Data Critical 02DT-7000 PATIENTNET User Manual 01 10001001 003 B

Data Critical Corporation PATIENTNET 01 10001001 003 B

Contents

manual 2

ADMIT, DISCHARGE, AND PATIENT DEMOGRAPHIC INFORMATIONPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 73All information contained herein is subject to the rights and restrictions on the title page.ADMIT, DISCHARGE, AND PATIENT DEMOGRAPHIC INFORMATIONThis chapter tells you how to admit and discharge patients to the PatientNet System and how to enter, view, modify and print patient demographic information. The settings described in this section are displayed on the Patient Settings screen (fig. 30). To display this screen, press Setup on the Main screen. Fig. 30. Patient Settings screenAdmitting a Patient to the SystemAdmit a patient at the Central Station as follows:1. Select an available patient channel by clicking on the waveform area. The presence of the Admit button on the Patient Settings screen indicates that a channel is available.2. Press the Admit button. 3. Enter demographic information and clinical setting for this patient as instructed in the following sections.If the transceiver is transmitting when you press Admit, the system verifies that the transceiver or device type matches the configuration for the channel. If the data does not match, the ?? SOURCE alarm is triggered. Note: The System Administrator may configure the system to make it mandatory to enter specific patient demographic data before admitting a patient. The required fields may include name, nursing unit, room number, physician, and ID number.
ADMIT, DISCHARGE, AND PATIENT DEMOGRAPHIC INFORMATION74 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.Entering Patient InformationOnce a patient is admitted, press the Patient Data button to display the Patient Data Entry screen (fig. 31). Fig. 31. Patient Data Entry screen1. Highlight Patient Name in the list of items.2. Press the Keyboard button.3. Using the on-screen keyboard, type in the patient’s name then press the Enter button. You can also enter information with the external keyboard. 4. Enter the additional demographic information for other items in the same way. Note: Notice that the patient’s name and ID number now appear on the waveform area. Available fields are shown below. The Number of Characters value is the maximum number allowed in each field.5. Click the Pager # button to display the number pad and enter the pager num-ber that is assigned to the patient. If a pager is not assigned, then click N on the number pad to indicate None.6. Click on the Display Wave button to toggle through the available waveforms for the selected patient.
ADMIT, DISCHARGE, AND PATIENT DEMOGRAPHIC INFORMATIONPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 75All information contained herein is subject to the rights and restrictions on the title page.7. Click the size mm/mv button (this button varies depending on the device type) to select the size of the waveform that is displayed.8. Click the Next button to select the Primary and Secondary leads for Arrhythmia analysis.Note: For best results, select lead II for your Primary Lead, and lead V or I for your Secondary Lead.Note: The Primary and Secondary Lead selection is a configurable option. See your system administrator if these buttons are inactive.Table 6. Patient information fields and character amounts.Viewing Patient Information1. Press Patient Data on the Patient Settings screen (fig. 30). The View Data screen appears, showing the information entered when the patient was admit-ted along with the admit date and time and the time since admit.2. Use the arrow buttons and PgUp and PgDn to scroll through the information fields.Patient Data Field Number of Characters Patient Name 18Room/Bed 6Nursing Unit 18Patient ID 20Date of Birth 18Sex (M/F) 1Physician 18Physician Group 18Diagnosis 18Orders 18Notes 1 18Notes 2 18Notes 3 18Medication 1 18Medication 2 18Medication 3 18
ADMIT, DISCHARGE, AND PATIENT DEMOGRAPHIC INFORMATION76 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.Modifying Patient InformationModify existing patient demographic information on the View Data screen (fig. 32). Fig. 32. View Data screen1. Press Patient Data on the Patient Settings screen.2. Press Modify Data on the View Data screen to re-display the Patient Data entry screen.3. Highlight the information field you wish to change and type in your changes for that field using either the on-screen keyboard or the external keyboard.4. Press the Enter button on the keyboard.Note: If any of the demographic fields are set to Pre-Admit by the System Admin-istrator, then the appropriate demographic information must be entered before a patient may be admitted. If any of the demographic settings are set to Pre-Admit and you attempt to admit a patient without entering the proper information, then a popup will be displayed stating that the information must be entered prior to admitting the patient.
ADMIT, DISCHARGE, AND PATIENT DEMOGRAPHIC INFORMATIONPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 77All information contained herein is subject to the rights and restrictions on the title page.Printing Patient InformationYou may want to maintain a record of patient demographic information as contained in the PatientNet System. To do so, print the Patient Data Report (fig. 33) from the laser printer for the patient’s file.1. Press Patient Data on the Patient Settings screen to display the Patient Data Entry screen (fig. 31) or the View Patient Data screen. 2. Press Laser to print the Patient Data Report.Fig. 33. Patient Data Report
ADMIT, DISCHARGE, AND PATIENT DEMOGRAPHIC INFORMATION78 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.Discharging a Patient From the SystemDischarging a Patient at the Central StationTo discharge a patient at the Central Station:1. Press Discharge on the Patient Settings screen. If you want to print a dis-charge report, click Ye s on the popup; otherwise click No. The information printed on the Patient Discharge Report is similar to that of the Patient Data Report, except that no ST or alarm configuration data is printed. 2. A confirmation popup appears asking if you want to clear patient data. Click No to cancel the discharge request and retain the patient. Or click Ye s to clear information and discharge the patient.If there are tagged events in the patient’s history file (see page 142), another popup informs you that continuing the discharge will erase these events. If any reports are queued for printing, another popup informs you that continu-ing with the discharge will cancel all queued reports.CAUTION: Selecting Ye s permanently clears all patient data and discharges the patient.The Discharge button now becomes Admit and may be used to admit a new patient.Note: If you have the Retrospective Viewer (page 181) option installed, then the discharged patient data will remain in a saved file on the Retrospective Viewer.Note: Merely deleting the name or identifying information from the trace display area does not stop data collection for the associated patient. Discharging a Patient at a Bedside DeviceIf you discharge a patient at a Bedside Device, the Remote Discharge screen will appear at the Central Station.Note: This feature is available only if it is enabled in the System Configuration Remote Functions screen. See your system administrator for details.Note: While the Remote Discharge screen is displayed, the main screen buttons and functions (except for the Strip/Laser button) are disabled.Click Ye s to clear patient information, or No to cancel the discharge request and retain the patient in the system. Note: You must select either Yes or No in order to remove the Remote Discharge screen and re-enable the main screen buttons and functions.
ADMIT, DISCHARGE, AND PATIENT DEMOGRAPHIC INFORMATIONPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 79All information contained herein is subject to the rights and restrictions on the title page.Printing a Discharge ReportTo print a Discharge Report:1. Select No on the Remote Discharge screen.2. Click the Setup button on the menu tool bar.3. Click the Discharge button on the Patient Settings screen. The Discharge Report popup will appear. If you want to print a discharge report, click Ye s on the popup; otherwise click No. The information printed on the Patient Dis-charge Report is similar to that of the Patient Data Report, except that no ST or alarm configuration data is printed. 4. A confirmation popup appears asking if you want to clear patient data. Click No to cancel the discharge request and retain the patient. Or click Ye s to clear information and discharge the patient.If there are tagged events in the patient’s history file (see page 142), another popup informs you that continuing the discharge will erase these events. If any reports are queued for printing, another popup informs you that continu-ing with the discharge will cancel all queued reports.CAUTION: Selecting Ye s permanently clears all patient data and discharges the patient.The Discharge button now becomes Admit and may be used to admit a new patient.Note: Merely deleting the name or identifying information from the trace display area does not stop data collection for the associated patient. Note: The Room Number, Nursing Unit, Pager Number, and List Trend Report parameters can be configured to be retained at the time of discharge.
ADMIT, DISCHARGE, AND PATIENT DEMOGRAPHIC INFORMATION80 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.This page is intentionally left blank.
PATIENT SETTINGSPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 81All information contained herein is subject to the rights and restrictions on the title page.PATIENT SETTINGSOnce a patient is admitted and demographic information is entered into the system, you can tailor the system to the individual patient. This section shows you how to make settings to accommodate patients’ specific monitoring needs.Note: All settings described in this chapter are channel-specific; they apply only to the patient channel selected when you make the settings. To select the patient, click on or touch the desired patient’s waveform. A box around the waveform indicates the selected patient.Unless otherwise noted, all instructions begin on the Patient Setting screen (fig. 34), and with the relevant patient’s waveform selected.Note: All patient settings modified at the Interactive-PatientNet Viewer (IRVS) are also modified at the Central Station.Fig. 34. Patient Settings screen
PATIENT SETTINGS82 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.Setting Device TypesPatients are classified as ambulatory, bedside monitored, or ventilator, depending on whether they are connected to an ambulatory transceiver, a bedside monitoring device, or a ventilator. Monitored parameters are different for the three types of patient. When you define the patient’s device, the system determines the set of moni-toring options available for the patient.To enter or change the device type that is connected to the selected patient:1. Press the Device button on the Patient Settings screen to display the Device popup (fig. 35).Fig. 35. Device popupNote: The device types that are displayed in the popup can be selected by the sys-tem administrator. If a device type that you need is not displayed here, then see your system administrator for details.2. Highlight the patient’s device type in the popup (available devices are listed in table 7).The device type setting must match the device transmitting the patient’s data. Otherwise, if alarms are enabled, the ??SOURCE alarm is trig-gered.3. Press Setup in the popup to select the highlighted device. If you change the device type, channel settings revert to the default settings of the new device.4. To leave the device type setting unchanged, press Exit on the popup.
PATIENT SETTINGSPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 83All information contained herein is subject to the rights and restrictions on the title page.Table 7. Device typesDevice Type Specific Device•5 wire•4 wire•3 wireAmbulatoryBedside Monitor •AT w/PRO• Passport 2• Exp w/EP•Encore• Passport• Expert•MPS•PRO-1000• DASH•Radical•Propaq• NK 4000• NK 2300•AgilentVentilator • PB 7200•Bird
PATIENT SETTINGS84 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.Selecting Monitored Parameters for the Configurable Data BlockThe configurable block displays up to four monitored parameters at a time. You can change the displayed parameters at any time as a patient’s monitoring needs change. The available parameters for each patient type are shown below. Table 8. Available parameters for configurable data blockPatient Type Available ParametersAmbulatory • Heart rate•PVC• Battery level of transceiver• Percent of paced beats• Transceiver ID• High/low heart rate limits• Leadset (3-, 4-, 5-wire)•ST levelBedside Monitor • Heart rate•P1 systolic/diastolic•P1 mean•P2 systolic/diastolic•P2 mean•P3 systolic/diastolic•P3 mean•P4 systolic/diastolic•P4 mean•P5 systolic/diastolic•P5 mean•P6 systolic/diastolic•P6 mean• BP systolic/diastolic• BP mean•EtCO2•InCO2•SpO2• Temperature1• Temperature2• Temperature ∆ • Respiratory rate•PVC• Heart rate source• RESP rate source•Battery• Percent of paced beats•BP Elapsed Time• Transceiver ID• Cardiac Output•Cardiac Index• Body Surface Area•PAWP• High/low heart rate limits• Device type name•ST level Ventilator • Heart rate•SpO2• Respiratory rate• Inspiration: Expiration ratio• Tidal volume• Minute volume• Spontaneous minute vol-ume• Peak inspiratory pressure• Mean airway pressure• Plateau pressure• Oxygen %•PEEP/CPAP• Transceiver ID• Device Type Name
PATIENT SETTINGSPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 85All information contained herein is subject to the rights and restrictions on the title page.To Select a monitored field:1. Click one of the four display fields in configurable block to display a popup (fig. 36) listing choices available for the type of patient. Fig. 36. Digital Parameter Popup - Bedside Device2. Highlight the data option you wish to display in the block and press Post.3. To display a blank field on the screen, highlight the blank space at the top of the popup screen and press Post.
PATIENT SETTINGS86 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.Assigning a Transceiver ID to a PatientNote: This button is configurable in the system administrator screens. If this but-ton is unavailable, then see your system administrator for details.To assign a transceiver to a patient channel:1. Click the Assign TX button on the Patient Settings screen (see Figure 34 on page 81) to display the Assign Transceiver screen (fig. 37).Fig. 37. Assign Transceiver Screen2. Use the arrow buttons to scroll through the patient channels that are currently available on the Central Station. Select and highlight the patient channel that will be assigned.3. Click the Device ID button to display the Numeric Pad Popup. Enter the Device’s Identification number and press Enter. 4. Select Transceiver ID button to display the Numeric Pad Popup. Enter the 6-digit transceiver’s identification number from the transceiver’s label and press Enter.5. If an invalid identification is entered, then the error message “Invalid transceiver (or device) ID. Please try again.” is displayed. Click OK in the message box to re-enter the transceiver identification number.6. Click the Ping button to measure and display the time that a message takes to travel back and forth between the Central Station and the transceiver.Note: This button is for administrative purposes only. Do not attempt to set the Ping.7. Click the Exit button to close the Assign Transceiver screen and return to the Patient Settings screen.
PATIENT SETTINGSPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 87All information contained herein is subject to the rights and restrictions on the title page.Selecting Waveforms for Display on the Main ScreenSince more than one waveform is transmitted from the patient to the Central Station, you may select which waveform(s) appear on the Main screen. The monitoring device type of the patient determines the set of choices available for display.Note: Ventilator patients have no waveforms.Ambulatory PatientsAmbulatory patients show one waveform on the Main screen. To select the waveform: 1. Press Patient Data on the Patient Settings screen to display the Patient Data Entry screen. If patient demographic information has been previously entered, the View Data screen appears instead. In this case press Modify Data to show the Patient Data Entry screen.2. Press Display Wave button on the Patient Data Entry screen to cycle through the available waveforms.• For 3-wire devices, only one lead is available.• For 4-wire devices, the choices are leads I, II, and III. • For 5-wire devices, the choices are leads I, II, III and V.• Augmented leads (aVR, aVL, aVF) are available when Augment is en-abled.Note: Enable Augmented Leads by clicking Label Set button.3. To select the size of the displayed waveform, press Size mm/mv repeatedly to choose a waveform of 2.5, 5, 10, 20 or 40 mm/mv.Note: Changing the waveform size on the monitor display does not change the size of the waveform that the arrhythmia analysis software views and reads.CAUTION: Select a size that is easy to see but stays within the display area borders.Bedside Monitored Patients For bedside patients, you can display one or two waveforms. 1. Press Patient Data on the Patient Settings screen to display the Patient Data Entry screen. If patient demographic information has been previously entered, the View Data screen appears; in this case press Modify Data to show the Patient Data Entry screen.2. Press the Top Wave button to select the ECG wave. The choices are ECG1, ECG2, and None.3. Select the size of the ECG waveform by pressing Top Size. Choices are 2.5, 5, 10, 20 or 40 mm/mv.
PATIENT SETTINGS88 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.4. Press the Bottom Wave button to select the non-ECG wave. The choices are PLETH, P1, P2, RESP, CO2 and None.5. Select the size of the bottom wave by pressing Bottom Size. Choices are as follows:•P1 and P2: 1.5, 3, 6, 12 or 24 mm/Hg, where 24 is the smallest and 1.5 the largest.•RESP, CO2 and PLETH: 0.25x (smallest), 0.5x, 1x, 2x, 4x (largest).Labeling WaveformsYou can select labels for each transmitted wave; the number of available waveforms depends on the device type selected in the Patient Settings screen. Available wave-forms are shown in table 9. OpenNet-compatible bedside monitors can transmit up to three waves of data. To label the waves:1. Press Label Set on the Patient Settings screen to display the Label Set Defini-tion popup shown in fig. 38. See table 9 for available wave labels.Fig. 38. Label Set Definition popup2. Press the three Wave buttons to cycle through available waves. 3. For 4- and 5-wire transceivers, toggle the Augment button to Ye s if you wish the system to derive the augmented leads aVR, aVL, and aVF automatically. If augmented leads cannot be derived from the leads, N/A appears.Note: Lead III is derived regardless of the Augment setting.4. Press Exit on the popup to save the new waveform labels.
PATIENT SETTINGSPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 89All information contained herein is subject to the rights and restrictions on the title page.Table 9. Waveform labelsAlarmsInformation on alarms and instructions on how to set and work with alarms are cov-ered in detail in the “Alarm Management” chapter starting on page 105.Enabling Remote AlertWith Remote Alert enabled, a designated PatientNet Viewer automatically displays an alarming patient’s channel and sounds the alarm. See “Remote Viewing Stations” on page 175 for more information.To enable Remote Alert:1. Press the Alarm Config button on the Patient Settings screen.2. Highlight the desired alarm in the alarm configuration screen and toggle the Assign button to On.Note: This applies to the PatientNet Viewer and the Interactive-PatientNet Viewer.Assigning a Pager Number to a PatientNote: This applies only if your system includes the paging option. See “Paging” starting on page 238 for further instructions and details on paging. To assign a pager number or telephone extension to a patient for notification in case of alarms:1. Press Pager # on the Patient Settings screen to bring up the on-line numeric keypad.2. Enter the pager number or telephone extension (maximum 7 characters) to be assigned to this patient and press Enter.3. If the patient belongs to a zone (a group of up to ten different pager numbers), enter Z and then the zone number. Alarms enabled for paging will be sent to all pagers in the zone. Zone group paging is set up by the system administra-tor. 4. Select None if you wish no page to be sent.Note: Pagers may also be set-up by group, where a number of pagers belong to a single group.3-Wire 4-Wire 5-Wire BedsideWave 1 N/A I, ML1 I ECG IWave 2 I, II, III, ML1, ML6II, ML6 II P1Wave 3 N/A N/A V, V1, V2, V3, V4, V5, or V6P2Augment N/A No, Yes, N/A Yes, No N/A
PATIENT SETTINGS90 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.Note: If the Pager # button is set to Pre-Admit, then a pager number must be entered before a patient may be admitted. If the Pager # setting is set to Pre-Admit and you attempt to admit a patient without a pager number, then a popup will be displayed stating that a pager number must be entered prior to admitting the patient.ImplantsPress the Implant button on the Patient Settings screen to cycle through the choices for patient implant. Choose the type below that applies to the patient: Setting the Implant field to a value other than None is for display only and has no effect on pacer processing or arrhythmia analysis. If the Central Station is currently processing arrhythmia, implant labels (except None) are displayed in the patient block. Pacer Processing or ST AnalysisYou can select ST analysis or pacer processing, or neither, for a patient, but not both. ST analysis and pacer processing are mutually exclusive functions. WARNING: Always set Process to Pacer for patients who have working electronic pace-makers. Do not set Process to Pacer for patients who do not have an elec-tronic pacemaker.Note: The Pacer button is not available if a 3-Wire device type is selected. Pacer Processing is not available for 3-Wire ambulatory patients.Press the Process button on the Patient Settings screen to scroll through Pacer, ST or None.CAUTION: If you select Pacer, no ST alarms are triggered.Type DefinitionPacer PacemakerAICD Automatic Implantable Cardioverter DefibrillatorPCD Pacer-Cardioverter-DefibrillatorNone No implant
PATIENT SETTINGSPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 91All information contained herein is subject to the rights and restrictions on the title page.Setting the Pacer Blanking PeriodSetting a blanking period before and after the pacer spike removes residual pacer arti-fact from the ECG signal. See “Pacemaker Processing” on page 95 for details.Note: This feature availability is configurable. If the Pacer Filter button is not avail-able, then see your system administrator for details.Arrhythmia ProcessingArrhythmia processing can take place at the Central Station or at the bedside patient monitor. See “Arrhythmia Analysis” on page 51 and “ST Analysis” on page 167 for details.The Central Station can perform arrhythmia processing on up to three ECG waves. It analyzes data sent by the patient monitor and issues alarms on arrhythmia events.Patient TransfersYou can transfer a patient’s settings and data from one channel on a Central Station to another channel or to a different Central Station on the same network. Note: Transferring the room number, nursing unit, transceiver ID, alarm actions are configurable options in the administrator’s screens.WARNING: If the Transceiver ID is not configured to transfer with the patient data, then transceivers will remain associated with their original channels. Therefore, the patient must be physically moved to the transceiver that is associated with the new channel to continue monitoring.Local TransferA local transfer is a transfer of a patient’s settings and data from one channel to another on the same Central Station. 1. Press Transfer on the Patient Settings screen and select the patient. The Transfer popup appears directing you to select the channel (ignore the bottom half of the popup; this applies to network transfers).2. Choose an empty channel and click on its waveform area to transfer the patient’s data and settings
PATIENT SETTINGS92 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.Fig. 39. Transfer popupNetwork TransferYou can move a patient’s settings and data from one Central Station to another in a network transfer.Setting The Network Transfer Status of a PatientThe network transfer status of a patient determines whether or not he or she can be transferred to a different Central Station. To make a patient transferable on the net-work: 1. Press Transfer on the Patient Settings screen. 2. On the Transfer popup, toggle the Transfer button to Ye s .Transferring the Patient from One Central Station to Another1. Press Setup on the Main screen and select the waveform area of an empty channel.2. Press the Transfer button to display a list showing all patients on the network who are available for network transfers. If no patients are available, a No Patients Available popup appears.3. From this list, choose the patient you wish to transfer to the selected empty channel on the current Central Station and click Select.4. Once the transfer is complete, with the transferred patient’s waveform area highlighted, press the Alarms button on the Patient Settings screen and select On to reactivate the alarms.Note: During a network transfer, all event storage for the patient being transferred stops. This includes any event you manually try to store or any alarm condi-tion that would cause the storage of an event.Note: To ensure that 24-hour or 72-hour full disclosure data is transferred, the transfer popup must indicate “Yes” in the text field. see Figure 39 on page 92.WARNING: A network transfer with full disclosure data may take at least twenty minutes or longer, depending on the amount of data being transferred. During this time, alarms are OFF. After a network transfer, alarms must be reactivated.
PATIENT SETTINGSPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 93All information contained herein is subject to the rights and restrictions on the title page.WARNING: It is possible that you can abort patient a transfer operation. If you abort the transfer, then the patient waveform will revert back to the source channel. The destination channel will not be monitored, and alarms at the source channel must be turned back on manually. System operators must diligently monitor patients undergoing transfers to assure that if an abort does occur, the transfer can be re-initiated.Aborting Transfers in ProgressYou can stop a transfer while it is in progress by pressing the Transfer button a second time. A popup message will appear asking you if you wish to halt/abort the transfer (fig. 40). Click Ye s if you wish to stop the transfer, or No to continue with the transfer as described above.Fig. 40. Halting a Transfer Popup
PATIENT SETTINGS94 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.This page is intentionally left blank.
PACEMAKER PROCESSINGPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 95All information contained herein is subject to the rights and restrictions on the title page.PACEMAKER PROCESSINGYou can select pacemaker processing, ST Analysis, or neither for a patient, but not both. These two processes are mutually exclusive functions.WARNING: Always set Process to Pacer for patients who have working electronic pace-makers. Do not set Process to Pacer for patients who do not have an elec-tronic pacemaker.Press the Process button on the Patient Settings screen to toggle through Pacer, ST, or None.Note: The Pacer button is not available if a 3-Wire device type is selected. Pacer Processing is not available for 3-Wire ambulatory patients.CAUTION: If you select Pacer, no ST alarms are triggered.Pacemaker DetectionPacemaker pulses are detected by the bedside monitor or ambulatory transceiver and sent to the Central Station, which processes pacemaker data in the same way for both ambulatory and bedside patients. See page 90 for instructions on how to make pace-maker settings.Note: False beat detections can be caused by low amplitude artifact on paced patients. To eliminate false beats, reposition the LA electrode. See “Patients with a Pacemaker” on page 49.Pacemaker AnalysisWhen pacemaker analysis is enabled in the Central Station, the central “looks” for the encoded pacemaker flag in the digital ECG data. The system indicates where pace-maker pulses were detected by inserting a pacemaker flag in the ECG data. The pace-maker flag is displayed in a selected color in order to easily distinguish the pacer flag from the background ECG. The pacemaker flag is represented in printed ECG data as a thick 10 mm line (See Figure 41 on page 96).Note: The PatientNet System complies with the Pacemaker Detection requirement per ANSI/AAMI EC-13 Cardiac monitors, heart rate meters, and alarms. We do not validate specific pacemakers. If the pacemaker does not produce pacer pulses at the skin within the parameters described under ANSI/AAMI EC-13, then the DT 4000 or DT4500 may not be able to detect the pacemaker. WARNING: Close surveillance of patients that have a pacemaker is required.
PACEMAKER PROCESSING96 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page. Fig. 41. Three Lead Depiction of Pacemaker RhythmPacemakers are electronic devices that stimulate the myocardium with an electrical impulse. The type of pacemaker and its settings determine the frequency of the impulse. Demand pacemakers detect the underlying heart rhythm and send an impulse only when the heart rate falls below a preset level/rate. Fixed-rate pacemakers send an impulse at a specific rate regardless of the intrinsic heart rate. Pacemakers are often set to sense and stimulate the ventricle, but may also sense and stimulate the atria, or both the atria and the ventricles (DDD or A-V sequential pacemakers). Whatever type of pacemaker is used, there are certain characteristics that the pacemaker detection algo-rithm looks for in order to identify a pacemaker spike. As noted earlier, when a pace-maker spike is detected, the resulting beat is tagged or flagged. These tagged beats activate a special algorithm to process and count the paced beats.Because not all pacemaker spikes have the same width and amplitude, detection of the spike and the subsequent QRS complex poses a two-fold challenge for the monitor.The first challenge is to differentiate the pacer spike from the QRS. This is not a prob-lem when each pacer spike is followed by an actual QRS complex. The problem arises if the patient should go into cardiac standstill and the pacemaker continues to fire. The monitor could count the spikes as if they were actual beats. This condition is com-monly referred to as “dead-man” pacer. Regardless of the use of arrhythmia monitor-ing, pacemaker patients always require additional surveillance.The second challenge is to filter out the residual pacemaker artifact, which might trip the QRS detector, without filtering too much of the QRS complex. The front-end device monitor (ambulatory transceiver or bedside monitor) must detect and flag the spike so that the residual artifact can be filtered correctly; thus allowing the algorithm to make the appropriate response.
PACEMAKER PROCESSINGPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 97All information contained herein is subject to the rights and restrictions on the title page.Determining Pacer Filter Blanking PeriodsWARNING: If the pacer filter is changed from 25 ms, an increased level of surveillance should be instituted.Note: This feature availability is configurable. If the Pacer Filter button is not avail-able, then see your system administrator for details.The pacer filter is enabled when Process is set to Pacer. The pacer filter setting con-trols the blanking interval, applied before and after the pacer flag, to remove residual pacer artifact from the ECG signal. The default pacer filter is 25 msec, which should be adequate for the majority of pacemaker signals from the PatientNet transceivers. In some cases, it may be necessary to increase or decrease the pacer filter. If the pacer fil-ter is changed from 25 msec, an increased level of surveillance should be instituted.Annotated disclosure review can help differentiate which beat detection performance issues may be attributed to pacer artifact or pacer filter problems. There should be one, and only one, beat annotation associated with every QRS complex. In general, if the system is calling false low rates, or false Asystoles, due to fused beats (missing beat annotations), then the pacer filter should be decreased (fig. 42). If the system is calling false high rates due to the detection of pacer artifact as beats (more than one annota-tion per beat), then the pacer filter should be increased (See Figure 43 on page 99). Note: The pacer filter does not affect pacer detection
PACEMAKER PROCESSING98 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.Fig. 42. False Asystole Alarms on Fused BeatsHOW TO VISUALIZE THE EFFECT OF THEPACER FILTERThe pacer filter controls how much data is blanked on both sides of adetected pacemaker spike. The blue flag indicates the position wherethe spike was detected. The red line represents the region of pacerblanking. If there is a fused pacemaker spike on a narrow QRScomplex, the blanking may remove the QRS complex. If false lowrate or asystole alarms are observed, try decreasing the pacer filter.WHAT THE USER SEESThe displayed and printed data show the unfiltered data. Thereshould be an annotation (N,V,etc.) associated with each detected beatin the 24 hour data. If missing annotations are noted on fused beats,decreasing the pacer filter may allow more of the QRS complexthrough to the arrhythmia module.FILTER TOO HIGH FILTER OKNFALSE ASYSTOLE ALARMS ON FUSED BEATSWHAT THE ARRHYTHMIA SEESThe filtered data is passed to the arrhythmia module. Note that if thepacer filter is too high some or all of the QRS complex may beblanked resulting in false asystole or low rate calls.
PACEMAKER PROCESSINGPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 99All information contained herein is subject to the rights and restrictions on the title page.Fig. 43. False High Rates Due to Detection of Beats on Pacer ArtifactHOW TO VISUALIZE THE EFFECT OF THEPACER FILTERThe pacer filter controls how much data is blanked on both sides of adetected pacemaker spike. The blue flag indicates the position wherethe spike was detected. The red line represents the region of pacerblanking.WHAT THE USER SEESThe displayed and printed data show the unfiltered data. Thereshould be one and only one annotation (N,V,etc.) associated witheach QRS beat in the 24 hour data. If there is more than oneannotation per beat and the additional annotation(s) are near theresidual pacer artifact, increasing the pacer filter (blanking period)will result in more of the artifact being blanked which reduces thelikelihood of the artifact being detected as a beat.FILTER TOO LOW FILTER OKFALSE HIGH RATES DUE TO DETECTION OFBEATS ON PACER ARTIFACTWHAT THE ARRHYTHMIA SEESThe filtered data is passed to the arrhythmia module. Note that if thepacer filter is too low, the pacer artifact is passed to the arrhythmia.If the artifact is significant, the arrhythmia may detect it as a beat,resulting in false high heart rates.Q N N
PACEMAKER PROCESSING100 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.The following procedure is recommended for determining the length of the optional blanking interval:1. Place the patient on the system.2. After establishing a stable waveform, store the paced rhythm in the view screen.3. Inspect the flag and measure the interval from the flag to the physiologic response (P wave or QRS), as shown in fig. 44 and fig. 45. Residual artifacts of the pacer may appear between the flag and the start of the QRS. You can use the electronic calipers to measure the interval.Fig. 44. Waveform Measurement - Blanking IntervalFig. 45. Detailed Waveform40 mm intervalArtifactsPacerPacer SpikeInterval before the spikeInterval after the spike
PACEMAKER PROCESSINGPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 101All information contained herein is subject to the rights and restrictions on the title page.4. You can also inspect the flag and artifacts by recording the waveform on a strip or a laser printout. You can use manual calipers for the inspection. Remember the following facts:• Not all monitors position the pacer flag in the same place in the data in re-lation to the actual pacemaker spike or artifact. The flag may be in the cen-ter of the artifact, or it may precede or follow the artifact. Examine the location of the artifact and measure it accordingly.• Widths of the artifacts will vary. Take several measurements and use the largest interval as the desired “blanking period” setting.Patients with Impedance-Derived Rate Response PacemakersThis type of pacemaker emits pulses (20 Hz) for adjusting the pacemaker rate to the patient’s respiration rate. The front-end device may detect such impedance pulses as pacemaker spikes and display them in very short, regular intervals, which are super-imposed on the patient’s ECG waveform. Telectronics manufactures such an imped-ance-based pacemaker to measure the respiration rate and adjust the pacemaker rate accordingly.The manufacturer’s documentation states that the impedance pulse amplitude is about one-tenth of the pacing pulse amplitude. This implies the existence of an electrode configuration that will enable the transceiver to detect the pacing pulse and not the impedance pulse. See fig. 46 for an example of the “picket fence” appearance of the pulses on the ECG waveform. This is more easily noted on real-time strips or in the history.Fig. 46. Picket Fencing - Impedance-Derived Rate Response Pacemakers
PACEMAKER PROCESSING102 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.Note the next four figures, where the system is accurately detecting and presenting the pacemaker flag.Fig. 47. Accurate Pacemaker Flag - Atrial-Ventricular PacingFig. 48. Accurate Pacemaker Flag - Ventricular Pacing
PACEMAKER PROCESSINGPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 103All information contained herein is subject to the rights and restrictions on the title page.Fig. 49. Accurate Pacemaker Flag - Ventricular PacingFig. 50. Accurate Pacemaker Flag - Atrial Pacing
PACEMAKER PROCESSING104 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.This page is intentionally left blank.
ALARMSPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 105All information contained herein is subject to the rights and restrictions on the title page.ALARMSAlarms are activated by life-threatening, medical and technical events. WARNING: Because of the large physiologic differences among individuals, we cannot ensure that every life threatening event will trigger an alarm. The PatientNet System cannot replace skilled nursing care and proper sur-veillance. Any alarm or abnormal indication displayed by this system should be reviewed by skilled clinical staff to determine if the appropriate diagnostic procedure should be initiated.This instrument may not produce alarms from some pacemaker patients who experience cardiac arrhythmias. Maintain high-risk and pacemaker patients under close surveillance.WARNING: When using a bedside device with the instrument transceiver (DT-7000/7001), the bedside device is the primary monitor and alarm source. Disabling alarms on the bedside device is not safe clinical practice.Alarm DetectionAlarms are detected according to patient type as follows:Ambulatory patients: all alarms are detected at the Central Station. Bedside monitored patients: alarms are detected at the bedside monitor, at the Central Station, or both. Ventilator patients: all alarms are processed at and by the ventilator unit; the Central Station only displays the alarms received from the ventilator.Alarm Sound IndicatorsThe Central Station produces characteristic sounds associated with the types and levels of alarms as shown below.Alarm Type Pitch Relative SpeedMedical: level 1 alternating tone fastMedical: level 2 single tone mediumMedical: level 3 single tone slowTechnical; level 1, 2, 3 single tone slowest
ALARMS106 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.Visual Alarm IndicatorsAlarms are indicated visually on the Main screen in the patient information block and on the Full Disclosure screen (fig. 51).Main Screen Patient Information BlockAlarm names are displayed in the patient block. Only the active or latched alarm with the highest priority is shown, but if more than one alarm is active, the alarms with the highest priority are displayed in rotation.Full Disclosure ScreenZoomed-Out ModeA line under the waveform indicates an alarm. Medical alarm lines are flashing red; technical alarm lines are yellow; and turned-off alarms have white lines.Zoomed-In ModeAlarms are shown in the lower left corner of the wave display window (no lines appear under the waveforms). Medical alarm text is flashing red; technical alarms are yellow (some are flashing red). Fig. 51. Visual alarm indicatorszoomed inalarmindicatorzoomed out
ALARMSPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 107All information contained herein is subject to the rights and restrictions on the title page.Acknowledging AlarmsWhen an alarm is triggered, you can temporarily silence the tone associated with the alarm while you analyze the rhythm and notify the appropriate personnel of the patient’s condition. The Silence button on the Main screen silences alarms for a dura-tion preset by the system administrator. This duration may be 30, 45, 60 seconds, or 3 minutes. During this period, a silence indicator (crossed-out bell) appears in the patient block. If a new alarm occurs during the silence period, the audio for the new alarm breaks through to assure clinical notification of all alarm events. At the end of the silencing period, if an alarm that was silenced is still active, the audio alarm is again sounded.Note: The recommended method to silence alarms is to silence the audio alarm by selecting the Silence button ONCE. This allows for clinical notification of new alarm events. Informed use of the Silence button is critical to safe and effective alarm management.Selecting the Silence button on the Main screen twice within 5 seconds, then immedi-ately selecting the alarm text in the patient information block, turns off all alarms for 3 minutes. The Alarm OFF text flashes in the patient information block, then, after 3 minutes, the alarms automatically turn on.CAUTION: Selecting the Silence button TWICE, and the alarm text in the patient informa-tion block, renders the Alarms OFF for 3 minutes. This is not safe clinical practice depending on the acuity, and the monitoring needs, of the patient. This is mentioned here to prevent inadvertent cancellation of alarms.Medical, Level 1Most urgent alarm (flashing red, loud alternating tone).1. Press the Silence button on the Main screen once.2. Press the View button and select the alarming patient to observe the patient’s real-time rhythm in available leads.3. Notify the appropriate staff according to hospital policy and procedure.4. If the alarm is configured for paging, analyze the rhythm and select Page or No Page as appropriate. 5. If the alarming rhythm continues, go to Step 6. If it returns to normal, click on the alarm text in the patient information block to acknowledge and clear the alarm.6. Press the Silence button twice and then press the alarm text in the patient block. This turns off all alarms for 3 minutes. ALARM OFF flashes yellow for 3 minutes, then a learn takes place and the alarms automatically turn on.If hospital policy allows, when a code is in progress and all needed staff are present in the room, all alarms can be turned off. Do this with the Alarms button in the Patient Setup screen.
ALARMS108 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.When you turn off all alarms, the alarm text in the patient block reads ALARM OFF in yellow until you click on it.Medical, Level 2Less urgent than a medical, level 1 alarm (flashing red, single fast tone).1. Press the Silence button on the Main screen once.2. Press the View button and select the alarming patient to observe the patient’s real-time rhythm in applicable leads.3. Notify the appropriate staff according to hospital policy and procedure.4. If the alarm is configured for paging, analyze the rhythm and select Page or No Page as appropriate.5. If the alarming rhythm corrects to normal, go to Step 6. If the alarming rhythm continues, go to Step 7.6. Select the alarm text in the patient information block to acknowledge and clear the alarm.7. Press the Silence button twice and then press the alarm text in the patient block. This turns off all alarms for 3 minutes. While the alarms are off, ALARM OFF flashes in yellow. Then, a learn takes place and all alarms are automatically turned on again after the 3 minute time limit.If hospital policy allows, when a medical code is in progress and all needed staff are present in the room, all alarms can be turned off. Do this with the Alarms button in the Patient Setup screen. When you turn off an active alarm, the alarm text in the patient block reads “ALARMOFF” in yellow until you click on it.Medical, Level 3Less urgent than a medical, level 2 alarm (flashing red, single slow tone).1. Press the Silence button on the Main screen once.2. Press the View button and select the alarming patient to observe the patient’s real-time rhythm in applicable leads.3. Notify the appropriate staff according to hospital policy and procedure.4. If the alarm is configured for paging, analyze the rhythm and select Page or No Page as appropriate.5. If the alarming rhythm corrects to normal, go to Step 6. If the alarming rhythm continues, go to Step 7.6. Press the Silence button as needed.7. Press the Silence button twice and then press the alarm text in the patient block. This turns off all alarms for 3 minutes. ALARM OFF flashes yellow for 3 minutes, then a learn takes place and the alarms automatically turn on.
ALARMSPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 109All information contained herein is subject to the rights and restrictions on the title page.Technical, Level 3Least urgent of all alarms (solid yellow, single slow tone).1. Press the Silence button on the Main screen once.2. Press the View button and select the alarming patient to observe the patient’s real-time rhythm in applicable leads.3. Notify the appropriate staff according to hospital policy and procedure.4. If the alarm is configured for paging, analyze the rhythm and select Page or No Page as appropriate.5. If the alarming rhythm corrects to normal, go to Step 6. If the alarming rhythm continues, go to Step 7.6. Press the Silence button as needed.7. Press the Silence button twice and then press the alarm text in the patient block. This turns off all alarms for 3 minutes. ALARM OFF flashes yellow for 3 minutes, then a learn takes place and the alarms automatically turn on.Silencing AlarmsPress the Silence button on the Main screen once to silence all active alarms while you analyze the rhythm and notify the appropriate personnel of the patient’s condition. Silencing lasts for 30, 45, or 60 seconds or 3 minutes, as pre-configured by the system administrator. A crossed-out bell icon in the patient block indicates that alarm silenc-ing is in effect.New alarms that occur during the silence period break through the silence; this ensures clinical notification of all alarm events. At the end of the silencing period, active alarms resume their sound.CAUTION: The recommended method to silence alarms is to silence the audio alarm by selecting the Silence button ONCE. This allows for clinical notification of new alarm events. Informed use of the Silence button is critical to safe and effec-tive alarm management. You can also press the Silence button twice within 5 seconds, then immediately click on the alarm text in the patient information block to turn off all alarms for 3 minutes. The ALARM OFF text flashes in yellow in the patient information block, then after 3 minutes, a learn takes place and the alarms automatically turn on.WARNING: Turning off all alarms is not a safe clinical practice, depending on the acuity and monitoring needs of the patient.
ALARMS110 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.If the bedside monitor permits alarm silencing, the Central Station responds as fol-lows:•Bedside alarm source: the Central Station silences alarms for the specified bed. A crossed-out bell appears in the patient block while the silence remains in effect. Alarms are silenced for a period of time set by your facility’s system administrator. •Central alarm source: the Central Station ignores the silence indicator from the bedside monitor.(See page 115 for alarm source information.)Suspending Alarms from the Bedside MonitorSome bedside monitors allow temporary suspension of all alarm processing. During such suspension the alarm text in the patient block is ALMSUSPEND.Enabling AlarmsAlarms must be enabled before they can be processed. Enabled alarms are alarms set to ON or to Smart Alarms, as described below.Fig. 52. Alarms popup1. Press the Alarms button on the Patient Settings screen to display the Alarms popup (fig. 52). 2. Select ON, OFF, or SMART ALARM and then double-click or press Post.ON enables all alarms for a patient. If you select ON, press Alarm Config to make settings for individual alarm.Off disables sound and alarm text of all alarms for this patient; no notification of an alarming condition takes place. The system does not monitor patients whose alarms are set to Off.WARNING: Do not turn alarms OFF as a substitute for Silence (see “Procedure Alarm Silence (PAS)” on page 127). Patients with alarms set to OFF are not moni-tored. Patient channels with silenced alarms, however, are still monitored and alarms resume, after the silence period ends, if the condition persists.
ALARMSPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 111All information contained herein is subject to the rights and restrictions on the title page.Smart AlarmWith Smart Alarm you can remove patients from monitoring temporarily for such pur-poses as testing or showering without having to re-enter their settings or turn off alarms. 1. Press Alarms on the Patient Settings screen to display the alarms popup. 2. Highlight Smart Alarm, then press Post. This brings up a popup with a list of locations the patient might be while monitoring is suspended. Default loca-tions are shown below; this list can by changed by the system administrator.3. Highlight the appropriate location and double-click or press Post. The loca-tion appears in the patient information block (fig. 53 shows CATH LAB as an example). If you select a blank space, SMART ALARM flashes instead. Fig. 53. Smart Alarm patient location4. You can return the patient to monitoring either manually or automatically.Manually: click on the location text in the patient block. This causes the text to disap-pear and the re-learn to begin.Automatically: when the transceiver is reconnected to the patient or when the signal comes back into range, the rhythm automatically reappears on the screen. The patient information block displays the location for three minutes after the signal re-appears. After three minutes of continuous good signal, the patient is automatically taken out of Smart Alarm mode, and the system performs a re-learn. During these three minutes, only Level 1 alarms are enabled; all others are suspended.The Alarms field on the Patient Settings screen automatically switches to On.TESTSHOWERX-RAYCATH LABNUCLEAR MEDEEGSTRESS TESTG.I. LABPHY THERAPYECHOBlank spaces
ALARMS112 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.Re-learning After Alarm State TransitionsRelearning (see “Learn and Relearn Considerations” on page 70) takes place automat-ically on resumption of monitoring after Smart Alarm and after alarm state transitions as shown in Table 10.Table 10. Relearning after alarm state transitions.CAUTION: The visual display of Learning (LEARNING) in the Patient Tile will not be seen if V-TACH occurs during a Smart Alarm condition.From To Re-learn InitiatedSmart Alarm Alarms On YesSmart Alarm Alarms Off YesSmart Alarm 3 Minute Alarm Off YesSmart Alarm Smart Alarm NoAlarms On Alarms On NoAlarms On Alarms Off NoAlarms On 3 Minute Alarm Off YesAlarms On Smart Alarm NoAlarms Off Alarms On YesAlarms Off Alarms Off NoAlarms Off 3 Minute Alarm Off YesAlarms Off Smart Alarm Yes3 Minute Alarm Off Alarms On Yes3 Minute Alarm Off Alarms Off Yes3 Minute Alarm Off 3 Minute Alarm Off N/A3 Minute Alarm Off Smart Alarm Yes
ALARMSPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 113All information contained herein is subject to the rights and restrictions on the title page.Alarm ConfigurationAlarm settings are made at the system-wide level and at the patient level. System-wide alarm settings apply to all alarms and are set by the system administrator. Alarm settings are made at the patient level to tailor alarms according to individual patient needs. To configure patient alarms, you must open the Alarm Configuration screen.To open the Alarm Configuration screen:1. Click on the Setup button in the toolbar2. Click on the Alarm Config button in the Application window.Note: The Alarm Config button is enabled and disabled by your System Adminis-trator. If this button is disabled, check with your System Administrator for details.3. The Alarm configuration application opens..Fig. 54. Alarm configuration screenSystem Alarm ConfigurationThe behavior of alarm indicators when the alarming event is no longer present can be configured by a system-wide “latch” setting, which can be changed by the system administrator. Consult the system administrator to determine the appropriate latch set-ting to use for your facility.Patient Alarm ConfigurationAutomatic Printing of Alarm-Triggered EventsIt may be helpful to have hard copies of alarmed events for the patient’s file. To have these events printed automatically on the recorder or laser printer, toggle the Record button to On. (The Record button is not available for ventilator patients.)
ALARMS114 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.Storing an Alarm Triggered EventYou can store an alarmed event automatically by setting the system to capture the event and ten seconds before and after the event that caused the alarm. The event is stored in the patient’s history file. Toggle the Store button to On.Enable Paging for an Alarm Triggered EventIf your system has the paging option, you can have the system automatically generate a page when an event triggers an alarm. See “Paging” on page 238. Toggle the Page button On.Assigning the Patient to a PatientNet ViewerTo permit the patient to be assigned to the PatientNet Viewer (also known as the RVS) configured to receive alarms, toggle the Assign button to On. See also “Enabling Remote Alert” on page 89.Setting Alarm Urgency LevelsAlarms are ranked according to urgency from level 1 alarms, the most urgent, through level 3 alarms, the least urgent.Press Level to select alarm level 1, 2, or 3, or Off. If you select Off, no audio or visual indications occur when an alarm is triggered.Technical alarms are typically set to level 3, but some may be set to higher levels at your discretion.If two alarms occur at the same time, the alarm with the highest priority appears in the patient information block and sounds a tone. If two alarms of equal priority occur at the same time, they rotate in the patients information block.Note: Asystole, V-FIB, and V-TACH alarms are always set to Level 1 and cannot be changed.Setting Alarm LimitsYou can adjust the upper and lower limits of alarms when the Alarm Source is set to Central but not to Bedside (except for High PVC alarm) or for ventilator patients. You cannot set alarm limits for technical and arrhythmia alarms (except for High PVC) since these alarms have no applicable limits.Note: If available, you can set the limits for the V-TACH alarm. See your system administrator for details. See “Configuring the V-TACH Alarm Limits” on page 115 for additional information.1. Press the Alarm Config button on the Patient Settings screen to display the Alarm Config screen.2. Highlight an alarm with a value under Limit in the list of alarms.3. Press the Limits button to display a vertical bar where you set the new limit. Note that the Limits button becomes Options.4. Click in the vertical bar or use the arrow buttons to select the new limit, which appears in the small window above the arrow buttons. Or, press Default to revert to the default limit.5. Press Options to return to the Alarm Config screen or Exit.
ALARMSPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 115All information contained herein is subject to the rights and restrictions on the title page.Configuring the V-TACH Alarm LimitsYou can set the limits, PVC and HR, for calling a level 1 V-TACH alarm on the V-TACH Config screen. Note: The changes made to the V-TACH alarm limits affect only the selected patient.To configure the V-TACH alarm:1. Click the Alarm Config button to display the Device Alarm Config screen (See Figure 55 on page 115).2. Use the Up and Down arrows on the Alarm Config screen (fig. 55) to high-light and select the V-TACH alarm.Fig. 55. Alarm Config Screen - V-TACH Configuration3. Click the Limits button to display the V-TACH Config screen (fig. 56).Fig. 56. V-TACH Config Screen4. Click the HR button to set the HR limit (from 100 to 120 bpm), and click the PVC button to set the PVC limit (from 3 to 8). When each of the set limits is reached, the system will call a V-TACH alarm.5. Click the Exit button on the Alarm Config screen to return to the Patient Set-tings screen.
ALARMS116 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.Alarm SourceAlarm Source may be set to Central for alarm processing at the Central Station or Bedside for alarm processing at the bedside monitor.Alarms for ambulatory patients are always set to central source.Alarms for bedside monitored patients can be set to central alarm source or bedside alarm source.Alarms for ventilator patients are always set to bedside source.To set the alarm source, press Source on the Alarm Config screen to display the alarm Source popup (fig. 57), then press the Alarm Source button on the popup to select the appropriate source.Fig. 57. Alarm Source popupCentral Alarm SourceIn central alarm source, the Central Station processes all physiological alarms (arrhythmia, ST, and high and low limit alarms) and ignores physiological alarms called by the bedside monitor. The Central Station processes all technical alarms except those listed in the Bedside Alarm Source section.Alarm settings–medical alarm limits, paging, storing, assign to net, and recording of medical alarms–are made at the Central Station.When arrhythmia is turned off, “AROFF” appears in the patient block.
ALARMSPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 117All information contained herein is subject to the rights and restrictions on the title page.Bedside Alarm SourceIn bedside alarm source, the bedside monitor performs alarm processing on all high/low limit alarms and the Central Station displays alarms exactly as they occur on the bedside monitor. Alarm settings must be made at the bedside monitor, except for paging, storing, assign to net, and recording, which may be made at the Central Station.The bedside monitor processes DEV LOWBATT, LEAD OFF (ECG), the COMM ERR and NO SIGNAL technical alarms. The Central Station processes all other technical alarms.Note: If a bedside monitored patient’s alarms are processed by the bedside moni-tor and not by the Central Station, the main block is a different color than the standard patient block. (see “Screen and Waveform Colors” on page 41).Arrhythmia AlarmsAll non-arrhythmia physiological alarms are processed by the bedside monitor.If the bedside monitor is capable of arrhythmia processing, arrhythmia alarms are called by the bedside monitor and sent to the Central Station. If the bedside monitor does not perform arrhythmia processing, the Central Station processes all arrhythmia alarms.When the bedside monitor processes arrhythmia alarms, “BEDAR” appears in the patient information block.SilencingWhen you press the silence button on the bedside monitor, the Central Station silences alarms for the corresponding patient channel and displays a crossed-out bell as an indicator (if the bedside unit makes silencing information available to the transceiver).Note: The Central Station displays apnea, CHK PATIENT, CHK BEDSIDE, and BEDALARM alarms called by the bedside monitor regardless of the alarm source setting.
ALARMS118 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.Patient-Specific AlarmsMonitored parameters differ among bedside monitored, ambulatory and ventilator patients. The tables in this section list patient-specific alarms along with their trigger-ing conditions.Ambulatory PatientsTable 11. Ambulatory physiological alarmsAlarm Label Alarm Triggering ConditionHIGH HR high heart rate heart rate greater than high HR limitLOW HR low heart rate heart rate below the low HR limitASYSTOLE asystole no QRS detected for 3.0 sec.V-FIB ventricular fibrillation Rapid disorganized ventricular impulses, no QRSV-TACH ventricular tachycardia Configurable.The number of consecutive PVCs can be set equal to, and between, 3 and 8. The Heart Rate can be set equal to, and between, 100 and 120 BPM. A V-TACH alarm is triggered when the consecutive PVC count is reached AND the heart rate is greater than or equal to the set Heart Rate Value.V-RUN ventricular run V-RUN is triggered when the number of consecutive PVCs is greater than 2 and less than the V-TACH configured PVC value (i.e. when the V-TACH is configured at 3 PVCs, the V-RUN alarm is never triggered).V-RHYTHM ventricular rhythm V-RHYTHM is triggered when the number of con-secutive PVCs is greater than or equal to the V-TACH configured PVC value, but the Heart Rate is less than the V-TACH configured heart rate value.HIGH PVC high PVC PVC count > high PVC limitPVC PVC single PVCSV-TACH supraventriculartachycardia8 or more consecutive Supraventricular ectopic beats, HR 150 or moreCOUPLET ventricular couplet 2 consecutive PVCsBIGEMINY ventricular bigeminy N-PVC-N-PVC-N-PVC sequence (N = normal beat)TRIGEMINY ventricular trigeminy N-N-PVC-N-N-PVC-N-N-PVC sequence (N = normal beat)ST ALARM ST alarm ST elevation/depression exceeds limitsZERO RATE zero heart rate heart rate = zero on a patient set to arrhythmia OFF
ALARMSPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 119All information contained herein is subject to the rights and restrictions on the title page.Table 12. Ambulatory technical alarmsBedside Monitored PatientsTable 13. Bedside device non-arrhythmia medical alarmsAlarm Label Alarm Triggering ConditionNURSE nurse nurse call button on the transceiver pressed?? SOURCE source data received does not match configured device typeLOW BATT low transceiver battery battery level on the patient transceiver is below limitMUSCLE muscle muscle artifact detectedNO SIGNAL no signal no signal received from transceiverCHKSIGNAL check signal intermittent no signal detectedWRONG ID wrong ID Incompatible transceiver IDEDIT edit number of history events has reached configured thresholdLEAD OFF lead off ECG electrode is disconnected or looseCHECK LEAD check leads One or more of the ECG leads has a poor connection and/or is causing significant baseline wanderNO ARR Arrhythmia unable to analyzeNo good leads are available for analysisATT PRESENT attendant present called when pressed on transceiverPA SILENCE PAS called when sent from transceiverAlarm Label Alarm Triggering ConditionHIGH HR high heart rate heart rate greater than high HR limitLOW HR low heart rate heart rate below the low HR limitHI SpO2high SpO2high limit exceeded for pulse oximetryLO SpO2low SpO2low limit exceeded for pulse oximetryHI P1SYS high systolic P1high limit exceeded for systolic P1 invasive pressureLO P1SYS low systolic P1low limit exceeded for systolic P1 invasive pressureHI P1MN high mean P1high limit exceeded for mean P1 invasive pressureLO P1MN low mean P1low limit exceeded for mean P1 invasive pressureHI P1DIA high diastolic P1high limit exceeded for diastolic P1 invasive pressureLO P1DIA low diastolic P1low limit exceeded for diastolic P1 invasive pressureHI P2SYS high systolic P2high limit exceeded for systolic P2 invasive pressureLO P2SYS low systolic P2low limit exceeded for systolic P2 invasive pressureHI P2MN high mean P2high limit exceeded for mean P2 invasive pressureLO P2MN low mean P2low limit exceeded for mean P2 invasive pressureHI P2DIA high diastolic P2high limit exceeded for diastolic P2 invasive pressureLO P2DIA low diastolic P2low limit exceeded for diastolic P2 invasive pressure
ALARMS120 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.HI P3SYS high systolic P3high limit exceeded for systolic P3 invasive pressureLO P3SYS low systolic P3low limit exceeded for systolic P3 invasive pressureHI P3MN high mean P3high limit exceeded for mean P3 invasive pressureLO P3MN low mean P3low limit exceeded for mean P3 invasive pressureHI P3DIA high diastolic P3high limit exceeded for diastolic P3 invasive pressureLO P3DIA low diastolic P3low limit exceeded for diastolic P3 invasive pressureHI P4SYS high systolic P4high limit exceeded for systolic P4 invasive pressureLO P4SYS low systolic P4low limit exceeded for systolic P4 invasive pressureHI P4MN high mean P4high limit exceeded for mean P4 invasive pressureLO P4MN low mean P4low limit exceeded for mean P4 invasive pressureHI P4DIA high diastolic P4high limit exceeded for diastolic P4 invasive pressureLO P4DIA low diastolic P4low limit exceeded for diastolic P4 invasive pressureHI P5SYS high systolic P5high limit exceeded for systolic P5 invasive pressureLO P5SYS low systolic P5low limit exceeded for systolic P5 invasive pressureHI P5MN high mean P5high limit exceeded for mean P5 invasive pressureLO P5MN low mean P5low limit exceeded for mean P5 invasive pressureHI P5DIA high diastolic P5high limit exceeded for diastolic P5 invasive pressureLO P5DIA low diastolic P5low limit exceeded for diastolic P5 invasive pressureHI P6SYS high systolic P6high limit exceeded for systolic P6 invasive pressureLO P6SYS low systolic P6low limit exceeded for systolic P6 invasive pressureHI P6MN high mean P6high limit exceeded for mean P6 invasive pressureLO P6MN low mean P6low limit exceeded for mean P6 invasive pressureHI P6DIA high diastolic P6high limit exceeded for diastolic P6 invasive pressureLO P6DIA low diastolic P6low limit exceeded for diastolic P6 invasive pressureHI BP SYS high systolic BP high limit exceeded for systolic noninvasive pressureLO BP SYS low systolic BP low limit exceeded for systolic noninvasive pressureHI BP DIA high diastolic BP high limit exceeded for diastolic noninvasive pressureLO BP DIA low diastolic BP low limit exceeded for diastolic noninvasive pressureHI BP MN high mean BP high limit exceeded for mean noninvasive pressureLO BP MN low mean BP low limit exceeded for mean noninvasive pressureHI RESP high respiration rate high limit exceeded for respiration rateLO RESP low respiration rate low limit exceeded for respiration rateHI EtCO2high EtCO2high limit exceeded for the end-tidal carbon dioxide concentration in the expired air (EtCO2)Alarm Label Alarm Triggering Condition
ALARMSPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 121All information contained herein is subject to the rights and restrictions on the title page.LO EtCO2low EtCO2low limit exceeded for the end-tidal carbon dioxide concentration in the expired air (EtCO2)HI InCO2high InCO2high limit exceeded for the inspired carbon dioxide concentration in the inspired air (InCO2)HI T1high T1high limit exceeded for T1 temperatureLO T1low T1low limit exceeded for T1 temperatureHI T2high T2high limit exceeded for T2 temperatureLO T2low T2low limit exceeded for T2 temperatureHI DT high ∆T high limit exceeded for temperature differenceLO DT low ∆T low limit exceeded for temperature differenceAPNEA ALM apnea alarm patient respiration stopped for predetermined period of timeCHKPATIENT check patient medical or technical alarm not supported by V-Link/V-Link II/Instrument TransceiverBED ALARM bedside alarm medical alarm not supported by V-Link/V-Link II/Instrument TransceiverAlarm Label Alarm Triggering Condition
ALARMS122 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.Table 14. Bedside arrhythmia alarms (in Bedside Alarm Source Mode)Note: These alarms may be called only on a bedside monitor when the Central Sta-tion is set to Bedside Alarm Source Mode. Please refer to the operator’s manual for the specific bedside device for the alarm definitions.Alarm Label AlarmASYSTOLE asystoleV-FIB ventricular fibrillationV-TACH ventricular tachycardiaHIGH PVC high PVCPVC PVCSV-TACH supraventriculartachycardiaCOUPLET ventricular coupletBIGEMINY ventricular bigeminyTRIGEMINY ventricular trigeminyV-RHYTHM ventricular rhythmST ALARM ST alarmZERO RATE zero heart rateVBRADY --IRREGULAR --ACC VENT --PAUSE --RONT --TACHY --BRADY --SALVO --TRIPLET --V-RUN --NO ARR No ECG data available for Arrhythmia analysisMISSED BEAT --SV-BRADY --
ALARMSPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 123All information contained herein is subject to the rights and restrictions on the title page.Table 15. Bedside device technical alarmsAlarm Label Alarm Triggering ConditionSYS ERR system error bedside monitor device equipment failure, printer failure, or printer paper errorECG ERR ECG error bedside ECG equipment failureBP ERR BP error non-invasive equipment failure; uncalibrated; no pulse detectedRESP ERR respiration error no probe detectedP1ERR P1 error P1 not zeroedP2ERR P2 error P2 not zeroedP3ERR P3 error P3 not zeroedP4ERR P4 error P4 not zeroedP5ERR P5 error P5 not zeroedP6ERR P6 error P6 not zeroedSpO2ERR SpO2 error equipment SpO2 failure, uncalibratedCO2ERR CO2 error equipment CO2 failure, uncalibratedT1ERR T1 error equipment T1 failure, uncalibrated T2ERR T2 error equipment T2 failure, uncalibratedNO ECG no ECG ECG not detectedNO BP no BP BP not detectedNO P1no P1P1 not detectedNO P2no P2P2 not detectedNO P3no P3P3 not detectedNO P4no P4P4 not detectedNO P5no P5P5 not detectedNO P6no P6P6 not detectedNO SpO2no pulse oximetry SpO2 not detectedNO CO2no CO2CO2 not detectedNO T1no T1temperature probe not detectedNO T2no T2temperature probe not detectedNO RESP no respiration respiration not detected?? SOURCE source data received does not match configured device typeNURSE nurse call nurse call button on transceiver was pressedLOW BATT low transceiver battery low battery on the V-Link/V-Link II transceiverDEV LOWBATT low device battery low battery level in the bedside monitorMUSCLE muscle artifact muscle artifact detectedWRONG ID wrong ID incompatible transceiver IDEDIT edit number of history events reached the edit limitLEAD OFF lead off ECG electrode disconnected or looseNO SIGNAL no signal no signal received from transceiver
ALARMS124 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.CHECK LEAD check leads One or more of the ECG leads has a poor connection and/or is causing significant baseline wanderNO ARR Arrhythmia unable to ana-lyzeNo good leads are available for analysisCHKSIGNAL check signal intermittent no signal detectedCHK BEDSIDE check bedside technical alarm not supported by the Central StationCHKPATIENT check patient medical or technical alarm not supported by the Central Sta-tionCOMM ERR communication error communications CRC errors between the transceiver and bedside monitor exceeds limitATT PRESENT attendant present called when pressed on transceiverPA SILENCE Procedure Alarm Silence called when sent from transceiver
ALARMSPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 125All information contained herein is subject to the rights and restrictions on the title page.Ventilator Patients AlarmsAlarm Label Alarm Name Triggering ConditionHI PRESS high pressure limit see ventilator operator’s manualLO INS PRES low inspiration pressure see ventilator operator’s manualLOW PEEP Low PEEP/CPAP see ventilator operator’s manualLOW EX VT low exhaled tidal vol-umesee ventilator operator’s manualLOW EX MV low exhaled min. vol-umesee ventilator operator’s manualHI RESP high respiratory rate see ventilator operator’s manualLoPresO2In low pressure O2 inlet see ventilator operator’s manualLoPresAirIn low pressure inlet see ventilator operator’s manualHI SpO2high SpO2see ventilator operator’s manualLO SpO2low SpO2see ventilator operator’s manualHIGH PULSE high HR see ventilator operator’s manualLOW PULSE low HR see ventilator operator’s manualAPNEA ALM apnea alarm see ventilator operator’s manualEX VALVE LK exhalation valve leak see ventilator operator’s manualI:E RATIO I:E ratio see ventilator operator’s manualALMS SILENC alarms silenced see ventilator operator’s manualAIRPRESSDIS airway pressure discon-nectsee ventilator operator’s manualDEV LOWBATT low device battery low battery level in the ventilatorSVO DUE LSP SVO due to LSP see ventilator operator’s manualCHK PATIENT check patient ventilator device alarm not supported by V-Link/V-Link II/Instrument Transceiver is triggered?? SOURCE source data from ventilator does not match selected device typeSpO2ERR SpO2 error equipment SpO2 failure, uncalibratedNO SpO2NO SpO2SpO2 not detectedAPNEA VENT apnea ventilation see ventilator operator’s manualNURSE nurse remote button on the transceiver was pressedLOW BATT low transceiver battery low battery level on the Instrument TransceiverNO SIGNAL no signal no signal received from the transceiverWRONG ID wrong ID incompatible transceiver IDEDIT edit number of history events has reached its limitATT PRESENT attendant present called when pressed on transceiver
ALARMS126 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.Special Alarm HandlingMuscleWhen muscle artifact is detected, the alarm annotation in the full disclosure one-hour report reads “Muscle” rather than any alarm that may have occurred during the same one-minute interval. This notifies you that any alarm call during this period may have been influenced by muscle artifact.Level 1Asystole, V-FIB, and V-TACH alarms are set to level 1 priority and cannot be changed. The Low Heart Rate (LOW HR) alarm may be designated a Level 1 alarm, if desired.Check PatientThe CHK PATIENT alarm is a “catch-all” alarm to display any alarms supported by the bedside, but not listed in the current alarm list. It is called regardless of alarm source.Bed AlarmThe Bed Alarm is a technical alarm that is equivalent to the CHK PATIENT Alarm. It is called when an alarm occurs on a patient monitor that is not supported by the Cen-tral Station. It is called regardless of alarm source.Check BedsideThe CHK BEDSIDE alarm is a technical alarm that is equivalent to the CHK PATIENT alarm. It is called regardless of alarm source.Zero RateThe ZERO RATE alarm is called on the Central Station for patients with arrhythmia set to OFF. For ambulatory patients and bedside monitored patients with heart rate source set to ECG, zero rate is called when asystole or V-FIB is detected. When a bed-side monitored patient’s heart rate source is not set to ECG, zero rate is called when the heart rate is 20 bpm or less and the transceiver signal is good.NurseThe nurse alarm may be configured to level 1,2,3 and OFF. Its priority is the same as physiological alarms; its sound is the medical alarm sound that corresponds to the level of the nurse alarm.
ALARMSPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 127All information contained herein is subject to the rights and restrictions on the title page.Attendant PresentThe instrument transceiver (DT-7000) and ambulatory transceiver (DT-4500) have the capability of sending an attendant present alarm indicator to the Central Station. Once the Central Station receives the attendant present alarm indicator, the Central Station activates the attendant present alarm and displays the text “ATT PRESENT” in the patient block. The alarm level may be configured to allow the attendant present alarm to rotate with other configured physiological alarms.Note: Refer to “Attendant Present / Procedure Alarm Silence (PAS) Unlock But-ton” on page 188 for further information.The following are examples of system alarm configurations.1. When configured as a level 3 alarm, all level 1 and 2 alarms supersede the attendant present alarm and the attendant present alarm rotates with all physi-ological level 3 alarms. 2. When set to OFF the attendant present alarm is ignored.The attendant present alarm sound has the medical alarm sound associated with the configured level of the attendant present alarm at the time the alarm was activated.Full disclosure is annotated “ATT PRESENT” when the attendant present alarm is triggered.Procedure Alarm Silence (PAS)The instrument transceiver (DT-7000/DT-7001) and ambulatory transceiver (DT-4500) have the capability of sending a procedure alarm silence indicator to the Central Station. When the procedure alarm silence indicator is received at the Central Station, the central station then triggers the procedure alarm silence and displays the text “PA SILENCE” in the patient block. Note: Refer to “Procedure Alarm Silence (PAS) Button” on page 189 for further information.The procedure alarm silence remains active until one of the following conditions occur:• the transceiver no longer sends the procedure alarm silence indicator to the central station• a level 1 alarm is triggered at the central station• the patient tile alarm text area is clicked on Note: Alarms are set to ON after the area is clickedThe PAS alarm also performs the following functions:• while the procedure alarm silence alarm is active, a timer is displayed in the fourth patient block configurable field denoting the procedure silence alarm time (which starts at 120 seconds) that is remaining on the transceiver
ALARMS128 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.• all non-level 1 alarms are ignored while the alarm procedure silence alarm is active• full disclosure is annotated “PA SILENCE” for the duration of the procedure alarm silence periodTechnical AlarmsThe following technical alarms do not support Record or Store, and can only be set to Page and Assign:SYS ERRECG ERRBP ERRP1 ERRP2 ERRSPO2 ERRCO2 ERRP3 ERRNO P3CHK LEADLEAD OFFCHKSIGNALT1 ERRT2 ERR?? SOURCELOW BATTMUSCLEP4 ERRNO P4NO ARRNO SIGNALWRONG IDEDITNO SPO2NO CO2NO ECGNO BPP5 ERRNO P5NO P1NO P2NO T1NO T2NO RESPCHK BEDSIDECOMMP6 ERRNO P6
VIEWING CURRENT PATIENT STATUSPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 129All information contained herein is subject to the rights and restrictions on the title page.VIEWING CURRENT PATIENT STATUSTo observe a patient’s current monitoring information, press the View button on the Main screen to display the View screen and select the patient. The NPB 7200 series ventilator patient View screen is different from that of bedside monitored and ambula-tory patients.The View screen also encompasses history and full disclosure, which are covered in their own chapters.Bedside Monitored and Ambulatory Patient View ScreenFig. 58. Bedside Monitored View Screen The View screens for bedside and ambulatory patients are similar except for the clini-cal data displayed (see table 16, “Clinical information window data,” on page 131) and the ST templates – for bedside monitored patients with ST analysis enabled, digi-tal ST data only is displayed.Selecting Waves for DisplayFor bedside monitored patients, you can select any available wave for display; for ambulatory patients, you can select any ECG wave.1. Press the Wave button to bring up the Display Wave popup.2. Press the Display button, or touch/click directly on the waveform, to choose waves to display.3. Press the Position button to select one of the waves (the selected wave desig-nation flashes).4. Press the Wave button on the popup to cycle through available waveforms for the label set of the selected patient.clinical information window
VIEWING CURRENT PATIENT STATUS130 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.5. Press the Wave button on the View screen to save your selections.Ventilator Patient View ScreenFig. 59. Ventilator Patient View screenThe ventilator patient View screen shows real-time patient data/ventilator settings. Real-time values are displayed in blue text; current ventilator settings are displayed in black text.Real-time data are updated every second if values have changed. Settings data are updated, at most, every 15 to 30 seconds, but only when they are changed on the ven-tilator.
VIEWING CURRENT PATIENT STATUSPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 131All information contained herein is subject to the rights and restrictions on the title page.Clinical DataAvailable clinical data for each patient type is shown in Table 16.PrintingThe Record button records and prints. If a laser printer is attached to the system it may be labeled Laser. If you do not have a laser printer, the record button is labeled Strip, and printouts are produced in strip form from the monitor. Your system admin-istrator can change this label if necessary. To print, click on the Record button. To cancel printing, click a second time.For ventilator patients, the record button is disabled because there is no waveform.Table 16. Clinical information window dataPatient Type Dataambulatory HR, PACE-OFF, PACE%, PVC countPatient Device TypeST LevelST Slopebedside monitoredHR, PACE-OFF, PACE%, PVC countP1,P2, P3, P4, P5, P6 BP, Elapsed TimeEtCO2InCO2SpO2RespT1, T2, ∆THRSRC (ECG, P1, P2, P3, P4, P5, P6, SpO2, or BP)BRSRC (ECG or CO2)ventilator Ventilator ModePeak FlowSensitivityPressure SupportAutomatic SighWaveformNebulizerO2 Suction
VIEWING CURRENT PATIENT STATUS132 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.Strip RecorderThere are three types of recording from the strip recorder: timed, continuous, and trend recording.Timed RecordingTimed recordings print trace data starting ten seconds before and ten seconds after the print request (the number of seconds can be changed by the system administrator). When more than one recording requests have been queued, a Now button appears in the upper right corner of the screen. If you want the most recent timed recording to print immediately, press Now. Note that this action cancels the recording currently printing.Continuous RecordingContinuous recordings print until you stop them. During a timed recording a Cont button appears in the upper left corner of the screen. Press Cont to initiate a continu-ous recording. Press the Strip/Laser button to stop a continuous recording.Note: If you experience a delay in requesting a continuous strip, verify that there is an interruption in the printed data.Note: If leads are changed on the bedside device while continuous recording is in process, then the current recording will stop. You must initiate the record-ing again.Trend RecordingTrend recordings print trend graphs and are covered in the Trends section. See “Print-ing Trend Data” on page 162 for details.Laser PrinterThe PatientNet System supports laser printers that meet the following requirements:• the printer is a Hewlett Packard laser printer• the printer supports Printer Control Language PCL 5 and higher• the printer has at least 2 MB of memoryNote: We only validate laser printers that are provided by us.The laser printer should be set to 300 dpi, so grid measurement corresponds to its actual screen size. Laser printers print waveform data and other reports on 8 1/2 x 11 inch paper. Infor-mation on specific reports is contained in relevant sections of this manual.
VIEWING CURRENT PATIENT STATUSPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 133All information contained herein is subject to the rights and restrictions on the title page.Automatic Alarm PrintingYou can configure the system to print alarmed events automatically when they occur. To do so, you must enable individual alarms for automatic printing as instructed below.1. Press Setup on the Main screen and select the patient’s waveform.2. Press Alarm Config on the Patient Settings screen to display the Alarm Con-fig screen.3. Highlight the desired alarm and toggle Record to On. This alarm will now trigger automatic printouts.4. Repeat this step for all alarms you wish to print automatically for this patient.You can also print manually at any time. Printing at the PatientNet ViewersAll recording requests made at a PatientNet Viewer (also known as an IRVS or RVS) are recorded at the IRVS/RVS.All printing requests made at the IRVS/RVS are printed at the same IRVS/RVS. Full Disclosure strips can be printed at either the Central Station, PatientNet Viewer, or the Interactive-PatientNet Viewer.Printing from the Bedside MonitorWhen you request a printout from the bedside monitor and DT-7000 instrument trans-ceiver notifies the Central Station, which generates a real-time strip for the corre-sponding patient channel as if the record button had been pressed. If the alarm is set to Record and Store on the Alarm Config screen, the real-time strip is printed and stored in history.Printing Real-time Waveform Strips For All PatientsYou can print real-time waveforms for all admitted patients displayed on the Central Station at one time:1. Press System on the Main screen.2. Press Record All button on the Passcode screen. A real-time waveform strip is printed to the laser printer or the strip recorder for all patients on the central Station.
VIEWING CURRENT PATIENT STATUS134 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.Canceling Printing Laser printer: press the System button and then press Cancel Laser on the Passcode screen.Strip recorder: click on the Strip/Laser button.
HISTORYPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 135All information contained herein is subject to the rights and restrictions on the title page.HISTORY The PatientNet System can store up to 100 history events for each patient. All avail-able data is stored with each history event.For ambulatory patients data includes all transmitted leads and current ST tem-plates for valid ECG leads if ST is enabled when the event is stored.For bedside monitored patients data stored with history events includes:• the three transmitted waves• all available digital data• current ST templates for any ECG lead if ST is enabled when the event is stored.For ventilator patients, one history event is stored automatically every hour. This event contains a snapshot of all current vital statistics. Only digital data is stored, since no waveforms are transmitted.Once an event is stored in a patient’s history, you can display, magnify, measure, archive, and print the stored information.Fig. 60. History screenNote: The Rhythm Indicator status is stored in full disclosure and history screens, as well as printed on laser strips. The beat quality percentage is calculated and displayed as a Learned Template Match (LTM) percentage. See (“Rhythm Indicator” on page 70).
HISTORY136 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.Storing Events in the History FileSome events are stored automatically in a patient’s history file. These include alarms if alarms are set to STORE on the Alarm Config screen, and hourly vital signs of ven-tilator patients.You can also manually store events for later review and printing. All available data is stored in the history event, including received waves of data, vital statistics, ST tem-plates (if ST is enabled), and derived ECG leads, if available. 1. Press Store on the View screen. This stores the event in the patient’s history file along with the following:• date and time of the event• 20 seconds of waveform data (10 seconds before the event and 10 seconds after the event)2. Press the History button to display the History screen. You will see the event listed in the patient’s history entries as Store VCOM. 3. The two wave windows below the history entries list show a compressed view of the entire history event. Press the Wave buttons to cycle through available leads.• For ambulatory patients, lead I is displayed in the upper window and lead II in the lower window. • For bedside monitored patients, the first transmitted wave is displayed in the upper window and the second transmitted wave is displayed in the low-er wave window.•The Wave buttons and windows are disabled for ventilator patients.CAUTION: If two events of the same priority occur at the same time, only the first event detected is stored in history and can be printed.
HISTORYPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 137All information contained herein is subject to the rights and restrictions on the title page.Re-labeling History EventsYou can change the labels of history entries on the History screen. To re-label an entry:1. Press Event on the History screen. The right-hand portion of the History screen displays the re-labelling choices (fig. 61).Fig. 61. Labeling History Events2. Highlight the history event you wish to re-label in the history event black-board.3. Highlight the desired label in the event label blackboard.4. Click the Post button to change the event label.The highlighted History entry is now re-labeled. All re-labeled History events are designated by an asterisk (*).Note: You can also archive (page 144) and report (page 143) from this screen.
HISTORY138 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.Customized Labeling for Stored EventsYou can change labels on the history events with the Chart popup.To change event labels:1. Click the Review button on the History screen to display the History Event Review screen (fig. 64 on page 139).2. Click the Chart button on the History Event Review screen to display the Chart popup.3. The Operator Passcode number pad will appear (fig. 62). Enter your operator passcode to display the Chart popup (fig. 63). If you do not know your pass-code, then see your system administrator.Fig. 62. Operator Passcode PopupFig. 63. History Chart Popup4. Change the event label by clicking the Event button, highlighting the new label in the Event blackboard, and then clicking the Post button to save your change. An asterisk (*) appears in front of all modified events.5. Add a comment to the history event by clicking the Comment button, high-lighting the comment in the blackboard, and clicking the post button to save your change.6. Click the Condition button to cycle through Symptomatic, Asymptomatic and Blank.
HISTORYPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 139All information contained herein is subject to the rights and restrictions on the title page.7. Click the Report and Archive buttons to tag and/or archive the event (see pages 143 and 144).8. When you have finished making your selections, press Exit to save your changes and close the popup.Reviewing Stored History EventsBedside Monitored and Ambulatory PatientsWith an event in the list highlighted, you can make more detailed observations and perform operations on the events. 1. Press the Review button to display the Review screen (fig. 64). The full 20-sec-ond segment of stored data appears in the small window at the bottom of the screen.Fig. 64. History Review screen2. The brackets in the small window indicate the segment shown in the large window. To change this segment, move the bracket location using the arrow buttons.If an ST template was stored with the event, it appears to the right of the large window.Ventilator PatientsThe History Review screen displayed by the Review button shows set and observed vital signs for ventilator patients. Viewing Stored Vital StatisticsWhen an event is stored, all vital statistics associated with the event are also stored. To display these stored vital statistics, press the Vitals button. Press Vitals again to dis-miss.
HISTORY140 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.Magnifying History WaveformsTo magnify history event waveforms 2.5 times for more detailed examination: 1. Move the brackets on the History Review screen small window to the desired location. 2. Press the Expand button. The magnified segment appears. The first wave-form that appears is the ECG waveform, if ECG is present. 3. Select the Wave button to display the other stored waveforms.Measuring History WaveformsYou can make and save up to five history waveform measurements for later printing for bedside monitored and ambulatory patients.Making Measurements1. Press Measure on the normal or expanded view of the History Review screen2. Use the brackets in the small window to display the appropriate wave segment in the large window.3. Use the “mouse calipers” to make both horizontal and vertical measurements in the large window as follows: click/touch on the beginning point of the wave segment you want to measure and then on the end point. Yellow X and Y axes, and intermediate measurements appear with each click. Vertical mea-surements are shown in millimeters (mm), and horizontal measurements are shown in seconds (sec).Note: When using a touchscreen display, you can touch and grab the calipers to measure waveforms.Saving MeasurementsSave the measurement by pressing as many of the caliper buttons below as appropri-ate. Make sure that the Clear button is not depressed before storing measurements.R-R saves the R-R caliper measurement in seconds. Heart rates are saved only with R-R. Q-T saves the Q-T caliper measurement in seconds.P-R saves the P-R caliper measurement in seconds.QRS saves the QRS caliper measurement in seconds.ST saves the measured distance between the two horizontal calipers in millimeters (mm).
HISTORYPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 141All information contained herein is subject to the rights and restrictions on the title page.Press caliper buttons only after making a measurement with the calipers. Otherwise, the following message box appears.Fig. 65. Caliper message boxPrinting Caliper-Annotated Waveforms Calipers can be printed from the expanded history mode only. 1. Press Expand on the History Review Screen2. Set the calipers as instructed in Making Measurements above.3. Save the measurements as instructed in the Saving Measurements section above.4. Press the Back button and then the Record or Laser button.Deleting MeasurementsTo delete an individual caliper measurement:1. Press the Clear button.2. With Clear depressed, press the caliper button of the measurement you wish to delete. The X-Y axes disappear and the cleared caliper window reads “Blank.”Reviewing and Editing History Events1. When reviewing the history entries (determine an interval at which time this should occur). Archive (save) the events you wish to keep or Report the events that you want to print on the tagged report. If using the DT-4500 trans-ceivers, the impedance numbers should be greater than 185. Erase all after you have completed this step. Starting at the end of the file will allow you to see those events that have been archived.2. If there are four or more consecutive false alarms due to wandering baseline and/or artifact, check the following:a. The impedance values of the electrodes (found under System in the Open-Net menu).b. If impedance is within normal limits, consider changing the electrode placement to better meet criteria for good placement (away from loose skin, limbs, and large muscles).c. If the false alarms are due to the system mislabelling a rhythm or history event, RELEARN under setup. See “Learn and Relearn Considerations” on page 70.3. Preparation and placement of electrodes is the number one challenge in pro-viding good signal quality and, if not provided, contributes to false alarms.
HISTORY142 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.4. If the history is filling with the same correct alarms (i.e. Bigeminy or Couplet) and your policy guidelines allow, do the following:a. Go to Alarm Config under “Setup” and turn Store OFF for that particular alarm.b. Archive an example of the alarm for your shift before disabling the Store function.c. Remember also that turning “Level” to OFF will disable the audio and vi-sual alarms, but will continue to go into the history as long as Store is still ON.CAUTION: When you use the Three-Minute Alarm Off (touching silence twice and the patient information tile once), be aware that you are turning off all of the alarms for that patient for three minutes. Lethal alarms will not break through. Remember that touching silence once will silence all active alarms for the configured time period (30, 45, 60, or three minutes).Deleting History EventsOnce a patient’s history file has reached its size limit (as set by the system administra-tor), new events trigger the Edit alarm. The oldest event is deleted when 100 events have been stored. If the oldest event is archived or is tagged as a report candidate (see pages 143 and 144), it is not deleted. It is good practice to purge events in a patient’s history file that are no longer significant. You can delete events from a history file in one of the ways shown in step 2. You can-not delete archived events or report candidates. 1. Highlight the appropriate event on the History screen.2. Press the Erase button to display the History Erase popup and select one of the following buttons:Single deletes the highlighted event.All deletes all but archived and report candidate entries for this patient.Cancel removes the popup without deleting an event.Fig. 66. History Erase Popup
HISTORYPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 143All information contained herein is subject to the rights and restrictions on the title page.Tagging Events as Report CandidatesYou can designate events in a patient’s history file as report candidates. This allows you to print reports of only these events.1. Highlight the event to be marked as a report candidate.2. Press the Event button on the History screen and then the Report button. This places an “R” to the right of the event number in the History blackboard. Press Report a second time to cancel the report candidate status.The Report button also appears on Chart popup (fig. 8 on page 139).Printing Tagged Event ReportsTagged event reports can print only on the laser printer; if you do not have a laser printer, these reports are not available. If you have a laser printer but the system is configured for strip printing, tagged event reports still print on the laser printer.1. Press the Laser or Record button. The Print popup appears with three choices.2. Select one of the following popup buttons:Tagged Events prints a report of all events tagged “R.”Single Event (for bedside monitored and ambulatory patients only) prints only the highlighted event.Venti lator Da ta (for ventilator patients only) prints all ventilator history events.Cancel closes the popup without printing.Fig. 67. Print popup3. If you select Tagged Events, a second popup asks, “Do you wish to add a comment to the tagged events report?” a. Press No to print without comment. b. Press Yes to display an on-screen keyboard on which you can type two lines of text to appear on the printout. The on-screen Enter button toggles between line 1 and line 2.c. Press Exit on the on-screen keyboard when you have finished typing.
HISTORY144 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.Archiving EventsArchived events are events that cannot be erased. You can archive the history events of all patient types. 1. Press the History button on the View screen.2. Highlight the appropriate event in the history blackboard. 3. Press the Archive button. This places an “A” to the left of the event number in the History blackboard. To remove the “A” and make it possible to delete the event, press Archive again.The Archive button also appears and has the same function on the Chart popup and Events screen.CAUTION: After 100 events are archived, the oldest events will be deleted as necessary to make room for new events.ST HistoryFor central source patients with ST enabled, ST episodes are stored as ST history events if the alarm is set to STORE on the Alarm Config screen.Such stored events include:• three 20-second waveforms• current ST templates for each surface ECG lead along with their time stamps• learned ST templates for each surface ECG lead along with their time stamps• location of ST measurement points for learned and current templatesFor bedside arrhythmia source patients, the ST level and slope data appear in the Vitals popup and strip or laser printouts if it is available from the bedside monitor.
HISTORYPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 145All information contained herein is subject to the rights and restrictions on the title page.Printing History EventsPrintingTo print a history event, press Record or Laser on the History or History review screen. You can also print from the expanded History Review screen. To print tagged events only, see page 143.All events in a patient’s history file can be printed from either the strip chart recorder or the laser printer. Printouts of history events are as follows:•Strip recordings of a history event include the top two waveforms in the His-tory Review screen printed with 10 seconds of waveform before the event and 10 seconds of waveform after the event. The vital signs of the patient at the time of the event precede the waveform.•Laser printouts include up to four waves displayed in the History Review screen. The patient’s vital statistics, as well as the alarm limit which triggered the laser printout, are printed under the waveforms and Chart data, if set on the Chart popup.If ST analysis was enabled when the event was stored, ST information is printed as shown in the next section.ST Information Printed• For patients with central arrhythmia processing, digital ST values and tem-plates, level and slope are printed on all strips and laser reports if ST data is available. If ST is enabled, only 18 seconds (rather than 20) are printed on laser.• For patients with arrhythmia processed by the bedside monitor, digital ST val-ues are printed without ST templates, if ST data is available from the bedside monitor.• ST digital data is printed preceding the waveform data on strip recordings and in the ST waveform templates on laser printouts.• Ventilator patient history events are printed only on the laser printer.
HISTORY146 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.This page is intentionally left blank.
FULL DISCLOSUREPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 147All information contained herein is subject to the rights and restrictions on the title page.FULL DISCLOSUREThe system stores all waveforms and digital data for 24 (or 72) hours with the Full Disclosure feature. You can review and print all or a portion of this data from the Full Disclosure screen (see fig. 69 on page 148), which lets you select the time period and how you want the information displayed and printed. Full Disclosure is available for ambulatory and bedside monitored patients but not for ventilator patients. Select the patient and press the 24 Hr (or 72 Hr) button on the View screen to display the Full Disclosure screen.Note: The 72 Hr button will be displayed if you have the 72 Hour Full Disclosure option enabled.Disclosure ModeDisclosure mode determines when to start and stop collection of the disclosure data. Press the Mode button on the Full Disclosure screen to display the Mode popup (fig. 68). Fig. 68. Mode popupSelect one of the following:Start 1-Pass begins one 24-hour (or 72-hour) period of complete patient data recording. At the end of 24 (72) hours, the mode automatically switches to Stop. Stop stops recording. Up to 24 (72) hours of previously recorded data is saved, but no new data is saved. Continuous collects waveform data continuously with no ending point. Oldest data is overwritten.
FULL DISCLOSURE148 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.Fig. 69. Full disclosure screensFig. 69 shows zoomed in and zoomed out versions of waveforms on the FullDisclosure screen.Note: There are two Zoomed Out displays in Full Disclosure. Press the Zoom Out button twice to display each Zoomed Out screen.zoomed outzoomed in
FULL DISCLOSUREPatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 149All information contained herein is subject to the rights and restrictions on the title page.Zooming In and Out Use the Zoom Out and Zoom In buttons to zoom out or in. Alarms and beat annota-tions are displayed differently on zoomed in and zoomed out views.Note: Zoomed-In full disclosure also displays a page indicator, which shows the time that a page was sent. The Page Indicator is displayed in blue text below the Zoomed-In waveform (fig. 70). Fig. 70. Page IndicatorBeat AnnotationsYou can display beat call annotations on zoomed-in waveforms and laser printouts for patients set to central arrhythmia source.1. Press the Options button on the Full Disclosure screen to display the Options popup (fig. 71).Fig. 71. Full Disclosure Options PopupZoomed In Zoomed OutAlarms Alarm text appears in the lower left corner of the waveform window.Alarms are indicated by a line under the waveform. See page 106 for details on alarm indicators.Beat Annotations Available. See the next section. Not available.
FULL DISCLOSURE150 PatientNet Operator’s Manual, v1.04, 10001001-00X, DraftAll information contained herein is subject to the rights and restrictions on the title page.2. Toggle Annotation to Yes on the popup. This following beat calls appear as appropriate.Table 17 1.05 Arrhythmia Beat Classification LabelsSelecting Waveforms for Disclosure ReportsYou can select waves to appear on Disclosure reports and the 24 Hour Disclosure screen by changing the display wave format. 1. Press the Wave button to bring up the Wave popup (fig. 72).Fig. 72. Wave popup2. Press the Display button to select the number of waves (one to four) to dis-play.3. Press the Position button to select one of the waves (the selected wave flashes).4. Press the Wave button on the popup to cycle through available waveforms for the label set of the selected patient.5. Press the Wave button on the Full Disclosure screen to save your selections.Beat Label DescriptionNNormal or DominantQAberrant NormalqFirst Occurrence of Aberrant NormalAPremature Normal or Premature Supraventricular (SVE)VPremature Ventricular Ectopic (PVC)XNot Classified Due to Bad Samples (RF drop out) in QRS Region?Unknown (Noise or First Occurrence of PVC Morphology)

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