMPLING

PUMPSPEED

50ml/min

100ml/min

150ml/min

75ml/min

125ml/min

175ml/min

200ml/min

XXX mmHg

E N2O

GAS - SETUP MENU - PUMP SPEED

PERCENTmmHg (kPa)

E AGNT

AGENTSELECT

HAL ENF ISO SEV

GAS - SELECT AGENT MENU - AGENT TYPE DETECTED: XXX

DES ID

AUTO

0-10.0 kPa

FeO2

0-7.5 kPa

100% O2SPAN

SERVICECAL MODE

See yourSystem Administratorfor access to this key


Multigas

Contents

Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Warnings and Cautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Analyzer Controls and Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Multigas Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Patient Connection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Replacing the Water Trap. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Replacing the Gas Analyzer Filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Setting Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Waveform Display. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Selecting a Text Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Selecting a Unit of Measure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Selecting an Agent ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Selecting Stand By Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Selecting a Pump Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Initiating a Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Suspending Sampling. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Multigas Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Overview

The Spacelabs Healthcare Multigas Analyzer simultaneously monitors gas concentrations and alerts clinical personnel when the concentration of anesthetic agents, oxygen, carbon dioxide, or nitrous oxide falls outside of defined limits. The anesthetic agent being administered is automatically identified.

The analyzer is for use primarily in the operating room, but can be used with any Ultraview monitor.

Although the analyzer sounds an alarm when the duration between monitored breaths exceeds user-defined limits, it is not intended to be a primary diagnostic apnea monitor and/or recording device.


Multigas

Warnings and Cautions

Warnings

The life or health of a patient, clinical staff member, multigas analyzer operator, or other persons may be endangered if the items in this Warnings section are not followed.

Warning:• Always test the sampling line adapter for a tight connection and proper operation before

attaching to a patient.

• To protect the patient’s safety, do not silence, suspend, or disable audible alarms without providing continuous, direct observation of the patient.

• Connect the sample gas outlet on the monitor’s rear panel to the scavenging system to prevent pollution of the room air.

• Always turn the power off and unplug the analyzer before cleaning to protect against electrical shock.

• To avoid explosion hazards, flammable anesthetic agents such as ether and cyclopropane must not be used in the analyzer.

• Only halothane (HAL), enflurane (ENF), isoflurane (ISO), sevoflurane (SEV), and desflurane (DES) are suitable for use with the analyzer. If any other halogenated anesthetic agent is present, it will be misidentified and/or will interfere with the reported anesthetic agent concentrations.

• The use of antistatic or electrically conductive breathing tubes when using high-frequency electrosurgery equipment may increase the risk of burns and is, therefore, not recommended in any application of this anesthetic monitor.

• The analyzer is not intended for use in an MRI environment.


Multigas

Cautions

Equipment may be damaged or cease to function properly if the items in this Cautions section are not followed.

Caution:• When administering anesthetic agents, incorrect agent identification may occur when a mixture

of two or more anesthetic agents occurs in the sample circuit.

• Always verify your vaporizer setting when administering anesthetic agents.

• Use only original Spacelabs Healthcare sampling lines and accessories; other sampling lines may cause inaccurate readings and malfunctions.

• The diameter of the scavenging system line must be two to three times larger than the sample line tubing to avoid changes in the operating pressure of the monitor, and consequential inaccurate readings or internal damage.

• Route the scavenger hose so that it does not kink during operation of the monitor. A kinked or partially kinked scavenger hose can impair performance of the monitor.

• If the patient’s airway is configured with a closed suctioning system, the airway adapter must be placed near the suctioning system (on the ventilator side). This helps to ensure that the sampling adapter is not impaired during and after suctioning.

• Do not use cellular phones or other wireless communications equipment near the analyzer.

Note:

• Check the disposable water trap regularly during monitoring. Replace the water trap when full.

• Between patients, replace the sampling line and check the disposable water trap. Replace the water trap when full.

• The Spacelabs Healthcare sampling lines are for single-patient use only. Cleaning deteriorates the properties of the sampling line, resulting in slower response time and more frequent occlusions.

• Before you administer nebulized drugs to a patient who is connected to the multigas analyzer, you must disconnect the sample line from the patient or stop the pump by using the SUSPEND SAMPLING key.

• To facilitate disconnecting and reconnecting the sample line, use a T-connector in the patient airway circuit and keep the sampling suspended, until all nebulized drugs have cleared from the patient’s airway.


Multigas

Analyzer Controls and Indicators

Figure 22-1: Analyzer front panel controls and indicators

Figure 22-2: Analyzer rear panel controls and indicators

POWER ON

OCCLUSION

WATER TRAP FULL

STAND BY

Gas analyzer filter

Water trap

Stand by switch

Sample line

access door

Product Orientation Up

SDLC connector

Fuse block

Power switch

Scavenger port

AC power input receptacle Fan grill

!

!

SDLC J2

J3

J4

MAINS

USE SPECIFIED FUSES

50/60 Hz1A/100-240V~

T1.0A/250V

Pb

CAUTION


Multigas

Multigas Setup

Before you put the unit into service, it must be unpacked and the exterior inspected for visible damage. A biomedical technician or an authorized Spacelabs Healthcare field service engineer should inspect the interior and exterior of the analyzer for signs of visible damage. Instructions for these procedures are in the 90518 Multigas Analyzer Service Manual (P/N 070-0643-xx).

Figure 22-3: Monitor connection

Caution:• The diameter of the scavenging system line must be two to three times larger than the sample-

out tubing to avoid changes in the operating pressure of the monitor, and consequential inaccurate readings or internal damage.

• Route the scavenger hose so that it does not kink during operation of the monitor. A kinked or partially kinked scavenger hose can impair performance of the monitor.

To connect the multigas analyzer:

• Verify that the power cord is connected as required by local standards.• Assemble the cables necessary for the desired configuration. (Refer to 90518 Multigas

Analyzer Service Manual, P/N 070-0643-xx.)• Connect the T-cable assembly between the multigas analyzer and the monitor.• Connect the SDLC terminator to the T-cable.• Connect the hospital scavenging system to the scavenger port.

Multigas Analyzer

SDLC terminator

SDLCconnector

. . . .. . . . .

T cable

included with the analyzer

Monitor

Scavengerport


Multigas

Patient Connection

Respiration can be monitored via a nasal cannula, an oxygen mask, or an airway and endotracheal or tracheostomy tube. There are several variations of closed circuit tracheal suction systems that can be used with Spacelabs Healthcare multigas units.

Figure 22-4: Example of sidestream multigas setup for an adult

The sample line must be connected to the disposable water trap and patient circuit. Connect the line to the water trap prior to the insertion of the water trap onto the analyzer to protect the sample port.

Caution:• If the multigas analyzer is powered on before the patient monitor, communication might not be

initiated. Make sure the patient monitor is powered on first.

• Use only original Spacelabs Healthcare sampling lines and accessories. Other sampling lines may cause inaccurate readings and malfunctions. The analyzer must use a sample line that is fabricated from a special material. Use of other sample lines results in erroneous readings. This sample line is color-coded as blue and is available from Spacelabs Healthcare.

• If you use the multigas analyzer with setups that do not include the Spacelabs Healthcare approved gas analyzer filters, and service inspection determines that patient fluids have contaminated the unit, your warranty will be nullified.

Note:

Use the filtered gas sampling tee when you operate the analyzer on patients that emit excessive mucous. This prevents patient fluids from clogging the sample line.

Prior to connecting to the patient airway, verify that there are no leaks in the sample line, water trap, and gas analyzer filter by sealing the end of the sample line with your thumb. After approximately 15 seconds, the Occlusion LED lights and an occlusion message appears on the monitor. If this does not occur within 30 seconds, check for an air leak by removing and carefully reinstalling the water trap, the gas analyzer filter, and/or the sample line. Repeat the test.

ventilator circuit

endotracheal tube

gas sampling tee

elbow


Multigas

Warning:Always test the sampling line adapter for a tight connection and proper operation before attaching to a patient.

Closed Circuit Tracheal Suction Systems

Closed circuit tracheal suction systems (such as those provided by Ballard) extend the life of the endotracheal tube and associated tubing by allowing the endotracheal tube to be periodically suctioned without detaching it from the ventilator circuit. Spacelabs Healthcare recommends use of Ballard Model #221 elbow closed tracheal suction systems, or similar systems, with Spacelabs Healthcare capnography units. Such a system allows the Spacelabs Healthcare airway adapter to be placed outside the tube through which fluids are being suctioned, reducing the chance of occluding the airway.

Spacelabs Healthcare does not recommend use of traditional setups that require the airway adapter to be in line with the endotracheal tube. However, if you prefer a traditional setup such as the Ballard Model 2205 style, using the Ballard Model 112 adapter moves the airway adapter away from the suction catheter.

Figure 22-5 shows examples of setups using the Ballard Model #221 and Model 2205 style (with Model 112 adapter). Similar closed systems, such as the Concord Pre-tax (not shown), must be placed in the ventilator circuit in the same positions as shown in Figure 22-5.

To start multigas monitoring when the unit is OFF:

• Plug the device power cord into an AC power outlet and assure that the unit is connected to a monitor.

• If not present, insert the gas analyzer filter above the water trap and close the lid.• If not present, insert the water trap with the patient connector on the right side.• Check to make certain the Stand By switch is OFF (in the “out” position). • Turn power to patient monitor ON.• Turn power to gas analyzer ON (ON/OFF switch on back of unit).• Prepare the patient according to hospital procedures.• Allow the analyzer to warm up for a minimum of two minutes. Full accuracy is achieved

after 30 minutes.• Connect one end of the gas sample line to the gas sampling tee or breathing circuit and

connect the other end to the water trap luer connection.• Check for a good seal at the top of the water trap.• During the use of anesthetic agents, ensure that the scavenge line connects to the

scavenger port on the multigas analyzer's rear panel.


Multigas

Figure 22-5: Ballard setups

Operation

CO2, N2O, and anesthetic agents are measured by drawing a sample gas stream into the measuring chamber. The absorption of different infrared light wavelengths is measured here. These measurements are compared to a zero concentration light level to calculate the different gas concentrations.

Warning:If any halogenated anesthetic agent other than halothane, enflurane, isoflurane, sevoflurane, or desflurane is present, it will be misidentified and/or will interfere with the reported anesthetic agent concentrations.

Caution:• When administering anesthetic agents, incorrect agent identification may occur when a mixture

of two or more anesthetic agents occurs in the sample circuit.

• Always verify your anesthetic vaporizer setting when administering anesthetic agents.

Oxygen concentration is measured using the micro-fuel cell sensing technology. During the sensing process, the oxygen molecules in the sampled gas diffuse through the sensing membrane and become reduced at the sensing electrode, creating a current signal. The current signal is proportional to the oxygen partial pressure in the sampled gas. The fast response of the oxygen measurement is achieved by combining a unique design of the pneumatic sampling system, fast sensing membrane, and state-of-the-art signal processing electronics. Because this method of measurement has a fast response time, inspired and expired values of O2 can be reported. This method of O2 measurement requires periodic replacement of the sensor. The user must perform routine calibration checks to determine when replacement is needed. Refer to Initiating a Calibration on page 22-22 for further details.

suction catheterBallard Adapter #112

ventilator circuit

mainstream airway

endotracheal tube

Ballard closed tracheal suction system

endotracheal tube

ventilator circuit

suction catheter

with adapter (Model 2205/Adapter #112)Ballard elbow closed tracheal suction system (Model 221)

-OR-

adapter adapter mainstream airway

sensor headsensor head


Multigas

The analyzer uses a side-stream sampling technique to acquire respiratory gases from an endotracheal tube, nasal cannula, or mask. A constant-flow vacuum system maintains the flow rate through the sample line.

The analyzer is equipped with an external water trap to prevent humidity, water drops, and patient secretions from contaminating the unit or affecting the accuracy of the gas measurements. The water trap collects water drops that condense in the sample line. A “Water Trap Full” indicator warns you that the water trap should be replaced. The analyzer is also equipped with a filter as a second line of defense in case the water trap overflows or nebulized drugs are accidentally drawn into the sample line. After the gas sample passes through the water trap and filter, it passes through a Nafion tube that is inside the analyzer. This helps to equalize the humidity of the gas sample so that it is close to the humidity of ambient air.

Caution:• The analyzer cannot be operated without a water trap and a gas analyzer filter installed.

• Replace the water trap and gas analyzer filter as needed. Verify the water trap is not broken as a result of connecting the sample line fitting too tightly or by tugging on the sample line. To verify, place a finger over the end of the sample line and wait for the alarm. Check the sample line connection on the water trap for damage. A broken water trap results in low values due to room air entrainment. If a span calibration is performed with a broken water trap, patient values will be unusually high. Refer to Initiating a Calibration on page 22-22 and Replacing the Gas Analyzer Filter on page 22-12 for details.

Note:

• Check the disposable water trap regularly during monitoring. Replace the water trap when full.

• Between patients, replace the sampling line and check the disposable water trap. Replace the water trap when full.

The analyzer automatically compensates for the ambient barometric pressure to ensure accurate readings. Both CO2 values may appear in partial pressure (in mmHg or kPa) or in percent.

Note:

Respiration rate and alarm limit accuracies are not specified above 100 breaths per minute.

Powering ON the Unit

Before powering the multigas analyzer ON, make sure it is attached to a patient monitor and the Stand By switch on the gas analyzer is OFF (in the “out” position). Press POWER ON/OFF located on the rear panel of the analyzer. The patient monitor must be powered on prior to powering on the analyzer.

When you first power ON a properly installed multigas device, the green power-on LED lights within five seconds. Within 30 seconds the patient monitor displays the vertical GAS parameter key adjacent to a flat waveform.

% Gas =PARTIAL PRESSURE GAS

x 100%BAROMETRIC PRESSURE


Multigas

If this does not occur, verify that the POWER ON/OFF button is pressed and appears green, and that the front panel STAND BY button is not pressed. The analyzer must be connected to an AC power outlet. Verify that the appropriate SDLC cable and terminator are connected from the unit to the monitor (refer to the 90518 Multigas Analyzer Service Manual, P/N 070-0643-xx). If the monitor or the module housing has a SDLC switch, check that the switch is in correct position (refer to the operations manual for the monitor or module housing). If the GAS parameter key does not display on the monitor, turn the power to the analyzer OFF, then turn the power to the monitor OFF. Power ON the monitor again, and then power on the analyzer again.

Note:

The analyzer is protected against the effects of a cardiac defibrillation discharge, and it is safe to use on patients with a cardiac pacemaker or other electrical stimulation.

No multigas analyzer data appears during the warm-up period following power-ON. Data first appears during the stabilization period.

Caution:The warm-up period is less than two minutes with full accuracy after 30 minutes. You may use it prior to full warm up but be aware of possible inaccuracies in gas analysis.

Upon initiation of power, all factory-default settings will be re-established. Any modifications made to the default settings (alarm limits, text display, etc.) prior to cessation of power will be lost.

Replacing the Water Trap

The water trap must be disposed of when full. To remove the water trap, grasp the water trap firmly and pull it down from underneath, then lower it from the assembly.

To install a new water trap, grasp it from the bottom and insert it up and into the assembly.

Replacing the Gas Analyzer Filter

The gas analyzer filter must be disposed of when occluded. To remove the gas analyzer filter, lift the filter door, grasp the filter tab, lift up, and remove.

To install the filter, open the filter door, hold the filter by the tab (with the gasket down) and place it into the recess. Close the door after insertion.

Warning:The used water trap and gas analyzer filter may contain hazardous fluids and should be disposed of in accordance with hospital procedures.


Multigas

Display Detail

When you connect the multigas device to a monitor, the waveform area is displayed in one of four formats, the large and small text formats in normal or VIEW ALARMS modes. Instructions for choosing a format are detailed later in this manual.

The full screen, large text format is the default display for bedside monitors. The full screen, small text format in VIEW ALARMS is the only display format for the full screen remote view monitors. The split screen central format is available only for central monitors operating in split screen mode. (Refer to Figure 22-10).

Figure 22-6: Full screen, large text

Figure 22-7: Full screen, small text

Figure 22-8: Full screen, large text, with VIEW ALARMS

I N2O 6 2.5

1.7

21

17

0.520%

I AGNT

E AGNT

%

FeO2

%

FiO2

%

I CO2

%

��

��

RR

bpm GAS 5 E N2O

%

%

5.2 ETCO2

%

�

�

GAS

ETCO2=5.2%RR=20BPMFiO2=21%

I N2O=6%I AGNT=2.5%

��

�

��

��

GAS

ETCO2 7.52.5

2.0I CO2

APNEA

RRI N2O FiO2

FeO2 30

3010

15 4020

2515

I AGNT

E AGNT

4.50.0

3.00.0

5

�

E N2O 150

0.5 I CO2

%

�

5.2 ETCO2

%

�


Multigas

Figure 22-9: Full screen, small text, with VIEW ALARMS

Figure 22-10: Split screen, central with numeric key display

� Inspired nitrous oxide data

� Inspired agent

� Fractional inspired O2

� Respiration rate in breaths/minute

� Alarms ON bell (refer to <i Italic>Table 1<p Plain> on page 22-16)

� End tidal carbon dioxide data

� Gas screen key

Fractional expired O2

Expired agent

� Expired nitrous oxide data

Inspired carbon dioxide data

� Apnea alarm setting (the delay value)

� Bed ID and patient name (remote displays only)

GAS

ETCO2=5.2%RR=20BPMFiO2=21%

I N2O=6%I AGNT=2.5%

ETCO2 7.52.5

2.0I CO2

APNEA

RRI N2O FiO2

FeO2 30

3010

15 4020

2515

I AGNT

E AGNT

4.50.0

3.00.0

5

E N2O 150

�

� �

�

�

�

�

GAS

BED1 DANIELS, R

I CO2=0.5%RR=20BPMFiO2= 21%I AGNT=2.5%I N2O=6%

ETCO2=5.2% APNEA=30s FeO2=17% E AGNT=1.7% E N2O=5%

RR=20BPMFiO2= 21%I N2O=6%

ETCO2=5.2%

Numeric key display

�

�

��

�

�

�


Multigas

Agent Parameter Label View

When in AUTO ID mode, the inspired and expired agent labels are displayed in normal video, and in the MANUAL mode, the labels are displayed in reverse video.

In MANUAL mode, full-screen large text view, the mixed condition is reported by displaying MIX under the parameter label area next to the units of measure. In the full-screen small text view, the parameter labels alternate between the mix label and agent type label. In AUTO ID mode, the agent labels are replaced by “I MIX” and “E MIX”.

No Breath Mode View

Normal mode of operation is in effect as long as breathing is detected. Twenty seconds after the last breath is detected, the analyzer switches to “no breath mode” automatically and the EtCO2, Resp rate, expired agent, FeO2, and expired N2O numeric values are shown as ???. The momentary data is displayed in place of the inspired numeric values.


You may set alarm limits for the following:

• Apnea (delay is measured in seconds) - high limit

• RR (respiratory rate) - high and low limits

• EtCO2 — high and low limits

• I CO2 — high limit

• FiO2 — high and low limits

• FeO2 — high and low limits

• Inspired and Expired N2O — high and low limits

• Inspired and Expired Agent — high and low limits

When alarm limits for EtCO2 and RR are initially enabled, the limit values depend upon the patient’s current readings for those parameters (these limit values are learned). Alarm limits for all other monitored parameters, when enabled, always have the same fixed values.

Factory-set default values appear for alarm limits when you initially power up the multigas unit. You may modify limits for any of the monitored parameters. These modifications will remain in check until the unit is turned off or placed on Standby. Default settings and ranges for alarm limits are shown in <i Italic>Table 2<p Plain> on page 22-16. Refer to Alarms on page 2-3 for additional information on alarms.

The VIEW ALARMS display format is the default for all full screen remote and central monitors. In this format, all text is cleared from the waveform zone and ten sets of parameter labels and their alarm limits are displayed. This is the only mode that displays all alarm limits.


Multigas

To set gas alarm limits:

1 Touch GAS.

2 Touch ALARM LIMITS.

3 Select the parameter for which you wish to set alarm limits.

4 Touch ON for the parameter selected in step 3.

5 Use the arrow keys to set the high and low alarm limit or the apnea alarm delay time.

6 Touch PREVIOUS MENU to select another parameter for setting alarm limits.

7 Repeat steps 3 through 6 until all limits are set.

Table 1: Alarm Status and Display

Alarm Status Bell Display

At least one alarm ON Present

At least one alarm ON and violated Flashing

All alarms OFF Replaced with GAS ALM OFF in reverse video

At least one alarm ON; alarms temporarily suspended by monitor

Replaced with GAS ALM SUSP in reverse video (flashes if any alarm is violated)

Table 2: Alarm Limit Ranges

Monitored Parameter

UnitsLow Alarm High Alarm


EtCO2 % 0.0 ** 9.9* 0.1 ** 10.0* 0.1

EtCO2 mmHg 0 ** 79 1 ** 80 1

EtCO2 kPa 0.0 ** 9.9 0.1 ** 10.0 0.1

I N2O % 0 0 75 5 80 80 5

E N2O % 0 0 75 5 80 80 5

RR BPM 0 ** 170 15 ** 1751 for 1 to 30

5 for >30

APNEA sec — — — 20 30 45 5

I CO2 % — — — 0.1 1.0 9.9 0.1

I CO2 mmHg — — — 1 8 80 1


Multigas

* The current barometric pressure measurement affects the maximum high and low alarm limits for EtCO2 when measured in %.

** Learned Alarm Limits.

The respiration rate alarm limits default as shown below:

The EtCO2 high alarm limit defaults to the displayed value +15% and is rounded to the next higher resolution, when needed.

The EtCO2 low alarm limit defaults to the displayed value -15% and is truncated to the next lower resolution, when needed.

Note:

If the current EtCO2 reading is 0 when the alarms are first turned on, special EtCO2 limits are defined. If mmHg is selected, the high and low limits are set to 0 and 1, respectively. If % or kPa is selected, the high and low limits are set to 0.0 and 0.1, respectively.

I CO2 kPa — — — 0.1 1.0 9.9 0.1

O2 Inspired (FiO2)

— 18 18 95 20 100 1005 for >30

Otherwise 1

O2 Expired (FeO2)

— 15 18 95 20 100 1005 for >30

Otherwise 1

Inspired Agent HAL, ISO, ENF, DES, SEV

% 0.0 0.0 19.9 0.1 3.0 20 0.1

Expired Agent HAL, ISO, ENF, DES, SEV

% 0.0 0.0 19.9 0.1 3.0 20 0.1

Condition Limit

RR 12 LO = 1 BPM

RR >12 LO = RR × 0.5 (truncated to the next lower resolution)

RR 20 HI = 30 BPM

RR >20 HI = RR × 1.5 (rounded to the next higher resolution)

Table 2: Alarm Limit Ranges (continued)

Monitored Parameter

UnitsLow Alarm High Alarm



Multigas

Waveform Display


The CO2 waveform can appear on your monitor in any of three scale sizes: 0 to 80 mmHg, 0 to 60 mmHg or 0 to 40 mmHg (0 to 10.0 kPa, 0 to 7.5 kPa, or 0 to 5.0 kPa).

Turning the Waveform Display OFF

To reduce display clutter, the multigas waveform can be turned off while leaving the numerics visible. When the waveform is off, the size adjustment, sweep speed, and freeze keys are disabled.

Selecting a Sweep Speed

You can view this waveform at any of the following sweep speeds: 25, 12.5, 6.25, 3.12, or 1.56 mm/second.

To adjust the waveform scale size:

• Touch GAS.• Touch SETUP.• Touch SIZE.• Select the desired scale size.

To turn the waveform display OFF:

• Touch GAS.• Touch SETUP.• Touch SIZE.• Select WAVEFORM OFF.

To select a sweep speed:

• Touch GAS.• Touch SETUP.• Touch SWEEP SPEED.• Select desired sweep speed.


Multigas

Freezing the Waveform

You can freeze the gas waveform display at any time. The waveform stays frozen until you press the FREEZE ON/OFF key again or until you press the NORMAL SCREEN key. When the waveform is frozen, the SIZE key in the Setup menu is disabled.

Selecting a Text Format

You can change display formats for multigas by switching between large and small text (refer to Display Detail on page 22-13).

Small text allows clear visualization of the waveform. However, it is recommended that large text be used for routine monitoring.

Selecting a Unit of Measure

You can monitor CO2 values as a percentage (%), as millimeters of mercury (mmHg) or kilo Pascal (kPa). If you want to use % as the measurement, press the PERCENT/mmHg (kPa) key until PERCENT is highlighted. If you want to measure in mmHg (kPa), press the PERCENT/mmHg (kPa) key until mmHg (kPa) is highlighted.

To freeze the gas waveform:

• Touch GAS.• Select FREEZE ON.

To switch text formats:

• Touch GAS.• Touch SETUP. • Select LARGE TEXT or SMALL TEXT.

To select a measurement unit:

• Touch GAS.• Touch SETUP.• Select PERCENT or mmHg (kPa).


Multigas

Selecting an Agent ID

You can manually choose an agent type by touching the SELECT AGENT key in the Main menu which opens the agent selection sub-menu. The prompt line above the sub-menu identifies the detected agent: DES, SEV, ISO, HAL, ENF. MIX is displayed if more than one agent is detected, and NONE if the agent type is not identified.

Warning:In the event an agent is selected manually, but not administered, the analyzer will detect the difference and begin flashing the agent parameter label area and the detected agent’s key. This is to alert the clinician to possible errors.

Touching the AUTO ID key sets the analyzer to automatically use the agent type detected. The five agent keys are the manual agent selection keys. Selecting one of the agent keys forces the analyzer to use and report the concentration levels based upon coefficient factors of the manually selected agent.

Caution:If you see AGNT or MIX next to the numeric values on the display, wait until HAL, ISO, ENF, SEV, or DES only appear on the screen to indicate that the multigas analyzer recognizes the agent you are using. The displayed values are based on the coefficient factors of the last detected or selected agent type. If the last detected or selected agent is different than the agent you are using, you may receive inaccurate values. Confirm the agent type before you continue with patient treatment.

To select Auto Agent ID:

• Touch GAS.• Touch SELECT AGENT.• Touch AUTO ID.

To select Agent ID manually:

• Touch GAS.• Touch SELECT AGENT.• Select HAL, ENF, ISO, SEV, DES.


Multigas

Agent ID Conflict Detection

In AUTO ID mode, if non-zero concentration levels are reported for more than two minutes and the agent type is not detected, a conflict is declared and the AUTO ID key flashes.

In manual mode, when an agent type other than the selected agent type is detected, a conflict is declared and the key with the detected agent type flashes.

When a conflict is declared, the agent parameter areas flash on all screens also.

The conflict is confirmed and the flashing of the keys and agent parameter areas stops when either a selection is made in the Select Agent menu (a key is touched) or the Select Agent menu is exited.

Conflict detection is restarted if:

• the agent concentration level goes to zero for more than two minutes.

• an agent type is selected that is not the type currently selected and not the first agent type in conflict.

Selecting Stand By Mode

Stand By mode should be used for short durations only (for example, case turnover). The Stand By feature keeps the unit warmed up.

The Stand By mode is not to be used in place of the power on/off. If the unit is in Stand By mode and loses power (for example, if the unit is unplugged during moving), when power is re-initiated, the analyzer may not display on the patient monitor. It is best to use Stand By mode under supervision.

Press the front panel STAND BY button to initiate the Stand By mode. The pumps stop drawing sampled gases, the analyzer display disappears from the monitor screen, and the STAND BY light illuminates. Press STAND BY again to return the analyzer to its normal operating mode when multigas monitoring is needed again.

Caution:• If the unit is taken out of Stand By and the analyzer display does not appear on the patient

monitor, turn the unit off and then power on correctly.

• Do not initiate the Stand By mode while the patient monitor is powered OFF. The patient monitor may not recognize the Stand By mode once the monitor is eventually powered ON.

To start multigas monitoring from Stand By mode:

• Press STAND BY to deactivate the Stand By mode (switch is “out”).• If the disposable water trap and filter are not present, install them now.• When multigas monitoring is no longer needed, press STAND BY (switch is “in”) or turn

unit OFF (on back of unit). Do not disconnect power to the analyzer or the monitor.


Multigas

Selecting a Pump Speed

You may select any of the following volumes of sampled gases that are drawn for use in measuring gas values: 50, 75, 100, 125, 150, 175, or 200 ml/min, or you may suspend sampling (pumps OFF). The unit defaults to 175 ml/min whenever it is turned ON.

Initiating a Calibration

Warning:• The gas analyzer calibrations must be performed by qualified personnel.

• The calibration should occur when the unit is not actively monitoring a patient.

Daily O2 Sensor Test

The oxygen channel may drift slightly over time; therefore, an O2 sensor test should be performed daily. This test uses room air to check for aging of the oxygen sensor and may be performed at any time (except during the first four minutes of operation). This check does not require special equipment or additional gases.

If drift or aging of the sensor is detected, the 100% O2 SPAN REQUIRED message will be displayed and a 100% O2 span must then be performed to calibrate the O2 sensor for high concentration levels (>60%) of oxygen.

To select a pump speed:

• Touch GAS.• Touch SETUP.• Touch PUMP SPEED.• Select desired pump speed.


Multigas

Further action is needed if an O2 SPAN FAILURE message or an O2 SPAN REQUIRED message displays on the screen. However, the gas analyzer is still functioning and all Agent, CO2, and N2O values remain accurate. The unit can be used until the required calibrations can be performed. To remove the message from the screen, simply touch the GAS key and then the NORMAL SCREEN key of the monitor.

Caution: If the message ??? appears in the numerics of FiO2 and FeO2 at any time you are monitoring a patient, you must perform a check O2 sensor test.

100% O2 Span Calibration

The 100% O2 Span is used to calibrate the response of the oxygen sensor to 100% O2. This function sets the level for oxygen so the monitor displays 100% when pure oxygen is input to the unit.

The 100% O2 Span calibration should be performed monthly or whenever the FiO2 value is not between 98% and 100% when sampling pure (100%) oxygen. The 100% O2 calibration must be done correctly. A source of pure O2 with adequate flow is required to perform this calibration. Some institutions rely on their biomedical engineering department to perform this calibration. When the 100% O2 calibration is completed successfully, the monitor displays a normal screen with measured values of all gases.

Further action is needed if an O2 SPAN FAILURE message or an O2 CELL REPLACEMENT REQUIRED message displays on the screen. However, the gas analyzer is still functioning and all Agent, CO2, and N2O values remain accurate. The unit can continue to be used until the required action can be performed. To remove the message from the screen, simply touch the GAS key and then the NORMAL SCREEN key of the monitor.

Caution:Performing a 100% O2 span calibration without using the proper concentration and flow of oxygen will result in span calibration failure.

To check O2 sensor:

• Turn unit on and allow warm up to occur (four minutes).• Touch GAS.• Touch CAL.• Touch CHECK O2 SENSOR.• At completion of successful test, normal monitoring will resume.


Multigas

O2 Cell Replacement

To change an O2 cell, plan on the analyzer to be out of operation for approximately two hours. Therefore, if the day begins with a CHECK O2 SENSOR calibration and it is found that additional calibration or O2 sensor replacement is required, you can simply schedule that within your department (when the biomedical engineers are available). You may continue to use the analyzer until there is time to re-calibrate the unit or change the sensor.

Autozero Calibration

To guarantee accurate readings, the zero reference of the multigas analyzer is automatically calibrated on a regular basis. Autozero calibrations last less than 1.5 seconds and are performed without notice to the user.

The interval between autozero calibrations depends upon the amount of time the unit operates (either in normal or stand by mode). After the unit has been ON for at least 30 minutes, and has become thermally stable, autozero occurs in normal mode at approximately 10-minute intervals.

Pump Calibration

This function is used by service personnel to adjust the pump flow rate. Refer to the 90518 Multigas Analyzer Service Manual (P/N 070-0643-xx) for details.

Gas Span Calibration

A gas span calibration is recommended whenever gas values appear to be too low or too high. Always perform a leak test first to verify that the suspected values are not the result of a leak (poor connection, cracked water trap, etc.).

The gas calibration (SPAN) procedure is used to recalibrate the gas channels for CO2, N2O, and anesthetic agents. This procedure should be done every 30 to 90 days. Equipment required for this calibration includes a gas mixture for the calibration, calibration adapter kit, gas pressure regulator, and flow meter. This equipment can be purchased from Spacelabs Healthcare Supplies Products.

To span calibrate O2 sensor with 100% O2:

• Allow unit to stabilize for 30 minutes.• Touch GAS.• Touch CAL.• Disconnect the sample line from patient.• Connect the sample line to the sampling port of an airway T-adapter.• Connect the airway T-adapter to a source of 100% oxygen supply.• Adjust the oxygen supply to flow through the T-adapter at a rate of approximately

500 ml/min.• Wait for O2 value to stabilize.• Touch 100% O2 SPAN.• Select YES.• At completion of successful test, normal monitoring will resume.


Multigas

Warning:• Performing a gas span calibration without the calibrated gas mixture connected adversely

affects the accuracy of the analyzer.

• Gas span calibrations must be performed by trained personnel only.

Refer to the 90518 Multigas Analyzer Service Manual (P/N 070-0643-xx) for details on calibrating the analyzer.

Note:

The waveform display and the numeric values may disappear during calibration.

Suspending Sampling

Sampling may be suspended by touching the SUSPEND SAMPLING key under the following conditions:

• When suctioning a patient

• Use (by the patient) is temporarily discontinued

• Nebulized drugs are being used

This stops the sampling pump and keeps the system free of debris. Touch the RESUME SAMPLING key to resume sampling.

Caution:The sampling must be resumed for proper monitoring of respiratory gases.

When sampling is suspended, the CAL key is disabled.

Refer to Patient Connection on page 22-8 for examples of recommended suction system setups.

To suspend sampling:

• Touch GAS.• Touch SUSPEND SAMPLING.• Touch RESUME SAMPLING when finished.


Multigas

Multigas Troubleshooting Guide

The analyzer displays error messages in the gas waveform zone. Many of these messages also trigger an alarm. If the prompt line is available, the monitor displays messages there as well.

Note:

The unit does not analyze sampled gases while the monitor displays any of the above messages.

Clinical Situation Possible Cause SolutionAlarm

Sounds

FILTER DOOR OPEN - Close filter access door

■ The gas analyzer filter door is ajar.

■ Close the door by pressing it downward.

■ Yes

OCCLUSION -Check T-adapter, sample line

■ The sample line is blocked. ■ Check the sample line for blockage or crimps, and replace as necessary.

■ Yes

■ The gas analyzer filter is plugged.

■ Replace the gas analyzer filter cartridge.

■ Yes

SPAN IN PROGRESS ■ One of the span calibration procedures is in progress.

■ Wait until span calibration is completed and message goes away.

■ No

WARMING UP ■ The unit is self testing or warming up.

■ Wait until warm up completes before operating.

■ No

WATER TRAP ABSENT - Install water trap

■ There is no water trap installed in the holder.

■ Install a water trap. ■ Yes

WATER TRAP FULL -Replace or empty

■ The water trap is full. ■ Replace the water trap. ■ Yes


Multigas


Sounds

100% O2 SPAN FAILED - Check 100% O2 gas supply, Check for leaks

■ Sampled gas supply does not have 100% O2 present when compared to room air O2.

■ Verify the O2 supply. Allow the analyzer to warm up for at least 30 minutes before attempting a 100% O2 span.

■ Yes

■ Air leak in external sample circuit.

■ Check water trap, gas analyzer filter, and sample lines for air leaks. Replace all leaking components.

■ Yes

■ Air leak in internal sample circuit.

■ Perform a unit leak test. Service may be required.

■ Yes

■ External/internal pressures may be out of operating range or measurement of the pressures has failed.

■ Check that the cell pressure in SERVICE CAL MODE is between 525 and 825 mmHg. If the cell pressure is greater than the barometric pressure, external sample circuit is over pressured, adjust circuit.

■ Yes

■ O2 cell linearity error. ■ Contact your Biomed or your Spacelabs Healthcare field service engineer.

■ Yes

■ O2 concentration may be more than 23% or less than 19% in vicinity of the analyzer.

■ Check the room air around the analyzer for high O2 concentrations. Successful completion of O2 span is not possible under this condition.

■ Yes

■ Repeat 100% O2 SPAN (refer to To span calibrate O2 sensor with 100% O2 on page 22-24). Contact a qualified service person if the span fails again after the above checks.

100% O2 SPAN FAILED - O2 cell replacement required

■ O2 cell output is below acceptable levels, O2 values are disabled.

■ Contact your Biomed or your Spacelabs Healthcare field service engineer.

■ Yes


Multigas

Note:

• The unit does not analyze sampled gases while the monitor displays any of the above messages.

• For the above messages, you can touch the GAS key and then the NORMAL SCREEN key to remove the message from the waveform zone and stop the alarm tone. However, the message will continue to display on the monitor’s prompt line. Whenever a span failure occurs, the previous calibration factors are not lost. The analyzer continues to function and report the gas values, but the full accuracy of the values are not guaranteed.

100% O2 SPAN REQUIRED

■ Initial 100% O2 CAL required. ■ Perform 100% O2 Span. ■ Yes

■ CHECK O2 SENSOR determined need for 100% O2 Span to restore specified O2 accuracy.

■ Perform 100% O2 Span. ■ Yes

O2 CELL REPLACEMENT REQUIRED

■ Previous O2 span determined that O2 cell has aged to the point of needing replacement.


■ Yes

O2 INSTALLATION FAILED - O2 install cal requires new O2 cell

■ Install cal detected an O2 cell output above or below the allowable threshold for a new O2 cell.


■ Yes

O2 SPAN FAILED - Check exhaust port

■ Scavenger port is blocked. ■ Remove scavenger port blockage and repeat the SPAN. If the SPAN fails again, contact a qualified service person.

■ Yes

■ O2 sensor assembly output is very negative.

■ After checking exhaust port, if RAW = 0 in SERVICE CAL MODE, service is required. Replacement of the O2 sensor electronics assembly is indicated.

■ Yes

CAL GAS SPAN FAILED - Check span gas supply

■ The unit could not calibrate the gas channel.

■ Repeat the span. Contact a qualified service person if the span fails again.

■ Yes


Sounds


Multigas


Sounds

HIGH VALUES OBSERVED

■ A span calibration was performed while there was a leak in the sample circuit.

■ Check connections and check for a broken water trap. Perform leak test. Verify the anesthesia delivery devices and vaporizer calibrations. Refer to the 90518 Multigas Analyzer Service Manual (P/N 070-0643-xx) for details.

■ Assure vaporizer accuracy.

■ No

LOW VALUES OBSERVED

■ A leak exists at the sample line connection, a water trap is broken at the luer connection, or a gas analyzer filter is leaking.

■ Check connections and check for a broken water trap. Perform leak test. Verify the anesthesia delivery devices and vaporizer calibrations. Refer to the 90518 Multigas Analyzer Service Manual (P/N 070-0643-xx) for details.

■ No

■ Assure vaporizer accuracy. ■ No

Minimum waveform deflection and very low or zero numeric values when breathing normally through a new or unused sample line

■ Clogged or missing gas analyzer filter.

■ Replace or install gas analyzer filter underneath the door above the water trap.

■ No

■ A large leak in the sample circuit.

■ Check connections and perform a leak test. Refer to the 90518 Multigas Analyzer Service Manual (P/N 070-0643-xx) for details.

■ No

MIX

NOTE: This message appears in agent numerics area.

■ Agent mixture detected.

■ The analyzer is not designed to simultaneously measure multiple anesthetic agents. Inaccurate numeric concentration values may be displayed when two or more agents are mixed.

■ No


Multigas

MIX (continued)

NOTE: This message appears in agent numerics area.

■ The displayed value of the mixed condition is based on the combined value of agents using the coefficient factors of the last detected or selected agent type.

■ No

■ When the analyzer detects an agent mixture:

■ In Auto ID Mode — The mixed condition is reported by displaying I MIX and E MIX as the agent labels on all screens.

■ In Manual ID Mode — In large text screen, the mixed condition is reported by displaying the word MIX under the parameter label area next to the units of measure. In the small text screen or the split screen central, the parameter labels will alternate between the mix labels in normal video and the selected agent-type labels in reverse video.

■ The display zones will continue with the above displays, until the mix of the agents has flushed from the patient and delivery system and a single agent identity has been detected.

■ Depending on the agents used, the residue in the patient, and the breathing or delivery system, mixed conditions can last for more than an hour.

■ If the message persists, contact a qualified service person.


Sounds


Multigas

Zeros or ??? are displayed for one or more of the inspired gases(I N2O, I AGNT, FiO2, orI CO2)

■ No gas is being administered.

■ Administer gas. ■ No

■ Sample line is not connected.

■ Check sample line connections, the water trap, and the filter above the water trap.

■ No

■ A leak in the system. ■ Perform a leak test; refer to the 90518 Multigas Analyzer Service Manual (P/N 070-0643-xx) for more details.

■ No

■ Failure in one of the internal electronics parts.

■ Cycle the power to the analyzer. If the problems persist, contact a qualified service person.

■ No


Sounds


BIS

Directory of Keys


BIS - MAIN MENU

ALARMLIMITS

SETUPTEST

ELECTPRINT

START

ALARM LIMITS MENU

HI=XX

BIS SETUP MENU

TIME SCALES MENU

1HR

YES NOEXIT

ELECT

B

I

S

CAUTION

ON OFF

ALARMS

ON OFF

PLOT SCALES MENU

0-100 40-100 20-80

SIZE MENU

0-60

PROCED

CLEAR DATA?

LO=YY

DISPLAYFORMAT

TIMESCALES

SIZESWEEPSPEED

PLOTSCALES

ADVSETUP

DISPLAY FORMAT MENU

1 3 AUTOZONE ZONE ZONE

2HR

4HR

8HR

12HR

24HR

SWEEP SPEED MENU

15 mm/sec 30 mm/sec 50 mm/sec

ADVANCED SETUP MENU

LOWFREQ

RESTORESETTINGS

HIGHFREQ

LINEFREQ

SAVESETTINGS

LOW FREQ MENU

0.25 HZ 1.0 HZ 2.0 HZ

HIGH FREQ MENU

30 HZ 50 HZ 70 HZ NONE

LINE FREQ MENU

50 HZ 60 HZ


BIS

Contents

Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Patient Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Initialization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Normal Bedside Display Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Remote View Display Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Split Screen Display Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Numeric Key Format. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12BIS Main Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Status Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Care and Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Overview

The Spacelabs Healthcare 90482 Bispectral Index® (BIS®) Analysis module acquires and processes real-time EEG data into a BIS number between 0 and 100. The EEG data is also displayed as:

• BIS

• Spectral Edge Frequency (SEF)

• Median Power (MF)

• EMGL (EMG energy in the 70–110 Hz band)

• Signal Quality Index (SQI)

• Suppression Ratio (SR)

The BIS module may be used in any of the Spacelabs Healthcare monitors listed in Table 1, with or without other Spacelabs Healthcare modules.


BIS

The BIS module uses disposable BIS sensors from Aspect Medical, Inc., a Digital Signal Converter (DSC), and a patient interface cable.

Figure 23-1: Module, DSC, PIC, and sensor

Table 1: BIS Compatibility

Model DescriptionMinimum Version of Software Required For Compatibility

90363 Ultraview 1500 1.01.10

90364 Ultraview 1600 1.03.08

90369 Ultraview 1050 1.01.10

90367 Ultraview 1030 1.01.12

90385/6 UCW/RDI 1.04.33

90387 Ultraview 1700 1.05.56

BIS module

digital signal converter (DSC)

patient interface cable (PIC)

BIS sensor


BIS

Caution:• Place the sensors as far away from the electrosurgery site as possible because considerable

high frequency current may flow into the electrodes. This can cause patient burns, especially if a defect is present in the neutral cable of the electrosurgical unit. Placing electrodes too close to the electrosurgery site can also cause a noisy EEG trace.

• Do not allow conductive parts of sensors or connectors, including the neutral electrode, to contact other conductive parts, including the ground.

• Detach all connectors and cables by grasping the connectors and pulling them straight out. Do not detach connectors and cables by pulling on the cables themselves.

Digital Signal Converter

The digital signal converter (DSC) receives the EEG input from the patient and converts it to digital information that is processed by the module.

Figure 23-2: Digital signal converter

The DSC plugs into the front of the module as shown in Figure 23-1.

top view side view bottom view

end view


BIS

Patient Interface Cable

The patient interface cable (PIC) is attached to the three-foot cable on the DSC and connects to the BIS sensor as shown in Figure 23-1.

Note:

• The PIC is not a disposable cable. Do not dispose of it when you dispose of the attached BIS Sensor.

• A cable tie is provided with the PIC to secure it to the DSC cable to prevent accidental disposal of the PIC.

To attach the PIC to the BIS sensor:

1 Remove the BIS sensor from its packaging.

2 Locate the small, raised arrows on both the light-blue end of the PIC connector and the BIS sensor connector.

Plug the BIS sensor into the PIC so that the arrows are on the same side and point toward each other. You may attach the BIS sensor to the PIC cable either before or after the sensor is placed on the patient.

To replace a faulty or damaged PIC:

1 Remove and discard the unusable cable.

2 Locate the end with a yellow dot on the PIC connector.

3 Engage the PIC connector and the DSC cable connector with the yellow dots oriented the same way, ensuring that they are fully seated.

Patient Preparation

To prepare the patient for monitoring:

1 Make sure the skin surface is clean and dry.

2 Position BIS sensor circle #1 and BIS sensor circle #2 high on the center of the patient’s forehead approximately 1.5 inches above the bridge of the nose.

3 Apply BIS sensor circle #3 on either temple between the corner of the patient’s eye and the hairline.

Caution:The BIS sensor will only work if it is placed on the patient’s forehead. Accordingly, it should not be used with any surgical procedure that precludes such placement.

4 Insert the tab into the patient interface cable until it is fully engaged (if you prefer, you may do this step before applying the sensor to the patient).

5 Using your finger, trace around the adhesive areas of the sensor, including the space between circles #1 and #2 to assure good adhesion and to prevent any bridging between the sensor elements.

6 Press each circle firmly and hold for five seconds to assure adequate prepping and to maximize sensor performance.

Caution:Do not expose the BIS sensor to surgical skin preparation solutions. This may result in harm to the patient’s skin.


BIS

Initialization

Before processing data, the BIS sensor must be applied to the patient.

When the sensor is applied and the PIC and DSC are connected to the module, you are ready to begin BIS monitoring.

1 Touch BIS.

2 Touch START PROCED (refer to START/STOP PROCED Key on page 23-16).

3 Touch YES at the Clear Data? prompt, and the module will automatically perform an impedance test.

Note:

You do not need to test electrode placement because this is done automatically when you touch START PROCED.

If the test passes, an Impedance Test Passed message displays (Figure 23-3).

Figure 23-3: Impedance Test Passed message

If the test fails, an Impedance Test Failed message displays (Figure 23-4).

Figure 23-4: Impedance Test Failed message

Impedance Test PassedImpedance Test FailedImpedance Test PassedImpedance Test Passed

Impedance Test Failed


BIS

Impedance Values

If the impedance value is too high, it could indicate that the BIS sensor is no longer making good contact and needs to be examined. Usually artifacts will signal this fact.

After touching the TEST ELECT key, additional feedback is given to the user by flashing the impedance value when the value exceeds the threshold. (Refer to Impedance Montage on page 23-11 and TEST ELECT Key on page 23-15.)

The Pass/Fail thresholds for the terminals are:

• Ground <100 K ohms

• Center <7.5 K ohms

• Left/Right <7.5 K ohms

Note:

• In normal use, the typical impedance value for the ground is less than or equal to 6 K ohms, while the values for the center and left/right terminals are between 0.5 and 1.5 K ohms.

• The user cannot control the impedance thresholds.

Normal Bedside Display Format

Monitor Software

The full bedside view requires three waveform zones. The example in Figure 23-5 displays the BIS plot and EMGL trends.

Figure 23-5: BIS bedside display (3 zones)

Analog Waveform

A single waveform is displayed in a box that is 300 pixels wide by 60 pixels high. With this display, roughly eight seconds of waveform data can be displayed at a sweep speed of 15 mm/sec, four seconds at 30 mm/sec, and 2.4 seconds at 50 mm/sec.


BIS

Numeric Zone

The numeric zone is to the right of the plot and the moving waveform on the monitor and is usually updated every two seconds. Some items, such as sweep speed, are only updated when the selection is changed.

Display Fonts:

• The BIS value is displayed in a large font.

• The units of measure are displayed in a small font.

• The remaining text is displayed in a small font.

Figure 23-6: Plot area numerics

Alarm Display

When the alarms are turned ON, the high and low alarm limit values are displayed. When the alarms are turned OFF, BIS ALM OFF is displayed. When the alarms are temporarily suspended, BIS ALM SUSP is displayed.

The alarm display consists of a block of reverse video text containing either BIS ALM OFF or BIS ALM SUSP. They are mutually exclusive, and only one will be displayed in the numeric area.

• Turn the alarms OFF by touching ALARM OFF on the Alarm Limits menu.

• Temporarily suspend the alarms by pressing the ALARM SUSPEND button on the monitor.

Alarm Suspend

Press the ALARM SUSPEND button on the monitor to temporarily turn off the audible alarm for three minutes. The text BIS ALM SUSP replaces the alarm limits. The BIS number continues to flash if the limit is exceeded.

When the temporary time has elapsed, the display returns to normal behavior. If the audible alarm is enabled, the alarm tone will sound again, and the limit number will flash.

In the split screen display, the bell symbol displays in reverse video when the alarms are enabled but suspended. During an alarm violation, the bell symbol flashes in reverse video.

50SR=0%SQI=100%EMGL=20dBSEF=30HzMF=30Hz

BIS

BIS value

Suppression Ratio value

Signal Quality Index value

Alarm limits

EMGL value

Spectral Edge Frequency value

Median Power Frequency value

6045


BIS

Top Line Annotation

The top of the plot area contains two labels:

• Primary trend label (BIS)

• Secondary trend label (EMGL)

Figure 23-7: BIS primary and secondary trends

Waveform Annotation

Waveform annotations are placed to the right of the moving EEG waveform (refer to Figure 23-8).

Figure 23-8: Waveform zone annotations

The analog scale size can be set at 2, 5, 10, 20, 50, 100, or 200 V. The analog scale limits are displayed with and V in the label.

+ 50V

L/R - CTR

15 mm/s

-50V

waveform upper size scale

BIS sensor labels

sweep speed

waveform lower size scale


BIS

Impedance Montage

If, during BIS monitoring, you wish to test impedance without losing your trended data, you can perform an impedance test. An impedance test is automatically checked (or tested) every 10 minutes.

The impedance montage is a temporary display that appears when the BIS sensor is connected to a patient and you touch the TEST ELECT key (refer to TEST ELECT Key on page 23-15).

The montage displays on the right side of the screen to the right of the second wave zone area from the top.

Note:

All processing is suspended until you stop the impedance test by touching EXIT ELECT.

Figure 23-9: Impedance test display

Remote View Display Format

The “Remote View” software option on Ultraview monitors allows you to view the BIS parameter from a remote monitor. This display shows the BIS plot in a single display zone format. No analog waveforms are available in this mode.

Figure 23-10: Remote display

Remote monitors permit one display zone to be used to display remote channels from other monitors, regardless of the type and the number of zones that are in use at the bedside monitor. When viewing the BIS from another monitor, the lower part of the BIS trend will not be visible due to the patient’s name being there.


BIS

In the one zone or remote view mode, all numeric text must be compacted into one display zone height.

In the remote view only, the BIS plot can have variable scaling and only the BIS value can be plotted.

The scaling options for remote view are shown in Table 2.

Split Screen Display Format

Note:

A split screen display is available only on central monitors.

The split screen display is shown in Figure 23-11.

Figure 23-11: Split screen display

Numeric Key Format

The numeric parameter key is labeled with the combined Bispectral Index value. You can display the BIS parameter as an icon on the bottom of the monitor screen. This allows other parameters to be displayed in the waveform zone. The full BIS display is restored whenever this icon is touched.

Table 2: BIS Variable Scaling

Parameter ScalingValue for the

Labels

BIS

0 to 100 0, 50, 100

40 to 100 40, 70, 100

20 to 80 20, 50, 80

0 to 60 0, 30, 60

212

5

/ 20%0%

Imp L/R = 0.5K

BIS=50 Bispectral Index value


BIS

BIS Main Menu

The Main menu is the initial menu that displays when you touch the BIS key.

Note:

In the remote view, only the ALARM LIMITS, SETUP, and PRINT keys are active. All other keys are disabled.

Refer to the following sections for descriptions of each key:

• ALARM LIMITS Key on page 23-13

• SETUP Key on page 23-14

• TEST ELECT Key on page 23-15

• PRINT Key on page 23-16

• START/STOP PROCED Key on page 23-16

ALARM LIMITS Key

Touch ALARM LIMITS on the Main menu to display the Alarm Limits menu.

This menu turns the BIS alarms ON or OFF, sets the upper and lower BIS alarm limits, and turns the Caution alarm ON or OFF.


To raise or lower each alarm limit setting, first touch the HI or LO key, then touch the up or down arrow key. Each touch of an arrow key raises or lowers the alarm limit by five units. There are separate values for the low limit and the high limit.

Note:

The alarm limits appear on the HI and LO keys as they are changed.

Caution Alarm

Touch CAUTION ON to enable the caution alarm.

When the caution alarm is enabled, you will be warned when the BIS value is within five units of either alarm limit.

When the BIS value is within the caution zone, the BIS number flashes.

Note:

No tone is emitted for the caution alarm.


BIS

SETUP Key

This menu enables you to set the display parameters to be used during the procedure. Refer to the following sections for descriptions of each key:

• DISPLAY FORMAT Key on page 23-14

• PLOT SCALES Key on page 23-15

• TIME SCALES Key on page 23-15

• SIZE Key on page 23-15

• SWEEP SPEED Key on page 23-15

• ADVANCED SETUP Key on page 23-15

DISPLAY FORMAT Key

From this menu, you can set the type of display you want to use.

• Touch 1 ZONE to display the single waveform zone format (Figure 23-12).

• Touch 3 ZONE to display the full bedside view format (Figure 23-13).

• Touching AUTO ZONE displays either format as follows:

- Three-zone format if the BIS parameter key is touched.

- One-zone format if the BIS parameter key is not touched.

Figure 23-12: One-zone display

Figure 23-13: Three-zone display


BIS

PLOT SCALES Key

Select the vertical display scale range options for the graphical BIS trend display in the one-zone or remote view format only. The selections are: 0–100, 40–100, 20–80, or 0–60.

TIME SCALES Key

This menu is used to select the time base for the BIS and EMGL trend plots to indicate the total number of hours represented by the x-axis of the BIS plot display. Available time base options are 1, 2, 4, 8, 12, and 24 hours.

SIZE Key

From this menu, you can modify the amplitude scale of the analog waveforms. The available amplitude scales (full scale) can be set at2, 5, 10, 20,50, 100, and 200 V. Touching the or key changes the scale to the next value up or down. The default setting is 50 V.

SWEEP SPEED Key

This menu allows you to modify the sweep speed of the analog waveform(s). The selections are 15, 30, or 50 mm/sec.

ADVANCED SETUP Key

This menu allows you to control a variety of functions. (On a remote display, only the BIS SCALES key is available.)

LOW FREQ — Touch LOW FREQ on the Advanced Setup menu to set the lowest frequency that is displayed and processed. The options are 0.25 Hz, 1.0 Hz, and 2.0 Hz.

HIGH FREQ — Touch HIGH FREQ on the Advanced Setup menu to set the highest frequency that is displayed and processed. The options are 30 Hz, 50 Hz, and 70 Hz. Selecting NONE disables any high frequency filtering.

LINE FREQ — Touch LINE FREQ on the Advanced Setup menu to select either a 50 Hz or 60 Hz line frequency.

SAVE SETTINGS — Touch SAVE SETTINGS to store the current selections in memory for later recall.

RESTORE SETTINGS — Touch RESTORE SETTINGS to recall the stored settings from memory and reset all the current settings. The display may change with this operation.

TEST ELECT Key

Touch TEST ELECT to initiate a continuous impedance check of all electrodes (refer to Impedance Montage on page 23-11). Touching this key displays the Impedance Montage, and the key label changes to EXIT ELECT.

When you touch EXIT ELECT, the Impedance Montage display disappears and the key label changes to TEST ELECT again.


BIS

PRINT Key

Touch PRINT to print a bitmap display of the BIS and EMGL trends. The analog waveform is not printed using this key. Press the RECORD button on the monitor and touch the BIS parameter key to print the analog waveform.

START/STOP PROCED Key

Touch START PROCED to denote the beginning of a procedure to be recorded.

If prior data has been stored for the patient, you have the option of retaining archived data or clearing it.

• Touch NO to append the new data to the existing data.

• Touch YES to erase the trend memory and clear the trend display.

When you touch START PROCED, its function and label change to STOP PROCED.

When you touch STOP PROCED, the label changes to START PROCED again.

Status Messages

Status messages are displayed in the waveform zone when in the three-zone format.

Processing may be suspended when any of these messages are displayed. The numeric data may be displayed as question marks. The EEG waveform may have artifacts.

The status message will continue to display until all faults are corrected.

Table 3: Status Messages

Message User Action

Impedance Test In ProgressThe impedance test is in progress; this should normally last 10 to 15 seconds.

Re-prep Ground ElectrodeThe impedance test has failed; check to see that all the electrodes are connected properly. The module will not collect data until the test passes.

DSC Test in Progress The system is performing a hardware self test of the DSC cable.

DSC Not ConnectedCheck that the PIC cable is connected to the DSC and at the front of the module. If connected, and the DSC doesn’t work, the DSC or module may require service.

DSC Shut Down - Restart Module

Too many fatal errors (overcurrent, voltage regulation) have occurred with this DSC, and the module has stopped communicating. Remove the module and reinsert it. If this problem persists, the DSC and/or module may require service.


BIS

Illegal DSC ID: DSC Turned OffAn unrecognized DSC has been connected to the module. Connect correct DSC. If error persists, the DSC and/or the module may require service.

Illegal PIC IDAn unrecognized Patient Interface Cable has been connected to the DSC. The PIC may be defective. Replace the PIC.

Check the SensorThe BIS sensor has an impedance which is too high. Check the cable connections and correct as necessary. If the message persists, check the impedance of the sensor and replace the sensor as necessary.

PIC Not ConnectedThe Patient Interface Cable may be disconnected from the DSC. Check the cable connections. The PIC may be defective. Replace the PIC.

Last Impedance Test Not Completed

At least one BIS element failed during the last impedance test and the test was ended by pressing the STOP PROCED key. Repress the element that failed. Re-test the impedance. This message will also appear if the test was ended prematurely by pressing STOP PROCED.

Poor Signal QualityThe Signal Quality Index is poor and the numeric display blinks. Check BIS Sensor. This may occur as a result of artifacts such as those generated from motion or the presence of electrocautery devices.

Bad Signal Quality

The Signal Quality Index is unacceptable, therefore, the Primary Trend variable cannot be calculated. Check BIS Sensor. This may occur as a result of artifacts such as those generated from motion or the presence of electrocautery devices.

Iso-electric EEG DetectedNo discernible EEG activity is detected for several minutes, SR = 100. Check the patient. Check the BIS Sensor for proper connection.

Check BIS Sensor (GND Element)

The ground element on the patient has an impedance that is too high. Check the Sensor and cable connections, and correct as necessary. If the message persists, check the impedances of the BIS Sensor. Re-prep the patient’s scalp if necessary.

Hardware Error, Service Required

Major problems in the DSC, BIS engine or module. Requires servicing.

Table 3: Status Messages (continued)

Message User Action


BIS

Definitions

BIS — Bispectral Index Analysis. A mathematical calculation derived from the frequency, power, and phase throughout the entire frequency range of the EEG. The Index is a number between 0 and 100.

DSC — The Digital Signal Converter. The DSC contains the input connector, amplifiers, and digitizer for the 90482 one channel EEG. The DSC is configured for referential montage monitoring.

EEG — Electroencephalogram. Real-time electrical activity of the brain. The EEG waveform can be further separated (digitized) into elements. The signal can be processed in time, frequency, and Fourier analysis.

EMG — Electromyogram. Electrical activity of the muscles. Processed as the absolute power in the frequency (Hz) range. This product calculates EMGL, which is over a fixed 70 to 110 Hz frequency range.

EMGL — EMG Low. Refer to EMG.

Epoch — The time during which the bispectral index is calculated.

MF — Median Power Frequency measured in Hz. The frequency at which 50% of the total power lies equally on either side. The frequency range is between 0.5 and 30 Hz.

Montage — A pattern of linking electrodes together over the scalp to generate a display of EEG channels in a particular way. Montages can be bipolar or referential.

PIC — The Patient Interface Cable. Used by the BIS module. This cable is configured to tell the DSC and module to automatically use a single channel montage for the BIS Sensor. The BIS Sensor is normally placed on the left or right side of the forehead.

SEF — Spectral Edge Frequency. The frequency (measured in Hz) at which 95% of the total EEG power lies below it and 5% lies above it. Frequency range is between 0.5 and 30 Hz.

SQI — Signal Quality Index. The percentage of good epochs in the last 60 seconds that are used to calculate the Bispectal Index and spectral variables. Not affected by the suppression ratio. Percentage values range between 1 and 100.

SR — Suppression Ratio. The percentage of time in the last 60 seconds in which the EEG signal is considered suppressed. Percentage values range from 0.0 to 100.


BIS

Care and Maintenance

BIS Module and Host Monitor Cleaning

To clean monitor screens and covers, modules, processors, and printers use a cloth or swab that has been slightly dampened in a solution of warm water and a mild detergent. Avoid solvents that may damage the product cases. Follow your hospital protocol.

Caution:Using cleaning agents other than those listed may cause degradation to the product’s plastic enclosure and labels. Refer to Cleaning and Sterilization on page 32-1 for questions or concerns regarding cleaning.

Digital Signal Converter Cleaning

Clean all visible blood, liquids, and soil as soon as possible from the Digital Signal Converter (DSC), cabling, and connectors. Use a lint-free, absorbent towel that has been moistened (damp, but not dripping) with a solution of mild detergent and lukewarm, clean water. Using light pressure, thoroughly clean all surfaces. Dilute and handle detergents and disinfectants according to their instructions. Dispose of the towels properly.

Caution:• When cleaning the connectors (or other small features of the DSC), do not let dirt, moisture, or

lint get trapped in the cracks or cavities of the receptacle or pin ends.

• Do not autoclave any of the components of the BIS monitoring system. Autoclaving will seriously damage the components.

Before cleaning, wipe thoroughly. Apply an approved disinfectant for the DSC with a germicidal, disposable wipe, such as the SANI-CLOTH. Active ingredients in the approved wipe are: n-Alkyl dimethyl benzyl ammonium choride (0.1%), and n-Alkyl dimethyl ethylbenzyl ammonium chloride (0.1%). Be sure the disinfectant is not dripping from the wipe. Using light pressure, wipe the surface of the DSC, its cabling, and connectors as indicated by manufacturer’s instructions. Dispose of the wipes properly.

BIS Sensor Disposal

The BIS Sensor is a patient-connected, single-use sensor that must be disposed of after each use. Dispose of the sensor per your applicable hospital practice.


EEG

Directory of Keys


DISPLAYFORMAT

SETUP MARKEVENT

PRINT STARTPROC

STOPPROC

EEG

DISPLAYFORMAT

SETUPMARKEVENT PRINT

EEG - MAIN MENU (SETUP # X)

EEG MAIN MENU (SETUP # X)

DSA &ANALOG

DSA &TREND

TREND &ANALOG

TWOTRENDS

EEG - DISPLAY FORMAT

DSA ANALOG TREND

EEG SETUP

STORE

SNAPSHOT

RECALL

SNAPSHOT

LIVE

DATA

ERASESNAPSHOT*

EEG - ARCHIVE

STORE SNAPSHOT - SNAPSHOT = 1 (11 Snapshots Available)

STORE

Review DSA/TRENDS

YES NO

YES NO

YES NO

RETAIN ARCHIVEDEEG DATA

ERASE ARCHIVEDEEG DATA

EEG- STOP PROC

EEG - PRINT DSA/TRENDS

EEG - MARK EVENT ‘a’

ARCHIVE

ARCHIVE

DSA ANALOG TRENDFREEZEON OFF

EEG - DISPLAY FORMAT

MAG 1 MAG 2 FBR 1 FBR 2 SEF PPF EMGMPF

FREEZEON OFF

MAG 1 MAG 2 FBR 1 FBR 2 SEF PPF EMGMPF

DSA ANALOG TREND

EEG - SETUP

RECALLSETUP

INITIALSETUP

DSA ANALOG TREND

INITIAL SETUP MENU

RECALLSETUP

STORESETUP

SYSTEMPARAMS

Continued on next page (System Params)

refer to DSA, ANALOG and Trend on page 24-3

EEG - START PROC

PRINTREVIEW REVIEW

RECALLSETUP

INITIALSETUP

TREND DISPLAY SELECTION Upper = MAG1 Lower = SEF

TREND DISPLAY SELECTION

Processing Off

Processing On

*not displayed at remote monitors

(DualFormat OFF)

(DualFormat On)

These keys are functionalonly when Processing

refer to DSA, ANALOG and Trend on page 24-3

is in the “OFF” mode *

DUAL FORMATOFFON

DUAL FORMATON OFF

see DSA, ANALOG and Trend on page 3


EEG

Directory of Keys — Processing Off


DSA ANALOG TREND

INITIAL SETUP MENU

RECALLSETUP

STORESETUP

SYSTEMPARAMS

MONTAGE

SYSTEM PARAMS

FILTERS SELECTLABEL

DISPLAYFORMAT

0.5Hz

1.0Hz

5.0Hz

20Hz

32Hz

50Hz

70Hz

LOW CUTOFF HIGH CUTOFFFILTERS -

EEG1 EEG2 EEG3 EEG4

SELECT LABEL

DUAL FORMATOFFON

DSA ANALOG TREND

EEG - DISPLAY FORMAT (Dual Format OFF)

DSA &TREND

DSA &ANALOG

TREND &ANALOG

TWOTRENDS

EEG - DISPLAY FORMAT (Dual Format ON)

MONTAGE

T3 C3 Cz C4 T4

Fp1Fpz

Fp2

F7

F3 Fz F4

F8

P3 Pz P4

T5

O1Oz

O2

T6

A1

M1

A2

M2

Left FRONTAL Right

2 CH4 CH

+ CH1 -—

+ CH2 -—

+ CH3 -—

+ CH4 -—

CLEARCHANNEL

EMG

CONTINUOUS

IMPEDANCE

LINE FREQ50HZ 60HZ

RETAIN ARCHIVEDEEG DATA

ERASE ARCHIVEDEEG DATA

These keys appear onlywhen data is stored inthe module.

The Select Label key is displayed only when more than one EEG moduleis in use.

DUAL FORMATON OFF

ON OFF

SYSTEM PARAMETERS

refer to page 24-3


EEG

Directory of Keys


SIZE SIZE 50mm/sec

30mm/sec

15mm/sec

ANALOG - SIZE = (+/-) 50 uV SWEEP SPEED

DSA ANALOG TREND

INITIAL SETUP MENU

SYSTEMPARAMS

TREND - BAND FREQUENCY (Hz) = 0.0 - 3.5

DELTA()

THETA()

ALPHA()

BETA1(1)

BETA2(2)

SELECTTRENDS

MAG 1 MAG 2 FBR 1 FBR 2 SEF PPF MPF

SELECT TRENDS

SET TRENDPARAMETERS

MAG 1 MAG 2 FBR 1 FBR 2 SEF PPF MPF TIMEBASE

TREND SETUP (only trends selected in the SELECT TRENDS menu will display in this menu)

5Min

10Min

20MIn

40Min

TIME BASE

SIZE SIZE DELTA()

THETA()

ALPHA()

BETA1 BETA2(2)

SIZE SIZE DELTA()

THETA()

ALPHA()

BETA1(1)

BETA2(2)

SEF/PPF/MPF - SIZE =30Hz BAND - 2

MAG 1/ MAG 2 - SIZE =100uV BAND - 2

SIZE SIZE DELTA()

THETA()

ALPHA()

BETA1(1)

BETA2(2)

FBR1/FBR2- SIZE= 100% BAND / - 2NUMERATOR

DENOMINATOR

EMG

EMG

FREQ FREQHI FREQ =200

LO FREQ =10

SIZE SIZE

EMG - SIZE = 200uV

RECALLSETUP

STORESETUP

SIZETIMEBASE

FREQUENCYRANGE

DSATREND

SIZE SIZE

DSA - SIZE = 100 uV2

5Min

10Min

20Min

40Min

DSA - TIME BASE

10Hz

15Hz

20Hz

30Hz

DSA - FREQUENCY RANGE

SEF PPF MPFTREND

OFF

DSA - DSA TREND

DSA SETUP

CONTINUOUSIMPEDANCE

This key appearsonly when Processingmode turned “ON”

DSA ANALOG TREND

EEG - SETUP

(refer to TREND SETUP below)

(1)


EEG

Contents

Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Setting Up the EEG Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Configuring the EEG Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Initial Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Storing a Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Recalling a Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15EEG Displays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16EMG Display. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Archiving EEG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Marking Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26Storing DSA/Trend Snapshots . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26Recalling DSA/Trend Snapshots . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Erasing Snapshots . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28Printing EEG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28Patient Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29Remote Monitors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Overview

The Spacelabs Healthcare Electroencephalograph (EEG) module is a two or four channel processed EEG monitor, used to acquire, process, and display brain electrical activity. The module also includes one channel of EMG (electromyogram) for measuring and displaying muscle electrical activity.

The EEG can be displayed as an analog waveform or as processed EEG. The analog EEG is displayed as a moving waveform similar to ECG. The analog signal is converted to the frequency domain using the Fast Fourier Transform (FFT) algorithm, and displayed as a spectral plot (density spectral array) or as trended parameters.

EEG data is displayed in a left/right hemisphere orientation for both the analog and processed data. The data appearing on the left part of the display indicates left hemisphere EEG, while the right part of the display shows right hemisphere EEG. This right and left orientation of the display remains consistent throughout the various display types. Display formats include analog EEG, density spectral array (DSA), and various EEG trends.

EEG can be viewed in single or dual format. The single format displays one type of EEG at a time. If you wish to see two EEG formats at one time, choose dual format display. With dual format display, you can see both DSA and analog, trend and analog, DSA and trend, or two trends.

A snapshot of DSA and trends can be stored and recalled. EEG data can also be marked with an event label to facilitate recall for later examination.

The EEG is commonly divided into four frequency bands. From lowest to highest, they are: Delta (less than 4 Hz), Theta (4 to 8 Hz), Alpha (8 to 13 Hz), and Beta (13 Hz and higher). Delta waves emanate from the central region of the brain, and occur most frequently if a patient is an infant or a sleeping adult. Theta waves, also from the central region, occur in children and lightly sleeping adults. Alpha waves originate primarily from


EEG

the occipital region of the brain, and occur in adults that are relaxed or drowsy. Finally, Beta waves emanate from the parietal and frontal regions of the brain, and indicate that the patient is alert and awake. Normal EEG patterns are influenced by cerebral blood flow, medications, and anesthetic levels.

The beta band can be divided into two bands. The low beta band is labeled beta1 and usually represents signals between about 13 Hz and 20 Hz. The high beta band is labeled beta2 and usually represents signals between about 20 Hz and 30 Hz. It is clinically useful to separate the beta band for trending purposes, especially when looking at high frequency activity.

Caution:The Spacelabs Healthcare model 90481 EEG module should only be used by someone with a knowledge of and/or background in EEG monitoring.

Setting Up the EEG Module

Up to six setup configurations can be saved and recalled as needed. To recall a particular EEG display setup requires only that you touch one of the six recall setup keys.

After determining what your EEG monitoring needs are, Spacelabs Healthcare recommends that you pre-configure the EEG module and store your configuration setup. Module configurations should be set up and stored prior to connecting a patient for monitoring. In this way, you can simply select a pre-configured setup after you connect the patient.

Also, some of the configuration menus are not available after EEG processing has started. Therefore, it is recommended that you pre-configure the module, defining the trend parameters, frequency ranges, and other variables (such as those outlined in the bulleted list below), before processing starts. This way, you will not have to stop processing to change some parameters.

The following sections describe:

• How to change the module’s EEG monitoring parameters and store them

• The EEG displays

• How to prepare the patient for monitoring

• How to connect the patient to the module

• Bedside and central monitors


EEG

Configuring the EEG Module

There are several different ways to configure the EEG module. You can monitor EEG in either two or four channel mode. You may also elect to monitor EMG. The EEG module also allows you to choose several formats for the EEG display, from analog waveforms to trend displays. Since the EEG module can store up to six setups, you will want to determine which setups best suit your needs, and store them in the module. You can then recall any of these configurations simply by recalling a setup you have pre-configured.

Some of the factors to consider when configuring a setup are:

• Electrode placement; what lead placement locations are best for your application?

• Filters; what should the low cutoff, high cutoff and line frequency settings be?

• Display format; what type of data display is best?

• Size; what size best shows the data you have chosen?

• Time base; which time base best reflects the information you need?

• Frequency range; what range do you wish to monitor?

• Trends; do you want to trend an EEG parameter?

• Sweep speed; what speed should an analog display use?

• EEG band frequencies; what frequency ranges do you want to apply to the delta, theta, alpha and beta bands?

• Trends; what size do you want your trends to be? What frequency bands should the trends reflect?

Initial Setup

Touching the INITIAL SETUP key will display the Initial Setup menu. The Initial Setup menu has four general categories of parameters:

• System Parameters

• DSA

• Analog

• Trends

Note:

• When the module is first inserted into the module housing, processing is stopped. To access the Initial Setup menus after the EEG module is processing information, first turn the processing OFF.

• The following instructions on accessing the initial setup menus assumes that processing is OFF. The quickstart steps addressing initial setup procedures also assume that processing is OFF.


EEG

System Parameters

The system parameters sub-menu accesses the montage display, where electrode lead placement is entered and EMG is enabled, the filters sub-menu, used to set the high and low cutoff and line frequency filters, the display format menu, used to choose the data format and the EEG label selecting sub-menu.

To access the initial setup menus: (processing must be OFF)

• Touch EEG.• Touch SETUP.• Touch INITIAL SETUP.

To enter electrode lead placement: (processing must be off)

1 Touch EEG.

2 Touch SETUP.

3 Touch INITIAL SETUP.

4 Touch SYSTEM PARAMS.

5 Touch MONTAGE.

6 Touch ERASE ARCHIVED EEG DATA (if data is stored in module).

7 Touch MONTAGE.

8 Select 2 or 4 channel.

9 Select desired channel.

10 Touch CLEAR CHANNEL.

11 Select desired electrode placement sites.

12 Repeat steps 9 through 11 until all channels are defined.

To set low cutoff, high cutoff and line frequency filters:

• Touch EEG.• Touch SETUP.• Touch INITIAL SETUP.• Touch SYSTEM PARAMS.• Touch FILTERS.• Select desired low cutoff, high cutoff and line frequency values).


EEG

DSA

The DSA sub-menu offers the following choices:

• SIZE

Use the up and down arrows to size the DSA. When you touch SIZE (after processing has started), the display will show a histogram of the EEG data (Histogram Display on page 24-22). As you touch the up and down arrows to change size, you will notice that the histogram changes size.

Choose a histogram size which gives the best DSA contrast for your application.

To display EEG in dual format:

• Touch EEG.• Touch DISPLAY FORMAT.• Select DUAL FORMAT ON.

To select an EEG label (if using more than one EEG module in one monitor):

• Touch EEG.• Stop processing (if started).• Touch SETUP.• Touch INITIAL SETUP.• Touch SYSTEM PARAMS.• Touch SELECT LABEL.• Select desired label.

To set the size of DSA:

• Touch EEG.• Touch SETUP.• Touch DSA.• Touch SIZE.• Adjust size.


EEG

• TIME BASE

Touch TIME BASE to choose the amount of time the x-axis display represents. Touch either 5,10, 20, or 40 min to select a DSA screen time. The active key will highlight.

Note:

The trend time base will change to track the DSA time base.

• FREQUENCY RANGE

Touch the FREQUENCY RANGE key to choose the DSA frequency range. Touch either 10Hz, 15Hz, 20Hz, or 30Hz. The active key will highlight.

• DSA TREND

Touch DSA TREND to choose the type of trend you wish to display on top of the DSA. Choose either SEF, PPF, MPF, or TREND OFF. The active key will highlight.

To set DSA time base:

• Touch EEG.• Touch SETUP.• Touch DSA.• Touch TIME BASE.• Select time base.

To set DSA frequency range:

• Touch EEG.• Touch SETUP.• Touch DSA.• Touch FREQUENCY RANGE.• Select frequency range.

To set DSA trend:

• Touch EEG.• Touch SETUP.• Touch DSA.• Touch DSA TREND.• Select trend.


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Analog

Touch the ANALOG key to show the sub-menu that allows you to set the SIZE of the analog trace, and the SWEEP SPEED of the display. Use the arrow keys to change the size. Touch the desired sweep speed to select.

Trends

Touch the TREND key in the INITIAL SETUP menu to access the Band Frequency sub-menu. This sub-menu allows you to set the frequency ranges for the five EEG frequency bands (DELTA, THETA, ALPHA, BETA1, BETA 2). Touch the up or down arrow keys to change the upper frequency range for each band. The lowest frequency for each band is set by the upper frequency of the band to its left.

The SELECT TRENDS key allows you to choose the various trends to be available for selection from the DISPLAY FORMAT, SETUP, and ARCHIVE menus.

You can select any combination of MAG1, MAG2, FBR1, FBR2, SEF, PPF, MPF, or EMG. You may not see all the trend options when you enter the trends sub-menus. This is because you must select which trends appear in the trend sub-menus. Select those trends you wish to have available by accessing the Initial Setup menu, and choosing the trends you want.

To display analog EEG:

• Touch EEG.• Touch DISPLAY FORMAT.• Select DUAL FORMAT OFF.• Touch ANALOG.

To set the analog size:

• Touch EEG.• Touch SETUP.• Touch ANALOG.• Select size

To select sweep speed:

• Touch EEG.• Touch SETUP.• Touch ANALOG.• Select sweep speed.


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Setting Trend Parameters

MAG1, MAG2, SEF, PPF, MPF

The sub-menu provides keys for changing the trend size and frequency band.

Note:

Greek symbols are used to represent the delta, theta, alpha, and beta bands.

BAND

Trend parameters are calculated and displayed for the frequency bands set in this menu. For example, magnitude in the alpha band can be calculated by selecting the alpha frequency band for MAG1. You define the frequency range for each band in the Initial Setup menu.

Touch the appropriate keys to select the frequency band for each trend. If more than one band is required, first touch the lowest frequency band (it will be highlighted), then touch the highest (it will also be highlighted). The keys between the lowest and highest frequency will be highlighted to indicate that these bands have been selected.

The frequency band setting is displayed above the frequency band keys on the message line as follows:

BAND x-y

x is the lowest frequency band, and y is the highest.

If only one band is selected, y is blank since the lowest and highest frequency bands are the same.

To add or delete trend:

• Touch EEG.• Touch SETUP.• Touch INITIAL SETUP.• Touch TREND.• Touch SELECT TRENDS.• Select or de-select trends.

To select the trend band:

• Touch EEG.• Touch SETUP.• Touch INITIAL SETUP.• Touch TREND.• Select band.• Set frequency.


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SIZE

Trend size should be set using the SIZE or SIZE keys so that the trend parameter lies close to the middle of the graph.

FBR1, FBR2

The frequency band ratio trends are a trend plot of the ratio (in percent) of total power in one frequency band divided by the total power in a second frequency band.

Frequency band ratio trend parameters (FBR1, FBR 2) require a frequency band for the numerator and denominator. The frequency range for each band is defined in the Initial Setup menu.

SIZE


NUMERATOR DENOMINATOR

Touch the NUMERATOR/DENOMINATOR key and select NUMERATOR. Touch the appropriate keys (DELTA, THETA, ALPHA, BETA 1, BETA 2) to select the frequency band for the numerator. Now touch the DENOMINATOR key, and again choose an appropriate band for the denominator.

If more than one band is required, first touch the lowest frequency band, then the highest.

The frequency band setting is displayed above the frequency band keys on the message line. You will see the following format for the display:

BAND x1-y1/x2-y2

where x1 is the lowest frequency band for the numerator, and y1 is the highest frequency band for the numerator. The lowest frequency band for the denominator is x2, and the highest, y2.

Time base

Touch TIME BASE to choose the amount of time the x-axis display represents. Touch either 5,10, 20, or 40 min to select a trend screen time. The active key will highlight.

Note:

The DSA time base will change to track the trend time base.

To set the trend size:

• Touch EEG.• Touch SETUP.• Touch TREND.• Select trend.• Adjust size.


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EMG

SIZE


FREQUENCY

Select either HI FREQ= or LO FREQ=. Press the FREQ or FREQ key until the desired value appears in the XFREQ= key. Repeat for the other key.

Storing a Setup

Once you have set the EEG module’s parameters the way you want them, you may store the current settings to one of six setup keys. Access the Initial Setup menu by first touching the SETUP key from the Main menu, then touching INITIAL SETUP. From the Initial Setup menu, touch STORE SETUP. You will then see six setup keys labeled SETUP #1, SETUP #2, etc. Store the current settings by touching one of the setup keys.

Note:

• Processing must be stopped before a setup can be stored.

• The message EEG Setup Successfully Stored is displayed on the message line when the setup is stored.

To store a setup:

• Touch EEG.• Touch SETUP.• Touch INITIAL SETUP.• Change desired parameters.• Touch STORE SETUP.• Touch the setup key to which you want to store the current setup.


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Recalling a Setup

To recall a setup, make sure processing is stopped, then touch the SETUP key. Touch RECALL SETUP. You will then see the retain or erase archived EEG data keys if data is stored in the module. If you want to change your setup, you will have to erase any archived EEG data. If you choose to retain archived EEG data, you cannot select another setup.

EEG Electrode Lead Selection (Montage)

To select which leads you have placed and their placement sites, touch the MONTAGE key (under SYSTEM PARAMS in the Initial Setup) to enter a sub-menu in which the electrodes can be selected and the impedance of each electrode can be measured. First, select either two or four channels for EEG recording. If two channel recording is selected, the CH3 and CH4 keys will be inactive, and the electrode names are removed.

The following procedure is used to select electrode names for each channel:

1 Touch the desired channel key (CH1, CH2, CH3, CH4).

2 Touch the CLEAR CHANNEL key to delete previously defined electrodes for the channel.

3 Touch one of the 25 keys in the montage to select the first electrode. The key will flash on and off, and appear in the channel key as the positive input. Select a second electrode. The key will again flash on and off, and your selection will appear in the channel key as the negative or reference input.

Note:

• The first electrode name displayed in the channel key is the positive input, while the second electrode name is the negative or reference input.

• When selecting the next channel, the electrodes that were selected for the first channel will stop flashing, but will remain highlighted.

4 Touch the CLEAR CHANNEL key to erase both electrode names if you make an error when entering the electrode names. Re-enter the pair of electrode names after you clear them.

5 Touch each of the channel (CH1, CH2, CH3, CH4) keys in succession to complete the setup.

To recall a setup (processing must be OFF):

• Touch EEG.• Touch SETUP.• Touch RECALL SETUP.• Touch ERASE ARCHIVED EEG DATA (if data is stored in module).• Touch RECALL SETUP.• Select desired setup.


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EEG Displays

Display Formats

The EEG module can display several formats. The formats can be grouped into two types: dual display format, and single display format.

The single format displays are:

• DSA

• ANALOG

• TREND

The dual display formats are:

• DSA & TREND

• DSA & ANALOG

• TREND & ANALOG

• TWO TRENDS

Note:

When the format is Two Trends, the message line indicates whether the upper or lower trend is selected by displaying the trend in reverse video.

To select EEG electrode leads:

1 Touch EEG.

2 Touch SETUP.

3 Touch INITIAL SETUP

4 Touch SYSTEM PARAMS.

5 Touch MONTAGE.

6 Touch ERASE ARCHIVED EEG DATA (if data is stored in the module).

7 Select 2 or 4 channel.

8 Select desired channel.

9 Touch CLEAR CHANNEL.

10 Select desired electrode placement sites.

11 Repeat steps 8 through 10 until all channels are defined.


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Analog EEG Display

Analog EEG is displayed as a moving waveform for each channel. The trace moves from left to right. The analog waveform clips or flat-lines when the amplitude exceeds full scale.

Figure 24-1: Four-channel analog EEG display

� Sweep Speed — This number represents the sweep speed of the displayed and recorded analog trace. The sweep speed can be set to 15, 30, or 50 mm/sec. All EEG channels use the same sweep speed.

� Amplitude Grid — This grid is drawn under the analog trace and divides the amplitude scale into four segments. A dashed line is drawn at the baseline or center of each display zone. Solid lines are drawn at the top and bottom edge of the zone (peak values), and dotted lines are drawn halfway between the edge of the zone and the baseline. Tick marks are drawn on the y-axis at each division. Each division represents peak amplitude divided by four.

� Analog Waveform — This trace sweeps from left to right, reflecting brain electrical activity for the channel monitored.

� Peak to Peak Signal Amplitude — These numbers indicate the maximum and minimum amplitude ranges of the analog signal (set by user).

� Electrode labels — These number-letter combinations indicate the electrode lead placement.

� Time Axis — Time is measured along the x-axis for each analog trace. Each waveform window displays four seconds at a sweep speed of 15 mm/sec, two seconds at 30 mm/sec, and 1.2 seconds at 50 mm/sec.

To display analog EEG:

• Touch EEG.• Touch DISPLAY FORMAT.• Select DUAL FORMAT OFF.• Touch ANALOG.

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Freezing the Display

To freeze the analog waveform, touch the FREEZE ON/OFF key. The ON section of the key will highlight. Touch the key again to turn off the freeze, and the OFF section of the key will highlight. Freeze mode is used to stop the moving waveform so transient features can be captured and inspected.

Density Spectral Array (DSA) EEG Display With Trend Overlay

Processed EEG is displayed as a Density Spectral Array (DSA) similar to the pattern shown in the four channel EEG below. The DSA pattern is shown with a SEF trend overlay.

Data moves from right to left, and is updated every four seconds (five-minute time base).

To freeze the EEG:

• Touch EEG.• Touch DISPLAY FORMAT.• Select FREEZE ON.

To display DSA EEG with trend overlay:

• Touch EEG.• Touch DISPLAY FORMAT.• Select DUAL FORMAT OFF.• Touch DSA.• Touch PREVIOUS MENU.• Touch SETUP.• Touch DSA.• Touch DSA TREND.• Select desired trend.


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Figure 24-2: Four-channel DSA EEG display with trend overlay

� Real-time Clock — Displays the time the last epoch was acquired.

� Time Base — Total time of the DSA plot; ranges from 5 to 40 minutes.

� Message Line — The following messages can be displayed: NOT PROCESSING, REDISPLAYING, REVIEWED, RECALLED.

� Electrode Impedance — Electrode impedances are automatically measured and displayed every five minutes after processing is started. If electrode impedances are greater than the acceptable range (5 K ohms for each electrode or 2 K ohms differential between the pairs) the impedance values will flash if the impedance of any electrode exceeds 5 K ohms, or if the difference between the electrode pairs exceeds 2 K ohms. If the impedance exceeds 99 K ohms, ++ is displayed.

� DSA Magnitude (DSA) — Total magnitude of the EEG in the frequency range displayed for the last epoch for channels 1 and 2. The number on the left indicates the left hemisphere magnitude, the right value shows right hemisphere magnitude.

� Overlay Trend Parameter — Numeric value for channels 1 and 2 of either the Spectral Edge Frequency (SEF), Peak Power Frequency (PPF), or Median Power Frequency (MPF) for the last epoch displayed. The number on the left is the frequency for the left hemisphere of the brain, while the right number is the frequency of the right hemisphere.

� Artifact Flag — Artifact detection is marked by lighting a pixel on the top line. On color monitors, artifacts will be marked with a red pixel.

Event Marker — Used to tag significant clinical events. Can place 52 unique letters; a-z and A-Z. Used in identifying and recalling stored DSA data.

Left Hemisphere Electrode Labels — EEG channels are labeled with lead names selected in the Initial Setup menu. Here, the left anterior EEG channel is labeled F3-C3, and the left posterior channel is labeled C3-P3.

� Right Hemisphere Electrode Labels — In this setup, the label for the right anterior channel is F4-C4, and the right posterior channel is labeled C4-P4.

Frequency Axis Label — Frequency is displayed along the vertical, or y axis. The labels indicate the range displayed. The bottom line will always read 0 Hz. The top line will show 10, 15, 20, or 30 Hz, depending on what maximum frequency is chosen.

� Density Spectral Array (DSA) Display With Trend Overlay — For monochrome monitors, the DSA pattern is formed by packing dots in proportion to signal amplitude at each frequency. Frequencies with higher power have higher dot densities. For color monitors, the DSA pattern is formed using seven levels

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of grey. The intensity of each pixel is proportional to signal amplitude at each frequency. The Trend Overlay is drawn on top of the DSA pattern. The overlay can indicate the Spectral Edge Frequency (SEF), Median Power Frequency (MPF), or Peak Power Frequency (PPF). On color monitors, it appears as a magenta line.

� Time Axis — The horizontal, or x axis represents time. Two vertical columns of pixels are drawn each update period. The display update rate depends on the time base selected. The time base is the total time of the displayed DSA, and can be set to 5, 10, 20 or 40 minutes. The time axis is divided into five equal segments using intensified dots.

� Frequency Axis — The vertical or y axis represents the DSA frequency. The vertical axis is divided into five segments. Each segment is equal to the total frequency displayed, divided by five.

� EEG parameter Key — Touch this key to access all EEG menus. If there is more than one EEG module connected to the monitor, then you can label the keys EEG1, EEG2, EEG3, or EEG4.

Trend Displays

The EEG module can trend up to seven EEG parameters:

• Two magnitude parameters (MAG 1 and MAG 2)

• Two frequency band ratio parameters (FBR 1 and FBR 2)

• Spectral edge frequency (SEF)

• Peak power frequency (PPF)

• Median power frequency (MPF)

All trends should be selected before processing starts. Select the frequency band for each trend in the Setup menu. In the figure below, the magnitude of the EEG (MAG 1) is calculated for the frequency bands delta to beta2 and trended. One trend parameter can be displayed at a time for each EEG channel when dual format is off. The trend is drawn as a double wide line. A five point moving average filter is used to smooth the data on the trend plot.

To display EEG trends:

• Touch EEG.• Touch DISPLAY FORMAT.• Select DUAL FORMAT OFF.• Touch TREND.• Select desired trend.


EEG

Figure 24-3: Four-channel EEG trend display

� Event Marker — Used to tag significant clinical events. Can place 52 unique letters; a-z and A-Z. Used in identifying and recalling stored trend data.

� Artifact Flag — Artifact detection is marked by lighting a pixel on the top line. On color monitors, artifacts will be marked with a red pixel.

� Horizontal Axis — The horizontal, or x-axis represents time. The time base is the total time of the displayed trend, and can be set to 5, 10, 20 or 40 minutes. The time axis is divided into five equal segments using intensified dots.

� Trend Line — The trend line represents the trended EEG parameter and moves from right to left.

� Vertical Axis — The vertical, or y-axis represents either the magnitude (in microvolts), frequency (in hertz), or ratio (in percent). When MAG 1, MAG 2, or EMG are displayed, magnitude is shown (values range from 2 to 900 V). When SEF, PPF, or MPF are displayed, frequency is shown (values are 5, 10, 15, 20, and 30 Hz). When FBR 1 or FBR 2 are displayed, percent is shown (values range from 10% to 900%).

� Band — The EEG band trended (Delta, Theta, Alpha, Beta1, Beta2, or combination. Greek letters are displayed to represent each band).

� Trend Value — Shows the type of trend displayed and its numeric value. MAG 1 indicates a magnitude trend.

Time Base — Total time of the trend plot; ranges from 5 to 40 minutes.

To change the trend time base:

• Touch EEG.• Touch SETUP.• Touch TREND.• Touch TIMEBASE.• Select timebase.

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EEG

Histogram Display

The histogram display is used to set the appropriate scale or size for the DSA display. This helps to optimize the DSA display contrast. The histogram vectors should fill as much of the window as possible without saturating. The histogram display can also be used to see EEG power and frequency changes in each epoch. It provides expanded information for each column of DSA data. The histogram display is only accessed when changing the DSA size after processing has been started.

Figure 24-4: EEG display of histograms (4 channels)

� Amplitude Axis — The vertical, or y-axis represents the amplitude. The bottom of the y-axis is always labeled as 0 µV2 (zero microvolts squared). The top of the y-axis is labeled with the maximum power you select. The power displayed in the Figure 24-4 (100 µV2) indicates full scale power of the histogram vectors.

� Frequency Axis — The horizontal, or x-axis represents the frequency range (0 to 30 Hz) and is divided into five equal sections with tic marks.

To change DSA size:

• Touch EEG.• Touch SETUP.• Touch DSA.• Touch SIZE.• Set DSA size.

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5 Min100

100


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Dual Format Display

You can display the EEG in two formats simultaneously. Enable dual format from the DISPLAY FORMAT menu. This allows the display of DSA and analog, DSA and trend, trend and analog, or two different trends. In addition, the second display zone can be used to show recalled snapshots of DSA or trends, simultaneously with live DSA or trend data.

Figure 24-5: Dual format DSA and analog EEG

To display DSA EEG with trend overlay and analog EEG:

• Touch EEG.• Touch DISPLAY FORMAT.• Select DUAL FORMAT ON.• Touch DSA & ANALOG.• Touch EEG.• Touch SETUP.• Touch DSA.• Touch DSA TREND.• Select desired trend.


EEG

EMG Display

There is one EMG channel that can be used to monitor muscle electrical activity. Select EMG with the EMG ON /OFF key in the Montage menu. The ON section of the key will be highlighted when it is on. Touch the key and select OFF to turn off the EMG channel. The OFF portion of the key will be highlighted.

Note:

EMG is displayed only as a trend.

Although EMG uses only one channel, the EMG trend is displayed in each channel so it can be used to compare against EEG when dual format is on.

Figure 24-6: EMG display

To enable EMG processing:

• Touch EEG.• Touch SETUP.• Touch INITIAL SETUP.• Touch SYSTEM PARAMS.• Touch MONTAGE.• Touch ERASE ARCHIVED EEG DATA (if data is stored in the module).• Touch MONAGE.• Select EMG ON.

To view EMG trend:

• Touch EEG.• Touch DISPLAY FORMAT.• Select DUAL FORMAT OFF.• Touch TREND.• Touch EMG.


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Archiving EEG

Reviewing EEG Data

The module continuously stores the last 2 to 24 hours of DSA and trend data. The number of hours it can store depends on the amount of memory installed. You can scroll back and forth in half screen increments using the left and rightREVIEW keys. Data is not displayed until you remove your finger from the left and right arrow keys. If you keep your finger pressed on one of the arrow keys, you can rapidly scroll to the approximate place in the data. Time and date information for the position in the data is displayed on the message line, as well as any event marks placed in the data.

When reviewed data is being displayed, the message REVIEWED is shown in reverse video on line two of the numeric zone.

Note:

When DSA & TRENDS are displayed simultaneously in Dual Format mode, the Review keys scroll through DSA and trend data.

Recalled EEG data (Dual Format Off)

You can store and recall snapshots of DSA and trended data. Recalled data is displayed in the same format as live data.

When dual format is OFF, recalled EEG data replaces live data for each channel.

When recalled data is being displayed, the message RECALLED is displayed in reverse video on line two of the numeric zone.

Recalled EEG Data (Dual Format On)

When dual format is on, two data formats (e.g., DSA and analog) are displayed. If recalled data is requested, the recalled EEG data is displayed in the second zone. Recalled data is always displayed below the live data. The message RECALLED tells you that the data in the second zone is recalled data. This can be used to display baseline data below the live data.

Live Data

Touch the LIVE DATA key to resume displaying live DSA, analog, or trends. This key provides an easy means to return to live data after displaying reviewed data or recalled snapshots.

To display live data:

• Touch EEG.• Touch ARCHIVE.• Touch LIVE DATA.


EEG

Marking Events

An event can be identified on the DSA or Trend displays by placing an event label on the display at the point where the event occurs. Up to 52 event labels (a-z; A-Z) can be placed on the DSA and Trend displays. The event label is stored and displayed with the DSA and all Trend displays in all four channels.

After touching the MARK EVENT key, touch the YES key to place an event label. Touch the NO key to cancel marking an event. Touching either key returns you to the Main menu.

The next event label to be placed is displayed above the YES/NO keys on the message line. The message appears as follows:

MARK EVENT ‘X’

‘X’ is a letter a-z; A-Z. If the event label is ‘Z,’ the message Z is the last event mark that can be placed is displayed and the Mark Event key will appear dotted after Z is placed.

Note:

Event labels will be placed as close in time as possible to the event. The Mark Event key appears dotted when an event label cannot be placed.

Storing DSA/Trend Snapshots

From the Main menu, touch the ARCHIVE key, touch the STORE SNAPSHOT key then touch the STORE key.

The following messages are displayed on the message line:

SNAPSHOT = UU (ZZ Snapshots Available)

UU is the snapshot number (1 to 44) and ZZ is the number (0 to 44) of snapshots that can still be stored.

The number of snapshots that can be stored depends on the amount of memory in the EEG module. The base module can store 11 four-channel or 22 two-channel snapshots. If the module has sufficient memory, then up to 44 snapshots (four-channel) can be stored.

To mark an event:

• Touch EEG.• Touch MARK EVENT.• Touch YES

To store a DSA or trend snapshot:

• Touch EEG.• Touch ARCHIVE.• Touch STORE SNAPSHOT.• Touch STORE.


EEG

Recalling DSA/Trend Snapshots

Touch the RECALL SNAPSHOT key. Use the arrow keys to choose a snapshot. Touch the RECALL key, then touch DSA to display the density spectral array for the selected snapshot, or touch a trend key to display the trended EEG.

Note:

You can use marked events as a method for keeping track of snapshots that you want to recall. Use the arrow keys to move through the stored data. The message prompt will indicate whether there are any marked events in the snapshot. Note which marked events appear in the message prompt, then recall the snapshot when you see the event label you want. The time and date of each snapshot is also displayed in the message prompt.

To recall a DSA or trend snapshot:

• Touch EEG.• Touch ARCHIVE.• Touch RECALL SNAPSHOT.• Select desired snapshot.• Touch Recall.• Select DSA or trend parameter.

To print a stored snapshot:

• Touch EEG.• Touch ARCHIVE.• Touch RECALL SNAPSHOT.• Select desired snapshot.• Touch Recall.• Select DSA or trend parameter.• Touch PRINT.• Touch YES.


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Erasing Snapshots

Touch ERASE SNAPSHOT to erase DSA/TRENDS snapshots.

Touch the left or right arrow keys to select the snapshot to be deleted.

DSA/Trends snapshots are identified by snapshot number, marked events and time and date at which the snapshot was stored.

Touch the ERASE key to erase the selected snapshot of DSA/Trends.

Printing EEG

From the Main menu, touch the PRINT key to display a sub-menu in which all displayed DSA and Trends are printed. One print key controls all four EEG channels. The printout is a screen dump of the entire DSA or trend display zone, including all data displayed in the numeric zone (on the right side of the EEG key).

Touch the YES key to print the DSA and trend display. Touch the NO key to cancel the printout.

Note:

• Analog EEG is not printed using the print key. Use the monitors RECORD key to print Analog EEG.

• Recording could be terminated if the analog size is changed during the recording.

To erase a DSA/ TREND snapshot:

• Touch EEG.• Touch ARCHIVE.• Touch ERASE SNAPSHOT.• Select desired DSA/TREND snapshot.• Touch ERASE.

To print DSA or Trends:

• Touch EEG.• Touch PRINT.• Touch YES.


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Patient Preparation

Patient Preparation

Electrodes must be properly placed on the patient to obtain the optimum signal. Use small ECG silver/silver chloride electrodes, EEG cup electrodes (silver or gold), or their equivalent. Electrodes are available from Spacelabs Healthcare.

Caution:Only use patient cables specified by Spacelabs Healthcare. Other cables may degrade performance and may damage the UCW or PCMS monitor during defibrillation. Do not use stainless steel electrodes.

Attach lead wires to the electrodes before applying them to the patient. If you apply lead wires after applying the electrodes, you may displace some of the conductive gel, resulting in signal degradation. Connect all electrodes needed for EEG monitoring. You will need six electrodes (minimum) for four channel operation, and five electrodes (minimum) for two channel monitoring. Missing electrodes will result in loss of EEG waveforms.

Warning:• To ensure against any possibility of electric shock, do not touch lead electrodes, or the monitor

during defibrillation. The conductive parts of electrodes or any other patient connection should not contact other conductive parts, including the neutral electrode and earth (ground).

• Keep the monitor and its power cord and cables away from the electrosurgery unit and its associated cables and power cord.

• If electrodes are used adjacent to the electrosurgical site, considerable high frequency current may flow through them, causing patient burns, especially if a defect is present in the return pad of the electrosurgical unit. For this reason, electrodes should be placed as far away from the surgery site as possible.

Prepare the patient for electrode placement as follows:

• If possible, choose a site that avoids hair interference, and is as high on the scalp as possible.

• Clean each site with a medically approved abrasive cleaner (such as OmniPrep or NuPrep) using a cotton tip applicator in a circular motion to mildly abrade the skin. (The abrasive cleaner should not be used on patients with a history of skin allergies to cosmetics or lotions. As a substitute, use a skin degreaser such as alcohol.)

To set up EEG or EMG monitoring:

• Attach lead wires to EEG or EMG electrodes.• Apply electrodes.• Attach electrode lead wires to patient cable.• Insert module into module slot.• Attach EEG patient cable to module.


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• Use alcohol wipes to further clean each site and remove residual OmniPrep. Then, using dry gauze, rub site briskly, avoiding excessive abrasion of the skin surface.

• Ensure that gel is moist in each electrode.

• Attach lead wires to electrodes before applying to patient.

• Apply electrodes to the site by pressing around the outer edge of the electrode. DO NOT press on the center of the electrode since this may interfere with proper adhesion. The electrode, especially its center, must lie flat against the patient’s skin.

• Select CONTINUOUS IMPEDANCE and measure electrode impedances after all electrodes have been placed and lead wires and patient cable are connected. Acceptable maximum impedances: 5 K ohms for each electrode, 2 K ohms differential between the pairs.

Figure 24-7: Electrode application

Note:

Electrode impedances are automatically measured and displayed every five minutes after processing is started. If electrode impedances are greater than the acceptable range (5 K ohms for each electrode or 2 K ohms differential between the pairs) the impedance values will flash if the impedance of any electrode exceeds 5 K ohms, or if the difference between the electrode pairs exceeds 2 K ohms. If the impedance exceeds 99 K ohms, ++ is displayed.

Position as high as possible on the placement sites. Avoid hair interference.

Smooth electrode adhesive area to the skin with a circular motion.


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EEG Electrode Placement

Figure 24-8: Recommended electrode lead placement for the operating room

You have the choice of monitoring in two channel or four channel mode. Note the changes in the color of the leads when using two channel as opposed to four channel mode. Also, if using the four channel mode, note that an extra lead (CZ - Red Wire) is necessary.

Note:

Use the special adaptor to connect CZ (red wire) to the + input of each channel. Use a silver cup for electrode CZ. Attach with conductive paste or collodion.

Channel # 4 Channel 2 Channel

Channel 1 CZ-F7 (Red/Red) F7-M1 (Red/Red)

Channel 2 CZ-F8 (Red/Black) F8-M2 (Black/Black)

Channel 3 CZ-M1 (Red/Brown)

Channel 4 CZ-M2 (Red/White)

Channel 5 EMG (two Yellow) EMG (two Yellow)

2 Ch and 4 Ch Ground (Green) Ground (Green)

Green Wire(Ground)

Red Wire (4 Channel Only)

(Right side has

Front View Left Side View

White wire for 4 Channel, Blackfor 2 channel)

Brown wire for4 channel, Redfor 2 channel

(M1)

(M2)

(Fp1)

(Fp2)(CZ)

Yellow Wires (EMG)

Black Wire(F8) Red Wire

(F7)

(EMG)


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Figure 24-9: EEG patient connector

Note:

Spacelabs Healthcare recommends the 10-20 International Electrode Placement System for charting electrode placement on a patient. Use this reference if you require additional information regarding electrode placement.

Figure 24-10: 10-20 International electrode placement system

The EEG module contains an electrosurgical interference suppression (ESIS) filter which automatically provides some noise suppression when electrocautery interference is detected.

EMG Electrode Placement

Use two yellow EMG lead wires and place the electrodes as shown in the electrode lead placement illustration. The EMG is displayed as a trend, and uses channel five in the EEG module.

+ - + - + - + - + - + -CH 1 CH 2 CH 3 CH 4 GND CH 5

EMGEEG

RED BLACK BROWN WHITE GREEN YELLOW


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Starting and Stopping Processing

The EEG module can operate in either the processing on or off mode. To set up the module, you need to have processing turned OFF. Processing OFF is the default mode when you first insert the module into the module housing.

Note:

You can only access the Initial Setup menu when processing is OFF.

The Initial Setup menu allows you to access other menus needed for defining the various configurations you may want to store.

Only analog EEG is displayed when the power has first been turned on, or the processing has been stopped. Processing of the data and the display of DSA or trends will start when the START PROC key is touched.

START PROC

Touch the RETAIN ARCHIVED EEG DATA key to begin processing without erasing EEG data stored in the module. This is useful if processing is suspended, then resumes on the same patient. The key will change to STOP PROC after it is pressed.

Touch the ERASE ARCHIVED EEG DATA key to erase all EEG data presently stored in the module. Processing begins and START PROC changes to STOP PROC.

STOP PROC

Touch the YES key to stop processing and return to the main menu. The STOP PROC key changes back to START PROC. Touch the NO key to return to the Main menu without interrupting processing.

To start processing:

• Touch EEG.• Touch START PROC.• Touch ERASE ARCHIVED EEG DATA for each new patient.

-OR-

• Touch RETAIN ARCHIVED EEG DATA if the data in the module is to be saved.

To stop processing:

• Touch EEG.• Touch STOP PROC.• Touch YES.


EEG

Continuous Impedance

Touch the CONTINUOUS IMPEDANCE key to put the module in continuous mode. In continuous mode, the impedance of each electrode is measured and displayed every two seconds. Use this mode when the electrodes are first placed on the scalp or when the impedance of an electrode is out of range (absolute above 5 K ohms and differential above 2 K ohms), and must be re-applied.

Note:

EEG/EMG data is corrupted when continuous impedance is selected.

Touch the CONTINUOUS IMPEDANCE key again to un-highlight it, and turn off continuous checking. This places the impedance checking in auto mode, which updates every five minutes when processing is on.

The displayed impedance value will flash to alert you if the values are out of range.

Note:

Continuous Impedance is automatically turned off when leaving the Montage or Analog Setup menus.

Filters

You can set the low and high cutoff filters and line frequency filter in the System Parameter menu. The low cutoff filter determines the lowest frequency that is displayed and processed, and the high cutoff filter determines the highest frequency that is displayed and processed. The LINE FREQ key selects either 50 Hz or 60 Hz line frequency.

Touch the FILTERS key to enter the sub-menu where the high cutoff, low cutoff and line frequency filters are set.

Touch one of the keys (0.5Hz, 1.0Hz, or 5.0Hz) to select the desired low cutoff filter. The key will be highlighted.

Touch one of the keys (20Hz, 32Hz, 50Hz, or 70Hz) to select the desired high cutoff filter. The key will be highlighted.

To put the module in continuous impedance mode from the Montage screen:

• Touch EEG.• Touch SETUP.• Touch INITIAL SETUP.• Touch SYSTEM PARAMS.• Touch MONTAGE.• Touch CONTINUOUS IMPEDANCE.

To put the module in continuous impedance mode:

• Touch EEG.• Touch SETUP.• Touch ANALOG.• Touch CONTINUOUS IMPEDANCE.


EEG

Touch LINE FREQ and select 50Hz or 60Hz. The selection will be highlighted.

Remote Monitors

This section covers the differences in display format and user menus between the local bedside monitor and remote monitors. EEG cannot be displayed on a split-screen central monitor and remote monitors do not have access to all keys and functions that are available at the local bedside.

Bed Name / Patient Name Interference

If the EEG key is not selected then bed name and patient name are displayed at the bottom of the display zone on remote monitors. This conflicts with display of the EEG data. When the EEG key is selected bed name is displayed on the message line instead.

Display Formats — Remote Bedside

EEG uses one, two or four display zones at the local bedside, depending on how you configure the module. Remote views at bedside monitors only use one display zone to display the remote EEG data.

Case #1 — One display zone used at the local bedside (2 EEG channels, dual format OFF).

In this case, the remote display of EEG data is almost identical to the local bedside’s display of that data (refer to Figure 24-11).

Figure 24-11: EEG remote displaypatient name/bed name ON

Case #2 — Two display zones used at the local bedside (4 EEG channels, dual format on or 2 EEG channels, dual format OFF).

To set the low cutoff, high cutoff or line frequency filters:

• Touch EEG.• Touch SETUP.• Touch INITIAL SETUP.• Touch SYSTEM PARAMS.• Touch FILTERS.• Select desired filter settings.


EEG

The local bedside requires two display zones to display EEG data for all EEG channels. The remote bedside can only use one display zone for EEG data, so a special key, labeled NEXT VIEW, is displayed in the EEG menu. This key allows you to toggle between each EEG view. The text displayed above this key indicates how many views are available and which is currently being displayed (refer to Figure 24-12).

Figure 24-12: EEG remote bedside display patient name/bed name OFFMultiple views with NEXT VIEW key

Case #3 — Four display zones used at the bedside (4 EEG channels, dual format ON).

The local bedside requires four display zones to display EEG data for all EEG channels. The remote bedside can only use one display zone for EEG data, so a special key, labeled NEXT VIEW, is displayed in the EEG menu. This key allows you to cycle between each EEG view. The text displayed above this key indicates how many views are available and which is currently being displayed.

ARCHIVE


Calculations

Directory of Keys — Remote Calcs


LOCALTRENDS/CALCS

REMOTETRENDS/CALCS

BED 1 BED 2 BED 3 BED 4 BED 5 MORE

SPECIAL FUNCTIONS

REMOTE TRENDS/CALCS - Select bed

See next page

UCW/Ultraview 1700

Ultraview 1030/1050/1500/1600

NOTE: Requires Trend/Calcs enabled


Calculations

Directory of Keys — Clinical Calcs


HEMOCALCS

RESPCALCS

OXYCALCS

RENALCALCS

UPDATEDATA

NEWENTRY INPUTS

EDITDAY/TIME

EDIT STORE

ENTRYDELETEENTRY SCROLL

PAGEPRINT

FIO2 PaO2 SpO2 PaCO2 PvO2 SvO2 Hgb% mmHg % mmHg mmHg % g/dl mmHg l/min m2

PB CO BSA

NOTE: Labels are dependent on type of calculation

CLINICAL CALCS for BED X

X CALCS - Select a menu key

EDIT INPUTS MENU - Select input to change

GRAPHICTRENDS

TABULARTRENDS

CALCS

TRENDS/CALCS for BED xxx

DRUGCALCS

Refer to Trends chapterRefer to page 25-3

Refer to page 25-1


Calculations

Directory of Keys — Drug Dosage


EDIT INPUTS

STOREENTRY

MIX

TITRATETITRATION

TABLE PRINT

UNITS AMT VOL CONC WEIGHT DOSE RATE DUR TOTALDOSE

TOTALVOL

AMOUNT

DOSEmcg mg g mEq units k units m units

DOSE/MINmcg/min

DOSE/HRmcg/hr

DOSE/WT/MINmcg/kg/min

DOSE/WT/HRmcg/kg/hr

VARY

RATEDOSETYPE

DOSE/MINmcg/min

DOSE/HRmcg/hr

DOSE/WT/MINmcg/kg/min

DOSE/WT/HRmcg/kg/hr

Displays on-screen keypad

(Neonate Only)

Displays Titrate Tables

Displays on-screen keypadDisplays on-screen keypad

SCROLLPAGE

PRINT

UPDATE DATA

DRUG

UCW/UV1700 only

DRUG A ...

DRUGCALCS

Refer to page 25-2

Select units

ADULT/NEONATAL DRUG DOSAGE - Select dosage type

EDIT INPUTS MENU - Select input to change

Select name

ADULT DRUG DOSAGE - Select a drug or menu key

ADULT/NEONATAL DRUG DOSAGE - Select dose type

DRUGS A - F

DOSE

ADULT TITRATION TABLE - Select dose type


Calculations

Contents

Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Setting Up Physiologic Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Setting Up Drug Dosage Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Accessing Calculation Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Updating Data Between Monitors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Display Detail — Physiologic Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Hemodynamic Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Respiration Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Oxygenation Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Renal Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Drug Dosage Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Display Detail - Drug Dosage Calculations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Configurable Drug Names (UCW and Ultraview 1700 Only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Overview

The Clinical Calculations feature can be divided into two types: (1) Physiologic and (2) Drug Dosage. Physiologic calculations include hemodynamic, respiration, oxygenation, and renal. These calculations use input values entered manually or collected automatically by the system to produce a set of output values. Drug Dosage calculations enable you to determine infusion rates for drugs based on drug concentration, desired dose, patient weight, and type (adult or neonate).

Setting Up Physiologic Calculations

Values are entered into the system in several ways. You can take a snapshot of currently monitored inputs by selecting the NEW ENTRY key (refer to Creating a New Entry on page 25-8). You may also specify a day and time to gather input data from the past, although this function is generally limited to the past 24 hours.

The system displays a combined total of 200 entries into the four physiologic calculations tables. Each table has an Edit Inputs menu that is used to edit input data. You can also create a record of both input and output data by printing the displayed table.


Calculations

Setting Up Drug Dosage Calculations

The Drug Dosage calculation feature enables you to edit the inputs and to store up to six drug records. Titration tables are displayed for each drug record entered.

Drug dosage calculations operate similarly to physiologic calculations except that weight is handled differently, and that you must select an ADULT or NEONATE patient type. Refer to Entering Patient Type and Gender on page 3-9 for details on adult/neonate selection.

Warning:If the monitor is turned OFF, all clinical calculations data will be lost.

Accessing Calculation Data

Calculations can be accessed via the local bedside monitor or from a remote monitor on the network depending upon the options purchased. Contact your system administrator for details if you are unable to access this function.

The data displayed in the Calculations table is from the local bedside or the specified remote monitor as selected.

Updating Data Between Monitors

The UPDATE DATA key is used to synchronize calculation data between multiple monitors. For example, if lab data for calculations were entered at the central monitor and stored in the bedside monitor database, using the UPDATE DATA key would provide those values for calculations performed at the bedside.

To access local or remote calcs:

• Touch SPECIAL FUNCTIONS.• Select LOCAL or REMOTE TRENDS/CALCS.• If you selected REMOTE TRENDS/CALCS, select a bed.• Touch CALCS.• Select a calcs key (HEMO, RESP, OXY, RENAL).


Calculations

Display Detail — Physiologic Calculations

Tables for Physiologic calculations occupy several display zones above the message line, allowing display of waveforms on the remaining display zones of the screen. The Drug Dosage calculations table has a different format, but occupies the same four lower display zones.

Figure 25-1: Physiologic calculations table

� The top line of the table shows the type of calculations performed, the bed name, and the patient name.

� A day/time key is displayed at the top of each data column. Each day/time key indicates the day, hour, and minute. The hours can be in either 12-hour or 24-hour format, depending on the system setup. When you use the 12-hour format, A or P are displayed to indicate either a.m. or p.m.

� Calculation inputs are listed on the top of the table. Output from the calculations are listed under the dividing line at the bottom of the table. Eight columns of data can display on the screen at once, each column appears under the key which corresponds to the day and time at which the data was collected. New data values are entered to the right of existing ones. If the table is full, older entries are shifted left one column. Data columns that do not display remain in memory. A highlighted key indicates a selected column.

Note:

All keys appear disabled except for NEW ENTRY and PRINT until at least one record (data column) is displayed in the table.

Scrolling and Paging

Toggle the PAGE/SCROLL key to SCROLL and use the left or right arrows to move the Calculations table over one column in the desired direction. Newer records display to the right, older records to the left.

Toggle the PAGE/SCROLL key to PAGE and use the left or right arrows to move the calculations table over seven columns, or one whole page, in the desired direction. Touch the right arrow key to display the next newer page (seven columns) of records. This key does not function when the newest record is displayed in the table. Touch the left arrow key to display the next oldest page (seven columns) of records. The scrolling stops when the oldest record is displayed on the table.

�

��

�

2007


Calculations

Creating a New Entry

Touch the NEW ENTRY key to create a new record for the current day and time and to add the record to the Calculations table. The new record is positioned immediately to the right of existing records. If all the columns on the screen are filled, the display shifts to the left and the new record is displayed in the far right column.

The new record's DAY/TIME key is highlighted and contains the current day and time. The available input values are displayed in the input column and calculated results appear in the output column. Any unavailable inputs or outputs are displayed as question marks.

NEW ENTRY does not function when a total of 200 records exist in all the Physiologic calculations tables for the selected system. If you want to make further entries, you must first delete some of the existing entries from one or more of the calculations tables.

Note:

Touch NEW ENTRY, then touch STORE ENTRY to store the entry in the database. Entries that have not been stored remain in the table until you select a different bed or patient, then they disappear.

To view calcs data:

• Touch CALCS.• Select a calcs key.• Toggle the PAGE/SCROLL key to SCROLL.• Use the or keys to move data by one column.

-OR-

• Toggle the PAGE/SCROLL key to PAGE.• Use the or keys to move data by seven columns.

To create a new entry:

• Access Local or Remote Calcs.• Touch NEW ENTRY.• Touch EDIT INPUTS to input new data not available in the system.• Select an input key.• Use the on-screen keypad to input the value.• Touch ENTER on the on-screen keypad.• Touch PREVIOUS MENU.• Touch STORE ENTRY to retain entry in Calcs table.


Calculations

Editing Inputs

Each type of calculation displays its own Edit Inputs menu containing the inputs listed in the upper part of the Calcs table. The name of the input and units of measure appear on each EDIT INPUTS key for the Physiologic calculations. Once an input has been edited, the letter e is displayed immediately after the edited value in the table.

Note:

The displayed units for pressure values, height, and weight may vary based on your monitor's configuration. Contact your system administrator for details.

When you select an input key, the on-screen keypad appears. Refer to Using the On-Screen Keypad (Ultraview 1030/1050/1500/1600 only) on page 3-8 for on-screen keypad operating instructions.

If you enter a height and weight in the BSA menu, the system automatically computes a BSA. However, changing the BSA directly invalidates any height or weight previously entered.

Note:

Changing the height and weight in the BSA menu does not affect the height and weight in the Admit/Discharge menu.

Refer to Table 1 for adult and neonatal BSA, height and weight values for hemodynamics, oxygenation, and renal calculations.

Table 1: BSA, Height, and Weight Calculations

Label Name Units

Default Value(1030, 1050, 1500, 1600

only)

Valid RangeAdult Neonatal

BSA Body Surface Area m2 1.81 0.11 0.03 to 3.69

HT Heightcm

in

170

66.9

35

13.8

20 to 215

7.9 to 84.6

WT Weightkg

lb

70.000

154.324

1.500

3.307

0.2 to 250.0

0.441 to 551.156

To edit a record:

• Access Local or Remote Calcs.• Touch EDIT INPUTS.• Select an input value to edit.• Use the on-screen keypad to change the input value.• Touch ENTER on the on-screen keypad.• Touch PREVIOUS MENU, then STORE ENTRY to retain entry in Calcs table.


Calculations

Editing Day and Time

To create a Calculations record for a specified day and time, create a new entry and highlight the DAY/TIME key. Then touch EDIT DAY/TIME and enter the day and time for the record you want to create.

Touch the DAY, HOUR, or MINUTE keys to highlight that key and display the on-screen keypad. The selected parameter and value appear in the on-screen keypad.

The hour can appear in either 12-hour or 24-hour format. If the system is set for 12-hour format, use the AM/PM key to select a.m. and p.m. on the DAY/TIME key.

When editing minutes and hours, you cannot change the value to a future time.

When you have entered the day, hour, and minute via the on-screen keypad, the input values and output calculations reflect data available from the system at the entered time. An e appears under any edited DAY/TIME key.

Storing an Entry

Touching the STORE ENTRY key after touching the DAY/TIME key stores the record of input values and output calculations in the selected monitor’s database. Up to 100 stored records may be saved in each system.

The letter s is displayed under the DAY/TIME key to indicate that the record has been stored. If you edit a record after it has been stored, the letter s is removed because the newly edited changes have not been stored. Storing a record overwrites the data already stored.

Note:

Stored records are saved until the system is powered down or until patient data is purged via the Admit/Discharge function.

To create a record for a past time:

• Access Local or Remote Calcs.• Touch NEW ENTRY.• Highlight the DAY/TIME key on a new or prior entry.• Touch EDIT DAY/TIME.• Select DAY, HOURS, or MINUTES.• Use the on-screen keypad to change.• Touch ENTER on the on-screen keypad.• Touch PREVIOUS MENU, then STORE ENTRY to retain entry in Calcs table.

To store an entry:

• Access Local or Remote Calcs.• Highlight DAY/TIME key of the entry to be stored.• Touch STORE ENTRY.


Calculations

Deleting an Entry

After selecting a DAY/TIME key, you may delete a record by touching the DELETE ENTRY key. A menu is displayed to confirm the deletion. A record previously stored in the database via the STORE ENTRY key will be deleted from the database, as well as from the table.

Automatically displayed records, such as cardiac output data, remain in the database. These records reappear, even if deleted, when you leave and then return to a patient or bed.

Printing

Touch the PRINT key to print the currently displayed page of the Calculations table. The complete table prints on a four-channel recorder. On a two-channel recorder, the top half of the table prints first followed by the bottom half.

To delete an entry:

• Access Local or Remote Calcs.• Highlight DAY/TIME of the entry to be deleted.• Touch DELETE ENTRY.• Touch YES.

To print calcs data:

• Access Local or Remote Calcs.• Touch PRINT.


Calculations

Hemodynamic Calculations

Hemodynamic calculations provide significant data describing cardiovascular system performance.

Cardiac output values from a Cardiac Output (CO) module automatically create records in the Hemodynamic Calculation table.

When you create a new entry, any current values for HR, MAP, CVP, MPA, and PCWP are displayed in the table. The system will enter the current body surface value into the table, if available. The most recent CO value (if less than 15 minutes old) is also put into the table. If the system locates a CO value, then values for MAP, CVP, MPA, or PCWP not currently available are put into the table from the CO record. Any inputs which remain unavailable display question marks. The DAY/TIME key displays the current time.

Hemodynamic Calculations require several specific pressure values, including CVP, MAP, and PCWP. CVP and MAP are monitored continuously; PCWP is an episodic value. A data substitution may occur if any of these pressure values are not available when you touch NEW ENTRY. When a substitution occurs, one of the error messages listed here displays on the message line.

• Warning...RAP has been substituted for CVP.

A continuous RAP value is used instead of the continuous CVP value if CVP is not available.

To view current hemodynamic calcs:

• Touch CALCS.• Touch HEMO CALCS.

Table 2: Hemodynamic Input


Valid Range

HR Heart Rate beats/min 70 0 to 300

MAP Mean Arterial PressuremmHg

kPa

80

10.7

-50 to 300

6.7 to 40.0

CVP Central Venous PressuremmHg

kPa

10

1.3

-50 to 99

-6.7 to 15.0

MPAMean Pulmonary Artery Pressure

mmHg

kPa

15

2.0

-50 to 99

-6.7 to 15.0

PCWPPulmonary Capillary Wedge Pressure

mmHg

kPa

10

1.3

-50 to 99

-6.7 to 15.0

CO Cardiac Output I/min 5.0 0 to 40.0


Calculations

• Warning...NIBP has been substituted for MAP.

An episodic mean NIBP value which is less than 15 minutes old is used instead of MAP if the continuous MAP value is not available.

• Warning...LAP has been substituted for PCWP.

A continuous LAP value is used instead of the episodic PCWP value if the PCWP value is not available or is more than 15 minutes old.

Table 3: Hemodynamic Output

Label Name Units

CI Cardiac Index L/min2

SV Stroke Volume ml/beat

SVI Stroke Volume Index ml/beat/m2

SVR Systemic Vascular Resistance dynes × sec/cm5

SVRISystemic Vascular Resistance Index

(dynes × sec/cm5) × m2

PVR Pulmonary Vascular Resistance dynes × sec/cm5

PVRIPulmonary Vascular Resistance Index

(dynes × sec/cm5) × m2

LVSW Left Ventricular Stroke Work g × min/beat

RVSW Right Ventricular Stroke Work g × min/beat

LVSWI Left Ventricular Stroke Work Index g × min/beat/m2

RVSWI Right Ventricular Stroke Work Index g × min/beat/m2

Table 4: Hemodynamic Equations

BSA = Ht 0.725 × Wt 0.425 × 0.007184

CI = CO/BSA

SV = (CO/HR) × 1000

SVI = SV/BSA

SVR = 79.9 × [(MAP – CVP)/CO]


Calculations

Respiration Calculations

Respiration calculations describe the performance of the lungs in the ventilation process.

Unless you have a ventilator Flexport interface, most input values for Respiration calculations must be manually entered.

SVRI

= 79.9 × [(MAP-CVP)/CI]= 79.9 × [(MAP-CVP)]/[CO/BSA]= 79.9 × [(MAP-CVP)]/[CO × 1/BSA]= 79.9 × [(MAP-CVP)/CO] × BSA= SVR × BSA

PVR = 79.9 × [(MPA-PCWP)/CO]

PVRI

= 79.9 × [(MPA-PCWP)/CI]= 79.9 × [(MPA-PCWP)]/[CO/BSA]= 79.9 × [(MPA-PCWP)]/[CO × 1/BSA]= 79.9 × [(MPA-PCWP)/CO] × BSA= PVR × BSA

LVSW

= 0.0136 × SV × (MAP - PCWP)

RVSW

= 0.0136 × SV × (MPA - CVP)

LVSWI

= LVSW / BSA

RVSWI

= RVSW / BSA

Assumes pressures are measured in mmHg

To view current respiration calcs:

• Touch CALCS.• Touch RESP CALCS.

Table 4: Hemodynamic Equations (continued)


Calculations

Table 5: Respiration Input


ValidRange

RR Respiration Rate breaths/min 20 0 to 200

PaCO2Partial Pressure of Arterial Carbon Dioxide

mmHg

kPa

40

5.30 to 1500 to 20.0

VT Tidal Volume ml/breath 500 0 to 3000

PIP Peak Inspiratory Pressure cmH2O 50 0 to 200

PLT Plateau Pressure cmH2O 30 0 to 200

PEEPPositive End Expiratory Pressure

cmH2O 10 0 to 50

PECO2Partial Pressure of Expired Carbon Dioxide

mmHg

kPa

35

4.70 to 1500 to 20.0

Table 6: Respiration Output

Label Name Units

VMIN Minute Volume l/min

Cst Static Compliance ml/cmH2O

Cdyn Dynamic Compliance ml/cmH2O

VD Dead Space Volume ml

VD/VT Dead Space to Tidal Volume Ratio Ratio

VA Alveolar Ventilation ml/min


Calculations

Oxygenation Calculations

Oxygenation calculations provide specific data describing the efficiency with which the body acquires, circulates, and utilizes oxygen in the cardiopulmonary system. Input values for Oxygenation calculations are automatically obtained from SpO2, SvO2, cardiac output modules, or Flexport interfaces. You must manually enter inputs for laboratory blood analysis values.

Table 7: Respiration Equations

VMIN = VT × RR/1,000

Cst = VT/(PLT – PEEP)

Cdyn = VT/(PIP – PEEP)

VD = (PaCO2 – PECO2) × (VT/PaCO2)

VD/VT = VD/VT

VA = (VT - VD) × RR

Table 8: Oxygenation Input


Valid Range

FiO2 Fractional Inspired Oxygen % 50 0 to 100

PaO2 Partial Pressure of Arterial OxygenmmHg

kPa

100

13.3

0 to 500

0 to 70.0

SpO2 Arterial Oxygen Saturation % 97 0 to 100

PaCO2Partial Pressure of Arterial Carbon Dioxide

mmHg

kPa

40

5.3

0 to 150

0 to 20.0

PvO2Partial Pressure of Mixed Venous Oxygen

mmHg

kPa

38

5.1

0 to 99

0 to 15.0

SvO2 Mixed Venous Oxygen Saturation % 75 0 to 99


Calculations

Calculating O2AV, O2AVI, VO2, and VO2I requires a CO value to complete the calculations. The most recent CO value (less than 15 minutes old) is used for these calculations if it is available.

To view current oxygenation calcs:

• Touch CALCS.• Touch OXY CALCS.

Table 9: Oxygenation Output

Label Name Units

CTaO2 Arterial Oxygen Content ml/dl

CTvO2 Venous Oxygen Content ml/dl

avDO2Arteriovenous Oxygen Content difference

ml/dl

O2AV Oxygen Availability ml/min

O2AVI Oxygen Availability Index ml/min/m2

VO2 Oxygen Consumption ml/min

VO2I Oxygen Consumption Index ml/min/m2

O2ER Oxygen Extraction Ratio None

PAO2 Partial Pressure of Alveolar OxygenmmHg

kPa

Qs/Qt Pulmonary Venous Admixture Shunt %

P/F PaO2/FiO2 ratio None

Table 10: Oxygenation Equations

CTaO2 = (1.34 × Hgb × SpO2100) + (0.0031 × PaO2)

CTvO2 = (1.34 × Hgb × SvO2/100) + (0.0031 × PvO2)

avDO2 = CTaO2 – CTvO2

O2AV = CTaO2 × CO × 10


Calculations

Renal Calculations

Renal calculations provide data related to kidney function. Input for Renal calculations, other than a previously entered BSA, must be manually entered. The system automatically computes BSA when you enter a height and weight into this menu.

O2AVI = O2AV/BSA

VO2 = avDO2 × CO × 10

VO2I = VO2/BSA

O2ER = (CTaO2 – CTvO2)/CTaO2

PAO2 = [(FiO2/100) × (PB* – 47)] – PaCO2 /0.8

Qs/Qt= 100 × [(1.34 × Hgb) + (0.0031 × PAO2) – CTaO2]

[(1.34 × Hgb) + (0.0031 × PAO2) – CTvO2]

* PB = Barometric Pressure

To view current renal calcs:

• Touch CALCS.• Touch RENAL CALCS.

Table 11: Renal Input


Valid Range

URK Urine Potassium mEq/l 60 0 to 300

PLOSM Plasma Osmolality mOsm/L 290 0 to 999

UROSM Urine Osmolality mOsm/L 575 0 to 9999

SerNa Serum Sodium mEq/l 140 0 to 999

CR Serum Creatinine mg/dl 1.10 0 to 9.99

Table 10: Oxygenation Equations (continued)


Calculations

UCR Urine Creatinine mg/dl 50.0 0 to 999.9

BUN Blood Urea Nitrogen mg/dl 12 0 to 999

URNa Urine Sodium mEq/L 90 0 to 999

URINE Urine Volume ml/day 2000 0 to 9999

Table 12: Renal Output

Label Name Units

URNaEX Urine Sodium Excretion mEq/day

URKEX Urine Potassium Excretion mEq/day

Na/K Urine Sodium: Potassium Ratio Ratio

COSM Osmolal Clearance ml/day

CH2O Water Clearance ml/day

U/POSM Urine: Plasma Osmolality Ratio Ratio

FENa Fractional Sodium Excretion %

CRCL Creatinine Clearance ml/min/m2

NSLOSS Non-Saline Loss ml/day

BUN/CR BUN: Creatinine Ratio Ratio

U/CR Urine: Serum Creatinine Ratio Ratio

Table 11: Renal Input (continued)


Valid Range


Calculations

Drug Dosage Calculations

When you touch DRUG CALCS, either the Adult Drug Calcs screen or the Neonatal Drug Calcs screen displays, along with the Drug Dosage menu (refer to Figure 25-2 and Figure 25-3).

Note:

Since only three columns appear on the screen at one time, each illustration includes two screens — one with columns for Drug A, B, and C, and one with columns for Drug D, E, and F.

Table 13: Renal Equations

URNaEX = URNa × URINE/1000

URKEX = URK × URINE/1000

Na/K = URNa/URK

COSM = (UROSM/PLOSM) × URINE

CH2O = URINE – COSM

U/POSM = UROSM/PLOSM

FENa = (URNa/SerNa) × (CR/UCR) × 100

CRCL = (UCR/CR) × (URINE/1440) × 1.73/BSA

NSLOSS = URINE – (URINE × UrNa/SerNa)

BUN/CR = BUN/CR

U/CR = UCR/CR


Calculations

Display Detail - Drug Dosage Calculations

Figure 25-2: Adult drug calcs (drug keys A - F)

2007

2007


Calculations

Figure 25-3: Neonatal drug calcs (drug keys A – F)

Select the DRUG A – F keys as you selected the DAY/TIME keys in other calculations tables. When you begin drug dosage calculations, the patient's currently stored weight (automatically converted to kilograms) appears in the table. Thereafter, selecting a drug key allows you to edit the data in the column below it.

2007

2007


Calculations

The DRUG A – F keys do not display actual drug names. However, each column's default values are derived from common mixtures of frequently used drugs.

Entering Drug Dosage Values

From the Drug Dosage menu you can edit the inputs, store up to six drug records, display two titration tables for each of these drug records, and print any of the displayed information.

You can enter drug values for adults or neonates, depending on the current patient type selection (refer to Discharging a Patient on page 3-10 for more information). If NEONATE was selected, the MIX/TITRATE key is displayed. The MIX/TITRATE key toggles to highlight either MIX or TITRATE and affects how calculations are performed when the DOSE is edited.

While WEIGHT is the only drug dosage input automatically entered by the system, default values are present when you first display the table. You can edit any value by manually entering a new value. Weight must be entered in kilograms.

Table 14: Drug Dosage Equations

CONC = Amount/Volume

RATE = Dose/Conc

DOSE = Rate × Conc

TOTAL VOL

= Rate × Duration

TOTAL DOSE

= Dose × Duration

Table 15: Drug Dosage Calculations

Label Name Valid Range Possible Units of Measure

AMT Amount 0.01 to 9999.99mcg, mg, g, mEq, units, k units, m units

VOL Volume 1 to 9999 ml

CONC Concentration 0.01 to 9999.99mcg/ml, mg/ml, g/ml, mEq/ml,units/ml, k units/ml, m units/ml

WEIGHT Weight 0.2 to 250.0 kg

DOSE/MIN & DOSE/HR

Dose/Time 0.01 to 9999.99* mcg/xx, mg/xx, g/xx, mEq/xx, units/xx, k units/xx, m units/xx


Calculations

* Where xx is minutes or hours.

To begin editing input values, touch a DRUG key. Touch EDIT INPUTS to display the Edit Inputs menu. Touch any input key on the Edit Inputs menu, except UNITS and DOSE (described later), to display the on-screen keypad. During editing, the menu prompt shows the minimum and maximum values you can enter. Touch ENTER in the on-screen keypad to update the Drug Dosage table.

Changing Units of Measure

Units of measurement are displayed on the table to the right of the data values. Changing the selected units for AMOUNT may also change the displayed units for CONC. Changing the selected units for DOSE may also change the displayed units for DOSE/WT and TOTAL DOSE.

If the values for CONC, DOSE/HR, DOSE/WT/HR, and TOTAL DOSE exceed the range of their currently selected units, that value is divided by 1000 and the units change accordingly. For example, if the value for TOTAL DOSE is 123,456 mg, it will be displayed as 123.46 g. This value is rounded because only two digits can be displayed to the right of the decimal point.

DOSE/WT/MINandDOSE/WT/HR

Dose/Weight/Time 0.01 to 9999.99* mcg/kg/xx, mg/kg/xx, g/kg/xx, mEq/kg/xx, units/kg/xx, k units/kg/xx, m units/kg/xx

RATE Flow Rates 0.1 to 999.99 ml/hr

DUR Duration 0.1 to 999.99 hr

TOTAL DOSE Total Dose 0.01 to 9999.9mcg, mg, g, mEq, units, k units, m units

TOTAL VOL Total Volume 0.1 to 9999.99 ml

To access local or remote drug calcs:

• Touch SPECIAL FUNCTIONS.• Select LOCAL or REMOTE TRENDS/CALCS.• If you selected REMOTE TRENDS/CALCS, select a bed.• Touch DRUG CALCS.• Select DRUG A, B, C, D, E, or F.

To enter a drug dose value:

• Access Local or Remote Drug Calcs.• Touch EDIT INPUTS.• Select the desired key.• Use on-screen keypad to change value.• Touch ENTER on the on-screen keypad.

Table 15: Drug Dosage Calculations (continued)

Label Name Valid Range Possible Units of Measure


Calculations

WEIGHT is displayed in kilograms (kg), regardless of the system's setting for weight. Weights in pounds automatically convert to kilograms prior to being displayed.

Units Submenu

This menu allows you to choose one of three types of units (grams, mEq, and units) for AMOUNT or DOSE.

Changing the units for AMOUNT may change the units for CONC. Changing the unit type for AMOUNT changes the unit type for DOSE. Either may scale the values and units for CONC, DOSE, DOSE/WT, and TOTAL DOSE up or down for values less than 0.01 or greater than 9999.99.

Changing the units for DOSE may change the units for DOSE/WT and TOTAL DOSE. As a result, both the minute and hour values for DOSE and DOSE/WT may change.

Dose Submenu

When you select DOSE in the Edit Inputs menu, four dose type keys are displayed. Select any of these keys to edit the corresponding value shown in the Drug Dosage Calculations table. The system automatically calculates and displays the changes for the other three dose types in the Drug Dosage Calculations table.

The dose type selected for a specific drug defines the dose unit used for that drug's titration tables. When you store a Drug Calculation record, the dose type is also stored.

Storing a Record

Touch STORE ENTRY to store the record and to display the letter s under the associated DRUG key. You can store six records, one for each DRUG key. If you edit a record that has been stored, the system removes the letter s because the newly edited changes have not been stored.

To change drug units:

• Access Local or Remote Drug Calcs.• Touch EDIT INPUTS.• Touch UNITS.• Select units to change.

To store a drug record entry:

• Access Local or Remote Drug Calcs.• Select a Drug key.• Touch STORE ENTRY.


Calculations

Displaying Titration Tables

The VARY RATE/DOSE toggle key and DOSE TYPE keys are displayed when you touch TITRATION TABLE. VARY RATE varies the rate (holding the concentration constant) and calculates (titrates) the corresponding dose using the selected dose unit type. VARY DOSE varies the dose (holding the drug concentration constant) and calculates (titrates) the corresponding delivery rate in ml/hr.

The DOSE TYPE key displays the DOSE TYPE menu where the dose values are displayed and the Titration table is updated with the selected dose type. This key is disabled whenever VARY RATE is selected, and enabled when VARY DOSE is selected.

In the titration tables, flow rate and dose are calculated using the equations below.

To display titration tables:

• Access Local or Remote Drug Calcs.• Touch TITRATION TABLE.

To vary based on rate/dose:

• Access Local or Remote Drug Calcs.• Touch TITRATION TABLE.• Touch VARY RATE/DOSE.

FLOW RATE in ml/hr =DOSE × 60 min/1 hr

AMOUNT/VOLUME

DOSE in xx/min =FLOW RATE × AMOUNT × 1 hr/60 min

VOLUME


Calculations

Figure 25-4: Titration table

Figure 25-4 displays a sample Vary Rate Titration table. The amount and volume is displayed at the top of the table along with the dose and rate units. The units for amount and dose are the same units used in the Drug Dosage table.

The drug (A through F) and patient weight are displayed at the top of the table.

Dosages can vary between 0.01 and 9999.99 mg/min, and rates can vary between 0.1 and 999.99 ml/hr.

The patient type (ADULT or NEONATE) is displayed in the upper left corner of the table.

Caution:If any value in the Drug Calculation table is over its designated range, ++++.++ will be displayed for values of AMOUNT, CONC or DOSE, or RATE and the Titration Table becomes inaccessible.

Adjusting the Table Range

Use the SCROLL and PAGE keys in the Titration Table menu to select the range of data displayed in the titration table. The default range is 1 to 100.

2007


Calculations

Printing

Touch the PRINT key to print the currently displayed page of the Calculations table. The complete table prints on a four-channel recorder. On a two-channel recorder, the top half of the table prints first followed by the bottom half.

Recalculations

You can recalculate all Drug Dosage inputs except for the amount/hour entries shown for DOSE and DOSE/WT. In most cases, changing one parameter automatically recalculates and redisplays other parameters under that DRUG key. Table 16 shows adult patient recalculation rules, except where noted in AMOUNT and VOLUME. When TITRATE on the MIX/TITRATE key is selected, DOSE, DOSE/WEIGHT, and FLOW RATE results are the same for Adult and Neonatal.

To print calcs data:

• Access Local or Remote Drug Calcs.• Touch PRINT.

Table 16: Drug Dosage Recalculations

Edit Constants Results

AMOUNT

Holds VOLUME constant Calculates CONC

Holds DOSE (dose/min) constant

Calculates FLOW RATE (ADULT only)

Holds DUR constant Calculates TOTAL VOL (ADULT only)

Holds DOSE constant Calculates FLOW RATE

Holds DUR constant Calculates TOTAL DOSE (NEONATAL only)

VOLUME

Holds AMOUNT constant Calculates CONC

Holds DOSE/MIN constant Calculates FLOW RATE (ADULT only)

Holds DUR constant Calculates TOTAL VOL (ADULT only)

Holds DOSE constant Calculates FLOW RATE

Holds DUR constant Calculates TOTAL DOSE and VOL (NEONATAL)

CONC

Holds VOLUME constant Calculates AMOUNT

Holds DOSE/MIN constant Calculates FLOW RATE

Holds DUR constant Calculates TOTAL VOL

WEIGHTHolds DOSE/MIN constant Calculates DOSE/WEIGHT/MIN

Holds DOSE/HR constant Calculates DOSE/WEIGHT/HR


Calculations

DOSE or DOSE/WEIGHT (TITRATE)

Holds WEIGHT constant Calculates other 3 DOSE and DOSE/WEIGHTS

Holds CONC constant Calculates FLOW RATE

Holds DUR constant Calculates TOTAL DOSE and TOTAL VOL

DOSE or DOSE/WEIGHT (MIX)

Holds WEIGHT constant Calculates other 3 DOSE and DOSE/WEIGHTS

Holds FLOW RATE constant Calculates CONC


Holds DUR constant Calculates TOTAL DOSE

FLOW RATE (TITRATE)

Holds CONC constant Calculates DOSE/MIN and DOSE/HR

Holds WEIGHT constantCalculates DOSE/WEIGHT/MIN and DOSE/WEIGHT/HR

Holds DUR constant Calculates TOTAL VOL

FLOW RATE (MIX)

Holds DOSE/HR constant Calculates CONC


Holds DUR constant Calculates TOTAL DOSE and TOTAL VOL

DURHolds DOSE/MIN constant Calculates TOTAL DOSE

Holds FLOW RATE constant Calculates TOTAL VOL

TOTAL DOSE

Holds CONC constant Calculates FLOW RATE

Holds DUR constant Calculates DOSE/MIN, DOSE/HR, and TOTAL VOL


TOTAL VOL

Holds DUR constant Calculates FLOW RATE

Holds CONC constantCalculates DOSE/WEIGHT/MIN and DOSE/WEIGHT/HR


Table 16: Drug Dosage Recalculations (continued)

Edit Constants Results


Calculations

Configurable Drug Names (UCW and Ultraview 1700 Only)

Using the Drug Name List

To use the list of drug names:

1 Touch the DRUG key in the Drug Calcs Edit Inputs menu.

Figure 25-5: Edit Inputs menu

2 The DRUG NAME LIST menu appears, enabling you to choose from the master drug list. Select the appropriate drug name and then touch ACCEPT. The drug name and stored default values are transferred into the currently selected drug (A through F). Select CANCEL to remove the selection menu without changing the current settings for the drug. Drug Calcs will display the selected drug name below the key.

Figure 25-6: Drug Calcs display

Note:

The drug default values for drugs A through F can be overwritten and not affect the master drug list entry. However, selecting another drug name for drug A, B, C, D, E, or F will override all previously edited values and will insert the master default settings. Ensure that the changes are effected after selecting the drug name (and not before).

Remote Drug Names

Drug names on local bedside monitors can be edited remotely from the host monitor. The local names can be stored in the remote monitor even if the remote bed does not include the drug in its own stored list. Drug names can be kept consistent by transferring master drugs lists from one bed to another allowing remote bed access to the master drug list.


Calculations

Table 17: Hemodynamic Calculations

Variable Calculation Normal Range*

Cardiac Index (CI) CO BSA 2.5 to 4.0 liters/min/m2

Stroke Volume (SV) CO × 1000 HR 60 to 130 ml/beat

Stroke Volume Index (SVI) SV BSA 30 to 65 ml/beat/m2

Systemic Vascular Resistance (SVR) MAP – CVP × 79.9 CO 900 to 1400 dynes × sec/cm5

Systemic Vascular Resistance Index (SVRI)

MAP – CVP × 79.9 CI(Converts to SVR × BSA)

1760 to 2600 (dynes × sec/cm5) × m2

Pulmonary Vascular Resistance (PVR) MPA - PCWP × 79.9 CO 20 to 130 dynes × sec/cm5

Pulmonary Vascular Resistance Index (PVRI)

MPA - PCWP × 79.9 CI(Converts to PVR × BSA)

36 to 235 (dynes × sec/cm5) × m2

Left Ventricular Stroke Work (LVSW) (MAP – PCWP) × SV × 0.0136

Left Ventricular Stroke Work Index (LVSWI)

(MAP – PCWP) × SVI × 0.0136(Converts to LVSW/BSA)

45 to 75 g × min/m2/beat

Right Ventricular Stroke Work (RSVW) (MPA – CVP) × SV × 0.0136

Right Ventricular Stroke Work Index (RVSWI))

(MPA – CVP) × SVI × 0.0136(Converts to RVSW/BSA)

4 to 8 g × min/m2/beat

(HR = Heart Rate; BSA = Body Surface Area; MAP = Mean Arterial Pulse; CVP = Central Venous Pressure; MPA = Mean Pulmonary Artery Pressure; PCWP = Pulmonary Capillary Wedge Pressure)

Table 18: Renal Calculations

Variable Acquisition Method or Calculation Units

Urine Potassium (URK) Laboratory Measurement mEq/L

Plasma Osmolality (PLOSM) Laboratory Measurement mOsm/L

Urine Osmolality (UROSM) Laboratory Measurement mOsm/L

Serum Sodium (SerNa) Laboratory Measurement mEq/L

Serum Creatinine (CR) Laboratory Measurement mg/dl

Urine Creatinine (UCR) Laboratory Measurement mg/dl

Blood Urea Nitrogen (BUN) Laboratory Measurement mg/dl

Urine Sodium (URNa) Laboratory Measurement mEq/L


Calculations

Note:

The values listed here represent commonly published ranges for adults and are for reference purposes only.

Urine Volume (URINE) Data Entry ml/day

Urine Sodium Excretion (URNaEX) URNa × URINE/1000 mEq/day

Urine Potassium Excretion (URKEX) URK × URINE/1000 mEq/day

Urine Sodium to Urine Potassium Ratio (Na/K) URNa/URK (ratio)

Osmolar Clearance (COSM) (UROSM/PLOSM) × URINE ml/day

Water Clearance (CH2O) URINE – COSM ml/day

Urine Osmolality to Plasma Osmolality Ratio (U/POSM)

UROSM/PLOSM (ratio)

Fractional Sodium Excretion (FENa) (URNa/SerNa) × (CR/UCR) × 100 %

Creatinine Clearance (CRCL) (UCR/CR) × URINE/1440) × 1.73/BSA ml/min/m2

Non-Saline Loss (NSLOSS) URINE – (URINE × URNa/SerNa) ml/day

BUN to Creatinine Ratio (BUN/CR) BUN/CR (ratio)

Urine Creatinine to Serum Creatinine Ratio (U/CR)

UCR/CR (ratio)

Table 19: Oxygenation Calculations


Arterial Oxygen Saturation (SaO2)

Laboratory Measurement (SaO2) -OR-Pulse Oximetry (SpO2)

95 to 100%

Partial Pressure of Arterial Oxygen (PaO2)

Laboratory Measurement 80 to 100 mmHg

Mixed Venous Oxygen Saturation (SvO2)

Laboratory Measurement or Monitored Value 60 to 80%

Partial Pressure of Mixed Venous Oxygen (PvO2)

Laboratory Measurement 35 to 45 mmHg

Oxygen Availability (O2AV) CTaO2 × CO × 10 900 to 1100 ml/min

Oxygen Availability Index (O2AVI)

O2AV/BSA 497 to 608 ml/min/m2

Table 18: Renal Calculations (continued)

Variable Acquisition Method or Calculation Units


Calculations

Arterial Oxygen Content (CTaO2)

(1.34 × Hgb × SpO2/100) + (PaO2 × 0.0031) 18 to 20 ml/dl

Mixed Venous Oxygen Content (CTvO2)

(1.34 × Hgb × SvO2/100) + (PvO2 × 0.0031) 14 to 16 ml/dl

Arterial/Venous Oxygen Difference (avDO2)

CTaO2 – CTvO2 3 to 5.5 ml/dl

Oxygen Consumption (VO2) avDO2 × CO × 10 200 to 300 ml/min

Oxygen Consumption Index (VO2I)

VO2/BSA 110 to 166 ml/min/m2

Oxygen Extraction Ratio (O2ER) VO2/O2AV (Simplifies to avDO2/CTaO2) 1/4 or 0.25

Partial Pressure of Alveolar Oxygen (PAO2)

[(FiO2/100) × (PB – 47)] – PaCO2/0.8 100 mmHg

Pulmonary Venous Admixture Shunt (Qs/Qt)

100 × [(1.34 × Hgb) + (0.0031 × PAO2) – CTaO2)](1.34 × Hgb) + (0.0031 × PAO2) – CTvO2

Variable, depending on FiO2

PaO2/FiO2 Ratio (P/F) PaO2/FiO2Variable, depending on FiO2

(Hgb = Hemoglobin; PB = Barometric Pressure)

Table 20: Respiration Calculations

Variable Calculation Units

Respiratory Rate (RR) Monitored Value or Ventilator breaths/min

Partial Pressure of Arterial Carbon Dioxide (PaCO2) Laboratory Measurement mmHg

Tidal Volume (VT) Ventilator ml/breath

Peak Inspiratory Pressure (PIP) Ventilator cmH2O

Plateau Pressure (PLT) Ventilator cmH2O

Positive End Expiratory Pressure (PEEP) Ventilator cmH2O

Partial Pressure of Expired Carbon Dioxide (PECO2) Data Entry mmHg

Minute Volume (VMIN) VT × RR/1000 L/min

Static Compliance (Cst) VT/(PLT - PEEP) ml/cmH2O

Dynamic Compliance (Cdyn) VT/(PIP – PEEP) ml/cmH2O

Table 19: Oxygenation Calculations (continued)



Calculations

Note:

Acceptable values for individual patients should be determined by hospital protocol and the attending physician.

Dead Space Volume (VD) (PaCO2 – PECO2) × (VT/PaCO2) ml

Dead Space to Tidal Volume Ratio (VD/VT) VD/VT (ratio)

Alveolar Ventilation (VA) (VT – VD) × RR ml/min

Table 20: Respiration Calculations (continued)

Variable Calculation Units


Trends

Directory of Keys


LOCALTRENDS/CALCS

REMOTETRENDS/CALCS

SPECIAL FUNCTIONS

NOTE: Requires Trend/Calcs enabled

Ultraview 1030/1050/1500/1600

UCW/Ultraview 1700

See next page

BED 1 BED 2 BED 3 BED 4 BED 5 MORE

REMOTE TRENDS/CALCS - Select bed


Trends

Directory of Keys


GRAPHICTRENDS

TABULARTRENDS

CALCS

2HRS

6HRS

12HRS

24HRS

ARTECGHR

CHANGE TIME BASE

TIMEBASE

TOPGRAPH

BOTTOMGRAPH

EXPANDON OFF

TABULARTRENDSPRINTSIZE

CURSOR CURSOR

RESPRR TEMP

TREND PARAMETERS

RESPRR

ECGHR

ECGABN

CHANGE SIZE

GRAPHIC TRENDS

NOTE: Keys are labeled according to parameters currently being trended

NOTE: Keys are labeled according to parameters currently being trended

1MIN

5MIN

10MIN

30MIN

15MIN

1.5HR

1HR

3HR

PRINTGRAPHICTRENDS

TIMEINTERVAL

PAGESCROLL

TABULAR TRENDS

CHANGE TIME INTERVAL

Refer to Printing the Trend Displayin this chapter

TRENDS/CALCS for BED xxx

DRUGCALCS

Refer to Calculations chapter

Refer to page 26-1


Trends

Contents

Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Printing the Trend Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Graphic Trends Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Tabular Trends Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Trends Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Overview

Trends are a convenient way of displaying numeric data that has been collected for a patient over the last 24 hours. Your monitor can display a graphic trend or tabular trend (depending on the option purchased) of collected numeric data for every parameter except delta temperature and EEG. This data appears in a table format similar to common flowsheets or spreadsheets.

Graphic trends can appear in three formats.

• Continuous trends represent parameters with continuous monitoring. A solid line connects trend points.

• Episodic trends represent parameters that produce individual events. Episodic values are displayed as an x, +, or 0. A dotted line connects each episode.

• Histogram trends are displayed as vertical bars starting at a base of zero.

The system collects trend values every minute and episodic trend values as they become available. Up to the last 24 hours of collected data in memory is displayed and the system saves trend values for as long as memory limitations allow. In most cases, an episodic trend contains at least 30 values.

Note:

When you suspend alarms with the TONE RESET/ALM SUSPEND key the system may not collect trend data. Contact your system administrator to enable this function.

To display a trend:

• Touch SPECIAL FUNCTIONS.• Select LOCAL TRENDS/ CALCS or REMOTE TRENDS/ CALCS.• If you touched REMOTE TRENDS/CALCS, select a bed.• Touch GRAPHIC TRENDS.

-OR-

• Touch TABULAR TRENDS.

(Follow these three steps to start each quickstart in this chapter.)


Trends

Display Detail

Graphic Trend Display

Figure 26-1: Graphic trends display

� Trend unit of measure (unit labels are not displayed for parameters with one acknowledged unit of measure for example, ECG, RESP, and CO.)

� Scale value - use SIZE key to select

� Bed and patient identification

� Cursor

� Data values for top graph*

� Upper trend time axis

� Right axis for bottom graph

Data values for bottom graph*

Lower trend time axis

� Left axis for bottom graph

* When the cursor is displayed, data values reflect those at the cursor location, and the Values at label is displayed. When the cursor is not displayed, data values reflect current values, and the Current Values label is displayed.

Bed: S114

Values atTime: 08:27

Left axis:ART (mmHg)SYS = 136MEAN = (96)DIA = 74

Left axis:ECGHR = 128Right axis:ABN = 10

-6 -5 -4 -3 -2 -1 0 hr0

300

200

08:30a 9:30a 10:30a 11:30a 12:30a 1:30p

0

20

kpa

mmHg

Date: 02 Dec 2008Patient: Smith, A.

� � �

�

�

�

�

�


Trends

The system maintains settings for trend displays (time base, parameters, size, etc.) until you change them or display a new patient's trend.

The messages No trends available for this bed or Trend data not available appear when trend data has yet to be accumulated for the selected bed.

Tabular Trends Display

You can view a tabular trend of continuous patient data and episodic patient data acquired within the last 24 hours by touching the TABULAR TRENDS key.

Figure 26-2: Tabular trends display

� Bed identification

� Patient name

� Times that data was collected

� Date of tabular trend

� Trended data

� Unit of measure for each parameter

� List of parameters

Parameters always appear in descending order of priority. Data that is monitored on a continuous basis always precedes episodic data. Episodic values are presented according to the sequence in which they were originally stored. Data older than 24 hours is not displayed.

Calculations data does not appear in tabular trends.

Bed: 220 Patient SMITH, JOHN Date: 02 DEC 2008 CURRENT

Time 05:30 06:00 06:30 07:00 07:30 08:00 08:30 09:00

HR(ECG) b/min 70 75 82 67 76 85 72 77

ABN b/min 0 0 0 0 0 0 0 0

RR(RESP) br/min 8 14 9 9 8 8 14 14

ART/s mmHg 165 137 165 165 165 165 137 138

MAP mmHg 136 136 136 136 136 136 108 109

ART/d mmHg 108 80 108 108 108 108 80 81

� � � �

� � �


Trends

Printing the Trend Display

You can print a copy of the displayed graphic trend or tabular trend at any time.

Note:

When using a two-channel printer, the top and bottom half of the trend display print consecutively.

Graphic Trends Features

Selecting Trend Parameters

The first time you display a patient's graphic trend, the highest priority parameter is displayed on the bottom trend graph and the next highest priority parameter is displayed on the top graph. You can view other trends by selecting them from the Trend Parameter menu.

To print the trend display:

• Adjust trend display as desired.• Touch PRINT.

To select a parameter for the top or bottom graph:

• Select TOP GRAPH or BOTTOM GRAPH.• Select desired parameter.


Trends

Using the Cursor

The graphic trends cursor is a solid, vertical line that moves across the entire trend graph (refer to Figure 26-1 on page 26-4). The home position of the cursor is at the extreme right end of the graph. Once the cursor moves from its home position, the CURRENT VALUES label changes to reflect the cursor’s current position. The CURRENT VALUES label now displays VALUES at and the time. These values represent the data acquired from the patient.

Note:

• The trend graph continues to update EXCEPT when the cursor is moved from its home position. It updates again when the cursor returns to its home position.

• When switching between Graphic Trends and Tabular Trends, the cursor remains in the same position. For example, if the cursor is placed on data two hours previous to the current time in Graphic Trends, when moving directly to Tabular Trends, the screen will display the same time frame, and the corresponding data column will be highlighted.

Selecting a Time Base

The time base for each trend graph can be set for 2, 6, 12, or 24 hours. The displayed resolution for each time base is:

To move the cursor:

• Touch cursor keys as needed.

2 hours = 1 minute

6 hours = 1 minute

12 hours = 2 minutes

24 hours = 4 minutes

To set a trend graph time base:

• Touch TIME BASE.• Select 2, 6, 12, or 24 HRS.


Trends

Selecting a Scale Size

You can adjust the scale for each parameter. Initially, the system selects a scale that includes all monitored values for the displayed parameter. You may adjust the scales using the arrow keys.

Expanding the Trend Display

You may expand the trend display to include only an hour's worth of information. With EXPAND ON, the TIME BASE key does not operate and updating of the trend graph is suspended on the graph as it is currently displayed. When EXPAND is OFF, the trend graph returns to its original display. Moving the cursor while EXPAND is ON does not change the cursor's position in the OFF mode.

Tabular Trends Features

Setting a Time Interval

You can display acquired data at various time intervals: 1, 5, 10, 15, and 30 minutes; and 1, 1.5, and 3 hours.

For continuous data, the value displayed in the tabular trend table is the value taken at the displayed time. It is not an average of all readings taken during that time period.

When more than one episodic reading occurs in the same time interval, only the most recent value is displayed. Asterisks to the right of the episodic value indicates that more data entries are available for that time interval.

The trend table automatically updates at the end of each time interval. This shifts all data columns to the left to include the new interval.

Note:

Updating is suspended when you review data while paging or scrolling.

To adjust the scale size:

• Touch SIZE.• Select desired parameter key.• Use arrow keys to adjust.

To expand the trend display:

• Touch either CURSOR key to move the cursor to the desired location.• Select EXPAND ON.


Trends

Viewing Off-Screen Information

You can view up to 22 rows and 7 columns of parameter data on a single screen in a tabular trend.

You can view additional parameters by moving rows up or down. When you select PAGE, the arrow keys move the entire page up or down. When you select SCROLL, the arrow keys move the display up or down one parameter row at a time.

You can view data collected at other times by moving columns left or right. When you select PAGE, the arrow keys move the display to show an entirely new set of columns. When you select SCROLL, the arrow keys move the display left or right by one column.

To set a time interval

• Touch TIME INTERVAL.• Select the desired time interval.

To view additional parameters and data (for Tabular Trends):

• Select PAGE or SCROLL. • Use the and arrow keys to move parameter rows up or down.

To view additional parameters and data (from a different time):

• Use the PAGE and SCROLL up and down arrow keys to move parameter rows vertically.

-OR-

• Use the PAGE and SCROLL left and right keys to move data columns horizontally.


Trends

Trends Troubleshooting Guide


Current patient data not being added to trends

■ If alarms are suspended data may not be trended at the bedside monitor.

■ Turn ON alarms or have your system administrator enable your system to trend while alarms are suspended.

■ EXPAND key ON(trend data will not be lost).

■ Change EXPAND to OFF.

■ ECG or SpO2 processing is suspended.

■ Resume ECG or SpO2 processing.

■ Cursor not in home position(trend data will not be lost).

■ Move the cursor to the extreme right position.

PCWP trend not available

■ PCWP values not saved. ■ Save the PCWP values.

Incorrect unit of measure displayed

■ Incorrect unit of measure configured for system.


CALCS data not trended

■ Trends cannot trend CALCS. ■ Use the CALCS menu to display this data.

NO TRENDS AVAILABLE FOR THIS BED message isdisplayed

■ No trend data has yet accumulated for the selected parameter.

■ Allow sufficient time for data to accumulate.

Numerous entries with ??? instead of vital signs

■ Alarm Suspend was selected frequently.

■ Contact your system administrator to collect data during Alarm Suspend periods.

■ ECG/Resp or SpO2 processing suspended.

■ Do not suspend ECG or SpO2 processing unless the patient is off the system.

■ Ensure that ECG/Resp amplitude and signal quality are sufficient.


Remote Keypad



ADMIT/DISCHARGE

MONITORCONFIG.

TONES

MONITOR SETUP

PRIVILEGEDACCESS

SECURE MODEON OFF

RESETMONITOR



UNITS OFMEASURE

USER MOREALARMSETUP


CLINICAL LEVEL: Select Parameter

TIME/DATE ACCESS

ALARM WATCHSETUP

CLINICAL LEVEL - Set remote keypad station address: X

RECORDERCONFIG.

MOUSECONTROL



Remote Keypad

Contents

Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Setting Up the Remote Keypad . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Setting Up the Receiver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Selecting a Parameter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Operating Menu Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Recording a Waveform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Programming Access Codes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Remote Keypad Troubleshooting Guide. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Overview

The remote keypad option allows you to remotely suspend or adjust alarms, access graphic trends, adjust waveform size, initiate recordings, etc. The zoom function enlarges menu keys on the monitor making them easy to read from across the room.

Note:

The operational range of the remote keypad is approximately 20 feet.

Setting Up the Remote Keypad

The remote keypad is a cordless, hand-held transmitter powered by an internal battery (refer to Figure 27-1). It sends your instructions via infrared signals to the monitor’s receiver. The maximum operating range is 20 feet at an angle of up to 45 degrees on either side of the receiver.

The remote keypad provides all of the functions you need to operate your monitor remotely.


Remote Keypad

Figure 27-1: Remote keypad

Setting Up the Receiver

An optional receiver is required for the Ultraview 1700. The receiver attaches to the side of the monitor and connects to the nurse alert port (J14) on the back of the monitor. A nurse alert may still be used with the monitor by plugging the nurse alert into the port on the rear of the receiver.

Note:

• The 90360-03 receiver is only compatible with the Ultraview 1700 S/N 387-1xxxxxx and higher.

• The receiver is integrated into the UCW, and no external receiver is required.

SPECIALFUNCTIONS

HELP

ZOOM ENTER RECORD


MONITORSETUP

WAVEFORMMENUPREVIOUS

MENU

NORMALSCREEN

97 8

64 5

31 2

.DEL 0ACCESS

CODE

Press to activate the keyhighlighted with the cursor

Press to place cursor on

Press to move cursorup, down, right, or left

Press to enlarge keys forease of viewing at a distance

Press to change focusamong multiple applications,

Press as necessary toenter a numeric value

Press to delete a previous entry

first parameter key

within an application

or to place cursor on first

or to enter the security code in access mode

menu key (or icon)

or to position cursor

up, down, right, or left


Remote Keypad

Selecting a Parameter

The parameter (waveform) keys display vertically near the right side of the screen, with parameter number one at the top (except on a split screen central display). Press the WAVEFORM key to activate the parameter (waveform) selection mode.

Note:

The remote keypad cursor remains on the screen for approximately one minute following the last keypad activity or until you touch the touchscreen itself.

Operating Menu Keys

The menu keys display horizontally across the bottom of the screen with menu key number one at the far left. Press the ZOOM key once to activate the zoom feature, making each key easier to see. Press the ZOOM key again to turn OFF the zoom feature.

To select a parameter:

• Point the remote keypad at the monitor’s receiver.• Press WAVEFORM for parameter number 1.• Press up or down arrow keys to desired parameter.

-OR-

• Press the number of the desired parameter.• Press ENTER.

To operate menu keys:

• Point the remote keypad at the monitor’s receiver.• Select a parameter key.• Press MENU.• Press left or right arrow key to desired position.

-OR-

• Press the number of the desired menu key.


Remote Keypad

Recording a Waveform

After you activate the RECORD key, you have two seconds to highlight a parameter (waveform) key. To ensure enough time in making a selection, place the cursor on the parameter (waveform) key and press the cursor for an additional two seconds, before you press the RECORD key on the remote keypad.

Note:

When printing several parameters at the same time or when trying to print an event such as a single abnormal beat, it is easier to use keys on the monitor rather than on the remote keypad to direct the recording.

Programming Access Codes

Access codes ensure that the receiver responds only to a remote keypad with a matching code number. If a keypad's access code differs from the receiver's, the command is ignored. This prevents interference from other remote keypads.

The programmed access code (1 to 32) is displayed on the monitor. This code is stored in the monitor’s memory and retained whenever the monitor is reset or powered OFF.

Note:

Remote keypad systems can be operated in an unsecured mode without access codes so that the receiver accepts commands from any remote keypad. When in the unsecured mode, the word ALL appears on the monitor.

When programming a monitor's access code, the keypad's access code must initially match the receiver's. The new access code is programmed simultaneously with the keypad's. The monitor temporarily displays the remote keypad's access code, then returns to displaying its own code.

Note:

To prevent inadvertently changing other access codes, unplug all other monitors (or move the remote keypad directly in front of the monitor to be programmed) and place your finger over the remote keypad's infrared window during programming (sufficient signal transmits through your finger to program the receiver).

To print data from a waveform zone:

• Point remote keypad at the monitor’s receiver.• Press up or down arrow keys to desired parameter.

-OR-

• Press the number of the desired parameter.• Press RECORD.• Repeat step 2.• Press ENTER.


Remote Keypad

To select the unsecured mode:

• Touch MONITOR SETUP.• Touch PRIVILEGED ACCESS.• Enter Clinical password.• Touch MORE.• Touch REMOTE KEYPAD STATION ADDRESS.• Select SECURED MODE OFF.

To verify a remote keypad's current access code:

• Point the remote keypad at the monitor’s receiver.• Touch ACCESS CODE.• Touch ENTER.

To set a remote keypad's access code:

• Point the remote keypad at the monitor’s receiver.• Touch ACCESS CODE.• Select first digit.• Select second digit.• Touch ENTER.

To set the monitor's access code:

• Touch MONITOR SETUP.• Touch PRIVILEGED ACCESS.• Enter Clinical password.• Touch MORE.• Touch REMOTE KEYPAD STATION ADDRESS.• Select SECURED MODE ON.• Use the arrow keys to select the number.


Remote Keypad

Remote Keypad Troubleshooting Guide


Monitor accepts commands from any keypad

■ Monitor operating in an unsecured mode.

■ Select an access code and program both the monitor/receiver and the keypad to that code.

During programming, another receiver was inadvertently changed

■ Remote keypad placed too close to another monitor’s receiver.

■ Move the keypad directly in front of the receiver to be programmed and place your finger over the keypad window during programming.

Monitor does not respond

■ Monitor may not support remote keypad.

■ Press the ACCESS CODE key. If an A is not displayed (below the NORMAL SCREEN key), contact your system administrator or biomed.

■ Depleted battery in remote keypad.

■ Replace battery in remote keypad.


Remote Display

Contents

Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Setting Up the Secondary Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Copying Stored Values of the Primary Monitor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Restoring a Stored Value . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Copying Primary Attributes to the Secondary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Resetting Default Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Tracking or Locking Displays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Adjusting Scaled Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Overview

The Ultraview 1700 provides an optional output to a remote-configurable secondary display. This secondary display enables you to view selected parameters from the primary display.

The primary monitor is used to control the configuration and waveform display characteristics of the secondary remote display. The secondary display has no touchscreen surface or functional keys.

Setting Up the Secondary Display

The Configuration menu for the secondary display appears on the primary monitor. The menu functions identically to the primary monitor’s menu although it has three additional keys.

To set up the remote display:

• Touch MONITOR SETUP.• Touch SECONDARY CONFIG.• Touch PARAMETER CONFIG.• Select a parameter.• Select the destination priority.• Select a color.• Select the parameter key to be colored (the key and waveform will appear in the

chosen color).• Touch STORE to store local color and priority settings.


Remote Display

Selecting Colors and Priorities

Each parameter has a specific default color and priority. You can change the colors or priority levels of the parameters to customize the monitor to your specific needs.

After making any configuration change, touch STORE to make the secondary display changes permanent. If you do not touch STORE, the system disregards your changes.

Note:

Your display may not be configured to allow changes to parameter priorities or colors. Contact your hospital system administrator for details.

The PARAMETER CONFIG key allows you to change the system default priorities and colors. The current parameter priority and color default is visible from the DISPLAY PRIORITIES toggle key. The LOCAL key displays the current active parameters and the ALL key displays all possible parameters. Each parameter is assigned a display priority, with the highest priority appearing at the top of the screen.

Blank parameter keys allow you to force a space above, between, or below other parameters. Blanks can be inserted into any priority template by selecting the blank and putting it into the desired location. This causes a blank zone to be inserted into the corresponding display area and all active parameters with a lower priority to be pushed down.

The STORE key stores the current local priority and color settings into non-volatile memory.

The RESTORE key restores the last stored local priorities and color settings from memory.

The FACTORY DEFAULTS key restores the factory default priority and color settings.

Copying Stored Values of the Primary Monitor

Touch COPY PRIMARY PRIO/COLOR to duplicate the primary display's stored settings for priorities and colors on the secondary display. Touch STORE to put these changes into effect.

You can use the Copy Primary Prio/Color function to remove blank zones resulting from parameters that were deleted while the secondary display was in Lock mode.

To copy the stored values of the primary:

• Touch MONITOR SETUP.• Touch SECONDARY CONFIG.• Touch PARAMETER CONFIG.• Touch COPY PRIMARY PRIO/COLOR.• Touch STORE.


Remote Display

Restoring a Stored Value

Touch RESTORE to reset the secondary display’s configuration screen to its last stored changes. Restoring the screen also stops the Copy Primary function (if STORE has not yet been touched).

Copying Primary Attributes to the Secondary

Touch COPY PRIMARY PARAM ATTR to copy the primary's current parameter attributes or settings to the secondary display. Parameter colors and priorities are not copied.

Use this key to:

• Remove any blank zones caused by deleting a parameter while the secondary was locked.

• Insert any new parameters added while the secondary was locked.

• Change sizes, sweep speeds, full scales ON/OFF, etc., to match the primary monitor’s configuration.

To restore the last stored configuration:

• Touch MONITOR SETUP.• Touch SECONDARY CONFIG.• Touch PARAMETER CONFIG.• Touch RESTORE.

To copy the primary monitors configuration:

• Touch MONITOR SETUP. • Touch SECONDARY CONFIG.• Touch PARAMETER CONFIG.• Touch COPY PRIMARY PARAM ATTR.


Remote Display

Resetting Default Values

Touching FACTORY DEFAULTS resets the secondary display to its factory values. Touch STORE to make these changes permanent.

Options that can be reset include:

• Relative priorities and colors to factory default configuration of primary

• Blanks caused by deleting a parameter while in Lock Mode

Touching this key does not insert any new parameters added while the secondary display was in Lock Mode.

Tracking or Locking Displays

In addition to parameter color and priority, you may configure other attributes of the secondary display to be different from the primary monitor. To make additional adjustments to each display separately, select LOCK after you configure the secondary display. This allows the secondary display to remain largely unchanged when you adjust the primary display. If you need the secondary display to duplicate changes to the primary, set the secondary display to TRACK. Refer to the Table 1 (where X = yes) for the effect of Track and Lock on each display characteristic.

To make additional changes to the secondary screen after you select LOCK, return to the Secondary Configuration menu and touch TRACK.

To set factory default values of secondary display:

• Touch MONITOR SETUP.• Touch SECONDARY CONFIG.• Touch PARAMETER CONFIG.• Touch FACTORY DEFAULTS.• Touch STORE.

To lock the secondary display:

• Adjust parameter attributes on primary to reflect how you want the secondary to appear.

• Touch MONITOR SETUP.• Touch SECONDARY CONFIG.• Touch PARAMETER CONFIG.• Touch LOCK.


Remote Display

Table 1: Remote Display Track and Lock Chart

Always independent of primary

Track mode copies primary

Lock mode copies primary

Lock mode does not

copy primary

Colors/priorities X

Waveform size X X

Sweep speed X X

Full scales ON/OFF X X

Full scales 4/6 zones X

# of minor graticules X

Screen/waveform attributes X X

Addition of parameter on primary

X X

Deletion of parameter on primary

X X

Pressure/ECG key labels X X

Zone size of certain displayed parameters

X X


Remote Display

Adjusting Scaled Display

The display of parameters in scales for the secondary display is independent of the primary monitor. Scales are adjusted using the same menu as the primary except when a secondary display is enabled, the PRIMARY/SECONDARY key appears in the menu. This key allows you to choose which display you want to change.

To adjust the scaled display:

• Touch MONITOR SETUP.• Touch PRIVILEGED ACCESS.• Enter Clinical password.• Touch SCALED DISPLAY.• Touch PRIMARY/SECONDARY key to choose display to change.• Select MINOR GRATICULE ON.• Use arrow keys to adjust.


Patient Data Logger

Directory of Keys — Bedside only


PRIVILEGED

Enter BIOMED

BIOMED LEVEL - Serial Port Configuration

BIOMED LEVEL - Serial Port Settings: Changes committed on exit

DIAGNOSTICS DATA

ACCESS

SETTINGS ASSIGNMENT

DATA BITS8

STOP BITS1

ECHONONE

CR/LFNONE

PARITYNONE

XON/XOFFDISABLE

BAUD RATE9600

Restart monitor after selecting owner for serial port

PATIENT DATA LOGGER

ON OFF

LOGGER

SETUP

ALARM LOGGING

ON OFF

CHECKSUMS

ON OFF

SERIALPORTS

1 2

Patient Data Logger

Patient Data Logger - SETUP: Change the settings

SAMPLE RATE15 sec

password

DATALOGGER

To access Patient Data Logger

BIOMED LEVEL - Select Parameter

Select serial port to assign owner to


Patient Data Logger

Contents

Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Data Printouts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Patient Data Logger Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Overview

The Patient Data Logger option automatically sends patient vital signs from the monitor to an external device, such as a printer or a terminal. Episodic patient data is also sampled and transmitted. The output is in the form of ASCII text byte strings, and is printed using standard RS232 serial communications via the monitor’s serial port. Refer to the Display Detail on page 29-5 for further information.

This option continues to send data whether the external device is online or offline. Data transmission can be stopped by reassigning the data port or disabling the Patient Data Logger.

Your system administrator (or other designated personnel) must first set up communication between the monitor and the external device by assigning the serial port to Patient Data Logger, and then adjusting the serial port settings. The various serial settings can be adjusted to suit the device attached to the serial port. Refer to the appropriate service manual for more details.

The sample rate refers to the frequency of data sampling and can be set to time intervals ranging from 5 seconds to 60 minutes. The new sample rate takes effect at once.

Note:

• The option is only available on bedside monitors.

• Ensure that any cables or other computer or communications equipment connected to the bedside monitor comply with applicable medical standards.

• The combination of PDL baud rate and sample rate must be selected carefully. Slow baud rates, in combination with frequent data transmissions, may cause loss of data. This is especially true if a large amount of patient vital sign data is being monitored. However, some devices cannot accept data at high baud rates. This may limit the range of sample rates at which your device can accept data readings from the monitors.


Patient Data Logger

The data logger output requires a serial cable that swaps pins (refer to Table 1). The serial cable must be properly connected at both ends and the data logger output enabled.

Table 1: Serial Cable Pinout

Input Output

2 3

3 2

4 5

5 4

To set up Patient Data Logger (the user must have System Administrator access):

• Touch MONITOR SETUP.• Touch PRIVILEGED ACCESS.• Enter biomed password.• Touch SERIAL PORTS and select a port.• Touch ASSIGNMENT.• Touch DATALOGGER.• Touch PREVIOUS MENU.

To set serial settings:

• Touch SETTINGS.• Touch the desired setting key(s) to display desired settings.• Touch NORMAL SCREEN to effect changes.


Patient Data Logger

PATI

TIME %

14: 0.0

14: 0.0

14: 0.0

14: 0.0

14: 0.0

14: 0.1

14: 0.1

14: 0.1

14: 0.1

14: 0.1

14: 0.1

14: 0.1

Display Detail

The Patient Data Logger report is automatically sent to an external device, such as a printer or terminal, once the serial port is assigned and toggled ON.

The data fields that appear on this report (ECG, RESP, ART, SpO2, and EtCO2) will vary depending on the parameter modules installed on the system.

Figure 29-1: Patient Data Logger report sample

Note:

• All lines on this report are terminated by a line-feed, carriage-return combination.

• Lines may wrap if the line length exceeds the display or printer width.

• The report prints a maximum of 132 characters per line and 2 lines per entry.

• The report prints data from a maximum of 11 parameter groups (for example, ECG, RESP, ART, etc.). (Fewer parameters are printed if the line length limit is reached.)

SPACELABS MEDICAL PATIENT DATA LOGGER

ENT NAME DOE, JOHN Bed # 01 DATE 02 DEC 2008

ECG RESP ART mmHg SPO2 EtCO2

HR ABN LEAD LEAD2 ST1 ST2 RATE SYS/DIA MEAN % RESP % AGENT

55:49 212 0 VI II 2.08 -2.00 52 138/81 109 93 0 0.1 HAL

55:54 158 0 VI II 2.08 -2.00 47 138/81 109 95 0 0.1 HAL

55:59 146 0 VI II 2.08 -2.00 39 138/81 110 96 0 0.1 HAL

56:04 146 0 VI II 2.08 -2.00 36 138/81 110 97 0 0.1 HAL

56:10 212 0 VI II 2.08 -2.00 47 138/81 109 97 0 0.1 HAL

56:15 200 0 VI II 2.08 -2.00 53 138/81 110 97 16 5.2 HAL

56:20 146 0 VI II 2.08 -2.00 43 138/81 110 97 16 5.2 HAL

56:25 146 0 VI II 1.84 -2.56 36 138/81 109 97 16 5.2 HAL

56:30 211 0 VI II 1.84 -2.56 43 138/81 110 97 16 5.2 HAL

56:35 212 0 VI II 1.84 -2.56 53 138/81 110 97 16 5.2 HAL

56:45 146 0 VI II 1.84 -2.56 36 138/81 110 97 16 5.2 HAL

56:52 200 0 VI II 1.84 -2.56 39 138/81 109 79 16 5.2 HAL


Patient Data Logger

Data Printouts

Each line of the data printout may contain up to 132 characters and is terminated with line feed and carriage return characters.

Note:

If you are monitoring a large number of parameters and have an 80-column printer, the data from one reading may require more than one line. If your printer has a wrap-around feature, this will be handled automatically. If you prefer that each data reading fits onto one line, condense the printer’s type or use a wide-carriage (132 columns) printer.

The PDL transmits two types of information: page headers and data lines. The page header appears at the top of each page and contains the patient’s name, the bed number, and the current date. A new page is generated when any the following situations occur:

• The end of a page is reached (that is, 50 data lines have been transmitted).

• The monitored vital signs parameters change.

• The patient name or bed number changes.

• The current date changes.

Data lines are transmitted at the interval specified at configuration. Each data line contains the time that the data was collected, as well as the data collected for each vital sign parameter being monitored.


Patient Data Logger

Patient Data Logger Troubleshooting Guide

Clinical Situation Possible Causes Solution

Data is displayed with improper spacing or double spacing

■ The PDL interface sends a carriage return/line feed sequence at each end-of-line. The external device may not be set up properly.

■ Set the external device for “0” line feed.

No data is displayed or printed on the external device

■ There is a power problem or the cables are faulty. The device may not be set up properly.

■ Check the power and cables. Ensure that the device is in the online mode and that RS-232 port requirements are satisfied.

■ Check for RS-232 compatibility at the monitor and at the external device.

■ Check the monitor port assignments and port connections.

Data is lost or garbled ■ The cable is faulty. ■ Check the cables.

■ The parity is set incorrectly. ■ Verify the baud rates and parity settings.

■ Baud rate settings may be inappropriate.


DNA

Directory of Keys

TONESADMIT/

DISCHARGEMONITORCONFIG

PRIVILEGED

Enter BIOMED password

ACCESS


MONITOR SETUP

NETWORKSETUP

MONITORCALIBRATION

CHANGE BIOMEDPASSWORD

TELEMETRYCONFIGURATION

CLINICALMENU

MORESERIALPORTS

TONECONFIGURATION


D N ACONFIGURATION

SECONDARY DISPLAY

ENABLE DISABLEMORE

RECORDERSETUP

RECORDERCONFIG

Refer to

Introduction

Refer to

chapterchapter

System Alarms

REMOTEVIEW

ALARMWATCH

RV/AWOFF

LOCALTRENDS/CALCS

REMOTETRENDS/CALCS

SPECIAL FUNCTIONS

DATALOGGER DNA


DNA

Contents

Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Overview

The Dynamic Network Access (DNA) feature allows you to view and control a remote application.

Your hospital system administrator (or other designated personnel) must first set up communication between the UCW and Ultraview 1700 and the external computer(s) before DNA can be accessed. Refer to the Universal Clinical Workstation (UCW) and Ultraview 1700 Monitors Service Manual (P/N 070-0470-xx) for more details.

Note:

Ensure that any computer or communications equipment connected to the network comply with applicable medical standards.

To set up DNA (must have System Administrator menu access):

• Touch MONITOR SETUP.• Touch PRIVILEGED ACCESS.• Enter biomed password.• Touch MORE.• Touch DNA CONFIGURATION.• Enter desired configuration using the keyboard.• Touch OK.• Touch RESET MONITOR.

To access DNA:

• Touch SPECIAL FUNCTIONS.• Touch DNA.• Touch the desired application icon.



Contents

System Safety Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Equipment Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Equipment Maintenance Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Ultraview Care Network Module Compatibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

System Safety Specifications

System Introduction and Network Basics on page 1-1 includes information concerning the interconnection of equipment within the Ultraview Care Network. Initial connection of auxiliary line-operated equipment to a monitor must be performed by a hospital biomedical engineer or a Spacelabs Healthcare field service engineer. For further information or instructions regarding interconnection of units, contact your local Spacelabs Healthcare field service engineer.

After installation and/or interconnection with other units, the equipment leakage current shall not exceed the local (provincial) acceptable values.

Accessory equipment connected to the analog and digital interfaces must be certified according to the respective IEC standards (that is, IEC 60950 for data processing equipment and IEC 60601-1 for medical equipment). All configurations shall comply with the system standard IEC 60601-1-1+A1. Everyone who connects additional equipment to the signal input part or signal output part configures a medical system, and is, therefore, responsible to ensure that the system complies with the requirements of the system standard IEC 60601-1-1+A1. If in doubt, consult your local field service engineer.

All Spacelabs Healthcare equipment is intended for use with a fixed mains socket-outlet. If a system is configured using multiple portable socket-outlets, this system must be reviewed for compliance with IEC 60601-1-1+A1, including the maximum load and enclosure leakage currents requirements. The multiple portable socket outlet cannot be placed on the floor. If the leakage limit is exceeded, a second Protective Earth, fixed at both ends with a tool, may be necessary. This second Protective Earth must be tested to the requirements of clause 18 of IEC 60601-1.

Equipment weighing more than 20 kg is not portable. To lift heavy equipment, support under corners and lift according to hospital procedures.

Use of patient cables, transducers, sensors and supplies other than those specified by Spacelabs Healthcare may degrade equipment performance, including defibrillation protection.

Input leakage current for all patient input channels is less than 10 A, making ECG units suitable for direct cardiac application. The maximum non-destructive voltage that can be applied to any input or output connector on the monitors, modules, or printers is +5 V. All signal inputs or outputs are for exclusive connection to equipment specified by Spacelabs Healthcare.

Disposal of these devices and all accessories must be in accordance with local and federal laws.



Warning:• To protect against electrical shock, proper grounding is essential.

• If the integrity of the external protective earth conductor is in doubt, the equipment must be operated from its internal power source (if applicable).

Power Cord:

• Three-wire, 18-gauge, hospital grade, or

• Three-wire, 0.75 mm2, European harmonized.

Plug:

• Three-terminal polarized, with protective ground

Warning:.• Do not use a 3-to-2 plug adapter.

• Ground terminal of the plug is connected directly to the frame of the instrument. Any interruption of the grounding connector can create an electric shock hazard.

Table 1: Ultraview Care Network Products Power Rating

Product Frequency Electrical Rating Fuse Rating

90367/90369 50/60 Hz100 to 240 VAC

2.0 to 1.0 AN/A

90385/90363 50/60 Hz2.5 A/100 to 120 V

1.3 A/220 to 240 V

2-T3 A/250 V

2-T3.15 A/250 V

90386 50/60 Hz1.35 A/100 to 120 V

0.8 A/220 to 240 V

2T2 A/250 V

2-T1.25 A/250 V

90479-A 50/60 Hz2 A/115 V

1 A/230 to 240 V

2-T2.5 A/250 V (Slow)

2-T1.6 A/250 V

90364/90387/90491/90499/94000

50/60 Hz100 to 240 V

2.0 to 1.0 AN/A



Equipment Classification

All of the products listed below are classified as “Class 1- ordinary equipment (not protected against harmful ingress of liquids or flammable anesthetic mixtures), continuous operation.” In addition, the 90367, 90369, and 94000 are internally powered.

* Refer to Appendix A — Symbols on page A-1 for type definitions.

Table 2: Equipment Classification

Product Type* Product Type*

90367/90369

Depends on module usedBF-Defibrillator-proof with O2/CO2 option*

94000

B-FHR (Ultrasound)BF-UACF-FECGDepends on module used

90478 B 90424 CF-Defibrillator-proof

90385/90363Depends on module used

90482 BF

90386Depends on module used

90496 CF-Defibrillator-proof

90387/90364Depends on module used


90426/29/30 BF-Defibrillator-proof 90513/14 BF-Defibrillator-proof

90449/69 B 90515/16 BF-Defibrillator-proof



90341 BF-Defibrillator-proof 90343 BF-Defibrillator-proof

90347 BF-Defibrillator-proof 91341 BF-Defibrillator-proof



Equipment Maintenance Requirements

Corrective or maintenance procedures must be performed by qualified personnel.

Periodic maintenance procedures are required every 12 months to verify that:

• the equipment is physically sound.

• resistance between the chassis ground connector on the rear panel and the protective ground of the mains input is not greater than 0.1 ohm.

• isolation resistance between ground and mains is greater than 2 M.

While the equipment is operating normally verify that:

• chassis leakage current is less than 100 A.

• patient leakage current is less than 10 A (Type CF), 100 A (Types B and BF).

While the equipment is operating in single fault condition verify that:

• chassis leakage current is less than 300 A (100 to 120 V), 500 A (220 to 240 V);

• patient leakage current is less than 50 A (Type CF), 500 A (Types B and BF).

Under non-optimal environmental conditions or periods of intense use, more frequent checks are recommended.

If the equipment has been dropped, abused, or damaged in any way (if the monitor or module becomes wet, for example), a qualified service person must verify that the unit is working correctly and that all safety features are intact.

Visually inspect all patient cables each time the unit is used. Check for worn or damaged plastic covering, frayed or broken wires, cracked connections or any other signs of damage. Do not use cables which exhibit obvious damage.

Ultraview Care Network Module Compatibility

If any function (NIBP, ECG, SpO2, etc.) on your system does not contain a feature described in this manual:

• Your product may contain an earlier version of software. Contact your field service engineer and refer to the original documentation that accompanied your system.

• Your system configuration may be different from that described in this manual. Refer to notes in this manual describing features where system configuration is likely to impact the available features.

Before moving a Ultraview Care Network module from one network to another, be certain that the module software version is compatible with that required by the second network. If in doubt, have a qualified service person verify compatibility between the module and the network.



Contents

Monitors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Cleaning Products Not Recommended for Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2TruLink Noninvasive Blood Pressure Cuffs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Cables and Lead Wires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Pulse Oximetry Sensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Capnography Sensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 490518 Multigas Analyzer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Ultrasound Transducers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Monitors

To clean Ultraview Care Network monitor screens and covers, modules, processors, and printers use a cloth or swab that has been slightly dampened in a solution of warm water and a mild detergent. Avoid solvents which may damage the product cases. Follow your hospital protocol.

Caution:Use of cleaning agents other than those listed may cause degradation to the product’s plastic enclosure and labels. Questions or concerns regarding cleaning issues should be directed to Spacelabs Healthcare Technical Support.

Touchscreen Cleaning

There is not a separate shield over the face of the screen on the UCW or Ultraview 1500. Clean the screen with a soft cloth moistened with either 70% alcohol OR soapy water.

Note:

• Follow your hospital protocol for the handling of blood and body fluids.

• Do not allow liquid to enter the monitor.

Cleaning Products Not Recommended for Use

Warning:Accelerated Hydrogen Peroxide (AHP) and quaternary ammonia-based products ARE NOT RECOMMENDED for cleaning monitors and cables. These chemicals attack the plastics used in patient monitors and cables, and will cause serious safety hazards as the electrical insulating properties and structural integrity of the equipment break down.



Cavicide, Virex, Virex 256, SaniCloth, and Sanicloth Plus are common quaternary ammonia germicidal products. The manufacturers of these solutions advertise that these germicidal products are safe for use on hard, non-porous surfaces, such as linoleum floors, formica countertops, and stainless steel. The manufacturers discourage the use of quaternary ammonia germicidal products on computer-grade plastics and on data, patient, and power cables, which are classified as porous materials.

Accessories

• Where provided, follow the manufacturers' instructions concerning disposable and reusable supplies.

• As applicable, follow your hospital protocol concerning cleaning, disinfection and/or sterilization of reusable supplies.

Use of patient cables, transducers, sensors or supplies other than those specified by Spacelabs Healthcare may degrade module performance.

TruLink Noninvasive Blood Pressure Cuffs

TruLink Disposable Cuff

The disposable cuff wrap is designed for single patient use. It is packaged non-sterile and cannot be soaked, rinsed or sterilized.

TruLink Reusable Cuff

The reusable cuff is packaged non-sterile. It may be cleaned and disinfected with an enzymatic detergent and 10% solution of household bleach (5.25% sodium hypochlorite).

Cuff Cleaning and Disinfection

Materials

• Enzymatic detergent such as ENZOL (US) or CEDEZYME (UK)

• 10% solution of household bleach (5.25% sodium hypochlorite) in distilled water

• Soft cloths or bristle brushes

• Spray bottles

Procedure

1 Prepare the enzymatic detergent and bleach solutions in separate bottles per the manufacturer’s instructions.

2 Spray detergent liberally on cuff, allow to sit for one minute.



3 Remove detergent with a soft cloth. For persistent contamination, scrub with a soft bristled brush.

4 Rinse cuff thoroughly with distilled water.

5 Spray bleach solution on the affected area until saturated. Allow the cuff to sit for five minutes.

6 Remove any excess solution with a soft cloth and rinse again with distilled water. Allow two hours for air drying at ambient temperature.

Cables and Lead Wires

Cleaning

TruLink cables and lead wires may be cleaned with the following agents:

• Mild soap and water solution

• U.S. Pharmacopeia (USP) green soap

• Sodium hypochlorite solution (1:10 dilution of household bleach in water)

• Phenolic germicidal detergent solutions (1% aqueous solutions)

• Isopropyl alcohol solution (70%)

To clean product:

1 Prepare cleaning agent according to manufacturer’s instructions.

2 Saturate a clean cloth with designated cleaning agent.

3 Wipe off exposed surfaces of product.

4 Re-wipe product with clean water.

5 Wipe dry.

Tape adhesive may be removed with Spacelabs Healthcare’s adhesive tape remover pads (P/N 392196-xxx).

Caution:Do not immerse connector ends or cables in liquid.

Note:

• The compatibility of TRU-LINK products with chemical agents other than the type identified is unknown.

• The effective use of any cleaning or disinfecting procedure is subject to the proper preparation of each agent per the manufacturer’s instructions.



Sterilization

TRU-LINK cable and lead wires are provided non-sterile. Following use they may be ethylene oxide (EO) sterilized. Follow standard hospital protocol for processing.

Caution:Do not steam autoclave.

Note:

Product is compatible with sterilization process. Actual product sterility is dependent on a qualified sterilization cycle and procedure.

Pulse Oximetry Sensors

For cleaning information see the manufacturer’s instructions enclosed with each sensor.

Capnography Sensors

The capnography sensor and cable should be cleaned routinely, especially between patient uses. Before cleaning, make sure the sensor is disconnected from the module and/or monitor. Sensors and cable assemblies may be wiped using a cloth or swab dampened in alcohol or 10% bleach solutions. Mild detergents may also be used initially to remove any residual buildup. Sensor should be wiped immediately following cleaning with distilled water and then dried to remove any cleaning residue.

Caution:• Under no circumstances should sensors be immersed in a solution of any type.

• Do not autoclave the sensor.

• Never use solvents, acetone, or abrasive cleaning agents.

• Do not force the sensor onto the airway adapter.

• Avoid undue stress on the sensor head and cable.

Note:

• After unpacking, keep the sensor container. When not in use, disconnect the sensor from the module and/or monitor, clean, and place it into the container for safe keeping.

• Sensor exposure to cleaning agents should be limited to a maximum of 15 to 20 minutes. Longer intervals of exposure could produce a slight dulling of the original surface finish.

Visually inspect the sensor, cable, and the airway adapters for any sign of physical damage. Verify that the plugs and connectors are in good working condition and that the pins and prongs are not bent. Use a cotton swab dampened with alcohol, or a mild soap, to carefully clean the windows of the sensor head and the calibration cells. Always remove any damaged or questionable sensor or airway adapter from service.



90518 Multigas Analyzer

Warning:Always turn the unit off and unplug the power cord before cleaning to protect against electrical shock.

Exterior

The exterior of the 90518 should be cleaned and disinfected as necessary. Use a clean cloth or swab dampened in a solution of warm water and mild detergent. Squeeze the cloth out thoroughly before use. Disinfect the unit with Hemosol or similar disinfectant.

Caution:Do not allow liquid to enter the interior of the 90518. If this should occur, check the unit for proper operation and verify its performance accuracy prior to reuse.

Disposable and reusable patient accessories are available for the 90518.

• Disposable accessories are for single-patient use only and must not be sterilized or cleaned for reuse on other patients. Refer to the instructions provided with each patient accessory to determine if the accessory may be cleaned and reused on the same patient.

• Reusable accessories can be used on multiple patients after cleaning and/or sterilizing. Refer to the instructions provided with these accessories for details.

Instructions provided with patient accessories may contain warnings regarding their use. Read these instructions carefully prior to use.

Note:

The Spacelabs Healthcare sampling lines are for single-patient use only. Cleaning deteriorates the properties of the sampling line, resulting in slower response time and more frequent occlusions.

Fan Grill

The analyzer has a fan grill located on the rear panel. It must be kept free from dust and other contaminants.

CO2 Scrubber

The analyzer contains an internal CO2 scrubber which must be replaced every year.

Refer to the 90518 Multigas Analyzer Service Manual (P/N 070-0643-xx) for details on replacing the CO2 scrubber, cleaning and sterilization procedures.



Ultrasound Transducers

Basic cleaning should be performed regularly to ensure continued reliability.

1 Keep accessories clean.

2 Wipe transducers with a soft cloth moistened with a germicidal solution after each use.

3 Wipe off any ultrasound gel on the ultrasound transducers or the monitor as soon as possible.



Contents

Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Sealed Lead-Acid Batteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Nickel Metal Hydride Batteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Ultraview 1030/1050/Maternal Obstetrical Monitor (MOM). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Ultraview 1600/1700 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Multigas Analyzer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Ultraview Digital Telemetry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Fetal Monitor Telemetry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Overview

Spacelabs Healthcare products are equipped with a variety of battery types and technologies to meet the demands of powering critical circuits and portable equipment. This section briefly describes the products and types of batteries required for proper operation. Additionally, suggestions are provided for charging practices to optimize battery performance and disposal after the battery no longer functions within the manufacturer’s specifications. No other maintenance is required.

Warning:Batteries exposed to short circuit, high temperature, or fire may leak, vent, or explode.

Caution:Follow the manufacturer’s recommended handling procedure: Collect and transport batteries in a manner that prevents short circuit, compacting, mutilation, or any other abuse that would compromise the physical integrity.

Note:

• Used batteries must be properly disposed of or recycled according to national and/or local regulation.

• Refer to the product service manual for more details.



Sealed Lead-Acid Batteries

Sealed lead-acid (SLA) batteries must be charged for approximately four hours prior to their first use.

Stored SLA batteries should be recharged every three months to maintain optimum performance.

Note:

SLA batteries contain lead. Used batteries must be properly disposed of or recycled according to national and/or local regulation.

Nickel Metal Hydride Batteries

New nickel metal hydride (NiMH) batteries should be fully charged and discharged at least three times before use. This battery conditioning will ensure maximum run time.

No other maintenance is required for NiMH batteries.

Note:

Used batteries must be properly disposed of or recycled according to national and/or local regulation.

Ultraview 1030/1050/Maternal Obstetrical Monitor (MOM)

SLA batteries can be used in all Ultraview 1030/1050 monitors.

NiMH batteries can be used in Ultraview 1030/1050 monitors with serial numbers starting from 369-1XXXXX and 367-1XXXXX, and all Maternal Obstetrical Monitors.

Refer to Figure 33-1 for installing one battery or two batteries.

Figure 33-1: Monitor battery installation

battery

battery compartment door

power on/off switch

green LED



Note:

• Refer to the appropriate service manual for instructions.

• SLA batteries contain lead. Used batteries must be properly disposed of or recycled according to national and/or local regulation.

Batteries can be exchanged, without a loss of patient data, under any of the following conditions:

• The unit is powered OFF.

• The unit is being powered by an external power supply.

• The unit is operating on batteries (provided one charged battery remains connected at all times during the exchange).

A green LED on the front panel flashes when the batteries are being charged. A variable flashing speed gives an indication of the battery-charging rate. The green power LED will be continually illuminated when the charging cycle is complete.

Note:

• A faulty battery will cause the green power LED to flash intermittently.

- Remove one battery at a time to identify the faulty battery.

- Replace the faulty battery with the same battery type.

• A solid green LED indicates that the external power supply is connected to the AC mains power.

- Only a charging cycle or a faulty battery will cause the green LED to flash.

- These conditions will only occur when a battery is installed in the monitor.

• A solid green power LED does not indicate the battery charge level.

Ultraview 1600/1700

The Ultraview 1600/1700 monitors contain nickel metal hydride batteries, which provide a short-term charge reservoir during a power interruption. The equipment will cease to function during a power interruption. However, these devices will retain the operating configuration for at least five minutes during an AC mains power interruption to hasten equipment recovery when the power is restored.

Note:

• Replace these batteries every year. Refer to the appropriate service manual for instructions.




Multigas Analyzer

The multigas analyzer contains two sealed lead-acid batteries, which provide short-term operation during a power failure. The analyzer retains the operating configuration for up to five minutes during an AC mains power interruption.

Note:

• Replace these batteries every year. Refer to the appropriate service manual for instructions.

• SLA batteries contain lead. Used batteries must be properly disposed of or recycled according to national and/or local regulation.

Ultraview Digital Telemetry

The Ultraview Digital Telemetry housing is equipped with an internal, rechargeable, SLA battery assembly. The housing and eight modules retain the operating configuration for up to ten minutes during an AC mains power interruption.

SLA batteries must be charged for approximately four hours prior to their first use. A battery-charging unit is built into the module housing and charges automatically when the housing is connected to the AC mains power. There is no external battery-charging accessory available for this device.

Note:

SLA batteries contain lead. Used batteries must be properly disposed of or recycled according to national and/or local regulation.

Ultraview Digital Telemetry transmitters use a single, 9-volt, alkaline or lithium battery.

Note:

• No maintenance is required for single-use, 9-volt, alkaline or lithium batteries.




Fetal Monitor Telemetry

Fetal monitor telemetry transmitters use a single, 9-volt, alkaline or lithium battery.

Note:

• No maintenance is required for single-use, 9-volt, alkaline or lithium batteries.



Diagnostic Messages

Message Cause/Action

MONITOR SUPPORTS xx PARAMETERS. ADDITIONAL PARAMETERS MAY OVERLOAD IT

Data for more than xx parameters is being input to the monitor. System performance may decline. Unplug modules to improve performance.

UNABLE TO SUPPORT A NEW MODULE AT THIS TIME

Insufficient memory to support a new module. Unplug modules to free memory.

UNABLE TO SUPPORT A NEW CHANNEL AT THIS TIME

Insufficient memory available to support a new channel. Detach channels to free memory.

DIAGNOSTIC ERROR ENCOUNTERED LOADING MODULE

Checksum error detected loading module. Module is unsupported.

DIAGNOSTIC ERROR ENCOUNTERED LOADING CHANNEL

Checksum error detected loading channel. Channel is unsupported.

OUT OF MEMORY — DELETING HEMO ENTRY

Insufficient memory available to the application to complete the requested operation. Try again later.

OUT OF MEMORY — DELETING RESP ENTRY


OUT OF MEMORY — DELETING OXY ENTRY


OUT OF MEMORY — DELETING RENAL ENTRY


CREATE NEW ENTRY FAILURE — MAXIMUM NUM ENTRIES EXCEEDED

The maximum number of Calcs entries are in use. Delete existing entries to create new ones.

REMOTE MONITOR NOT RESPONDINGCalcs timeout expired waiting for remote GDS response. Verify remote monitor is on network, and try again.

ERROR READING STORED CALCS DATABad return code from GDS on data read. GDS is possibly corrupt. Reboot monitor.

ERROR STORING CALCS DATABad return code from GDS on data store. GDS is possibly corrupt. Reboot monitor.

ERROR DELETING STORED CALCS DATABad return code from GDS on data delete. GDS is possibly corrupt. Reboot monitor.

NO TRENDS AVAILABLE FOR THIS BEDThere is no trend data in GDS. Wait one minute and try again.

NO OTHER BED ON THE NETWORK HAS ACTIVE PARAMETERS

This message is in response to a remote request. The monitor has determined that there are no beds on the network with active parameters so remote operations are not possible at this time.


Diagnostic Messages

THERE ARE NO PARAMETERS ACTIVE ON THIS BED

The selected bed has no active parameters. In order to remotely work with the monitor at the selected bed, it must have active parameters.

PARAMETER IS NOT AVAILABLE TO MONITOR

Failed attempt to attach to channel. Try again.

COMMUNICATIONS WITH REMOTE MONITOR INTERRUPTED

Lost connection to remote monitor. Verify that the remote monitor is on the network and retry remote operation.

THIS OPERATION WILL CAUSE THE MONITOR TO RESET

The requested operation will reboot the monitor. If you do not want this to occur, touch PREVIOUS MENU or NORMAL SCREEN.

THIS INSERTION WILL CAUSE PRIOR ASSIGNMENT TO BE LOST

The requested zone assignment will cause a previously assigned zone to be lost. Touch PREVIOUS MENU or NORMAL SCREEN to abort the operation.

REMOTE BED SELECT FEATURE IS IN USE BY ANOTHER APPLICATION

The Remote Bed Select window is in use by another application. Only one application may use this window at one time. Touch the application which is using the Remote Bed Select feature and touch PREVIOUS MENU or NORMAL SCREEN to abort the selection. The window will now be available for use.

UNABLE TO RECORD THE REQUESTED ALARM CHANNEL(S)

Unable to perform the requested operation. Verify that a recorder is selected and operational (has paper) and try again.

UNABLE TO RECORD THE REQUESTED CHANNEL(S)


PARAMETERS NOT AVAILABLE FOR RECORDING


CAUTION — MONITOR SETTINGS MAY HAVE CHANGED

The battery for non-volatile memory has failed. That memory resets the monitor to the default settings and the default settings may not match hospital preferences. Contact your hospital biomed to check Biomed and Clinical menu settings and Alarm Watch setup.

PAPER OUT There is no paper in the fetal chart recorder. Load paper.

RECORDER OFFIndication that the fetal chart recorder is powered OFF. Power ON fetal chart recorder.

“CHECK CABLE”“NO CONNECTION”

Invalid CIM address. Verify that the CIM cable is properly connected to the monitor and the wall outlet.



Diagnostic Messages

“CHECK CABLE” then “OLD XXX NEWXXX”then “ID CHANGE!” ALTERNATELY

The CIM ID has changed unexpectedly during operation. Verify that the CIM cable is properly connected to the monitor and the wall outlet.

ADMIT PATIENTNo patient name has been entered. Enter patient name into BirthNet or standalone monitor.

MAXIMUM NUMBER OF PARAMETERS EXCEEDED

Insufficient memory to support a new parameter.




The following list of international and safety symbols describes all symbols used on Spacelabs Healthcare products. No one product contains every symbol.

HELP Key Keyboard Connection

SPECIAL FUNCTIONS Key Mouse Connection

RECORD Key START/STOP Key

NORMAL SCREEN Key START/STOP

MONITOR SETUP Key STOP or CANCEL Key

ALARMS Key CONTINUE Key

PREVIOUS MENU Key ENTER Key

ON — Power Connection to MainsOFF — Power Disconnection from Mains

ON Position for Push Button Power Switch

OFF Position for Push Button Power Switch

On Direction ON/OFF

ON — Part of the Instrument Only OFF — Part of the Instrument Only

StandbySTANDBY KeyPower ON/OFF Key

Ultraview Care Network Operations Manual A-1


PAUSE or INTERRUPT Slow Run

Alarm, General Reset

Alarm Reset Power Indicator LED

Alarm Audio ON Alarm Audio OFF

Alarm Audio Paused Activate Telemetry Recorder

Indicator — Remote Control Indicator — Local Control

PRINT REPORT Key Indicator — Out of Paper

Partial ON/OFF Recorder Paper

Normal Screen Return to Prior Menu

Clock/Time Setting Key TREND/TIMER Key

HELP (Explain Prior Screen) Key Keypad

Activate Recorder for Graphics Indoor Use Only

START (NIBP) Key Auto Mode (NIBP)

Television; Video Display Video Output

123 1

23

?



Video Output, Primary Video Output, Secondary

Output (Non-terminated) No Output (Terminated)

Data Input/Output Input/Output

Input Touchscreen, External

Menu Keys Waveform/Parameter Keys

Monitor SetupSelect Program Options

Set Initial Conditions Menu

Access Special Function Menu Return Unit to Monitor Mode

Serial Port 1 Serial Port 2

Serial Port Universal Serial Bus

External Marker Push Button Connection

SDLC Port

Arterial PulseElectrocardiograph or Defibrillator Synchronization

Gas Exhaust Foot Switch

Enlarge, Zoom Delete

PCMCIA Card Event

1

2

3

1

2

3

A

1

2

3

B1

2

3

1 2

SDLC

x



Keep Dry Fragile; Handle with Care

Environmental Shipping/Storage Altitude Limitations

This Way Up

Environmental Shipping/Storage Temperature Limitations

Environmental Shipping/Storage Humidity Limitations

Open Padlock Closed Padlock

Down Arrow Up Arrow

Hard Drive Power Indicator LED

Antenna Mermaid Connector

Microphone Omnidirectional Microphone

Audio Output, Speaker Audio Output, Speaker

Network Connection Oxygen reference gas port

Gas Sampling Port Gas Return Port

Low Priority Alarm Nurse Call

High Priority Alarm Medium Priority Alarm

Alarms Paused Nurse Alert Interface

12,200 m

Ref.



Parameter above measurement range

Alarm OFF

Parameter below measurement range

Parameter measurement indeterminate

BatteryReplace only with the appropriate battery.

Low Battery

Battery StatusReplace only with the appropriate battery.(+ / - signs may be reversed)

BatteryReplace only with the appropriate battery.

This symbol indicates that the waste of electrical and electronic equipment must not be disposed as unsorted municipal waste and must be collected separately. Please contact an authorized representative of the manufacturer for information concerning the decommissioning of your equipment.

All batteries should be disposed of properly to protect the environment. Lithium batteries should be fully discharged before disposal. Batteries such as lead-acid (Pb) and nickel-cadmium (Ni-Cd) must be recycled. Please follow your internal procedures and or local (provincial) laws regarding disposal or recycling.

Functional Earth Ground

Caution - hazardous voltages. To reduce risk of electric shock, do not remove the cover or back. Refer servicing to a qualified field service engineer (U.S.A.).DANGER - High Voltage (International)

Fuse

Protective Earth Ground Equipotentiality Terminal

Replace Fuse Only as Marked Direct Current

+++

--- ???



Power supply jack polarity. (+ / - signs may be reversed)

Input Power. Use only Spacelabs Power Supply (P/N 119-0527-xx).

Alternating Current AC/DC Input

Both Direct and Alternating Current Hertz

Amperes Watts

Volts

IEC 60601-1 Class II equipment, double-isolated. The unit displaying this symbol does not require a grounded outlet.

IEC 60601-1 Type B equipment. The unit displaying this symbol contains an adequate degree of protection against electric shock.

IEC 60601-1 Type BF equipment. The unit displaying this symbol is an F-type isolated (floating) patient-applied part providing an adequate degree of protection against electric shock.

IEC 60601-1 Type BF equipment which is defibrillator-proof. The unit displaying this symbol is an F-type isolated (floating) patient-applied part which contains an adequate degree of protection against electric shock, and is defibrillator-proof.

IEC 60601-1 Type CF equipment. The unit displaying this symbol is an F-type isolated (floating) patient-applied part providing a high degree of protection against electric shock.

IEC 60601-1 Type CF equipment. The unit displaying this symbol is an F-type isolated (floating) patient-applied part providing a high degree of protection against electric shock, and is defibrillator-proof.

Adult Noninvasive Blood Pressure (NIBP)

Loop FilterCanadian Standards Association Approved

ETL-certified device in Canada and United States

Operates on Non-Harmonized Radio Frequencies in Europe

Hz

A W

V

®C US

!



A CE mark certifies that a product has met EU health, safety, and environmental requirements, which ensure consumer safety.

XXXX is the European Notified Body number. 0123 is the number for TÜV SÜD Product Service GmbH, München, Germany.

Risk of Explosion if Used in the Presence of Flammable Anesthetics

Caution - Consult Accompanying Documents

Consult Instructions For Use Follow Instructions For Use

Note Note CautionCaution About Potential Danger to a Device

WarningWarning About Potential Danger to Human Beings

Fetal Monitor Connection (Analog)

Noninvasive Blood Pressure (NIBP), Neonate

Physiological Monitor Connection RS-232 (Digital)

Fetal Monitor ConnectionRS-232 (Digital)

NIBP Cuff, Neonatal 2

Symbol Set, Adult/Pediatric Cuff Sizes

Symbol Set, Neonatal Cuff Sizes

NIBP Cuff, Neonatal 1 NIBP Cuff, Neonatal 4

NIBP Cuff, Neonatal 3 NIBP Cuff, Single Hose

NIBP Cuff, Neonatal 5NIBP Cuff, Child Size (12 to 19 cm)

XXXX

!

CHILD



NIBP Cuff, Dual HoseNIBP Cuff, Neonatal 1 Size (3 to 6 cm)

NIBP Cuff, Surface Applied to Patient

NIBP Cuff, Child Size, Long (12 to 19 cm)

NIBP Cuff, Small Adult Size, Long (17 to 25 cm)

NIBP Cuff, Small Adult Size (17 to 25 cm)

NIBP Cuff, Adult Size, Long (23 to 33 cm)

NIBP Cuff, Large Adult Size, Long (31 to 40 cm)

NIBP Cuff, Large Adult Size (31 to 40 cm)

NIBP Cuff, Adult Size (23 to 33 cm)

NIBP Cuff, Neonatal 3 Size (6 to 11 cm)

NIBP Cuff, Infant Size (8 to 13 cm)

NIBP Cuff, Neonatal 5 Size(8 to 15 cm)

NIBP Cuff, Neonatal 2 Size (4 to 8 cm)

NIBP Cuff, Soft Material

NIBP Cuff, Neonatal 4 Size(7 to 13 cm)

NIBP Cuff, Vinyl Material

NIBP Cuff, Thigh Size (38-50 cm) Quantity

NIBP Cuff, Nylon MaterialPlace Artery Symbol and Arrow over Brachial or Femoral Artery

NEONATAL 1

THIS SIDE TO PATIENT

CHILD, LONG

SMALL ADULT, LONG

SMALL ADULT

ADULT, LONG

LARGE ADULT, LONG

LARGE ADULT

ADULT NEONATAL 3

INFANT NEONATAL 5

NEONATAL 2 SOFT

NEONATAL 4 VINYL

THIGH QTY

NYLON ARTERY



Happy Face Sad Face

Compression List of Rooms

Magnifying Glass Printer

File Cabinet Service Message

Arrows PVC-Free (Polyvinyl Chloride)

Recycle Do Not Reuse; Single Use Only

Non Sterile Reusable

Latex-Free Drip-Proof

Radio transmitting device; elevated levels of non-ionizing radiation

Reference Number or Order Number

Batch Code Nellcor Oxisensor II Compatible

Date of Manufacture Novametrix Compatible

UL recognized component in Canada and United States

Spacelabs TruLink Compatible

Nellcor OxiMax Compatible Nellcor OxiMax Compatible

Masimo SET Compatible Spacelabs Compatible

PVC

2

LATEX

REF

LOT NE2

NVX

R



Abbreviations used as symbols are shown below.

1 - 32 Access Codes 1 Through 32 AIR Air

ANT 1ANT 2

Diversity Antenna System 1Diversity Antenna System 2

Arr1ArrNet2

Arrhythmia Net 1Arrhythmia Net 2

avDO2 Arterial/Venous Oxygen Difference CaO2 Arterial Oxygen

CHch

EEG, EMG, or ECG ChannelEEG Channels - CH1, CH2, CH3, CH4EMG Channel - CH5

cmH2O Centimeters of Water

C.O.COco

Cardiac Output CvO2 Venous Oxygen

CO2CO2

Carbon DioxideDIAdia

Diastolic

ECGecg

ElectrocardiogramEMGemg

Electromyogram

EEGeeg

Electroencephalogram EXT External

ESISElectrosurgical Interference Suppression

FHR1FHR2

Fetal Heart Rate, Channel 1Fetal Heart Rate, Channel 2

FECG Fetal Electrocardiogram Hgb Hemoglobin

GNDgnd

Ground Multiview Multi-Lead Electrocardiogram

HLOhlo

High-Level Output N2O Nitrous Oxide

NIBPnibp

Noninvasive Blood Pressure O2AV Oxygen Availability



O2 OxygenPRESSpressPRS

Pressure

PaO2 Partial Pressure of Arterial OxygenRESPresp

Respiration

PvO2Partial Pressure of Mixed Venous Oxygen

SPO2SpO2SpO2SaO2

Arterial Oxygen Saturation as Measured by Pulse Oximetry

SDLC Synchronous Data Link ControlSYSsys

Systolic

SVO2SvO2SvO2

Mixed Venous Oxygen SaturationTEMPtemp

Temperature

T1T2T3T4

Temperature 1Temperature 2Temperature 3Temperature 4

VO2 Oxygen Consumption

UA Uterine Activity or Umbilical Artery UV Umbilical Venous

VAC Vacuum Connection
