Draeger Medical Systems MS24895 802.11b/g WIRELESS ADAPTER User Manual ICS F83 EN R01
Draeger Medical Systems, Inc. 802.11b/g WIRELESS ADAPTER ICS F83 EN R01
Contents
- 1. Users Manual 1
- 2. Users Manual 2
Users Manual 1
Instructions for Use Infinity® CentralStation™ with Infinity® Telemetry System™ and with Infinity® M300™ WARNING: F or a fu l l un der stan di ng o f t he p erfo rman ce ch arac teristics o f th is d evice, the u ser sh ou ld ca refu lly re ad this man ua l b ef or e use o f t h e de vic e. Infinity® CentralStation™ with Infinity® Telemetry System™ and with Infinity® M300™ Instructions for Use WA R N I NG ! F o r a f u l l u n d e r s ta n d i n g o f t h e p e r f o r m a n c e c h a r a c t e r i s t i c s o f t h i s d e v i c e , t h e u s e r s h o u l d c a r e f u ll y r e a d t h i s manual before use of the device. Infinity CentralStation Instructions for Use Manufactured By: Draeger Medical Systems, Inc. 3135 Quarry Road Telford, PA 18969 Infinity CentralStation with Infinity Telemetry System and Infinity M300 Instructions for Use Software VF8 ©Draeger Medical Systems, Inc. 2008. All rights reserved. Printed in the United States of America. This software bears the CE label in accordance with the provisions of the Directive 93/ 42/EEC of 14 June 1993 concerning medical devices (this label is not applicable for US devices). Distributed By: Dräger Medical AG & Co. KG Moislinger Alee 53-55 D-23558 Lübeck Germany The Infinity Telemetry System complies with the Radio Equipment and Telecommunications Terminal Equipment Directive (1999/5/EC). ii NOTE: In the United States, Federal Law restricts these devices to sale by, or on order of a physician. Patient monitoring equipment, however sophisticated, should never be used as a substitute for the human care, attention, and critical judgment that only trained health care professionals can provide. MultiMed, Infinity Network, Pick and Go, VentCentral, and TruST are registered trademarks of Dräger Medical AG & Co. KG. Unpublished rights reserved under the copyright laws of the United States RESTRICTED RIGHTS LEGEND Use duplication or disclosure by the Government is subject to restrictions as set forth in subparagraph (c)(1)(ii) of the Rights in Technical Data & Computer Software clause at DFARS 252 227:7013 All other brand or product names are trademarks or registered trademarks of their respective companies. This device is subject to EU Directive 2002/96/ EC (WEEE). It is not registered for use in private households, and may not be disposed of at municipal collection points for waste electrical and electronic equipment. Dräger Medical has authorized a firm to dispose of this device in the proper manner. For more detailed information, please contact your local Dräger Medical organization. Infinity CentralStation VF8 Infinity CentralStation Instructions for Use Table of Contents Table of Contents ............................................................................................................ iii Intended Use ................................................................................................................... xii Introduction.................................................................................................................... xiii Documentation Features .............................................................................................. xiii Warnings, Cautions, and Notes ............................................................................. xiii Applicability............................................................................................................. xiii Safety Considerations................................................................................................... xiv General Precautions ............................................................................................... xiv Infinity Telemetry Precautions................................................................................ xv Infinity M300 Precautions........................................................................................ xv Defibrillator Precautions ......................................................................................... xv ECG Report Precautions ........................................................................................ xvi Pacemaker and TENS Precautions ....................................................................... xvi Pacer Fusion Mode Precautions .......................................................................... xvii Pulse Oximetry Precautions ................................................................................ xviii QRS Processing Precautions .............................................................................. xviii Vital Connection Cable Precautions ..................................................................... xix Maintenance, Modifications, and Repairs............................................................. xix Site of Operation ..................................................................................................... xix Electromagnetic Compatibility...................................................................................... xx Reducing EMI ........................................................................................................... xx Device Markings ............................................................................................................ xxi CHAPTER 1: About the Infinity CentralStation General Description/Product Option & Accessory Information ...............................1-2 MS18500 Infinity CentralStation ............................................................................1-2 MS18501 Infinity M300 ............................................................................................1-3 MS11200 Infinity Telemetry ....................................................................................1-4 Infinity Network..............................................................................................................1-5 Local and Remote Patient Monitoring...................................................................1-5 Interacting with the Infinity CentralStation Keys........................................................1-6 User Interface.................................................................................................................1-7 On line Help....................................................................................................................1-8 Using On Line Help .................................................................................................1-8 CHAPTER 2: Infinity M300 About Infinity M300 .......................................................................................................2-2 User Controls ..........................................................................................................2-3 Battery Status LED Indicator Description.............................................................2-4 Audio Alerts.............................................................................................................2-4 Starting up Infinity M300...............................................................................................2-5 VF8 Infinity CentralStation iii Infinity CentralStation Instructions for Use Infinity M300 Power ................................................................................................2-5 Parameter Displays.................................................................................................2-8 Other Infinity M300 Displays ..................................................................................2-9 Infinity M300 Monitoring System Alarms............................................................2-12 Trends...........................................................................................................................2-13 Setting up Infinity M300 at the Infinity CentralStation .............................................2-13 Infinity M300 Setup Screens ................................................................................2-13 Infinity M300 Setup......................................................................................................2-14 Recordings...................................................................................................................2-15 Recording Types ...................................................................................................2-15 Monitoring a Patient Using Infinity M300 ..................................................................2-15 ECG Monitoring.....................................................................................................2-15 SpO2 Monitoring ...................................................................................................2-15 Arrhythmia Monitoring .........................................................................................2-15 Infinity M300 Messages...............................................................................................2-16 Message Area ........................................................................................................2-16 Infinity M300 Status Messages ............................................................................2-16 Infinity M300 Recording Messages .....................................................................2-17 CHAPTER 3: Infinity Telemetry Transmitter Transmitter Components..............................................................................................3-2 Lead Connector.......................................................................................................3-2 Programming Port Connector/Interface...............................................................3-3 Transmitter Buttons................................................................................................3-4 Transmitter LED Error Patterns (Normal Mode)...................................................3-4 Transmitter Operating Modes ................................................................................3-5 Transmitter Battery ..................................................................................................3-5 Installing or Replacing the Battery .......................................................................3-7 Transmitter Setup..........................................................................................................3-8 Accessing the Transmitter Setup Screen .............................................................3-8 Received Transmitter Status Information.............................................................3-8 Transmitter Setup Screen Functions ....................................................................3-9 Attaching the Transmitter to the Patient .....................................................................3-9 Transmitter Messages.................................................................................................3-10 Status Messages ...................................................................................................3-10 CHAPTER 4: Infinity CentralStation Setup Accessing the Setup Screens ......................................................................................4-2 Password-Protected Screens ................................................................................4-2 Setup - Central Screen ..................................................................................................4-3 Setup - Recorder Screen...............................................................................................4-5 Setup - Central Layouts Screen ...................................................................................4-6 iv Infinity CentralStation VF8 Infinity CentralStation Instructions for Use CHAPTER 5: Infinity M300 System Setup Overview.........................................................................................................................5-2 Accessing the Telemetry Setup Screens..............................................................5-2 Changing the System Default Patient Category...................................................5-2 Infinity M300 System Setup Screen .............................................................................5-3 Infinity M300 Patient View Defaults Setup Screen .....................................................5-4 Infinity M300 ST Defaults Setup ...................................................................................5-7 Infinity M300 Alarm Limits Defaults Screen................................................................5-8 Available Functions on the Default Settings - Alarm Limits Screen ..................5-8 Infinity M300 Arrhythmia Defaults Screen ................................................................5-10 Available Functions on the Arrhythmia Screen .................................................5-10 Infinity M300 Find Device............................................................................................5-13 CHAPTER 6: Infinity Telemetry System Setup Overview.........................................................................................................................6-2 Accessing the Telemetry Setup Screens..............................................................6-2 Changing the System Default Patient Category...................................................6-2 Infinity Telemetry System Setup Screen .....................................................................6-3 Infinity Telemetry Patient View Defaults Setup Screen .............................................6-4 Infinity Telemetry ST Defaults Setup ...........................................................................6-7 Infinity Telemetry Recordings Setup Screen ..............................................................6-8 Recordings Setup Screen Functions ....................................................................6-8 Infinity Telemetry Alarm Limits Defaults Screen........................................................6-9 Available Functions on the Default Settings - Alarm Limits Screen ..................6-9 Infinity Telemetry Arrhythmia Defaults Screen ........................................................6-11 Available Functions on the Arrhythmia Screen .................................................6-11 CHAPTER 7: Main Screen Overview.........................................................................................................................7-2 Main Screen Layout.......................................................................................................7-2 Split vs. Full Main Screen .............................................................................................7-2 Selecting a Main Screen Layout ............................................................................7-3 Main Screen Setup .......................................................................................................7-3 Menu Bar..................................................................................................................7-3 Waveform Area........................................................................................................7-4 Stopping Waveforms ..............................................................................................7-7 Waveform Color ......................................................................................................7-7 Telemetry Waveform Dropout Display (Infinity Telemetry only) ........................7-7 Parameter Areas .....................................................................................................7-7 Notes Area .............................................................................................................7-10 Status Area ............................................................................................................7-11 Manual Waveform Configuration Mode.....................................................................7-12 Main Screen Status Area Messages ..........................................................................7-13 VF8 Infinity CentralStation Infinity CentralStation Instructions for Use CHAPTER 8: Patient Setup - Bed View General Bed View Setup ...............................................................................................8-2 Accessing a Patient’s Bed View Screen......................................................................8-3 Bed View Screen Layout...............................................................................................8-3 Waveform Assignment ...........................................................................................8-3 Bed View Menu Bar.................................................................................................8-4 Bed View Submenu Selections..............................................................................8-5 Information Area .....................................................................................................8-6 Waveform Area........................................................................................................8-7 Putting Monitoring Into Standby Mode .................................................................8-7 Parameter Areas in Bed View.......................................................................................8-9 Bed View Screen Display............................................................................................8-10 Selecting the Bed View.........................................................................................8-10 Bed View Review Screens ..........................................................................................8-10 Alarm Limits and Arrhythmia Setup ..........................................................................8-11 Configuring Alarm Limits .....................................................................................8-11 Configuring Arrhythmia Setup.............................................................................8-11 Telemetry Setup Screens............................................................................................8-12 Accessing the Telemetry Setup Screens............................................................8-12 Infinity TruST 12-Lead Monitoring Option.................................................................8-13 Use of TruST Reference ECG ..............................................................................8-13 Patient View Setup Chest Lead Selection...........................................................8-14 CHAPTER 9: Admit/Discharge/Transfer Overview.........................................................................................................................9-2 Admitting a Patient........................................................................................................9-2 Entering Patient Demographics ...................................................................................9-3 Changing Patient Category ....................................................................................9-4 Admitting Wireless Monitor Patients...........................................................................9-4 Moving Between Wired and Wireless Communication .......................................9-4 Wireless Transmission Interruption......................................................................9-6 Admitting Under Special Conditions ...........................................................................9-6 Discharging a Patient....................................................................................................9-7 The Patient Transfer Function......................................................................................9-8 Special Data Transfer Conditions .........................................................................9-8 Transferring Data to the Infinity CentralStation ...................................................9-8 Transferring Data From the Infinity CentralStation .............................................9-9 Transfer Messages .................................................................................................9-9 CHAPTER 10: Arrhythmia Overview.......................................................................................................................10-2 About the Arrhythmia Template.................................................................................10-2 Relearning the Template.............................................................................................10-3 vi Infinity CentralStation VF8 Infinity CentralStation Instructions for Use Customizing a Patient’s Arrhythmia Setup...............................................................10-4 Accessing the Arrhythmia Setup Table ..............................................................10-4 Available Functions on the Arrhythmia Setup Table ........................................10-4 Available Bedside Event Settings..............................................................................10-6 Arrhythmia Beat and Rhythm Classification ...........................................................10-7 CHAPTER 11: Telemetry Pulse Oximetry and NIBP Monitoring Overview.......................................................................................................................11-2 Pulse Oximetry ............................................................................................................11-3 Turning Pulse Oximetry Monitoring On/Off ..............................................................11-4 Display of Pulse Oximeter Information ...............................................................11-4 Vital Connection Cable ..............................................................................................11-5 Getting an NIBP or SPO2 measurement .............................................................11-5 Alarm Functions ..........................................................................................................11-7 Alarm Messages ..........................................................................................................11-7 CHAPTER 12: Telemetry ST Analysis Option Overview.......................................................................................................................12-2 ST Segment Morphology......................................................................................12-2 Parameter Display .......................................................................................................12-4 Sensor Application......................................................................................................12-4 Relearning ST ..............................................................................................................12-5 ST Points Setup Screen ..............................................................................................12-5 Hexaxial (Cabrera) Lead Support ........................................................................12-5 Accessing the ST Points Setup Screen ..............................................................12-6 Display Order of ST Complexes ..........................................................................12-7 Available Functions on ST Points Setup Screen ...............................................12-8 Telemetry ST Setup Screen ........................................................................................12-9 Accessing the Telemetry ST Setup Screen ........................................................12-9 ST Alarms...................................................................................................................12-10 ST Alarm Messages...................................................................................................12-10 CHAPTER 13: Alarms Overview.......................................................................................................................13-2 Alarm Validation....................................................................................................13-2 Alarm Grades ...............................................................................................................13-3 Latching alarms ....................................................................................................13-4 Non-latching Alarms .............................................................................................13-4 Visual and audible Alarm Signals .......................................................................13-4 The Surveillance Feature ............................................................................................13-5 Display of Surveillance Alarm Messages ...........................................................13-5 Audible Alarm Signals ..........................................................................................13-5 VF8 Infinity CentralStation vii Infinity CentralStation Instructions for Use Special Surveillance Alarm Conditions ..............................................................13-6 MIB Ventilator Alarms .................................................................................................13-6 Alarm Groups...............................................................................................................13-6 Silencing Alarms .........................................................................................................13-7 Silencing Local Alarms ........................................................................................13-7 Configuring a Patient’s Alarm Setup .......................................................................13-10 Opening the Alarm Limits Setup Screen.................................................................13-11 Pausing Alarms ...................................................................................................13-11 Changing a Parameter’s Alarm Limits ..............................................................13-12 Automatic Alarm Limits Selection (Auto Set)...................................................13-13 Turning Alarm Recordings ON/OFF ..................................................................13-13 Turning Event Storage On/Off ...........................................................................13-14 CHAPTER 14: Recordings / Reports Overview ......................................................................................................................14-2 Laser Printers ..............................................................................................................14-2 Processing of Strip Recordings.................................................................................14-3 Active Recordings ................................................................................................14-3 Pending Recordings .............................................................................................14-3 Requesting a Remote Recording.........................................................................14-3 Recorder Setup............................................................................................................14-4 Replacing the Recorder Paper.............................................................................14-4 Setting up a Recording.........................................................................................14-4 Recording Types .........................................................................................................14-5 Timed Recordings.................................................................................................14-6 Continuous Recordings .......................................................................................14-9 Reports .......................................................................................................................14-10 Simultaneous ECG Report .................................................................................14-10 Full Disclosure Strip Report ..............................................................................14-11 Full Disclosure Hour Report ..............................................................................14-11 Full Disclosure 24 Hour Report .........................................................................14-11 Event Disclosure Strip Reports .........................................................................14-11 Shift Report .........................................................................................................14-12 Graphical Trend Report ......................................................................................14-17 Selected Strip Report .........................................................................................14-17 Selected Events Report ......................................................................................14-17 ECG Caliper Report ............................................................................................14-18 Ventilator Report .................................................................................................14-19 Requesting Recordings and Reports ......................................................................14-22 Canceling a Recording..............................................................................................14-25 Actions that Affect Recordings................................................................................14-26 Recording Status Messages ...................................................................................14-27 viii Infinity CentralStation VF8 Infinity CentralStation Instructions for Use CHAPTER 15: Trends Overview.......................................................................................................................15-2 Accessing a Patient’s Trends.....................................................................................15-2 Trend Graphs ...............................................................................................................15-3 Parameter Display Order and Trend Scales for Telemetry Patients ................15-4 Trend Table ..................................................................................................................15-5 Trend Cursor................................................................................................................15-6 Representation of Special Conditions.......................................................................15-7 CHAPTER 16: Full/Event Disclosure Overview.......................................................................................................................16-2 Full/Event Disclosure Census Operations ................................................................16-2 Accessing the Census Screen.............................................................................16-2 Admitting a Patient to Full/Event Disclosure............................................................16-5 Data Collection Rules ...........................................................................................16-5 To Manually Admit a Patient: ...............................................................................16-6 Accessing Disclosure History....................................................................................16-6 Locking a Full/Event Disclosure Record ............................................................16-6 Accessing the Full/Event Disclosure Review Screen ..............................................16-7 Full Disclosure Review Screen ..................................................................................16-8 Event Disclosure Review Screen ...............................................................................16-9 Full/Event Disclosure Review Screen Functions ...................................................16-10 Full/Event Disclosure Storage/Display Options...............................................16-12 Annotating Events ..............................................................................................16-14 Viewing Events....................................................................................................16-15 Deleting Events ...................................................................................................16-16 Viewing Parameter Values .................................................................................16-16 Renaming/Reclassifying Events........................................................................16-17 Disclosure Review Screen Cursor ....................................................................16-18 Full Disclosure ECG Caliper Tool ............................................................................16-19 Caliper Measure Screen ....................................................................................16-20 Caliper Review Screen .......................................................................................16-24 Full/Event Disclosure Reports .................................................................................16-25 Exporting Full/Event Disclosure Data .....................................................................16-26 Exporting Full Disclosure Data to a Third-Party Device..................................16-26 Exporting Events from Event Disclosure .........................................................16-27 Special Conditions ....................................................................................................16-28 CHAPTER 17: VentCentral Option Overview.......................................................................................................................17-3 The Ventilator Screen.................................................................................................17-5 Accessing the Ventilator Screen .........................................................................17-6 Waveform Area in Ventilator Screen ...................................................................17-6 VF8 Infinity CentralStation ix Infinity CentralStation Instructions for Use Loops Area in Ventilator Screen .........................................................................17-7 Trend Area in Ventilator Screen ..........................................................................17-7 The Ventilator Settings Review Screen .....................................................................17-8 Accessing the Ventilator Settings Review Screen.............................................17-8 Parameter and Settings Order .............................................................................17-9 Special Conditions..............................................................................................17-10 Ventilator View Setup Screen...................................................................................17-11 Accessing the Ventilator View Setup Screen ...................................................17-12 Selecting Waveforms for Display ......................................................................17-12 Selecting Waveforms for the Trend Display.....................................................17-13 VentCentral Trend Parameters.................................................................................17-14 MIB Ventilator Alarms ...............................................................................................17-18 Ventilator Report .......................................................................................................17-18 VentCentral Messages ..............................................................................................17-19 Ventilator and Device Messages/Labels .................................................................17-19 Dräger Cato Anesthesia System .....................................................................17-20 Dräger Cicero Anesthesia System ....................................................................17-21 Dräger Julian/Julian Primus/Primus Anesthesia System ...............................17-22 Dräger Narkomed IIC / IV / 6000 / 6400 Anesthesia System ............................17-25 Dräger Fabius GS/Fabius CE/Tiro Anesthesia System ...................................17-26 Dräger Apollo Anesthesia System ....................................................................17-28 Dräger Zeus Anesthesia System .......................................................................17-30 Ohmeda Modulus CD Anesthesia System........................................................17-32 Dräger BabyLog Ventilator ...............................................................................17-33 Dräger Evita 1 Ventilator ...................................................................................17-34 Dräger Evita 2 Ventilator ....................................................................................17-37 Dräger Evita 2D / 4 / XL Ventilator .....................................................................17-40 Dräger Savina Ventilator ....................................................................................17-43 P-B 7200/840 Ventilators ....................................................................................17-45 Taema Horus Ventilator......................................................................................17-47 Hamilton Galileo Ventilator ................................................................................17-49 Maquet SV 300/SV 300A/Servoi Ventilator........................................................17-50 Maquet SV 900 Ventilator ...................................................................................17-52 Viasys Bear 1000 Adult Ventilator .....................................................................17-53 Viasys BearCub 750 Infant Ventilator .............................................................17-55 Baxter Vigilance/Vigilance II Cardiac Output Monitor ...................................17-57 etCO2/Respiratory Mechanics Pod ...................................................................17-58 CHAPTER 18: Biomed Functions Biomed Screen Selections .........................................................................................18-2 Accessing the Biomed Screens ..........................................................................18-2 Show Devices Screen .................................................................................................18-3 Configure Central Screen ...........................................................................................18-3 To edit Event Class:..............................................................................................18-5 Infinity CentralStation VF8 Infinity CentralStation Instructions for Use To modify Configure Central selections:............................................................18-5 Configure Locked Options Screen ............................................................................18-6 Enabling Available Options .................................................................................18-6 Raid Option ..................................................................................................................18-6 System Console...........................................................................................................18-6 Rest ECG Reports .......................................................................................................18-7 Available Report Formats ....................................................................................18-7 Viewing Logs ...............................................................................................................18-9 Copying Logs to Disk .........................................................................................18-10 Telemetry System Set Up .........................................................................................18-11 Infinity M300 Set Up ............................................................................................18-11 Infinity Telemetry Set Up ....................................................................................18-13 Radio Frequency Diagnostics .................................................................................18-16 Available Information on the RF Diagnostics Screen......................................18-16 APPENDIX A: Patient Preparation General .......................................................................................................................... A-2 ECG Electrode Placement ........................................................................................... A-3 Lead Wire Color Codes ......................................................................................... A-4 Attaching the Pulse Oximeter ..................................................................................... A-4 APPENDIX B: Technical Specifications Technical Data .............................................................................................................. B-2 Infinity Telemetry Systems ................................................................................... B-5 Electromagnetic Compatibility.................................................................................. B-18 APPENDIX C: Cleaning Cleaning the Infinity CentralStation............................................................................ C-2 Cleaning and Disinfecting Infinity Telemetry and Infinity M300 ............................. C-2 Recommended Cleaning Agents .......................................................................... C-3 Patient Cables ........................................................................................................ C-3 Reusable ECG Electrodes ..................................................................................... C-3 Reusable SpO2 Sensor ......................................................................................... C-3 Cleaning the MicrO2/MicrO2+® Oximeter .................................................................. C-4 Oximeter ................................................................................................................. C-4 Reusable Sensor .................................................................................................... C-4 VF8 Infinity CentralStation xi Infinity CentralStation Instructions for Use Intended Use The Infinity CentralStation is indicated for use by healthcare professionals for the purposes of centralized monitoring within the hospital or clinical environment of adult, pediatric and neonatal patient monitor data on the Infinity patient monitoring network. The Infinity CentralStation is intended to measure and produce visual and audible alarms for one or more physiological parameters. The Infinity CentralStation with Rest ECG can provide interpretive diagnostic statements and reports for adults and pediatric patients when connected to a monitor with ECG monitoring capability. Infinity M300 Telemetry System is indicated to be used by healthcare professionals for the purpose of monitoring ECG and pulse oximetry parameters of ambulatory and non-ambulatory adult and pediatric patients in healthcare type facilities. Infinity M300 is intended to operate with the Infinity CentralStation using wireless communication over the Infinity patient monitoring network. Infinity Telemetry System is indicated for use in an environment where patient care is provided by healthcare professionals (physicians, nurses, technicians) when the professional determines that a device is required to measure and produce visual and audible alarms for adult and pediatric patient populations. Infinity Telemetry System transmits via radiofrequency physiological signals for display and/or measurement at the Infinity CentralStation. The Infinity CentralStation Telemetry System with TruST is intended for 12-Lead ECG monitoring with a reduced set of electrodes. Reconstructed leads are intended for real-time assessment of ST segment changes. CAUTION! All Dräger hardware and screen shots shown in this manual are examples only. Actual product or screens may differ slightly. NOTE: The Infinity CentralStation, Infinity Telemetry receiver, and Infinity M300 central charger are not intended for use in the patient vicinity. Federal Law in the U.S. restricts this device to sale by, or on the order of a physician. This device complies with part 15 of the FCC rules. Operation is subject to the following two conditions: (1) This device may not cause harmful interference. (2) This device must accept any interference received, including interference that may cause undesired operation. Note for Industry Canada. Operation is subject to the following two conditions: (1) This device may not cause harmful interference. (2) This device must accept any interference received, including interference that may cause undesired operation. xii Infinity CentralStation VF8 Infinity CentralStation Instructions for Use Introduction Before using all Dräger devices, read all provided documentation carefully. Patient monitoring equipment, however sophisticated, should never be used as a substitute for the care, attention, and critical judgment that only trained health care professionals can provide. WA R N I N G ! D o n o t u s e s o ft w a r e n o t a p p r o v e d b y D r ä g e r o n t h e C P U o f t h e I n f i n i t y C e n t r a l Sta t i o n , o t h e r w i s e t h e c o r r e c t functioning of the Infinity Network may be compromised. D i a g n o s i s b a s e d o n i n t e r p r e ta t i o n o f 1 2 - l e a d m o n i t o r i n g r e s u l ts s h o u l d o n l y b e d o n e b y q u a l i f i e d p e r s o n n e l . P r i o r t o f i n a l i n t e rp re ta t i o n a n d d i a gn os is , q u a l i f ie d p h y s i c i a n s s h o u l d r e v i e w s u g g e s t e d d i a g n o s t i c s ta t e m e n ts a n d a l l o t h e r a v a i l a b l e information. O n l y e q u i p m e n t t e s t e d a n d a p p r o v e d b y D r ä ge r m a y b e c o n n e c t e d t o t h e I n f in i t y N e t w o rk , o t h e r w i s e t h e c o r r e c t functioning of the Infinity Network may be compromised. Documentation Features Warnings, Cautions, and Notes Definitions WA R N I N G ! A w a r n i n g s ta t e m e n t p r o v i d e s i m p o r ta n t i n f o r m a t i o n a b o u t a p o t e n t i a l l y h a z a r d o u s s i t ua t i o n w hi c h , i f n ot a v oi d e d , c o u l d re s u l t in d e a t h o r s e ri o u s i n j u r y. CAUTION! A caution statement provides important information about a potentially hazardous situation which, if not avoided may result in minor or moderate injury to the user or patient, or in damage to the equipment or other property. NOTE: A note provides additional information intended to avoid inconvenience during operation. Applicability For applicability of discontinued product names, (e.g. Infinity SC 7000, Infinity SC 8000, Infinity SC 9000XL) see the current Infinity Network Software Compatibility Chart, included with this Instructions for Use in product packaging. VF8 Infinity CentralStation xiii Infinity CentralStation Instructions for Use Safety Considerations CAUTION! Dräger recommends the use of an Uninterruptible Power Manager in conjunction with the Infinity CentralStation at all times. Without an Uniterruptible Power Manager power losses may cause the Infinity CentralStation to reboot and electrical anomalies may cause unwanted operation. General Precautions WA R N I N G ! B e c a u s e o f t h e d a n g e r o f e l e c t r i c s h o c k , n e v e r r e m o v e t h e c o v e r o f a n y d e v i c e w hi l e i t i s i n o p e r a t i o n o r c o n nected to a power outlet. The user must check that the equipment functions safely and is in proper working condition before use. In the interest of safety, regular equipment inspection and maintenance is required. Once a year, check all cables, devices, and accessories for damage, ground resistance, chassis and patient leakage currents, and all alarm functions. Also, ensure that all safety labels are legible. Maintain a record of safety inspections. Safety checks, device verification, calibration, and maintenance should be carried out and verified by properly trained personnel. WA R N I N G ! O pe r a t i o n o f t h i s d e v i c e s h o u l d b e i n a c c o r d a n c e w i t h pa r t 1 5 . 2 4 2 s e c t i o n s A , D , E , F, G a n d H o f t h e F C C rules. Ta k e a l l p re c a u t i o n s a g a i n s t e l e c t r i c s ho c k d ue t o e x p o s e d e l e c t r i c a l c o n ne c t i o n s , s p i l l e d f l u i d s , d e f i b r i l l a t i o n , e t c . o r i n j u r y t o pa t i e n t a n d d a m a g e t o e q u i p m e n t m a y o c c u r. CAUTION! Conductive parts of electrodes and associated connectors for applied parts, including the neutral electrode, should not contact other conductive parts including earth or damage to equipment may occur. NOTE: This equipment has been tested and found to comply with the limits for a Class B digital device, pursuant to Part 15 of the FCC Rules. This equipment generates, uses, and can radiate radio frequency energy and, if not installed and used in accordance with the instructions, may cause harmful interference to radio communications. However, there is no guarantee that interference will not occur in a particular installation. If this equipment does cause harmful interference to radio or television reception, which can be determined by turning the equipment off and on, the user is encouraged to try to correct the interference by one or more of the following measures: Reorient or relocate the receiving antenna, Increase the separation between the equipment and receiver, Connect the equipment into an outlet on a different circuit from that to which the receiver is connected, Consult the dealer or an experienced radio/TV technician for help. Changes or modifications to this equipment not expressly approved by the party responsible for compliance could void the user’s authority to operate the equipment. xiv Infinity CentralStation VF8 Infinity CentralStation Instructions for Use Infinity Telemetry Precautions WA R N I N G ! Under NO circumstances should the I nf i n i t y telemetry transmitter be used without the battery cover securely in place. D o n o t u s e t h e I n f i n i t y t e l e m e t r y t ra n s m i t t e r s n e a r e q u i p m e n t t ha t p ro du c e s s ta t i c o r g r a d i e n t m a g ne t i c fields. Do not use Infinity telemetry transmitters in MR ( M a g n e t i c R e s o n a n c e ) e nv i r o n m e n ts . Use only Dräger-approved sensors and leads, and apply t h e m p e r t h e m a n u f a c t u r e r ’s r e c om m e n d a t i o n s . O t h e r s e n s o r s a n d l e a d s m a y n o t p r o v i d e a d e qu a t e p r o t e c t i o n a g a i n s t d e f i b r i l l a t i o n n o r o pt i m u m p e r f o r m a n c e . S e e y o u r l o c a l D r ä g e r r e p re s e n ta t i v e f o r a l i s t o f D r ä g e ra p p r o v e d e q u ip m e n t . Infinity M300 Precautions WA R N I N G ! Do not use the Infinity M300 near equipment that p ro d u c e s s ta t i c o r g r a d i e n t m a g n e t i c f i e l d s . Do not use Infinity M300 in MR (Magnetic Resonance) e nv i r o n me n ts . Use only Dräger-approved sensors and leads, and apply t h e m p e r t h e m a n u f a c t u r e r ’s r e c om m e n d a t i o n s . O t h e r s e n s o r s a n d l e a d s m a y n o t p r o v i d e a d e qu a t e p r o t e c t i o n a g a i n s t d e f i b r i l l a t i o n n o r o pt i m u m p e r f o r m a n c e . S e e y o u r l o c a l D r ä g e r r e p re s e n ta t i v e f o r a l i s t o f D r ä g e ra p p r o v e d e q u ip m e n t . T he I n f i n i t y M 3 0 0 i s p ro t e c t e d a g a i n s t h i g h - f re q u e n c y i n t e r f e r e n c e f r o m e l e c t r o s u r g e r y u n i ts a n d d i s c h a r g e s from defibrillators, as well as against 50- and 60-Hertz power line interference. Defibrillator Precautions WA R N I N G ! U s e o n l y D r ä g e r - a p pr o v e d s e n s o r s . O t h e r s e n s o r s m a y n o t p r o v i d e a d e q u a t e p r o te c t i o n a g a i n s t d e f i b r i l l a t i o n . VF8 Infinity CentralStation xv Infinity CentralStation Instructions for Use ECG Report Precautions WA R N I N G ! I f y o u r e q u i r e a d i a g n os t i c q u a l i t y r e c o r d i n g y o u must use a Rest ECG Report (18-7). Pacemaker and TENS Precautions Certain difficulties are inherent to ECG monitoring and require special attention. Use care to not misinterpret ECG waveforms of patients with pacemakers. WA R N I N G ! P a c e m a k e r P e r f o r m a n c e I n a r e a s o f u n c e r ta i n p e r f o rm a n c e , t h e m o n i t o r h a s b e e n d e s i g n e d t o e r r i n t he d i r e c t i o n o f f a l s e p os i t i v e rather than false negative alarms. I n pa c e d pa t i e n ts , Q R S c o m p l e x e s m a y n o t b e c o u n t e d that result in false low rate alarms under the following c i rc u ms ta nc e s : F u s e d b e a ts a n d a s y n c h r o n o u s pa c e r s w h e n c o u pling intervals are +10 to -90 msec. 7 0 0 m V pa c e r p u l s e s f o l l o w e d b y Q R S c om p l e x e s < 0 . 5 m V. A s y n c h r o n o u s pa c e r p u l s e s w i t h o v e r s h o o t . E v e n t h o u g h t h e I n f i n i t y C e n t r a l Sta t i o n pa s s e d t h e A s s o c i a t i o n f o r t h e A d v a nc e me nt o f M e d i c a l I n s t r u m e n ta t i o n ( A A M I ) pa c e r p u l s e r e j e c t i o n t e s t , i t c a n n o t a n t i c i pa t e e v e r y w a v e f o r m c ha r a c t e r i s t i c . T h e system may count heart rates inaccurately and m i s i n t e r p r e t r a t e - d e p e n d e n t a r r h y t h m i a s i n s o m e pa c e d pa t i e n ts . D o n o t r e l y e n t i r e l y o n t h e d i s p l a y e d h e a r t r a t e t o a s s e s s a pa c e d pa t i e n t ’s c o n d i t i o n . A l w a y s c l o s e l y o b s e r v e a n d c a r e f u l l y m o n i t o r t h e s e pa t i e n ts ’ v i ta l s ig n s . NOTE: xvi The Infinity M300 device contains a magnet which generates an extremely low static magnetic field of approximately 2 gauss at 12.7 mm (0.5 in.) distance. Please refer to the manufacturer’s Instructions for Use of any third party medical devices in the patient vicinity for compatibility. The Infinity Telemetry transmitter device contains a magnet which generates an extremely low static magnetic field of approximately 11 gauss at 12.7 mm (0.5 in.) distance. Please refer to the manufacturer’s Instructions for Use of any third party medical devices in the patient vicinity for compatibility. Infinity CentralStation VF8 Infinity CentralStation Instructions for Use For Patients Without a Pacemaker: Disable pacer detection. (See page 5-3.) Be aware that transcutaneous electrical nerve stimulation (TENS) signals are similar to pacemaker spikes and may be labeled as such. WA R N I N G ! Va l i d Q R S c o m p l e x e s f o l l o w i n g m i s l a b e l e d T E NS s ig na l s c o u l d b e r e j e c t e d , r e s u l t i n g i n f a l s e a s y s t o l e o r l o w h e a r t r a t e a l a rm s . F o l l o w t h e d i r e c t i o n s f o r pa c e m a k e r pa t i e n ts . I f T E N S s i g n a l s c o n t i n u e t o b e i n t e r p r e t e d a s pa c e r s pi k e s , di s a b l e pa c e m a k e r d e t e c t i o n . Pacer Fusion Mode Precautions WA R N I N G ! F u s i o n m o d e pa c e r d e t e c t i o n i s n o t i n t e n d e d f o r u s e w i t h l a r g e - v o l ta g e , u n i p o l a r pa c e m a k e r s . I t i s i n t e n d e d f o r u s e o n l y w i t h b i p h a s i c pa c e m a k e r s . P l e a s e o bs e r v e t h e following: B e f or e s e l e c t i n g F u s i o n m od e b e c e r ta i n t h a t t h e pa t i e n t h a s a b i p h a s i c pa c e m a k e r ( e x t e r n a l o r i m p l a n t e d ) a n d t h a t i t i s a c c u r a t e l y p ro g r a m m e d a s a p p r o p r i a t e f o r t h a t pa t i e n t . D o n o t s e l e c t F u s i o n m o d e i f y o u a r e n o t c e r ta i n w ha t t y p e o f pa c e m a k e r i s i n u s e , o r h o w i t i s p r o g r a m m e d . Select Pacer Fusion mode only to suppress repeated false asystole and/or false low heart rate alarms. S e l e c t i o n o f F u s i on m o d e m a y i n c r e a s e t h e r i s k o f f a l s e l y c o u n t i n g pa c e r s p i k e s a s Q RS c o m p l e x e s , a n d m a y c a u s e c a r d i a c a r r e s t t o b e u n d e t e c t e d . T h e re f o r e , s pe c i a l s u r v e i l l a nc e o f a n y pa c e m a k e r pa t i e n t monitored with this mode is strongly recommended. VF8 Infinity CentralStation xvii Infinity CentralStation Instructions for Use Pulse Oximetry Precautions WA R N I N G ! Sp O 2 m e a s u r e m e n ts a r e pa r t i c u l a r l y s e n s i t i v e t o p u l s a t i o n s i n t h e a r t e r y a n d t h e a r t e r i o l e . T he re f o re , m e a s u r e m e n ts m a y n o t b e a c c u r a t e i f a pa t i e nt i s e x p e r i e n c i n g s h o c k , h y p ot h e r m i a , a n e m i a , o r h a s r e c e i v e d m e d i c a t i o n s t h a t r e d u c e a r t e r y b l o od f l o w. Check the sensor at least every four hours. Move the s e n s o r i f t h e r e i s a n y s i g n o f s k i n i r r i ta t i o n o r i m pa i r e d c i rc u l a t i o n. B r i g h t s u n l i g h t c a n i n t e r f e re w it h p u l s e o x i m e t r y m e a s u r e m e n ts , c a u s i n g e r r a t i c o r m i s s i n g v a l u e s . W h e n t h e s e n s o r i s l ik e l y t o b e e x p o s e d t o d i r e c t s u n l i g h t , c o v e r i t w i t h a n o pa q u e m a t e r i a l . E l e v a t e d l e v e l s o f c a r b o x y h e mo gl o b i n o r m e t h e m o g l o b i n i n m o n i t o r e d pa t i e n ts c a n r e s u l t i n inaccurate pulse oximetry readings. I n f r a re d r e m o t e c o n t r o l d e v i c e s , s u c h a s t h o s e u s e d w it h T Vs a n d V C R s t h a t a r e a i m e d d i r e c t l y a t t h e Sp O 2 sensor can interfere with accurate pulse oximetry m e a s u r e m e n ts . S i g n i f i c a n t l e v e l s o f i n d oc y a n i n e g re e n , m e t h y l e n e b l u e , o r o t h e r i n t ra v a s c u l a r d y e s c a n i n t e r f e re w i t h a c c u r a t e p u l s e o x i m e t r y m e a s u r e m e n ts . CAUTION! Use only Dräger-approved power supplies and batteries (contact your local Dräger representative), otherwise the correct functioning of the product may be compromised. QRS Processing Precautions WA R N I N G ! H i g h a m p l it u d e ( > 0 . 2 m V ) P - a n d T- w a v e s o f l o n g duration may register as integral QRS complexes. So that the s y s t e m a c c u r a t e l y d e t e c ts l o w h e a r t r a t e i n t h e s e c a s e s , s e l e c t t h e l e a d w i t h t h e h i g h e s t R - w a v e ( r e l a t i v e t o t h e T- a n d / o r P - w a v e ) f or E C G 1 . I f t h e s y s t e m c o n t i n u e s t o m i s i n t e rp re t P o r T- w a v e s , r e p o s i t i o n e l e c t r o d e s o r u s e o t h e r m o d a l i t i e s t o m o n i t o r t h e pa t i e n t . xviii Infinity CentralStation VF8 Infinity CentralStation Instructions for Use Vital Connection Cable Precautions CAUTION! Do not allow fluids to come in contact with the Vital Connection Cable or its transmitter interface. If fluids are accidentally spilled on equipment, remove affected device from service as soon as possible. Contact the Hospital Biomedical Engineering Dept. to ensure that there is no compromise in electrical safety. Maintenance, Modifications, and Repairs WA R N I N G ! D i s p o s a b l e a c c e s s o r i e s ( s u c h a s d i s p o s a b le e l e c t r o d e s ) a re f or s i n g l e - u s e o n l y. D o n o t r e u s e d i s p o s a b l e a c cessories. Safety requires regular equipment inspection and maintenance. Be sure that devices are used and serviced in accordance with Dräger Service Documentation: “Preventative Maintenance Procedure” and “Preventative Maintenance Schedule”. A full technical description of the Infinity Network and Service Documentation: “Preventative Maintenance Procedure” and “Preventative Maintenance Schedule” is available from your local Dräger representative. An effective maintenance schedule should be established for your monitoring equipment and reusable supplies. This should include inspection as well as general cleaning on a regular basis. The maintenance schedule must comply with the policies of your hospital infection control department or biomedical department. Check with your biomedical maintenance to be sure a preventative maintenance and calibration is complete. CAUTION! The hospital using this monitoring equipment must implement a satisfactory inspection and maintenance schedule equal to or more frequent than those in Dräger's “Preventative Maintenance Procedure” and “Preventative Maintenance Schedule” or equipment failure and possible health hazards may occur. Site of Operation The site of operation of all equipment must meet environmental requirements. For details, see Appendix B. WA R N I N G ! Do not operate th e Infinity M300 and I n f in i t y Telemetry, its components, or its remote displays in the presence of flammable gases. The Infinity CentralStation, Telemetry System and Infinity M300 are not intended for home care use or the following hospital environments: Hyperbaric Chambers, In the presence of flammable gases (i.e. Anesthetic Agents), CT areas, VF8 Infinity CentralStation xix Infinity CentralStation Instructions for Use Environments containing MRI equipment, or While using electrosurgical unit (ESU), Diathermy, or any other device that injects electric current to the surface of the body which could cause interference on the ECG signal. Electromagnetic Compatibility The Infinity M300 and the Infinity Telemetry System have been designed and tested for compliance with current regulatory standards as to its capacity to limit electromagnetic emissions (EMI), and also as to its ability to block the effects of EMI from external sources. The Infinity M300 and the Infinity Telemetry System are designed to comply with the EMI/EMC standard, EN60601-1-2. For further details see B-18. Reducing EMI To reduce possible problems caused by electromagnetic interference, Dräger recommends the following: xx Use only Dräger-approved, accessories, otherwise the correct functioning of the device may be compromised. Contact your local Dräger representative for a list of approved accessories. Ensure that other products used in areas where patient monitoring and/or lifesupport is used comply to accepted emissions standards (EN55011). Try to maximize distance between electromedical devices. Strictly limit access to portable radio-frequency sources, e.g., cellular phones and radio transmitters. Be aware that portable phones may periodically transmit even when in standby mode. Maintain good cable management. Try not to route cable over electrical equipment. Do not intertwine cables. Be sure all electrical maintenance is performed by trained personnel. Infinity CentralStation VF8 Infinity CentralStation Instructions for Use Device Markings Markings on various Infinity CentralStation hardware components may include the following: Consult accompanying documents Display ON/OFF button CPU ON/OFF LED IPX7 Protected against the effects of immersion IPX4 Protected against splashing water IPX1 Protected against dripping water IPX0 Non-protected against water Defibrillator-proof equipment, Type CF IC: 267I-ABTU4 Canadian certification (The term “IC:” before the radio certification number only signifies that Industry Canada technical specifications were met.) Observe WEEE (Waste Electrical and Electronic Equipment) disposal requirements (ii). Complies with the European Medical Device Directive 93/42/ EEC for medical devices Danger: Risk of explosion if used in presence of flammable anesthetics xxi Infinity CentralStation VF8 Infinity CentralStation Instructions for Use Tested to comply with FCC standards USB Connector xxii Infinity CentralStation VF8 1 About the Infinity CentralStation General Description/Product Option & Accessory Information ...............................1-2 MS18500 Infinity CentralStation ............................................................................1-2 MS18501 Infinity M300 ............................................................................................1-3 MS11200 Infinity Telemetry ....................................................................................1-4 Infinity Network..............................................................................................................1-5 Local and Remote Patient Monitoring...................................................................1-5 Interacting with the Infinity CentralStation Keys........................................................1-6 User Interface.................................................................................................................1-7 On line Help....................................................................................................................1-8 Using On Line Help .................................................................................................1-8 1: About the Infinity CentralStation General Description/Product Option & Accessory Information WA R N I N G ! L os s o f c o m m u n i c a t i o n b e t w e e n t h e I n f i n i t y C e n t r a l Sta t i o n a n d t h e b e d s i d e m o n i t o r i s p o s s i b l e . Dräger recommends using the bedside monitor for p ri m a r y d i a g n o s i s a n d t h e I n f i n i t y C e n t ra l Sta t i o n f o r pa t i e n t v i e w i n g . T h e I n f i n i t y C e n t r a l Sta t i o n C P U m u s t b e p l a c e d s o t h a t i t c a n b e h e a r d e a s i l y i f t h e e x t e r n a l s p e a k e r s b e c om e n on - f u n c t i o n a l . Yo u mu s t k e e p t h e I n f i n i t y C e n t r a l Sta t i o n e x t e r n a l s p e a k e r s c o n n e c t e d a t a l l times. T h e I n f i n i t y C e n t r a l Sta t i o n C P U a n d i ts d i s p l a y ( s ) m u s t a l w a y s s ta y o n . N e v e r p r e s s a n y o f t h e O N / O F F b u t t o n s to turn the CPU or the display(s) off. MS18500 Infinity CentralStation MS18500 Infinity CentralStation provides centralized monitoring and critical care management for bedside and telemetry monitored patients. From the Infinity CentralStation, clinicians can gain access to patient information for patients on the Infinity Network. The Infinity CentralStation displays waveforms, parameters, and alarm status of Infinity bedside monitors, Infinity M300, Infinity Telemetry, and ventilators (via an etCO2 pod or an MIB interface) for up to 16 patients on a single screen or up to 32 patients using two screens. The standard MS18500 Infinity CentralStation includes the following features: 1-2 Central Processing Unit (CPU) Configurable Main Screen display Audio alarm annunciation 2-hour storage of 4-waveform Full Disclosure 2-hour storage of up to 1000 events per patient Export of waveforms 24-hour graphical and tabular trends Accessory Kit Instructions for Use (paper and online .PDF in application) one or two PC displays, or touch screens external speakers, Infinity CentralStation VF8 General Description/Product Option & Accessory Information mouse and keyboard optional remote displays 2-channel R50N recorder network laser printer uninterruptible power management Infinity Network components Options for the MS18500 Infinity CentralStation include: Second video RAID 1 for storage disk CPU mounting Package Patient licenses to support 32-patients 28-, 48-, or 72-hour Full and Event Disclosure Expanded Full Disclosure VentCentral™ Patient Census Rest ECG Analysis Infinity Telemetry Infinity M300 Telemetry ST Analysis Telemetry TruST 12-lead Infinity Paging Interface for alarm notification via Infinity Gateway Suite Infinity Symphony for web-based review of stored data Infinity WebViewer and Infinity Pocket WinView for near real-time review of patient data HL7 bi-directional interfacing via Infinity Gateway Suite MS18501 Infinity M300 MS18501 Infinity M300 is a patient worn transceiver that uses the Infinity CentralStation as the primary patient monitoring display and primary alarm source. The Infinity M300 device includes a color display, local alarm alerts and rechargeable internal battery. Infinity M300 use is restricted to one patient at a time. The standard MS18501 Infinity M300 includes the following features: VF8 Infinity M300 patient worn device Infinity CentralStation 1-3 1: About the Infinity CentralStation Infinity M300 Bedside Charger Infinity M300 Central Charger Infinity M300 programming kit ECG lead sets MS18500 Infinity CentralStation Options for the MS18501 Infinity M300 include: MS18500 Infinity CentralStation options as indicated above Pulse Oximetry software enabled at Infinity CentralStation Pulse Oximetry cables and sensors Infinity M300 Replacement battery Infinity M300 disposable pouches Infinity M300 shower pouches Infinity M300 bedside clips MS11200 Infinity Telemetry MS11200 Infinity Telemetry is a patient worn transmitter that uses the Infinity CentralStation as the primary patient monitoring display and primary alarm source. Infinity Telemetry device includes LED lights in lightweight, water resistant package and uses disposable 9V batteries. Infinity Telemetry use is restricted to one patient at a time. The standard MS11200 Telemetry includes the following features: Infinity Telemetry Receiver CPU Infinity Telemetry Receiver Expansion Kits Infinity Telemetry UHF or VHF antenna components Infinity Telemetry Transmitters Infinity Telemetry programming kit ECG lead sets MS18500 Infinity CentralStation Options for the MS11200 Infinity Telemetry include: 1-4 MS18500 Infinity CentralStation options as indicated above MicrO2+ Pulse Oximeter and connection cable VitalConnection cable for Non-invasive Blood pressure SpO2 measurements Analog ECG cable, Infinity CentralStation VF8 Infinity Network Pulse Oximetry cables and sensors Non-invasive Blood pressure hoses and cuffs 9V disposable batteries or disposable lithium ion batteries Infinity Telemetry disposable pouches Infinity Telemetry/MicrO2+ non-disposable carrying case Infinity Network The Infinity® Network is a standards-based network providing connectivity and data access among Infinity devices. The Infinity Network can include wired and wireless components. For detailed information about the configuration, installation and operation of wireless components in the Infinity Network, contact your local Dräger representative. NOTE: Please refer to manufacturer’s documentation for hazards associated with wireless components. Local and Remote Patient Monitoring Local patients are patients admitted to the Infinity CentralStation you are currently viewing, where the Infinity CentralStation is the primary monitor. Remote patients are patients on the Infinity network that are available to view on the Infinity CentralStation you are currently viewing, yet the Infinity CentralStation is not the primary monitor. Bedside patients - Remote control is possible only if the Bed Control and the Bed Silence features are enabled at the Infinity CentralStation (page 4-3) and remote control is activated at the bedside monitor (refer to monitor documentation). Telemetry patients - Remote control is possible only if the remote functions are enabled at patient’s local Infinity CentralStation (page 5-3). Although you can view patients outside the Infinity CentralStation monitoring unit, you cannot silence alarms or make any setup changes for those patients. VF8 Infinity CentralStation 1-5 1: About the Infinity CentralStation Interacting with the Infinity CentralStation Keys To interact with the Infinity CentralStation, you can use a keyboard, a mouse, or a touch screen. When your Infinity CentralStation is configured to use the touch screen display, the keyboard and mouse are still active. The Infinity CentralStation keyboard has the following quick-access keys: F1 silences all active alarms at the Infinity CentralStation for 1 minute. F5 displays Main Screen. F8 invokes Help. F9 generates Shift report for currently assigned beds. F11 initiates a timed recording for all beds assigned to Main Screen. If the Dual Display option is enabled, recordings are generated for the display in which the mouse pointer is located. Print Screen prints the contents of a screen on an optional laser printer. The keyboard also has the following special keys: 1-6 Enter (↵) moves the cursor to the next input field or selects a highlighted menu item. Delete erases either the character to the right of the cursor or an entire selected text block. Backspace erases the character to the left of the cursor. Keyboard arrow keys are only active in text entry boxes, where they move the cursor in the direction indicated by the arrow. Infinity CentralStation VF8 User Interface User Interface User Interface Function/Purpose Remarks/Illustration/Example BUTTONS Action button Executes a function Examples of action buttons are: • Audio Pause (1 min), which silences alarms at the Infinity CentralStation (1 minute). • Audio Paused (in bed view), which silences the alarms of an individual patient. • Accept Menu button Activates a menu Option button A small rectangle inside the button implies fixed selections. Radio button Available choices are visible. The button next to the current selection appears depressed. Increment button Allows scrolling through predetermined settings Page button Allows scrolling through screen pages MENUS Cascading menu Menu items followed by an arrow indicate additional related submenu selections. SCROLL BARS Horizontal/ vertical scroll bars VF8 Allow navigation through data To scroll through information, click on the arrows or drag the slide bar. Infinity CentralStation 1-7 1: About the Infinity CentralStation User Interface Function/Purpose Remarks/Illustration/Example PASSWORD POPUPS Confirmation popup Safeguards against accidental execution of a function that may have significant consequences For example, when you try to change the time, a confirmation popup appears because the change may affect other devices on the network. Informational popup Contains information, warnings about operational errors, or necessary steps that must be performed For example, if you try to transfer data from a bed that is not in ‘Standby’ mode, an informational popup with the following message displays: The source bed for the transfer must be in Standby. Please put this bed in Standby. Menu-specific popup Provides function-specific information The Assign Bed popup in the Setup and may accommodate setting changes Central Layouts menu allows you to select another bed in the network for display. Password popup A Password pop-up restricts access to functions only intended for authorized personnel. • The clinical password safeguards several setup procedures of the Infinity CentralStation. Often these setup procedures are performed by a Nurse Manager or a Unit Director. • The biomedical password protects functions only intended for use by Service or Biomedical personnel. These functions include setting up the Infinity CentralStation, accessing the system console, configuring locked options, and accessing Diagnostic and Clinical Events logs. On line Help The Infinity CentralStation Instructions for Use are available via the Help screen. When active, the Instructions for Use PDF occupies the left side of the screen. Using On Line Help Function Instruction Open • Click on Help in the upper right-hand corner of the Infinity Central menu bar to launch the Infinity Central Instructions for Use. Search • Use Adobe Reader’s Find function to search for the wanted instructions. Close • Close the Instructions for Use by clicking on File and Close in the PDF window, or on the X-button in the window’s upper right-hand corner. 1-8 , Bookmarks tab, and navigation tools Infinity CentralStation VF8 2 Infinity M300 About Infinity M300........................................................................................................2-2 User Controls ..........................................................................................................2-3 Battery Status LED Indicator Description.............................................................2-4 Audio Alerts .............................................................................................................2-4 Starting up Infinity M300 ...............................................................................................2-5 Infinity M300 Power.................................................................................................2-5 Parameter Displays .................................................................................................2-8 Other Infinity M300 Displays ..................................................................................2-9 Infinity M300 Monitoring System Alarms ............................................................2-12 Trends...........................................................................................................................2-13 Setting up Infinity M300 at the Infinity CentralStation .............................................2-13 Infinity M300 Setup Screens ................................................................................2-13 Infinity M300 Setup ......................................................................................................2-14 Recordings ...................................................................................................................2-15 Recording Types ...................................................................................................2-15 Monitoring a Patient Using Infinity M300 ..................................................................2-15 ECG Monitoring .....................................................................................................2-15 SpO2 Monitoring ...................................................................................................2-15 Arrhythmia Monitoring .........................................................................................2-15 Infinity M300 Messages...............................................................................................2-16 Message Area ........................................................................................................2-16 Infinity M300 Status Messages ............................................................................2-16 Infinity M300 Recording Messages .....................................................................2-17 2: Infinity M300 About Infinity® M300™ Infinity M300 is a patient worn device that uses the Infinity CentralStation as the primary patient monitoring display and primary alarm source. Infinity M300 use is restricted to one patient at a time. NOTE: During installation, the Infinity CentralStation must be configured correctly to work with Infinity M300. The Infinity M300 screen is the secondary display for: 2-2 ECG waves (heart rate), and Pulse Oximetry (SpO2, pleth waveform) Charger interface Battery compartment SpO2/Aux port Battery Status LED Indicator SpO2/Aux port cap Lead wire illustration Fixed keys Audible alarm speaker WARNING: The Infinity M300 speaker is intended for use only in the patient vicinity. It is not intended for primary alarm annunciation. Use the Infinity CentralStation speaker for primary alarm annunciation. Infinity CentralStation VF8 About Infinity“ M300‘ User Controls The Infinity M300 fixed keys give you quick access to a variety of functions. Fixed Key Action/Description When you press the Record key: • a timed recording is generated, or • a timed recording is cancelled, or • an event is stored and is recorded at the Infinity CentralStation. NOTE: If controlling from the Infinity M300, Recording duration is fixed at 20 seconds and recording delay is fixed at 10 seconds. NOTE: For Infinity M300 patients admitted to the Infinity CentralStation, the Infinity M300 Record setting (page 18-12) determines if the Infinity M300 Record key is enabled and how it can be used. When you press the STAFF ALERT key, Infinity M300 sends a STAFF ALERT message to the Infinity CentralStation along with a Serious alarm. NOTE: For Infinity M300 patients admitted to the Infinity CentralStation, the Infinity M300 Staff Alert setting (page 18-12) determines if the Infinity M300 Staff Alert key is enabled and how it can be used. When you press either the Up Arrow or Down Arrow key: • From the Infinity M300 monitoring screen, you can scroll through available waveforms, or • The menu field value changes incrementally, When you press the Views key, you can: • Page through Monitoring, Electrode Check, Volume (if enabled at the Infinity Central Station, and Demographics screens, • Take Infinity M300 out of Standby mode, or • Accept/confirm user-selected values. When you press and hold the Views key for more than 3 seconds the LCD display turns ON or OFF: When you press and hold the Alarm Paused key for more than 3 seconds: • A confirmation screen displays, and if you select Yes, • Infinity M300 and Infinity CentralStation alarms are temporarily paused. If Alarm Paused is ON, pressing the Alarm Paused key again turns Alarm Paused OFF. NOTE: For Infinity M300 patients admitted to the Infinity CentralStation, the Alarm Paused setting (page 18-12) determines if the Infinity M300 Alarm Paused key is enabled and how it can be used. VF8 Infinity CentralStation 2-3 2: Infinity M300 Battery Status LED Indicator Description Behavior Description Blinking green (approximately every 5 seconds) Power ON Infinity M300 is being used away from the charger. Battery OK Blinking amber (approximately every 5 seconds) Power ON Infinity M300 is being used away from the charger. Low battery Solid amber Charging in progress (while in charger) Solid green Charging complete (while in charger) Audio Alerts If the Infinity M300 speaker is enabled (page 18-12) alarm alerts will be triggered for the following conditions. WA R N I N G : T h e I n f i n i t y M 3 0 0 s p e a k e r i s i n t e n d e d f o r u s e o n l y i n t h e pa t i e n t v i c i n i t y. I t i s n o t i n t e n d e d f o r p ri m a r y a l a rm a n n u n c i a t i o n . U s e t h e I n f i n i t y C e n t r a l Sta t i o n s p e a k e r f o r p ri m a r y a l a r m a n n un c i a t i o n . Condition Tone Description Acknowledgement 2 brief tones Error 1 tone Find Device tone alternating tone Alarm conditions ADV, SER, LT tones Adjusting Alarm Tones You can select an Infinity M300 alarm tone pattern at the Infinity CentralStation (see page 5-3). For information about setting or changing the volume of the Infinity M300 alarm, see 2-11. Finding the Infinity M300 Infinity M300 generates a Find Device tone (with volume set at 100%) when you request it at the Infinity CentralStation (see page 5-13). The brief tone automatically silences. 2-4 Infinity CentralStation VF8 Starting up Infinity M300 Starting up Infinity M300 To turn on the Infinity M300, simultaneously press the up and down arrows. When you turn Infinity M300 on, a startup screen displays the current software version and possible messages. During this operation Infinity M300 also sounds a verification tone. WA R N I N G : I f n o v e r i f i c a t i o n t o n e s o u n d s , d o n o t u s e t h e d e v i c e a n d c o n ta c t t h e H o s p i ta l B i o m e d i c a l E n g i n e e r i n g D e p t . NOTE: The verification tone generated when Infinity M300 is turned on is a confirmation that alarm annunciation is functional. Discontinue use of Infinity M300 and contact the Hospital Biomedical Engineering Dept. upon receiving any of the following messages: Startup Message Condition High Temperature Reset Reset due to the internal temperature exceeding the acceptable limit. Default Patient Settings Restored User settings have been reset to factory defaults. Software Reset, see Diagnostic Log Reset due to a software error. Patient Data Erased (followed by error code) Trend data or at least one stored event was erased. Low Battery Reset An error was detected with the battery. Software Watchdog Reset due to software error. Infinity M300 Power Infinity M300 operates using a rechargeable battery. A Bedside Charger can be used to power the device and recharge the battery during patient use. The battery runtime is shortened with continuous use of the display and speaker. The device’s Battery Status LED Indicator provides indication to the battery status (see page 2-4). CAUTION! VF8 Infinity M300 Shower Pouch must be used when it is worn in the shower so that water does not get in the battery compartment. When the Infinity M300 internal battery requires replacement, please contact the Hospital Biomedical Engineering Dept. Battery replacement information is available in service documentation. Infinity CentralStation 2-5 2: Infinity M300 NOTE: The Infinity M300 enters a deep-discharge state when it is stored for a long period of time away from either the bedside or the central chargers. To exit the deep-discharge state, place the Infinity M300 in either the Bedside or Central Charger for at least half an hour. This allows the battery to come out of the deep-discharge state. Recycle or dispose of batteries in accordance with the directive EC 91/156/ EWG or equivalent country-specific regulation. Infinity M300 Bedside Charger WA R N I N G : F o r pa t i e n ts i n a b e d o r c h a ir, i t i s r e c o m m e n d e d t ha t the Infinity M300 Bedside Charger be clipped to the bed l i n e n a n d n o t b e p l a c e d i n a pa t i e n t ’s p o c k e t o r p o u c h . Draeger Medical recommends the use of the Infinity M300 Bed Clip. Place the Infinity M300 device to avoid any possibility of: - t h e d e v i c e f a l l i n g o n o r i n j u r i n g pa t i e n t . - a n y a c c e s s o r y c a b l e s a c c i d e n ta l l y e nta n g l e d a ro u n d pa t i e n t ’s n e c k . 3-le NOTE: When illuminated, the green LED on the Infinity M300 Bedside Charger indicates that the bedside charger is connected to the AC Mains voltage and is capable of charging the Infinity M300. Infinity M300 reports the internal battery charge level continuously by means of a battery symbol (when screen is on). When the screen is off, battery condition is indicated using the Battery Status LED Indicator. When the remaining battery level is 10%, the message, Low Battery displays on the Infinity CentralStation and on the Infinity M300 display. When the device is placed on the Bedside Charger the status message discontinues. When the device battery level is 5%, an Advisory alarm is generated at the 2-6 Infinity M300 (FRIWO® brand) power supply Infinity M300 Bedside Charger Green LED Infinity CentralStation VF8 Starting up Infinity M300 Infinity CentralStation and the message, Recharge Battery displays on the Infinity CentralStation and on the Infinity M300 display. When Infinity M300 is removed from the Bedside Charger, the green Battery Status LED indicator blinks once every 5 seconds and the battery icon shows available battery power. Removing Infinity M300 from the Bedside Charger Place your fingers over the top of the Infinity M300 device, between the back of the Infinity M300 and the Bedside Charger. Gently pry the top of the Infinity M300 device away from the Bedside Charger until the Infinity M300 is loose. Lift the Infinity M300 Device out of the charger. Placing Infinity M300 into the Bedside Charger WA R N I N G : R e m o v e t h e L e a d Wi r e S e t f r o m I n f i n i t y M 3 0 0 b e f o r e p l a c i n g t h e I n f i n i t y M 3 0 0 i n t o t h e C e n t r a l C h a r g e r, o r p os s i b l e e l e c t r i c a l s h o c k c o u l d o c c u r. Place the bottom of the Infinity M300 device into the Bedside Charger. Gently press the top of the Infinity M300 toward the Bedside Charger until it snaps into place. Infinity M300 Central Charger Infinity M300 devices are stored in the Central Charger, which accommodates up to 10 devices. When the Infinity M300 is placed on the Central Charger, the battery recharges and the device goes through a patient discharge cycle, which includes: erasing data in device’s memory (i.e. trends, demographics) and discharging that patient from the Infinity CentralStation. CAUTION: Do not use the Infinity M300 Central Charger in the patient environment (see IEC 60601-1-1), or fluids may cause damage to the equipment. VF8 Infinity CentralStation 2-7 2: Infinity M300 Parameter Displays Infinity M300 ECG Display The Battery Charge icon appears in the Message Area and illustrates how much battery power is available. Wireless signal strength icon appears in the Message Area Bed Label appears in the Message Area Waveform If pacer detection is enabled, pacer spikes are indicated on the waveform. Lead label ECG default is Lead II Scale next to the waveform is configured at the Infinity CentralStation. Waveform Area The waveform scale at the left of the waveform is configured at the Infinity CentralStation. To scroll through available leads use the Infinity M300 Up Arrow and Down Arrow keys. 2-8 Infinity CentralStation VF8 Starting up Infinity M300 ECG/SpO2 Display NOTE: SpO2 does not display unless the parameter is being monitored Message Area (Bed Label and Time become Message Area) When alarms are OFF the Alarms OFF Icon appears. Waveform Lead being displayed Scale next to the waveform is configured at the Infinity CentralStation. HR Parameter Box on the left and SPO2 parameter box on the right. Battery Charge Icon Other Infinity M300 Displays Start Up Screen The Start Up screen displays while the Infinity M300 is powering up. A progress bar provides a visual display of the Start up process. New Patient Screen NOTE: To admit a patient to Infinity M300, use the ADT screen at the Infinity CentralStation. Once Start Up is completed, the New Patient screen will display if a previous patient’s data are still in the Infinity M300 memory. If you want to admit a new patient, you must select Yes to confirm that the former patient data is erased from memory. Use the Up Arrow or Down Arrow keys to toggle between Yes and No selections. WA R N I N G : W h e n y o u a d m i t a pa t i e n t t o t h e I n f i n i t y M 3 0 0 , m a k e s u r e t h a t t h e A l a r m L i m i ts a nd A r r h y t h m i a S e t t i n gs a re a p p r o p r i a t e f o r t h e pa t i e n t . U p o n a d m i t s o m e p re d e f i n e d d e f a u l t s e t t i n g s m a y n o t b e a p pl i e d . VF8 Infinity CentralStation 2-9 2: Infinity M300 NOTE: You may also discharge a patient from Infinity M300 using the ADT screen at the Infinity CentralStation or placing Infinity M300 on the Central Charger. When you discharge a patient: Patient data is erased in Infinity M300 memory. The patient is discharged from the Infinity CentralStation. When an Infinity M300 patient is discharged from the Infinity Central Station (see page 9-7), the Discharge banner covers the Infinity M300 screen along with the message, Press to exit. To exit the Infinity M300 Discharge screen press the Views key. Transfer Screen If you want to transfer patient information from Infinity M300 you must put the Infinity M300 in Standby mode and then initiate the transfer at the destination Infinity CentralStation (page 9-8). During the transfer process the message, Transferring data, displays on the destination Infinity CentralStation screen. When the transfer is complete a Discharge screen displays on the CentralStation. Standby Screen Standby mode must be initiated at the Infinity CentralStation. When a telemetry patient’s monitoring is in Standby mode, the Standby banner displays on the Infinity to exit. M300 screen along with the message, Press When Standby mode is selected at the Infinity CentralStation, the Infinity M300: Patient monitoring is suspended, Screen is blank except for a Standby banner, Network and system status messages circulate in the message area. You can set Standby time-out selections at the Infinity CentralStation. The selections are: No time out, 5 mins., 10 mins., 20 mins., 30 mins., 1 hr., 2 hr., and 3 hr. To return the Infinity M300 to Monitoring mode, press the Infinity M300 Views key. 2-10 Infinity CentralStation VF8 Starting up Infinity M300 Demographics Screen The Infinity M300 Demographics screen shows patient demographic information. All patient demographic information is received from the Infinity CentralStation and may include: Patient name Primary ID# Bed Label Care Unit Patient Category Volume Setup Screen If the Infinity M300 Speaker is enabled at the Infinity CentralStation (see page 18-12) you can access the Infinity M300 Volume Setup screen and change the device alarm volume. To access the Infinity M300 Volume Setup screen press the Views key. WA R N I N G : T h e I n f i n i t y M 3 0 0 s p e a k e r i s i n t e n d e d f o r u s e o n l y i n t h e pa t i e n t v i c i n i t y. It i s n o t i n t e n d e d f o r p ri m a r y a l a rm a n n u n c i a t i o n . U s e t h e I n f i n i t y C e n t r a l Sta t i o n s p e a k e r f o r p ri m a r y a l a r m a n n un c i a t i o n. To scroll through the available volume settings, press the Infinity M300 Up Arrow or Down Arrow key. Available selections are: Off, 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, and 100%. WA R N I N G : S e t a l a r m v o l u m e i n a c c o r d a n c e w i t h a m b i e n t s o u n d l e v e l i n t h e r o o m s o t h a t a l a rm v o l u m e i s a u d i b l e . CAUTION: If speaker is disabled, the Volume screen will not be available to the user. Electrode Status Screen An Electrode Status screen provides a status of electrode connection. The color of the dot indicates which electrodes are disconnected or connected to the patient. Green represents that electrode is connected; red represents that electrode is disconnected. To access the Electrode Status screen press the Views key. This screen allows you to quickly check which electrodes are disconnected without disturbing the patient. VF8 Infinity CentralStation 2-11 2: Infinity M300 Infinity M300 Monitoring System Alarms CAUTION: Upon startup and after a patient discharge, the following Infinity M300 alarms are not active until a numeric value has been received for that parameter: ECG Leads Off, ECG Artifact,Leads Off, Cannot Analyze ST, SpO2 Unplugged, SpO2 Transparent, SpO2 Light Blocked, SpO2 Regulation Error, SpO2 Artifact, SpO2 Weak Signal, SpO2 No Measurement Alarm Grade Display Infinity M300 Monitoring System supports three alarm severity grades: lifethreatening, serious and advisory. Each grade is accompanied by a different pattern and color-coded display: Severity Grade Color Audible Tone Life-threatening Red Two Frequencies (alternating high and low) Serious Yellow Single Frequency, high Advisory White Single Frequency, low When a parameter is alarming, the parameter box flashes the color representing the severity grade and the Infinity M300 sounds an associated tone. Alarm Paused WA R N I N G : N o a l a r m s w il l b e a n n ou n c e d w h i l e I n f i n i t y M 3 0 0 i s i n A l a r m P a u s e d mo d e . NOTE: The Alarm Paused key on the Infinity M300 can only be disabled at the Infinity CentralStation. To initiate the Alarm Paused, press and hold the Alarm Paused key for 3 seconds. A confirmation screen displays. If YES is selected (if confirmed) an Alarm Paused message displays in the Infinity M300 Message area with a timer, which represents the length of pause time remaining. For a description of alarm behavior at the Infinity CentralStation, see Chapter 13. 2-12 Infinity CentralStation VF8 Trends Trends You can review and set up the Trends for an Infinity M300 patient at the Infinity CentralStation (see page 15-2). Although Infinity M300 does not display trend data, it can store up to 72 hours of trend data for each monitored parameter. All trend data is deleted when you: discharge the patient, or update Infinity M300 software. Setting up Infinity M300 at the Infinity CentralStation Infinity M300 Setup Screens If you want to . . . Refer to . . . Location Assign Infinity M300 IDs and IP Addresses Biomed Telemetry Devices screen page 18-11 Configure Infinity M300 System Defaults Biomed M300 Setup screen page 18-11 Configure Infinity M300 monitoring for an individual patient Bed View Telemetry setup screens page 8-12 Assign an Infinity M300 to a patient Admit screen page 9-2 Set system defaults for Infinity CentralStation telemetry patient windows Telemetry System Setup screen page 5-3 View Infinity M300 status information and configure device keys M300 Setup screen page 18-11 VF8 Infinity CentralStation 2-13 2: Infinity M300 Infinity M300 Setup The M300 Setup screen is accessible for local Infinity M300 patients and displays information received from the Infinity M300. It provides Infinity M300 status information and permits configuration functions. Selection Description Settings Telemetry ID Displays Infinity M300 identification number Battery Level Bar Graph Graphically displays remaining battery time The Infinity M300 current battery voltage appears next to the Bar Graph. ECG Lead Prep Shows the quality of the ECG Lead Prep. The displayed information is received from Infinity M300 and can be updated dynamically. Alarm Paused1 Determines if Infinity M300 Alarm Pause key is enabled Alarm Paused time is set in Telemetry System Setup (5-3) • On • Off Record1 Generates manual timed recordings • • • • Staff Alert1 Determines if Infinity M300 STAFF ALERT key is enabled or disabled. • On • Off Record Off Record/Store Store When you select On, you can generate a STAFF ALERT alarm at the Infinity Central Station when you press the Infinity M300 STAFF ALERT key. Speaker1 Determines if the Infinity M300 speaker is enabled • On WARNING: The Infinity M300 speaker is intended for use • Off only in the patient vicinity. It is not intended for primary alarm annunciation. Use the Infinity CentralStation speaker for primary alarm annunciation. M300 Volume WARNING: Set alarm volume in accordance with ambient sound level in the room so that alarm volume is audible. Sets Infinity M300 audible alarm If the Speaker setting is OFF, this setting is not available. • OFF • 10 - 100% • Click on Accept or on Undo to return to previous settings. 1Unless 2-14 the system default setting (18-12) is Per Patient, these selections are ghosted. Infinity CentralStation VF8 Recordings Recordings Recording Types You can generate manual timed recordings from the Infinity M300 by pressing the device Record key or using the Infinity CentralStation. You can also generate manual or continuous timed recordings for an Infinity M300 patient admitted to the Infinity CentralStation from the Infinity CentralStation (page 14-5). Monitoring a Patient Using Infinity M300 ECG Monitoring 1. Apply electrodes to patient. (Appendix A). 2. Connect the appropriate EG lead wire set to the Infinity M300. 3. Attach the lead wires to the electrodes. 4. Admit the Infinity M300 connected to the patient to the desired Infinity CentralStation patient window (Chapter 9). 5. Set alarm and arrhythmia limits at the Infinity CentralStation (page 13-10). SpO2 Monitoring 1. Select an appropriate sensor and place the sensor on the patient. 2. Connect the pulse oximetry cable to the Infinity M300. 3. Turn SpO2 “ON” in the Patient View Setup screen (page 11-4) NOTE: Pulse Oximetry must be enabled via a locked option, please call your local Dräger representative. 4. Select the desired Averaging Mode. 5. Set alarm limits at the Infinity CentralStation (page 13-10). Arrhythmia Monitoring Infinity M300 devices include basic arrhythmia monitoring. Full Arrhythmia is a locked option (call your local Dräger representative). VF8 Infinity CentralStation 2-15 2: Infinity M300 Infinity M300 Messages Message Area The Infinity M300 message area displays alarms, network-generated or locally generated messages. If more than one message must display, the messages circulate in a round-robin manner, with each message appearing for 1 second. These messages include: Alarm messages, which display in cyan characters on a background color defined by the alarm grade (page 13-5). Status messages, which display in black characters on a white background. System information messages, which display in white text on a blue background. Network messages, which display in yellow text on a blue background. See page 7-5 for a description of Status message display at the Infinity CentralStation. NOTE: If communication with a Infinity CentralStation can not be established when trying to admit a patient, please contact or call your local Dräger representative. Infinity M300 Status Messages Alarm Message in Message Area Grade Description Action STAFF ALERT SER Check the patient. Recharge battery ADV HR Alarms Off SER Alarm Paused: xxx ADV 2-16 The Infinity M300 STAFF ALERT key was pressed. This message requires acknowledgement. Infinity M300 battery charge is Recharge battery or contact the low. Hospital Biomedical Engineering Dept. to replace Infinity M300 battery. Heart rate alarms are turned Pay close attention to the patient. Off at the Infinity This message remains until HR CentralStation. alarms are turned back ON at the Infinity CentralStation Alarm Paused key was Condition remains until timer pressed. The remaining pause expires or until Alarm Paused key time displays with the is pressed at the Infinity M300 message. while Alarm Paused is active. Infinity CentralStation VF8 Infinity M300 Messages Offline Lead X OFF SER ADV HR Limits OFF N/A HR, ASY, VF OFF N/A The Infinity M300 cannot communicate with the Infinity CentralStation. ECG lead Disconnected as indicated. Check the patient. Make sure patient is not out of designated coverage area. Check the patient. Reapply electrodes. The Infinity M300 will not alarm Informational message only. for HR Limit violations The Infinity M300 will not alarm Informational message only. for HR Limit violations, asystole, or ventricular fibrillation. Infinity M300 Recording Messages Condition Tone Message Recording request not accepted because recorder is out of paper Yes Recorder Out of Paper Recording request not accepted because recorder door is open Yes Recorder Door Open Recording request not accepted because of recorder hardware failure Yes Recorder Failure Recording started Yes Recording Started Recording stored Yes Recording Stored Recording finished Yes Recording Finished Recording cancelled Yes Recording Cancelled Recorder is disconnected during recording Yes Recorder Offline VF8 Infinity CentralStation 2-17 2: Infinity M300 - This page left blank intentionally - 2-18 Infinity CentralStation VF8 3 Infinity Telemetry Transmitter Transmitter Components ..............................................................................................3-2 Lead Connector.......................................................................................................3-2 Programming Port Connector/Interface...............................................................3-3 Transmitter Buttons ................................................................................................3-4 Transmitter LED Error Patterns (Normal Mode) ...................................................3-4 Transmitter Operating Modes ................................................................................3-5 Transmitter Battery ...................................................................................................3-5 Installing or Replacing the Battery .......................................................................3-7 Transmitter Setup ..........................................................................................................3-8 Accessing the Transmitter Setup Screen .............................................................3-8 Received Transmitter Status Information .............................................................3-8 Transmitter Setup Screen Functions ....................................................................3-9 Attaching the Transmitter to the Patient .....................................................................3-9 Transmitter Messages.................................................................................................3-10 Status Messages ...................................................................................................3-10 3: Infinity Telemetry Transmitter Transmitter Components Infinity TruSTTM Telemetry Transmitter 3-lead insert Lead Placement Diagram Recording Button Lead Connector Accommodates 3-, 5-, and 6-Wire Lead Set Lead Block 6-Wire Lead Set is illustrated Programming Port /MicrO2+ Interface/Analog ECG Cable Port/Vital Connection Cable Interface Staff Alert Button Lead Connector The Infinity TruST Telemetry transmitter, which has a 6-pin lead connector, can accommodate a 3-, 5-, or 6-wire ECG lead set. WA R N I N G : D o n o t u s e I n f i n i t y M o n o l e a d s w i t h I n f i n i t y Te l e m e t r y o t h e r w i s e t h e c o r r e c t f u n c t i o n i n g o f t h e p ro d u c t m a y b e c om p r o m i s e d a n d m i s d i a g n o s i s m a y o c c u r. 3-2 Infinity CentralStation VF8 Transmitter Components Programming Port Connector/Interface The transmitter has a connector that can be used to: Program the transmitter. Connect to the MicrO2® pulse oximeter for monitoring SpO2 and pulse (page 11-4). Connect a Telemetry Analog ECG Cable to an Infinity bedside monitor (via the MultiMed pod) to display ECG waveform (lead II) and possible pacer spikes. NOTE: For the best possible ECG signal, you should only use the analog ECG cable with 5- or 6-wire lead sets. VF8 Connect a Vital Connection Cable to an Infinity bedside monitor to display NIBP, SPO2 and PLS (page 11-5). Infinity CentralStation 3-3 3: Infinity Telemetry Transmitter Transmitter Buttons NOTE: The transmitter buttons are only functional if they have been activated (page 18-13). The red staff alert button allows the patient to initiate a serious alarm which sounds at the Infinity CentralStation. The message Staff Alert is displayed in the patient window. You can silence this alarm at the Infinity CentralStation with the Audio Pause (1 min) button. The white recording button allows you to begin a recording. Press this button less than 3 seconds for a timed recording; press it longer than 3 seconds for a continuous recording. If you press both transmitter buttons simultaneously, a 1 mV calibration pulse is superimposed on the patient’s Bed View lead display at the Infinity CentralStation. Transmitter LED Error Patterns (Normal Mode) Transmitter Self-Test - When you put a battery into a transmitter, it performs a selftest. If the test completes successfully, all of the LEDs flash briefly. If an error is detected, all the LEDs flash initially and then alternate an error-specific pattern. Transmitter Orientation as you examine LED Patterns Transmitter shown is Infinity TruST Telemetry transmitter. Error codes display on four of the LEDs. From To One lighted diode “ripples” across display. Description Action Battery critically low. Transmitter operating, but not sending data. Reinsert or replace battery (page 3-5) immediately. If error continues, take transmitter out of service. Transmitter unable to tune Reprogram transmitter. Two diodes flash. Analog ECG cable connected Two diodes flash. For other possible error messages related to the transmitter that may appear at the Infinity CentralStation see page 3-10. 3-4 Infinity CentralStation VF8 Transmitter Battery Transmitter Operating Modes Normal Mode During Normal mode the transmitter is connected to a patient and collects data which it relays to the Infinity CentralStation. NOTE: Staff mode lasts for 30 seconds, after which the transmitter returns to Normal operating mode. Staff Mode Staff mode may be used to troubleshoot the transmitter or indicate a lead-off condition. To activate Staff Mode, Press the Staff Alert Button for more than 3 seconds. The LEDs may identify the following possible conditions: Condition LED Reaction Lead(s)-off The LED(s) corresponding to the detached lead(s) flash(es). Reference lead-off (or all other leads-off) All LEDs flash simultaneously On transmitters using 3-wire mode only 3 LEDs flash when the reference lead is off. Low battery and Lead-off The LED patterns alternate for each condition. Transmitter Battery WA R N I N G ! To a v o i d e x p l o s i o n , d o n o t r e c h a r g e o r disassemble a battery or dispose of it in fire. CAUTION! Infinity Telemetry Shower Pouch must be used when it is worn in the shower so that water does not get in the battery compartment. Always remove the battery before storing the transmitter. If the transmitter will not be in use for an extended time, remove the battery. Always use a new, fully charged battery each time you begin monitoring a patient with the transmitter. NOTE: Recycle or dispose of batteries in accordance with the directive EC 91/156/ EWG or equivalent country-specific regulation. VF8 Infinity CentralStation 3-5 3: Infinity Telemetry Transmitter Battery Type Nominal Voltage Typical Life Characteristics Alkaline/manganese oxide 9V 2 days, minimum General purpose battery Good shelf life (DURACELL PROCELL model PC1604) WA R NI N G ! U s e o n l y t he b ra n d ULT R A L I F E ( mo d e l U 9 V L- FP ) l i t h i u m b a t t e r y. A n y o t h e r l i t h i u m b a t t e r y m a y p r e s e n t a r i s k of f i re o r e x p l o s i o n . Lithium/manganese dioxide (ULTRALIFE model U9VL-FP) 3-6 9V 4 days, minimum Infinity CentralStation High energy density Excellent shelf life VF8 Transmitter Battery Installing or Replacing the Battery Each time you begin monitoring a patient with the transmitter you should install a new transmitter battery. Also, to avoid interruption in patient monitoring, promptly replace the transmitter battery when: the Transmitter Low Battery alarm displays at the Infinity CentralStation (page 3-10), or the transmitter LED lights flash (page 3-5). Install the transmitter battery as follows: 1. Remove the transmitter battery cover. 2. Insert a fully charged battery into the transmitter. The transmitter performs a self-test. 3. Slide the battery cover back on and snap into place. If the battery cover is not closed properly the transmitter will not operate. VF8 Infinity CentralStation 3-7 3: Infinity Telemetry Transmitter Transmitter Setup The Transmitter Setup screen provides transmitter status information and permits configuration and programming functions for local telemetry channels. Accessing the Transmitter Setup Screen 1. Open the patient’s Bed View screen. 2. Click on Setup. 3. Click on Telemetry. 4. Click on Transmitter Setup. Received Transmitter Status Information Received Transmitter Status section of Transmitter Setup Menu Information Description ID The transmitter ID cannot be changed; it is configured by the Hospital Biomedical Engineering Dept. during installation. ECG Lead Wires 3-, 5-, or 6-wire mode cannot be changed by the user; it is configured by the Hospital Biomedical Engineering Dept. during installation. Battery A bar graph showing the transmitter battery charge and current voltage. The color of the graph also indicates the status of the remaining battery charge. ECG Lead Prep The color of the dot indicates the quality of lead prep. A label may also appear next to the button. green = good yellow = acceptable red = poor *L* = Lead Off *N* = No signal detected from transmitter Frequency Cannot be changed by the user; it is configured by the Hospital Biomedical Engineering Dept. during installation. • ECG Lead Prep RL is not displayed as this is a reference lead only. • An Infinity TruST Telemetry transmitter programmed for 6-wire monitoring displays: RA, LA, LL, C, and C+. • An Infinity telemetry transmitter programmed for 5-Wire monitoring displays: RA, LA, LL, and C. If programmed for 3-wire monitoring, it displays: RA and LA. Update Status 3-8 Allows you to update the screen with the latest status information. Infinity CentralStation VF8 Attaching the Transmitter to the Patient Transmitter Setup Screen Functions Customizing the Transmitter Buttons NOTE: You can only activate/deactivate the transmitter buttons for an individual patient if Per Patient mode was selected during setup (page 18-15). 1. Open the Transmitter Setup screen (page 3-8). 2. Click on the On/Off toggle button next to Transmitter Record:, and/or Click on the On/Off toggle button next to Transmitter Staff Alert:. 3. Click on Accept to save or Undo to keep previous settings. Attaching the Transmitter to the Patient 1. Verify that the transmitter is programmed for the appropriate monitoring mode. 2. Apply electrodes to patient. (Appendix A). 3. Connect the appropriate ECG lead wire set to the transmitter. 4. Attach the lead wires to the electrodes. 5. Admit the patient to the Infinity CentralStation patient window for which the transmitter is selected. VF8 Infinity CentralStation 3-9 3: Infinity Telemetry Transmitter Transmitter Messages Status Messages Alarm Message Grade Description Action Parameter Area Status Area HR: ARR: PVC/min: SpO2: PLS: STx: HR: *N* ARR: PVC/min: SpO2: PLS: STx: HR: *I* ARR: PVC/min: SpO2: PLS: STx: HR: ARR: PVC/min: SpO2: PLS: STx: staff alert SER The transmitter staff Check the patient. alert button was pressed. This message requires acknowledgement. transmitter no signal ADV The receiver cannot Be sure patient is within telemetry detect the antenna range. transmitter. Check cable connections. Replace transmitter battery. transmitter ID incorrect ADV The transmitter ID Reprogram transmitter with and programmed ID correct ID. do not match. Make sure that transmitters do not have duplicate IDs. transmitter low battery ADV Transmitter’s battery Replace transmitter battery charge is low. immediately. 3-10 The message remains until battery is replaced. Infinity CentralStation VF8 4 Infinity CentralStation Setup Accessing the Setup Screens ......................................................................................4-2 Password-Protected Screens ................................................................................4-2 Setup - Central Screen ..................................................................................................4-3 Setup - Recorder Screen...............................................................................................4-5 Setup - Central Layouts Screen ...................................................................................4-6 4: Infinity CentralStation Setup Accessing the Setup Screens 1. Click on Setup in the Main Screen menu bar. 2. Click on one of the drop down menu selections. Selection Reference Central... page 4-3 Recorders... page 4-5 Central Layouts... page 4-6 Telemetry Chapters 5 and 6 Password-Protected Screens Access to the following setup functions is controlled with assignment of a required password (page 18-3). Screen Required Password Setup > Telemetry > System Setup Setup > Telemetry > Patient View Defaults Setup > Telemetry > Alarm Limits Defaults Setup > Telemetry > Arrhythmia Defaults Setup > Telemetry > ST Defaults Setup > Central Setup > Recorder Setup > Central Layout Clinical Clinical Clinical Clinical Clinical Clinical/Biomed Clinical/Biomed Clinical Password access to this function can be set during configuration (page 18-3). If a password is required, a popup window appears when you click on the Setup menu item. 1. Type the password in the popup text entry box. NOTE: You can only enter the password if the mouse pointer is on the text entry box. 2. Click on Accept. If the password is incorrect, an error message displays. 4-2 Infinity CentralStation VF8 Setup - Central Screen Setup - Central Screen To open the Setup - Central screen, refer to page 4-2. Setup - Central Screen Selections Selection Description Available Settings Default Sweep Speed Determines how fast the erase bar sweeps across the screen to update the waveforms • 25 mm/s • 50 mm/s 25 mm/s Display Limits Determines whether or not alarm limits appear in the Infinity CentralStation parameter areas • ON • OFF OFF WA R N I N G ! A l w a y s s e t t h e a l a r m v o l u m e s o i t c a n b e h e a r d d u r i n g t he b us ie s t p e ri o ds o f t h e da y. Alarm Volume Determines alarm tone volume • 10% - 100% 50% Attention/Error Volume Determines the attention and error tone volume • 10% - 100% 50% Display Timeout Determines how long the screen will display without user interaction Display Time out does not apply to screens displaying context-sensitive Help. • • • • 3 min Audio Paused Enable Determines whether or not you can silence • ON bedside alarms from the Infinity • OFF CentralStation Remote silence is only possible at the Infinity CentralStation if also activated at the bedside network device. ON Bed Control Enable Determines whether or not you can control • ON certain bedside monitor functions from the • OFF-The alarm Infinity CentralStation and arrhythmia Remote control is only possible at the Infinity setup entries and CentralStation if also activated at the network Relearn buttons device. are ghosted. If this function is disabled, the Infinity CentralStation can still silence bedside alarms if Audio Paused Enable is ON. ON 1 min 3 min 5 min No Timeout WA R N I N G ! A c o n f i r m a t i o n p o p u p w a r n s y o u t h a t c h a n g i n g t h e t i m e o r d a t e a t t h e I n f i n i t y C e n t r a l Sta t i o n a l s o c h a n g e s t h e t i m e a t a l l d e v i c e s c o n n e c t e d t o t h e n e t w o rk . C h a n g e s c a n n o t b e u nd on e o n c e c o n f i r m e d . Hour: Minute Sets current time • Hour • Minute Day - Month Sets current date • Day • Month VF8 Infinity CentralStation 4-3 4: Infinity CentralStation Setup Setup - Central Screen Selections Selection Description Available Settings Year Sets current year • 1995 - 2099 Report Trend Order Displays System Trend Order Setup screen, • Enable Auto Scale Disabled which allows selection and sorting of (page 14-17) parameters for a Shift (page 14-12) or Click selection box Graphical Trend Report (page 14-17). to activate. • Trends Per Page Click on 1, 2, 3, 4, 3 To configure Trend Order Setup for a specific or 5. patient, see page 14-24. Batch Shift Report: Permits assignment of report length for batch • 2 Hour shift reports • 4 Hour • 8 Hour When you press F9 a Shift Report is • 12 Hour generated for all currently active beds. • 24 Hour Accept/Undo Permits saving current changes 4-4 Infinity CentralStation Default • Accept - save changes • Undo - keep previous settings VF8 Setup - Recorder Screen Setup - Recorder Screen To open the Setup - Recorder screen, refer to page 4-2. Setup - Recorder Screen Selections Selection Description Primary Recorder Selects preferred recorder Secondary Recorder Available Settings Default When you click on Assign... in the Assign Recorder popup a list of available Determines recorder to be used when recorders displays. Primary Recorder is unavailable • Click on the desired recorder. • Click on Accept in the popup to choose the selected recorder or on Cancel. Speed Sets recording speed • 50, 25, 12.5, 6.25, 1 mm/s 25 mm/s Alternate Speed Determines recording speed when • 50, 25, 12.5, 6.25, R 50 Alternate Speed key is pressed 1 mm/s (page 14-4) 50 mm/s Manual Recording Duration Sets time length of a Manual Record- • 5/6, 10, 15, 20 s ing 20 s Manual Recording Delay Determines amount of pre-event data included in Manual Recording • 5, 10, 15 s 10 s Available selections depend on your recording speed setting. Inactive settings for a particular recording speed are ghosted. Manual Recording Duration Available Delay Setting 5/6 s 10 s 15 s 20 s •5s • 5, 10 s • 5, 10, 15 s • Click on Accept to save or Undo to keep previous settings. VF8 Infinity CentralStation 4-5 4: Infinity CentralStation Setup Setup - Central Layouts Screen To open the Setup - Central Layouts screen, refer to page 4-2. Setup - Central Layouts Screen Selections Selection Description Available Settings Default Select Central Layout Permits configuration and storage A, B, C, D of desired layout Central Layout Name Text box for naming the layout Central Layout Mode Sets the number beds and wave- • 2 Beds x 4 waves each forms per bed that will display • 4 Beds x 2 waves each • 4 beds x 4 waves each • 8 Beds x 2 waves each • 8 Beds x 1 waves each • 16 Beds x 1 waves each 2 Beds x 4 waves each Notes Permits display of note area (page 7-10) OFF Assign... Activates the Assign Bed • Select a bed from the list. screen, which lists all of the beds • Click on Accept. being advertised in the monitoring unit 12 character max. • OFF • ON • After all changes are made on the Central Layouts setup screen, click on Accept to save changes or Undo to keep previous settings. 4-6 Infinity CentralStation VF8 5 Infinity M300 System Setup Overview.........................................................................................................................5-2 Accessing the Telemetry Setup Screens ..............................................................5-2 Changing the System Default Patient Category...................................................5-2 Infinity M300 System Setup Screen .............................................................................5-3 Infinity M300 Patient View Defaults Setup Screen......................................................5-4 Infinity M300 ST Defaults Setup ...................................................................................5-7 Infinity M300 Alarm Limits Defaults Screen ................................................................5-8 Available Functions on the Default Settings - Alarm Limits Screen ..................5-8 Infinity M300 Arrhythmia Defaults Screen.................................................................5-10 Available Functions on the Arrhythmia Screen .................................................5-10 Infinity M300 Find Device............................................................................................5-13 5: Infinity M300 System Setup Overview The Telemetry setup screens allow you to set system defaults for Infinity CentralStation telemetry channels (see page 5-7).These defaults are activated at telemetry patient admission. Accessing the Telemetry Setup Screens Select Telemetry from the Setup drop-down menu. Telemetry Submenu Selections Submenu Selection Password Required Category Selection System... Clinical 5-3 Patient View Defaults Clinical 5-4 ST Defaults (Requires option, page 18-6) Clinical Recorders Clinical Alarm Limits Defaults... Clinical Arrhythmia Defaults... Clinical Find Device Clinical Reference 5-7 5-8 Adult 5-8 Pediatric Adult 5-10 Pediatric 5-13 Changing the System Default Patient Category You can select a system default patient category that is initially used by all telemetry channels using a System screen setting (5-2). The system default patient category setting is Adult. If after making changes you want to return all settings to the defaults, see page 18-4. When you select Alarm Limits Defaults or Arrhythmia Defaults, an additional submenu permits selection of Adult or Pediatric patient category screens. Each of these screens includes the patient category in the screen name. The Alarm Limits Defaults and Arrhythmia Defaults screens have a selection that permits you to quickly change to the alternate category screen (5-8) To configure the patient category for an individual Telemetry patient see page 9-3. 5-2 Infinity CentralStation VF8 Infinity M300 System Setup Screen Infinity M300 System Setup Screen To access the Infinity M300 System Setup screen, see 5-2. System Setup Screen Selections Selection Description Settings Default Alarm Pause Time Determines duration of Alarm PausedTime • 1, 2, 3, 4, 5 min 3 min Alarm Tone Pattern Determines alarm pattern used by the Infinity • Infinity M300 device only. • High Frequency • Low Frequency Infinity Weight Units Sets weight units in Admit screen • kg • lbs lbs Height Units Sets height units in Admit screen • cm • in in Remote Audio Pause Enabled Determines whether or not you can silence • ON alarms for telemetry patients from other • OFF monitors in the monitoring unit When OFF, the Audio Paused button in Bed View is ghosted and the corresponding icon will not appear in the Main Screen during an alarm. ON Remote Control Enabled Determines if you can control telemetry patients’ monitoring at other monitors in the monitoring unit • ON • OFF ON Patient Category Sets default patient category • Adult • Pediatric Adult Pacer Detect Mode Sets pacer detection mode • Basic • Advanced Basic Beds x - x Toggle button for selecting beds 1 - 16 or beds 17 - 32 Label Permits assignment of Bed Labels to each Infinity CentralStation Channel (or patient window) • 7 character max You can select up to 32 bed labels that will identify Infinity CentralStation Main Screen patient windows. Alarm Group Assigns an Alarm Group to each Infinity CentralStation Channel (or patient window) • 3 character max. • Click on Accept or on Undo to return to previous settings. VF8 Infinity CentralStation 5-3 5: Infinity M300 System Setup Infinity M300 Patient View Defaults Setup Screen The Main Screen Default Patient View Setup screen allows you to define systemwide, default, patient-monitoring settings. It is similar to the Bed View Patient View Setup, which allows you to customize a particular patient’s monitoring (page 18-3). The Default Patient View Setup screen for Telemetry patients provides selections to configure SpO2 and ECG monitoring. When you click on the button labeled SpO2, the setup selections for that parameter display. When you click on the button labeled ECG, the setup selections for that parameter display. Patient View Setup Screen Selections Selection Required Action Available Settings Channel Setup Parameter Click in Channel 1 through 6 Parameter column. HR, ARR, ST, SpO2 + PLS, None For 6-wire monitoring 8 channel rows are available. Waveform Click in the Channel’s ‘Waveform column. Gain/Scale Click in the Channel’s ‘Gain/Scale’ column. 0.25, 0.5, 1, 2, 4, 8 mV. ECG QRS Processing Settings Display Scale mV/cm 0.5 0.25 5-4 Gain QRS ≥ 0.5 mV QRS ≥ 0.15 mV Infinity CentralStation • 3-wire mode - I, II, III • 5-wire mode - I, II, III, aVR, aVL, aVF, V • 6-wire mode - I, II, III, aVR, aVL, aVF, V, V+ The Infinity CentralStation uses an AAMI-compliant regular QRS threshold when you select a channel size of 1, 2, 4, or 8 mV/cm. If you select a channel size of 0.25 or 0.5 mV/cm, the Infinity CentralStation lowers the detection threshold, and the AAMI requirement is not met. VF8 Infinity M300 Patient View Defaults Setup Screen Patient View Setup Screen Selections Selection Required Action Available Settings ECG Monitoring Setup QRS Processing Select leads for ECG and ARR monitoring. • ECG1 & ECG2 • ECG1 WA R N I N G ! H i g h a m p l i t u d e ( > 0 . 1 5 m V ) P - a n d T- w a v e s o f l o n g d ur a t i o n m a y r e g i s t e r a s i n t e g r a l Q R S c o m p l e x e s . To e ns u r e t h a t t h e s y s t e m a c c u r a t e l y d e t e c ts l o w h e a r t r a t e i n t h e s e c a s e s , s e l e c t t h e l e a d w i t h t h e h i g h e s t R - w a v e ( r e l a t i v e t o t h e T- a n d / o r P - w a v e ) f o r E C G 1 . I f t h e s y s t e m c o n t i n u e s t o m i s i n t e r p r e t P - o r Tw a v e s , r e p os i t i o n e l e c t r o d e s o r u s e o t h e r m o d a l i t i e s t o m o n i t o r t h e pa t i e n t . ECG 1 ECG 2 Top and second lead assigned to ECG 1 and ECG 2 display ECG Color Assign color of ECG associated wave• Red forms to telemetry channel for an individual • White patient. • Yellow • Green (Default) • Light Blue • Blue • Purple • Orange ECG Lead Wires Select device lead wire mode •3 • 5 (Default) •6 ECG Filter Control the channel bandwidth • Monitor (Default) • OFF A banner displays in the ECG 1 channel if ECG Filter is OFF Pacemaker Detection Set the pacer detection function. • ON (Default) When On, pacer spikes display on a • OFF patient’s waveform whenever a pacemaker • FUSION pulse is detected. The Fusion selection is only available if the Pacer Detect Mode is Advanced (5-3) WA R N I N G ! Sp e c i a l s u r v e i l l a n c e i s n e c e s s a r y f o r pa t i e n ts w it h pa c e m a k e r s w h o a re m o n i t o r e d w i t h P a c e m a k e r D e t e c t i o n s e t t o F us i o n m o d e b e c a u s e m o r e pa c e r s p i k e s m a y r e g i s t e r a s i n t e g ra l Q RS c om p l e x e s . VF8 Infinity CentralStation 5-5 5: Infinity M300 System Setup Patient View Setup Screen Selections Selection Required Action TruST 12-lead: Activate/deactivate TruST monitoring (Selection only appears (page 8-13) when ECG Wire Mode Precordial leads are fixed as V2 and V5. setting is 6 wire and TruST locked option is enabled.) Available Settings • ON • OFF (Default) SpO2 Monitoring Setup SPO2 Monitoring: Enable/disable SpO2 monitoring. • ON • OFF (Default) Selection appears ghosted if an SpO2 option is not available. NOTE: You can only activate SpO2 Monitoring for local telemetry patients. If SpO2 Monitoring is OFF, the parameter box is blank. SpO2 Color Assign color of SpO2 associated wave• Red forms to telemetry channel for an individual • White (Default) patient. • Yellow • Green • Light Blue • Blue • Purple • Orange Averaging Determines how the Infinity M300 calculates the oxygen saturation of the arterial blood and the derived pulse rate Normal: updates the SpO2 value and the derived pulse rate in 30 seconds or less. (Less sensitive to artifact, but slower to alarm.) Fast: updates the SpO2 value and the derived pulse rate in 12 seconds or less. (Quicker to alarm, but more sensitive to artifact.) • Normal (Default) • Fast NOTE: When monitoring most patients, Dräger recommends using the Normal averaging mode. The Fast mode is designed for neonatal patients where fast reporting of oxygen desaturation is of concern. Sensory Type Determines device sensor type • Nellcor • Masimo (Default) • Click on Accept to save changes or Undo to keep previous settings. 5-6 Infinity CentralStation VF8 Infinity M300 ST Defaults Setup Infinity M300 ST Defaults Setup The Default ST Setup screen is similar to the ST Setup screen in Bed View, which allows you to customize a particular patient’s ST monitoring. The Default ST Setup screen allows you to define system-wide ST monitoring default settings, except ST alarm default settings which must be configured in the Setup - Alarm Limits screen (5-8). Also, ST monitoring default settings are for 3- or 5-wire monitoring only. All 6-wire monitoring must be configured at the individual patient’s Bed View ST Setup screen (page 12-9). If ST monitoring is enabled, the default ST Setup settings are activated whenever a telemetry patient is admitted. They can also be activated on a Bed View ST Setup screen that is configured for 3-/5-wire monitoring. For more information on ST monitoring see Chapter 12. ST Setup Screen Selections Selection Description Available Settings Factory Default ST Lead 1 Sets ECG lead vector for ST Lead 1 parameter box • I, II, III, aVF, aVL, I aVR, V, V+, None ST Lead 2 Sets ECG lead vector for ST Lead 2 parameter box II ST Lead 3 Sets ECG lead vector for ST Lead 3 parameter box III ST Lead 4 Sets ECG lead vector for ST Lead 4 parameter box aVR ST Lead 5 Sets ECG lead vector for ST Lead 5 parameter box aVL ST Lead 6 Sets ECG lead vector for ST Lead 6 parameter box aVF ST Lead 7 Sets ECG lead vector for ST Lead 7 parameter box ST Units: Sets units for ST measurements Event Duration Determines how long an ST event has 60 seconds. to remain outside the set ST alarm limit before an alarm sounds • mm • mV ST Measurement Point Determines whether the ST measuring • 60 ms point is 60 or 80 ms after QRS offset • 80 ms mm 60 sec 80 ms • Click on Accept to save changes or Undo to keep previous settings. VF8 Infinity CentralStation 5-7 5: Infinity M300 System Setup Infinity M300 Alarm Limits Defaults Screen The Default Settings - Alarm Limits screen allows you to define system-wide, telemetry alarm default settings. These default settings are activated upon patient admittance or by clicking Restore System Defaults on a particular patient’s Bed View screen (page 12-9). The patient category is part of the screen title, and parameter limits are based on that category (5-9). The Default Settings - Alarm Limits screen is similar to the Setup - Alarm Limits screen in Bed View in which you can customize alarm limits for a particular patient. Available Functions on the Default Settings - Alarm Limits Screen Button/Function Description Arrhythmia Opens Default Settings - Arrhythmia screen (5-10) Parameter alarm limit setup 1.Click on the table row you wish to set up. This activates the configuration mode for that row during which you can set limits within each column. 2.Click on the arrows or toggle button so that the desired setting appears. 3.Click on OK. 4.Repeat steps 1 to 3 for each parameter. →Pediatric... →Adult... 5-8 • Changes the patient category from Adult to Pediatric or vice versa. • Changes all of the parameters and limits to the defaults in the selected patient category. Infinity CentralStation VF8 Infinity M300 Alarm Limits Defaults Screen Alarm Limits Parameter Settings Parameter Heading Adult Default HR Upper Limit Lower Limit Alarm On On On/Off Alarm Archive Rec/Store Rec/Store Rec, Store, Rec/Store, Off Upper Limit 100% 100% 21 - 100% Lower Limit 90% 90% 20 - 99% Alarm On On On/Off Alarm Archive Off Off Rec, Store, Rec/Store, Off Upper Limit 120 beats/min 150 beats/min 35 - 240 beats/min Lower Limit 45 beats/min 50 beats/min 30 - 235 beats/min Alarm Off Off On/Off Alarm Archive Off Off Rec, Store, Rec/Store, Off +2 mm +0.20 mV +2 mm +0.20 mV -14.9 to +15.0 mm -1.49 to +1.5 mV -1mm -0.10 mV -1mm -0.10 mV -15.0 to +14.9 mm -1.5 to +1.49 mV SpO2 PLS ST (I, II, III, aVF, Upper Limit aVL, aVR, V, V+, V1, V2, V3, Lower Limit V4, V5, V6, dV1, dV2, dV3, dV4, dV5, dV6) Alarm STVM STCVM PVC/min VF8 Pediatric Default Setting Range 120 beats/min 150 beats/min 25 - 300 beats/min 45 beats/min 50 beats/min 20 - 295 beats/min Off Off On/Off Alarm Archive Off Off Rec, Store, Rec/Store, Off Upper Limit +2 mm +0.2 mV +2 mm +0.2 mV 0.1 to 45 mm 0.01 to 4.5 mV Lower Limit 0.0 to 44.9 mm 0.0 to 4.49 mV Alarm Archive Off Off Rec, Store, Rec/Store, Off Upper Limit 10 beats/min 10 beats/min 1 - 60 beats/min Alarm Off Off On/Off Alarm Archive Off Off Rec, Store, Rec/Store, Off Infinity CentralStation 5-9 5: Infinity M300 System Setup Infinity M300 Arrhythmia Defaults Screen This screen allows you to define system-wide default settings for arrhythmia event categories. These defaults are passed to the Infinity M300 upon patient admission or by clicking Restore System Defaults on a particular patient’s Bed View screen (page 12-9). The patient category is part of the screen title, and event defaults are based on that category (page 5-11). The Default Settings - Arrhythmia screen is similar to the Setup - Arrhythmia screen in Bed View in which you can customize each event category for a particular patient (page 10-4). Available Functions on the Arrhythmia Screen Button/Function Description/Selection Alarm Limits... Opens Default Settings - Alarm Limits screen Select Arrhythmia event settings 1.Click on the table row of the event you wish to set up. This activates the configuration mode for that row during which you can set limits within each column. 2.Click on the arrows or toggle button so that the desired setting appears. 3.Click on OK. 4.Repeat steps 1 to 3 for each parameter. 5.Click on Accept to save or Undo to cancel changes. Set arrhythmia ‘monitoring mode’ To select the arrhythmia monitoring mode, click on the appropriate radio button. • Off • Basic (Default) • Full In order to set the arrhythmia monitoring mode to Off, you must enter the clinical password in the Password popup. Full arrhythmia monitoring requires that the locked option is enabled. →Pediatric... →Adult... 5-10 • Changes the patient category from Adult to Pediatric or vice versa. • Changes all of the Arrhythmia settings to the defaults in the selected patient category. Infinity CentralStation VF8 Infinity M300 Arrhythmia Defaults Screen Events available for arrhythmia monitoring are determined by the monitoring mode. Mode Available Events Full Full arrhythmia monitoring requires that the locked option is available. ASY, VF, VT, ARTF, RUN, AIVR, CPT, BGM, PAUS, TACH, BRDY, SVT Basic (Default) ASY, VF, VT, ARTF Off Arrhythmia Event Settings Parameter ASY Heading Adult Default Setting Pediatric Default Setting Count Rate VF Alarm Grade LT Alarm/Archive Rec, Rec/Store Count Rate VT ARTF Alarm Grade LT Alarm/Archive Rec, Rec/Store Count 5 - 15 Default: ≥ 10 5 - 15 Default: ≥ 10 Rate 100 - 200 Default: ≥ 120 100 - 200 Default: ≥ 160 Alarm Grade LT (default), SER, ADV, OFF Alarm/Archive Rec, Store, Rec/Store, Off Count Rate RUN VF8 Alarm Grade LT, SER, ADV, OFF (default) Alarm/Archive OFF Count Not adjustable; upper value is VT count - 1. Default: 3 - 4 Rate Not adjustable; same as VT rate. Default: ≥ 120 Alarm Grade LT, SER (default), ADV, OFF Alarm/Archive Rec, Store, Rec/Store, Off Not adjustable; same as VT rate. Default: ≥ 160 Infinity CentralStation 5-11 5: Infinity M300 System Setup Arrhythmia Event Settings Parameter Heading Adult Default Setting AIVR Count Not adjustable. Default: ≥ 3 Rate Not adjustable, upper value is VT rate - 1. Default: < 119 Alarm Grade LT, SER, ADV (default), OFF Alarm/Archive Rec, Store, Rec/Store, Off CPT Pediatric Default Setting Not adjustable, upper value is VT rate - 1. Default: < 159 Count Rate BGM Alarm Grade LT, SER, ADV (default), OFF Alarm/Archive Rec, Store, Rec/Store, Off Count Rate PAUSE TACH BRDY SVT 5-12 Alarm Grade LT, SER, ADV (default), OFF Alarm/Archive Rec, Store, Rec/Store, Off Count Rate 1.0,1.5, 2.0, 2.5 (default), 3.0, 3.5 1.0,1.5, 2.0 (default), 2.5, 3.0, 3.5 Alarm Grade LT, SER, ADV, OFF (default) Alarm/Archive Rec, Store, Rec/Store, Off Count 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15 Default: ≥ 8 Rate 100 - 200 Default: ≥ 130 Alarm Grade LT, SER, ADV, OFF (default) Alarm/Archive Rec, Store, Rec/Store, Off 100 - 200 Default: ≥ 180 Count ≥8bpm Rate 30 - 70 Default: < 50 30 - 105 Default: < 60 Alarm Grade LT, SER, ADV, OFF (default) LT, SER (default), ADV, OFF Alarm/Archive Rec, Store, Rec/Store, Off Count 3, 4, 5, 6, 7, 8, 9, 10 Default: ≥ 3 Rate 120, 130, 140, 150, 160, 170, 180, 190, 200 Default: ≥150 Alarm Grade LT, SER (default), ADV, OFF Alarm/Archive Rec, Store, Rec/Store, Off Infinity CentralStation 120, 130, 140, 150, 160, 170, 180, 190, 200, 210, 220 Default: ≥ 220 VF8 Infinity M300 Find Device Infinity M300 Find Device You can initiate a Find Device tone that will help you locate an Infinity M300 in the event it is misplaced. 1. Select Telemetry from the Main Screen Setup drop-down menu. 2. Select Find Device. Enter the Infinity M300 ID you are trying to find. NOTE: Devices admitted to the Infinity CentralStation will not appear in the list as selections. 3. Click on the device you wish to locate. 4. Click on Locate. The Infinity CentralStation sends a command to the selected Infinity M300 to sound a Find Device tone (2-4). VF8 Infinity CentralStation 5-13 5: Infinity M300 System Setup - This page left blank intentionally - 5-14 Infinity CentralStation VF8 6 Infinity Telemetry System Setup Overview.........................................................................................................................6-2 Accessing the Telemetry Setup Screens ..............................................................6-2 Changing the System Default Patient Category...................................................6-2 Infinity Telemetry System Setup Screen .....................................................................6-3 Infinity Telemetry Patient View Defaults Setup Screen..............................................6-4 Infinity Telemetry ST Defaults Setup ...........................................................................6-7 Infinity Telemetry Recordings Setup Screen ..............................................................6-8 Recordings Setup Screen Functions ....................................................................6-8 Infinity Telemetry Alarm Limits Defaults Screen ........................................................6-9 Available Functions on the Default Settings - Alarm Limits Screen ..................6-9 Infinity Telemetry Arrhythmia Defaults Screen.........................................................6-11 Available Functions on the Arrhythmia Screen .................................................6-11 6: Infinity Telemetry System Setup Overview Set system defaults for Infinity CentralStation telemetry channels using the Telemetry setup screens. These defaults are activated at telemetry patient discharge. Accessing the Telemetry Setup Screens Select Telemetry from the Setup drop-down menu. Telemetry Submenu Selections Submenu Selection Password Required Category Selection System... Clinical 6-3 Patient View Defaults Clinical 6-4 ST Defaults (Requires option, 18-6) Clinical Recordings Clinical Alarm Limits Defaults... Clinical Arrhythmia Defaults... Clinical Reference 6-7 6-8 Adult 6-9 Pediatric Adult 6-11 Pediatric Changing the System Default Patient Category You can select a system default patient category that is initially used by all telemetry channels using a System screen setting (6-3). The system default patient category setting is Adult. If after making changes you want to return all settings to the defaults, see 18-4. When you select Alarm Limits Defaults or Arrhythmia Defaults, an additional submenu permits selection of Adult or Pediatric patient category screens. Each of these screens includes the patient category in the screen name. The Alarm Limits Defaults and Arrhythmia Defaults screens have a selection that permits you to quickly change to the alternate category screen (6-9) To configure the patient category for an individual Telemetry patient see 9-3. 6-2 Infinity CentralStation VF8 Infinity Telemetry System Setup Screen Infinity Telemetry System Setup Screen To access the Telemetry System Setup screen, see 6-2. System Setup Screen Selections Selection Description Settings Default Alarm Paused Time Determines duration of Alarm PausedTime • 1, 2, 3, 4, 5 min • Disable • No Time Out 3 min Weight Units Sets weight units in Admit screen • kg • lbs lbs Height Units Sets height units in Admit screen • cm • in in Remote Audio Determines whether or not you can silence • ON Paused Enabled alarms for telemetry patients from other • OFF monitors in the monitoring unit When OFF, the Audio Paused button in Bed View is ghosted and the corresponding icon will not appear in the Main Screen during an alarm. ON Remote Control Enabled Determines if you can control telemetry patients’ monitoring at other monitors in the monitoring unit • ON • OFF ON Default Patient Category Sets default patient category • Adult • Pediatric Adult Pacer Detect Mode Sets pacer detection mode • Basic • Advanced Basic Bed Label Permits assignment of Bed Labels to each Infinity CentralStation Channel (or patient window) • 7 character max You can select up to 32 bed labels that will identify Infinity CentralStation Main Screen patient windows. Alarm Group Assigns an Alarm Group to each Infinity CentralStation Channel (or patient window) • 3 character max. • Click on Accept or on Undo to return to previous settings. VF8 Infinity CentralStation 6-3 6: Infinity Telemetry System Setup Infinity Telemetry Patient View Defaults Setup Screen If a password is required to access this screen, see 4-2. The Main Screen Default Patient View Setup screen allows you to define systemwide, default, patient-monitoring settings. It is similar to the Patient View Setup screen in Bed View, which allows you to customize a particular patient’s monitoring. See page 8-3 for a detailed description of the Bed View Patient View Setup screen. Patient View Setup Screen Selections Selection Required Action Available Settings Channel Setup Parameter Click in the Channel’s Parameter column. Depends on monitoring selections Waveform Click in the Channel’s Waveform column. • 3-wire mode - II • 5-wire mode - I, II, III, aVR, aVL, aVF, V Monitoring Setup QRS Processing Select leads for ECG and ARR monitoring. • ECG1 & ECG2 • ECG1 WA R N I N G ! Hi g h a m p l i t u d e ( > 0 . 1 5 m V ) P - a n d T- w a v e s o f l o ng du ra t i o n ma y r e g i s t e r a s i n t e g r a l Q R S c o m p le x e s . S o t h a t t he s y s t e m a c c u r a t e l y d e t e c ts l o w h e a r t r a t e i n t h e s e cases, select the lead with the highest R-wave (relative to t h e T- a n d / o r P - w a v e ) f o r E C G 1 . I f t h e s y s t e m c o n t i n u e s t o m i s i n t e r p r e t P - o r T- w a v e s , r e p o s i t i o n e l e c t r o d e s o r u s e o t h e r m o d a l i t i e s t o m o n i t o r t h e pa t i e n t . Gain/Scale Click in the Channel’s Gain/Scale column. ECG QRS Processing Settings Display Scale mV/cm 0.5 0.25 6-4 Gain QRS ≥ 0.5 mV QRS ≥ 0.15 mV Infinity CentralStation 0.25, 0.5, 1, 2, 4, 8 mV. The Infinity CentralStation uses an AAMI-compliant regular QRS threshold when you select a channel size of 1, 2, 4, or 8 mV/cm. If you select a channel size of 0.25 or 0.5 mV/cm, the Infinity CentralStation lowers the detection threshold, and the AAMI requirement is not met. VF8 Infinity Telemetry Patient View Defaults Setup Screen Patient View Setup Screen Selections Selection Required Action Available Settings Parameter Color Assign system-wide color of SPO2, NIBP, • Red and ECG associated waveforms to teleme- • White try channels. • Yellow • Green (Default) • Light Blue • Blue • Purple • Orange Pacemaker Detection Set the pacer detection function. • ON When ON, pacer spikes display on a • OFF patient’s waveform whenever a pacemaker • FUSION pulse is detected. WA R N I N G ! When Pacemaker Detection is set on Fusion mode pa c e r s p i k e s m a y r e g i s t e r a s i n t e g ra l Q R S c o m p l e x e s . Sp e c i a l s u r v e i l l a n c e i s n e c e s s a r y f o r pa t i e n ts w i t h pa c e m a k e r s w h o a re m o n i t o r e d w i t h this mode enabled. VF8 F u s i o n m o d e pa c e r d e t e c t i o n i s n o t i n t e n d e d f o r u s e w i t h l a r g e - v o l ta g e , u ni p o l a r pa c e m a k e r s . I t i s i n t e n d e d f o r u s e o n l y w i t h b i p h a s i c pa c e m a k e r s . Please observe the following: B e f o r e s e l e c t i n g F us i o n m o d e b e c e r ta i n t h a t t h e pa t i e n t h a s a b i p ha s i c pa c e m a k e r ( e x t e r n a l o r implanted) and that it is accurately programmed as a p p ro p r i a t e f o r t ha t pa t i e n t . D o n ot s e l e c t F u s io n m o d e i f y o u a r e n o t c e r ta i n w h a t t y p e o f pa c e m a k e r i s i n u s e , o r h o w i t i s programmed. S e l e c t P a c e r F u s i o n m o d e o nl y t o s up pr e s s r e p e a t e d f a l s e a s y s t o l e a n d / o r f a l s e l o w h e a r t r a t e a l a rm s . S e l e c t i o n o f F u s i o n m o d e m a y i n c r e a s e t he r i s k o f f a l s e l y c o u n t i n g pa c e r s p i k e s a s Q R S c o m p l e x e s , and may cause cardiac arrest to be undetected. T h e r e f o r e , s p e c i a l s u r v ei l l a n c e o f a n y pa c e m a k e r pa t i e n t m o n i t o r e d w i t h t h i s m o d e i s s t r o n g l y re c o m m e n d e d . Infinity CentralStation 6-5 6: Infinity Telemetry System Setup Patient View Setup Screen Selections Selection Required Action Available Settings NOTE: Display the lead with the least interference and the highest R-wave in the patient’s waveform channel 1. Verify that the HR calculation is accurate in comparison to the ECG waveform. SPO2 Monitoring Verify that the ♥P symbol is displayed for each paced beat. Enable/disable SpO2 monitoring. • ON • OFF NOTE: This selection is only available for local telemetry patients. If SpO2 Monitoring is OFF, SpO2 and PLS parameter boxes are blank. • Click on Accept to save changes or Undo to keep previous information. 6-6 Infinity CentralStation VF8 Infinity Telemetry ST Defaults Setup Infinity Telemetry ST Defaults Setup The Default ST Setup screen is similar to the ST Setup screen in Bed View, which allows you to customize a particular patient’s ST monitoring. The Default ST Setup screen allows you to define system-wide ST monitoring default settings, except ST alarm default settings which must be configured in the Setup - Alarm Limits screen (6-9). Also, ST monitoring default settings are for 3- or 5-wire monitoring only. All 6-wire monitoring must be configured at the individual patient’s Bed View ST Setup screen (12-9). The default ST Setup settings are activated whenever a telemetry patient is discharged. They can also be activated on a Bed View ST Setup screen that is configured for 3-/5-wire monitoring. For more information on ST monitoring see Chapter12. ST Setup Screen Selections Selection Description Available Settings Factory Default ST Lead 1 Sets ECG lead vector for ST Lead 1 parameter box • I, II, III, aVF, aVL, I aVR, V, V+, None ST Lead 2 Sets ECG lead vector for ST Lead 2 parameter box II ST Lead 3 Sets ECG lead vector for ST Lead 3 parameter box III ST Lead 4 Sets ECG lead vector for ST Lead 4 parameter box aVR ST Lead 5 Sets ECG lead vector for ST Lead 5 parameter box aVL ST Lead 6 Sets ECG lead vector for ST Lead 6 parameter box aVF ST Lead 7 Sets ECG lead vector for ST Lead 7 parameter box ST Units: Sets units for ST measurements Event Duration Determines how long an ST event has • 15, 30, 45, 60 75, 60 sec to remain outside the set ST alarm limit 90, 105, 120 before an alarm sounds seconds • mm • mV ST Measurement Point Determines whether the ST measuring • 60 ms point is 60 or 80 ms after QRS offset • 80 ms mm 80 ms • Click on Accept to save changes or Undo to keep previous settings. VF8 Infinity CentralStation 6-7 6: Infinity Telemetry System Setup Infinity Telemetry Recordings Setup Screen If a password is required to access this screen, see 4-2. Recordings Setup Screen Functions Use the Recordings Setup screen to set various telemetry-specific recording properties, independent of the basic Infinity CentralStation recorder settings. Recordings Setup Screen Selections Selection Description Available Settings Default Waveform Selection: Determines whether waveforms to be printed are selected automatically or manually • Auto - Automatically selects topmost displayed waveform for printing • Manual - Prints selected Waveform 1 and 2 Auto Waveform 1: Selects top waveform for R 50 recording • I, II, III, aVF, aVL, aVR, V II Waveform 2: Selects second waveform for R 50 recording Alarm Condition Waveform: Determines if pre-event data is included in an alarm recording If you choose OFF, the recording consists of real-time data only. • ON • OFF ON • Click on Accept to save or Undo to return to the previous settings. 6-8 Infinity CentralStation VF8 Infinity Telemetry Alarm Limits Defaults Screen Infinity Telemetry Alarm Limits Defaults Screen Use the Default Settings - Alarm Limits screen to define system-wide, telemetry alarm default settings. These default settings are activated at telemetry patient discharge or by clicking Restore System Defaults on a particular patient’s Bed View screen (13-10). The patient category is part of the screen title, and parameter limits are based on that category (6-10). The Default Settings - Alarm Limits screen is similar to the Setup - Alarm Limits screen in Bed View in which you can customize alarm limits for a particular patient. Available Functions on the Default Settings - Alarm Limits Screen Button/Function Description Arrhythmia Opens Default Settings - Arrhythmia screen (6-11) Parameter alarm limit setup 1.Click on the table row you wish to set up. This activates the configuration mode for that row during which you can set limits within each column. 2.Click on the arrows or toggle button so that the desired setting appears. 3.Click on OK. 4.Repeat steps 1 to 3 for each parameter. →Pediatric... →Adult... VF8 • Changes the patient category from Adult to Pediatric or vice versa. • Changes all of the parameters and limits to the defaults in the selected patient category. Infinity CentralStation 6-9 6: Infinity Telemetry System Setup Alarm Limits Parameter Settings Parameter Heading Adult Default HR Upper Limit Lower Limit Alarm On On On/Off Alarm Archive Rec/Store Rec/Store Rec, Store, Rec/Store, Off Upper Limit 100% 100% 21 - 100% Lower Limit 90% 90% 20 - 99% Alarm On On On/Off Alarm Archive Off Off Rec, Store, Rec/Store, Off Upper Limit 120 beats/min 150 beats/min 35 - 240 beats/min Lower Limit 45 beats/min 50 beats/min 30 - 235 beats/min Alarm Off Off On/Off Alarm Archive Off Off Rec, Store, Rec/Store, Off +2 mm +0.20 mV +2 mm +0.20 mV -14.9 to +15.0 mm -1.49 to +1.5 mV -1mm -0.10 mV -1mm -0.10 mV -15.0 to +14.9 mm -1.5 to +1.49 mV SpO2 PLS ST (I, II, III, aVF, Upper Limit aVL, aVR, V, V+, V1, V2, V3, Lower Limit V4, V5, V6, dV1, dV2, dV3, dV4, dV5, dV6) Alarm STVM STCVM PVC/min Pediatric Default Setting Range 120 beats/min 150 beats/min 25 - 300 beats/min 45 beats/min 50 beats/min 20 - 295 beats/min Off Off On/Off Alarm Archive Off Off Rec, Store, Rec/Store, Off Upper Limit +2 mm +0.2 mV +2 mm +0.2 mV 0.1 to 45 mm 0.01 to 4.5 mV Lower Limit 0.0 to 44.9 mm 0.0 to 4.49 mV Alarm Archive Off Off Rec, Store, Rec/Store, Off Upper Limit 10 beats/min 10 beats/min 1 - 60 beats/min Alarm Off Off On/Off Alarm Archive Off Off Rec, Store, Rec/Store, Off NOTE: NBP alarm limits must be set up at the bedside monitor. For details see the bedside monitor Instructions for Use. 6-10 Infinity CentralStation VF8 Infinity Telemetry Arrhythmia Defaults Screen Infinity Telemetry Arrhythmia Defaults Screen This screen allows you to define system-wide default settings for arrhythmia event categories. These defaults are activated at telemetry patient discharge or by clicking Restore System Defaults on a particular patient’s Bed View screen (10-4). The patient category is part of the screen title, and event defaults are based on that category (6-12). The Default Settings - Arrhythmia screen is similar to the Setup - Arrhythmia screen in Bed View in which you can customize each event category for a particular patient (10-4). Available Functions on the Arrhythmia Screen Button/Function Description/Selection Alarm Limits... Opens Default Settings - Alarm Limits screen Select Arrhythmia event settings 1.Click on the table row of the event you wish to set up. This activates the configuration mode for that row during which you can set limits within each column. 2.Click on the arrows or toggle button so that the desired setting appears. 3.Click on OK. 4.Repeat steps 1 to 3 for each parameter. 5.Click on Accept to save or Undo to cancel changes. Set arrhythmia ‘monitoring mode’ To select the arrhythmia monitoring mode, click on the appropriate radio button. • Off • Basic (Default) • Full In order to set the arrhythmia monitoring mode to Off, you must enter the clinical password in the Password popup. →Pediatric... →Adult... VF8 • Changes the patient category from Adult to Pediatric or vice versa. • Changes all of the Arrhythmia settings to the defaults in the selected patient category. Infinity CentralStation 6-11 6: Infinity Telemetry System Setup Events available for arrhythmia monitoring are determined by the monitoring mode. Mode Available Events Full ASY, VF, VT, ARTF, RUN, AIVR, CPT, BGM, PAUS, TACH, BRDY, SVT Basic (Default) ASY, VF, ARTF, VT Off Arrhythmia Event Settings Parameter ASY Heading Adult Default Setting Pediatric Default Setting Count Rate VF Alarm Grade LT Alarm/Archive Rec, Rec/Store Count Rate VT ARTF Alarm Grade LT Alarm/Archive Rec, Rec/Store Count 5 - 15 Default: ≥ 10 5 - 15 Default: ≥ 10 Rate 100 - 200 Default: ≥ 120 100 - 200 Default: ≥ 160 Alarm Grade LT (default), SER, ADV, OFF Alarm/Archive Rec, Store, Rec/Store, Off Count Rate RUN 6-12 Alarm Grade LT, SER, ADV, OFF (default) Alarm/Archive OFF Count Not adjustable; upper value is VT count - 1. Default: 3 - 4 Rate Not adjustable; same as VT rate. Default: ≥ 120 Alarm Grade LT, SER (default), ADV, OFF Alarm/Archive Rec, Store, Rec/Store, Off Infinity CentralStation Not adjustable; same as VT rate. Default: ≥ 160 VF8 Infinity Telemetry Arrhythmia Defaults Screen Arrhythmia Event Settings Parameter Heading Adult Default Setting AIVR Count Not adjustable. Default: ≥ 3 Rate Not adjustable, upper value is VT rate - 1. Default: < 119 Alarm Grade LT, SER, ADV (default), OFF Alarm/Archive Rec, Store, Rec/Store, Off CPT Pediatric Default Setting Not adjustable, upper value is VT rate - 1. Default: < 159 Count Rate BGM Alarm Grade LT, SER, ADV (default), OFF Alarm/Archive Rec, Store, Rec/Store, Off Count Rate PAUSE TACH BRDY SVT VF8 Alarm Grade LT, SER, ADV (default), OFF Alarm/Archive Rec, Store, Rec/Store, Off Count Rate 1.0,1.5, 2.0, 2.5 (default), 3.0, 3.5 1.0,1.5, 2.0 (default), 2.5, 3.0, 3.5 Alarm Grade LT, SER, ADV, OFF (default) Alarm/Archive Rec, Store, Rec/Store, Off Count 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15 Default: ≥ 8 Rate 100 - 200 Default: ≥ 130 Alarm Grade LT, SER, ADV, OFF (default) Alarm/Archive Rec, Store, Rec/Store, Off 100 - 200 Default: ≥ 180 Count Rate 30 - 70 Default: < 50 30 - 105 Default: < 60 Alarm Grade LT, SER, ADV, OFF (default) LT, SER (default), ADV, OFF Alarm/Archive Rec, Store, Rec/Store, Off Count 3, 4, 5, 6, 7, 8, 9, 10 Default: ≥ 3 Rate 120, 130, 140, 150, 160, 170, 180, 190, 200 Default: ≥150 Alarm Grade LT, SER (default), ADV, OFF Alarm/Archive Rec, Store, Rec/Store, Off 120, 130, 140, 150, 160, 170, 180, 190, 200, 210, 220 Default: ≥ 220 Infinity CentralStation 6-13 6: Infinity Telemetry System Setup - This page left blank intentionally - 6-14 Infinity CentralStation VF8 7 Main Screen Overview.........................................................................................................................7-2 Main Screen Layout.......................................................................................................7-2 Split vs. Full Main Screen .............................................................................................7-2 Selecting a Main Screen Layout ............................................................................7-3 Main Screen Setup........................................................................................................7-3 Menu Bar..................................................................................................................7-3 Waveform Area ........................................................................................................7-4 Stopping Waveforms ..............................................................................................7-7 Waveform Color ......................................................................................................7-7 Telemetry Waveform Dropout Display (Infinity Telemetry only).........................7-7 Parameter Areas......................................................................................................7-7 Notes Area .............................................................................................................7-10 Status Area ............................................................................................................7-11 Manual Waveform Configuration Mode .....................................................................7-12 Main Screen Status Area Messages ..........................................................................7-13 7: Main Screen Overview The Infinity CentralStation Main Screen displays waveforms, parameters, status messages, banners, and alarm messages for telemetry and bedside patients on the Infinity Network. It can be configured in various central layouts. Main Screen Layout The Infinity CentralStation displays monitoring data for patients who are assigned to a window of the current Main Screen. The Main Screen layout can be customized with the Setup Central Layout screen (page 4-6). For a description of screen layouts see page 7-3. Split vs. Full Main Screen The following table shows how much patient data can be visible in the Split and Full Main Screen layouts. If the NOTES feature (page 7-10) is enabled (page 4-6), less waveform data displays. Main Screen Layout 7-2 Split Screen Full Screen Amount of Waveform Data (approximate) 2x4 Yes 8 - 10 seconds 4x2 Yes 8 - 10 seconds 8x1 Yes 8 - 10 seconds 4x4 Yes 4 seconds 8x2 Yes 4 seconds 16 x 1 Yes 4 seconds Infinity CentralStation VF8 Main Screen Setup Selecting a Main Screen Layout 1. Click on View in the Main Screen menu bar. 2. Click on the Central Layout menu selection. A submenu with available Main Screen layout selections appears. 3. Click on the desired layout. A popup window displays. 4. Click on Yes in the popup to select the new layout or on No to exit the menu and keep the current layout. Main Screen Setup Menu Bar Selection Allows you to... VIEW • access Full/Event Disclosure applications (Chapter 16) SETUP • configure Infinity CentralStation monitoring • configure Main Screen layouts (page 4-6) • access Telemetry setup menus (Chapter 5) BIOMED • • • • HELP • open the Infinity CentralStation Instructions for Use on the screen (Chapter 1) Alarm Silence • silence active alarms at the Infinity CentralStation for one minute VF8 observe the status of all devices on the network configure the Infinity CentralStation and telemetry receivers enable options access the system console Infinity CentralStation 7-3 7: Main Screen Waveform Area Depending on the selected Main Screen layout, each patient window may have up to four waveforms. All patient waveforms are updated from left to right. In addition to parameter waveforms, the patient window includes other information. Infinity CentralStation Patient Window 7-4 Manual configuration mode, telemetry, or wireless monitor icon (page 7-6) Keys that generate manual Timed or Continuous recordings (page 14-5) Bed Label (for Infinity M300 or Infinity Telemetry Bed Label is followed by device ID) MIB Ventilator Alarm Icon area Patient Name Area reserved for ventilator alarm messages Bedside alarm, banner, status, standby, or discharge message area Location for the following: • “WAVE PAUSED” message • “STANDBY“ message Icons from bedside monitors 10 Lead Label and Scale Infinity CentralStation VF8 Main Screen Setup Banner and Status Messages Banner Telemetryspecific Monitorspecific Appearance Description Alarm Paused Yes Yes All Alarms OFF Yes Yes Black text/yellow background Patient’s alarm function is disabled Yes Yes HR Limits OFF Yes Yes HR, ASY, VF OFF Yes Yes Bed Disconnected No Yes Black text/white background Bedside monitor disconnected for patient transport Bedside Offline Yes Yes Yellow text Network communication interrupted CODE 2 No Yes Black text /red background Code fixed key was pressed at bedside monitor Discharged Yes Yes Black text/white background Patient discharged or transferred at bedside monitor Duplicate Address No Yes Yellow text CPS/IDS detects a duplicate address on network Offline No Yes Yellow text Network communication interrupted Pacer Fusion Yes Yes Black text/white background Pacemaker Fusion mode activated for local telemetry patient Pacer Off Yes Yes Black text/white background Pacemaker detection activated Pacer On Yes Yes Black text/white background Pacer detection activated Pacer On/Fusion Yes Yes Black text/white background Pacemaker Fusion mode activated for a remote bed that cannot distinguish between On and Fusion modes STANDBY3 Yes Yes Black text/white background Patient monitor in STANDBY mode HR Alarms OFF1 If an alarm occurs while this banner is displayed, the alarm message replaces the banner during the alarm. 2 If a code condition is activated at the bedside during an alarm, the banner, CODE, replaces the alarm message. 3 When a patient monitor is put into STANDBY mode, only the patient name and bed label displays. When a telemetry patient is put in to standby mode the ecg waveform continues to display along with patient name, lead labels and scales. A selectable standby label also displays (page 8-8). For both bedside and telemetry patients the framed message STANDBY displays prominently over the center of the top waveform area. VF8 Infinity CentralStation 7-5 7: Main Screen Icons Icon Location Description Audio Paused Upper right corner of top waveform channel Appears when the patient has an active nonsilenced alarm or a latching alarm message (a message corresponding to an alarm whose condition is no longer valid but that has not yet been acknowledged). Click on icon to clear a latching alarm message or silence the current alarm for 1 minute (for a telemetry patient the alarm is silenced at the central station; for a bedside patient it is silenced at the bedside monitor and at the central station). The icon only appears if the Audio Paused function is enabled for bedside patients (page 4-3) or the Remote Silence function is enabled for telemetry patients (page 5-3). All Alarms OFF Next to parameter value Alarm Volume Upper right corner of patient’s Zero top waveform channel MIB Alarm Tone in yellow Off Lower right corner of patient’s top waveform channel in orange Appears in place of alarm limits when the parameter’s alarms are disabled Appears if the alarm tone is disabled at the bedside monitor Appears when you click on the MIB Alarm Tone icon MIB Alarm Tone Lower right corner of patient’s ON top waveform channel Appears in a patient’s top waveform channel in Main Screen when the MIB alarm tone is enabled Telemetry Left of bed label Identifies a telemetry patient Manual Configuration Mode Left of bed label Identifies that the waveform configuration mode is active for the bedside patient Wireless Bed Left of bed label Identifies a patient being monitored by a wireless monitor Selected event Upper right of Event Disclosure Review Screen When checked, denotes event for inclusion in Shift Report Markers Pacer spikes for all leads are blue (they start at the detection point in the waveform and end at the ECG scale bar height). Breath detection spikes for impedance respiration display as white lines vertically centered on the waveform at detection point and extend 1 cm. 7-6 Infinity CentralStation VF8 Main Screen Setup Stopping Waveforms You can stop all patient waveforms by clicking anywhere in the waveform area. Stopping a patient’s waveforms in Main Screen does not stop them in Bed View. Stopping waveforms has the following effect: The banner WAVE(S) PAUSED displays below the topmost waveform. The CONT and REC buttons appear ‘ghosted’ in the parameter area and you cannot request a manual recording. You can request a print screen, however. Parameter values and banners continue to be updated and the Bed Silence icon and alarm message display in case of alarm. To restart the waveforms, click inside the waveform area again. All previously displayed waveforms erase and are replaced by new waveforms. Waveform Color The Infinity CentralStation supports the display of all real time and stored waveforms and parameter values using the bedside currently selected colors or telemetry system default settings. For information about changing waveform color at a bedside monitor, see the monitor’s Instructions for Use. For information about changing waveform color for a specific telemetry patient, see page 8-9. Telemetry Waveform Dropout Display (Infinity Telemetry only) You can choose to display a dropout on a telemetry waveform in a clearly identifiable negative Square-wave configuration to indicate a non-physiological event should RFdropouts occur when using Infinity Telemetry. Square-wave display must be configured via a system Biomed setting during installation. Parameter Areas The parameter areas to the right of each waveform may consist of several parameter fields. The parameter areas allow you to access each patient’s Bed View (Chapter 8). If the patient is in alarm, the background of the respective parameter area on the Infinity CentralStation flashes in the color associated with the highest grade alarm for that bed. VF8 Infinity CentralStation 7-7 7: Main Screen A parameter area appears blank if no parameter data is available for a displayed patient due to one of the following conditions: patient monitor is in Standby or the patient was discharged, monitor was disconnected for patient transport, monitor/transmitter stopped communicating with network. NOTE: The parameter area does not flash or change color during Offline, Bedside Offline, or Duplicate Address conditions. 1 Generates a timed recording 4 Secondary parameter labels 2 Displays alarms off icon when alarms are turned off, or alarm limits when alarms are turned on 5 Primary parameter label 3 Secondary parameter values 6 Generates a continuous recording NOTE: Parameter units are only displayed if they appear at the bedside monitor. For telemetry patients, units always appear. 7-8 Infinity CentralStation VF8 Main Screen Setup Primary Vs. Secondary Parameters The Infinity CentralStation displays primary and secondary parameters. The primary parameter has an associated waveform displayed in the waveform area, but secondary parameters do not. The number of a patient’s displayed primary and secondary parameters depends on the selected Main Screen layout. Layout Primary Secondary 16 x 1 One up to two Two up to four Four up to eight 8x1 8x2 4x2 4x4 2x4 Each parameter field may contain: one single-valued primary parameter and up to two secondary parameters, or one multi-valued parameter set (e.g. pressures) The Primary Parameter is distinguished by its size. The Primary Parameter value(s) and the label are the color of the associated waveform. If the Primary Parameter has no waveform displayed, the values and the label appear white. Up to two Secondary Parameters, not associated with waveforms, can be displayed per Primary Parameter. Secondary Parameters are white and appear smaller. Secondary Parameters consisting of triple-valued pressures are displayed in a single row, in the format SYS/DIA (MEAN). Allocation of Parameters - Bedside Monitors The bedside monitors determine how parameters are allocated to the parameter areas of the Infinity CentralStation. If more parameter slots are available than parameters to fill them, the fields that are not allocated are blank. If no parameters are available for a bed assigned to Main Screen because the monitor is in “Standby” mode, the patient has been discharged, or the monitor has been removed for transport, the entire waveform and parameter area for that bed appears blank. A message banner in the waveform area explains the reason for the absence of data. Delta/Delta XL/Kappa/GammaX XL parameters are assigned in descending order. The top waveform/parameter of the bedside monitor becomes the first Primary VF8 Infinity CentralStation 7-9 7: Main Screen Parameter/waveform at the Infinity CentralStation. Parameters continue to be assigned in consecutive order (Primary Parameters first, then Secondary Parameters) from the bedside to available parameter fields at the Infinity CentralStation. The Infinity CentralStation supports two icons specific to these monitors. The symbol in the parameter box alerts users that the O2 lower alarm limit has been set to a value less than 21% at the MultiGas Module. Parameters that originate from devices that are not part of the Infinity Network, such as MIB devices, and duplicate parameters originating at the Delta/Delta XL/Kappa/GammaX XL are marked with an asterisk. The same is true when parameters are derived from two different sources within the Infinity Network (such as the monitor and a connected pod). If the next parameter box at the bedside monitor consists of a “set” of parameter values for ST or the MIB device, only the topmost parameter value will be used as a Secondary Parameter. NOTE: If a single-value Primary Parameter has minor parameter(s) associated with it (e.g., SpO2 has PLS as a minor parameter), the Infinity CentralStation designates these minor parameter(s) as secondary. Gamma/Gamma XL/Vista monitor parameters are assigned using the top waveform and corresponding parameter as the first primary waveform/parameter at the Infinity CentralStation. The second waveform and associated parameter fill the next Primary/ Secondary fields. The remaining parameters are assigned top-to-bottom, left-to-right, from the bedside parameter boxes to available parameter fields at the Infinity CentralStation. Allocation of Parameters - Telemetry Channels The waveforms selected on the system Patient View Setup screen (Chapter 5) determine the display order of parameters and waveforms in Main Screen. Any changes in the waveform and parameter assignments in Bed View are automatically reflected in Main Screen. Notes Area If the NOTES function is enabled (page 4-6), an area for entering patient notes displays before each patient window. Notes are only stored locally at the Infinity CentralStation, they are not stored at the bedside monitor. Stored notes are deleted when you: 7-10 reconnect any bedside monitor to that network location, discharge the patient, remove the patient from Main Screen, or Infinity CentralStation VF8 Main Screen Setup select a Main Screen layout that does not include the patient. The size of the notes area is relative to the number of waveforms in a waveform area. Each notes area can accommodate up to 300 text characters and has a scroll bar if necessary. Status Area The status area is located along the bottom of the screen. Alarm/Status Messages These messages may originate from the Infinity CentralStation, network recorders, or bedside monitors. With Dual Display, the status messages appear on both displays. Some status messages appear only briefly and indicate a one-time occurrence. Others appear for as long as the cause for the message exists. Host Label Identifies the Infinity CentralStation Time and Date Surveillance alarm messages (page 13-5) overwrite the date/time field VF8 Infinity CentralStation 7-11 7: Main Screen Manual Waveform Configuration Mode With Manual waveform configuration mode you can choose different waveforms (not parameters) for a bedside patient in Main Screen. NOTE: Once you configure a bedside patient’s waveform setup via the manual configuration mode, the new setup remains intact for that channel even if you discharge the patient and admit a different one to that channel. For a new patient you can manually change waveforms again or switch to ‘Automatic’ mode. 1. Move the mouse over the patient’s waveform channel. 2. Press the right mouse button. The Waveform Configuration popup displays. 3. Click on the Manual radio button. 4. Click on the option button next to the desired channel. A list of available waveforms appears. 5. Set the desired waveform. 6. Repeat steps 3 and 4 for additional channels. NOTE: The waveform scale information displayed underneath the manual waveform popup is not redrawn after the popup is closed. However, this does not affect the waveform or patient monitoring. To completely redraw the waveform and associated scale, click the left mouse button twice. 7. When you are finished, click on Accept to keep the changes or Cancel to return to previous settings. 7-12 Infinity CentralStation VF8 Main Screen Status Area Messages Main Screen Status Area Messages The following table lists possible status messages that may display in the Main Screen status area. For recorder-specific status messages, see Chapter 14. Device/Network Status Messages Status Message Tone Description Central Offline Serious Infinity CentralStation is not communicating with network due to incorrect configuration information. Reverting to Default Settings for yyy Data Serious Error during a setup file read operation Recorder Setup Data Not Saved Central Setup Data Not Saved Central Configuration Data not Saved Locked Options Data Not Saved Serious Error during a setup file write operation. The file will be created at the next restart. Central Configuration Incomplete Serious All labels identifying Infinity CentralStation are not entered. Standalone Attention The patient is not connected to the network. Remote Control Failed Attention Remote control action failed for named device. Notes Access Error Attention Notes cannot be accessed. Central Duplicate Address Serious Infinity CentralStation has same address as another network device. File Access Error Attention File cannot be accessed. Data Export Finished Attention The data has arrived at the MegaCare system. Waveform Export Completed none The data was sent to the third party device. Waveform Export Failed Attention The data export to the third party device failed. Hardware Watchdog Failure none Watchdog timer failure during start-up. Call the Hospital Biomedical Engineering Dept. No Bed Assigned Attention No bed has been assigned to the selected parameter area in Main Screen. Select the correct parameter area or assign a patient to the available slot. stands for the device/host label; yyy stands for the specific setup data file. VF8 Infinity CentralStation 7-13 7: Main Screen Device/Network Status Messages Status Message Tone Description Copy Logs Started none The copying of the logs has started. Copy Logs Formatting Disk none The disk is being formatted. Copy Logs Failed Advisory The logs could not be copied. Try to copy the logs again (page 18-10). Patient Not found in HIS/CIS none There was no HIS/ CIS data available for the patient. Check if you have selected the right patient. Too Many Beds in this Monitoring Unit none You have tried to add more than 32 beds to this monitoring unit. You cannot add any new patients to this monitoring unit until you delete some (maximum number is 32 patients). Param (YYY) not found none The selected parameter is not detected. Make sure the necessary hardware is connected correctly. Wait until procedure is finished. stands for the device/host label; yyy stands for the specific setup data file. 7-14 Infinity CentralStation VF8 8 Patient Setup - Bed View General Bed View Setup ...............................................................................................8-2 Accessing a Patient’s Bed View Screen......................................................................8-3 Bed View Screen Layout ...............................................................................................8-3 Waveform Assignment ...........................................................................................8-3 Bed View Menu Bar.................................................................................................8-4 Bed View Submenu Selections ..............................................................................8-5 Information Area .....................................................................................................8-6 Waveform Area ........................................................................................................8-7 Putting Monitoring Into Standby Mode .................................................................8-7 Parameter Areas in Bed View .......................................................................................8-9 Bed View Screen Display ............................................................................................8-10 Selecting the Bed View .........................................................................................8-10 Bed View Review Screens ..........................................................................................8-10 Alarm Limits and Arrhythmia Setup ..........................................................................8-11 Configuring Alarm Limits .....................................................................................8-11 Configuring Arrhythmia Setup.............................................................................8-11 Telemetry Setup Screens............................................................................................8-12 Accessing the Telemetry Setup Screens ............................................................8-12 Infinity TruST 12-Lead Monitoring Option.................................................................8-13 Use of TruST Reference ECG...............................................................................8-13 Patient View Setup Chest Lead Selection...........................................................8-14 8: Patient Setup - Bed View General Bed View Setup In Bed View you can: remotely view a patient’s monitor, remotely view a bedside patient’s ventilation data (with VentCentral option), print the Bed View screen, and print a simultaneous ECG Report (14-11). The Bed View screen constantly updates patient data, immediately reflecting changes in configuration or signal availability from the patient monitor. You can configure a bedside patient’s setup at the Infinity CentralStation and override bedside monitor setup when the bedside monitor is configured appropriately and the Infinity CentralStation Bed Control Enable feature is On (4-3). NOTE: For bedside monitor configuration instructions, refer to the monitor Instructions for Use. Available Infinity CentralStation functions differ depending on whether a patient is local or remote to the Infinity CentralStation Monitoring Unit. Function WITHIN OUTSIDE monitoring unit monitoring unit Relearn ECG Yes Request timed recording Yes Silence alarm Yes Set up alarm limits Yes Set up arrhythmia events Yes Admit patient Yes Edit patient demographic information Yes ST Setup and measuring points Yes VentCentral review (bedside monitor patients) Yes Yes Bed View Print screen request Yes Yes Bed View Print Simultaneous ECG Report request Yes Yes Stop waveforms Yes Yes Review trend graphs and tables Yes Yes Review alarm limits Yes Yes Review arrhythmia event setup Yes Yes Review patient’s demographic information Yes Yes Review Full/Event Disclosure Data (with Client option) Yes Yes Request reports Yes Yes 8-2 Infinity CentralStation VF8 Accessing a Patient’s Bed View Screen Accessing a Patient’s Bed View Screen Viewing a Patient Displayed in Main Screen Click on the patient’s parameter area in the Main Screen patient window. When the Bed View screen opens, the last viewed screen mode will display. Bed View mode descriptions and selection instructions are on (8-10). Viewing a Patient Not Displayed in Main Screen 1. Click on View on the Main Screen menu bar. 2. Click on the Bed... menu selection. A screen with two list boxes appears. 3. Click on a care unit in the box labeled, Select Care Unit: A list of patients in that care unit displays in the box labeled, Select Bed. 4. Use the scroll bars to scroll through the available patients, and click on the desired patient. 5. Click on Continue. Bed View Screen Layout A patient’s Bed View screen occupies the left half of the Infinity CentralStation display, leaving patients in the Main Screen still visible. It displays parameters that originate at a bedside monitor or patient worn device. Waveform Assignment Bedside Monitor Patients The Infinity CentralStation Bed View screen can display bedside monitor main screen layouts. Telemetry Patients You can assign specific parameters and waveforms to each available Bed View waveform channel. The availability of displayed waveforms depends on the ECG configuration mode (3-, 5-, or 6-wire) of the transmitter assigned to a particular channel. VF8 Infinity CentralStation 8-3 8: Patient Setup - Bed View Bed View Menu Bar 8-4 Selection Allows you to... Review • access patient Ventilator Settings Review screen (Chapter 17) Setup • • • • ADT • admit /discharge/transfer patient (Chapter 9) • edit patient demographics (Chapter 9) Main Screen • access Main Screen (Chapter 7) Help • open the Infinity CentralStation Instructions for Use on screen Alarm Silence • silence all active alarms for 1 minute access patient arrhythmia setup menu (Chapter 10) access patient alarm limits setup menu (Chapter 13) access Telemetry setup menus (8-12) with Telemetry option access VentCentral functions (Chapter 17) with VentCentral option Infinity CentralStation VF8 Bed View Screen Layout Bed View Submenu Selections The Bed View submenu selections are below the main menu bar, and differ for Telemetry and bedside patients. NOTE: If any selection appears ghosted, remote control is not possible, or the function is not available for the patient category. Bedside Telemetry Description/Selection • Relearn Relearn ECG initiates a Relearn of the normal ECG waveform template for processing arrhythmias and ST. If arrhythmia monitoring is Off, this selection is ghosted and cannot be executed. • Relearn RESP initiates a Relearn of the breath detection threshold (only available for bedside patients). Record Starts a timed recording Print Audio Paused • Silences for 1 minute all active alarms at the monitor and/or Infinity CentralStation For bedside monitor patients Bed Silence Enable must be On (4-3). View • Bed View (8-10) • All Leads - displays all available leads from the bedside or telemetry patient (8-10) The All Leads screen mode supports the hex axial (Cabrera) display format (12-5). • Ventilator - (with VentCentral option, 17-5) Alarm Paused VF8 • Bed View initiates print request of Bed View screen. • Simultaneous ECG report Initiates print request of that report (14-22). If Print button is ghosted, no printer is configured. • Suppresses any further alarms for a predefined period Standby • Opens pulldown menu of STANDBY text labels (8-8) which once selected display in the upper right of the waveform channel • Suspends monitoring • Displays “STANDBY” prominently in the center of the top waveform Save Events • Allows manual storage of an 18-second waveform Save Events is also available for patients not assigned to Main Screen but located in the same monitoring unit (if the remote control function is enabled). Infinity CentralStation 8-5 8: Patient Setup - Bed View Information Area The information area is directly above the top waveform. It is visible in Bed View so alarm and bedside messages can be seen. NOTE: If the patient category ‘Neonate’ is selected and displayed at the bedside monitor, the category label ‘Neonate’ appears in the center of the information area. Message Type Display Color Description Banners 1 CODE (Delta/Delta XL/Kappa) Black text on red The Code fixed key was pressed at the background bedside monitor. ALARM PAUSED (Delta/Delta XL Black text on and telemetry) yellow background Alarms are turned off for the selected patient for a selected period of time. (Countdown timer displays) All Alarms OFF Alarms are turned off indefinitely. (No countdown timer displayed) 2, 3 HR alarms are off. HR ALARMS OFF BED DISCONNECTED Black text on white background (yyy) Out of Range (LOW) Bedside monitor is disconnected. Appears when a parameter falls below the measuring range (yyy) Out of Range (HIGH) Appears when a parameter exceeds the measuring range STANDBY (secondary) Patient monitor is in standby mode. DISCHARGE Monitor Internal Battery Low White text on black background Internal Battery Depleted The patient was discharged at the bedside monitor. The wireless bedside monitor internal battery is low. The wireless bedside monitor internal battery is depleted. The patient’s waveform area is blank. Local Messages Alarm Messages Color See Chapters 10, 11, 12, and 17 for corresponding to messages. alarm grade Parameter-specific local messages Black text on white background STAFF ALERT TRANSMITTER FAILURE Technical error TRANSMITTER NO SIGNAL MIB Alarm Messages 8-6 Infinity Telemetry or Infinity M300 STAFF ALERT key was pressed. No signal from the transmitter Orange Chapter 17. Infinity CentralStation VF8 Bed View Screen Layout Message Type Display Color Description If a code condition is activated at the bedside during an alarm, the banner CODE replaces the alarm message. If an alarm occurs while this banner is displayed, the alarm message replaces the banner for the duration of the alarm. This banner appears if no local bedside messages are displayed. Waveform Area Each waveform in Bed View consists of approximately 4 seconds of data. Waveform colors for both telemetry and bedside patients are described on 8-12. NOTE: Waveforms in Bed View are always updated at a 25 mm/s sweep speed, regardless of the selected bedside monitor setting. The waveform area does not display a waveform when: the bedside monitor/transmitter is disconnected, the patient has been transferred or discharged, the bedside monitor is in Standby mode, the bedside monitor or Infinity Telemetry receiver is offline, or the wireless bedside monitor battery is depleted. Telemetry Signal Strength In a telemetry system there are conditions during which signal losses or “dropouts” can occur. When there is a signal loss the Infinity CentralStation displays a blank in the telemetry patient’s waveform. However, during installation, you can configure the Infinity CentralStation to display a “dropout” as a negative square-wave (see page 7-7). To change how the Infinity CentralStation displays dropouts, contact Dräger Service. Putting Monitoring Into Standby Mode WA R N I N G ! Yo u m u s t ta k e t h e pa t i e n t o ut o f Sta nd by t o r e s u m e m o n i t o r i n g w h e n t h e pa t i e n t r e t u r n s t o t h e c a r e u n i t . Standby mode allows you to suspend patient monitoring when necessary. When patient monitoring is in Standby mode, you can still view all of the patient’s stored data such as trends and configuration settings from any Infinity CentralStation with the client option. When selected, Standby mode will display the message, Standby prominently in the center of the waveform. VF8 Infinity CentralStation 8-7 8: Patient Setup - Bed View Bedside Monitor Patients Bedside patient monitoring must be put in Standby at the bedside monitor. Infinity M300 and Infinity Telemetry Patients Standby is initiated at the Infinity CentralStation for local telemetry patients or for remote telemetry patients if their Infinity CentralStation server has enabled remote control. For telemetry patients you can select a secondary standby label that indicates a standby status. NOTE: Monitoring of a telemetry patient assigned to a different Infinity CentralStation within the same monitoring unit can also be put in Standby mode provided the remote control functions are enabled at both devices (5-3). 1. Open the telemetry patient’s Bed View screen. 2. Click on Standby to display a pull-down of the following available standby labels. Standby Off Unit Cath Lab X-Ray Surgery Shower Procedure Ultrasound MRI CT 3. Click on the desired label. NOTE: To cancel Standby and resume monitoring, click on Standby again, or click the VIEWS button on the Infinity M300. Standby labels can be customized by your local Dräger service representative. Effect of Standby Mode at the CentralStation 8-8 All alarms become inactive. Waveforms continue to display, if available. Main Screen parameter labels remain visible but values do not display. The message STANDBY displays prominently in the patient waveform area. For a telemetry patient, a selected label displays in the upper right of the waveform channel. Infinity CentralStation VF8 Parameter Areas in Bed View Parameter Areas in Bed View Each waveform channel in Bed View has an associated parameter area, which displays information. The amount of information may differ slightly between bedside and telemetry patients. Information Types Bedside Patient Telemetry Patient Parameter values Varies according to parameters monitored at bedside HR, ARR, PVC/min, ST, NIBP, SPO2, and PLS Alarm limits Display if available at the bedside Always display monitor All Alarms OFF symbol displays when alarms are disabled. Blinking green heart symbol Always displays For pacemaker patients the letter ‘P’ also appears next to the green blinking heart symbol Displays for local patients when the function is activated during System setup +++ The measurement value exceeds the measuring range. --- The measurement value is below the measuring range. Parameter Label and Unit Defaults Bedside Telemetry Parameter Labels/Units Color Parameter Labels/Units HR Matching the color of the associated waveform at the bedside monitor HR Green ARR, PVC/min Green STx Green ARR, PVC/min STx SpO2 and PLS SpO2 + PLS NPB NPB Parameter Color White Waveform Color Blue Ventilator Blue Alarm Limits Color Alarm Limits Color HR Gray (provided the limits are displayed at the bed) HR Gray ARR, PVC/min ARR, PVC/min STx STx SpO2 and PLS SpO2 + PLS Symbols Color no symbols are displayed VF8 Symbols Color Blinking heart green Infinity CentralStation 8-9 8: Patient Setup - Bed View Bed View Screen Display The Bed View screen has three different displays: Bed View is a view of a or remote patient. All Leads displays all available leads of an individual patient (telemetry or bedside). Ventilator (17-6) displays the ventilation status of an individual bedside patient. Selecting the Bed View 1. Click on the patient’s parameter box in the Main Screen to activate the Bed View mode that was last active. 2. Click on View. 3. Click on Bed View, All Leads, or Ventilator. Bed View Review Screens If applicable options are enabled, the Bed View Review screens allow the following: If you want to... From the patient’s Bed View screen . . . Access Trends 1. Click on Review in the Bed View menu bar. 2. Click on Trend Graphs... or Trend Table... (Chapter 15). Review Full/Event Disclosure Data 1. Click on Review in the Bed View menu bar. 2. Click on Full Disclosure... or Event Disclosure... (Chapter 16) Review Ventilator Settings 1. Click on Review in the Bed View menu bar. 2. Click on Ventilator Settings Review... (Chapter 17) 8-10 Infinity CentralStation VF8 Alarm Limits and Arrhythmia Setup Alarm Limits and Arrhythmia Setup The Bed View application provides Alarm Limits and Arrhythmia setup tables for customizing a patient’s monitoring attributes. Bedside Patients For bedside patients, the Alarm Limits and Arrhythmia setup tables reflect those at the corresponding bedside monitor. When a bedside monitor acknowledges that it is being remotely controlled, a message is displayed in the local message area at the bedside monitor. Once the bed has successfully processed the change, the setup tables at the bedside monitor and at the Infinity CentralStation reflect the change. If the bedside monitor is unable to receive or process a change in setup, the following happens: The table entry returns to the previously saved value. A corresponding status message is displayed in the status area of the Infinity CentralStation (7-13). An attention tone sounds. Telemetry Patients Configuration of a telemetry patient’s alarm setup is similar to that of a bedside patient except for the addition of SpO2, PLS, and ST parameters for the telemetry patient. For Telemetry patients you can select Alarm Limits and Arrhythmia setup screens according to patient category (5-2). Configuring Alarm Limits For information regarding Alarm Setup, see Chapter 13. Configuring Arrhythmia Setup Refer to Chapter 10 for setup information. VF8 Infinity CentralStation 8-11 8: Patient Setup - Bed View Telemetry Setup Screens When the Telemetry option is enabled, the Bed View Setup pull-down menu includes a Telemetry menu item which has several submenu selections. Settings made in these submenu screens for individual patients temporarily supersede the system defaults (Chapter 5) until you discharge the patient or restore system defaults. You can only perform these setup functions for telemetry patients who are local (1-5) or admitted to another Infinity CentralStation within the same monitoring unit. Accessing the Telemetry Setup Screens 1. Select Telemetry from the Bed View Setup menu. 2. Select Patient View, ST, or M300 Setup/Transmitter Setup from the submenu. 8-12 Infinity CentralStation VF8 Infinity TruST 12-Lead Monitoring Option Infinity TruST 12-Lead Monitoring Option NOTE: Infinity TruST is intended for 12-lead ECG monitoring with a reduced electrode set. Reconstructed leads are intended for real-time assessment of ST segment changes. Infinity TruST is a 12-lead ECG obtained with only six conventionally placed electrodes. Its function is based on the knowledge that, in general, the signal from a measured lead provides information common to other leads. When this information is appropriately combined, the signal of leads not otherwise configured can be interpolated. This type of lead derivation has a high correlation with measured leads. TRUST electrodes are placed in accordance with current clinical practice. Like a conventional 6-lead ECG system, waveforms from eight leads (typically, Leads I, II, III, aVR, aVL, aVF, V2, and V5) can be viewed on the Infinity CentralStation. These leads are processed and displayed in the same manner as a conventional system. However, unlike a conventional system, TRUST processes and displays four additional lead waveforms. These derived leads are viewable in the same fashion as the conventional leads, but are designated as dV1, dV3, dV4, and dV6. Electrode configuration includes limb leads and the selection of any two precordial leads. Leads V2 and V5 are typically used as these often provide the highest correlation for the remaining precordial leads. Alternate lead configurations can be selected based on signal amplitudes and clinical requirements. See Appendix A: and Chapter 3 for details regarding proper electrode placement. WA R N I N G ! T h e r e m a y b e i n s ta nc e s w h e r e t h e Q R S m o r p h o l o g y i n o n e o f t h e f o u r d e r iv e d l e a ds di f f e rs f rom t h a t o f a n e q u i v a l e n t c o n v e n t i o n a l l e a d . I n t h e s e i n s ta n c e s , always refer to the conventional lead. D o n o t s e l e c t d e r i v e d l e a ds f o r E C G p ro c e s s i n g . Use of TruST Reference ECG When TruST 12-lead is activated, the Infinity CentralStation uses generic coefficients that are based on a general population. Performance in this mode meets the established correlation to conventional leads. VF8 Infinity CentralStation 8-13 8: Patient Setup - Bed View The following table shows the correlation between TruST generic derived leads and conventionally measured leads for various lead configurations (a value of 1.0 being a perfect match). Recommended Lead Configurations and Respective Correlation Correlation Precordial Lead Placement 0.956 V2, V5 0.953 V2, V6 0.953 V1, V5 0.952 V3, V5 0.950 V1, V6 The performance above is based on a minimum 0.3 mV amplitude and QRS duration < 180 milli-seconds on patients with a body surface area (BSA) of 1.5 – 2.5 m2. Performance on patients outside these ranges may be less. Patient View Setup Chest Lead Selection When the Infinity TruST 12-Lead Monitoring option is enabled (18-11) and the TruST 12-Lead: setting is On, recommended lead placements for Set V and Set V+ are V2 and V5. Available selections are V1 through V6 and the lead selections must match the actual electrode placement on the patient’s body. With the two actual selected chest leads, the Infinity CentralStation calculates and reconstructs the four remaining chest lead measurements designated as dV1 through dV6. Chest lead selection on the Patient View Setup Screen will affect the patient’s related screen displays (e.g. ST Setup, ST Points, Trend Graphs, Trend Table, All Leads). NOTE: When using Infinity M300, the precordial leads are always V2, V5. They cannot be changed. 8-14 Infinity CentralStation VF8 9 Admit/Discharge/Transfer Overview.........................................................................................................................9-2 Admitting a Patient ........................................................................................................9-2 Entering Patient Demographics ...................................................................................9-3 Changing Patient Category ....................................................................................9-4 Admitting Wireless Monitor Patients ...........................................................................9-4 Moving Between Wired and Wireless Communication .......................................9-4 Wireless Transmission Interruption ......................................................................9-6 Admitting Under Special Conditions ...........................................................................9-6 Discharging a Patient ....................................................................................................9-7 The Patient Transfer Function......................................................................................9-8 Special Data Transfer Conditions..........................................................................9-8 Transferring Data to the Infinity CentralStation ...................................................9-8 Transferring Data From the Infinity CentralStation .............................................9-9 Transfer Messages..................................................................................................9-9 9: Admit/Discharge/Transfer Overview On the Infinity CentralStation you can view, enter, and edit demographic information for any patient and located within the Infinity CentralStation monitoring unit. Although entering demographics is not essential for monitoring, this data provides helpful information for easy patient identification. Admitting a Patient NOTE: Be sure to enter a patient’s demographic information accurately. You can edit and view demographics of patients at the Infinity CentralStation where they were originally admitted. If remote control is enabled you can view and change demographics for patients within the same monitoring unit even though they are not currently displayed in a Main Screen patient window. You can view, but cannot make changes to, demographics for patients outside the monitoring unit. In this case the Admit screen appears ghosted. NOTE: If the patient was removed for patient transport or the Infinity M300 monitor is not communicating with the Infinity network, you cannot view, enter, or edit demographic data. The Admit screen for the viewed patient appears blank. The Admit screen is ghosted for patients outside the monitoring unit. From Main Screen 1. Click on the Bed Label/Patient Name in the patient’s waveform area. 2. Click on Admit. From Bed View 1. Click on ADT in the Bed View menu bar. 2. Click on Admit. 9-2 Infinity CentralStation VF8 Entering Patient Demographics Entering Patient Demographics To open the Admit screen see page 9-2. Demographic Data Selections of the Admit Screen Selection Possible Settings Name 1 to 25 characters ID# 1 to 12 characters Birth Date Day-Month-Year selection fields Physician 1 to 12 characters Admit Date Day-Month-Year selection fields Click on the up/down arrow buttons to scroll to the appropriate settings for each category. Height • 20 to 240 cm or • 8 to 100 inches Click on the up/down arrow buttons to scroll to the appropriate settings. Weight • 0.0 to 350.0 kg • 0 to 772 lb The unit of measure is determined by the bedside monitor or, in case of telemetry patients, by the setting selected under System setup (page 5-7). Click on the up/down arrow buttons to scroll to the appropriate settings. Category Bedside monitor: Adult, Pediatric, Neonate Obtained from bedside monitor Cannot be modified Telemetry patient: Adult, Pediatric Select patient category from dropdown list. Gender Male, Female, or Unknown Pacer/ICD/PCD: • • • • • PACER ICD PCD EXT NONE (default) Special Consideration Click on the up/down arrow buttons to scroll to the appropriate settings for each category. 20-character max limit The Pacer/ICD/PCD identifier displays on all patient reports. If a bedside does not support this function the Pacer/ICD/PCD label displays on the report with a place to write the patient’s pacer information. Telemetry ID: Lists available devices from a configuration file populated during Infinity M300 Setup page 18-12 Click on a device in the list. Get HIS/CIS Demographics Allows you to retrieve a patient’s demographics from the hospital’s admission system. You must have the correct patient ID. • Click on Accept to save changes or Undo to keep original settings. VF8 Infinity CentralStation 9-3 9: Admit/Discharge/Transfer Changing Patient Category When you change Category in the ADMIT screen, a popup displays with the message: CAUTION: Alarm settings, arrhythmia settings, and QRS processing will be changed to the defaults for this category . You must press Confirm in the popup to accept the change. Whenever you successfully change a patient category, the following occur. Label and QRS-sensitivity settings are changed. All Alarm Limit and Arrhythmia settings are changed. If arrhythmia is enabled, a RELEARN is initiated. Admitting Wireless Monitor Patients The Infinity CentralStation treats wired and wireless monitors similarly. The Infinity CentralStation provides a list of available wireless monitors in the care unit. NOTE: For detailed information about the configuration and operation of wireless components in the Infinity Network, refer to the Dräger publication, “Infinity OneNet Network Planning and Installation Handbook” or “Infinity Network Planning, Design, and Installation Handbook, Third Edition”. See specific monitor documentation for information about using the monitor with the Infinity CentralStation in a wireless network configuration. Moving Between Wired and Wireless Communication When a wireless bedside monitor is docked at an Infinity Docking Station, the monitor automatically accepts the Infinity Docking Station’s Care Unit and Bed Label assignments and communicates with the Infinity Network. When the bedside monitor is removed from the Infinity Docking Station, the wireless network maintains communication. 9-4 Infinity CentralStation VF8 Admitting Wireless Monitor Patients Assigning a Wireless Monitor to a Patient Window If a wireless bedside monitor is removed from the Infinity Docking Station (IDS) and it is configured to keep the IDS bed label, the Infinity CentralStation patient window remains assigned to the wireless monitor and displays a wireless icon before the bed label. When the wireless monitor returns to the IDS, the wireless icon disappears from the patient window bed label. If you dock another bedside monitor on the IDS associated with the wireless monitor, the new monitor can select the same bed label and becomes available for assignment on the Assign Bed screen in the Main Screen (page 4-5). Waveform of patient on monitor communicating to the network via IDS After monitor is removed from IDS and begins wireless communication, the waveform is preceded by icon. You must re-assign an Infinity CentralStation patient window in the following situations: If a wireless monitor bed label is changed to one that is not currently assigned to a Infinity CentralStation patient window, or If you dock another bedside monitor on a IDS whose bed label is currently associated with a wireless monitor. Collecting Full/Event Disclosure Data If a patient is currently admitted to Full/Event disclosure and is using a wireless monitor, all data collection will continue regardless of bed label change. NOTE: There will be short breaks in Full/Event Disclosure data while the network resumes communication with the patient monitor. VF8 Infinity CentralStation 9-5 9: Admit/Discharge/Transfer Wireless Transmission Interruption If a wireless monitor loses contact with all APs and wireless transmission is interrupted, the Infinity CentralStation generates an Offline alert. Admitting Under Special Conditions Circumstance Effect on Admit Function Bedside monitor is powering up. Patient admission is not possible. Infinity M300/CPU/receiver is offline. 9-6 Bedside monitor, bedside monitor IDS, or Infinity M300 cannot communicate with the network. The Infinity CentralStation exits the Admit screen without accepting any changes, displays a blank Bed View screen, and generates a serious alarm. Patient admission is not possible. The patient monitor is either put into or taken out of Standby mode. No effect; the demographic information can be viewed and edited. The bedside monitor is removed for transport (Pick and Go). The Infinity CentralStation exits the Admit screen without accepting changes and displays a blank Bed View screen. The banner BED DISCONNECTED appears in Bed View and in Main Screen. Patient admission is not possible. The bedside monitor returns from transport. You can view, enter, and/or edit the patient’s demographic information immediately. Infinity CentralStation VF8 Discharging a Patient Discharging a Patient Bedside patients must be discharged at the bedside monitor. Telemetry patients must be discharged at the Infinity CentralStation where they were originally admitted. Remote discharges are not possible. When you discharge a telemetry patient: Demographics are deleted. All patient setup data such as alarm limits, arrhythmia setup, etc. are replaced by system defaults. Trends are deleted. All pending and active recordings are cancelled. The Pacer Identifier label reverts to None. A Bed Disconnected banner displays in Main Screen. (Infinity M300 only) If the patient’s SpO2 Monitoring setting was ON, an SpO2 license becomes available. Discharging a Telemetry Patient 1. Open the patient’s Bed View screen. 2. Click on ADT in the Bed View menu bar. 3. Click on Discharge. This activates the Admit screen with the discharge confirmation popup. 4. Click on Yes inside the popup to discharge the patient or on No to cancel the discharge. For information about how a patient discharge affects the Infinity M300, see page 2-9. VF8 Infinity CentralStation 9-7 9: Admit/Discharge/Transfer The Patient Transfer Function NOTE: After a successful transfer, the source monitor automatically discharges the patient. If an error occurs during the transfer, the data remains unchanged at the original location. You can transfer a patient’s trend and demographic data from one location to another. For example, you can transfer data from a telemetry patient at the Infinity CentralStation to any bedside monitor on the Infinity network or vice versa, or you can transfer telemetry patients’ data from one Infinity CentralStation to another. All transfers must be initiated from the destination device (the monitor/Infinity CentralStation you wish to transfer the data to). Special Data Transfer Conditions During a patient transfer from a telemetry patient to a Gamma/Gamma XL/Vista monitor, only the data from ST leads I and II is sent to the monitor. ST values may be offset by up to 3 minutes due to different trend update intervals between devices. Transferring Data to the Infinity CentralStation 1. Put the source device (bedside monitor or Infinity CentralStation Telemetry patient window or Infinity M300) in Standby mode. Only beds that are in Standby mode are candidates for transfer. 2. Open the patient’s Bed View screen at the destination Infinity CentralStation. 3. Click on ADT in the Bed View menu bar. 4. Click on Transfer. The Transfer Data From screen displays. 5. Click on the desired care unit in the Select Care Unit: section of the screen. A list of care unit beds displays in the Select Bed: window. 6. Click on the desired bed from the selection list. If the selected bed’s monitor is not in Standby mode an information popup displays the message: The source bed for the transfer must be in Standby. Please put this bed in Standby. 7. You must click on Continue to close the popup. A Confirmation popup displays a message similar to the following example: 9-8 Infinity CentralStation VF8 The Patient Transfer Function Before proceeding with Transfer ... You have requested to transfer data from Bed_xx to Tel_xx. This action will replace any stored data at Tel_xx with data from Bed_xx. Data stored at Bed_xx will also be deleted once the transfer is complete. Do you wish to begin the transfer? 8. Click on Yes to transfer or No to cancel. Transferring Data From the Infinity CentralStation For Bedside Patients: 1. At the Infinity CentralStation Select the patient whose data you wish to transfer and open the patient’s Bed View screen. 2. Click on Standby in the Bed View menu bar. 3. Go to the destination monitor and start the transfer (refer to the monitor documentation). For Telemetry Patients: Go to the destination Infinity CentralStation to start the transfer. See page 9-8. Transfer Messages Transfer Message Description Transfer not allowed A transfer of neonatal patient data was attempted. Patient Data Transfer Failed The data transfer was unsuccessful. Partial data received by the destination device is discarded. The source monitor remains in Standby ready for a restart of the transfer. Transfer in Progress The data is being transferred. You cannot make any changes to the source/destination device during that time. Transfer Completed The data transfer was successful. All data is permanently deleted from the source monitor, which remains in Standby mode. VF8 Infinity CentralStation 9-9 9: Admit/Discharge/Transfer - This page left blank intentionally - 9-10 Infinity CentralStation VF8 10 Arrhythmia Overview.......................................................................................................................10-2 About the Arrhythmia Template .................................................................................10-2 Relearning the Template .............................................................................................10-3 Customizing a Patient’s Arrhythmia Setup ...............................................................10-4 Accessing the Arrhythmia Setup Table ..............................................................10-4 Available Functions on the Arrhythmia Setup Table ........................................10-4 Available Bedside Event Settings ..............................................................................10-6 Arrhythmia Beat and Rhythm Classification ............................................................10-7 10: Arrhythmia Overview With the Infinity CentralStation, Infinity Telemetry, Infinity M300 system, arrhythmia monitoring is available for adult and pediatric patients. The mode you select (Full, Basic, or OFF) determines the events processed. Arrhythmia monitoring is not available for neonates. The system matches incoming beats against beats previously recorded and stored in a reference template. Through this process, the system can verify an arrhythmia event’s occurrence, classify it, and draw clinically useful conclusions based on the frequency and morphology of the signal. The system considers all beats questionable if a baseline shift exceeds specified limits. WA R N I N G : E l e c t r i c a l a r t i f a c ts o f n o n - c a r d i a c o r i g i n , s u c h a s s e i z u r e , m a y p r e v e n t d e t e c t i o n o f c e r ta i n a r r h y t h m i a s . D o n o t r e l y s o l e l y o n E C G w i t h s e i z u r e - p r o n e pa t i e n ts . NOTE: Arrhythmia detection may not work properly in all patients. The monitor classifies only QRS complexes > 0.25mV, for widths > 70ms. An artifact condition (ARTF) may occur when the ECG signal does not meet these minimums. While continuing to monitor HR, you can turn off ARR Monitoring for patients whose QRS complexes do not meet these minimums. The system uses the results of QRS processing for arrhythmia analysis. During multiple-lead arrhythmia processing, each lead’s QRS complexes are measured and compared against its learned dominant normal beat. The system classifies beats based on information acquired from all available leads. About the Arrhythmia Template The system creates a reference template based on its identification of the patient’s dominant QRS pattern. It then classifies individual beats by comparing them with the learned reference template. In the third and final phase of arrhythmia processing, the monitor compares sequences of valid beats with the template. In most situations, the learning phase takes about 30 to 40 seconds. If the system detects more than 100 QRS complexes and less than 16 matching beats, it displays the message, . While the system is in the learning phase, all arrhythmia alarms and trend collection are suspended; LRN appears in the parameter box; and the message, Relearning, displays in the local message area. 10-2 Infinity CentralStation VF8 Relearning the Template Relearning the Template During the Relearn process a beat classification template is created against which each detected beat is compared and classified. An automatic Relearn is initiated in the following conditions: Arrhythmia monitoring is enabled for the first time. A patient’s monitor (or Infinity CentralStation) comes out of Standby mode. The processing mode (ECG1 or ECG 1&2) changes. Lead assignment changes. TRUST monitoring is enabled. The Telemetry Patient Category changes. During the learning process no arrhythmia events are reported, and the parameter area displays the message LRN. NOTE: If you assign more than one lead and if only one of those leads is available, the algorithm will learn from that lead only. Dräger recommends that you initiate a manual Relearn of the patient’s normal template in the following instances: Eight hours after the last Relearn occurred, After the patient’s electrodes are repositioned, replaced, or disturbed, or If the message CANNOT LEARN or CANNOT LEARN is displayed. Initiating a Relearn 1. Open the patient’s Bed View screen. 2. Click on Relearn in the Bed View menu bar. 3. Click on Relearn ECG. Once the Relearn successfully completes, the assigned leads do not require relearning, even if they fall off and are reconnected. If the message CANNOT LEARN is displayed in the patient’s waveform area, try to Relearn once more and confirm the quality of the signal. If the message persists, reposition or properly replace the electrodes, then try again. NOTE: If the ST option is enabled, the ST algorithm also performs a Relearn of the ST template whenever a Relearn of the arrhythmia template is initiated. VF8 Infinity CentralStation 10-3 10: Arrhythmia Customizing a Patient’s Arrhythmia Setup Accessing the Arrhythmia Setup Table 1. Open the patient’s Bed View screen and click on Setup in the Bed View menu bar. 2. Click on Arrhythmia.... Column heading is ‘Alarm Archive’ for telemetry patients admitted to Event Disclosure and ‘Record’ for telemetry patients not admitted to Event Disclosure.. Opens Alarm Limits Setup Table (page 13-11) Selects Arrhythmia monitoring mode Restores values to system settings Row in ‘configuration mode’ Available Functions on the Arrhythmia Setup Table Heading/Function Description Alarm Grade 1. Click on the ‘Alarm Grade’ column of the • L-T event you wish to configure and scroll to the • SER desired setting. • ADV 2. Click on OK. • OFF Rate Determines when an event call is triggered 1. Click on ‘Rate’ or ‘Count’ column of the event you wish to configure and scroll to the desired setting. 2. Click on OK. See page 10-6. For arrhythmia settings based on the Rate and Count settings of other calls, there may be no scrolling arrows (e.g.RUN is dependent on VT settings). Automatically generates a timed recording for each validated alarm condition. 1. Click on the “Record’ column of the event you wish to configure and scroll to the desired setting. 2. Click on OK. • ON • OFF This function cannot be OFF for ASY and VF. Count Record 10-4 Infinity CentralStation Available Settings VF8 Customizing a Patient’s Arrhythmia Setup Heading/Function Description Available Settings Alarm/Archive Depending on the setting, can automatically store waveform and generate a timed recording for each validated alarm condition. Each stored event is 18 seconds long, and includes 9 seconds of data collected before and after the event. (Alarms do not have to be turned on for events to be stored.) 1. Click on the ‘Alarm Archive’ column of the event you wish to configure and scroll to the desired setting. 2. Click on OK. • REC • REC/STORE • STORE • OFF This function cannot be OFF for ASY and VF. Arrhythmia Determines which arrhythmia events are monitored • Basic - ASY, VF, VT, ART • Full - ASY, TACH, BRDY, PAUS, VT, RUN, AIVR, CPT, BGM, ARTF, SVT (‘Full’ arrhythmia capabil• Click on the appropriate radio button. ity at the Infinity CentralStation for bedside patients is only active if the bedside monitor has that capability.) NOTE: To select OFF for telemetry patients, a pass• OFF word is required. (If you select ‘OFF’, arrhythmia setup table and arrhythmia field in patient’s parameter area are blank.) WA R N I N G ! I f a r r h y t h m i a m o n i t o r i n g i s O f f , e v e n t a l a r m s a re a u t o m a t i c a l l y t u r n e d o f f . T h e e x c e p t i o n s a re A S Y a n d V F e v e n ts , w h i c h a l w a y s g e n e r a t e a n a l a r m s i n c e t h e y a r e pa r t o f E C G m o n i t o r i n g . H o w e v e r, t h e s e e v e n ts w i l l n o t c a u s e a n a l a r m i f t h e H R a l a rm f u n c t i o n i s a l s o O F F. T h e r e f o re , i t i s s t r o n g l y r e c o m m e n d e d t h a t H R a l a rm s a r e always ON. VF8 Infinity CentralStation 10-5 10: Arrhythmia Available Bedside Event Settings For available event settings for Telemetry patients see page 5-11. NOTE: Some arrhythmia settings are based on the Rate and Count settings for other calls (e.g. RUN is dependent on the VT settings). For available monitor bedside settings, see the appropriate monitor Instructions for Use. Event Count (bpm) Rate (bpm) ASY VF VT Alarm Setting Record Setting Store Setting not adjustable Default: LT On, Off Default: On On, Off Default: On 5 - 15 Default: ≥10 100 - 200 Default: ≥120 LT, Off, ADV, SER On, Off Default Off On, Off Default: Off RUN Not adjustable; upper value is VT count -1. Default: 3 - 9 Not adjustable; LT, Off, ADV, same as VT rate. SER Default: ≥120 On, Off Default: On On, Off Default: On AIVR Not adjustable Not adjustable, LT, Off, ADV, upper value is VT SER rate -1 bpm Default: ≥119 On, Off On, Off Default: Off Default: Off LT, Off, ADV, SER On, Off Default: On On, Off Default: On ARTF Default: ≥3 CPT BGM SVT 3 - 10 Default: ≥ 3 120 - 200 Default: ≥150 LT, Off, ADV, SER On, Off Default: On On, Off Default: Off TACH 5 - 15 Default: ≥ 8 100 - 200 Default ≥130 LT, Off, ADV, SER On, Off Default: Off On, Off Default: Off BRDY Not adjustable Default: ≥ 8 30 - 105 Default: ≥ 50 Not adjustable Default: SER On, Off Default: On On, Off Default: On PAUS PVC/min 1.0 - 3.5 Default: 2.5 0 - 50 Default: ≥ 12 To set alarm limit see page 13-12. NOTE: HR, ASY, and BRDY alarms may be active simultaneously. The HR alarm function provides adjustable alarm limits for heart rates less than 30 beats/min. 10-6 Infinity CentralStation VF8 Arrhythmia Beat and Rhythm Classification Arrhythmia Beat and Rhythm Classification Category Definition ASY Asystole: indicated if 4 seconds pass without the detection of a valid QRS complex VF Ventricular Fibrillation: indicated if the source device identifies a sinusoidal waveform with fibrillation characteristics VT 1 Ventricular Tachycardia: “N” or more consecutive PVCs have been detected with a beat-to-beat rate ≥ the VT rate. RUN 1 Ventricular run: a series of 3 to “N – 1” consecutive PVCs with a beatto-beat rate ≥ the VT rate AIVR Accelerated idioventricular rhythm: a series of 3 or more PVCs with a rate less than the VT rate CPT Ventricular Couplet: a sequence of beats with the pattern: normal, PVC, PVC, normal BGM Ventricular Bigeminy: a sequence of beats with the pattern: normal, PVC, normal, PVC, normal TACH 1,2 Sinus Tachycardia: “N” or more consecutive normal beats with a beatto-beat rate ≥ to the set TACH rate BRDY 2 Sinus bradycardia: 8 or more consecutive normal beats are detected with an average rate ≤ to the set sinus bradycardia rate. PAUS Pause: a sequence of 2 normal or PVC beats with an interval ≥ to pause rate value in seconds (± 100ms) SVT Supra ventricular Tachycardia: “N” or more consecutive normal beats with a beat-to-beat rate ≥ the SVT rate ARTF Artifact: indicated if more than 50% of the beats in the last minute are questionable “N” represents the value in the Arrhythmia setup table ’Count’ column. of a VPB or other abnormal beat breaks the analysis sequence and analysis restarts. 2 Arrival Beat classification refers to the analysis of individual beats. If the new beat’s features do not match those of the reference template, the new beat is classified as abnormal, paced, or questionable. The monitor uses all detected beats to calculate the heart rate, eliminating questionable beats from arrhythmia classifications. VF8 Infinity CentralStation 10-7 10: Arrhythmia The following table describes available beat classifications: Label Event and Beat Classification ASY Asystole: 4 seconds pass without the detection of a valid QRS complex VF Ventricular Fibrillation: The monitor identifies a sinusoidal waveform with fibrillation characteristics1 VT Ventricular Tachycardia: N or more PVC’s are detected in a time interval T = (60 * (N - 1)) / R, where N is defined as the VT count and R is defined as the VT rate RUN Ventricular Run: Series of 3 to N-1 consecutive PVCs with a beat-to-beat rate ≥ the VT rate1 AIVR Accelerated Idioventricular Rhythm: Series of 3 or more PVCs with a rate less than the VT rate SVT Supraventricular Tachycardia: N or more consecutive normal beats, with a beat-to-beat rate greater than or equal to the SVT setting CPT Ventricular Couplet: Sequence of beats with the pattern: normal, PVC, PVC, normal BGM Ventricular bigeminy: Sequence of beats with the pattern: normal, PVC, normal, PVC, normal TACH Sinus Tachycardia: N or more consecutive normal beats, with a beat-to-beat rate ≥ TACH rate setting2,3 BRDY Sinus bradycardia: 8 or more consecutive normal beats, with an average rate ≤ sinus bradycardia rate setting2 Notes: • When in neonatal mode, bradycardia is a low heart rate alarm. • Brady Alarm (neonate only), which is a life threatening alarm, can be configured independently of the low HR alarm, which is a serious alarm. PAUS Pause: Sequence of two beats classified as normal or PVC, with interval ≥ pause rate value in seconds (±100ms) ARTF Artifact: More than 50% of beats in the last minute classified as questionable 1Certain ventricular tachycardias have sinusoidal waveforms closely resembling those of ventricular fibrillation. Because of the similarity of these waveforms, the monitor may classify such types of ventricular tachycardia as ventricular fibrillation, the more serious of the two conditions. 2 “N” is the event count set in the Arrhythmia setup table’s count column. 3A PVC or other abnormal beat breaks the analysis sequence and restarts analysis. 10-8 Infinity CentralStation VF8 11 Telemetry Pulse Oximetry and NIBP Monitoring Overview......................................................................................................................11-2 Pulse Oximetry.............................................................................................................11-3 Turning Pulse Oximetry Monitoring On/Off ..............................................................11-4 Display of Pulse Oximeter Information ...............................................................11-4 Vital Connection Cable ...............................................................................................11-5 Getting an NBP or SPO2 measurement ..............................................................11-5 Alarm Functions ..........................................................................................................11-7 Alarm Messages ..........................................................................................................11-7 11: Telemetry Pulse Oximetry and NIBP Monitoring Overview Infinity Telemetry and Infinity M300 offer pulse oximetry monitoring. The Infinity M300 contains an internal pulse oximeter. To enable pulse oximetry monitoring through Infinity M300, a license option must be enabled. Infinity Telemetry connects to the MicrO2+ Pulse Oximeter to provide pulse oximetry monitoring. Infinity Telemetry also connects to Infinity monitors using the Vital Connection cable for both pulse oximetry and NIBP monitoring (See page 11-5). SPO2 and PLS measurements and their associated trend values are labeled identically regardless of the source (Infinity monitor/Vital Connection Cable, MicrO2/MicrO2+, or bedside monitor). 11-2 Infinity CentralStation VF8 Pulse Oximetry Pulse Oximetry A pulse oximeter determines the percentage of functional hemoglobin saturated with oxygen (% SpO2) in the patient’s arterial blood. A light sensor on the patient’s finger measures the absorption levels of red and infrared light. Since oxyhemoglobin and deoxyhemoglobin absorb different amounts of red light, but nearly the same amount of infrared light, the monitor uses the difference between the two measurements to calculate the percentage of saturated hemoglobin. Because light absorption varies with blood volume and blood volume varies with the pulse rate, a pulse rate (PLS) can also be derived. WA R N I N G ! B e f o r e y o u s ta r t y o u r m o n i t o r i n g s e s s i o n , p l e a s e r e f e r t o p r e c a u t i o n s o n pa g e x v i ii , i n t h e s e I n s t r u c t i o n s f o r Use. Check the sensor at least every four hours. Move the s e n s o r i f t h e re i s a n y s i g n o f s k i n i r r i ta t i o n o r i m pa i r e d c i rc u l a t i o n . Bright light can interfere with pulse oximetry m e a s u r e m e n ts , c a us i ng e rr a t i c o r m i s s in g v a l ue s . W h e n t h e s e n s o r i s l i k e l y t o b e c o m e e x p os e d t o d i r e c t b r i g h t l i g h t , i t s h o u l d b e c o v e r e d w i t h a n o pa q u e m a t e ri a l . C a r b o x y h e m o g l o b i n m a y e rr o n e o u s l y i n c r e a s e readings. The level of increase is approximately equal to the amount of carboxyhemoglobin present. D y e s , n a i l p o l i s h e s a n d o t h e r s u b s ta n c e s , m a y a b s o r b a n a b n o r m a l a m o u n t o f r e d l i g h t , w hi c h c a n e f f e c t t h e accuracy of the measurement. Be sure to apply the s e n s o r t o a s i t e f r e e o f a n y a r t i f i c i a l p i g m e n ts . NOTE: VF8 A functional tester cannot be used to assess the accuracy of a pulse Oximeter probe or a pulse Oximeter monitor. Because pulse oximeter equipment measurements are statistically distributed, only about two-thirds of pulse oximeter equipment measurements can be expected to fall within ± Arms of the value measured by a CO-oximeter. If there is independent demonstration that a particular calibration curve is accurate for the combination of a pulse oximeter monitor and a pulse oximeter probe, then a functional tester can measure the contribution of a monitor to the total error of a monitor/probe system. The functional tester can then measure how accurately a particular pulse oximeter monitor is reproducing that calibration curve. Infinity CentralStation 11-3 11: Telemetry Pulse Oximetry and NIBP Monitoring Turning Pulse Oximetry Monitoring On/Off If pulse oximetry monitoring is enabled for telemetry patients, set it as follows: 1. Open the patient’s Bed View screen. 2. Click on Setup in the Bed View menu bar. 3. Click on Telemetry (If selection does not appear, the Telemetry option is not enabled). 4. Click on Patient View. The Patient View Setup screen displays. 5. Click on SpO2 monitoring to enable. 6. (Infinity M300 only) Click on the ON/OFF toggle button next to SpO2 Monitoring. 7. (Infinity M300 only) If you choose to monitor SpO2, select settings for SpO2 Color, SpO2 Averaging, and SpO2 Sensor. 8. (Infinity M300 only) Click on Accept to change or Undo to keep previous settings. When SpO2 monitoring is set as a system default, but turned off for an individual patient, the parameter box SpO2 and PLS fields are blank. Display of Pulse Oximeter Information When pulse oximetry monitoring is ON, the Infinity CentralStation Bed View also displays: 11-4 SpO2 value and alarm limits (or All Alarms OFF icon if alarms are off) PLS and alarm limits Infinity CentralStation VF8 Vital Connection Cable Vital Connection Cable NOTE: Use of the Vital Connection cable requires software version VF5 or higher in the Infinity CentralStation and Infinity Kappa, Delta, Delta XL, Gamma X XL, and Vista XL patient monitors. The Vital Connection Cable links the Infinity Telemetry Transmitter with a compatible Infinity bedside patient monitor so that a telemetry patient’s SPO2 and NIBP measurements can be transmitted to the Infinity CentralStation. Getting an NIBP or SPO2 measurement 1. Turn on Pulse Oximetry monitoring (11-4). 2. Set up the Patient View screen Channels (6-4) so that NIBP and SPO2 + PLS parameters display in the patient window. 3. Plug the appropriate end of the Vital Connection Cable into the local telemetry patient’s transmitter programming port. 4. Attach the other end of the Vital Connection Cable into the X-8 port of a compatible bedside monitor on the Infinity network. Be sure that the Vital Connection LED is lit. This determines an active connection. 5. For details about obtaining SpO2 and NIBP measurements, refer to the appropriate Infinity patient monitor Instructions for Use. NOTE: If you use the Vital Connection Cable to spot-check SPO2, you must disable the SPO2 alarm to avoid a reoccurring Advisory alarm caused by disconnecting the Vital Connection cable. If the SPO2 alarm is not disabled, an Advisory alarm will continue every minute. VF8 Infinity CentralStation 11-5 11: Telemetry Pulse Oximetry and NIBP Monitoring The Vital Connection LED indicates connection status to both associated devices (bedside or transmitter) as follows: LED Appearance Status Not lit There is no physical connection to or communication with either bedside or transmitter. Continuous light The Vital Connection cable is physically connected and communication is established with both bedside and transmitter. A Vital Connection interface failure or disconnection will send the following message to the Infinity CentralStation. EXT. DEVICE NO SIGNAL As soon as the patient’s NIBP measurement is available the Infinity CentralStation displays the data in a parameter box as illustrated. The measured value updates whenever you take a new measurement. The latest measurement displays until you discharge the patient or the measurement is older than 24 hours. Systolic measurement 1 Diastolic measurement 1 Time of last measurement Mean measurement1 Units of measurement 1When alarms are OFF the Alarm Off icon displays Vital Connection Cable measurements display on the Infinity CentralStation Bed View and Main Screens, and are stored in Tabular and Graphic Trends. 11-6 Infinity CentralStation VF8 Alarm Functions Alarm Functions For specific Infinity CentralStation SpO2 and PLS alarm setup instructions, see Chapter 13. Alarm Messages SpO2 Alarm Messages via Infinity Telemetry and Infinity M300 Alarm Message Alarm Grade Description Action PLS > UL SER Parameter value exceeds the upper alarm limit. • Check the patient. PLS: PLS < LL SER Parameter value is below the lower alarm limit. PLS: +++ Pulse rate out of range SER The pulse rate is outside the measuring range. SpO2: SpO2> UL SER Parameter value exceeds the upper alarm limit. SpO2: SpO2< LL SER Parameter value is below the lower alarm limit. Parameter Area Status/ Information Area PLS: • Reset the alarm limits. Messages unique to MicrO2 SpO2: *U* PLS: *U* P1 VF8 MicrO2 sensor unplugged ADV Sensor is disconnected from the oximeter. Infinity CentralStation • Check all cable connections. • Replace sensor if necessary. 11-7 11: Telemetry Pulse Oximetry and NIBP Monitoring Alarm Message Parameter Area Status/ Information Area Alarm Grade Description Action SpO2: *A* PLS: *A* P2 (at oximeter) Micro2 transparent ADV Sensor cannot detect any signals. • Check the patient. • Check sensor and reapply or replace it if necessary. SpO2: *A* PLS: *A* P3 (at oximeter) Micro2 opaque ADV Sensor does not detect any light. • Make sure the LED on the oximeter is not blocked. SpO2: *A* PLS: *A* P4 (at oximeter) Micro2 artifact ADV Motion artifact • Make sure the patient remains as still as possible. • Check sensor; reapply or replace it if necessary. SpO2: *A* PLS: *A* P5 (at oximeter) Micro2 regulation error ADV Too much ambient light • Cover the sensor with an opaque material. SpO2: *A* PLS: *A* P6 (at oximeter) Micro2 weak signal * ADV/ SER 1 Pulse is weak or nonexistent. • Check the patient. • Check sensor/ oximeter and reapply or replace it if necessary. SpO2: *N* PLS: *N* Micro2 no signal ADV Oximeter signal is not available. • Check connections and MicrO2 battery. 1After 11-8 the 30-second advisory alarm, this alarm is upgraded to SER. Infinity CentralStation VF8 Alarm Messages SpO2 Alarm Messages via Vital Connection Cable Alarm Message Alarm Grade Description Action • Check the patient. Parameter Area Status/ Information Area SpO2: SpO2> UL SER Parameter value exceeds the upper alarm limit. SpO2: SpO2< LL SER Parameter value is below the lower alarm limit. SpO2: +++ SpO2: - - - out of range SER Parameter rate is outside the measuring range. PLS: PLS > UL SER Parameter value exceeds the upper alarm limit. PLS: PLS < LL SER Parameter value is below the lower alarm limit. PLS: +++ PLS: - - - Pulse rate out of range SER The pulse rate is outside the measuring range. PLS: +++ will also display at the Infinity CentralStation if the measured PLS at the bedside exceeds 255. The actual PLS value displays at the bedside monitor, however. SpO2: * * * PLS: * * * SpO2 Technical Alarm ADV SpO2 technical Alarm VF8 Infinity CentralStation • Reset the alarm limits. • See bedside monitor Instructions for Use 11-9 11: Telemetry Pulse Oximetry and NIBP Monitoring NIBP Alarm Messages via Vital Connection Cable Alarm Message Parameter Area Status/ Information Area S S+++ S--- SYS Alarm D D+++ D--- DIA Alarm M M+++ M--- MEAN Alarm S*** D*** M*** NIBP Technical Alarm 11-10 Alarm Grade Description Action SER NIBP alarm at bedside monitor • Check the patient and treat if necessary. • Reset the alarm limits. ADV Technical NIBP alarm at bedside monitor • This message displays for any bedside-generated NIBP Advisory alarm. For details, see bedside monitor Instructions for Use. Infinity CentralStation VF8 12 Telemetry ST Analysis Option Overview.......................................................................................................................12-2 ST Segment Morphology ......................................................................................12-2 Parameter Display .......................................................................................................12-4 Sensor Application ......................................................................................................12-4 Relearning ST...............................................................................................................12-5 ST Points Setup Screen ..............................................................................................12-5 Hexaxial (Cabrera) Lead Support ........................................................................12-5 Accessing the ST Points Setup Screen ..............................................................12-6 Display Order of ST Complexes ..........................................................................12-7 Available Functions on ST Points Setup Screen ...............................................12-8 Telemetry ST Setup Screen ........................................................................................12-9 Accessing the Telemetry ST Setup Screen ........................................................12-9 ST Alarms ...................................................................................................................12-10 ST Alarm Messages...................................................................................................12-10 12: Telemetry ST Analysis Option Overview ST deviation measurements are performed on averaged ECG segments. An averaged ECG segment is 900 ms long and is calculated from a minimum of 4 normal QRS complexes having occurred in the previous 15 seconds. To reduce the effects of artifact, only normal beats are included in the average (if no normal beats are available, no complex or corresponding parameter box values display). ST parameters are included in the trend function, and you can configure the ST alarm functions as for any other parameter (see Chapter 13). ST Segment Morphology ST segment deviations are defined in terms of displacement above or below the isoelectric level. The measurement compares the isoelectric point to the ST deviation measurement point. The isoelectric point defines the point of zero voltage (no electrical activity, 0 mm) with a default position of 28 ms before the onset of the QRS complex on the horizontal (time) axis. The ST deviation point occurs in the ST segment between the QRS offset (J point) and the T-wave, at a default position of 80 milliseconds after the QRS offset. 12-2 Infinity CentralStation VF8 Overview The value of the ST measurement point is compared to the isoelectric point value, and the difference between the two measurements is the ST deviation. The onset and offset points for the QRS complex are determined by the QRS detection algorithm. mV ST Deviation Fiducial Point ST Measurement Point Default ST Measurement Point = 80 ms after QRS Offset ST Level QRS Offset Time QRS Onset Isoelectric Level 10 Isoelectric Point Default ST Measurement Point = 28 ms before QRS Onset VF8 Infinity CentralStation 12-3 12: Telemetry ST Analysis Option Parameter Display When ST monitoring is enabled the Infinity CentralStation parameter area lists the ECG leads selected by the user as data sources for ST analysis.The ST values displayed depend on the transmitter lead configuration mode. Sensor Application The quality of SpO2 measurements depends largely on the strength and quality of the signal received by the sensor. Infinity M300 and Infinity Telemetry support Dräger, Nellcor and Masimo SpO2 sensors. The Patient View shows which sensor type is currently selected. If you connect a sensor different from the type shown in the Patient View screen, the Infinity CentralStation displays an error message. STEPS: Applying the Sensor 1. Select a sensor that is best suited for your patient. NOTE: For a complete list of accessories available with this product, contact your Draeger Medical Systems, Inc. local representative to obtain a catalogue. 2. Clean reusable sensors before and after each use. 3. Position the sensor correctly and attach it to your patient (see sensor manufacturer’s recommendations). 4. Connect the sensor to the intermediate cable. 5. Inspect the sensor application site frequently. If the sensor is too tight, it may damage the tissue and impede blood flow. If the sensor is damaged, do not use it. CAUTION: Read the instructions provided with the sensor to select the best application technique and to review all safety related information. 12-4 Infinity CentralStation VF8 Relearning ST Relearning ST The Infinity CentralStation initiates a Relearn automatically under the following circumstances: Whenever you enable ST for the first time After you change leads When the monitor, Infinity M300, or Infinity CentralStation comes out of Standby mode After a device restart Initiating a relearn manually 1. Open the patient’s Bed View screen. 2. Click on Relearn in the Bed View menu bar. 3. Click on Relearn ECG. During the Relearn, the ST fields within the parameter area do not display any parameter values, and the message ECG RELEARNING appears in the information area of the Bed View screen. A vertical dotted line on the ST trend graphs marks the time of a Relearn, and the label LRN appears to the right of the trend window when you move the trend cursor on the dotted line. Also, for each Relearn an entry is made in the clinical events log. ST Points Setup Screen The ST Points Setup screen displays the current averaged complex for each lead with associated deviation measurement values and times. Hexaxial (Cabrera) Lead Support NOTE: Infinity M300 does not support Hexaxial (Cabrera) display. In Cabrera display mode (page 18-4), the aVR lead is presented in inverted polarity as -aVR. The order of the lead presentation in Cabrera is: aVL, I -aVR, II aVF, III V1-V6. VF8 Infinity CentralStation 12-5 12: Telemetry ST Analysis Option Accessing the ST Points Setup Screen 1. Open patient’s Bed View screen. 2. Click on Setup in the Bed View menu bar. 3. Click on ST Points. 12-6 ISO point Accepts ST setup changes J-Point Changes the display size (amplitude) ST point Moves the ISO point back and forth Stores new reference complex 10 Averaged complex Moves the reference point back and forth 11 Lead label Displays/removes latest reference complex 12 Amplitude Infinity CentralStation VF8 ST Points Setup Screen Display Order of ST Complexes 3-/5-wire 1-/7-lead 6-wire 12-lead aVF aVF V3, dV3 II aVL II aVL V4, dV4 III III V, V1, dV1 V5, dV5 aVR V+, V2, dV2 V6, dV6 aVR The averaged complexes and corresponding ST deviation measurements and times are updated as each new complex is computed. If an averaged complex is not available, the reserved display area appears blank. You can change the gain of the complexes and adjust the measurement points. The current ST measurement point, the QRS offset (J-point), and isoelectric point are labeled and identified by vertical lines. If you make any adjustments to the measurement point, the ST deviation is recomputed and displayed below the current value. Zoom Mode To examine an individual ST complex in greater detail and view the current ST measurement point selections, click on the desired complex in the ST Points Setup screen. VF8 Lead label Reference deviation Current deviation value Lead selection Amplitude Infinity CentralStation 12-7 12: Telemetry ST Analysis Option NOTE: gain. A portion of the complex may be clipped if you do not select an appropriate Available Functions on ST Points Setup Screen Function Description Available Settings Adjust Display Size • Click on the option button and select from available settings. 0.25, 0.5, 1, 2, 4, and 8 mV/cm Save Ref. Permits comparison of reference ST complex with another, more recent complex • Click on Save Ref. Ref. ON/OFF Allows visual comparison of a stored reference QRS complex to current complex • Click on Ref. On/Off toggle button. (Current complex is green and the reference complex is purple.) Change ISO point • Click on the arrow buttons in the lower left of the screen and scroll to the desired setting. The number next to ISO point is the time before QRS onset. A green vertical line marks the point at which the ISO point intersects the ECG waveform. A marker is put into the ST trend graphs and an entry is stored in the clinical events log. If you move the trend cursor over the marker, the label HG appears. The setting changes in 4 ms increments each time you click on the arrows. • Click on the arrow buttons in the lower right of the screen and scroll to the desired setting. The ST deviation point is set from the QRS offset to the end of the displayed ECG complex (including the T-wave). When you change the Measurement Point, the ST deviation is recomputed and the current value is displayed. A marker is put into the ST trend graphs and an entry is stored in the clinical events log. If you move the trend cursor over the marker, the label CHG appears. The setting changes in 4 ms increments each time you click on the arrows. Change ST Deviation Measurement Point Default: -28 ms. Default: 60/80 ms. • Click on Set Points to change settings or Undo to keep previous selections. NOTE: You can change ST settings for telemetry patients at the Infinity CentralStation, but changes for bedside patients must be done at the bedside monitor. 12-8 Infinity CentralStation VF8 Telemetry ST Setup Screen Telemetry ST Setup Screen Use the telemetry ST Setup screen to customize a telemetry patient’s ST setup. For bedside patients, please refer to the specific monitor documentation. Accessing the Telemetry ST Setup Screen A patient’s ST Setup Screen differs according to transmitter monitoring mode. 1. Open the patient’s Bed View screen. 2. Click on Setup in the Bed View menu bar. 3. Click on Telemetry. 4. Click on ST. Transceiver Bed View ST Setup Selections Selection 3-/5-wire Monitoring 6-wire Monitoring ST Lead 1 - 7 None, I, II, III, None, I, II, III, aVR, aVL, aVR, aVL, aVF, Note: In 3-wire V, V+ monitoring mode, aVF, V ST Lead 1 is set to Lead II and ST Leads 2 - 7 are set to NONE. ST Lead 9 - 14 Event Duration Settings are ghosted and set to None TRUST 12-Lead Monitoring Description None, I, II, III, aVR, aVL, aVF, 2 chest leads (V1 - V6), 4 reconstructed leads (dV1 dV6), STVM, STCVM Sets displayed lead order in the Bed View parameter boxes • Click on the desired ST Lead x option button and scroll to a lead setting. 15, 30, 45, 60, 75, 90, 105, and 120 seconds For Infinity M300 this is fixed at 60 seconds. Restore System See Chapter 5 Defaults for details on ST default settings. Specifies the time that an ST alarm condition must persist before it is classified as a valid alarm • Click on Restore System Defaults. • Click on Accept to change settings or Undo to keep previous selections. VF8 Infinity CentralStation 12-9 12: Telemetry ST Analysis Option ST Alarms An ST alarm occurs when the ST deviation measurement for any lead violates the set alarm limits for the user-selected duration (page 12-9). An ST alarm is cleared if the majority of intervals following the alarm are within the specified limits. ST alarms are subject to the same alarm guidelines as any other parameter. Refer to Chapter 13 for information on setting up the various alarm functions. ST Alarm Messages The following alarm messages pertain specifically to ST parameters, and are displayed in the status area in Main Screen and in the top waveform channel in Bed View. In addition, the parameter areas display an abbreviated message in the appropriate parameter field. Please note that the ‘x’ next to the ST label (e.g. in the message STx:***) is a place holder for the actual ST lead. Message Alarm Grade Description Action STx > UL SER Value exceeds upper alarm limit. • Check the patient. • Reset alarm limits. STx: STx < LL SER Value is below lower alarm limit. • Check the patient. • Reset alarm limits. STx: +++ STx OUT OF RANGE (HIGH) SER Value exceeds upper measuring range. • Check the patient. • Reset alarm limits. STx - - - STx OUT OF RANGE (LOW) SER Value is below measuring range. • Check the patient. • Reset alarm limits. STx: ST x CANNOT LEARN Algorithm cannot determine ST values. • Check the electrodes Relearn ECG RELEARNING ARR/ST morphologies are being relearned. • Wait until the relearning process is finished. Parameter Area Status/ Information Area STx: 12-10 Infinity CentralStation VF8 13 Alarms Overview.......................................................................................................................13-2 Alarm Validation ....................................................................................................13-2 Alarm Grades ...............................................................................................................13-3 Latching alarms.....................................................................................................13-4 Non-latching Alarms .............................................................................................13-4 Visual and audible Alarm Signals........................................................................13-4 The Surveillance Feature ............................................................................................13-5 Display of Surveillance Alarm Messages ...........................................................13-5 Audible Alarm Signals ..........................................................................................13-5 Special Surveillance Alarm Conditions ..............................................................13-6 MIB Ventilator Alarms .................................................................................................13-6 Alarm Groups...............................................................................................................13-6 Silencing Alarms..........................................................................................................13-7 Silencing Local Alarms.........................................................................................13-7 Configuring a Patient’s Alarm Setup .......................................................................13-10 Opening the Alarm Limits Setup Screen .................................................................13-11 Pausing Alarms ...................................................................................................13-11 Changing a Parameter’s Alarm Limits ..............................................................13-12 Automatic Alarm Limits Selection (Auto Set)...................................................13-13 Turning Alarm Recordings ON/OFF ..................................................................13-13 Turning Event Storage On/Off ...........................................................................13-14 13: Alarms Overview The Infinity CentralStation is the primary alarm annunciator for telemetry patients; for bedside patients the bedside monitor is the primary alarm annunciator. For Telemetry patients, the Infinity CentralStation issues visual and audible alarm signals for the following: HR, SpO2, PLS, ST, NIBP (Infinity Telemetry only) and arrhythmia event parameters and associated technical conditions, Physiological conditions that are detected by the algorithms, Technical network events, and Infinity CentralStation or telemetry system error conditions. For patients connected to Bedside Monitors and MIB-connected devices, all alarm signals are sent to the Infinity CentralStation for display and broadcast. WA R N I N G ! F o r p r i m a r y m o n i t o r i n g a n d d i a g n o s i s o f b e d s id e pa t i e nts , u s e t h e b e d s i d e m o n i t or. U s e t h e I n f i n i t y C e n t r a l Sta t i o n o n l y f o r r e m o t e a s s e s s m e n t o f a pa t i e nt ’s s ta t u s . The Infinity CentralStation can report surveillance alarm messages for life-threatening and active serious alarms of any bedside monitor within the monitoring unit even though it is not assigned to its current Main Screen. (see 13-5) Alarm Validation Infinity Telemetry: The Infinity CentralStation generates an alarm when a parameter remains outside alarm limits longer than an assigned delay time. If the limit violation ceases within the delay time, no alarm occurs. 13-2 Parameter Upper Limit Alarm Delay Lower Limit Alarm Delay HR 2 seconds no delay SpO2/SpO2* 4 seconds 4 seconds ΔSpO2 no delay N/A PLS/PLS* 4 seconds no delay ST (telemetry patients) user-defined (12-9) user-defined (12-9) Infinity CentralStation VF8 Alarm Grades Infinity M300 NOTE: The Alarm delay time from an Infinity M300 device to the Infinity CentralStation is < 4 seconds. Parameter Upper Limit Alarm Delay Lower Limit Alarm Delay HR 6 seconds 6 seconds SpO2 6 seconds 10 seconds PLS 6 seconds 10 seconds ST 60 seconds 60 seconds NOTE: If communication is interrupted between the network and the Infinity M300 device, monitoring will continue locally and the Infinity M300 automatically sets its volume to 100%. Any alarms that are active at the time the Infinity M300 lost connection and all future alarms will be annunciated locally. If there is an active alarm while Infinity M300 has lost connection with the Infinity CentralStation, the display will not shut off despite the Infinity CentralStation Display Shut Off Timer setting (page 16-15). You can not shut off the display manually unless the alarm is paused. For bedside monitor alarm delays, see the applicable monitor Instructions for Use. Alarm Grades All alarms are classified according to three alarm grades: Life-threatening Serious Advisory Each alarm grade has its own unique tone and color scheme (13-5). Depending on the seriousness of the alarm condition, alarms are either Latching or Non-latching. NOTE: If several alarms are simultaneously active for a single patient, the Infinity CentralStation reports the highest grade active alarm (alarm that has not been silenced and whose condition remains valid). VF8 Infinity CentralStation 13-3 13: Alarms Latching alarms Latching alarms indicate either life-threatening or serious conditions such as an asystole or a ventricular fibrillation. Life-threatening alarm audible and visual indicators continue (even if the alarm condition is no longer valid) until the alarm is manually acknowledged. Serious alarms behave similarly, except that only the visual alarm indicators continue until you acknowledge the alarm. NOTE: A latching alarm is cleared if another life-threatening or serious alarm occurs for the same parameter. Non-latching Alarms Non-latching Alarms indicate advisory conditions and continue for as long as the event exists. The visual and audible alarm signals stop automatically when the alarm condition ends. You can also silence non-latching alarms manually (13-7). Visual and audible Alarm Signals Life-threatening (e.g. asystole, ventricular fibrillation) first or highest priority Serious (limit violation) second priority Advisory (e.g. network events, bedside events such as lead-off) third or lowest priority Alarm Indication in Main Screen Entire parameter area flashes red. Entire parameter area flashes yellow. Entire parameter area flashes white. Alarm Indication in Bed View Parameter area of respective parameter flashes red. Parameter area of respective parameter flashes yellow. Parameter area of respective parameter flashes white. Alarm Tone Two-tone, high pitched, rapid tone Two, medium-pitch, short tones followed by a pause Short, single, low-pitch tone every 10 seconds Message Location in Main Screen Message displays in red Message displays in in top waveform channel. yellow in top waveform channel. Message displays in white in top waveform channel. Message Location in Bed View Message displays in red in information area. Message displays in yellow in information area. Message displays in white in information area. Message displays in parameter area and tone continues until alarm is acknowledged. Message stays in waveform area until alarm is acknowledged. Alarm Grade and Priority Latching behavior 13-4 Infinity CentralStation VF8 The Surveillance Feature The Surveillance Feature This feature provides alarm messages for life-threatening and serious alarms to bedside monitors that are not currently assigned to the Infinity CentralStation Main Screen but are located within the same monitoring unit. Display of Surveillance Alarm Messages All surveillance alarm messages overwrite the date/time field of the Main Screen status area. A surveillance alarm message includes the bed label and alarm grade. If the surveillance alarm is for a wireless bedside monitor an icon precedes the alarm message. Message background colors vary with alarm grade and status. Alarm Grade Status Background Color Life-threatening Alarm condition is valid and the alarm has not been silenced at the bed. Flashing red Alarm condition is no longer valid but the alarm has not been silenced at the bed. Serious Alarm condition is valid and the alarm has been silenced at the bed. Solid red Alarm condition is valid and the alarm has no been silenced at the bed. Flashing yellow Alarm condition is valid and the alarm has been silenced at the bed. Solid yellow Multiple Alarm Situations/Priorities If several beds issue surveillance alarms the alarm messages display alternately for three seconds at the Infinity CentralStation. Audible Alarm Signals The Infinity CentralStation sounds the latest alarm condition with the highest priority. Audible alarm signals accompanying surveillance alarms act the same as other alarms (13-4). Silencing Surveillance Alarms A surveillance alarm continues until it is either acknowledged or the alarm condition ceases.You can silence the audible alarm signal of a surveillance alarm locally by clicking on Alarm Silence in the Main Screen menu bar or by pressing F1. VF8 Infinity CentralStation 13-5 13: Alarms Special Surveillance Alarm Conditions Condition Effect on surveillance alarm Bedside CPS/IDS goes offline or fails while a surveillance alarm for that bed is reported at the Infinity CentralStation. Surveillance alarm is canceled at the bedside. A bedside monitor goes offline or fails while a surveillance alarm for that bed is reported at the Infinity CentralStation. The bedside CPS/IDS or monitor changes to standalone mode. The bedside CPS/IDS or monitor detects that it has the same IP address as another device on the network. Monitor is removed from the network. Surveillance alarm is canceled. MIB Ventilator Alarms For MIB-connected ventilator events, the Infinity CentralStation provides alarm messages which are accompanied by a serious alarm tone. However, not all ventilator messages are reported at the Infinity CentralStation. MIB ventilator alarms are described in detail in Chapter 17. The most recent MIB ventilator alarm message appears in the patient’s top waveform channel in orange on the Main Screen. In Bed View the MIB ventilator alarm message appears in the information area in orange. MIB ventilator alarm messages are non-latching. If a patient experiences multiple alarm conditions simultaneously, the messages rotate. Unlike other Bed View parameters, the parameter boxes of MIB ventilator parameters do not blink while in alarm. Alarm Groups Use an alarm group to configure monitors and telemetry patients to display their highest grade active alarm at each device in the alarm group. If multiple beds in the alarm group detect an alarm, each corresponding alarm message briefly rotates along the bottom of the screen on each device. To assign a telemetry channel to an alarm group, see 5-3. For bedside patients, you must set the alarm group at the bedside monitor. (Refer to the monitor Instructions for Use.) 13-6 Infinity CentralStation VF8 Silencing Alarms Silencing Alarms The Audio Pause (1 min) function clears all audible and visual alarm indicators for life-threatening and serious latched alarms (13-4). This function also suspends audible signals for life-threatening and serious alarms associated with conditions that are still valid for one minute. There are two ways to silence alarms. Local Audio Pause (1 min) • Silences active alarms for all local patients at the Infinity CentralStation for 1-minute. Bed Audio Pause • Silences active alarms for an individual bedside patient at the Infinity CentralStation and at the bedside monitor for 1-minute, when the Bed Audio Paused function is enabled at the Infinity CentralStation (4-3). • Silences alarms for an individual local telemetry patient. NOTE: The Audio Pause (1 min) function also deactivates one-time alarms. The Audio Pause (1 min) button does not remain selected if it has deactivated a one-time alarm. Also, you cannot deactivate the Audio Pause (1 min) state by clicking on the Audio Pause (1 min) button again. If a new alarm occurs while an alarm is silenced, the Infinity CentralStation announces the new alarm. Silencing the new alarm resets the timer for all previously silenced alarms for another minute. The Audio Paused timer for Infinity M300 is 2 minutes. When the Infinity M300 is already in the Audio Pause state, if you press the Audio Pause button again at the Infinity CentralStation, the Audio Pause state will be cancelled. After the Audio Pause (1 min) period expires, the alarm tone resumes if the alarm condition still exists. Visual alarm indicators are also reactivated. Silencing Local Alarms To silence all active local alarms (telemetry, bedside, and MIB alarms) at the Infinity CentralStation for one minute: Click on Audio Pause (1 min) in the Main Screen menu bar, or Press the F1 fixed key. A local Audio Pause (1 min) has the following consequences: VF8 The alarm tone stops for all active alarms at the Infinity CentralStation for one minute. The affected parameter area continues to flash in the color of the highest grade alarm. Infinity CentralStation 13-7 13: Alarms For latched alarms all audible and visual signals are removed. Alarm messages and the Audio Pause (1 min) icon remain displayed. The orange ventilator MIB Alarm Tone icon remains displayed (for an MIB alarm). The Audio Pause (1 min) button remains selected. After the Audio Pause (1 min) period expires, the alarm tone resumes if the alarm condition is still valid. In contrast to a local Audio Pause (1 min), which silences all active alarms at the Infinity CentralStation only, a Bed Audio Pause silences all alarms for an individual patient at the Infinity CentralStation and at the bedside. From Main Screen Click on the yellow Audio Pause (1 min) icon which appears during an alarm in the patient’s waveform channel. If the icon appears ghosted for a bedside patient, the required Audio Pause (1 min) function has not yet been enabled at the Infinity CentralStation (4-3) or the patient is outside the monitoring unit in which case you cannot silence the alarm. Click on the orange alarm tone icon located in the lower right hand corner of the waveform channel to silence ventilator and MIB alarm tones. From Bed View Click on Audio Paused button in the Bed View menu bar. NOTE: You cannot silence MIB ventilator alarms in Bed View. The button appears ghosted. Silencing a bedside alarm has the following consequences: 13-8 silences all active alarms for an individual bedside patient at the bedside monitor and at the Infinity CentralStation. This function is only available for bedside patients within the monitoring unit of the Infinity CentralStation server whose Bed Silence function is enabled (4-3). silences all active alarms for an individual local telemetry patient at the Infinity CentralStation. freezes the visual alarm indicators in the color of the highest grade active alarm. Infinity CentralStation VF8 Silencing Alarms After the Audio Paused period expires, the alarm tone resumes if the alarm condition is still valid. Also, the visual alarm indication is reactivated. NOTE: Bed Audio Paused does not affect the Audio Paused state of other patients or any other local alarms that may be present at the Infinity CentralStation. It only silences the alarms of the selected patient. VF8 Infinity CentralStation 13-9 13: Alarms Configuring a Patient’s Alarm Setup The Setup - Alarm Limits screen appearance varies depending on the parameters monitored. To adjust alarm tone see 4-3. Setup - Alarm Limits Screen Illustration 13-10 Parameter row in Configuration mode Opens Arrhythmia Setup screen Restores system default settings (only available on telemetry patient screen) Resets alarm limits to automatically calculated values (13-13) Infinity CentralStation VF8 Opening the Alarm Limits Setup Screen Opening the Alarm Limits Setup Screen 1. Open the patient’s Bed View screen. 2. Click on Setup in the Bed View menu bar. 3. Click on Alarm Limits... Pausing Alarms Telemetry Patient 1. Open the patient’s Bed View screen. 2. Click on Alarm Paused in the Bed View menu bar. After you click on Alarm Paused, all current Active alarms clear and additional alarm events are suppressed for a predefined time (pages 5-3 and 6-3). During the Alarm Paused time period, the banner ALARM PAUSED and time remaining for the pause displays. For Infinity Telemetry only, the user can set the Alarm Pause function to “No Time Out”. In this case the banner will say ALL ALARMS OFF instead. Bedside Patient 1. Open patient’s Alarm Limits Setup screen (13-11). 2. Click on the parameter whose alarm you wish to turn on/off. The parameter row changes to Configuration Mode. 3. Set the On/Off toggle button in the All Alarms column. 4. Click on OK. 5. Repeat steps 2 through 4 for additional parameter alarms. NOTE: When a parameter alarm is OFF, all parameter settings in the table row display in yellow and a crossed bell icon appears in the All Alarms column. VF8 Infinity CentralStation 13-11 13: Alarms Changing a Parameter’s Alarm Limits 1. Open patient’s Alarm Limits Setup screen (13-11). 2. Click on the parameter whose alarm limits you wish to change. The parameter row changes to Configuration Mode. 3. Click on the up/down arrows in the Upper Limit and Lower Limit columns to set limits. 4. Click on OK. 5. Repeat steps 2 through 4 for each parameter. Alarm Limit Ranges for Telemetry Patients Parameter Patient Category Upper Limit Range Default Lower limit range Default HR Adult 20 − 300 bpm 120 bpm 15 − 295 bpm 45 bpm Pediatric 50 − 150 bpm 150 bpm 50 − 150 bpm 50 bpm Adult 21 − 100% 100% 20 − 99% 90% Adult 35 − 250 bpm 120 bpm 30 − 245 bpm 45 bpm Pediatric 50 − 150 bpm 150 bpm 50 − 150 bpm 50 bpm Adult -1.49 − +1.5 mV +2.0 mV -1.5 − +1.49 mV -2.0 mV Pediatric -14.9 − +15.0 mm 20.0 mm -15 − +14.9 mm -20.0 mm Adult 1 − 60 10 SpO2 Pediatric PLS ST PVC/min Pediatric Alarm Limit Ranges for Bedside Patients Refer to the bedside monitor Instructions for Use. 13-12 Infinity CentralStation VF8 Opening the Alarm Limits Setup Screen Automatic Alarm Limits Selection (Auto Set) Parameter Upper Limit Lower Limit SpO2 105% of current value 95% of current value PVC/min N/A N/A HR, PLS 125% of current value 80% of current value ST Current value plus absolute value of upper alarm limit default setting Current value minus absolute value of lower alarm limit default setting NOTE: change. If there is no current value for the parameter, the alarm limits do not Initiating an AutoSet As soon as you click on Auto Set, the alarm limits for all monitored parameters are replaced. There is no confirmation process. 1. Open patient’s Alarm Limits Setup screen (13-11). 2. Click on Auto Set. NOTE: If a parameter value is outside the limit range during the Auto Set, alarm limits are not changed for that parameter. The automatically calculated alarm limits can be manually replaced at any time (13-12). Turning Alarm Recordings ON/OFF To configure timed recordings, see 4-5. 1. Open patient’s Alarm Limits Setup screen (13-11). 2. Click on the table row of the parameter whose alarm recording function you wish to change. The parameter row changes to Configuration Mode. 3. If the last column heading is ‘Record’, select ON or OFF by clicking on the toggle button If the last column heading is ‘Alarm Archive, click on the desired selection. 4. Click on OK. 5. Repeat steps 2 through 4 for each parameter. VF8 Infinity CentralStation 13-13 13: Alarms Special Conditions What happens if... Effect on alarm recording function an alarm is re-activated (e.g., an alarm condition is valid beyond the Alarm Silence state) A new alarm recording is not generated. an alarm is silenced during an alarm recording or pending recording All alarm -progress and pending recordings are printed completely. a parameter’s alarm function is turned off Alarm recording is still generated provided the alarm recording function is turned on. an alarm waveform is activated in the Telemetry Recording Setup screen (5-8) 1 The waveform associated with the alarm parameter is printed in the bottom channel of the strip recording (instead of the waveform assigned to that channel). This function only pertains to telemetry patients. Turning Event Storage On/Off When a parameter’s storage and alarm functions are turned on, waveforms are stored automatically at the bedside for each validated alarm condition. 1. Open patient’s Alarm Limits Setup screen (13-11). 2. Click on the table row of the parameter whose alarm recording function you wish to set up. The parameter row changes to Configuration mode. 3. Click on the arrow buttons in the Alarm Archive column and scroll to STORE. 4. Click on the OK button. 5. Repeat steps 2 through 4 for each parameter. Special Conditions What happens if... Effect on alarm storage function an alarm is reactivated (e.g., when alarm condition is valid beyond the Alarm Silence state) A new alarm waveform is not stored. the alarm waveform is activated in the Telemetry Recording Setup menu1 The waveform associated with the alarm parameter is stored in the bottom channel (instead of the waveform assigned to that channel). This function only pertains to telemetry patients. 13-14 Infinity CentralStation VF8 14 Recordings / Reports Overview ......................................................................................................................14-2 Laser Printers...............................................................................................................14-2 Processing of Strip Recordings .................................................................................14-3 Active Recordings.................................................................................................14-3 Pending Recordings .............................................................................................14-3 Requesting a Remote Recording.........................................................................14-3 Recorder Setup ............................................................................................................14-4 Replacing the Recorder Paper .............................................................................14-4 Setting up a Recording .........................................................................................14-4 Recording Types..........................................................................................................14-5 Timed Recordings .................................................................................................14-6 Continuous Recordings .......................................................................................14-9 Reports .......................................................................................................................14-10 Simultaneous ECG Report .................................................................................14-10 Full Disclosure Strip Report...............................................................................14-11 Full Disclosure Hour Report ..............................................................................14-11 Full Disclosure 24 Hour Report .........................................................................14-11 Event Disclosure Strip Reports .........................................................................14-11 Shift Report..........................................................................................................14-12 Graphical Trend Report ......................................................................................14-17 Selected Strip Report..........................................................................................14-17 Selected Events Report ......................................................................................14-17 ECG Caliper Report.............................................................................................14-18 Ventilator Report .................................................................................................14-19 Requesting Recordings and Reports ......................................................................14-22 Canceling a Recording..............................................................................................14-25 Actions that Affect Recordings ................................................................................14-26 Recording Status Messages ...................................................................................14-27 14: Recordings / Reports Overview WA R N I N G : I f y o u r e q u i r e a d i a g n os t i c q u a l i t y r e c o r d i n g y o u m u s t u s e a R e s t E C G R e p o r t ( pa g e 1 8 - 7 ) . U s i n g a n y r e c o r d i n g other than Rest ECG Report may lead to misdiagnosis. From the Infinity CentralStation you can request several types of recordings/reports on the following recorders and printers: R 50/R 50-N recorders on the network NOTE: The R50 recorder should always be installed and configured as part of the Infinity M300 system. An optional network laser printer NOTE: All Telemetry ECG recordings and reports are filtered at a bandwidth of 0.5 - 40 Hz. For the filtering bandwidth of a bedside patient’s ECG recording/report, see the bedside monitor Instructions for Use. When you request a recording for a bedside patient at the Infinity CentralStation, the request is sent back to the bedside monitor for printing on a recorder assigned at that monitor. For telemetry patients, recordings are printed at the recorder assigned to the local Infinity CentralStation (page 4-5). If an assigned recorder is unavailable at the time of a recording request, the request (or recorded data) is stored and executed as soon as the recorder becomes available. If the Full/Event Disclosure and/or VentCentral options are enabled, you can also print a variety of reports on a laser printer. Status messages in the Main Screen status area indicate when a request is accepted, canceled, or rejected. See page 7-13 for a list of Status messages. Laser Printers A laser printer can print Infinity CentralStation screens and reports. Refer to the manufacturer’s operating instructions for specific information regarding the use of your particular type of laser printer. 14-2 Infinity CentralStation VF8 Processing of Strip Recordings Processing of Strip Recordings A recording request can generate an active or pending recording. Active Recordings If a recorder is available and no pending recordings of higher priority exist, the recording begins printing immediately. If a recording is interrupted and another recorder is available, the complete recording is rerouted and printed at the available recorder. If no recorder is available, the recording or request becomes a pending recording and is added to the top of the pending recording list. Pending Recordings If no recorder is available to process a print request, the data or recording request is stored until it can be printed. NOTE: The actual data of a timed recording is stored, then printed. For a continuous recording only the request is stored; the data is that which is current at the actual print time. Pending recordings are stored on a first-in, first-out basis. As soon as the buffer is full, the oldest request is deleted. The buffer can store the following number of recordings for each patient: two manually requested timed recordings one continuous recording one automatic recording (alarm or event recording) Requesting a Remote Recording Other Infinity Central Stations within the same monitoring unit can request recordings of local patients. These requests use the recording attributes of the remote device. VF8 Infinity CentralStation 14-3 14: Recordings / Reports Recorder Setup The R 50 and R 50-N recorders have two buttons: The mm/s button on the recorder’s front panel (Alternate Speed on older recorders) The Alternate Speed button allows you to change the recording speed while a recording is in progress. The recorder stops briefly and then restarts automatically at the new recording speed. The Stop button stops a recording in progress. Replacing the Recorder Paper 1. Open the paper door and remove the empty paper roll and any paper remaining in the printing mechanism. 2. Place a new paper roll with printed side facing up into the spool holder. Unroll a few inches of paper from the bottom. 3. Align the paper roll with the paper guides, and close the door. (If not aligned properly, the paper may jam.) 4. Generate a timed recording to verify that the recorder is connected properly, and the paper is loaded correctly. Setting up a Recording For general recording setup attributes, see page 4-5. For telemetry-specific recording setup information see page 5-8. 14-4 Infinity CentralStation VF8 Recording Types Recording Types Recording Type Priority Description Alarm recording override Continuous recording A strip recording that runs until interrupted manually (generated from Infinity CentralStation). A continuous recording request will cancel any alarm recording in progress. Alarm recording A timed recording generated automatically in response to a limit violation for a parameter whose recording function is enabled. • If a second alarm recording is requested within 5 seconds of the first, the second request is ignored if the alarm grade is an equal or a lower alarm grade (e.g. if the first is a lifethreatening and the second is a serious alarm). • If the second alarm recording is a higher alarm grade, the first recording is canceled and the second is printed. • If the second request occurs 5 seconds after the first, both recordings are either printed or are stored and printed later. Timed recording (Manual) A strip recording that consists of delay and real-time data and runs for a specified time (generated from or Infinity CentralStation). Event recording A timed recording that is generated automatically in response to an occurrence of an arrhythmia event whose recording function is enabled. VF8 Infinity CentralStation 14-5 14: Recordings / Reports Timed Recordings Timed recordings are strip recordings of a specified duration. They contain delay data originating before the recording is initiated and real-time data acquired after the recording started. NOTE: If the patient was monitored for less time than the specified delay, the amount of delay data is adjusted accordingly. If no delay data is available at the recording request time, that part of the printed waveform is blank. Timed recordings consist of up to two waveforms. For a waveform to be printed, it must first be displayed. Pressure waveforms are recorded in either Standard or Pressure Overlap mode, depending on their configuration at the bedside monitor (see Instructions for Use for specific bedside monitor). The size of the printed waveforms is identical to the screen display. Manual vs. Automatic Recordings Timed recordings are either requested manually or generated automatically when a parameter or arrhythmia event occurs whose recording function is enabled. For detailed information on how to enable/disable an event’s/parameter’s automatic recording function, see page 10-5 and page 13-13. An alarm strip recording is the same as one manually requested except that it has a different recording type in the header. Telemetry Recordings All alarm-generated telemetry strip recordings ignore Manual timed settings and use the following fixed settings. Duration: 20 seconds Delay: 10 seconds Speed: 25 mm/sec Header Information The header along the top of the recording contains a diagnostic code, information about the patient, the recorder settings, the monitor, and the monitored parameters. It also shows the values and Alarm Silence indicators that are valid at the time of the recording request. 14-6 Infinity CentralStation VF8 Recording Types Timed recording with header Patient Name Recorder label Patient ID Recording type: CENTRAL TIMED, CENTRAL CONT., alarm string for alarm recording, arrhythmia label for event recording Bed Label 10 Diagnostic Code (page 14-8) Date of recording request 11 Alarm Silence indicator Time the recording was printed 12 Parameter value at the time of the request Selected delay 13 3-Second interval markers Selected recording speed VF8 Infinity CentralStation 14-7 14: Recordings / Reports Diagnostic Code Digit Possible Values Description Lead processed for VF and pacer pulse rejection ECG filter Pacemaker detection QRS/ARR processing Patient category/QRS classification Leads available for processing VT count VT rate 0-A SVT count 3-A 10 SVT rate 0-A 14-8 5-F Definition None II III aVR aVL aVF V+ V1 V2 V3 V4 V5 V6 dV1 dV2 dV3 dV4 dV5 dV6 Monitor Off ESU On - Artifact Rejection Off - Artifact Rejection ECG1 & ECG2 ECG1 Adult, neither lead completed learning Adult, ECG1 lead completed learning Adult, ECG2 lead completed learning Adult, ECG1&2 lead completed learning Neonate No valid lead to process ECG1 is valid to process ECG2 is valid to process ECG1 & ECG2 are valid to process Value = VT count (where A-F corresponds to 10-15) Value = (VT rate - 100)/10 (where A corresponds to 10) value = SVT count (where A corresponds to 10) value = (SVT rate - 100)/10 (where A corresponds to 10) Infinity CentralStation VF8 Recording Types Possible Values Digit Description 11 TACH count 5-F 12 TACH rate 0-A 13 BRDY rate 0-F 14 PAUS rate 0-5 15 HR source 16 RESP mode 17 RESP size 1-K 18 Minutes since breath detector initialization 20 21 Not used Monitor model 00-99 xxxxx (ASCII) 22 - 26 Software version Definition value = TACH count (where A-F corresponds to 10-15) value = (TACH rate - 100)/10 (where A corresponds to 10) value = (BRDY rate - 30)/5 (where A-F corresponds to 10-15) value = (PAUS rate - 1.0)/0.5 (where A-F corresponds to 10-15) ECG is HR source IBP (AP) is HR source SPO2 is HR source RESP monitoring off Manual Automatic value = (RESP size)/5 (where A-K corresponds to 10-20) Number of minutes that have elapsed since the breath detector was initialized. (where 99 corresponds to ≥ 99 minutes) SC 9000 Delta/Delta XL/Kappa/GammaX XL SC 6000 Gamma/Gamma XL/Vista Infinity ACS Infinity Telemetry Infinity M300 First five characters of base software (for example, VA1-1) Continuous Recordings Continuous recordings run until stopped manually and can only be generated for an individual patient. They consist of up to two waveforms which are printed the same size as those displayed. Pressure waveforms are recorded in either Standard or Overlapped mode, depending on selected bedside monitor setting. Header Information Continuous recordings contain a header, which is identical to that of timed recordings, except that the recording type data is different and there is no data for DELAY TIME. VF8 Infinity CentralStation 14-9 14: Recordings / Reports Reports Depending on the configuration of your Infinity CentralStation, the following reports can be generated. Simultaneous ECG Report Full Disclosure (Strip, Hour, 24-Hour, Shift, Selected Strip, Graphical Trend, Patient Status, and Caliper Reports) Event Disclosure (Strip, Graphical Trend, Shift, and Selected Events Reports) VentCentral Reports Reports are processed and printed even if you leave the respective application. Pacer marks, Pacemaker identifiers, and time change indicators are printed where applicable. All printed reports include the following: Header Footer Report Title COMMENTS area for handwritten comments Patient Name Page Number and Total Number of Pages (e.g. Page 1 of 3) Patient ID Date area (for dating signature) Date of Birth Signature area Care Unit Label Bed Label Admit Date Pacer/ICD/PCD Identifier Report Start Time Report Stop Time Duration Simultaneous ECG Report A simultaneous ECG Report for any patient monitored by the Infinity CentralStation can be printed from the patient’s Bed View. The report includes three 4 x 2.5 second 25mm per second ECG waveforms for each lead (up to 12), one 10 second ECG waveform for lead II, and ST values for each lead. This is a Non-Diagnostic report. To request a Simultaneous ECG Report see page 14-22. 14-10 Infinity CentralStation VF8 Reports Full Disclosure Strip Report The Full Disclosure strip report prints the screen-displayed waveforms. A report page may contain a 2-channel strip, each twenty seconds long with data centered around the cursor time. To request a Full Disclosure strip report, see page 14-22. Full Disclosure Hour Report The Hour Report consists of up to three user-selectable waveforms in a compressed format of one minute per row. There are 60 minutes of data per page. Each data channel produces one report page. Data is captured 30 minutes before cursor time. To request this report, see page 14-22. Full Disclosure 24 Hour Report The 24 Hour Report is similar to the Hour Report except that it prints 24 hours of data (24 pages). The end time is the cursor time and data is collected 24 hours before that time. The report supports one waveform selection from one of three channels (Channel 1 is the default). To request this report, see page 14-22. Event Disclosure Strip Reports An Event Disclosure strip report contains 20 seconds of data centered around the time of the event. It also includes event class label, time, date, and the ECG lead on which an event is detected (if applicable). To request this report, see page 14-22. VF8 Infinity CentralStation 14-11 14: Recordings / Reports Shift Report You can request a 2, 4, 8, 12, or 24 hour shift report from Full or Event Disclosure. From either application the cursor time represents the report ‘stop time’. The report ‘start time’ equals ‘stop time’ minus the selected report length. The shift report has four sections: Shift Report Section Description / Contents Maximum pages Shift Report Cover • • • • Header Three waveform channels (10 seconds each) Comments/signature/date field Footer One Patient Status • • • • • • • • • Header Hr (calculated from trend data) Bradycardia Pacemaker Ventricular and Supraventricular Ectopics S-T Deviation Caliper Results Latest Alarm Event (within alarm categories) Footer One Graphical Trends • Header • Trend graphs • Footer Two • Header • Event strips (10 seconds each) with annotations • Footer Three Selected Events (6 trends/page) (4 events/page) NOTE: 14-12 You must select each event on the report. Click on the icon check mark displays on the icon (page 16-8). You can select up to 12 events that occurred before the request time. The parameter values at the time of the event appear at the top of each strip. Event selections are saved through program resets and power losses. Infinity CentralStation so that a VF8 Reports Shift Report Cover Cursor time minus selected report length (2, 4, 8, 12, 24 hrs) Delay Recording Speed Patient information Each waveform contains 5 seconds of pre-event data and 5 seconds of real-time data. VF8 Infinity CentralStation 14-13
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