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

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ADMIT, DISCHARGE, AND PATIENT DEMOGRAPHIC INFORMATION
ADMIT, DISCHARGE, AND PATIENT DEMOGRAPHIC INFORMATION
This 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 screen
Admitting a Patient to the System
Admit 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.
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ADMIT, DISCHARGE, AND PATIENT DEMOGRAPHIC INFORMATION
Entering Patient Information
Once a patient is admitted, press the Patient Data button to display the Patient Data
Entry screen (fig. 31).
Fig. 31. Patient Data Entry screen
1. 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 number 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.
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ADMIT, DISCHARGE, AND PATIENT DEMOGRAPHIC INFORMATION
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.
Patient Data Field
Number of Characters
Patient Name
18
Room/Bed
Nursing Unit
18
Patient ID
20
Date of Birth
18
Sex (M/F)
Physician
18
Physician Group
18
Diagnosis
18
Orders
18
Notes 1
18
Notes 2
18
Notes 3
18
Medication 1
18
Medication 2
18
Medication 3
18
Viewing Patient Information
1. Press Patient Data on the Patient Settings screen (fig. 30). The View Data
screen appears, showing the information entered when the patient was admitted 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.
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ADMIT, DISCHARGE, AND PATIENT DEMOGRAPHIC INFORMATION
Modifying Patient Information
Modify existing patient demographic information on the View Data screen (fig. 32).
Fig. 32. View Data screen
1. 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:
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If any of the demographic fields are set to Pre-Admit by the System Administrator, 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.
PatientNet Operator’s Manual, v1.04, 10001001-00X, Draft
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ADMIT, DISCHARGE, AND PATIENT DEMOGRAPHIC INFORMATION
Printing Patient Information
You 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
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ADMIT, DISCHARGE, AND PATIENT DEMOGRAPHIC INFORMATION
Discharging a Patient From the System
Discharging a Patient at the Central Station
To discharge a patient at the Central Station:
1. Press Discharge on the Patient Settings screen. If you want to print a discharge report, click Yes 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 Yes 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 continuing with the discharge will cancel all queued reports.
CAUTION: Selecting Yes 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 Device
If 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 Yes to clear patient information, or No to cancel the discharge request and retain
the patient in the system.
Note:
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You must select either Yes or No in order to remove the Remote Discharge
screen and re-enable the main screen buttons and functions.
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ADMIT, DISCHARGE, AND PATIENT DEMOGRAPHIC INFORMATION
Printing a Discharge Report
To 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 Yes 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.
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 Yes 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 continuing with the discharge will cancel all queued reports.
CAUTION: Selecting Yes 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.
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PATIENT SETTINGS
PATIENT SETTINGS
Once 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
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PATIENT SETTINGS
Setting Device Types
Patients 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 monitoring 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 popup
Note:
The device types that are displayed in the popup can be selected by the system 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 triggered.
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.
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Table 7. Device types
Device Type
Specific Device
Ambulatory
• 5 wire
• 4 wire
• 3 wire
Bedside Monitor
•
•
•
•
•
•
•
•
•
•
Ventilator
AT w/PRO
Passport 2
Exp w/EP
Encore
Passport
Expert
MPS
PRO-1000
PB 7200
Bird
•
•
•
•
•
•
DASH
Radical
Propaq
NK 4000
NK 2300
Agilent
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PATIENT SETTINGS
Selecting Monitored Parameters for the Configurable Data Block
The 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 block
Patient Type
Ambulatory
Bedside Monitor
Ventilator
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Available Parameters
• Heart rate
• Percent of paced beats
• PVC
• Transceiver ID
• Battery level of transceiver • High/low heart rate limits
• Leadset (3-, 4-, 5-wire)
• ST level
• Heart rate
• Temperature1
• P1 systolic/diastolic
• Temperature2
• P1 mean
• Temperature ∆
• P2 systolic/diastolic
• Respiratory rate
• PVC
• P2 mean
• Heart rate source
• P3 systolic/diastolic
• RESP rate source
• P3 mean
• Battery
• P4 systolic/diastolic
• Percent of paced beats
• P4 mean
• BP Elapsed Time
• P5 systolic/diastolic
• Transceiver ID
• Cardiac Output
• P5 mean
• Cardiac Index
• P6 systolic/diastolic
• Body Surface Area
• P6 mean
• PAWP
• BP systolic/diastolic
• High/low heart rate limits
• BP mean
• Device type name
• EtCO2
• ST level
• InCO2
• SpO2
•
•
•
•
•
•
•
Heart rate
SpO2
Respiratory rate
Inspiration: Expiration ratio
Tidal volume
Minute volume
Spontaneous minute volume
•
•
•
•
•
•
•
Peak inspiratory pressure
Mean airway pressure
Plateau pressure
Oxygen %
PEEP/CPAP
Transceiver ID
Device Type Name
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PATIENT SETTINGS
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 Device
2. 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.
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Assigning a Transceiver ID to a Patient
Note:
This button is configurable in the system administrator screens. If this button 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 Screen
2. 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.
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PATIENT SETTINGS
Selecting Waveforms for Display on the Main Screen
Since 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 Patients
Ambulatory 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 enabled.
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.
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PATIENT SETTINGS
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 Waveforms
You can select labels for each transmitted wave; the number of available waveforms
depends on the device type selected in the Patient Settings screen. Available waveforms 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 Definition popup shown in fig. 38. See table 9 for available wave labels.
Fig. 38. Label Set Definition popup
2. Press the three Wave buttons to cycle through available waves.
3. For 4- and 5-wire transceivers, toggle the Augment button to Yes 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.
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Table 9. Waveform labels
3-Wire
5-Wire
Bedside
II
ECG I
P1
Wave 3
N/A
I, ML1
I, II, III, ML1, II, ML6
ML6
N/A
N/A
Augment
N/A
Yes, No
Wave 1
Wave 2
4-Wire
No, Yes, N/A
V, V1, V2, V3, P2
V4, V5, or V6
N/A
Alarms
Information on alarms and instructions on how to set and work with alarms are covered in detail in the “Alarm Management” chapter starting on page 105.
Enabling Remote Alert
With 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 Patient
Note:
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 administrator.
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.
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PATIENT SETTINGS
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 PreAdmit 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.
Implants
Press 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:
Type
Definition
Pacer
AICD
PCD
None
Pacemaker
Automatic Implantable Cardioverter Defibrillator
Pacer-Cardioverter-Defibrillator
No implant
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 Analysis
You 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 pacemakers. Do not set Process to Pacer for patients who do not have an electronic 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.
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Setting the Pacer Blanking Period
Setting a blanking period before and after the pacer spike removes residual pacer artifact 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 available, then see your system administrator for details.
Arrhythmia Processing
Arrhythmia 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 Transfers
You 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 Transfer
A 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
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PATIENT SETTINGS
Fig. 39. Transfer popup
Network Transfer
You 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 Patient
The 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 network:
1. Press Transfer on the Patient Settings screen.
2. On the Transfer popup, toggle the Transfer button to Yes.
Transferring the Patient from One Central Station to Another
1. 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 condition 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.
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PATIENT SETTINGS
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 Progress
You 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 Yes if you wish to stop the transfer, or No to continue with the transfer
as described above.
Fig. 40. Halting a Transfer Popup
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PACEMAKER PROCESSING
PACEMAKER PROCESSING
You 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 pacemakers. Do not set Process to Pacer for patients who do not have an electronic 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 Detection
Pacemaker 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 pacemaker 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 Analysis
When 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 pacemaker pulses were detected by inserting a pacemaker flag in the ECG data. The pacemaker 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.
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Fig. 41. Three Lead Depiction of Pacemaker Rhythm
Pacemakers 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 algorithm looks for in order to identify a pacemaker spike. As noted earlier, when a pacemaker 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 problem 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 commonly referred to as “dead-man” pacer. Regardless of the use of arrhythmia monitoring, 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.
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Determining Pacer Filter Blanking Periods
WARNING: 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 available, then see your system administrator for details.
The pacer filter is enabled when Process is set to Pacer. The pacer filter setting controls 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 filter 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 annotation per beat), then the pacer filter should be increased (See Figure 43 on page 99).
Note:
The pacer filter does not affect pacer detection
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FALSE ASYSTOLE ALARMS ON FUSED BEATS
FILTER TOO HIGH
FILTER OK
HOW TO VISUALIZE THE EFFECT OF THE
PACER FILTER
The pacer filter controls how much data is blanked on both sides of a
detected pacemaker spike. The blue flag indicates the position where
the spike was detected. The red line represents the region of pacer
blanking. If there is a fused pacemaker spike on a narrow QRS
complex, the blanking may remove the QRS complex. If false low
rate or asystole alarms are observed, try decreasing the pacer filter.
WHAT THE USER SEES
The displayed and printed data show the unfiltered data. There
should be an annotation (N,V,etc.) associated with each detected beat
in the 24 hour data. If missing annotations are noted on fused beats,
decreasing the pacer filter may allow more of the QRS complex
through to the arrhythmia module.
WHAT THE ARRHYTHMIA SEES
The filtered data is passed to the arrhythmia module. Note that if the
pacer filter is too high some or all of the QRS complex may be
blanked resulting in false asystole or low rate calls.
Fig. 42. False Asystole Alarms on Fused Beats
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FALSE HIGH RATES DUE TO DETECTION OF
BEATS ON PACER ARTIFACT
FILTER TOO LOW
FILTER OK
HOW TO VISUALIZE THE EFFECT OF THE
PACER FILTER
The pacer filter controls how much data is blanked on both sides of a
detected pacemaker spike. The blue flag indicates the position where
the spike was detected. The red line represents the region of pacer
blanking.
WHAT THE USER SEES
The displayed and printed data show the unfiltered data. There
should be one and only one annotation (N,V,etc.) associated with
each QRS beat in the 24 hour data. If there is more than one
annotation per beat and the additional annotation(s) are near the
residual pacer artifact, increasing the pacer filter (blanking period)
will result in more of the artifact being blanked which reduces the
likelihood of the artifact being detected as a beat.
WHAT THE ARRHYTHMIA SEES
The filtered data is passed to the arrhythmia module. Note that if the
pacer 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.
Fig. 43. False High Rates Due to Detection of Beats on Pacer Artifact
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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.
40 mm interval
Artifacts
Fig. 44. Waveform Measurement - Blanking Interval
Pacer
Pacer Spike
Interval before the spike
Interval after the spike
Fig. 45. Detailed Waveform
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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 relation to the actual pacemaker spike or artifact. The flag may be in the center 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 Pacemakers
This 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 superimposed on the patient’s ECG waveform. Telectronics manufactures such an impedance-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
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Note the next four figures, where the system is accurately detecting and presenting the
pacemaker flag.
Fig. 47. Accurate Pacemaker Flag - Atrial-Ventricular Pacing
Fig. 48. Accurate Pacemaker Flag - Ventricular Pacing
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Fig. 49. Accurate Pacemaker Flag - Ventricular Pacing
Fig. 50. Accurate Pacemaker Flag - Atrial Pacing
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ALARMS
ALARMS
Alarms 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 surveillance. 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 Detection
Alarms 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 Indicators
The Central Station produces characteristic sounds associated with the types and
levels of alarms as shown below.
Alarm Type
Pitch
Relative
Speed
Medical: level 1
alternating tone
fast
Medical: level 2
single tone
medium
Medical: level 3
single tone
slow
Technical; level 1, 2, 3
single tone
slowest
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Visual Alarm Indicators
Alarms are indicated visually on the Main screen in the patient information block and
on the Full Disclosure screen (fig. 51).
Main Screen Patient Information Block
Alarm 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 Screen
Zoomed-Out Mode
A 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 Mode
Alarms 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).
zoomed out
zoomed in
alarm
indicator
Fig. 51. Visual alarm indicators
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Acknowledging Alarms
When 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 duration 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 immediately 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 information 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 1
Most 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.
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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 2
Less 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 “ALARM
OFF” in yellow until you click on it.
Medical, Level 3
Less 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.
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Technical, Level 3
Least 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 Alarms
Press 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 silencing 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 effective 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.
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If the bedside monitor permits alarm silencing, the Central Station responds as follows:
•
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 Monitor
Some bedside monitors allow temporary suspension of all alarm processing. During
such suspension the alarm text in the patient block is ALMSUSPEND.
Enabling Alarms
Alarms 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 popup
1. 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 monitored. Patient channels with silenced alarms, however, are still monitored
and alarms resume, after the silence period ends, if the condition persists.
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Smart Alarm
With Smart Alarm you can remove patients from monitoring temporarily for such purposes 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 locations are shown below; this list can by changed by the system administrator.
TEST
SHOWER
X-RAY
CATH LAB
NUCLEAR MED
EEG
STRESS TEST
G.I. LAB
PHY THERAPY
ECHO
Blank spaces
3. Highlight the appropriate location and double-click or press Post. The location 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 location
4. 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 disappear 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.
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Re-learning After Alarm State Transitions
Relearning (see “Learn and Relearn Considerations” on page 70) takes place automatically on resumption of monitoring after Smart Alarm and after alarm state transitions
as shown in Table 10.
Table 10. Relearning after alarm state transitions.
From
To
Re-learn Initiated
Smart Alarm
Alarms On
Yes
Smart Alarm
Alarms Off
Yes
Smart Alarm
3 Minute Alarm Off
Yes
Smart Alarm
Smart Alarm
No
Alarms On
Alarms On
No
Alarms On
Alarms Off
No
Alarms On
3 Minute Alarm Off
Yes
Alarms On
Smart Alarm
No
Alarms Off
Alarms On
Yes
Alarms Off
Alarms Off
No
Alarms Off
3 Minute Alarm Off
Yes
Alarms Off
Smart Alarm
Yes
3 Minute Alarm Off
Alarms On
Yes
3 Minute Alarm Off
Alarms Off
Yes
3 Minute Alarm Off
3 Minute Alarm Off
N/A
3 Minute Alarm Off
Smart Alarm
Yes
CAUTION: The visual display of Learning (LEARNING) in the Patient Tile will not be seen
if V-TACH occurs during a Smart Alarm condition.
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Alarm Configuration
Alarm 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 toolbar
2. Click on the Alarm Config button in the Application window.
Note:
The Alarm Config button is enabled and disabled by your System Administrator. If this button is disabled, check with your System Administrator for
details.
3. The Alarm configuration application opens.
Fig. 54. Alarm configuration screen
System Alarm Configuration
The 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 setting to use for your facility.
Patient Alarm Configuration
Automatic Printing of Alarm-Triggered Events
It 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.)
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Storing an Alarm Triggered Event
You 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 Event
If 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 Viewer
To 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 Levels
Alarms 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 Limits
You 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.
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Configuring the V-TACH Alarm Limits
You can set the limits, PVC and HR, for calling a level 1 V-TACH alarm on the VTACH 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 highlight and select the V-TACH alarm.
Fig. 55. Alarm Config Screen - V-TACH Configuration
3. Click the Limits button to display the V-TACH Config screen (fig. 56).
Fig. 56. V-TACH Config Screen
4. 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 Settings screen.
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Alarm Source
Alarm 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 popup
Central Alarm Source
In 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.
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Bedside Alarm Source
In 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 monitor 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 Alarms
All 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.
Silencing
When 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 BED
ALARM alarms called by the bedside monitor regardless of the alarm source
setting.
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Patient-Specific Alarms
Monitored parameters differ among bedside monitored, ambulatory and ventilator
patients. The tables in this section list patient-specific alarms along with their triggering conditions.
Ambulatory Patients
Table 11. Ambulatory physiological alarms
Alarm Label
Alarm
Triggering Condition
HIGH HR
high heart rate
heart rate greater than high HR limit
LOW HR
low heart rate
heart rate below the low HR limit
ASYSTOLE
asystole
no QRS detected for 3.0 sec.
V-FIB
ventricular fibrillation
Rapid disorganized ventricular impulses, no QRS
V-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 VTACH 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.
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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 consecutive PVCs is greater than or equal to the VTACH 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 limit
PVC
PVC
single PVC
SV-TACH
supraventricular
tachycardia
8 or more consecutive Supraventricular ectopic
beats, HR 150 or more
COUPLET
ventricular couplet
2 consecutive PVCs
BIGEMINY
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 limits
ZERO RATE
zero heart rate
heart rate = zero on a patient set to arrhythmia OFF
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Table 12. Ambulatory technical alarms
Alarm Label
Alarm
Triggering Condition
NURSE
nurse
nurse call button on the transceiver pressed
?? SOURCE
source
data received does not match configured device type
LOW BATT
low transceiver battery
battery level on the patient transceiver is below limit
MUSCLE
muscle
muscle artifact detected
NO SIGNAL
no signal
no signal received from transceiver
CHKSIGNAL
check signal
intermittent no signal detected
WRONG ID
wrong ID
Incompatible transceiver ID
EDIT
edit
number of history events has reached configured
threshold
LEAD OFF
lead off
ECG electrode is disconnected or loose
CHECK LEAD
check leads
One or more of the ECG leads has a poor connection
and/or is causing significant baseline wander
NO ARR
Arrhythmia unable to
analyze
No good leads are available for analysis
ATT PRESENT
attendant present
called when pressed on transceiver
PA SILENCE
PAS
called when sent from transceiver
Bedside Monitored Patients
Table 13. Bedside device non-arrhythmia medical alarms
Alarm Label
Alarm
Triggering Condition
HIGH HR
high heart rate
heart rate greater than high HR limit
LOW HR
low heart rate
heart rate below the low HR limit
HI SpO2
high SpO2
high limit exceeded for pulse oximetry
LO SpO2
low SpO2
low limit exceeded for pulse oximetry
HI P1 SYS
high systolic P1
high limit exceeded for systolic P1 invasive pressure
LO P1 SYS
low systolic P1
low limit exceeded for systolic P1 invasive pressure
HI P1 MN
high mean P1
high limit exceeded for mean P1 invasive pressure
LO P1 MN
low mean P1
low limit exceeded for mean P1 invasive pressure
HI P1 DIA
high diastolic P1
high limit exceeded for diastolic P1 invasive pressure
LO P1 DIA
low diastolic P1
low limit exceeded for diastolic P1 invasive pressure
HI P2 SYS
high systolic P2
high limit exceeded for systolic P2 invasive pressure
LO P2 SYS
low systolic P2
low limit exceeded for systolic P2 invasive pressure
HI P2 MN
high mean P2
high limit exceeded for mean P2 invasive pressure
LO P2 MN
low mean P2
low limit exceeded for mean P2 invasive pressure
HI P2 DIA
high diastolic P2
high limit exceeded for diastolic P2 invasive pressure
LO P2 DIA
low diastolic P2
low limit exceeded for diastolic P2 invasive pressure
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120
Alarm Label
Alarm
Triggering Condition
HI P3 SYS
high systolic P3
high limit exceeded for systolic P3 invasive pressure
LO P3 SYS
low systolic P3
low limit exceeded for systolic P3 invasive pressure
HI P3 MN
high mean P3
high limit exceeded for mean P3 invasive pressure
LO P3 MN
low mean P3
low limit exceeded for mean P3 invasive pressure
HI P3 DIA
high diastolic P3
high limit exceeded for diastolic P3 invasive pressure
LO P3 DIA
low diastolic P3
low limit exceeded for diastolic P3 invasive pressure
HI P4 SYS
high systolic P4
high limit exceeded for systolic P4 invasive pressure
LO P4 SYS
low systolic P4
low limit exceeded for systolic P4 invasive pressure
HI P4 MN
high mean P4
high limit exceeded for mean P4 invasive pressure
LO P4 MN
low mean P4
low limit exceeded for mean P4 invasive pressure
HI P4 DIA
high diastolic P4
high limit exceeded for diastolic P4 invasive pressure
LO P4 DIA
low diastolic P4
low limit exceeded for diastolic P4 invasive pressure
HI P5 SYS
high systolic P5
high limit exceeded for systolic P5 invasive pressure
LO P5 SYS
low systolic P5
low limit exceeded for systolic P5 invasive pressure
HI P5 MN
high mean P5
high limit exceeded for mean P5 invasive pressure
LO P5 MN
low mean P5
low limit exceeded for mean P5 invasive pressure
HI P5 DIA
high diastolic P5
high limit exceeded for diastolic P5 invasive pressure
LO P5 DIA
low diastolic P5
low limit exceeded for diastolic P5 invasive pressure
HI P6 SYS
high systolic P6
high limit exceeded for systolic P6 invasive pressure
LO P6 SYS
low systolic P6
low limit exceeded for systolic P6 invasive pressure
HI P6 MN
high mean P6
high limit exceeded for mean P6 invasive pressure
LO P6 MN
low mean P6
low limit exceeded for mean P6 invasive pressure
HI P6 DIA
high diastolic P6
high limit exceeded for diastolic P6 invasive pressure
LO P6 DIA
low diastolic P6
low limit exceeded for diastolic P6 invasive pressure
HI BP SYS
high systolic BP
high limit exceeded for systolic noninvasive pressure
LO BP SYS
low systolic BP
low limit exceeded for systolic noninvasive pressure
HI BP DIA
high diastolic BP
high limit exceeded for diastolic noninvasive pressure
LO BP DIA
low diastolic BP
low limit exceeded for diastolic noninvasive pressure
HI BP MN
high mean BP
high limit exceeded for mean noninvasive pressure
LO BP MN
low mean BP
low limit exceeded for mean noninvasive pressure
HI RESP
high respiration rate
high limit exceeded for respiration rate
LO RESP
low respiration rate
low limit exceeded for respiration rate
HI EtCO2
high EtCO2
high limit exceeded for the end-tidal carbon dioxide
concentration in the expired air (EtCO2)
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Alarm Label
Alarm
Triggering Condition
LO EtCO2
low EtCO2
low limit exceeded for the end-tidal carbon dioxide
concentration in the expired air (EtCO2)
HI InCO2
high InCO2
high limit exceeded for the inspired carbon dioxide
concentration in the inspired air (InCO2)
HI T1
high T1
high limit exceeded for T1 temperature
LO T1
low T1
low limit exceeded for T1 temperature
HI T2
high T2
high limit exceeded for T2 temperature
LO T2
low T2
low limit exceeded for T2 temperature
HI DT
high ∆T
high limit exceeded for temperature difference
LO DT
low ∆T
low limit exceeded for temperature difference
APNEA ALM
apnea alarm
patient respiration stopped for predetermined period
of time
CHKPATIENT
check patient
medical or technical alarm not supported by V-Link/
V-Link II/Instrument Transceiver
BED ALARM
bedside alarm
medical alarm not supported by V-Link/V-Link II/
Instrument Transceiver
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Table 14. Bedside arrhythmia alarms (in Bedside Alarm Source Mode)
Note:
122
These alarms may be called only on a bedside monitor when the Central Station 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
Alarm
ASYSTOLE
asystole
V-FIB
ventricular fibrillation
V-TACH
ventricular tachycardia
HIGH PVC
high PVC
PVC
PVC
SV-TACH
supraventricular
tachycardia
COUPLET
ventricular couplet
BIGEMINY
ventricular bigeminy
TRIGEMINY
ventricular trigeminy
V-RHYTHM
ventricular rhythm
ST ALARM
ST alarm
ZERO RATE
zero heart rate
VBRADY
--
IRREGULAR
--
ACC VENT
--
PAUSE
--
R ON T
--
TACHY
--
BRADY
--
SALVO
--
TRIPLET
--
V-RUN
--
NO ARR
No ECG data available for Arrhythmia analysis
MISSED BEAT
--
SV-BRADY
--
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Table 15. Bedside device technical alarms
Alarm Label
Alarm
Triggering Condition
SYS ERR
system error
bedside monitor device equipment failure, printer failure, or
printer paper error
ECG ERR
ECG error
bedside ECG equipment failure
BP ERR
BP error
non-invasive equipment failure; uncalibrated; no pulse
detected
RESP ERR
respiration error
no probe detected
P1 ERR
P1 error
P1 not zeroed
P2 ERR
P2 error
P2 not zeroed
P3 ERR
P3 error
P3 not zeroed
P4 ERR
P4 error
P4 not zeroed
P5 ERR
P5 error
P5 not zeroed
P6 ERR
P6 error
P6 not zeroed
SpO2 ERR
SpO2 error
equipment SpO2 failure, uncalibrated
CO2 ERR
CO2 error
equipment CO2 failure, uncalibrated
T1 ERR
T1 error
equipment T1 failure, uncalibrated
T2 ERR
T2 error
equipment T2 failure, uncalibrated
NO ECG
no ECG
ECG not detected
NO BP
no BP
BP not detected
NO P1
no P1
P1 not detected
NO P2
no P2
P2 not detected
NO P3
no P3
P3 not detected
NO P4
no P4
P4 not detected
NO P5
no P5
P5 not detected
NO P6
no P6
P6 not detected
NO SpO2
no pulse oximetry
SpO2 not detected
NO CO2
no CO2
CO2 not detected
NO T1
no T1
temperature probe not detected
NO T2
no T2
temperature probe not detected
NO RESP
no respiration
respiration not detected
?? SOURCE
source
data received does not match configured device type
NURSE
nurse call
nurse call button on transceiver was pressed
LOW BATT
low transceiver battery
low battery on the V-Link/V-Link II transceiver
DEV LOWBATT
low device battery
low battery level in the bedside monitor
MUSCLE
muscle artifact
muscle artifact detected
WRONG ID
wrong ID
incompatible transceiver ID
EDIT
edit
number of history events reached the edit limit
LEAD OFF
lead off
ECG electrode disconnected or loose
NO SIGNAL
no signal
no signal received from transceiver
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124
CHECK LEAD
check leads
One or more of the ECG leads has a poor connection and/or
is causing significant baseline wander
NO ARR
Arrhythmia unable to analyze
No good leads are available for analysis
CHKSIGNAL
check signal
intermittent no signal detected
CHK BEDSIDE
check bedside
technical alarm not supported by the Central Station
CHKPATIENT
check patient
medical or technical alarm not supported by the Central Station
COMM ERR
communication error
communications CRC errors between the transceiver and
bedside monitor exceeds limit
ATT PRESENT
attendant present
called when pressed on transceiver
PA SILENCE
Procedure Alarm Silence
called when sent from transceiver
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ALARMS
Ventilator Patients Alarms
Alarm Label
Alarm Name
Triggering Condition
HI PRESS
high pressure limit
see ventilator operator’s manual
LO INS PRES
low inspiration pressure
see ventilator operator’s manual
LOW PEEP
Low PEEP/CPAP
see ventilator operator’s manual
LOW EX VT
low exhaled tidal volume
see ventilator operator’s manual
LOW EX MV
low exhaled min. volume
see ventilator operator’s manual
HI RESP
high respiratory rate
see ventilator operator’s manual
LoPresO2In
low pressure O2 inlet
see ventilator operator’s manual
LoPresAirIn
low pressure inlet
see ventilator operator’s manual
HI SpO2
high SpO2
see ventilator operator’s manual
LO SpO2
low SpO2
see ventilator operator’s manual
HIGH PULSE
high HR
see ventilator operator’s manual
LOW PULSE
low HR
see ventilator operator’s manual
APNEA ALM
apnea alarm
see ventilator operator’s manual
EX VALVE LK
exhalation valve leak
see ventilator operator’s manual
I:E RATIO
I:E ratio
see ventilator operator’s manual
ALMS SILENC
alarms silenced
see ventilator operator’s manual
AIRPRESSDIS
airway pressure disconnect
see ventilator operator’s manual
DEV LOWBATT
low device battery
low battery level in the ventilator
SVO DUE LSP
SVO due to LSP
see ventilator operator’s manual
CHK 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
type
SpO2 ERR
SpO2 error
equipment SpO2 failure, uncalibrated
NO SpO2
NO SpO2
SpO2 not detected
APNEA VENT
apnea ventilation
see ventilator operator’s manual
NURSE
nurse
remote button on the transceiver was pressed
LOW BATT
low transceiver battery
low battery level on the Instrument Transceiver
NO SIGNAL
no signal
no signal received from the transceiver
WRONG ID
wrong ID
incompatible transceiver ID
EDIT
edit
number of history events has reached its limit
ATT PRESENT
attendant present
called when pressed on transceiver
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Special Alarm Handling
Muscle
When 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 1
Asystole, 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 Patient
The 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 Alarm
The 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 Central Station. It is called regardless of alarm source.
Check Bedside
The CHK BEDSIDE alarm is a technical alarm that is equivalent to the CHK
PATIENT alarm. It is called regardless of alarm source.
Zero Rate
The 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 bedside 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.
Nurse
The 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.
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Attendant Present
The 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 Button” 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 physiological 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 (DT4500) 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 clicked
The 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
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ALARMS
•
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 period
Technical Alarms
The following technical alarms do not support Record or Store, and can only be set to
Page and Assign:
SYS ERR
ECG ERR
BP ERR
P1 ERR
P2 ERR
SPO2 ERR
CO2 ERR
P3 ERR
NO P3
CHK LEAD
128
LEAD OFF
CHKSIGNAL
T1 ERR
T2 ERR
?? SOURCE
LOW BATT
MUSCLE
P4 ERR
NO P4
NO ARR
NO SIGNAL
WRONG ID
EDIT
NO SPO2
NO CO2
NO ECG
NO BP
P5 ERR
NO P5
NO P1
NO P2
NO T1
NO T2
NO RESP
CHK BEDSIDE
COMM
P6 ERR
NO P6
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VIEWING CURRENT PATIENT STATUS
VIEWING CURRENT PATIENT STATUS
To 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 ambulatory patients.
The View screen also encompasses history and full disclosure, which are covered in
their own chapters.
Bedside Monitored and Ambulatory Patient View Screen
clinical information window
Fig. 58. Bedside Monitored View Screen
The View screens for bedside and ambulatory patients are similar except for the clinical data displayed (see table 16, “Clinical information window data,” on page 131)
and the ST templates – for bedside monitored patients with ST analysis enabled, digital ST data only is displayed.
Selecting Waves for Display
For 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 designation flashes).
4. Press the Wave button on the popup to cycle through available waveforms for
the label set of the selected patient.
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VIEWING CURRENT PATIENT STATUS
5. Press the Wave button on the View screen to save your selections.
Ventilator Patient View Screen
Fig. 59. Ventilator Patient View screen
The 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 ventilator.
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VIEWING CURRENT PATIENT STATUS
Clinical Data
Available clinical data for each patient type is shown in Table 16.
Table 16. Clinical information window data
Patient Type
ambulatory
bedside
monitored
ventilator
Data
HR, PACE-OFF,
PACE%, PVC count
Patient Device Type
ST Level
ST Slope
HR, PACE-OFF, PACE%,
PVC count
P1,P2, P3, P4, P5, P6
BP, Elapsed Time
EtCO2
InCO2
SpO2
Resp
T1, T2, ∆T
HRSRC (ECG, P1, P2, P3, P4, P5, P6, SpO2, or BP)
BRSRC (ECG or CO2)
Ventilator Mode
Peak Flow
Sensitivity
Pressure Support
Automatic Sigh
Waveform
Nebulizer
O2 Suction
Printing
The 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 administrator 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.
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VIEWING CURRENT PATIENT STATUS
Strip Recorder
There are three types of recording from the strip recorder: timed, continuous, and
trend recording.
Timed Recording
Timed 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 Recording
Continuous 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 continuous 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 recording again.
Trend Recording
Trend recordings print trend graphs and are covered in the Trends section. See “Printing Trend Data” on page 162 for details.
Laser Printer
The 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 memory
Note:
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. Information on specific reports is contained in relevant sections of this manual.
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VIEWING CURRENT PATIENT STATUS
Automatic Alarm Printing
You 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 Config 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 Viewers
All 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 Monitor
When you request a printout from the bedside monitor and DT-7000 instrument transceiver notifies the Central Station, which generates a real-time strip for the corresponding 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 Patients
You 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.
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VIEWING CURRENT PATIENT STATUS
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.
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HISTORY
HISTORY
The PatientNet System can store up to 100 history events for each patient. All available data is stored with each history event.
For ambulatory patients data includes all transmitted leads and current ST templates 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 screen
Note:
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).
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HISTORY
Storing Events in the History File
Some 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 ventilator 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 templates (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 lower 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.
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HISTORY
Re-labeling History Events
You 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 Events
2. Highlight the history event you wish to re-label in the history event blackboard.
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.
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HISTORY
Customized Labeling for Stored Events
You 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 passcode, then see your system administrator.
Fig. 62. Operator Passcode Popup
Fig. 63. History Chart Popup
4. 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, highlighting 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.
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HISTORY
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 Events
Bedside Monitored and Ambulatory Patients
With 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-second segment of stored data appears in the small window at the bottom of the
screen.
Fig. 64. History Review screen
2. 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 Patients
The History Review screen displayed by the Review button shows set and observed
vital signs for ventilator patients.
Viewing Stored Vital Statistics
When 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 dismiss.
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HISTORY
Magnifying History Waveforms
To 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 waveform that appears is the ECG waveform, if ECG is present.
3. Select the Wave button to display the other stored waveforms.
Measuring History Waveforms
You can make and save up to five history waveform measurements for later printing
for bedside monitored and ambulatory patients.
Making Measurements
1. Press Measure on the normal or expanded view of the History Review screen
2. 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 measurements 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 Measurements
Save the measurement by pressing as many of the caliper buttons below as appropriate. 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).
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Press caliper buttons only after making a measurement with the calipers. Otherwise,
the following message box appears.
Fig. 65. Caliper message box
Printing Caliper-Annotated Waveforms
Calipers can be printed from the expanded history mode only.
1. Press Expand on the History Review Screen
2. 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 Measurements
To 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 Events
1. 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 transceivers, 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 OpenNet 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 providing good signal quality and, if not provided, contributes to false alarms.
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HISTORY
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 visual 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 Events
Once a patient’s history file has reached its size limit (as set by the system administrator), 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 cannot 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
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HISTORY
Tagging Events as Report Candidates
You 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 Reports
Tagged 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.
Ventilator Data (for ventilator patients only) prints all ventilator history events.
Cancel closes the popup without printing.
Fig. 67. Print popup
3. 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.
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HISTORY
Archiving Events
Archived 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 History
For 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 templates
For 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.
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HISTORY
Printing History Events
Printing
To 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 History 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 templates, 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 values 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.
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FULL DISCLOSURE
FULL DISCLOSURE
The 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 Mode
Disclosure 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 popup
Select 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.
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FULL DISCLOSURE
zoomed out
zoomed in
Fig. 69. Full disclosure screens
Fig. 69 shows zoomed in and zoomed out versions of waveforms on the Full
Disclosure screen.
Note:
148
There are two Zoomed Out displays in Full Disclosure. Press the Zoom Out
button twice to display each Zoomed Out screen.
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FULL DISCLOSURE
Zooming In and Out
Use the Zoom Out and Zoom In buttons to zoom out or in. Alarms and beat annotations are displayed differently on zoomed in and zoomed out views.
Zoomed In
Zoomed Out
Alarms
Alarm text appears in the lower left Alarms are indicated by a line
corner of the waveform window.
under the waveform. See page 106
for details on alarm indicators.
Beat Annotations
Available. See the next section.
Note:
Not available.
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 Indicator
Beat Annotations
You 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 Popup
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FULL DISCLOSURE
2. Toggle Annotation to Yes on the popup. This following beat calls appear as
appropriate.
Table 17
1.05 Arrhythmia Beat Classification Labels
Beat Label
Description
Normal or Dominant
Aberrant Normal
First Occurrence of Aberrant Normal
Premature Normal or Premature Supraventricular (SVE)
Premature Ventricular Ectopic (PVC)
Not Classified Due to Bad Samples (RF drop out) in QRS Region
Unknown (Noise or First Occurrence of PVC Morphology)
Selecting Waveforms for Disclosure Reports
You 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 popup
2. Press the Display button to select the number of waves (one to four) to display.
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.
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