GE Medical Systems Information Technologies 2014748-002 Medical Telemetry Transmitter User Manual

GE Medical Systems Information Technologies Inc. Medical Telemetry Transmitter

Manual Draft1 Part 7

7-2 ApexPro™ 2001989-301A- draft 1Viewing real-time patient dataReal-time patient viewsYou can view real-time data for patients located in your care unit, and when networked with other CIC Pro centers, you may also view real-time data for patients located outside of your care unit.The CIC Pro center allows you to view real-time patient data from two different patient viewers. Each viewer provides a different level of data granularity:Multi-patient viewerSingle patient viewerCAUTIONTREATMENT — Do not treat a patient based solely on the alarm messages and/or numerics presented via the connectivity device to the monitor. You must verify the accuracy of the alarm message and/or numerics at the peripheral device itself before initiating treatment. Treatment should be based on the information presented at the peripheral device.Data synchronizationInformation displayed on the ECG tab sheet is synchronized with the source (transmitter) every two seconds. If differences are detected, the display is refreshed with new patient data.Multi-patient viewerThe multi-patient viewer displays a snapshot of real-time parameter data for a maximum of 16 patients. You can do the following real-time tasks from the multi-patient viewer:View abbreviated real-time patient data. View a snapshot of real-time Graphic Trends data for a maximum of two different parameters. See Configuring the real-time trend window on page 7-6.Print parameter limits or waveform data for all patients in the care unit. See Printing parameter limits or waveforms for all in-unit patient beds on page 7-9.View a single patient’s detailed real-time parameter data. See Single patient viewer on page 7-3.View a single patient experiencing an alarm condition. See Viewing in-unit patients experiencing an alarm condition on page 7-5.Admit or discharge a patient. See Chapter 6.View beds outside your care unit. See Out-of-unit patient beds on page 7-6.Silence all alarms. See Silencing alarms on page 5-7.The multi-patient viewer displays menu bar options similar to the following:Draft
Viewing real-time patient data2001989-301A- draft 1 ApexPro™ 7-3059ASingle patient viewerThe single patient viewer displays detailed real-time parameter data for a selected patient. You can complete the following tasks from the single patient viewer:View detailed real-time parameter data.View, change, or print Alarm Control or parameter control settings for any in-unit patient. These changes are also adopted by the monitor. See Adjusting alarm control settings on page 5-8. See Adjusting parameter control settings on page 7-11.View Alarm Control or parameter control settings for out-of-unit patient beds on the Unity Network. See Adjusting alarm control settings on page 5-8. See Adjusting parameter control settings on page 7-11.Multi-patient viewer menu bar optionsOption FunctionAuto Display When enabled, the Auto Display button is selectable from the menu bar. Clicking the Auto Display button while viewing the multi-patient viewer automatically completes the following tasks:Removes any un-locked, unoccupied beds.Adds at least one empty patient window with an Admit button.Resizes the remaining patient windows to maximize the amount of displayed patient data.View Other View any patient bed on the Unity Network that is inside or outside of the care unit, floor, or hospital. See In-unit patient beds on page 7-5. See Out-of-unit patient beds on page 7-6.CIC Setup View the CIC Pro center default settings. You can customize some of the user-level defaults. See Customizing the system on page 4-4.Silence Alarms Silence audible alarm tones for one minute. See Silencing alarms on page 5-7.Graph All Print the parameter limits or the waveform data for all patients in the care unit.Browser Access stored patient data from the web access server.Draft
7-4 ApexPro™ 2001989-301A- draft 1Viewing real-time patient dataNOTEYou cannot change the Alarm Control or parameter control settings of an out-of-unit patient.Adjust the real-time trend window for any in-unit patient. See Configuring the real-time trend window on page 7-6.Print real-time parameter data and waveforms for any in-unit patient. See Printing real-time data on page 7-8.The single patient viewer displays menu bar options similar to the following:060ASingle patient viewer menu bar optionsOption FunctionReal-Time View Return to the real-time display of patient data.Admit Display the Admit window.Monitor Setup... Temporarily adjust a patient’s parameter, alarm, or print control settings.Patient Data... Display stored patient data. See Chapter 8.System Utilities... Access web access server data. View all ECG Display waveforms for ECG leads I, II, III, V, aVR, aVL, and aVF.Sample Record and store a 10-second sample of a patient’s real-time ECG data. Data samples are stored in Events directory.Monitor: Parameter numeric data and up to three waveforms.Telemetry: ECG waveforms only.Relearn Relearn the selected patient’s ECG rhythm after changes occur to heart rate or rhythm. The CIC Pro center uses 14 current complexes to relearn the patient’s ECG pattern.The heart rate value appears briefly as Xs during the relearn process and returns to numerics when the relearn process is complete.Configuration Configure the selected patient’s real-time trend window. See Configuring the real-time trend window on page 7-6.Draft
Viewing real-time patient data2001989-301A- draft 1 ApexPro™ 7-5In-unit patient bedsYou can view any in-unit patient bed that is on the Unity Network.Viewing in-unit patients experiencing an alarm conditionWhen an in-unit patient experiences an alarm condition, you can quickly display this patient’s data by displaying the single patient viewer. You can use one of the following methods to display the single patient viewer of an alarming patient bed:Click in the patient window.Click the alarm button.The CIC Pro center can display an alarm button for a maximum of four patients. This row of alarm buttons display across the top of the multi-patient viewer and show the unit name, bed number, and the cause of the alarm. The color of the alarm button indicates the severity of the patient alarm condition. Red indicates a Crisis alarm condition, yellow indicates a Warning alarm condition, and white indicates an Advisory alarm condition.Another name for this row of alarm buttons is the Alarm Display Unit (ADU) line.058AAlarm buttons, also known as Alarm Display Unit (ADU) lineViewing patient beds from another in-unit CIC Pro centerWhen you have more than one CIC Pro center in your care unit, you can view (monitor) a patient bed from another in-unit CIC Pro center.Complete the following procedure to view (monitor) in-unit patient beds from another in-unit CIC Pro center:Draft
7-6 ApexPro™ 2001989-301A- draft 1Viewing real-time patient data1. Go to the CIC Pro center in your care unit that has room to view additional admitted patient beds.2. From the multi-patient viewer, right click in an empty patient window displaying an Admit button. The right click menu displays.3. From the right click menu, choose Select Care Unit then Bed Number. A list of networked care units displays.4. From the list, choose the care unit and bed name you want to view. The patient bed is displayed in the multi-patient viewer.Out-of-unit patient bedsYou can view out-of unit patient beds that are not displayed at your CIC Pro center. The bed you wish to view must be on the Unity Network.NOTEYou cannot change the Alarm Control or parameter control settings of an out-of-unit patient.Viewing an out-of-unit patient bedComplete the following procedure to view networked out-of-unit patient beds:1. From the multi-patient viewer, click View Other. A list of networked care units, floors, or hospitals displays. 2. Click the + sign next to the desired unit, floor, or hospital to display the list of viewable beds.3. Select the bed you want to view and click OK. The single patient viewer displays for this patient. The patient bed is displayed in the multi-patient viewer and the single patient viewer also displays for this patient.4. To close the single patient viewer, click the (close button) on the top right side of the window.Removing viewed out-of-unit patient bedsComplete the following steps to remove out-of-unit patient beds you are viewing from the multi-patient viewer:1. From the multi-patient viewer, right click on the patient bed you want to remove.2. From the right click menu, choose Select Care Unit then Bed Number > None.Configuring the real-time trend windowYou can configure the display of a real-time trend window in the multi-patient viewer. The real-time trend window displays the recent patient trends for a maximum of two parameters.Draft
Viewing real-time patient data2001989-301A- draft 1 ApexPro™ 7-7Complete the following procedure to configure a patient’s real-time trend window:1. Choose one of the following methods to access the Real-time Trend Graph configuration window from the multi-patient viewer:Right-click on the patient you want to configure and select Configuration. The Real-time Trend Graph window displays.Click on the patient you want to configure. The single patient viewer displays. From the single patient viewer, click Real-time View to display the real-time window.2. Click Configuration to display the Real-time Trend Graph window.062A3. Change any of the undimmed setting options. Draft
7-8 ApexPro™ 2001989-301A- draft 1Viewing real-time patient data4. After making your selections, complete one of the following tasks:Click OK to apply your changes and close the window.Click Cancel to cancel your changes and close the window.Click Apply to apply your changes without closing the window.See Viewing stored patient data on page 8-1.Printing real-time data While viewing the in-unit real-time patient data from the multi-patient viewer, you can manually print a continuous ECG strip for a single patient bed or print the parameter limits and waveforms for all displayed patient beds. Printing a continuous ECG stripFrom the multi-patient viewer, you can click in the ECG parameter window of any displayed in-unit patient bed to print a continuous ECG strip. A print icon appears as you position the cursor over the ECG parameter window. Real-time Trend Graph control settingsOption FunctionDisplay Real-time Trend Graph Display a real-time trend window with a maximum of two real-time parameter trends.To display the Real-time Trend Graph, click in the empty check box to fill the box with a check mark.Display Parameter 1 Display the first real-time parameter trend. To display one real-time parameter trend, click in the empty check box to fill the box with a check mark. Then, click the down arrow to set the display properties:Parameter Name: Set the displayed parameter.Scale: Set the size of the displayed waveform trend.Color: Set the color of the displayed parameter text and waveform trend.Display Parameter 2 Display the second real-time parameter trend.To display a second real-time parameter trend, click in the empty check box to fill the box with a check mark. Then, click the down arrow to set the display properties:Parameter Name: Set the displayed parameter.Scale: Set the size of the displayed waveform trend.Color: Set the color of the displayed parameter text and waveform trend.Draft
Viewing real-time patient data2001989-301A- draft 1 ApexPro™ 7-9NOTEWhen using a digital writer, click in the ECG parameter window of any displayed in-unit patient bed. Then, press the (Graph Stop) button on the front of the digital writer to stop printing a continuous ECG strip.NOTEThe printing formats are controlled by the data source device (monitor or telemetry system). This includes printed waveforms, speed, and graph location. See the operating instructions for the devices you are using.Printing parameter limits or waveforms for all in-unit patient bedsYou can print the parameter waveform data for all in-unit patients displayed at a CIC Pro center by using the Graph All function. In addition, you can also print the parameter limits for telemetry beds.Selecting the Graph All function results in printing a 10-second graph for each admitted telemetry bed and a 20-second graph for hard-wired beds. The graph speed of a telemetry graph is 25 millimeters per second and the graph speed of a hard-wired graph is determined by the monitor.NOTEClose any open single patient viewer windows before selecting the Graph All function. Otherwise, only the single patient viewer data prints.The following conditions apply when using the Graph All function:When you press the (Graph Stop) button on the local digital writer, the current patient’s graph stops and the writer begins to print a 10-second graph for the next patient.When a patient’s data is currently graphing or is being saved to graph when a Graph All function request is started, this patient’s data is not included in the Graph All Patients graph. This patient’s data graphs independently of the Graph All Patients graph.When you click in the ECG parameter window of a patient whose data is saving, this cancels the Graph All Patients request for that patient.When an arrhythmia alarm sounds for a patient while a Graph All Patients request is running, the alarm data replaces the data that was saved for the Graph All Patients request.When a telemetry patient initiates a graph from a transmitter while a Graph All Patients request is running, the Graph All Patients graph for that patient is replaced by a transmitter graph.Complete the following procedures to print parameter limits or waveforms for all patient beds displayed in the multi-patient viewer:Printing limitsNOTEThe Limits option only prints parameter limits for telemetry beds.Draft
7-10 ApexPro™ 2001989-301A- draft 1Viewing real-time patient dataComplete the following procedure to print telemetry bed parameter limits:1. From the multi-patient viewer, click Graph All. The Graph All Patients window displays.2. From the Graph All Patients window, click Limits.3. Click OK to begin printing.Printing waveformsComplete the following procedure to print parameter waveforms for all displayed patient beds:1. From the multi-patient viewer, click Graph All. The Graph All Patients window displays.2. From the Graph All Patients window, click Waveforms.3. Click OK to begin printing.Stopping a print jobYou must stop a print job from the same CIC Pro center you used to send the print job to the printer.Stop printing to a laser printerComplete the following procedure to stop printing all print jobs sent to the laser printer:1. From the multi-patient viewer, click CIC Setup > CIC Defaults. The CIC Defaults window displays.2. Under Printer/Writer, click Cancel Print Jobs for the printer you want to stop printing to.3. After making your selection, complete one of the following tasks from the CIC Defaults window:Click OK to apply your changes and close the CIC Defaults window.Click Cancel to cancel your changes and close the CIC Defaults window.Click Apply to apply your changes without closing the CIC Defaults window.Stop printing to a local digital writerComplete the following procedure to stop printing all print jobs sent to a local digital writer:1. Locate the digital writer.2. Press the (Graph Stop) button located on the front of the digital writer to stop the print job.Draft
Viewing real-time patient data2001989-301A- draft 1 ApexPro™ 7-11Monitored parametersThe CIC Pro center can display data for many monitoring parameters. NOTEFor a complete list of supported parameters, refer to the CIC Pro Clinical Information Center Operator’s Manual.Adjusting parameter control settingsThe following guidelines apply to adjusting parameter control settings at the CIC Pro center:You may view and adjust parameter settings for any in-unit patient. Any changes are temporary and return to the default settings when a patient is discharged. These changes are also adopted by the monitor. You may not be able to adjust some of the control settings for non-GE acquisition devices that are interfaced via the Unity Network Interface Device.You may view parameter settings for any out-of-unit patient. However, you cannot adjust these settings.To permanently change the parameter default settings, see the CIC Pro Clinical Information Center Bedrock Hardware Platform Service Manual.This section briefly covers adjusting control settings for the following parameters:ECGSpO2Non-invasive pressuresInvasive pressuresECGECG control settingsComplete the following procedure to adjust the control settings.1. From the multi-patient viewer, click on the patient you want to view. The single patient viewer displays.2. From the single patient viewer, click Monitor Setup.3. Click ECG to display the control window.4. Change any of the undimmed setting options. When an option appears dimmed, you cannot change it unless you enter the service-level password.Draft
7-12 ApexPro™ 2001989-301A- draft 1Viewing real-time patient data063AECG control settingsOption FunctionDisplay Lead Set the top or first lead displayed on the monitor and on the CIC Pro center. This is the lead data that prints during an alarm or manual graph.Relearn button Relearn the selected patient’s ECG rhythm after changes occur to heart rate or rhythm. The CIC Pro center uses 14 current complexes to relearn the patient’s ECG pattern.Remove the V Fail message or activate the second V-lead when changing between a 5-and 6-leadwire set on the transmitter.NOTEThe heart rate value appears briefly as Xs during the relearn process and returns to numerics when the relearn is complete.Size Set the waveform size. 1X is standard.Detect Pace Set the pacemaker detection mode:Pace 1: Alternate pacemaker detection mode when Pace 2 does not adequately detect pacemaker spikes.Pace 2: Normal pacemaker detection mode.For more information, refer to Monitoring pacemaker patients on page 7-13.Pace Help button View solutions to common pacemaker detection problems.Lead Analysis Set the leads for ECG and arrhythmia data processing:Single-Lead: Use the top Display Lead.Multi-Lead: Use leads I, II, III and V lead.Draft
Viewing real-time patient data2001989-301A- draft 1 ApexPro™ 7-135. After making your selections, complete one of the following tasks:Click a different Monitor Setup option to apply your changes without closing the Monitor Setup window.Click the (close button) on the top right side of the window to apply your changes and close the Monitor Setup window.Monitoring pacemaker patientsBe aware of the following when monitoring a patient with a pacemaker.WARNINGFALSE CALLS—False low heart rate indicators or false asystole calls may result with certain pacemakers because of electrical overshoot.WARNINGMONITORING PACEMAKER PATIENTS—Monitoring of pacemaker patients can only occur with the pace program activated.Arrhythmia Set the arrhythmia detection level:Full: Detect all arrhythmia conditions defined by the software.Lethal: Detect lethal arrhythmia conditions.Off: Turn off arrhythmia detection. Arrhythmia detection remains off until you choose Full or Lethal, or the patient is discharged.NOTEOFF appears dimmed and is not selectable when the following option is set: CIC Setup > CIC Defaults > Allow Alarms OFF on this CIC > No. The Allow Alarms OFF on this CIC setting is a service-level default and is protected by the Service Password.PVC Limit Turn On to count PVCs per minute. A PVC counter appears in the ECG parameter window.NOTETo display the PVC counter, the Arrhythmia detection level must be set to Full.ST Turn On to display, store, and enable ST alarms.V Lead Label the V Lead position.ECG control settingsOption FunctionDraft
7-14 ApexPro™ 2001989-301A- draft 1Viewing real-time patient dataWARNINGPACEMAKER SPIKE—An artificial pacemaker spike is displayed in place of the actual pacemaker spike. All pacemaker spikes appear uniform. Do not diagnostically interpret pacemaker spike size and shape.WARNINGPATIENT HAZARD—A pacemaker pulse can be counted as a QRS during asystole in either pace mode. Keep pacemaker patients under close observation.WARNINGRATE METERS—Keep pacemaker patients under close observation. Rate meters may continue to count the pacemaker rate during cardiac arrest and some arrhythmias. Therefore, do not rely entirely on rate meter alarms.CAUTIONFDA POSTMARKET SAFETY ALERT—The United States FDA Center for Devices and Radiological Health issued a safety bulletin October 14, 1998. This bulletin states “that minute ventilation rate-adaptive implantable pacemakers can occasionally interact with certain cardiac monitoring and diagnostic equipment, causing the pacemakers to pace at their maximum programmed rate.”The FDA further recommends precautions to take into consideration for patients with these types of pacemakers. These precautions include disabling the rate responsive mode and enabling an alternate pace mode. For more information contact:Office of Surveillance and Biometrics, CDRH, FDA1350 Piccard Drive, Mail Stop HFZ-510Rockville, MD 20850U.S.A.NOTEECG monitoring with patients on non-invasive transcutaneous pacemakers may not be possible due to large amounts of energy produced by these devices. Monitoring ECG with an external device may be needed.The Detect Pace option enables/disables the pacemaker detection program. It must be used whenever the monitored patient has a pacemaker.There are two pacemaker processing modes, Pace 1 and Pace 2. The modes use different algorithms for pacemaker artifact rejection. The clinician must be the judge as to which mode is better for each patient. The pacemaker detection program defaults OFF, so if you have a patient with a pacemaker, you will have to select a mode. For more information, refer to ECG control settings on page 7-11.Draft
Viewing real-time patient data2001989-301A- draft 1 ApexPro™ 7-15The Pace 1 mode allows successful detection of the largest variety of paced QRS morphologies. As a direct consequence, this mode does have a higher risk of counting pacemaker artifact as QRS complexes during ASYSTOLE. For this reason, it is imperative that the user keep patients with pacemakers under close observation. It is also recommended that the user set the low heart rate limit on the monitor close to the minimum pacing rate, and that the BRADY arrhythmia alarm level be elevated to a Warning or Crisis level.The Pace 2 mode is much more conservative in recognizing paced QRS morphologies and is recommended for use whenever possible. It is designed to minimize the possibility of counting pacemaker artifact as QRS complexes during ASYSTOLE. If the monitor does not adequately detect paced beats in the Pace 2 mode, then the user may wish to try the Pace 1 mode.When either pace mode is enabled, the software places an artificial spike on the waveform whenever the pacemaker triggers. When pacemaker detection is on, it is indicated by a “P” in the patient’s ECG parameter window.For successful monitoring of pacemaker patients follow these suggestions:Use recommended electrode placement.Brady, Pause, and Low Heart Rate are additional alarms available for use when monitoring pacemaker patients.Problems you may experience are:heart rate double counting;inaccurate alarms for low heart rate or asystole;pacemaker spikes not recognized by the software.Possible solutions to above problems are:relearn arrhythmia;try an alternate electrode placement;try Single-Lead analysis;try switching to the other pace detection mode.Multi-vector pace detectionThe T14 transmitter uses multi-vector pace detection. Here are some additional guidelines for successful monitoring pacemaker patients when using the T14 transmitter.When using the 5- or 6-leadwire set with all the electrodes attached, pace detection occurs on two ECG leads simultaneously. The default leads used for detection are II and V. If these leads are not available, multi-vector pace detection switches to available leads. Pace detection switches to Single-Lead when using a 3-leadwire set. For more information, refer to “Pacemaker troubleshooting” on page D-3.Pace helpClicking on the Pace Help button opens a window that shows common problems and solutions in regard to pacemaker detection. This window is shown below.Draft
7-16 ApexPro™ 2001989-301A- draft 1Viewing real-time patient data047ALead analysisThe Lead Analysis control signals the transmitter to process the ECG in Single-Lead or Multi-Lead mode. Use the mouse to click on your selection. Multi-Lead analysis is the default setting for Adult.NOTEECG is relearned whenever Lead Analysis is changed.Multi-Lead analysisMulti-Lead analysis simultaneously examines ECG leads I, II, III, and V (whether they are displayed or not) to help eliminate false alarms and improve the ability of the system to:Detect beats which occur isoelectric to a single chest lead.Discriminate artifact that appears in one lead compared to the other lead vectors.Provide a smart-lead fail feature, where the failed lead is identified, and if available, another lead is provided for display.Continue arrhythmia processing even after a lead change.Single-Lead analysisSingle-Lead analysis uses only the lead displayed on the CIC Pro center screen to process ECG and arrhythmia information. To change the lead used for Single-Lead analysis, you must change the displayed lead. Single-Lead ECG may be acquired using a 3-, 5-, or 6-leadwire set. However, only a Single-Lead ECG is transmitted or processed.Single-Lead analysis is beneficial when troubleshooting pacemaker detection and/or arrhythmia detection. Single-Lead analysis must always be used when monitoring with a 3-leadwire set. Single-Lead analysis can be set up as a unit default. Refer to Customizing the system on page 4-4 for more information.Draft
Viewing real-time patient data2001989-301A- draft 1 ApexPro™ 7-17Single-Lead ECG telemetry dataNOTEWhen acquiring Single-Lead ECG data using a 5- or 6-leadwire set, it is not necessary to connect the V leads or the right leg lead to the transmitter or to the patient.The following constraints apply when using Single-Lead ECG telemetry data.ArrhythmiaWARNINGINCORRECT ALGORITHMS, ARRHYTHMIA PROCESSING AND CALCULATIONS BASED ON PATIENT AGE — After manually updating or automatically retrieving patient demographic information from a network database, always confirm that the entered patient’s date of birth matches the patient’s actual date of birth. Otherwise the appropriate age-related algorithms, arrhythmia detection, and calculations will not be applied.Function Single-Lead Constraintschange the displayed leadThe factory default Display Lead is lead II. Contact your local service representative to change the default displayed lead.Display Lead appears to be selectable at the CIC Pro center. However, your selection is temporary and will revert back to the transmitter’s default displayed lead.NOTEWhen the clinical situation dictates monitoring a lead other than the default lead, you can move the leads and/or electrodes to view a different lead. Be aware that the label on the display and on the printout will show the default lead label.Lead Analysis Multi-Lead analysis may appear to be selectable at the CIC Pro center. However, your selection is temporary and will revert back to the Single-Lead analysis mode.select a V lead V leads may appear to be selectable at the CIC Pro center. However, your selection does not change the transmitter’s default displayed lead.select displayed leads from a single viewerLeads other than the default displayed lead may appear to be selectable at the CIC Pro center. However, your selection is temporary and will revert back to the transmitter’s default displayed lead.select graph waveforms Leads other than the default displayed lead may appear to be selectable at the CIC Pro center. However, you must select the transmitter’s default displayed lead to obtain a graph of the waveform.Draft
7-18 ApexPro™ 2001989-301A- draft 1Viewing real-time patient dataWARNINGSUSPENDED ANALYSIS—Certain conditions suspend arrhythmia analysis. When suspended, arrhythmia conditions are not detected and alarms associated with arrhythmias do not occur. The messages which alert you to the conditions causing suspended arrhythmia analysis are: ALL ALARMS OFF, ALARM PAUSE, ARR OFF, ARR SUSPEND, DISCHARGED, LEADS FAIL, and NO TELEM. Additionally, the alarms off with reason options and disabling the Alarm Pause Breakthrough feature also suspend arrhythmia analysis.WARNINGVENTRICULAR ARRHYTHMIAS—The arrhythmia analysis program is intended to detect ventricular arrhythmias. It is not designed to detect atrial or supraventricular arrhythmias, with the exception of atrial fibrillation. Occasionally it may incorrectly identify the presence or absence of an arrhythmia. Therefore, a physician must analyze the arrhythmia information in conjunction with other clinical findings.The arrhythmia control signals the CIC Pro center to ignore or accept arrhythmia calls. To modify arrhythmia settings, use the mouse to click on Full, Lethal, or Off.NOTEFull arrhythmia processing is suspended when the level 1 ARTIFACT message is displayed. Lethal arrhythmia is still active but its accuracy may be hindered by the artifact.NOTEWhen arrhythmia program is in Full mode, the program counts the number of PVCs that occur within a minute.Turning arrhythmia on automatically starts a relearn procedure.When arrhythmia is turned off, ARR OFF appears in the ECG parameter window.No arrhythmia detection with 7015 software level patient monitorsIf an ApexPro system patient is admitted to a patient monitor at the 7015 software level (ECG source is telemetry, not the monitor), the following scenario may occur when monitoring in Combo or Rover Combo monitoring modes:Since the 7015 software level does not support arrhythmia processing, arrhythmia detection for the telemetry patient is reduced from full arrhythmia detection to no arrhythmia detection (arrhythmia OFF). This occurs because the software is designed to take on the attributes of the bedside monitor when in Combo or Rover Combo monitoring modes.Draft
Viewing real-time patient data2001989-301A- draft 1 ApexPro™ 7-19CAUTIONUnder these conditions, arrhythmia detection is OFF. There is NO INDICATION of this at the bedside monitor, central station or CIC Pro center.If the patient is later discharged from the monitor, and monitoring continues from telemetry, the message ARR OFF will then appear at the central station or CIC Pro center. Arrhythmia monitoring remains OFF.NOTESolar 7000 monitors, Solar 8000 monitors, Dash monitors, and Eagle monitors may include the 7015 software level.Full arrhythmia conditionsThe following is an alphabetical list of the Arrhythmia messages that are displayed when full arrhythmia is selected and the condition occurs. Definitions of each condition are included. The CIC Pro center’s response to each condition is determined by the alarm level to which the arrhythmia has been assigned.ACC VENT Adult—Accelerated ventricular occurs when six or more ventricular beats are detected with an average heart rate for the ventricular beat between 50 and 100 beats per minute.0-2 years—Occurs when six or more ventricular beats are detected with an average heart rate for the ventricular beat between 60 and 160 beats per minute.3-10 years—Occurs when six or more ventricular beats are detected with an average heart rate for the ventricular beat between 60 and 140 beats per minute.11-13 years—Occurs when six or more ventricular beats are detected with an average heart rate for the ventricular beat between 60 and 130 beats per minute.Atrial FIB Atrial fibrillation identification occurs when random. chaotic, low-amplitude deflections of the supraventricular component of the ECG waveform. This results in irregular timing of QRS complexes and the absence of uniform P waves proceeding the QRS complex. NOTEAFIB alarms can take up to 90 seconds to display while the algorithm verifies the event. ASYSTOLE Ventricular asystole occurs whenever the displayed heart rate drops to zero.BIGEMINY Occurs when three or more bigeminal cycles (a ventricular beat followed by a non-ventricular beat) are detected.BRADY Bradycardia is the average of the most recent eight R-to-R intervals at a heart rate less than the set LOW heart rate limit.NOTEThe Brady limit matches the low heart rate limit. If the low heart rate limit is changed, the Brady limit changes.COUPLET Occurs when two ventricular beats are detected and have non-ventricular beats before and after the couplet. The coupling interval must be less than 600 milliseconds.Draft
7-20 ApexPro™ 2001989-301A- draft 1Viewing real-time patient dataIRREGULAR Occurs when six consecutive normal R-to-R intervals vary by 100 milliseconds or more.PAUSE Occurs when a 3-second interval without a QRS complex is detected.NOTESome bedside monitors allow the Pause time interval to be adjusted. For more information, refer to the appropriate bedside monitor’s operator’s manual.PVC Isolated premature ventricular complexes occur when a premature ventricular beat is detected and has non-ventricular beats before and after.PVC limit When on, the PVC Limit control displays a PVC counter in the ECG parameter window. When off, the PVC counter is not displayed. Use the mouse to turn the PVC Limit control On or Off. The PVC limits are preset in Alarm Control defaults. R ON T Occurs when a ventricular complex is detected within the repolarization period of a non-ventricular beat.TACHY Tachycardia is four R-to-R intervals at a heart rate greater than the set HIGH heart rate limit.NOTEThe Tachy limit matches the high heart rate limit. If the high heart rate limit is changed, the Tachy limit changes.TRIGEMINY Occurs when three or more trigeminal cycles (a ventricular beat followed by two non-ventricular beats) are detected.V BRADY Adult—Ventricular bradycardia occurs when a run of three or more ventricular beats is detected with an average heart rate that is less than or equal to 50 beats per minute.0-2, 3-10, and 11-13 years—Occurs when a run of three or more ventricular beats is detected with an average heart rate that is less than or equal to 60 beats per minute.VFIB/ VTAC Ventricular fibrillation occurs when the ECG waveform indicates a chaotic ventricular rhythm.WARNINGVFIB/VTAC should not be considered a substitute for the V TACH arrhythmia call. Efforts to lower the V TACH alarm level can result in missed ventricular tachycardia alarms.Draft
Viewing real-time patient data2001989-301A- draft 1 ApexPro™ 7-21Lethal arrhythmia conditionsWhen Lethal arrhythmia is selected, the following conditions (as defined for Full arrhythmia) are detected:ASYSTOLEVFIB/VTACV TACH (defaults to the Crisis level, but can be moved to a different level)BRADY (if the Patient Age range selected is 0-2 years or 3-10 years)AFIB identificationNOTEAFIB trending is only available when the bedside monitor supports this feature. If your bedside monitor does not support AFIB trending, this feature is not available. Contact your sales/service representative for more information.Atrial fibrillation (AFIB) is characterized by random, chaotic, low-amplitude deflections of the supraventricular component of the ECG waveform, resulting in irregular timing of QRS complexes and an absence of uniform P waves preceding the QRS complex. V TACH Adult—Ventricular tachycardia occurs when a run of six or more ventricular beats is detected with an average heart rate greater than or equal to 100 beats per minute.0-2 years—Occurs when a run of six or more ventricular beats is detected with an average heart rate greater than or equal to 160 beats per minute.3-10 years—Occurs when a run of six or more ventricular beats is detected with an average heart rate greater than or equal to 140 beats per minute.11-13 years—Occurs when a run of six or more ventricular beats is detected with an average heart rate greater than or equal to 130 beats per minute.VT > 2 Adult—Ventricular tachycardia >2 occurs when a run of ventricular beats is detected with a duration of less than six beats but longer than two beats and with an average heart rate that is greater than or equal to 100 beats per minute.0-2 years—Occurs when a run of ventricular beats is detected with a duration of less than six beats but longer than two beats and with an average heart rate that is greater than or equal to 160 beats per minute.3-10 years—Occurs when a run of ventricular beats is detected with a duration of less than six beats but longer than two beats and with an average heart rate that is greater than or equal to 140 beats per minute.11-13 years—Occurs when a run of ventricular beats is detected with a duration of less than six beats but longer than two beats and with an average heart rate that is greater than or equal to 130 beats per minute.Draft
7-22 ApexPro™ 2001989-301A- draft 1Viewing real-time patient dataThe AFIB algorithm feature identifies atrial fibrillation arrhythmias for the transmitter. When an AFIB event is detected, the ATRIAL FIB alarm text replaces the IRREGULAR arrhythmia alarm text.AFIB event patient data is stored for review in the Graphic Trends and Vital Signs tab sheets.AlarmsA patient status alarm is triggered when an AFIB arrhythmia is detected. The message ATRIAL FIB is displayed in the message area of the display.NOTEThere is approximately a 90 second delay while the AFIB algorithm verifies the AFIB arrhythmia condition.The AFIB alarm defaults to a Message alarm level but can be changed under Arrhythmia Alarm Level, in the Telemetry Alarm Control Defaults tab sheet on the CIC Pro center. How the monitor responds to each condition is determined by the alarm level to which the AFIB arrhythmia detection has been assigned. When set for Advisory or greater, AFIB alarms will be recorded and displayed in the alarm area on the CIC Pro center.NOTEAFIB alarms can only be adjusted at the CIC Pro center. If AFIB is not available/enabled at a bedside monitor in Combo mode, you will not be able to immediately adjust the alarm. You must discharge the patient from the bedside monitor, adjust the alarm setting at the CIC Pro center and then admit the patient at the bedside monitor.ST analysisThe patient’s most dominant, normal beat is used for ST measurement. This beat is identified by the arrhythmia analysis program. Turn ST ON to display the numerics calculated for ST at the CIC Pro center.GE identifies the ST segment of the QRS complex as beginning at the J point and ending 60 milliseconds following the J point in Adult mode. The ST measurement factory defaults are:Adult— J+ 60ms0–2 years— J+ 30ms3–10 years— J+ 40ms11–13 years— J+ 50msThe ST numeric displayed (millimeters) indicates either a positive or negative elevation in relation to the isoelectric reference point (which is also determined by the arrhythmia program and the patient’s age).When ST is on, numerics are displayed under each ECG lead label on the screen. (A negative deflection is preceded by a minus sign.) These numerics are updated about every 15 seconds.Draft
Viewing real-time patient data2001989-301A- draft 1 ApexPro™ 7-23The ST value shown in the ECG parameter window is the lead with the greatest ST deviation. This may or may not be the lead that is in alarm, since a lead with a lesser deviation from the isoelectric line may have changed more than the lead with the greatest deviation.NOTEST numerics are always calculated with reference to 1X size. Displaying the ECG waveform at a different size does not affect the ST values.NOTEWhen a new dominant beat is detected or a relearn occurs, the arrhythmia program calculates ST based on the new beat. This could affect the ST values displayed. This may not necessarily represent a change in the patient’s condition. The clinician needs to assess the patient any time there is an ST change.NOTEAdjustable ST alarms are only available when using a CIC Pro center running software version 5 or later. If your CIC Pro center is running an earlier version of software, this feature is not available. Contact your sales/service representative for more information. ST deviation alarmWhen any individual ST value is beyond the limit, an ST deviation alarm occurs. It is considered a parameter alarm, and the default alarm level is Warning. This can be modified in the parameter alarm level setup.When the ST program is turned on, or a relearn is done with ST on, the ST deviation values are set for all leads of ST.The current ST value is determined in all eight leads.The ST value in the ECG parameter window turns red to indicate an alarm.ST limits can also be adjusted individually in the patient’s Alarm Control tab.NOTEST limits can also be adjusted at the CIC Pro center from Monitor Setup > ECG.Adjusting ST limits ST alarm limits and levels for telemetry patients are typically controlled by the default ST alarm levels from the CIC Pro center. Some bedside monitors allow users to adjust ST alarm limits and levels at the bedside when the patient is admitted in combination monitoring mode. For more information on adjusting ST limits, refer to the bedside monitor operator’s manual.Draft
7-24 ApexPro™ 2001989-301A- draft 1Viewing real-time patient dataSpO2 IntroductionNOTESpO2 and SPO2 are used interchangeably throughout this manual to refer to pulse oximetry.The transmitter supports the Apex oximeter and the Xpod oximeter. Unless specified, oximeter refers to both units.The Xpod oximeter connects to the transmitter and provides the following oximetry vital signs for display at the CIC Pro center:arterial oxygen saturation (SpO2)peripheral pulse rate (PPR)perfusion quality indicatorThe Apex oximeter functions as a stand-alone device, and displays digital values for SpO2 and pulse rate. When the Apex oximeter is connected to the transmitter, digital values for SpO2 and pulse rate are also displayed at the CIC Pro center.NOTEWhen monitoring SpO2 using an transmitter, an SpO2 waveform is neither generated nor displayed on the Apex oximeter or CIC Pro center. Additionally, no alarm histories are generated or stored.SpO2 in the multi-patient viewerIn the multi-patient viewer, the bed window for a telemetry patient being monitored for SpO2 displays the current SpO2 value; one, two, or three asterisks indicating signal strength; and, if turned on, the derived pulse rate for the patient. Below is an example of a telemetry patient’s bed window in the multi-patient viewer.346BSpO2 control settingsComplete the following procedure to adjust the control settings.1. From the multi-patient viewer, click on the patient you want to view. The single patient viewer displays.2. From the single patient viewer, click Monitor Setup.Signal Strength IndicatorSpO2 ValuePulse Rate ValueDraft
Viewing real-time patient data2001989-301A- draft 1 ApexPro™ 7-253. Click SPO2/Resp to display the control window.NOTEThe SpO2 tab is labeled SpO2/Respiration because respiration monitoring settings are available on this tab sheet for bedside monitored patients only.Respiration monitoring is not an option for telemetry patients. Therefore only SpO2 information appears on this tab sheet when monitoring a telemetry patient.4. Change any of the undimmed setting options. 064A5. After making your selections, complete one of the following tasks:Click a different Monitor Setup option to apply your changes without closing the Monitor Setup window.Click the (close button) on the top right side of the window to apply your changes and close the Monitor Setup window.SpO2 probe safetyBe sure to read all literature accompanying probes for specific safety information. Be aware of the following safety precautions when using SpO2 probes.SpO2 control settingsOption FunctionRate Turn On to display the SpO2 heart rate.Size Set the waveform size. No waveform is displayed for telemetry patients. This option will appear dimmed.Draft
7-26 ApexPro™ 2001989-301A- draft 1Viewing real-time patient dataWARNINGDATA VALIDITY—Do not expose probe detector to strong ambient light while monitoring a patient. A poor signal may result.Do not allow tape to block the probe light detector.WARNINGPATIENT SAFETY—Prolonged monitoring may require changing the probe site periodically. Move the probe if there is any sign of skin irritation or impaired circulation. Change the probe site AT LEAST every four hours to prevent ischemic skin necrosis. If required, reduce the application periods to HALF the times recommended above.If a probe is damaged in any way, discontinue use immediately.CAUTIONUse only Nonin SpO2 probes with the Apex oximeter and Xpod oximeter. The reliability of SpO2 data obtained with any other probe has not been verified.Infants and pulse oximetryWARNINGThe display of inaccurate pulse oximetry (SpO2) values has been linked to the presence of poor signal strength or artifact due to patient motion during signal analysis. This condition is most likely to be encountered when the equipment is used on infants. These same conditions in adults do not impact the SpO2 values to the same extent.When using pulse oximetry on infants, always observe the following precautions.PrecautionsWe recommend the application of the following criteria when using the pulse oximetry function on infants:1. The peripheral pulse rate (PPR) as determined by the SpO2 function must be within 10% of the heart rate, and2. the SpO2 signal strength indicator must have 2 or 3 asterisks displayed, and 3. stable SpO2 values are displayed for six seconds.Draft
Viewing real-time patient data2001989-301A- draft 1 ApexPro™ 7-27Procedures or devices previously applied in your facility for SpO2 monitoring should be used in the event that the SpO2 value from the equipment cannot be validated by the above criteria.CAUTIONDo not use the Apex oximeter on neonatal patients. It is not designed for use on neonates.Signal and data validityIt is extremely important to determine that the probe is attached to the patient correctly and the data is verifiable. To make this determination, the signal strength indicators on the Apex oximeter and the CIC Pro center are of assistance.Signal strength indicatorA signal strength (perfusion) indicator is displayed on the Apex oximeter display and at the CIC Pro center in the appropriate patient window. On the Apex oximeter, this indicator is a perfusion LED that blinks with each SpO2 pulse detected. The LED blinks green for each acceptable strength pulse. It blinks yellow for SpO2 signals of marginal quality, and blinks red when the SpO2 signal is too weak or the quality is very poor. When the perfusion LED blinks red, the numeric data displayed on the Apex oximeter will be replaced by dashes within 10 seconds.At the CIC Pro center, the signal strength indicator consists of 0, 1, 2, or 3 (strongest) asterisks, depending on the strength of the signal. Proper environmental conditions and probe attachment help ensure a strong signal.WARNINGIn the monitoring of patients the coincidence of adverse conditions may lead to a disturbed signal going unnoticed. In this situation artifacts are capable of simulating a plausible parameter reading, so that the monitor fails to sound an alarm. In order to ensure reliable patient monitoring, the proper application of the probe and the signal quality must be checked at regular intervals.Error messagesIf the probe is not correctly attached to the patient and data is not verifiable, one of the following error messages may appear in the patient’s bed window at the CIC Pro center:SPO2 PROBE OFFSPO2 PROBEIf either of the above messages appears, check the position of the probe or replace the probe. If the problem persists, call GE Service or contact your sales/service representative.Draft
7-28 ApexPro™ 2001989-301A- draft 1Viewing real-time patient dataPressuresThe Pressures tab sheet allows you to view and modify settings specific to the viewed telemetry patient’s NBP display. Settings may be viewed for any patient. However, you can only modify settings for patients who are admitted to a bed in your unit.NOTEThe NBP tab is labeled Pressures because other invasive pressures settings are available on this tab sheet for bedside monitored patients only.Invasive pressure monitoring is not an option for telemetry patients. Therefore, only NBP information appears on this tab sheet when monitoring a telemetry patient.Non-invasive blood pressure control settingsComplete the following procedure to adjust the control settings.1. From the multi-patient viewer, click on the patient you want to view. The single patient viewer displays.2. From the single patient viewer, click Monitor Setup.3. Click Pressures to display the control window.4. Change any of the undimmed setting options.065ADraft
Viewing real-time patient data2001989-301A- draft 1 ApexPro™ 7-295. After making your selections, complete one of the following tasks:Click a different Monitor Setup option to apply your changes without closing the Monitor Setup window.Click the (close button) on the top right side of the window to apply your changes and close the Monitor Setup window.NBP monitoring with telemetryNBP monitoring via telemetry is done with an Accutracker DX or Dinamap Pro blood pressure monitor connected to the transmitter. The blood pressure cuff is connected to the blood pressure monitor, which measures and displays systolic and diastolic blood pressures using the auscultatory method. When the blood pressure monitor is connected to an transmitter, digital values are also displayed at the CIC Pro center.WARNINGThe following conditions may affect the accuracy of noninvasive blood pressure readings: seizures, tremors, extreme hypotension or hypertension, arrhythmias, or extremely high or low heart rate.Patient preparationBlood pressure cuff selection and application are important. Inappropriate selection or improper application of the cuff will result in erroneous measurements. Most people use their non-dominant arm for acquiring ambulatory noninvasive blood pressure readings.Follow these steps to prepare the patient for NBP monitoring:Non-invasive blood pressure control settingsOption FunctionAuto Turn Off automatic NBP measurements. When turned On at the monitor, NBP measurements are acquired automatically at regular intervals.NOTEThis option does not apply to telemetry beds and cannot be turned on from the CIC Pro center.Cuff Size Set the inflation pressure used during the first NBP measurement and for calculating the NBP pressure:NOTEFor more information, refer to the appropriate bedside monitor’s operator’s manual.Clear Message button Clear the display of inflation messages and current NBP readings.Draft
7-30 ApexPro™ 2001989-301A- draft 1Viewing real-time patient data1. Place the K-sound microphone in the microphone pad (or blood pressure cuff). For more information on microphone placement, refer to Microphone placement on page 7-30.2. Locate the patient’s brachial artery on the inside of the arm, just above the elbow. Mark the location with a pen for easy microphone placement.3. Remove the backing from the microphone pad and adhere it in the location marked on the patient’s arm. Do not bend or squeeze the microphone. Route the microphone cable up, toward the patient’s shoulder.4. Wrap the blood pressure cuff around the arm. Be sure that the artery marker is aligned over the brachial artery.5. Drape the cuff hose over the patient’s shoulder and attach an adhesive cuff anchor to the snap on the cuff hose. Do not adhere the cuff anchor to the patient at this time.6. Place the blood pressure monitor in its pouch and attach it to the patient using the belt or shoulder strap provided.7. Adhere the cuff anchor to the patient’s upper arm by removing the adhesive backing and pressing firmly.When attached, the blood pressure cuff and hoses should be positioned like those in the following illustration.408AMicrophone placementA microphone is used to hear the Korotkoff sounds (K-sounds) that the blood pressure monitor uses to determine the systolic and diastolic pressure readings. The microphone can be placed in a microphone pad and adhered to the patient’s arm under Hoses Routed Over ShoulderCuff Anchor ClipCuff/Microphone ConnectionsDraft
Viewing real-time patient data2001989-301A- draft 1 ApexPro™ 7-31the blood pressure cuff, or alternatively, it can be placed directly into the microphone pocket inside the blood pressure cuff.Placement in the microphone padUsing a microphone pad is recommended. Place the microphone in the pad as illustrated below. Do not bend or squeeze the microphone when placing it in the pad, or when adhering the pad to the patient’s arm.410APlacement in the blood pressure cuffAs already stated, using the microphone pad is recommended, especially in the case of ambulatory patients or patients with weak K-sounds. However, as an alternative, the microphone can also be placed directly in the blood pressure cuff. Follow the directions below.NOTEBlood pressure readings taken with the microphone in the blood pressure cuff may not be as accurate as readings obtained when using the microphone pad.1. Remove the bladder from the cuff.2. Turn the cuff bladder pouch inside out to expose the microphone pocket.3. Open the Velcro pocket flap and gently insert the microphone into the pocket.4. When the microphone is completely inserted, close the Velcro flap over the microphone cable and turn the cuff right side out.5. Replace the bladder and exit the bladder hose and microphone cable out of the same exit site, either right arm or left arm, as marked on the cuff.Microphone CableK-sound MicrophoneMicrophone PadDraft
7-32 ApexPro™ 2001989-301A- draft 1Viewing real-time patient dataSafety considerationsWARNINGThe Accutracker DX blood pressure monitor is designed for use with adult patients only. Do not use on neonates or on patients known to be susceptible to bruising.Do not attach the blood pressure cuff to a limb being used for IV infusions as the cuff inflation can block the infusion, causing harm to the patient.CAUTIONThe blood pressure monitor’s safety and effectiveness in neonates has not been established.Blood pressure measurements may be affected by the patient’s position, physical condition, and other factors.Do not use the blood pressure monitor if it has failed its diagnostic self test or if it displays a pressure greater than zero with no cuff attached. The values displayed by such a unit may be inaccurate.If you must ship the Accutracker DX blood pressure monitor for service or other reasons, place it in a sealable plastic bag, seal it tightly, then package it in a cardboard box. Label the shipping container –20 to +50° C and ship appropriately. Failure to follow these instructions can result in device failure due to improper shipping/storage conditions.Setting the measurement intervalWhen the blood pressure monitor is turned on, it performs a battery voltage check, then the display shows the following:INT= 5 (***)INCR DECR START?NOTEThe number 5 above represents any measurement interval, including MAN (manual). When the blood pressure monitor is turned on, the number displayed is the last measurement interval set as the default.Use the YES + button or the NO – button on the blood pressure monitor to increase or decrease the interval (INT) at which the blood pressure readings are taken.The available measurement intervals are: MAN (manual), or 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 90, 120, or 240 minute intervals.Draft
Viewing real-time patient data2001989-301A- draft 1 ApexPro™ 7-33When the desired measurement interval is reached, press the START/STOP button. The blood pressure monitor immediately begins a measurement cycle. It will attempt one retry if the first measurement cycle fails.Measurements are taken at the selected interval. A measurement may be initiated in between intervals by pressing the START/STOP button. This wakes up the blood pressure monitor from sleep mode, and offers the option to change the measurement interval as described above, as well as the option to view the time left until the next measurement. A manual measurement is initiated by pressing the START/STOP button a second time. The next measurement will then be taken at the scheduled interval (X number of minutes) after the manual measurement is complete.The patient’s blood pressure is displayed for one minute on the blood pressure monitor and for two hours on the CIC Pro center. The blood pressure reading is updated each time a measurement is successfully completed.Measurements are taken at the selected interval until the blood pressure monitor is turned off, or until the monitor determines that the batteries are too weak for additional measurements.A measurement may be stopped by pressing the START/STOP button while the measurement is in progress.Setting test parametersThe maximum and minimum inflation pressures, dynamic or fixed inflate, and deflate rate can be adjusted. Follow these steps:1. Turn the blood pressure monitor on while holding down the NO – button. The display shows:CHANGE TESTPARAMETERS?2. Press the YES + button to change the parameters.3. The MAXIMUM PRESSURE can be set to: 250, 240, 230, 220, 210, 200, 190, 180, 170, 160, 150, 140, 130, 120, 110, or 100 mmHg using the YES + and NO – buttons. A setting of 200 to 250 mmHg is recommended for the maximum cuff inflation pressure.4. When the maximum pressure has been set, press the NEXT button to set the MINIMUM PRESSURE. It can be set to: 100, 90, 80, 70, 60, 50, 40, 30, 20, or 10 mmHg using the YES + and NO – buttons. A setting of 40 mmHg is recommended for the minimum cuff deflate pressure.5. When the minimum pressure has been set, press the NEXT button to select DYNAMIC INFLATE or FIXED INFLATE. Press the YES + button to turn dynamic inflate on, or press the NO – button for fixed inflate.When dynamic inflate is turned on, the blood pressure cuff inflation pressure automatically ranges 30 mmHg above the most recent systolic reading.Fixed inflate always inflates the blood pressure cuff to the set maximum inflation pressure.Draft
7-34 ApexPro™ 2001989-301A- draft 1Viewing real-time patient dataDynamic inflate is recommended for most patients. However, if a patient’s systolic pressure readings vary by 25 mmHg or more, fixed inflate may be more comfortable for the patient. In all likelihood, dynamic inflate would not inflate the cuff high enough for such a patient, prompting the blood pressure monitor to retry, and causing the patient to endure two inflations for each reading. A fixed inflation to the set maximum pressure eliminates the double inflation and increases the patient’s comfort. Reducing the maximum cuff inflation pressure setting for a patient being monitored with fixed inflate will also increase the patient’s comfort.6. After selecting dynamic or fixed inflate, the DEFLATE RATE can be set. It can be set to: 6, 5, 4, 3, or 2 mmHg, using the YES + and NO – buttons. A deflate rate of 3 mmHg per second is recommended.NOTEA patient with a slow heart rate requires a slower deflation rate than a patient with a faster heart rate. If the cuff deflates too quickly, it may not be possible to determine a blood pressure. If the cuff deflates too slowly, it may be uncomfortable for the patient. The recommended deflate rate of 3 mmHg per second meets most patients’ requirements, but it can be adjusted when needed.7. Press the NEXT button to return to the CHANGE TEST PARAMETERS? prompt, then press the NO – button to return to:INT= 5 (***)INCR DECR START?Setting limitsIt is possible to set the maximum and minimum values, as well as the change (delta) limit, at which the blood pressure monitor will reject a systolic, diastolic, or pulse pressure reading and attempt a new measurement. Contact technical support for more information about setting these limits.Software and hardware versionsTo verify what software and hardware versions your blood pressure monitor has, turn on the blood pressure monitor while holding down the LAST button. A display similar to the following appears:Vsn: XX/ZZK3: 0 PR: 0Your hardware version appears in place of the XX in the above example; your software version appears in place of the ZZ in the above example.NOTEAlthough it is not shown on the blood pressure monitor display, both the software and hardware version have a period in them. For example, if the hardware version reads 11 on the display, this actually indicates that it is hardware version 1.1.Draft
2001989-301A- draft 1 ApexPro™ 8-18Viewing stored patient dataDraft
8-2 ApexPro™ 2001989-301A- draft 1Viewing stored patient dataStored dataThe CIC Pro center can retrieve in-unit parameter data from patient monitors connected to the Unity Network and retrieve parameter data from secondary devices connected through a Unity Network Interface. Stored events, parameter numeric data, graphic trends, and full disclosure patient data is identified by the date and time the data was collected. As a result, stored data is linked to a specific time focus. You can review or print stored patient data from the following data review tools:Events directoryEvent StripFD Strip (full disclosure) (purchased option)FD Page (full disclosure) (purchased option)Graphic TrendsVital Signs (parameter numeric data)CalipersNOTEWhen using a second display, the second display will always open the most recently used data review tool. NOTESolar 9500 information monitor parameters not supported by the CIC Pro center will not be available for viewing or printing at the CIC Pro center. However, this data will be available locally at the Solar 9500 monitor.Time focus dataWhen parameter data is collected and stored, the stored patient data is linked to a specific time focus. When viewing an area of interest for one type of patient data (e.g. Vital Signs), you can view another type of patient data (e.g. Graphic Trends) that was collected and stored at that same time focus.As a result, when viewing a patient’s parameter numeric data (vital signs) that was collected and stored at 7:28 pm on January 10, you can select Graphic Trends to view the graphic trend data that was also collected and stored at 7:28 pm on January 10.NOTEWhen reviewing stored ECG data samples or strips, the degree of linking between time focus and the data is determined by your Full Disclosure license. You can only view full disclosure data that was stored within the time span identified by your Full Disclosure license. If you attempt to view data that exceeds your Full Disclosure license, the CIC Pro center displays the following message: No data is available for requested time.NOTEWhen using a second display, you can display data from two different data review tools using the same time focus in the top and bottom halves of the display screen.Draft
Viewing stored patient data2001989-301A- draft 1 ApexPro™ 8-3Events directoryFrom the Events directory, you can view information about any Crisis, Warning, or Advisory level arrhythmia or ST event that is stored at a bedside monitor. You can also view any ECG data sample that is also stored at a bedside monitor from the Events directory.Up to 131 alarm events are stored for each admitted patient, with the following maximum number of event types:100 arrhythmia alarm events20 ST limit alarm events10 samples1 ST referenceNOTEThe Events directory can be displayed along with the other data review tools. If it is not displayed, you can display the directory by clicking Events.NOTETo review stored non-ECG parameter data, use the FD Strip and FD Page data review tools.Viewing the Events directoryComplete the following procedure to view the Events directory:1. From the multi-patient viewer, click on the patient you want to view. The single patient viewer displays.2. From the single patient viewer, click Patient Data... > Events. The Events directory window displays.066AEvent list. When the list is sorted by type, click the plus sign to expand the list or the minus sign to collapse the list.Sort tool. Click the down arrow to sort stored events and data samples by the date and time the event occurred or by the type of event (e.g. arrhythmias).Draft
8-4 ApexPro™ 2001989-301A- draft 1Viewing stored patient dataPrinting the Events directoryComplete the following procedure to print a list of events and data samples stored in the Events directory:1. From the single patient viewer, click Patient Data... > Events. The Events directory displays.2. Sort the data by event time or by event type.3. Click (print directory button) located under the Events directory to print the displayed list of events.Counting how many events occurredComplete the following procedure to identify how many events occurred in each event category (e.g. V TACH or VFIB/VTAC):1. From the single patient viewer, click Patient Data... > Events. The Events directory displays.2. When the Events list is not sorted by type, click the down arrow next to Sort by: Time and choose Sort by: Type from the displayed list. The list sorts itself by event category.3. Use the scroll bar to move up or down through the list. The quantity of each event category is listed in square brackets next to the event name (e.g. V TACH [2]).Identifying the most recent occurring eventComplete the following procedure to identify the most recent occurring event:1. From the single patient viewer, click Patient Data... > Events. The Events directory window displays.2. When the Events list is not sorted by date and time, click the down arrow next to Sort by: Type and choose Sort by: Time from the displayed list. The list sorts itself by event time.3. To move up or down through the list of events one at a time, click arrows located under the Events directory.Scroll bar. Move up or down through the directory.Print directory button. Print the list of events displayed in the Events directory.Up and down buttons. Move up or down through the directory one event at a time.Delete event button. Delete the selected event or data sample from the Events directory.Draft
Viewing stored patient data2001989-301A- draft 1 ApexPro™ 8-54. Use the scroll bar to move up or down through the list of events and data samples.Deleting a stored event or data sampleNOTEDeleting an event or data sample from the CIC Pro center Events directory also deletes the corresponding data from the monitor or telemetry system.When the Patient Data Server (PDS) is active, the delete events button is dimmed and you cannot delete any events or data samples from the Events directory.To delete a stored event or data sample, use the (delete event button) with the red X.Complete the following procedure to delete an event or data sample stored in the Events directory:1. From the single patient viewer, click Patient Data... > Events. The Events directory displays.2. Sort the data by event time or by event type.3. Use the scroll bar to move up or down through the list of events and data samples.4. Click the single event or data sample you want to delete, or hold down CNTRL and continue to click the left mouse button to select multiple events or data samples.5. Click the (delete event button). This button is located under the Events directory and has a red-colored X on it. A window displays a message similar to the following, Are you sure you want to delete this event?6. Verify you selected the correct event or data sample for deletion:Click OK to delete this event or data sample.Click Cancel if you do not want to delete this event or data sample.Viewing or printing an Event stripYou can view or print a maximum of a 10-second strip for any arrhythmia event or ECG data sample stored in the Events directory. You can also view or print the current and reference ST complexes for all available ECG leads.The following is an example of an Event Strip.Draft
8-6 ApexPro™ 2001989-301A- draft 1Viewing stored patient data066AComplete the following procedure to view or print an event strip or data sample stored in the Events directory:1. From the single patient viewer, click Patient Data... > Events. The Events directory displays.2. Sort the data by event time or by event type.3. Use the scroll bar to move up or down through the list of events and data samples.4. Click on a single event or data sample you want to view or print.5. From the patient data menu, click Event Strip. The selected event strip displays.6. To print this strip, click (print button) located in the upper right corner of the single patient viewer.Full disclosure dataNOTEThis section provides a brief overview of the Full Disclosure function. For more information, refer to the CIC Pro Clinical Information Center Operator’s Manual.An admitted patient’s parameter waveforms and numeric data is continually collected for a maximum of 72 hours (license dependent). After the maximum hours of data collection have elapsed, the oldest data is deleted to accommodate newer data.NOTEThe amount of full disclosure data collected for a patient is determined by the type of licenses installed on the CIC Pro center. One hour of full disclosure data collection and storage is standard without additional licensing.You can view full disclosure data using the following data review tools:Full disclosure strip: Automatically scan forwards and backwards through full disclosure data for specific areas of interest.Full disclosure page: View full disclosure waveform data in a full page format and view specific areas of interest.Draft
Viewing stored patient data2001989-301A- draft 1 ApexPro™ 8-7Full disclosure stripA full disclosure strip displays a maximum of 10-seconds of available full disclosure parameter waveforms and numeric data. You can choose to view the waveforms and numeric data for all monitored parameters or all of the ECG waveforms and numeric data. You can automatically scroll backward or forward through the displayed data, view, and print a selected full disclosure strip. For more information, refer to the CIC Pro Clinical Information Center Operator’s Manual.Viewing or printing a full disclosure stripNOTERequires a laser printer to print.NOTEWhen viewing the full disclosure strip, the arrhythmia label text follows the waveform event and is displayed to the left of the cursor.Complete the following procedures to view or print a full disclosure strip:Display the full disclosure strip window1. From the multi-patient viewer, click on the patient you want to view. The single patient viewer displays. 2. From the single patient viewer, click Patient Data... > FD Strip. The full disclosure strip window displays.067A8195 62347Draft
8-8 ApexPro™ 2001989-301A- draft 1Viewing stored patient dataPrint a full disclosure stripOnce you have placed the cursor on an area of interest, you can print a strip of this full disclosure data. The printed strip displays the parameter waveform and numeric data for the selected time focus. The duration of the printed FD Strip is determined by the in the Strip > Duration setting in the Full Disclosure Defaults window. FD Strip windowItem Description1 Parameter numeric data corresponding with the cursor’s time focus.2Speed. Adjust the sweep speed of the scanned waveforms. For example, when you choose 25 mm/s, the displayed data scrolls in 8-second increments.3Scan Older. Scan through the older full disclosure data. When the end of the data has been reached, the scan automatically stops.During the scanning process, this button function changes to Stop. Click Stop to stop the scan at any time.4Scan Newer. Scan through the newer full disclosure data. When the end of the data has been reached, the scan automatically stops.During the scanning process, this button function changes to Stop. Click Stop to stop the scan at any time.5 Print button. Print the full disclosure waveform and parameter numeric data displayed in the FD Strip window. The print duration of the FD Strip is determined by the in the Strip > Duration setting in the Full Disclosure Defaults window. 6 Close button. Close the FD Strip window.7View All ECG. Display all of the available ECG leads and parameter numeric data. Once selected, this button function and label changes to Monitor.Monitor. Display all of the parameter waveforms and numeric data displayed at the monitor when the CIC Pro center collected the full disclosure data. Once selected, this button function and label changes to View All ECG.8 Scroll bar. Move backward or forward in time.NOTEThe scroll bar and the scroll bar arrows move the displayed data at different rates of speed:Clicking inside the scroll bar moves the displayed data in time increments defined by the Speed setting.Clicking the scroll bar arrows moves the displayed data in one-second increments.9 Cursor. Identify the date and time of the parameter waveform and parameter numerics data you are currently viewing.You can move the cursor by using the scroll bar or by clicking on the waveform to move the cursor to that position. Draft
Viewing stored patient data2001989-301A- draft 1 ApexPro™ 8-9Complete the following procedure to print a full disclosure strip:1. Position the cursor on the waveform area of interest.2. Click (print button) located in the top right corner of the FD Strip window. The full disclosure strip prints.Full disclosure pageThe full disclosure page allows you to view and examine the full range of stored waveforms, zoom in on areas of interest, and print a customized full disclosure report.Viewing or printing a full disclosure pageNOTECan print to a laser printer or DDW.Complete the following procedures to view the stored full disclosure waveforms:Display the FD Page window1. From the multi-patient viewer, click on the patient you want to view. The single patient viewer displays.2. From the single patient viewer, click Patient Data... > FD Page. The full disclosure page displays.NOTEWhen you select a specific time focus or an alarm event from the Events, Event Strip, Graphic Trends, or Vital Signs data review tools, the FD Page automatically displays the available full disclosure data for that time focus or event. Otherwise, the most current full disclosure data displays. NOTEWhen an event or ECG data sample occurs outside of the time limit of your full disclosure license, a message similar to the following displays: No patient data is available for the selected time.Draft
8-10 ApexPro™ 2001989-301A- draft 1Viewing stored patient data068AGraphic trends dataThe CIC Pro center can retrieve parameter numeric data from patient monitors connected to the Unity Network and retrieve parameter numeric data from secondary devices connected through a Unity Network Interface. The CIC Pro center can display this collected data in a graphical format, over a specified period of time. Depending how your CIC Pro center is configured, you can view a maximum of six graphic trends in half-screen mode and a maximum of 12 graphic trends in the full-screen mode. You can view graphic trends in varying time scales and print them at a laser printer or a digital writer.A patient’s parameter numeric data is continually collected for a maximum of 24 hours. After the maximum hours of data collection have elapsed, the oldest data is deleted to accommodate the newer data.FD Page windowItem Description1 Time and date stamp for this row of waveform data.2 Zoom box.Click inside the small blue-colored zoom box to display an enlarged view of the selected waveform area.Click on another area of interest to re-position the zoom box.3 Waveform data.4 Tools icon. Customize the on-screen display of full disclosure data.5 Print icon. Customize and print a full disclosure report.6 Close icon. Close the FD Page window.7 Scroll bar. Display older or newer data.8Zoom Window. View the enlarged waveform selected in the small blue-colored zoom box.123 45 678Draft
Viewing stored patient data2001989-301A- draft 1 ApexPro™ 8-11The CIC Pro center retrieves non-episodic parameter data at one-minute resolution from the patient monitor and displays it at one-minute resolution. Episodic parameter events (e.g. NBP) are retrieved every time episodic events are recorded. If more than one episodic event occurs during the same minute, the more recent episodic event overwrites the older episodic event.The CIC Pro center also retrieves AFIB trend data from telemetry patients. AFIB event patient data is stored for review in the Graphic Trends and Vital Signs tab sheets.Viewing graphic trendsNOTEFrom the multi-patient viewer, you can click in the real-time trend window to automatically display the current Graphic Trends window for this patient.NOTEWhen two trends are displayed across from each other in the Graphic Trends window and both trends have the same data values, those graphic trend waveform areas will overlap each other. The overlapping waveform colors will not blend together. This is a normal behavior. As the trend values change, the waveform shape will also change, allowing its individual waveform color to become visible. NOTEIf you position the time cursor inside a visible gap of trended data, parameter numerics are displayed. Depending upon the position of the time cursor within the gap, the displayed parameter numerics are either the last known parameter values before the gap or the first known parameter values after the gap.NOTEWhen viewing episodic telemetry data, any data reading collected after the minute mark will display in the next trended minute.Complete the following procedures to view the graphic trends of parameter numeric data:Display the graphic trends window1. From the multi-patient viewer, click on the patient you want to view. The single patient viewer displays.2. From the single patient viewer, click Patient Data... > Graphic Trends. The Graphic Trends window displays the current parameter trends. Draft
8-12 ApexPro™ 2001989-301A- draft 1Viewing stored patient data073AChoose the trend group you want to displayComplete the following procedure to display trends from a preset group of parameters: 1. From the Graphic Trends window, click Groups. A list of trend groups displays.2. Choose the trend group you want to display.Adjust the displayed time periodNOTEThe Graphic Trends window displays the current trends.Graphic Trends windowItem Description1Graphic Trends window.2 Graphic trend scales.3 Graphic trend buttons. Identify the trended data and the associated parameter numeric values. Click on a graphic trend button to change the scale of this graphic trend.4 Scroll bar. Move backward or forward in time.5 Time focus cursor (yellow line) and time focus label (yellow label). Landmark the date, time, and parameter numeric data corresponding to the cursor placement.NOTEThe date only appears in the time cursor label when the viewed data is not from the current day.6 Event summary. Display a brief overview of the type and number of events that occurred during a specific time focus.123645Draft
Viewing stored patient data2001989-301A- draft 1 ApexPro™ 8-13Complete the following steps from the Graphic Trends window to adjust the start and stop time of the displayed graphic trends:1. To make minor time adjustments, use the scroll bar to move backward and forward in time.2. To display a specific time range (e.g. 30 Minutes), complete the following steps:a. Click Range to display a list of time ranges.b. Choose the time range for the displayed trended data. You can choose from 15, 30 minutes or 1, 2, 4, 8, 12, 24 hours.Adjust the trend scale sizeComplete the following steps to adjust the scale size of a parameter trend:1. From the Graphic Trends window, click on the parameter trend you want to adjust. A window displays the parameters scales available for the selected parameter trend.2. Choose the desired scale. The window closes and the scale setting is automatically applied.3. Repeat step 1 and step 2 for each parameter trend scale you want to adjust.Printing graphic trends dataWhen printing graphic trends data, the following factors apply:Graphs print in the same scale as displayed on screen. A maximum of four graphs can be printed on each page.The event trend prints on its own page and includes all the event calls that occurred during the report period.Trend values that exceed the displayed trend scale print as a red-colored dashed line.For monitor patients, graphic trend printouts that are initiated from a CIC Pro center print only to a laser printer. If the graphic trend printout is initiated from a patient’s bedside, it can print to a digital writer or to a laser printer (depending on how the print functions are configured on the monitor).For telemetry patients, graphic trend printouts can print to a laser printer or to a digital writer.NOTEWhen printing graphic trends data from telemetry patients to a digital writer, the time duration of the printed output is as follows: Digital writer output for stored telemetry graphic trends dataDisplayed data Printed output15, 30, 60 minutes 90 minutes2 hours 3 hours4 hours 6 hoursDraft
8-14 ApexPro™ 2001989-301A- draft 1Viewing stored patient dataTo print the displayed graphic trends data, click (print button) located in the top right corner of the Graphic Trends window.Vital signs dataThe CIC Pro center can continuously retrieve parameter numeric data (vital signs) from in-unit or out-of-unit patient monitors connected to the Unity Network and retrieve parameter numeric data from secondary devices connected through a Unity Network Interface. You can view trended parameter numeric data for varying time intervals. When the CIC Pro center is connected to a laser printer, you can also print the trended parameter numeric data. Telemetry beds can print to a writer if a laser printer is not connected to the CIC Pro center.For non-episodic parameters (e.g., HR), a median value is determined and stored for display at one-minute resolution. Episodic parameters (e.g., NBP) are stored every time one occurs. If more than one episodic event occurs during the same minute, the more recent event overwrites the earlier one.NOTEWhen the first parameter on the list is an episodic parameter (e.g. NBP), all other parameters on the list only display data at the episodic measurement points. For example, when NBP is the first parameter on the list, and NBP measurements were taken at 10:10, 10:15, and 10:20, then data for all other parameters on the list is only available for the same times.NOTEEpisodic data is displayed at the closest time interval for the selected time. If the time for the measurement occurred before or after the displayed time, an ellipses symbol (...) is appended after the episodic value.The CIC Pro center also retrieves AFIB trend data from telemetry patients. AFIB event patient data is stored for review in the Graphic Trends and Vital Signs tab sheets.Viewing vital signs dataComplete the following procedure to view periodic and episodic trend data in a tabular format:1. From the multi-patient viewer, click on the patient you want to view. The single patient viewer displays.8 hours 12 hours24 hours 24 hoursDigital writer output for stored telemetry graphic trends dataDisplayed data Printed outputDraft
Viewing stored patient data2001989-301A- draft 1 ApexPro™ 8-152. From the single patient viewer, click Patient Data... > Vital Signs. The Vital Signs window displays.074A3. Click the down arrow next to the Vital Signs sort tool and choose the data group you want to display. The data sorts itself by your chosen category.NOTEWhen reviewing data in the Vital Signs window, be aware that if you changed to monitoring a different V lead, both the current and previous V lead data is trended and both V lead labels will appear in the Vital Signs window. In addition, the V lead numeric data appears at the time the V lead data was collected.4. Click the Interval button to choose the time interval of the displayed data. You can choose from 1, 5, 15, 30, or 60 minutes.5. Use the up and down or left and right scroll bars to move through the displayed data.Vital Signs windowItem Description1Vital Signs sort tool. Click the down arrow to choose the data group you want to display.2 Print button. Print the list of events displayed in the Events directory.3 Close button. Close this window.4 Scroll bars. Move up and down or left and right through the displayed data.5 Focus indicator. Highlights one event for easier viewing.6 Interval button. Click the down arrow to choose the time interval of the displayed data.1 2 3456Draft
8-16 ApexPro™ 2001989-301A- draft 1Viewing stored patient dataPrinting vital signs dataNOTEUp to five events of the Vital Signs data for telemetry patients can be printed to a digital writer.Complete the following procedure to print periodic and episodic trend data in a tabular format to a laser printer:1. From the single patient viewer, click Patient Data... > Vital Signs. The Vital Signs window displays.2. Click the down arrow next to the Vital Signs sort tool and choose the data group you want to display. The data sorts itself by your chosen category.3. Click the Interval button to choose the time interval of the displayed data.4. Click (print button) located in the top right corner of the Vital Signs window.Measuring ECG waveform intervals and amplitudeNOTEThis section provides a brief overview of the calipers function. For more information, refer to the CIC Pro Clinical Information Center Operator’s Manual. When full disclosure data is collected and stored at the CIC Pro center, you can use the Calipers measurement tool to measure the PR, QRS, QT, and R-R waveform intervals and the ST waveform amplitude.Viewing or printing a waveform from the Calipers windowComplete the following procedure to print or view a waveform from the Calipers window:1. From the multi-patient viewer, click on the patient you want to view. The single patient viewer displays.2. From the single patient viewer, click Patient Data... Then, choose the data review tool you want to use to locate a waveform segment or waveform strip you want to measure.NOTEWhen an event or ECG data sample occurs outside of the time limit of your full disclosure license, the data will not be available to view from the Calipers measurement tool.3. Click Calipers to display the Calipers window. Ten seconds of waveform data displays.Draft
Viewing stored patient data2001989-301A- draft 1 ApexPro™ 8-17079ACalipers windowItem Description1 Measurement table. Enter or clear the waveform measurement values for the PR, QRS, QT, R-R, and ST intervals or amplitudes.NOTEThe QTc value is a calculated value. 2 Measurement window. View, measure time intervals and amplitude for displayed waveforms, and compare the interval of multiple waveform complexes.3 Scroll bars. Move up and down or left and right through the displayed data.4 Calculated measurement label. Click and drag to reposition.5 Calipers central handle. Click and drag this handle to position the caliper on a desired waveform complex.6 Caliper arm handles. Click and drag these handles to resize or reposition the caliper arms over the waveform.Measurement: Choose one of the following leads to measure: I, II, III, V, AVR, AVL, and AVF. For telemetry only, a second V lead would be available for display. Reference: Fill the Enable box with a check mark and choose one of the following reference leads for display: I, II, III, V, AVR, AVL, and AVF. For telemetry only, a second V lead would be available for display. Measurements taken on a reference lead are not recorded in the measurement table.Gain: Adjust the gain of the displayed waveform.Marching Calipers: Compare the rate of multiple waveforms. Grids: Apply a background grid. Zoom: Zoom in for a closer look at the waveform. Speed: Change the sweep speed of the displayed waveform.1423665Draft
8-18 ApexPro™ 2001989-301A- draft 1Viewing stored patient data4. Click (print button) located in the top right corner of the Calipers window. All measurements are lost when the window is closed.ReportsThe following reports are available for telemetry patients if a laser printer is configured for the CIC Pro center. These reports are enabled and configured through Webmin. Refer to the CIC Pro Clinical Information Center Bedrock Hardware Platform Service Manual for more information.Patient discharge summary reportThe Patient Discharge Summary report automatically prints to a configured laser printer for the CIC Pro center when a telemetry patient is discharged. The report provides general patient, system status alarm and patient status alarm information.Transmitter battery status reportThe Transmitter Battery Status report prints to a configured laser printer for the CIC Pro center on a user demand basis. The report lists all transmitters with admitted telemetry patients, the associated unit and bed name and transmitter’s current battery level. Draft
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9-2 ApexPro™ 2001989-301A- draft 1PrintingPrint devicesYou can print real-time and stored parameter data to the following Unity Network print devices:PRN 50-M digital writerLaser printer Print outputYou can print displayed real-time or stored parameter data from a CIC Pro center or from other GE patient monitors that are connected to the Unity Network.The type of parameter data available to print depends on the source of the patient data (e.g., hardwired bed, Combo bed, or telemetry bed) and from where you choose to initiate the printing of this information (e.g., CIC Pro center or patient monitor).Telemetry bed parameter dataThe following table identifies the telemetry bed parameter data available to print from a CIC Pro center or GE patient monitor.Graph locationWhere your data prints out (graph location) is first determined by the default Graph Setup control settings and second, by other operating conditions.Telemetry bed parameter dataData printed from a CIC Pro center Data printed from a monitorParameter data Writer Printer Writer PrinterVital Signs Yes Yes Yes YesGraphic Trends Yes Yes Yes YesAlarm history Yes Yes Yes YesEvents directory Yes Yes Yes YesAlarm control Yes Yes Yes YesView patient Yes Yes Yes YesAlarm graph Yes Yes Yes YesFull disclosure strip -- Yes -- --Full disclosure report -- Yes -- --Calipers -- Yes -- --Draft
Printing2001989-301A- draft 1 ApexPro™ 9-3Use the following guidelines to identify the operating conditions that determine where your data prints out (graph location):Manual graphs and print windows: These print at the CIC Pro center where the graph was requested, provided that CIC Pro center has the same type of writer or printer as the graph location set for the patient for that type of graph. If the CIC Pro center where the graph was requested does not have the same type of writer or printer, the graph prints to the patient’s specified graph location.When the CIC Pro center is not connected to a printer: When viewing a patient on a CIC Pro center that is not connected to a printer, the graph settings default to the graph location configured in the Graph Setup defaults. Patient moved to a different bed: When you move a patient bed, the patient’s graph settings are retained as set on the CIC Pro center where the patient was first admitted.Duplicated telemetry patient: When a telemetry patient is duplicated on another CIC Pro center, alarm graphs continue to print at the CIC Pro center where the patient was first admitted.No graph location for a telemetry patient: When no graph location is defined for a telemetry patient at the time of admission, the message Saving displays. Graphs are not sent to printers outside the unit.Printing real-time dataIn addition to patient alarm graphs printing automatically, you can print a continuous strip for a single patient, or print parameter waveforms or parameter limits for all patients displayed in the multi-patient viewer. To print real-time data, see the following sections of this manual: Printing a continuous ECG strip on page 7-8.Initiating a graph all patients request on page 9-5.Printing stored patient dataYou can print patient data that has been collected and stored at this CIC Pro center.To print stored patient data, see the following sections of this manual:Printing the Events directory on page 8-4.Viewing or printing an Event strip on page 8-5.Viewing or printing a full disclosure strip on page 8-7.Printing graphic trends data on page 8-13.Printing vital signs data on page 8-16.Initiating a manual graphIf you click on a patient’s ECG parameter window, a continuous graph is initiated for the patient. Clicking on the ECG parameter window again will stop the graph.Draft
9-4 ApexPro™ 2001989-301A- draft 1PrintingThe PRN 50 digital writer and the Direct Digital Writers (DDW) print patient data (generally referred to as a graph or graph strip). Data can also be printed on a laser printer. The waveforms graphed and graph speed are controlled in the individual patient’s Graph Setup tab sheet. Unit defaults for telemetry patients can be set in the CIC Defaults tab sheet and the Telemetry Unit Defaults tab sheet. Refer to Telemetry unit defaults on page 4-7 for more information on setting Telemetry Unit Defaults.Transmitter initiated graphs (manual graphs) When the Graph button on the transmitter is pressed, a 20-second graph strip is printed at a speed of 25 millimeters per second and the event is stored in alarm history.When an IMPACT.wf paging system (version II or later) is also available in the same care unit, pressing the Graph button enables the View on Demand feature (also called the Apex Graph Button Push feature). The IMPACT.wf server generates a manually initiated sample page or snapshot of the patient’s ECG waveform and any other enabled/monitored non-arrhythmia parameters. When you press the Graph button on the transmitter, it generates both an IMPACT.wf update page as well as a standard ECG waveform graph at the CIC Pro center. The IMPACT.wf page is labeled Sample when this data is displayed on the IMPACT.wf receiver and stored in history. Additionally, all pagers assigned to the patient receive a page.Automatic alarm graphsA graph prints automatically when a patient experiences a Crisis or Warning alarm condition. Arrhythmia alarm graphs run until the end of the alarm event unless manually stopped by the user. The printer prints up to 10 seconds of data that occurred immediately before the event, and prints for the duration of the event. The printer stops printing when the patient returns to a normal rhythm. If a printer is not available at the time of the alarm event, a 20-second graph is saved. This saved graph will print when a printer becomes available.Graph messagesOne of the following messages is displayed on the CIC Pro center screen during graphing:GRAPH ALARM—An alarm graph was initiated and is running.GRAPH MANUAL—A manual graph was requested and is running.GRAPH TTX—The Graph button on the transmitter was pressed and a 20-second graph strip is running.PRINTING—A non-real time graph is currently being printed.SAVING—An alarm or a manual graph has been requested but the writer is in use; the writer door is open; or the writer is out of paper. The graph is being saved until the Draft
Printing2001989-301A- draft 1 ApexPro™ 9-5writer is available. The most recent 20-second alarm or manual graph will be saved in alarm history. Additional data maybe available with Full Disclosure.Graph all patientsClicking on the Print button at the bottom of the CIC Pro center display sends a Graph All Patients request to all beds displayed on the CIC Pro center, initiating a 10-second graph for all telemetry and Combo patients and a 20-second graph for all bedside patients. When this option is selected for telemetry patients, graph requests always print at a speed of 25 millimeters per second.NOTEThis Graph All Patients function is only available when the single patient viewer is closed. If a single patient viewer is open, selecting Print from the main menu initiates a printout of whichever tab sheet is in front.The print process stops automatically. If the Graph Stop control key is pressed on the external DDW, the current patient’s graph stops and the writer begins to print a graph for the next patient.If a patient’s data is currently printing or is being saved to print when a Graph All Patients request is initiated, this patient’s data will not be included in the Graph All Patients graph. This patient’s data will print independently of the Graph All Patients graph. Clicking on the ECG parameter window for a patient whose data is saving will cancel the Graph All Patients request for that patient.If, while a Graph All Patients request is in progress, an arrhythmia alarm occurs for a patient, the alarm data will replace the data that was saved for the Graph All Patients request. The alarm data will then appear on the graph printout.If, while a Graph All Patients request is running, a telemetry patient initiates a graph from his or her transmitter, the saved data for the Graph All Patients graph will be replaced by data from the patient’s transmitter. The data from the transmitter will then appear on the graph printout.Initiating a graph all patients requestTo initiate a Graph All Patients request, follow these steps.1. Click on the Print button at the bottom of the CIC Pro center display. The Graph All Patients window opens.2. Click on Limits or Waveforms.Selecting Limits graphs all patient limits.Selecting Waveforms graphs all patient waveforms.3. Click on the OK button to complete the Graph All Patients request.Draft
9-6 ApexPro™ 2001989-301A- draft 1PrintingStopping a print jobYou must stop a print job from the same CIC Pro center you used to send the print job to the printer.Stop printing to a laser printerComplete the following procedure to stop printing all print jobs sent to the laser printer:1. From the multi-patient viewer, click CIC Setup > CIC Defaults. The CIC Defaults window displays.2. Under Printer/Writer, click Cancel Print Jobs for the printer you want to stop printing to.3. After making your selection, complete one of the following tasks from the CIC Defaults window:Click OK to apply your changes and close the CIC Defaults window.Click Cancel to cancel your changes and close the CIC Defaults window.Click Apply to apply your changes without closing the CIC Defaults window.Stop printing to a local digital writerComplete the following procedure to stop printing all print jobs sent to a local digital writer:1. Locate the digital writer.2. Press the (Graph Stop) button located on the front of the digital writer to stop the print job.Adjusting print control settingsTo temporarily adjust the graph location and settings for a specific patient, complete the following procedure:NOTEAll changes are temporary and return to the default settings when the patient is discharged. To permanently change these settings, see the CIC Pro Clinical Information Center Bedrock Hardware Platform Service Manual.1. From the multi-patient viewer, click on the patient you want to view. The single patient viewer displays.2. From the single patient viewer, click Monitor Setup > Graph Setup to display the Graph Setup window.Draft
Printing2001989-301A- draft 1 ApexPro™ 9-7081A3. Change any of the undimmed setting options. When an option appears dimmed, you cannot change it unless you enter the service-level password.Enable transmitter graphThe Enable Transmitter Graph option allows you to turn off/on the Transmitter Graph function for telemetry patients. When this option is enabled at the CIC Pro center, you can initiate a graph by pressing the graph button on the transmitter. When this option is disabled at the CIC Pro center, no graph can be initiated from the transmitter. To enable or disable this option, follow this procedure:1. To enable the Transmitter Graph option, point and click with the mouse to place a check mark in the Enable Transmitter Graph check box.Option FunctionGraph Waveforms Set the print order of the ECG waveforms:ECG 1: Set the lead and its associated waveform to print first.Waveform 2: Set the ECG lead or parameter and its associated waveform to print second.Waveform 3: Set the ECG lead or parameter and its associated waveform to print third.Waveform 4: Set the ECG lead or parameter and its associated waveform to print fourth.Graph Location Choose from available printers to set the graph location of the manual, alarm, and print window graphs:Manual: Any real-time patient data you initiate the printing of.Alarm: An alarm graph that is triggered by a patient Crisis or Warning alarm condition.Print Window: Any stored patient data you initiate the printing of. This graph location also prints the Graph All > Limits data.Enable Transmitter Graph Turn on or turn off the ability to initiate graph printing from a transmitter.Speed Set the print speed. The slower the speed, the more condensed the data. 25 mm/second is standard.Draft
9-8 ApexPro™ 2001989-301A- draft 1Printing357C2. To disable the Transmitter Graph option, point and click with the mouse to remove the check mark in the Enable Transmitter Graph check box.Alarm graphs enabled/disabledThis message line indicates whether the graph on alarm feature is on (Alarm Graph ENABLED) or off (Alarm Graph DISABLED). This feature cannot be set on an individual patient basis. Use the Alarm Graph option in the Telemetry Unit Defaults tab sheet to set it for all patients admitted to the CIC Pro center.Graph paper out indicatorWhen there is no graph paper in the writer (or the door is open), the message Graph Paper Out/Door Open is displayed at the top of the screen.When printing to a laser printer, a similar status message is displayed if the printer is unable to print.NOTEBecause the CIC Pro center can communicate with many laser printers, specific status messages are not documented in this manual.Enable Transmitter Graph Check BoxDraft
2001989-301A- draft 1 ApexPro™ A-1AAbbreviations and symbolsDraft
A-2 ApexPro™ 2001989-301A- draft 1Abbreviations and symbolsAbbreviationsAbbreviations and symbols that you may encounter while reading this manual are listed below with their meanings.12SL 12-lead ECG analysisAAC alternating currentAcc acceleratedACI acceleration indexAD adultADU alarm display unitAFIB atrial fibrillationALRM alarmAMI acute myocardial infarctionsANT anteriorArr, Arrhy arrhythmiaART arterialAuto automaticAux auxiliaryA-V arterial venousAVG averageAVOA automatic view on alarmBBIS bispectral indexBP blood pressureBrady bradycardiaBT blood temperatureCCcelsiusCal calibrateCalc, calcs calculation(s)cc cubic centimeterCC computation constantCCO continuous cardiac outputCD compact discDraft
Abbreviations and symbols2001989-301A- draft 1 ApexPro™ A-3CI cardiac indexCIC CIC Pro Clinical Information Centercm centimeterCO cardiac outputCO carbon monoxideCO2carbon dioxidecomm communicationCP cardiopulmonaryCPP cerebral perfusion pressureCRG cardiorespirogramCSA Canadian Standards AssociationCVP central venous pressureDD diastolicDES desfluraneDIDCA direct interface device connection adapterDSC digital signal converterEEexpirede.g. for exampleECG electrocardiographeDO2I estimated delivered oxygen indexEEG electroencephalographEMC electromagnetic compatibilityEMI electromagnetic interferenceENF enfluraneESU electrosurgical cautery unitet al and othersET CO2end-tidal carbon dioxideetc. etceteraETO ethylene oxideEXP expiredFF FahrenheitFEM femoralDraft
A-4 ApexPro™ 2001989-301A- draft 1Abbreviations and symbolsGggramgHz gigahertzgtt dropsHHAL halothaneHb hemoglobinHR heart rateHz hertzII inspiredIABP intra-aortic balloon pumpICG impedance cardiographyICP intracranial pressureICU intensive care unitID identificationin inchesINDV individualINF infusion, inferiorInject injectateINSP inspiredINT interiorISO isofluraneIT injectate temperatureIV intravenousJJ ST measurement pointKkg kilogramLL, LD leadLleftlliterLA left armLA left arterialLAN local area networkDraft
Abbreviations and symbols2001989-301A- draft 1 ApexPro™ A-5LAT laterallbs poundsLCWI left cardiac work indexLED light emitting diodeLIS lab information systemLL left legLVET left ventricular ejection timeLVSWI left ventricular stroke work indexMM meanMAC minimum alveolar concentrationMAP mean arterial pressureMin minimummm millimetersmmHg millimeters of mercuryMPSO multiple portable socket outletMRI magnetic resonance imagems millisecondsmV millivoltNN/A not applicableN2O nitrous oxideNBP, NIBP non-invasive blood pressureNeo neonatalOO2oxygenO2CI oxygen consumption indexOR operating roomPPpacePA pulmonary arteryPAD pulmonary artery diastolicPar parameterPAW pulmonary artery wedgePC personal computerDraft
A-6 ApexPro™ 2001989-301A- draft 1Abbreviations and symbolspCO2, pO2partial pressure of arterial carbon dioxidePED pediatricPEP pre-ejection periodPVC premature ventricular resistanceQQRS interval of ventricular depolarizationQty quantityRR rightRrateR&TTE Radio and Telecommunication Terminal EquipmentRA right armRA right artialREF referenceReprep re-prepareRES resistanceResp respirationRF radio-frequencyRHY rhythmRL right legRR respiration rateSSsystolicsec secondSEV sevofluraneSIM simulatorSol solutionSP specialSpO2arterial oxygen saturation (pulse oximetry)SQI signal quality indexST interval of ventricular repolarizationStat right awaySTR systolic time radioSV stroke volumeSvO2 mixed venous oxygen saturationDraft
Abbreviations and symbols2001989-301A- draft 1 ApexPro™ A-7SymbolsSVR systemic vascular resistanceSVRI systemic vascular resistance indexSync synchronizedTT1, T2 temperature sitesTachy tachycardiaTC transcutaneousTech technicalTemp, TMP, TP temperatureTFC thoracic fluid contentTIR technical information reportUUAC umbilical artery catheterUO urometerUVC umbilical venous catheterVVvoltV versionV ventrical leadVent ventilatorVFib ventricular fibrillationVI velocity indexVOA view on alarmVol volumeVTach ventricular tachycardiaWWF, WFS waveform(s)XX multiplier (2X)X invalid data& and° degree(s)Draft
A-8 ApexPro™ 2001989-301A- draft 1Abbreviations and symbols> greater than< less than- minus# number% percent± plus or minus" inchesµmicroDraft
2001989-301A- draft 1 ApexPro™ B-1BCustomized defaults worksheetDraft
B-2 ApexPro™ 2001989-301A- draft 1Customized defaults worksheetNOTEBefore filling out this worksheet, you should make additional copies for future use.Use this worksheet to record customized settings for the following defaults:Alarms Off selection on page B-2.Telemetry Unit Defaults on page B-2.Telemetry parameter limits and alarm levels on page B-3.Alarms Off selectionThis telemetry setting is located in CIC Setup > CIC Defaults.Telemetry Unit DefaultsAllow Alarms Off On this CIC? (Circle one) Yes NoTelemetry unit default Default settingGraph SetupDefault Locations for this CIC ManualAlarmPrint WindowWaveforms ECG 1 IIWaveform 2 VWaveform 3 OffWaveform 4 OffTransmitter Graph OnAlarm Graph Always OnEvent Marker Graph OnECGDisplay Lead IIArrhythmia FullLead Analysis Multi-LeadST Analysis OnVa Lead V1Vb Lead V2Detect Pace OffDraft
Customized defaults worksheet2001989-301A- draft 1 ApexPro™ B-3Telemetry parameter limits and alarm levelsPatient Age AdultTransmitter Pause EnabledAlarm Pause Breakthrough Always OnEvent Marker1On1The Event Marker Graph and Event Marker features are not applicable to all transmitters.Telemetry unit default Default settingParameter Limits and Alarm Levels Low High Level Arrhythmia Alarm Levels LevelsHR bpm 50 150 Warning Asystole CrisisST-I mm -2.0 2.0 Warning VFIB/VTAC CrisisST-II mm -2.0 2.0 Warning V Tach CrisisST-III mm -2.0 2.0 Warning VT > 2 CrisisST-V mm -2.0 2.0 Warning V Brady CrisisST-V2 mm -2.0 2.0 Warning Acc Vent AdvisoryST-V3 mm -2.0 2.0 Warning Pause AdvisoryST-V4 mm -2.0 2.0 Warning Tachy AdvisoryST-V5 mm -2.0 2.0 Warning Brady AdvisoryST-V6 mm -2.0 2.0 Warning R on T MessageST-AVR mm -2.0 2.0 Warning Couplet MessageST-AVL mm -2.0 2.0 Warning Bigeminy MessageST-AVF mm -2.0 2.0 Warning Trigeminy MessageNBP-S mmHg 80 200 Warning PVC MessageNBP-D mmHg 20 120 Warning Irregular MessageNBP-M mmHg 40 140 Warning Atrial Fib MessageSPO2 % 90 105 WarningSPO2-R bpm 50 150 Warning System Alarm Levels LevelsRR breaths/min 5 30 Warning CHANGE BATTERY System WarningRR-APNEA seconds 30 Warning OFF NETWORK System WarningPVC #/min 6 Advisory ARR SUSPEND System WarningLEADS FAIL System WarningPROBE OFF System WarningDraft
B-4 ApexPro™ 2001989-301A- draft 1Customized defaults worksheetDraft
2001989-301A- draft 1 ApexPro™ C-1CMaintenanceDraft
C-2 ApexPro™ 2001989-301A- draft 1MaintenanceBiocompatibilityWhen used as intended, the parts of the product described in this operator manual, including accessories that come in contact with the patient during the intended use, fulfill the biocompatibility requirements of the applicable standards. For more information, contact your local sales/service representative.SuppliesTo ensure patient safety, use only supplies manufactured or recommended by GE. For more information, contact your local sales/service representative.InspectionAn 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 institution’s infection control unit and/or biomedical department.CAUTIONFailure on the part of the responsible hospital or institution employing the use of this monitoring equipment to implement a satisfactory maintenance schedule may cause undue equipment failure and possible health hazards.Check with your biomedical department to be sure preventive maintenance and calibration is complete. Qualified service personnel should repair or replace damaged equipment or reusable supplies. Refer to the appropriate service manuals for detailed maintenance and repair information.Use the following guidelines when inspecting the equipment:Inspect the equipment for obvious physical damage.Inspect all cords for fraying or other damage. Inspect all plugs and connectors for corrosion, contaminants, bent prongs or pins.Inspect all cable insulation for cracks, tears, or other damage.In the U.S., GE Service is available 24-hours a day by calling 800-558-7044. Outside the U.S., please contact your local sales/service representative.NOTERefer to the appropriate service manuals for more comprehensive checkout procedures.Draft
Maintenance2001989-301A- draft 1 ApexPro™ C-3DisposalWARNINGPACKAGING DISPOSAL—Dispose of all packaging material, observing all applicable waste control regulations and keeping out of children’s reach.WARNINGDISPOSAL—At the end of its service life, the products described in this manual, as well as its accessories, must be disposed of in compliance with guidelines regulating the disposal of each product. If you have any questions concerning disposal of a product, please contact GE or its representatives.CleaningAll equipment should be cleaned on a regular basis. Comply with the policies of your institution’s infection control unit and/or biomed department. The decision to disinfect or sterilize must be made per your institution’s requirements with an awareness of the effect on the integrity of the transmitter and leadwire.WARNINGDisconnect AC-powered equipment from the power line before cleaning or disinfecting its surface. Turn off the power to battery-powered equipment before cleaning or disinfecting its surface.WARNINGCONTAMINATED LEADWIRES— Contaminated leadwires may cause infection. Always follow the skin preparation guidelines and leadwire cleaning instructions provided in this manual.WARNINGIMPROPER TRANSMITTER/LEADWIRE APPLICATION — Applying a transmitter and/or leadwire that is not thoroughly dry to a patient can result in an electrically conductive path being established and a Leads Fail alarm not being provided if leadwires come off the patient.CAUTIONNever immerse devices, cables, or leadwires in any liquid. Draft
C-4 ApexPro™ 2001989-301A- draft 1MaintenanceCAUTIONDo not pour or spray any liquid directly on cables or leadwires or permit fluid to seep into connections or openings.CAUTIONNever use conductive solutions, solutions that contain chlorides, wax, or wax compounds to clean devices, cables or leadwires.CAUTIONNever use solutions or products that contain the following:Any type of Ammonium Chloride such as, but not limited to:Dimethyl Benzyl Ammonium ChlorideQuaternary Ammonium Chloride solutionsAbrasive cleaners or solvents of any kindAcetoneKetoneBetadineAlcohol-based cleaning agentsSodium saltsCAUTIONNever autoclave or steam clean devices, cables or leadwires.CAUTIONDo not attach the device to a patient until it is thoroughly dry.Results of improper cleaningAppearance of waveforms when the device is not connected to a patient, causing false alarms instead of a Leads Fail alarm and may not provide a visual and/or audible Leads Fail alarm.Brittle and breaking device case.Overall system performance degradation.Melting, dulling, or distorting the case.Total handheld medical device failure requiring replacement.Unit malfunction. Void warranty.Draft
Maintenance2001989-301A- draft 1 ApexPro™ C-5Cleaning products to avoidCleaning products known to cause the types of problems listed above include, but are not limited to:Sani-Cloth Wipes Ascepti WipesHB QuatClorox Wipes (they do not contain bleach)Over-the-counter detergents (e.g. Fantastic, Tilex, etc.)Products that contain active ingredients and solutions similar to these products should also be avoided.Transmitter/device cleaningThese instructions apply to transmitters and any other devices, such as oximeters, blood pressure monitors, etc. Cleaning/disinfecting1. Remove all batteries and leadwires.2. Close the battery door before cleaning the device.3. Wipe the exterior of the device with a soft lint-free cloth, using the following solution as recommended in the APIC Guidelines for Selection and Use of Disinfectants (1996):Sodium hypochlorite (5.2% household bleach) minimum 1:500 dilution (minimum 100 ppm free chlorine) and maximum 1:10 dilution.Any sodium hypochlorite wipe product that meets the above guidelines of can be used.NOTEWring excess disinfectant from wipe before using.NOTEAny contact of disinfectant solutions with metal parts may cause corrosion.4. Allow disinfectant solution to remain on device for a minimum of one minute or per hospital guidelines.5. Wipe off cleaning solutions with a clean, moist cloth.6. Dry thoroughly with a dry lint-free cloth and let air dry for at least 30 minutes.NOTEDrying times may vary based on the environmental conditions.7. Take care not to let fluid pool around connection pins. If this should happen, blot dry with a soft, lint-free cloth.Draft
C-6 ApexPro™ 2001989-301A- draft 1MaintenanceStorageAlways remove batteries when the device is not in use (even for short periods of time).Store in a dry well-ventilated area.Hang the device, use a holder if available. If leadwires/cables are attached, they should hang straight.Do not coil leadwires/cables tightly around the device.ECG cable/leadwire cleaningResults of improper cleaningProduct discoloration.Metal part corrosion.Brittle wires. Brittle and breaking connectors.Reduced cables and leadwires life.Unit malfunction. Void warranty.Cleaning/disinfecting1. Remove cables and leadwires from the handheld device or system before cleaning.2. Use care in cleaning leadwires to prevent pulling the long wires from the connector ends. Metal connections can be pulled away from the connectors.3. For general cleaning of cables and leadwires, wipe using a lightly moistened cloth with a mild soap and water solution. Then wipe and air dry.4. For disinfecting the cables and leadwires, wipe exterior with a soft lint-free cloth, using the following solution as recommended in the APIC Guidelines for Selection and Use of Disinfectants (1996):Sodium hypochlorite (5.2% household bleach) minimum 1:500 dilution (minimum 100 ppm free chlorine) and maximum 1:10 dilution.Any sodium hypochlorite wipe product that meets the above guidelines of can be used.NOTEWring excess disinfectant from wipe before using.NOTEAny contact of disinfectant solutions with metal parts may cause corrosion.5. Do not immerse either end of a cable or leadwire connector. Immersing or soaking the connector ends may corrode metal contact ends and affect signal quality.Draft
Maintenance2001989-301A- draft 1 ApexPro™ C-76. Wipe off cleaning solutions with a clean, lightly moistened cloth.7. Dry thoroughly with a dry lint-free cloth and let air dry for at least 30 minutes.NOTEDrying times may vary based on the environmental conditions.8. Take care not to let fluid pool around connection pins. If this should happen, blot dry with a soft, lint-free cloth.9. Do not use excessive drying techniques, such as oven, forced heat or sun drying.SterilizingNOTEEtO sterilization is not recommended, but may be required for cables and leadwires. Frequent sterilization will reduce the useful life of cables and leadwires.Sterilize with ethylene oxide gas (EtO) at a maximum temperature of 50° C (122° F). After EtO sterilization, follow the recommendations from the sterilizer manufacturer for required aeration.StorageStore in a dry well-ventilated area.Vertically hang cables and leadwires.Do not coil leadwires or cables tightly around any medical device.Draft
C-8 ApexPro™ 2001989-301A- draft 1MaintenanceDraft
2001989-301A- draft 1 ApexPro™ D-1DTroubleshootingDraft
D-2 ApexPro™ 2001989-301A- draft 1TroubleshootingECGArrhythmia troubleshootingProblem: Inaccurate heart rate and/or false asystoleSolution: Check ECG signal from patient:1. Check/adjust lead placement.2. Check/perform skin preparation.3. Check/replace electrodes.Check amplitude of ECG waveform:1. Click on the patient’s ECG tab.2. Click on all ECG leads in the Display section and check for 0.5 mV amplitude at normal (1X) size. (At least 0.5 mV amplitude is required for QRS detection.) For borderline signals, validate on a graph.3. If amplitudes are low, electrodes may need to be repositioned or replaced.Relearn arrhythmia:1. Click on the patient’s ECG tab.2. Click on the Relearn button.IF PROBLEM CONTINUES: Change to Single-Lead ECG detection and processing:1. Click on the patient’s ECG tab.2. Click on Single-Lead in the Lead Analysis section.3. Click on the ECG leads in the Display section and change top ECG waveform to display the lead with the greatest amplitude. (At least 0.5 mV amplitude is required for QRS detection.)Problem: False ventricular callsSolution: Check ECG signal from patient: (V leads may exhibit polarity changes which may occasionally cause an inaccurate call.)1. Check/adjust lead placement.2. Check/perform skin preparation.3. Check/replace electrodes. (If V lead is a problem, move the V lead to another V position.)4. Relearn ECG:Click on the patient’s ECG tab.Click on the Relearn button.IF PROBLEM CONTINUES: 1. Remove the V lead(s).Draft
Troubleshooting2001989-301A- draft 1 ApexPro™ D-32. Click on the patient’s ECG tab.3. Click on the Relearn button.Problem: ARR SuspendSolution: Check ECG signal from patient.1. Check/adjust lead placement.2. Check/perform skin preparation.3. Check/replace electrodes.4. Correct artifact source.Pacemaker troubleshootingThere are two general things that occur when the pace mode is activated for pacemaker patients:1. Beats that would otherwise be classified as ventricular are instead classified as V-paced if a ventricular pacemaker event is detected.2. Residual pacemaker energy that might otherwise appear in the ECG is removed, and a white pacemaker enhancement spike is artificially placed in the ECG.Pace detection is indicated visually in the ECG parameter box. When watching the ECG waveform, pace detection is indicated by uniform, upright pacemaker enhancement spikes in the ECG data (both displayed and graphed). NOTETo improve pacemaker detection, reposition the electrodes and ensure a good skin preparation to maximize R-wave detection. Perform a relearn any time lead positions are changed. For more information, refer to Electrode placement on page 6-2.During telemetry monitoring, the pacemaker signal is acquired from lead II or on II and V simultaneously when using the T14 transmitter. Changing the displayed lead has no effect on pacemaker detection.NOTEWith all leads connected, pacemaker signal acquisition occurs on lead II or on II and V simultaneously when using the T14 transmitter. In a Leads Fail condition, signal acquisition occurs on any available lead. When a 3-leadwire set is used, single channel acquisition occurs on the programmed lead.To improve pacemaker detection, reposition the electrodes and assure a good skin preparation to maximize R-wave detection. The following is a suggested configuration:Draft
D-4 ApexPro™ 2001989-301A- draft 1Troubleshooting369B, 374BThe right arm electrode is moved down to the fifth intercostal space, and the left leg electrode is moved up to the fifth intercostal space. NOTEAfter all electrodes are in place, ensure that a minimum of 1/2 mV of signal is present on each lead (I, II, III, V).Interface connector portsPace detection performance is optimized with proper lead application and correct use of the serial interface connector ports. If you are experiencing degraded pace detection performance, verify that all leads are properly attached to the patient and verify that any connected serial device(s) are in the appropriate serial interface connector ports.The inside port, labeled 2 on the dust cover, is for use with episodic monitoring serial devices, such as NBP.The outside port, labeled 1 on the dust cover, is for use with continuous monitoring serial devices, such as SpO2.Problem: Inaccurate pacemaker detectionSolution: Use pacemaker processing:1. Click on the patient’s ECG tab.2. In the Detect Pace section, select either Pace 1 or Pace 2.Solution: Exchange the right and left arm leads and perform a relearn.NotesIn general, BE AWARE that a pacemaker pulse could be falsely counted as a QRS during asystole.Pace 1 mode analyzes the presence of a pacer spike, assesses the waveform for residual pacemaker energy, and determines the presence of an R wave following the pacer spike. If an event occurs during the first few milliseconds following the pacer spike, it will be counted. RALAV1 LL RLLC1RFNDraft
Troubleshooting2001989-301A- draft 1 ApexPro™ D-5Pace 2 mode analyzes waveforms with the added capability of minimizing the chance of counting severe residual pacemaker energy as QRS complexes. In relation to the event rejection capability of Pace 2 pace mode, certain morphologies may not be detected. Arrhythmia calls like asystole or pause may be made with heart rate identified as less than actual.Again, pacemaker patients should be kept UNDER CLOSE OBSERVATION. The appropriate pace mode may be determined at the time the pacemaker patient is admitted to the monitoring system. The Pace 2 mode is recommended for use whenever possible.Check ECG signal from patient:1. Check/adjust lead placement.2. Check/perform skin preparation.3. Check/replace electrodes.ST troubleshootingProblem: ST numerics changed to XsSolution: An ST value changes to Xs when the patient’s dominant morphology has not been detected 16 times in the last 30 seconds. The program waits one minute and then automatically relearns. ST numerics will be displayed after the relearn.IF PROBLEM CONTINUES: 1. Check for morphology change.2. Check for noise on ECG.3. Relearn:a. Click on the patient’s ECG tab.b. Click on the Relearn button.SpO2 messagesBelow is a list of system status alarm messages that may be displayed in the patient’s bed window during monitoring. SpO2 messages appear in abbreviated form in graph headers. If you are unable to resume SpO2 monitoring, contact your sales/service representative.NOTEThe Xpod oximeter can display the same SpO2 system status messages as the Apex oximeter, except for the CHANGE BATTERY message. The Xpod oximeter uses the battery power supplied by the transmitter and therefore does not support this message. Draft
D-6 ApexPro™ 2001989-301A- draft 1TroubleshootingNBPTroubleshootingProblem: Erroneous NBP measurementSolution:1. Check for proper cuff size:Too small a cuff can give an erroneously high value.Too large a cuff can give an erroneously low value.NOTEFor proper fit of an NBP cuff, the arm should be measured from the top of the shoulder joint to the elbow. Divide the length by 2 and measure from the middle of measurement on the arm. Measure the circumference in centimeters around the arm. Refer to the NBP cuffs for proper fitting size.2. Check for residual air left in the cuff from a previous measurement. This could indicate a hardware problem that may require service.3. Make sure the cuff is not too tight or too loose.4. Make sure the cuff and the heart are at the same level; otherwise hydrostatic pressure will offset the NBP value.5. Watch for pulsus paradoxis.6. Check for leak in cuff or tubing.CHANGE BATTERY Message displayed with SPO2 data displayed—The batteries in the Apex oximeter are low. There is approximately 1 hour of reserve power left in the batteries. Change the batteries. Message displayed, no SPO2 data displayed—The batteries in the Apex oximeter are depleted. Replace the batteries. This is a system Warning alarm. The alarm will sound, and a red alarm button will appear on the CIC Pro center display. If the batteries are not replaced within 20 minutes, all SPO2 parameter information will be removed from the display. If the batteries are replaced within 20 minutes, SpO2 monitoring will resume.SPO2 PROBE The probe has been disconnected from the oximeter (no data is displayed).SIGNAL SpO2 data continues to be displayed, but the quality of the signal is questionable. Check the patient and the probe.NO DATA The oximeter is still connected, but no valid data is being transmitted to the receiver. Check that the patient is within antenna range. If the problem persists, contact GE Service.SPO2 PROBE OFF The probe is off the patient. Check the probe.The saturation value is X The oximeter is still connected, but no valid data is being received at the receiver. The patient may be in an area of poor antenna reception, where some, but not all data is being transmitted.This message remains on the CIC Pro center for three minutes. If no data is detected after three minutes, the message changes to NO DATA.Draft
Troubleshooting2001989-301A- draft 1 ApexPro™ D-77. Patient may have a weak pulse.8. Calibration may be necessary.NBP status messagesNBP status messages appear in abbreviated form in graph headers, when applicable.A message will clear when the next measurement is initiated, or a message can be cleared manually with the Clear Message option on the NBP tab sheet.The following system status alarm messages may be displayed in the patient’s bed window during monitoring. MessagesAlarm messagesThe following messages appear in the patient’s bed window at the CIC Pro center.CHANGE BATTERY An NBP measurement was attempted with low batteries. Change the batteries in the blood pressure monitor and try another measurement.FAIL A hardware failure has been detected in the blood pressure monitor. In the U.S., contact GE Service. Outside the U.S., contact your local sales/service representative.LEAK The NBP cuff is loose or there is an air leak in the cuff or tubing. Check that the cuff is on snugly. Check the connection between the cuff and the tubing. Check the connection between the tubing and the blood pressure monitor. Try another measurement. If the problem persists, contact your local sales/service representative.LOW INFLATION PRESS This message appears when K-sounds are detected immediately upon inflation. The inflation pressure is too low for proper NBP measurement. Try another measurement or adjust dynamic/fixed inflate. If the problem persists, contact your local sales/service representative.MOVEMENT This message appears when there is excessive patient arm movement, or if the patient’s arm was bent during the measurement. Check the patient and try another measurement.SENSOR? This message appears when the K-sounds on the measurement were too weak, or not enough sounds were detected. Reposition the microphone and try another measurement. This message can also appear if the deflate rate is not properly adjusted. If the problem persists, contact your local sales/service representative.WEAK PULSE The patient’s heart rate is erratic. Check that the microphone cable is plugged firmly into the patient cable, and check that the microphone is positioned correctly on the patient. Try another measurement. If the problem persists, it could indicate a defective microphone, microphone cable, or patient cable. Contact your local sales/service representative.Draft
D-8 ApexPro™ 2001989-301A- draft 1TroubleshootingALARM PAUSE All alarms for this patient have been turned off for five minutes. This is initiated from the transmitter by pressing both the Verify Leads and Graph buttons simultaneously. Refer to ALL ALARMS OFF.ALL ALARMS OFF All alarms for this patient have been turned off. No graph strips run, arrhythmia events are not stored, and no audible tones sound if an alarm condition should occur.ARR OFF The arrhythmia program for a selected patient has been turned off. No arrhythmia messages are displayed, arrhythmia event s are not stored, no graph strips run, and no audible tones sound if an arrhythmia alarm condition occurs.ARTIFACT ARR SUSPEND All artifact begins at level 1. Sustained artifact progresses to level 2 when noise on ECG lasts for 20 of the last 30 seconds.Level 1 — Upon immediate detection of artifact, the message ARTIFACT is displayed. There is no alarm tone. Only lethal arrhythmia processing is available.Level 2 — Arrhythmia monitoring is suspended in this condition. A system warning alarm sounds, no arrhythmia messages are displayed, no graph strips run and no arrhythmia events are stored. Heart rate and PVC values change to X, an additional message, ARR SUSPEND, is displayed.LEADS FAIL All leads have failed, right leg lead failed, lead wires unplugged or reference lead failed. If set to Warning or Advisory level, a system alarm is heard. This will self-silence if condition is corrected, or the user can silence for one minute with the Silence Alarms button at the bottom of the CIC Pro center display.Draft
Troubleshooting2001989-301A- draft 1 ApexPro™ D-9Graph messagesThe following messages appear in the patient’s bed window on the CIC Pro center display. These relate to running graphs at the printer.NO TELEM The NO TELEM alarm occurs in two situations:1. The patient moves out of range. If the transmitter is out of range for more than 30 seconds, the NO TELEM message displays. Should a LEADS FAIL condition occur prior to a NO TELEM condition, the LEADS FAIL condition takes priority. The LEADS FAIL message is displayed along with the NO TELEM message.2. Transmitter batteries are extremely low or dead.If batteries are extremely low or completely dead, the NO TELEM message appears, a CHANGE BATTERY message appears in the patient’s bed window, and the audible alarm sounds. Activating the ALL ALARMS OFF feature prevents the audible alarm from sounding.OFF NETWORK In the Combo mode, telemetry patient data is provided from the bedside monitor to the CIC Pro center. If the bedside monitor is removed from the network or becomes otherwise unavailable, the NO COMM message displays first on the CIC Pro center and there is a loss of monitoring for about 45 seconds, then waveforms return and the OFF NETWORK message is displayed below the HR parameter window.The CIC Pro center will then display patient data directly from the telemetry bed along with this message in that CIC Pro center bed window. Should the bedside monitor reappear on the network, the Combo monitoring application will automatically resume and the alarm will be cleared.This alarm is also generated if the receiver system is removed from the network or becomes otherwise unavailable. The bedside monitor does not sound alarms, but the alarms must be turned back on at the bedside monitor if they were previously paused or off.GRAPH ALARM An alarm graph was initiated and is running.GRAPH MANUAL A manual graph was requested and is running.GRAPH TTX The Graph button on the transmitter was pressed and a 20-second graph strip is running.PRINTING A non-real time graph is currently being printed. SAVING An alarm or a manual graph has been requested but the writer is in use, the writer door is open, the print location is not correct, or the writer is out of paper. The request is saved and will run as soon as the writer is available.Draft
D-10 ApexPro™ 2001989-301A- draft 1TroubleshootingTransmitter-related messagesThe following messages appear in the patient’s bed window on the CIC Pro center display.System status messagesSystem status alarms (generated by mechanical conditions) are displayed in the lower left corner of the CIC Pro center screen. Each message is preceded by the receiver system’s name, if it has been entered, or a name created by using the last six numbers of the receiver system Ethernet address.Patient status messagesPatient status messages are also displayed in the lower left corner of the CIC Pro center screen. They are not, however, preceded by the receiver system name or Ethernet address.CHANGE BATTERY This message flashes when the batteries are low. There is approximately 1 hour of use left after this message appears. If the batteries are extremely low or completely dead, a NO TELEM message flashes, and an audible alarm sounds.LEADS FAIL All leads have failed, right leg lead failed, right arm lead failed, leadwires unplugged or reference lead failed. If set to System Warning or System Advisory level, a system alarm occurs. This will self-silence if condition is corrected, or user can silence for one minute with Silence Alarms button at the bottom of the CIC Pro center display. NOTELEADS FAIL will not result in a NO TELEM alarm message after 30 seconds.RA (LA, LL, V) FAIL One of these may appear, indicating failure of a lead.NO TELEM The transmitter was out of range for more than 30 seconds. If this condition persists, contact GE Technical Support.If a LEADS FAIL condition occurs prior to a NO TELEM condition, the LEADS FAIL condition takes priorityTTX number is already in use This message displays when attempting to admit a transmitter that is sequentially numbered with another admitted transmitter. For example, you cannot admit TTX ID number 54078 and 54079 at the same time. Use another transmitter with a non-sequential TTX ID number to admit the patient.DUPLICATE TOWER NAME A network problem exists. Restart the system. If this condition persists, contact GE Technical Support.DUPLICATE NAME A network problem exists. Restart the system. If this condition persists, contact GE Technical Support.Draft
Troubleshooting2001989-301A- draft 1 ApexPro™ D-11“Unit/Bed” IS UNMONITORED A telemetry patient is admitted but is not displayed (and therefore is unmonitored) on any CIC Pro center. If an alarm occurs on an unmonitored bed, the information will appear in the alarm text line and an audible tone will sound. You must view the patient first if you would like to silence the alarm. To view an unmonitored bed, click on the View Other button. “Unit/Bed”: DUPLICATE NAME There is another device on the network with the same bed name. The duplicate device must be renamed. Draft
D-12 ApexPro™ 2001989-301A- draft 1TroubleshootingDraft
2001989-301A- draft 1 ApexPro™ E-1ETechnical specificationsDraft
E-2 ApexPro™ 2001989-301A- draft 1Technical specificationsNOTESpecifications are provided to help you determine the space, ventilation, air conditioning and power requirements to ensure proper operation of your system. Specifications are approximate and may change with the actual unit shipped. Specifications are subject to change without notice. Contact your sales or service representative for more information.T14 transmittersPower requirementsAlarms and controlsTransmissionECGBattery type ANSI/NEDA 15 A, 1.5V AA alkaline (2 required)Battery life hoursPolarity Electronic reverse polarity protectionBattery integrity Transmitted and indicated via LEDLeads Fail indication Transmitted and indicated via LEDChannel spacing 25 kHzFrequency stability ± 0.0001% of assigned channel frequencyBit rate 10 kbpsAntenna Formed by leadwire shieldMulti-channel configuration (5- or 6- leadwire) I, II, III, Va, Vb, aVR, aVL, aVFLeads analyzed simultaneouslyFour (I, II, III, V)Single-channel (3-leadwire) configurationI, II or III, configurableHeart rate detection 30 to 300 BPMQRS detection range 0.5 to 5 mVFrequency response 0.05 to 40 Hz (-3 dB)Draft
Technical specifications2001989-301A- draft 1 ApexPro™ E-3Environmental specificationsOperating conditionsStorage conditionsDevice specificationsA/D converter resolution 10 bits, 9.75 µV (RTI)Sample rate 240 samples/secondsTemperature 5 to 40° CRelative humidity 15 to 95% (non-condensing)Temperature -20 to 70° CRelative humidity 15 to 95% (non-condensing)Pressure 700 to 1060 hPaWater resistance IEC 60529 IPX7 rating (can survive inadvertent submersion)Input configuration 3, 5 or 6 electrodesFrequency rangeModulation GFSKSerial I/O ports 2Alarm pause Transmitted and indicated via LEDGraph request TransmittedEvent Marker TransmittedAttendant request TransmittedMaximum transmitters 239 active within WTMS at a single facilityDynamic range ± 5 mV (RTI)Input offset ± 400 mV (RTI)Input impedance 15 M ohm minimum differential @ 10 HzECG gain selection 5, 10, 20, 40 mm/mV (RTI)ECG gain accuracy ± 5% @ 15 HzCommon mode rejection 100 dB minimum @ 60 HzDefibrillator protection ± 5000 VDC, 360 joules into 100 ohmDefibrillator recovery time Transmitter recovers within 2 secondsDraft
E-4 ApexPro™ 2001989-301A- draft 1Technical specificationsPhysical specificationsFCC compliance informationThis device complies with Part 95 of the FCC Rules and RSS-210 of Industry Canada. Operation of this equipment requires the prior coordination with a frequency coordinator designated by the FCC for the Wireless Medical Telemetry Service. CertificationsUL/IEC/EN 60601-1IEC/EN 60601-1-1IEC/EN 60601-1-2IEC/EN 60601-1-4IEC/EN 60601-2-27IEC/EN 60601-2-49608.025 to 613.975 MHz - FCC Part 95ApexPro telemetry serverDisplay specificationsPower specificationsPacemaker detection ± 2 mV to ± 700 mV (RTI); 100 µsec to 2 msec; either polarity; on multiple leadsPatient leakage current Meets UL/IEC 60601-1Serial communications 2 ports at 9600 baud asynchronousHeight 13.7 cm (5.38 in)Width 7.3 cm (2.875 in)Depth 2.3 cm (0.91 in)Weight 141.8 g (0.275 lb) without battery; 170.1 g (0.375 lb) with batteryVideo output 1024 X 768 @ 75 HzPower supply 300 watt ATX dual-redundantDraft
Technical specifications2001989-301A- draft 1 ApexPro™ E-5Environmental specificationsOperating conditionsStorage conditionsPhysical specificationsFCC compliance informationThis device complies with Part 95 of the FCC Rules and RSS-210 of Industry Canada. Operation of this equipment requires the prior coordination with a frequency coordinator designated by the FCC for the Wireless Medical Telemetry Service. CertificationsIEC/EN/UL 60950-1CAN/CSA C22.2 No.950IEC/EN 60601-1-4EN 55022 (Class A)EN 55024EN 61000-3-2EN 61000-3-3CE marked to the Medical Device Directive 93/42/EECTemperature 10 to 35° C (50 to 95° F)Relative humidity 15 to 80% (non-condensing)Vibration 5 to 500 Hz, 0.5 G RMSAltitude 0 to 3048m (0 to 10000 ft)Acoustic noise Less than 52 dB sound pressure at 5 to 28° C (41 to 82° F)Temperature -23 to 49° C (-10 to 120° F)Relative humidity 10 to 90% (non-condensing)Height 8.8 cm (3.46”)Depth 45 cm (17.7”)Width 48.2 cm (19”)Weight 15.8 kg (35 lb)Draft
E-6 ApexPro™ 2001989-301A- draft 1Technical specificationsApexPro receiver systemPerformance specificationsNetwork requirementsPower requirements Environmental specificationsOperating conditionsRF module type GFSK and GMSK digitally demodulatedUHF frequency range 560.025 to 613.975 MHz (U.S.)420 to 460 MHz (International)Frequency step resolution Synthesized tuning to any transmitter; 25 kHz spacingReceiver system capacity 1 to 4 quad receiver modules (4 to 16 receivers)Frequency stability ± 0.0003% (3 PPM) of assigned channel frequencyBit rate 10 kbpsSensitivity 8.7 µV (-90 dB) minimum for 1 bit error/million bits receivedPhysical IEEE 802.3 compatible, physical connector via 10 base TSerial protocol 19200 baud, 1 stop bit, 8 data bits, no parity, XON/XOFF flow controlSystem status indicators 7 bicolor LEDsInput voltage 100 to 240 VACInput frequency 50/60 HzPower consumption 25 watts maximum with 4 quad receiverCooling Free air convectionTemperature 5 to 40° C Relative humidity 15 to 90% (non-condensing)Draft
Technical specifications2001989-301A- draft 1 ApexPro™ E-7Storage conditionsPhysical specificationsFCC compliance informationThis device complies with Part 95 of the FCC Rules and RSS-210 of Industry Canada. Operation of this equipment requires the prior coordination with a frequency coordinator designated by the FCC for the Wireless Medical Telemetry Service. CertificationsUL/IEC/EN 60601-1CAN/CSA C22.2 No.601.1IEC/EN 60601-1-2IEC/EN 60601-1-4CE marked to the Medical Device Directive 93/42/EECTemperature -20 to 50° CRelative humidity 15 to 90% (non-condensing)Pressure 700 to 1060 hPaHeight 17.0 cm (6.7 in)Width 32.5 cm (12.8 in)Depth 25.0 mm (9.8 in)Weight 6.4 kg (14 lb)Draft
E-8 ApexPro™ 2001989-301A- draft 1Technical specificationsDraft
2001989-301A- draft 1 ApexPro™ 1IndexAadmit ..................................................................... 6-11alarmcontrol settings ................................................. 5-8levels .............................................................. 5-10notification ........................................................ 5-2patient status alarms ........................................ 5-3pause breakthrough.......................................... 5-6silence .............................................................. 5-7system status alarms........................................ 5-4unit defaults .................................................... 5-12volume............................................................ 4-18automatic graphs .................................................... 9-4Bbatteryblood pressure monitor................................... 3-11transmitters....................................................... 3-3bed number........................................................... 6-15blood pressure monitor ......................................... 3-10Ccalipers.................................................................. 8-16CE marking information ....................................... CE-1compliance .................................................... CE-1exceptions ..................................................... CE-1compliance............................................................ 1-15FCC ................................................................ 1-16IEC, UL, EN.................................................... 1-15Industry Canada ............................................. 1-16configurationdefaults............................................................. 4-6service-level ............................................... 4-7licenses............................................................. 4-5configurecontrol settings ............................................... 4-18control settings...................................................... 4-18Ddefaults ................................................................... 4-6discharge .............................................................. 6-19displayprimary.............................................................. 4-3secondary......................................................... 4-3EECGcalipers ........................................................... 8-16control settings ............................................... 7-11electrode placement ......................................... 6-33-leadwire................................................... 6-45-leadwire................................................... 6-46-leadwire................................................... 6-3neonate patients......................................... 6-5pediatric patients........................................ 6-5measurements................................................ 8-16setting source ................................................. 6-21signal ................................................................ 6-6skin preparation ................................................ 6-2troubleshootingarrhythmia .................................................. D-2pacemaker ................................................. D-3ST............................................................... D-5electrode placement................................................ 6-3events directory....................................................... 8-2FFCC compliance.................................................... 1-16RF exposure ................................................... 1-16full disclosure .......................................................... 8-7Ggraph location.......................................................... 9-2graphic trends ....................................................... 8-11IIMPACT.wf paging system...................................... 3-3Llead analysis ......................................................... 7-16multi-lead analysis .......................................... 7-16single lead analysis ........................................ 7-16licenses ................................................................... 4-5Mmanual graph .......................................................... 9-3monitoring modecombo............................................................. 6-10rover ............................................................... 6-10rover combo.................................................... 6-10standard.......................................................... 6-10move patient.......................................................... 6-17multi-patient viewer ................................................. 7-2NNBPcontrol settings ............................................... 7-28microphone placement ................................... 7-30patient preparation.......................................... 7-29troubleshooting ................................................. D-6Pparameter alarm limits........................................... 5-10patient demographics............................................ 6-13primary display........................................................ 4-3Draft
2 ApexPro™ 2001989-301A- draft 1printalarm graphs................................................... 5-17all patients ........................................................ 9-5automatic graphs.............................................. 9-4control settings ................................................. 9-6devices ............................................................. 9-2graph location................................................... 9-2manual graph.................................................... 9-3real-time data.................................................... 9-3stop................................................................... 9-6stored data........................................................ 9-3telemetry data................................................... 9-2transmitter graph .............................................. 9-7RR&TTE ................................................................. CE-1real-time data .......................................................... 7-2real-time trend window............................................ 7-6Ssecondary display ................................................... 4-3single patient viewer................................................ 7-3SpO2..................................................................... 7-24control settings ............................................... 7-24messages ......................................................... D-5signal .............................................................. 7-27ST analysis............................................................ 7-22ST troubleshooting.................................................. D-5stored data .............................................................. 8-2Ttransmitter graph..................................................... 9-7transmitters ............................................................. 2-2battery............................................................... 3-3buttons/LEDs .................................................... 3-2electrodes ......................................................... 3-5leadwires .......................................................... 3-5Vvital signs .............................................................. 8-14Draft
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GE Medical SystemsInformation Technologies, Inc.8200 West Tower AvenueMilwaukee, WI 53223 USATel: + 1 414 355 50001 800 558 5120 (US only)Fax: + 1 414 355 3790GE Medical SystemsInformation Technologies GmbHMunzinger Straße 3-5D-79111 FreiburgGermanyTel: + 49 761 45 43 - 0Fax: + 49 761 45 43 - 233Asia HeadquartersGE Medical SystemsInformation Technologies Asia; GE (China) Co., Ltd.24th Floor, Shanghai MAXDO Center,8 Xing Yi Road, Hong Qiao Development ZoneShanghai 200336, P.R. ChinaTel: + 86 21 5257 4650Fax: + 86 21 5208 2008GE Medical Systems Information Technologies, a General Electric Company, going to market as GE Healthcare.www.gehealthcare.com0459Draft

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