GE Medical Systems Information Technologies SHU-WMTS EA-WMTS-SHU-4 User Manual 2001989 134B

GE Medical Systems Information Technologies Inc. EA-WMTS-SHU-4 2001989 134B

1. System Operators Manual Part 1
2. System Operators Manual Part 2

System Operators Manual Part 2

7-10 ApexPro Telemetry System Revision D

2001989-134

Admit/View a Patient: Discharge Instructions

Clearing a Patient Window

To clear discharged patient information from the window and bring up

the Admit button, use the right-click menu.

1. Use the RIGHT mouse button to click anywhere inside a discharged

bed window. The right-click menu appears.

2. Slide the mouse over the Select Care Unit, then Bed Number text,

without pressing either mouse button. The text highlights, and a list

of units on the network pops up.

3. Without pressing either mouse button, slide the mouse pointer to

None at the bottom of the list. Click the left mouse button on None.

4. The popup list closes, and the patient window will now be empty,

except for an Admit button.

NOTE

On a locked bed, None is not an option. When beds are locked, you

must discharge from the single patient viewer.

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Admit/View a Patient: Move Telemetry Patients

Move Telemetry Patients

This option allows you to move a telemetry patient to a new bed within

the same care unit or to move Combo patients in and out of combo mode.

The Move feature is located on the Admit tab sheet on the CIC Pro.

To move a patient within the same care unit, follow this procedure:

1. At the CIC Pro, select the bed window of the patient you wish to

move.

2. Click on the Admit tab to bring the tab sheet to the front.

3. Select a new bed from the Location Bed: list.

4. The Save button changes to Move, click Move to move the patient to

the bed you selected from the bed list.

5. Select Yes when the Patient Move dialog is displayed.

Admit Patient Tab Sheet

A patient can not be moved to an unlocked bed if no bed slot is available.

A dialog window appears indicating that the change is disallowed

because the patient would be unmonitored.

Moving Locked/Unlocked Beds

The following guide lines apply when moving locked and unlocked beds.

A patient can be moved from an unlocked bed to another available

unlocked bed.

A patient can be moved from a locked bed to another available locked

bed.

A patient can be moved from an unlocked bed to an available locked

bed.

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Admit/View a Patient: Viewing a Patient

Viewing a Patient

When you wish to see detailed information about a patient’s status, you

can use the View Patient tab in the single patient viewer.

1. Click in the bed window of the patient you wish to view. The display

rearranges to accommodate the single patient viewer at the bottom.

2. Click on the View Patient tab to bring it to the front.

The View Patient tab sheet shows all the information that normally

appears in patient’s bed window in the multiple patient viewer, and also

displays up to eight leads of ECG waveforms.

There are two buttons in the View Patient tab sheet that can be used for

telemetry patients. Their functions are described below.

NOTE

The third button, View All ECG, is dimmed when viewing telemetry

patients because all the ECG waveforms available for telemetry

patients are normally displayed.

Sample

Clicking on the Sample button records a sample of the patient’s real-time

ECG data. This sample is then stored in alarm histories, and can be

viewed in the Alarm Histories tab sheet under the title of Sample. For

more information about viewing alarm histories, refer to Chapter 10,

Patient Data, in this manual.

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Admit/View a Patient: Viewing a Patient

Relearn

Clicking on the Relearn button initiates a relearn of the patient’s ECG

rhythm. The relearn takes only a few seconds. The patient’s heart rate

reading will appear as Xs momentarily, and then be replaced by

numerics once the relearn is complete.

Use the relearn function whenever there has been a significant change in

the patient’s normal rhythm.

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Admit/View a Patient: Viewing Another Patient

Viewing Another Patient

NOTE

When viewing a patient from another unit, you cannot make any

changes to the patient’s information or settings.

Viewing in the Single Patient Viewer

To display the single patient viewer of a patient on the network who is

not currently displayed on your CIC Pro, follow the steps below.

1. Click on the View Other button in the Main Menu at the bottom of

the CIC Pro display.

2. The View Other Patient window appears. This window displays all

the units currently available on your network.

3. Click on the next to the unit from which you wish to view a bed. A

list of beds admitted to that unit appears below the unit name.

NOTE

If a unit name has a next to it but no bed list below it, there

are no beds admitted into that unit.

4. Click on the bed name you wish to view. The name is highlighted.

5. Click on the OK button. The single patient viewer opens at the

bottom of the display, showing the viewed patient’s data.

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Admit/View a Patient: Viewing Another Patient

Viewing in the Multiple Patient Viewer

When in the multiple patient viewer, you can replace the data in any

unlocked bed window with the data from another patient on the network

who is not currently displayed on your CIC Pro.

NOTE

The data for the patient who was originally displayed in the bed

window you select will not be visible on your CIC Pro once you use

that patient’s bed window to view another patient.

To view another patient in the multiple patient viewer, follow the steps

below.

1. Use the right mouse button to click anywhere inside a bed window.

The right-click menu appears.

NOTE

You must use the right mouse button to access the right-click

menu.

2. Slide the mouse over the Select Care Unit then Bed Number text,

without pressing either mouse button. The text highlights, and a list

of units on the network pops up.

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Admit/View a Patient: Viewing Another Patient

3. Without pressing either mouse button, slide the mouse pointer to the

unit name you wish to select a bed from. The unit name highlights,

and a list of beds on that unit pops up.

4. Without pressing either mouse button, slide the mouse pointer to the

bed you wish to view. The bed name becomes highlighted.

NOTE

A check mark next to a bed name means that the bed is already

being viewed at this CIC Pro.

5. Once you have chosen the bed you wish to view, and its bed name is

highlighted on this list, use the LEFT mouse button to click on the

bed name.

6. The popup lists close, and the viewed patient’s data appears in the

bed window.

For more detailed patient information, use the left mouse button to

click in the bed window. The single patient viewer will open at the

bottom of the display, allowing you to view all the patient’s data.

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Admit/View a Patient: Viewing Patients Through Alarm Condition Indicators

Viewing Patients Through Alarm Condition Indicators

You can open the single patient viewer for any patient in your care unit

who is experiencing an alarm condition.

When a patient experiences an alarm condition, a red button appears at

the bottom of the CIC Pro display. The button contains the unit name

and bed number, as well as the cause of alarm.

NOTE

Up to four of these red buttons display at one time, so only the four

highest-level alarms are indicated in this way.

To access the single patient viewer for the alarming patient, simply click

on the red button at the bottom of the display. The display rearranges to

accommodate the single patient viewer at the bottom of the display, and

all the patient’s information will be available to you.

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Admit/View a Patient: Viewing Patients Through Alarm Condition Indicators

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8Alarm Control

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For your notes

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Alarm Control: Alarm Structure

Alarm Structure

The alarm structure of the CIC Pro is divided into two classifications:

Patient status alarms

System status alarms

Within each classification there are levels that correlate to the severity of

the condition that is causing the alarm. The levels and how the CIC Pro

responds to each are described below.

Patient Status Alarms

Patient status alarms are triggered by a patient condition that exceeds

parameter limits, or by an arrhythmia condition. Patient status alarms

provide the highest priority information.

The levels within the patient status alarm category and how the CIC Pro

responds to each are shown in the following chart. The chart begins with

the most critical type of alarm (Crisis) and ends with the least critical

type of alarm (Message).

NOTE

Only arrhythmia alarm conditions are stored in alarm histories.

Patient Status Alarms Chart

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Alarm Control: Alarm Structure

Colored Window Borders

Crisis and Warning alarms are indicated with a large border around the

individual patient’s bed window in the multiple patient viewer. This

border flashes on and off several times when the alarm occurs before

staying on. The color of the border indicates the severity of the alarm —

red for a Crisis alarm and yellow for a Warning alarm. When the alarm

is silenced, the colored border reverts to the black background.

NOTE

Only Crisis and Warning alarms activate the colored border.

Patients selected for single patient view have a white border in the

multiple patient viewer.

Automatic Alarm Graphs

A graph prints automatically when a patient experiences a Crisis or

Warning alarm. Arrhythmia alarm graphs run until the end of the alarm

event. The printer prints the 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.

System Status Alarms

System status alarms are triggered by mechanical or electrical problems

and are of lesser priority than patient status alarms. The levels within

the system status alarm category and how the CIC Pro responds to each

are shown in the following chart.

System Status Alarms Chart

System status alarms cannot, in most cases, be moved from one level to

another. However, the CIC Pro allows you to set default alarm levels for

the following system alarms: CHANGE BATTERY, OFF NETWORK,

ARR SUSPEND, LEADS FAIL, PROBE OFF.

The System Alarm Levels are configurable in Telemetry Alarm Control

Defaults.

TEXT

366B

Fog-horn Tone

Warning sounds continuously

Advisory sounds only once

White Text Displayed on Red

Background

Alarm Level: Monitor Response:

WARNING

ADVISORY

MESSAGE

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Alarm Control: Alarm Control Tab

Alarm Control Tab

Parameter and arrhythmia alarm levels are, from most critical to least

critical, Crisis, Warning, Advisory, and Message.

Each alarm level elicits a specific response from the CIC Pro. The four

alarm levels are configurable. This means that an alarm can be moved

from one category to another if the default is not satisfactory to your

situation. This is done in the Alarm Control tab sheet for the patient

whose alarm settings you wish to adjust.

NOTE

ASYSTOLE and VFIB/VTAC alarms cannot be moved from the

Crisis level.

Accessing the Alarm Control Tab

1. Use the mouse to click in the window of the telemetry patient whose

alarm settings you wish to view or change.

2. The CIC Pro display rearranges as the single patient viewer opens at

the bottom of the display. Click on the patient’s Alarm Control tab to

bring the tab sheet to the front.

The telemetry patient Alarm Control tab sheet is divided into three

sections: Parameter Limits and Alarm Levels, Arrhythmia Alarm Levels,

and Alarms On/Off. The options on this tab sheet are detailed on the

following pages.

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Alarm Control: Alarm Control Tab

Parameter Limits

1. To change the individual patient’s settings for Parameter Limits and

Alarm Levels, click in the Low or High field for the parameter you

wish to change.

NOTE

The alarm limits for some parameters cannot be changed. To

indicate that they cannot be changed, the text in the Low and

High fields for these parameters always appears dimmed.

Once you click in the field, it is framed by a rectangle, and up and

down arrow buttons appear in the field.

NOTE

Alarms generated by parameter

limit violations are not stored in

Alarm Histories.

2. To increase or decrease the limit by 5, click on the up or down arrow

button.

To increase or decrease the limit in increments other than 5, use the

keyboard to enter a new limit value.

3. If you are finished making changes in the Alarm Control tab sheet,

click on the Close button in the bottom right corner of the display to

close the single patient viewer.

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Alarm Control: Alarm Control Tab

Parameter Alarm Levels

1. Click in the Level field for the parameter whose alarm level is to be

changed. A down arrow button appears in the field.

2. Click on the down arrow button. A popup list of alarm level selections

appears.

NOTE

Alarms are always sorted from top

to bottom in highest to lowest

priority. When you change a level,

the list is re-sorted to reflect the

change in alarm priority.

3. Click on the desired alarm level to select it.

4. If you are finished making changes in the Alarm Control tab sheet,

click on the Close button in the bottom right corner of the display to

close the single patient viewer.

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Alarm Control: Alarm Control Tab

Arrhythmia Alarm Levels

1. To change the Arrhythmia Alarm Levels, click in the Level field of the

arrhythmia alarm you wish to change. A down arrow button appears

in the field.

NOTE

The Arrhythmia Alarm Levels for ASYSTOLE and VFIB/VTAC

cannot be changed. Therefore, the text in the Level field for these

alarms always appears dimmed.

NOTE

You may need to use the scroll bar on the right side of the

Arrhythmia Alarm Levels section in order to view the

arrhythmia alarm that you wish to modify.

NOTE

Alarm levels are usually shown in black type. An alarm level

shown in blue indicates that it is NOT the default level.

2. Click on the down arrow button. A popup list of alarm level selections

appears.

3. Click on your choice to select it.

4. If you are finished making changes in the Alarm Control tab sheet,

click on the Close button in the bottom right corner of the display to

close the single patient viewer.

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Alarm Control: Alarm Control Tab

Alarms On/Off

To turn a telemetry patient’s alarms on or off, click on the appropriate

radio button or on the text itself in the Alarms On/Off section of the

Alarm Control tab.

Selecting Off turns all alarms off until you turn them back on by

selecting On.

NOTE

Refer to the Alarm Pause Breakthrough section in this chapter for

important information about turning alarms off.

ON and OFF

buttons

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Alarm Control: Alarm Control Tab

Alarm Off Reason

Selecting from a list of reasons, you can define why alarms have been

turned off. This text is displayed in addition to the ALARMS OFF

message in the patient’s window at the CIC Pro.

The following are the options for alarms off reasons.

Selecting OFF turns all alarms off until you turn them back on.

Selecting any reason establishes an alarm pause state for 5 minutes

in the presence of a valid waveform. After 5 minutes, alarms will

reactivate if the patient is within range of the antenna system for 15

seconds or longer. If the patient remains out of antenna range, the

alarm pause state will continue until the patient re-enters antenna

range for 15 seconds or longer.

NOTE

The patient must be in antenna range for the alarm pause state

to cease.

WARNING

Alarms do not sound, alarm histories are not stored, and

alarm graphs do not print during an alarms off with

reason condition.

Alarms Off Reason Text Displayed At CIC Pro Text Printed On Graph

On (no text) (no text)

Off ALARMS OFF OFF

X-ray XRAY X-RAY

Shower SHOWER SHOWER

Surgery SURGERY SURGERY

Physical therapy P.T. PHYSICAL THERAPY

Cardiac rehab CAR REHAB CARDIAC REHAB

GI Lab GI LAB GI LAB

Occupational therapy O.T. OCCUPATIONAL THERAPY

Off unit OFF UNIT OFF UNT

Cath Lab CATH LAB CARDIAC CATH LAB

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Alarm Control: Alarm Control Tab

The alarms off reason appears in the event trend for graphic trends.

If the patient is in LEADS FAIL or NO TELEM and an alarms off

reason is selected, the reason is displayed in the waveform window.

NOTE

After the patient has returned to antenna range and/or alarms have

been turned back on, verify that the patient’s waveforms are

displayed at the CIC Pro or bedside monitor.

NOTE

Refer to the Alarm Pause Breakthrough section in this chapter for

important alarm pause information.

Enable Transmitter Pause

The Enable Transmitter Pause check box, when checked, allows alarms

to be paused by pressing both ApexPro transmitter buttons

simultaneously.

To enable the transmitter pause option for a telemetry patient admitted

to the CIC Pro, click in the Enable Transmitter Pause check box. A check

mark appears in the check box.

To disable the transmitter pause option, click in the Enable Transmitter

Pause checkbox. The check mark is removed from the check box and the

option is disabled.

NOTE

If Off is selected for the Transmitter Alarm Pause option in the

Telemetry Unit Defaults tab sheet, no check box appears on the tab.

To make the Enable Transmitter Pause option active (check box

available), either Enabled or Disabled must be selected for the

Transmitter Alarm Pause option in the Telemetry Unit Defaults tab

sheet. Refer to Chapter 6, Telemetry Setup, for information about

setting the Transmitter Alarm Pause option.

Alarm Pause Breakthrough Enabled/Disabled

Refer to the Alarm Pause Breakthrough section in this chapter for

information about this alarm pause breakthrough status message.

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Alarm Control: Alarm Control Tab

Recalling Unit Defaults

To recall the preset telemetry patient unit defaults for all options in the

Alarm Control tab, simply click on the Recall Unit Defaults button on the

bottom right side of the Alarm Control tab sheet. All data on the tab

sheet will clear, and after a moment the preset unit defaults will appear.

In addition, clicking on the Recall Unit Defaults button also restores the

default graph locations and settings on the patient’s ECG tab sheet.

Alarm Help

For additional information about alarms, click on the Alarm Help button

at the bottom right side of the Alarm Control tab sheet. An Alarm Help

window appears.

You can click on the buttons in this window to hear how each type of

alarm sounds. When you are finished browsing the window, click on the

Close Window button to close the window and return to the single patient

viewer.

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Alarm Control: Alarm Control Tab

Printing Alarm Settings

A telemetry patient’s Alarm Control tab sheet can be printed, showing all

current alarm settings and limits. Click on the Print button in the main

menu to start a printout of the Alarm Control tab sheet.

The Alarm Control tab sheet prints at the Print Window location. For

more information about setting the Print Window location, refer to

Chapter 9, Printing, in this manual.

NOTE

The Alarm Control tab sheet must be the front tab of the single

patient viewer in order to print it. Click on the Alarm Control tab to

bring it to the front if necessary.

Silencing Alarms

WARNING

Do NOT continuously press the silence key. You may

inadvertently silence new patient alarms.

You can silence the audible alarm tones in one of two ways:

Use the mouse and click on the Silence Alarms

button located on the display monitor’s screen.

Press the Silence Alarms key located on the

keyboard.

Alarm Silence Icon

When an alarm is silenced, a visual indication (Alarm

Icon) of the silenced alarm is displayed at the CIC Pro.

The alarm silence icon is displayed in the ECG

parameter window next to the ECG heart rate. The

alarm silence icon remains on the display for one

minute unless a new alarm occurs.

NOTE

If you are monitoring telemetry patients, new alarms of equal or

greater priority level break the alarm silence condition.

427A

426A

Alarm Silence

Icon

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Alarm Control: Alarm Pause Breakthrough

Alarm Pause Breakthrough

The alarm pause breakthrough feature allows any crisis level alarm to

“break through” (interrupt) an alarm pause and sound at the CIC Pro.

In other words, when this feature is turned on in the Telemetry Unit

Defaults tab sheet, Crisis level alarms will sound at the CIC Pro, even if

an alarm pause is in effect.

NOTE

The Alarm Pause Breakthrough feature defaults to Always On. It

must be set to Always Off in the Telemetry Unit Defaults tab sheet

BEFORE admitting a telemetry patient if you do not wish to have

Crisis level alarms break through alarm pauses.

This feature cannot be set on an individual patient basis. It is either

on or off for all telemetry patients admitted to the CIC Pro. A status

message on each patient’s Alarm Control tab sheet indicates whether

it is enabled (on) or disabled (off).

The chart below illustrates the function of the alarm pause breakthrough

feature during the various alarm states.

After a Crisis level alarm has broken through an alarm pause, the

telemetry system does NOT return to an alarm pause state. All alarms at

any alarm level will sound at the CIC Pro.

Alarm State Alarm Pause Breakthrough Function

Alarms on No alarm pause breakthrough; all alarms are on.

Alarms off No alarm pause breakthrough; all alarms are off.

Alarm off reason (X-ray,

shower, etc.)

Alarms are paused; Crisis level alarms will break through

the alarm off reason if the patient is in antenna range.

Alarms paused from the

ApexPro transmitter

Alarms are paused; Crisis level alarms will break through

the alarm pause.

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Alarm Control: Alarm Pause Breakthrough

If you wish to continue pausing alarms after an alarm pause

breakthrough occurs, you must re-initiate the alarm pause:

1. To re-initiate an alarms off with reason condition, select the alarms

off reason in the telemetry patient’s Alarm Control tab sheet.

2. To re-initiate an alarm pause from the ApexPro transmitter, press

both transmitter buttons simultaneously twice.

NOTE

The transmitter buttons must be pressed once to “end” the alarm

pause at the transmitter, then a second time to start a new alarm

pause at the transmitter (see below).

The Pause Alarm LED on the ApexPro transmitter continues to flash

after an alarm pause breakthrough occurs. This is because there is no

communication from the CIC Pro back to the ApexPro transmitter to

indicate that the alarm pause has ended. After an alarm pause

breakthrough occurs, you can turn off the flashing Pause Alarm LED by

pressing both transmitter buttons simultaneously.

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Alarm Control: Unit Default Settings for Alarms

Unit Default Settings for Alarms

Telemetry Alarm Control Defaults

You can set Telemetry Unit Defaults for parameter limits and alarm

levels, as well as for arrhythmia alarm levels. These defaults are in effect

for all telemetry patients admitted to your unit, unless they are modified

in an individual patient’s Alarm Control tab sheet (for more information,

see the Alarm Control Tab section in this chapter).

To set telemetry alarm control defaults, follow the steps below:

1. Click on the Setup CIC button at the bottom of the CIC Pro display. A

set of tabs appears.

2. Click on the Service Password tab to bring it to the front.

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Alarm Control: Unit Default Settings for Alarms

3. Use the keyboard to enter the service password, then click the Apply

button. The Current Permission entry changes from User to Service.

CAUTION

The service mode is intended for use only by qualified

personnel with training and experience in its use. The

consequences of misuse include loss of patient data,

corruption of the CIC Pro operating system software, or

disruption of the entire Unity network.

4. Click on the Telemetry Alarm Control Defaults tab to bring it to the

front.

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Alarm Control: Unit Default Settings for Alarms

Parameter Limits

5. To change the unit defaults for Parameter Limits and Alarm Levels,

use the mouse to click in the Low or High field for the parameter you

wish to edit. The field is framed by a rectangle, and up and down

arrow buttons appear in the field.

6. To increase or decrease the limit by 5, click on the up or down arrow

button.

To increase or decrease the limit in increments other than 5, use the

keyboard to enter a new limit value.

7. Once you have set the desired limit, click on the Apply button for the

changes to take effect.

NOTE

If you make only one change, you do not need to click on the

Apply button. The change will take effect automatically, and the

Apply button will appear dimmed.

8. If you are finished making changes to the Telemetry Alarm Control

Defaults tab sheet, click the OK button.

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Alarm Control: Unit Default Settings for Alarms

Parameter Alarm Levels

To make a change in the telemetry unit default alarm level for a

parameter, first access the Telemetry Alarm Control Defaults tab as

described in the Telemetry Alarm Control Defaults section in this

chapter. Then follow the procedure below.

1. In Telemetry Alarm Control Defaults tab, use the mouse to click in

the Level field of the parameter for which the alarm level is to be

changed. A down arrow button appears in the field.

2. Click on the down arrow button. A popup list of alarm level selections

appears.

3. Click on the desired alarm level to select it.

4. Once you have set the desired level, click the Apply button for the

changes to take effect.

5. If you are finished making changes to the Telemetry Alarm Control

Defaults tab sheet, click the OK button.

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Alarm Control: Unit Default Settings for Alarms

Arrhythmia Alarm Levels

To make a change in the telemetry unit default alarm level for

arrhythmia alarms, first access the Telemetry Alarm Control Defaults

tab as described in the Telemetry Alarm Control Defaults section in this

chapter. Then follow the procedure below.

1. In the Telemetry Alarm Control Defaults tab, the arrhythmia alarm

levels for which unit defaults can be set appears on the right side of

the window:

2. Click in the Level field of the arrhythmia alarm you wish to modify. A

down arrow button appears in the field.

NOTE

The arrhythmia alarm levels for ASYSTOLE and VFIB/VTAC

cannot be changed. Therefore, the text in the Level field for these

alarms always appears dimmed.

3. Click on the down arrow button. A popup list of alarm level selections

appears.

4. Click on your choice to select it.

5. Once you have set the desired level, click the Apply button for the

changes to take effect.

If you are finished making changes to the Telemetry Alarm Control

Defaults tab sheet, click the OK button.

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Alarm Control: Unit Default Settings for Alarms

System Alarm Levels

WARNING

ADJUSTING SYSTEM ALARM LEVELS — The LEADS

FAIL alarm indicates that one or more electrodes are not

connected to the patient and, as a result, there is loss of

all waveforms and arrhythmia analysis. The ARR

SUSPEND alarm indicates that arrhythmia conditions

are not being detected and therefore alarms associated

with arrhythmias will not occur. The LEADS FAIL and

ARR SUSPEND alarms should be adjusted to a lower

priority level only by experienced qualified personnel and

with great caution. Adjusting these alarms to a lower

priority level may result in reduced awareness of

conditions that indicate the loss of patient monitoring.

To make a change in the telemetry unit default alarm level for system

alarms, first access the Telemetry Alarm Control Defaults tab as

described in the Telemetry Alarm Control Defaults section in this

chapter. Then follow the procedure below.

1. In the Telemetry Alarm Control Defaults tab, the system alarm levels

for which unit defaults can be set appears on the right side of the

window:

2. Click in the Level field of the system alarm you wish to modify. A

down arrow button appears in the field.

3. Click on the down arrow button. A popup list of alarm level selections

appears.

4. Click on your choice to select it.

5. Once you have set the desired level, click the Apply button for the

changes to take effect.

If you are finished making changes to the Telemetry Alarm Control

Defaults tab sheet, click the OK button.

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Alarm Control: Unit Default Settings for Alarms

For your notes

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9Printing

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For your notes

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Printing: Initiating a Manual Graph

Initiating a Manual Graph

If 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.

The 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 Chapter 6, Telemetry Setup, for more information on

setting telemetry unit defaults.

Automatic Alarm Graphs

A graph prints automatically when a patient experiences a Crisis or

Warning alarm condition. Arrhythmia alarm graphs run until the end of

the alarm event. 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.

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Printing: Initiating a Manual Graph

Transmitter Initiated Graphs (Manual Graphs)

When the Graph button on the ApexPro transmitter is pressed, a 20-

second graph strip is printed at a speed of 25 millimeters per second.

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 ApexPro transmitter, it

generates both an IMPACT.wf update page as well as a standard ECG

waveform graph at the CIC Pro. 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.

Graph button

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Printing: Initiating a Manual Graph

Graph Messages

One of the following messages is displayed on the CIC Pro 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 writer is available. (The most recent 20-

second alarm or manual graph will be saved.)

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Printing: Graph All Patients

Graph All Patients

Clicking on the Print button at the bottom of the CIC Pro display sends a

Graph All Patients request to all beds displayed on the CIC Pro,

initiating a 10-second graph for each admitted telemetry patient. When

this option is selected for telemetry patients, graph requests always print

at a speed of 25 millimeters per second.

NOTE

This 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 10-second 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 telemetry transmitter, the saved data

for the Graph All Patients graph will be replaced by data from the

patient’s telemetry transmitter. The data from the telemetry transmitter

will then appear on the graph printout.

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Printing: Graph All Patients

Initiating a Graph All Patients Request

To initiate a Graph All Patients request, follow these steps.

1. Click on the Print button at the bottom of the CIC Pro 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.

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Printing: Graph Location Settings

Graph Location Settings

Graphs print at the graph locations specified in the patient’s Graph

Setup tab sheet. Upon admission of a patient, these locations are set

from the unit defaults, but they can be modified if desired.

Following are guidelines for Graph Location:

Manual graphs and print window requests print at the CIC Pro

where the graph was requested, provided that CIC Pro 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 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.

If a telemetry patient is duplicated on another CIC Pro, alarm

graphs continue to print at the clinical information center where the

patient was first displayed (admitted).

If using the move feature, the patient’s graph settings are retained as

set on the original clinical information center.

If a patient displays on a clinical information center that is not

connected to a printer, the graph settings default to the graph

location designated in the unit defaults. See “Telemetry Unit

Defaults” on page 6-7.

If 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.

For more information on designating graph locations, refer to the Graph

Location Controls section in this chapter.

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Printing: Stopping a Graph

Stopping a Graph

To stop a graph request that has been sent to an external writer, press

its Graph Stop control key. This stops any graph already in process. If

this key is pressed when no graph is in process, it advances the paper in

the writer.

A manual graph may also be stopped by clicking on the patient's ECG

parameter window. An Automatic Alarm Graph may be stopped by

clicking on the patient's ECG window twice, once to change the graph to

a manual graph, and then a second time to stop the graph.

NOTE

Because the CIC Pro can communicate with many laser printers, the

specific procedure for stopping a graph sent to a laser printer is not

documented in this manual. Refer to the laser printer manufacturer’s

instructions.

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Printing: Graph Paper Out Indicator

Graph Paper Out Indicator

When 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.

NOTE

Because the CIC Pro can communicate with many laser printers,

specific status messages are not documented in this manual.

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Printing: Graph Setup Tab Sheet

Graph Setup Tab Sheet

The Graph Setup tab sheet allows you to define the waveforms to be

graphed, change the graph location and speed, and turn the telemetry

transmitter graph on and off.

NOTE

Changes made in the Graph Setup tab sheet affect only the patient

currently being viewed.

To make changes to graph information for all telemetry patients in

the unit, you must use the CIC Setup and the Telemetry Unit

Defaults tab sheets (refer to Chapter 6, Telemetry Setup, in this

manual).

To view a patient’s Graph Setup tab sheet, follow these steps.

1. Click on the desired patient’s information in the multiple patient

viewer. The single patient viewer for that patient opens.

2. Click on the Graph Setup tab. The Graph Setup tab sheet moves to

the front.

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Printing: Graph Setup Tab Sheet

Graph Waveforms Controls

The Graph Waveforms controls allow you designate which waveforms

should print in which positions on a patient’s graph printout.

ECG 1 Control

1. Click in the ECG 1 field. A down arrow button is displayed next to

the waveform currently in the ECG 1 position.

2. Click on the down arrow to display a list of available ECG

waveforms.

3. Click on the desired ECG waveform. The ECG 1 menu closes, with

the selected ECG waveform name remaining visible.

NOTE

This action also changes displayed waveforms in the multiple patient

viewer.

Waveform 2, Waveform 3, and Waveform 4

1. Click in the field for the waveform you wish to designate. A down

arrow icon is displayed next to the waveform currently in the

Waveform X position.

NOTE

Waveform X refers to Waveform 2, Waveform 3, or Waveform 4,

depending on which field you are in.

2. Click on the down arrow to display a list of available waveforms.

3. Click on the desired waveform. The waveforms menu closes, with the

selected waveform name remaining visible.

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Printing: Graph Setup Tab Sheet

Graph Location Controls

The Graph Location controls allow you to set the print destinations for

manual, alarm, and print window graphs.

Manual Graph Location

To designate where manual graph requests will print, follow these steps.

1. Click in the Manual field. A down arrow icon is displayed next to the

printer currently designated for printing manual graphs.

2. Click on the down arrow to display a list of available printers.

3. Click on the desired printer. The printers menu closes, with the

selected printer name remaining visible.

Alarm Graph Location

To designate where alarm graphs will print, follow these steps.

1. Click in the Alarm field. A down arrow icon is displayed next to the

printer currently designated for printing alarm graphs.

2. Click on the down arrow to display a list of available printers.

3. Click on the desired printer. The printers menu closes, with the

selected printer name remaining visible.

Print Window Location

To designate where print window requests will print, follow these steps.

1. Click in the Print Window field. A down arrow icon is displayed next

to the printer currently designated for printing alarm graphs.

2. Click on the down arrow to display a list of available printers.

3. Click on the desired printer. The printers menu closes, with the

selected printer name remaining visible.

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Printing: Graph Setup Tab Sheet

Enable Transmitter Graph

The Enable Transmitter Graph option allows you to turn off/on the

transmitter graph function for telemetry patients. When this option is

enabled, a telemetry patient can initiate a graph by pressing the Graph

button on the ApexPro transmitter. When this option is disabled, no

graph can be initiated. 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.

2. 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/Disabled

This 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.

Enable Transmitter

Graph Check Box

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Printing: Graph Setup Tab Sheet

Graph Speed Controls

The graph Speed controls allow you to adjust the speed at which a graph

prints (mm/s). Simply click on the desired speed.

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Printing: Laser Printer

Laser Printer

A laser printer can be connected to the back of the CIC Pro. (Refer to the

service manual for more information on printer connections.) The CIC

Pro must be formatted for a laser printer upon installation in order for a

laser printer to function with it. Refer to the service manual for the CIC

Pro for more information.

Printing to a laser printer for a telemetry patient may be configured on

an individual basis or set up as a unit default. For more information,

refer to the Graph Setup Tab Sheet section in this chapter, and to

Chapter 6, Telemetry Setup, in this manual.

You can send all information that can currently be formatted for a writer

to a laser printer at the CIC Pro.

To graph information to a laser printer at the CIC Pro, select the laser

printer under the Graph Location controls in the Graph Setup tab sheet.

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10 Patient Data

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For your notes

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Patient Data: Introduction

Introduction

For the purposes of this manual, patient data consists of the information

presented within these tab sheets:

Alarm Histories

Graphic Trends

Vital Signs

Full Disclosure

Once a patient is admitted to the CIC Pro, a history of the patient’s vital

signs is continually collected. The most recent 24 hours of data can be

viewed in a tabular format (vital signs) or in a graphic format (graphic

trends).

Every non-episodic parameter is sampled every two seconds. A median

value is determined, and that value is stored for display at one-minute

resolution. Episodic parameters (NBP, etc.) are stored every time one

occurs. If more than one episodic event occurred during the same minute,

the more recent event will overwrite the earlier one.

Alarm histories for arrhythmia events are recorded and stored, up to a

maximum of 100 events (36 events in Combo mode) per patient.

When full disclosure is turned on, complete ECG data for each patient is

recorded and stored for viewing.

You cannot change any patient data values, but you can use the controls

to view all the data collected.

Patient data can be viewed in varying time scales and can be printed to a

connected laser printer or a writer.

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Patient Data: Alarm Histories

Alarm Histories

A patient’s arrhythmia events are stored in Alarm Histories, and can be

reviewed, printed, and deleted at the CIC Pro. To access a patient’s

Alarm Histories tab sheet, follow the instructions below.

1. Click in the bed window of the patient whose Alarm Histories you

wish to view. The CIC Pro display rearranges to accommodate the

single patient viewer at the bottom of the display.

2. In the single patient viewer, click on the Alarm Histories tab,

bringing it to the front.

The Alarm Histories tab sheet contains an event directory (a list of

arrhythmia events recorded) for the patient, and an event window for

viewing individual events. It also contains several buttons, which control

the functions available in Alarm Histories. These functions are described

in this chapter.

Event Directory

Event Window

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Patient Data: Alarm Histories

Event Directory

An event directory appears on the left side of the Alarm Histories tab.

This directory is a list of all arrhythmia events that have occurred for

this particular patient.

A maximum of 100 events is stored for each patient (36 events in the

Combo monitoring mode). Following are the numbers for each type of

event that can be stored.

20 ST Alarm Histories

1 ST Reference

10 Sample Events (user stored)

100 Arrhythmia Events

After 100 events have been stored, the oldest event is deleted to make

room for any new event that occurs.

Approximately 10 events can be seen in the event directory at one time.

There are two ways to access events that are not currently visible in the

event directory. You can use the mouse and the scroll bar on the right

side of the event directory to scroll up and down through all the events,

or you can use the Scan Newer Events and/or Scan Older Events buttons.

How to use these two buttons is discussed later in this chapter.

Event Window

The event window appears on the right side of the Alarm Histories tab

sheet. The event shown in the event window corresponds to the event

that is highlighted in the event directory. The date, time, and name of

the event are shown in the event window header.

The event window displays 10 seconds of the patient’s ECG waveform

that was recorded when the event occurred. It displays up to three leads

that were being monitored at the time the event occurred. For an ST

event, the alarm ST event is displayed, along with a superimposed ST

template for reference purposes.

To print an event shown in the event window, use the mouse to click on

the Print button in the Main Menu at the bottom of the CIC Pro. One

event is printed per page.

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Patient Data: Alarm Histories

Alarm Histories Buttons

There are nine buttons that perform various functions in the Alarm

Histories tab. They are described below.

Data Source

This option allows the user to select the specific data source from which

historical patient data can be retrieved (option not shown on figure).

Refer to “Data Source” on page 10-16 for additional information.

Scan Newer Events

Click on the Scan Newer Events button to move through all events in the

event directory that are newer than the event that is currently

highlighted. If there are no events newer than the highlighted event, this

button is dimmed and does not function. This button changes to STOP

when a scan is in process. To stop a scan, click on the button again. While

the scan is in progress, you can also select Scan Older Events to reverse

the scanning direction.

Scan Older Events

Click on the Scan Older Events button to move through all events in the

event directory that are older than the event that is currently

highlighted. If there are no events older than the highlighted event, this

button is dimmed and does not function. This button changes to STOP

when a scan is in process. To stop a scan, click on the button again. While

the scan is in progress, you can also select Scan Newer Events to reverse

the scanning direction.

Print Directory

Click on the Print Directory button to print a list of all events currently

stored in the event directory. The list prints at the Print Window graph

default location.

View Newer Event

Click on the View Newer Event button to view the next newer event

waveforms, if any. If there are no events newer than the highlighted

event, this button is dimmed and does not function.

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Patient Data: Alarm Histories

View Older Event

Click on the View Older Event button to view the next older event

waveforms, if any. If there are no events older than the highlighted

event, this button is dimmed and does not function.

Delete Event

Click on the Delete Event button to delete the event that is currently

highlighted in the event directory. This cannot be undone.

If more than one event is highlighted (using Shift or Ctrl and the mouse),

a message appears when you press the Delete Event button, asking if you

are sure you wish to delete the events. Click on Ok to continue the delete.

Learn As

The Learn As button is inactive for telemetry patients and appears

dimmed.

Relearn

Select the Relearn button to initiate a relearn procedure. A relearn will

clear the patient’s waveforms and templates, and learn the patient’s

current rhythm as the dominant, “normal” rhythm.

Relearn is useful when you have changed a patient’s electrodes or

leadwires, or when it appears that false alarm calls are being made by

the arrhythmia program. The relearn takes only a few seconds.

Caliper

Select the Caliper button to perform caliper measurements on the ECG

waveform. When selected, the Caliper window opens displaying default

ECG waveform and Calipers which allow you to measure time intervals

for the following waveform measurements: PR, QRS, QT, R-R, and ST.

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Patient Data: Graphic Trends

Graphic Trends

To view a patient’s graphic trends, follow these steps.

1. Click on the desired patient’s bed window in the multiple patient

viewer. The single patient viewer for that patient opens.

2. Click on the Graphic Trends tab in the single patient viewer. The

Graphic Trends tab sheet moves to the front.

Trend Directory Window

Up to three graphic trend plots can be displayed in the Graphic Trends

window at one time. You can select from preset groupings of trends or

individual trends.

To select the trends for display in the Graphic Trends window, click on a

preset trend grouping or individual trends (up to three). When selected, a

check appears in the box to the left of the label.

Trend Directory

Window

Graphic Trends Window Graphic Trend

Labels

Numeric

Values at the

Cursor

Time Resolution

Scans Older/Newer

Graphic Trends

Cursor

384C

Indicates PDS Information

is Being Displayed

Scales Trends

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Patient Data: Graphic Trends

Cursor

One-minute median values can be accessed through the use of a cursor at

the CIC Pro.

The default cursor location is at the current time when entering the

Graphic Trends tab sheet.

You can move the cursor to any median value and review the actual

numeric data.

The cursor is not printed with the graphic trend data.

384C

Cursor

Time and Date Corresponding to

Cursor Position

Arrow Keys Move Cursor

Numeric Values at

the Cursor

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Patient Data: Graphic Trends

Time Resolution Menu

In the Graphic Trends tab sheet, you can define the amount of trend data

(resolution) to display in the trend window. This is done with the popup

menu located to the right of the time and date.

1. Click on the down arrow to display the time options.

2. Click on the desired time resolution. The time resolution menu

closes, with the selected resolution remaining visible. The selected

time resolution is also reflected immediately in the Graphic Trends

window.

Graphic Trends Buttons

There are six buttons that perform various functions in the Graphic

Trends tab. The function of each button is described below.

Data Source

This option allows the user to select the specific data source from which

historical patient data can be retrieved (option not shown on figure).

Refer to “Data Source” on page 10-16 for additional information.

Deselect All

Click on the Deselect All button to clear all trends from the Graphic

Trends window. Selecting this option also removes any checks from the

Trend Directory window.

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Patient Data: Graphic Trends

Scan Older

Click on the Scan Older button to initiate a scan of older trend data.

When clicked, the scan begins and older trend data scrolls across the

display. While the scan is in progress, you can select Scan Newer to

reverse the scanning direction.

This button changes to STOP when a scan is in process. Click on the

STOP button to stop a scan in process. When the oldest event is

displayed, the scan automatically stops, and the label on this button will

be dimmed.

Scan Newer

Click on the Scan Newer button to initiate a scan of newer trend data.

When clicked, the scan begins and newer trend data scrolls across the

display. While the scan is in progress, you can select Scan Older to

reverse the scanning direction.

This button changes to STOP when a scan is in process. Click on the

STOP button to stop a scan in process. When the most recent event is

displayed, the scan automatically stops, and the label on this button will

be dimmed.

Arrow Keys

The arrow buttons on the Graphic Trends tab sheet allow you to move

the cursor one minute to the left or right.

Using the left arrow moves the cursor one minute in the “older” direction.

When the oldest (least recent) event is displayed, the left arrow is

dimmed.

Using the right arrow moves the cursor one minute in the “newer”

direction. When the newest (most recent) event is displayed, the right

arrow is dimmed.

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Patient Data: Graphic Trends

Scalable Trends Key

The Scalable Trends keys allow you to adjust the graphic trend plots.

Selecting this key will scale the trend up or down in preset increments.

For example, the preset scales for HR are:

50–150

0–100

100–200

0–250

PDS Icon

The PDS (Patient Data Server) icon indicates that information has been

archived to the PDS server and is available to be viewed on the Graphic

Trends tab sheet.

If this icon does not appear in the lower right corner of the Graphic

Trends tab sheet, it could mean two things:

The PDS server is not available for retrieving patient information, or

No PDS information has been archived to the PDS server for this

patient.

Printing Graphic Trends

Trends can be printed using the same time scale as the display. To print

a graphic trend, click on the Print button at the bottom of the CIC Pro

display.

Graphic trend printouts for telemetry patients can be printed to a laser

printer or to a writer. Graphic trends print to the Print Window default

printer location.

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Patient Data: Vital Signs

Vital Signs

To view a patient’s vital signs, follow these steps.

1. Click in the desired patient’s bed window in the multiple patient

viewer. The single patient viewer for that patient opens.

2. Click on the Vital Signs tab in the single patient viewer. The Vital

Signs tab sheet moves to the front. The Vital Signs tab sheet displays

periodic and episodic trend data in tabular, or spreadsheet, form.

NOTE

When a telemetry patient’s vital signs are printed to a Direct Digital

Writer, the anchor column (the column closest to the time interval

selected) and four additional columns print, based on the time

interval selected.

Printed data may be delayed by one minute from the displayed data

due to time of request and update of trend files.

Data Source

This option allows the user to select the specific data source from which

historical patient data can be retrieved (option not shown on figure).

Refer to “Data Source” on page 10-16 for additional information.

Sort Mode Menu Increment Menu

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Patient Data: Vital Signs

Sort Mode

The Sort Mode popup menu provides options for sorting the way vital

signs data is viewed. If the telemetry patient is being monitored for NBP,

the sort options are All Data and NBP. If the patient is not being

monitored for NBP, the only option available is All Data. All other sort

options appear dimmed.

Increment

In the Vital Signs tab sheet, you can define the amount of data

(resolution) to display in the Vital Signs window. This is done with the

Increment popup menu.

1. Click on the down arrow to display all of the Increment options.

2. Click on the desired increment. The Increment menu closes, with the

selected increment remaining visible. The selected increment is also

reflected immediately in the Vital Signs window.

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Patient Data: Vital Signs

Scroll Bars

If all of the Vital Signs data does not fit into the available display space,

use the scroll bars to navigate among columns and rows of data. For

more information on using scroll bars, refer to the CIC Pro Clinical

Information Center Operator’s Manual.

Printing Vital Signs

Displayed trends can be printed using the same time scale as the display.

To print a set of vital signs, click on the Print button at the bottom of the

CIC Pro display.

Trends for telemetry patients can be printed to a laser printer or to a

writer. Printing to a writer can only be done in Combo monitoring mode

and must be done from a bedside monitor.

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Patient Data: Data Source

Data Source

The Data Source option allows the user to select the specific data source

from which historical patient data (Alarm Histories, Graphic Trends, and

Vital Signs) can be retrieved. The Data Source option is only available

when PDS is Enabled (refer to “Telemetry Unit Defaults” on page 6-7).

The Data Source option is labeled Data Source and exists on the left side

of the screen, between the Multi-patient viewer and the Single view

window. Next to this label are two radio buttons that indicate the

possible data sources:

Bedside — This can be either a telemetry or a hardwire bedside. The

amount of historical data is limited to the specific data source. For

most hardwire bedsides, there is a limit of around 32 history events

and 24 hours of trend data.

PDS — This server gathers and stores trend and history events from

hardwire bedsides and telemetry transmitters (refer to the

compatibility list in the Unity Network Patient Data Server (PDS)

Operator’s Manual. Patient data recorded during previous (72 hours)

bedside or telemetry device admissions can be viewed as a single

“patient centric” session. Up to 72 hours of trend data and 500

history events can be stored for a single patient.

The radio button for PDS data source will be disabled in the Alarm

Histories, Graphic Trends and Vital Signs tab sheets for a bedside that is

not being monitored by PDS.

Once the user makes a data source selection for a specific patient, the

setting remains in effect, allowing the user to interact with the data from

the selected data source. Data for printing will be consistent with the

currently selected data source. Selecting a different patient in the multi-

viewer or re-selecting the same patient will automatically change the

data source to be the bedside device.

NOTE

If the operator is on a tab sheet other than Alarm Histories, Graphic

Trends, or Vital Signs, no selection of the data source is possible. For any

application where information needs to be retrieved, such as patient

name, patient ID and alarm control information, the bedside device will

be used.

Data Source: ~Bedside { PDS

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Patient Data: Time Focus

Time Focus

The CIC Pro has a feature called time focus. When you are viewing one of

the four types of patient data (alarm histories, vital signs, graphic

trends, or full disclosure), time focus allows you to view the other three

types of patient data that were recorded at that same time.

For example, if you are viewing an arrhythmia event in the Alarm

Histories tab that occurred at 1:00 pm, clicking on the Vital Signs tab

would move that tab sheet to the front, with data corresponding to the

time focus (1:00 pm) highlighted. Likewise, if you click on any of the

other patient data tabs, that tab sheet will move to the front, with data

corresponding to the time focus (1:00 pm) at the cursor location.

Since graphic trends are only visible for the period of time specified in

the Graphic Trends tab (refer to the Graphic Trends section in this

chapter for more details), it is possible to view vital signs data, full

disclosure data, or an alarm history event for which the corresponding

graphic trend is no longer stored in the CIC Pro. In this case, clicking on

the Graphic Trends tab takes you to the most recent graphic trend, not

the trend that corresponds to the alarm history, vital signs, or full

disclosure you were viewing.

Alarm histories are episodic events. Therefore, clicking on the Alarm

Histories tab in a time focus situation displays the alarm history event

that occurred closest to the time focus.

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Patient Data: Full Disclosure

Full Disclosure

NOTE

This section provides a brief overview of the Full Disclosure function.

Refer to the CIC Pro Clinical Information Center Operator’s Manual

for detailed information.

The full disclosure feature must be enabled in the Full Disclosure

Defaults tab sheet. Refer to the CIC Pro Clinical Information Center

Operator’s Manual for details on enabling this feature.

When full disclosure is enabled, follow these steps to view a patient’s Full

Disclosure window.

1. Click in the desired patient’s bed window in the multiple patient

viewer. The single patient viewer for that patient opens.

2. Click on the Full Disclosure tab in the single patient viewer. The Full

Disclosure tab sheet moves to the front.

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Patient Data: Full Disclosure

Full Disclosure Options

Speed

The Speed popup list allows you to set the waveform compression for the

full disclosure waveform display.

Caliper

Select the Caliper button to perform caliper measurements on the ECG

waveform. When selected, the Caliper window opens displaying default

ECG waveform and Calipers which allow you to measure time intervals

for the following waveform measurements: PR, QRS, QT, R-R, and ST.

Stop/Start FD

When Full Disclosure is set for manual mode, this option stops or starts

the Full Disclosure process. If Stop FD is selected, the user is prompted,

"Are you sure you want to stop Full Disclosure?" before Full Disclosure is

stopped.

NOTE

When the Full Disclosure mode is set for automatically if listed or

automatically for all beds, the Stop/Start FD button is hidden.

Scan Older

Clicking on the Scan Older button initiates a scan of older full disclosure

data. When the button is clicked, the scan begins and older trend data

scrolls across the display.

This button changes to STOP when a scan is in process. Click on the

STOP button to stop a scan in process. When the oldest data is displayed,

the scan automatically stops and the label on this button will be dimmed.

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Patient Data: Full Disclosure

Scan Newer

Clicking on the Scan Newer button initiates a scan of newer full

disclosure data. When the button is clicked, the scan begins and newer

data scrolls across the display.

This button changes to STOP when a scan is in process. Click on the

STOP button to stop a scan in process. When the newest data is

displayed, the scan automatically stops and the label on this button will

be dimmed.

Older Event

Clicking on the Older Event button moves the cursor to the next older

alarm history event.

Newer Event

Clicking on the Newer Event button moves the cursor to the next most

recent alarm history event.

View All ECG/Monitor

This option switches between View All ECG and Monitor. The View All

ECG option displays all ECG waveforms. The Monitor option displays all

waveforms that are displayed at the bedside at the time of full disclosure.

In the case of telemetry patients, these are the same, since only ECG

waveforms are displayed for telemetry patients.

Print Report

Clicking on the Print Report button allows you to set up a report for

printing. In the Print Report window, clicking on Print initiates a full

disclosure report printout. This report prints at the printer designated in

the Full Disclosure Defaults tab sheet.

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11 ECG Monitoring

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For your notes

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ECG Monitoring: Introduction

Introduction

This chapter describes how a telemetry patient’s ECG monitoring

information is displayed at the clinical information center.

Data Synchronization

Information displayed on the ECG tab sheet is synchronized with the

source (ApexPro transmitter) every two seconds. If differences are

detected, the display is refreshed with new information.

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ECG Monitoring: Patient Preparation

Patient Preparation

The quality of ECG information received and displayed is a direct result

of the quality of the electrical signal at the electrode.

Skin Preparation

Proper skin preparation is necessary for good signal quality at the

electrode.

Choose flat, non-muscular areas to place electrodes, then follow the

established prep protocol for your unit. Following is a suggested

guideline for skin preparation:

1. Shave hair from skin at chosen sites.

2. Gently rub skin surface at sites to remove dead skin cells.

3. Thoroughly cleanse site with a mild soap and water solution. Be sure

to remove all oily residue, dead skin cells, and abrasives. Leftover

abrasion particles can be a source of noise.

4. Allow the skin to dry completely before applying the electrodes.

Electrode Placement

Following is a chart identifying each lead and its associated color code—

AHA and IEC.

Verify Lead Quality and Electrode Status

After the transmitter leads have been properly attached to the patient's

electrodes, verify lead quality and electrode status.

Refer to “ApexPro Transmitter Buttons and LEDs” on page 3-7 for

the ApexPro and ApexPro CH transmitter.

Refer to “LED Indicators Function” on page D-12 for the ApexPro FH

transceiver.

Leadwire

(Software Label) AHA Color AHA Label IEC Color IEC Label

V (precordial) brown V white C

LL (left leg) red LL green F

RL (right leg) green RL black N

LA (left arm) black LA yellow L

RA (right arm) white RA red R

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ECG Monitoring: Patient Preparation

5-Leadwire (Einthoven + V Lead) and 6-Leadwire Electrode Placement

Following are the standard 5- and 6-leadwire electrode configurations for

AHA and IEC:

Right arm and left arm electrodes should be placed just below the right

and left clavicle.

Right leg and left leg electrodes should be placed on a flat non-muscular

surface on the lower edge of the rib cage.

For standard 5-leadwire electrode placement, the chest electrode should

be placed according to the physician’s preference.

For standard 6-leadwire electrode placement, any TWO V leads (chest

electrodes) may be placed according to the physician’s preference.

NOTE

The V1 lead is recommended for arrhythmia detection, and the V5

lead is recommended for ST depression monitoring.*

* Barbara J. Drew, RN, PhD, FAAN (2000). Value of Monitoring a

Second Precordial Lead for Patients in a Telemetry Unit, GE Medical

Systems (order document number M04243ME0).

C3 C4C5

RA LA

RL LL

V3 V4 V5

AHA Configuration IEC Configuration

368B 372B

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ECG Monitoring: Patient Preparation

3-Leadwire Electrode Placement

When a 5-leadwire electrode configuration is not desirable, a 3-leadwire

cable can be used.

NOTE

Electrode configuration will vary depending on the type of leadwire

set you are using.

Right arm and left arm electrodes should be placed just below the right

and left clavicle.

Left leg electrode should be placed on a non-muscular surface on the

lower edge of the rib cage.

Electrode Placement for Pediatric Patients

Typically, pediatric patients are large enough for a 5- or 6-leadwire

electrode configuration. This is the preferred monitoring setup for

receiving the benefits of multi-lead analysis. However, if the patient is

too small for five or six electrodes, the 3-leadwire electrode configuration

can be used. The right arm and left arm electrodes are positioned on the

right and left sides of the chest. The right leg electrode can be placed on

either the right or left side of the abdomen. Refer to the illustrations in

the 3-Leadwire Electrode Placement section above.

RA LA

3-Leadwire AHA Configuration 3-Leadwire IEC Configuration

370A 373A

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ECG Monitoring: Patient Preparation

Modified Chest Lead (MCL) Electrode Placement

Following is the modified chest lead (MCL) electrode configuration with

the associated location:

Right arm electrode should be placed in the fourth intercostal space to

the right of the sternum.

Left arm electrode should be placed just below the left clavicle.

Left leg electrode should be placed in the sixth intercostal space along

the mid-axillary line.

Right leg electrode should be placed on a flat non-muscular surface on

the lower edge of the rib cage.

AHA Configuration

MCL Electrode Placement

IEC Configuration

MCL Electrode Placement

371A 375A

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ECG Monitoring: Patient Preparation

Electrode Placement for Pacemaker Patients

Electrodes need to be repositioned to modify detection of the electrical

signals generated by the pacemaker. Following is a suggested

configuration:

The right arm electrode is moved down to the fifth intercostal space, and

the left leg electrode is moved up to the fifth intercostal space.

NOTE

After all electrodes are in place, ensure that a minimum of 1/2 mV of

signal is present on each lead (I, II, III, V).

V1 LL

AHA Configuration

Pacemaker Electrode Configuration

IEC Configuration

Pacemaker Electrode Configuration

369A 374A

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ECG Monitoring: Patient Preparation

Maintaining Quality ECG Signal

Regardless of patient type, electrodes should be replaced at least every

48 hours to maintain quality signals during long-term monitoring. Over

the course of 48 hours, the electrode gel will start to dry out and the

adhesive will age. This may irritate the patient’s skin.

Stabilize the electrode and leadwire with a leadwire stress loop near the

electrode. Tape the stress loop to the patient. A secured stress loop

prevents leadwire rotation about the electrode snap, leadwire tugging at

the electrode, and ECG artifact.

Stress Loop

306A

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ECG Monitoring: Special Considerations for 6-Lead Monitoring

Special Considerations for 6-Lead Monitoring

V FAIL Message

CAUTION

The clinical information center does not detect 6-lead

monitoring until a signal from the sixth lead is received

at the clinical information center. Therefore, if the sixth

lead on the ApexPro transmitter has failed before the

telemetry patient is admitted to the clinical information

center, the clinical information center will NOT generate

a V FAIL message for the sixth lead.

At the patient’s ApexPro transmitter, verify that the sixth lead on the

ApexPro transmitter is good. Press the Verify Leads button on the

ApexPro transmitter and ensure that all the good lead LEDs illuminate.

(Refer to Chapter 3, Equipment Overview, for button and LED locations.)

Relearn

If a telemetry patient is switched from 6-lead monitoring to 5-lead

monitoring while ADMITTED to the clinical information center, a V

FAIL message will appear. The clinical information center “assumes”

that the telemetry patient is being monitored for six leads and that the

sixth lead has failed.

In situations where the admitted telemetry patient has been switched

from 6- to 5-lead monitoring, the associated V FAIL message can be

cleared by clicking on the Relearn button in the telemetry patient’s ECG

tab sheet. (Refer to the ECG Tab Sheet section in this chapter for

information about the Relearn button.)

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ECG Monitoring: ECG Monitoring

ECG Monitoring

ECG in the Multiple Patient Viewer

For telemetry patients, up to four leads of ECG can be displayed in the

bed window of the multiple patient viewer. Also displayed are the

patient’s heart rate, current PVC per minute value, ST analysis, and a

“P” if pace detection is turned on. Below is an example of a telemetry

patient’s bed window in the multiple patient viewer.

Heart rate

Indicates pace

detection is on

ST analysis

ECG waveform

346B

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ECG Monitoring: ECG Monitoring

ECG in the Single Patient Viewer

View Patient Tab Sheet

For telemetry patients, up to eight leads of ECG can be seen in the View

Patient tab sheet. It is also possible to sample ten seconds of ECG data

for storage in Alarm Histories, and to initiate a relearn of the patient’s

rhythm. The patient’s heart rate, current PVC per minute value, ST

information, and “P” for pace detection (if turned on) are also displayed.

To access the View Patient tab sheet, follow the steps below.

1. Click in the desired patient’s bed window in the multiple patient

viewer. The display rearranges to accommodate the single patient

viewer for that patient.

2. If it is not already visible at the front of the tabs, click on the View

Patient tab to bring the tab sheet to the front.

For more details about the features and functions of the View Patient tab

sheet, refer to Chapter 7, Admit/View a Patient, in this manual.

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ECG Monitoring: ECG Monitoring

Full Disclosure Tab Sheet

When you purchase the appropriate Full Disclosure licenses, you can

acquire either 24-hours or 72-hours of Full Disclosure data per bed

license. If full disclosure is turned on, data can be viewed in the Full

Disclosure tab sheet.

To access the Full Disclosure tab sheet, follow the steps below.

1. Click in the desired patient’s bed window in the multiple patient

viewer. The display rearranges to accommodate the single patient

viewer for that patient.

2. Click on the Full Disclosure tab to bring the tab sheet to the front.

For more details about the features and functions of the Full Disclosure

tab sheet, refer to the CIC Pro Clinical Information Center Operator’s

Manual.

ECG Limits

You can adjust the alarm limits for ECG (such as HR, ST, etc.) in the

Telemetry Alarm Control Defaults tab and in the patient’s Alarm Control

tab. For more information on how to set the alarm limits, refer to

Chapter 8, Alarm Control, in this manual.

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ECG Monitoring: ECG Monitoring

ECG Artifact

The clinical information center has two levels for artifact alarms.

Level 1 artifact displays the ARTIFACT message, but continues to

display a heart rate.

The ARTIFACT message does not flash or generate an audible

alarm.

The ARTIFACT message will be relocated to the lead fail area of

the display.

If the patient is in a lead fail, the lead fail message has priority

over the ARTIFACT message on the display.

Level 2 artifact displays the ARTIFACT message, but the heart rate

values are removed from the display.

The ARR SUSPEND message is a System Status Alarm and can

be set at Warning, Advisory, or Message level.

The clinical information center displays the ARR SUSPEND

message when it is determined that the arrhythmia is in the

level 2 ARTIFACT state.

The ARR SUSPEND message is displayed in the Arrhythmia

event line and, if set at Warning or Advisory level, is sent to the

ADU line for alarm notification.

For more information about alarms, refer to Chapter 8, Alarm Control, in

this manual.

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ECG Monitoring: ECG Tab Sheet

ECG Tab Sheet

The ECG tab sheet allows you to view and modify settings specific to the

viewed patient’s ECG display. Settings may be viewed for any patient.

However, you can only modify settings for patients who are admitted to a

bed in your care unit.

Accessing the ECG Tab Sheet

To access a patient’s ECG tab sheet in the single patient viewer, follow

this procedure:

1. Click in the desired patient’s bed window in the multiple patient

viewer. The display rearranges to accommodate the single patient

viewer for that patient.

2. Click on the ECG tab in the single patient viewer. The ECG tab sheet

moves to the front.

302A

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ECG Monitoring: ECG Tab Sheet

Display Lead

This option allows you to change the lead currently displayed as the

primary lead. Use the mouse to click on your Display Lead selection.

Relearn

Clicking on the Relearn button initiates a relearn of the patient’s ECG

rhythm. The relearn takes only a few seconds. The patient’s heart rate

reading is momentarily replaced by Xs. Numerics return once the relearn

is complete.

You should use the relearn function whenever there has been a

significant change in the patient’s rhythm.

Size

This option allows you to change the size of the ECG waveforms

displayed at the clinical information center. This may be necessary when

diagnosing or problem solving. Normal size (1x) is recommended unless

circumstances require otherwise.

To change the waveform display size, use the mouse to click on an option.

NOTE

If a size other than 1x is used, the size is displayed on the left side of

the screen next to the ECG waveform.

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ECG Monitoring: ECG Tab Sheet

Detect Pace

Safety Considerations

Be aware of the following when monitoring a patient with a pacemaker.

WARNINGS

FALSE CALLS—False low heart rate indicators or false

asystole calls may result with certain pacemakers

because of electrical overshoot.

MONITORING PACEMAKER PATIENTS—Monitoring

of pacemaker patients can only occur with the pace

program activated.

PACEMAKER 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.

PATIENT HAZARD—A pacemaker pulse can be counted

as a QRS during asystole in either pace mode. Keep

pacemaker patients under close observation.

RATE 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.

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ECG Monitoring: ECG Tab Sheet

CAUTION

FDA 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, FDA

1350 Piccard Drive, Mail Stop HFZ-510

Rockville, MD 20850

U.S.A.

NOTE

ECG 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.

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ECG Monitoring: ECG Tab Sheet

Monitoring Pacemaker Patients

The Detect Pace option enables/disables the pacemaker detection

program. It must be used whenever the monitored patient has a

pacemaker. Pace detection choices are Pace 1 and Pace 2. You can also

choose to turn pace detection Off. Use the mouse to click on a Detect Pace

selection.

NOTE

The Off option turns pacemaker detection off. It does NOT perform

pacemaker detection. Either the Pace 2 or Pace 1 option MUST be

used with patients who have pacemakers.

There are two pacemaker processing modes, Pace 1 and Pace 2. The Pace

1 and Pace 2 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 turn the program on.

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.

NOTE

Please observe all cautions as described when choosing the Pace 1

mode of operation.

The 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.

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.

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ECG Monitoring: ECG Tab Sheet

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.

Pacemaker mode:

In most cases, Pace 2 mode will effectively monitor a pacemaker

patient. However, if you are experiencing problems, select the Pace 1

mode as an option, and observe all cautions as described for the

Pace 1 mode of operation.

Multi-Vector Pace Detection (ApexPro CH only)

NOTE

The ApexPro CH transmitter is not for sale outside of the U.S. and

Canada.

The ApexPro CH transmitter uses multi-vector pace detection. Here are

some additional guidelines for successful monitoring pacemaker patients

when using the ApexPro CH transmitter.

When using the 5 or 6-leadwire patient cable 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

patient cable.

For more information, refer to the Pacemaker Troubleshooting section in

this chapter.

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ECG Monitoring: ECG Tab Sheet

Pace Help

Clicking on the Pace Help button opens a window that shows common

problems and solutions in regard to pacemaker detection. This window is

shown below.

047A

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ECG Monitoring: ECG Tab Sheet

Lead Analysis

The Lead Analysis control signals the ApexPro 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 adults.

Multi-Lead Analysis

Multi-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 Analysis

Single lead analysis uses only the lead displayed on the clinical

information 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 analysis is beneficial when troubleshooting pacemaker

detection and/or arrhythmia detection. Single lead analysis must always

be used when monitoring with a 3-lead cable. Single lead analysis can be

set up as a unit default. Refer to Chapter 6, Telemetry Setup, for more

information.

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ECG Monitoring: ECG Tab Sheet

Single Lead ECG Telemetry Data

NOTE

When acquiring Single Lead ECG data using a 5-leadwire or 6-

leadwire cable, 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.

Function Single Lead Constraints

change 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.

However, your selection is temporary and will revert back

to the ApexPro transmitter’s default displayed lead.

NOTE

When 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. 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.

However, your selection does not change the ApexPro

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. However, your selection is

temporary and will revert back to the ApexPro transmitter’s

default displayed lead.

select graph waveforms Leads other than the default displayed lead may appear to

be selectable at the CIC Pro. However, you must select the

ApexPro transmitter’s default displayed lead to obtain a

graph of the waveform.

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ECG Monitoring: ECG Tab Sheet

Arrhythmia

NOTE

Full 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.

WARNINGS

SUSPENDED 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.

VENTRICULAR ARRHYTHMIAS—The arrhythmia

analysis program is intended to detect ventricular

arrhythmias. It is not designed to detect atrial or

supraventricular arrhythmias. 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 clinical information center to ignore

or accept arrhythmia calls. To modify arrhythmia settings, use the

mouse to click on Full, Lethal, or Off.

NOTE

When 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.

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ECG Monitoring: ECG Tab Sheet

No Arrhythmia Detection with Patient Monitors at 7015 Software Level

If an ApexPro telemetry 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.

CAUTION

Under these conditions, arrhythmia detection is OFF.

There is NO INDICATION of this at the bedside monitor,

central station or clinical information 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 clinical information center. Arrhythmia

monitoring remains OFF.

NOTE

Solar 7000 monitors, Solar 8000 monitors, Dash monitors, and Eagle

monitors may include the 7015 software level.

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ECG Monitoring: ECG Tab Sheet

Full Arrhythmia Conditions

Below 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’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.

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.

NOTE

The 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.

IRREGULAR Occurs when six consecutive normal R-to-R intervals vary by

100 milliseconds or more.

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ECG Monitoring: ECG Tab Sheet

WARNING

VFIB/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.

PAUSE Occurs when a 3-second interval without a QRS complex is

detected.

PVC Isolated premature ventricular complexes occur when a

premature ventricular beat is detected and has non-ventricular

beats before and after.

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.

NOTE

The 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.

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ECG Monitoring: ECG Tab Sheet

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.

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ECG Monitoring: ECG Tab Sheet

Lethal Arrhythmia Conditions

When 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)

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. For more

information on setting the limits, refer to Chapter 8, Alarm Control, in

this manual.

The ST control turns the display of ST segment analysis data on and off.

Use the mouse to turn ST segment analysis On or Off. For more

information about ST analysis, refer to the ST Analysis section in this

chapter.

Va Lead and Vb Lead

Correctly labelling V leads is important to facilitate correct ECG analysis

when viewing real time waveforms, histories or printouts. These two

option lists allows you to label the V leads. Use the mouse to click on your

Va Lead and Vb Lead selections.

NOTE

Vb Lead selections are only available with 6-lead monitoring.

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ECG Monitoring: ECG Tab Sheet

AFIB Identification

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.

The AFIB algorithm feature identifies atrial fibrillation arrhythmias for

the ApexPro transmitter. When the AFIB arrhythmia detection feature

is selected, it replaces the IRREGULAR arrhythmia alarm text with the

ATRIAL FIB alarm text.

Alarms

A patient status alarm is triggered when an AFIB arrhythmia is

detected. The message ATRIAL FIB is displayed in the message area of

the display.

NOTE

There 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. 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.

Alarm Limitations

Some bedside monitors do not support atrial fibrillation. When the

ApexPro telemetry system is used in combo monitoring mode with a

monitor that does not support atrial fibrillation, there may be alarm

limitations.

Following is a list of alarm limitations:

No AFIB message in the CIC Pro single/multi-viewer window or at

the bedside monitor.

No alarms broadcasted to other CIC Pro’s

No alarm text on the graph header

Instead of AFIB, a question mark (?) is displayed in Alarm History

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ECG Monitoring: ST Analysis

ST Analysis

The 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 clinical information

center.

GE Medical Systems Information Technologies identifies the ST segment

of the QRS complex as beginning at the J point and ending 60

milliseconds following the J point. The 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.

The 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.

NOTE

ST numerics are always calculated with reference to 1X size.

Displaying the ECG waveform at a different size does NOT affect the

ST values.

NOTE

When 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.

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ECG Monitoring: ST Analysis

ST Deviation Alarm

When 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 flashes to indicate an

alarm.

ST limits can also be adjusted individually in the patient’s Alarm

Control tab.

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ECG Monitoring: Arrhythmia Troubleshooting

Arrhythmia Troubleshooting

Problem: Inaccurate heart rate

and/or false asystole

Solution: 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.)

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ECG Monitoring: Arrhythmia Troubleshooting

Problem: False ventricular calls Solution: 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:

a. Click on the patient’s ECG tab.

b. Click on the Relearn button.

IF PROBLEM CONTINUES:

1. Remove the V lead(s).

2. Click on the patient’s ECG tab.

3. Click on the Relearn button.

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ECG Monitoring: Pacemaker Troubleshooting

Pacemaker Troubleshooting

There 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 “pacemaker enhancement spike” (shown in an

offset color from the ECG waveform) 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).

During telemetry monitoring, the pacemaker signal is acquired from lead

II or on II and V simultaneously when using the ApexPro CH

transmitter. Changing the displayed lead has no effect on pacemaker

detection.

NOTE

With all leads connected, pacemaker signal acquisition occurs on

lead II or on II and V simultaneously when using the ApexPro CH

transmitter. In a lead fail condition, signal acquisition occurs on any

available lead. When a 3-leadwire patient cable 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.

Interface Connector Ports

Pace 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.

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ECG Monitoring: Pacemaker Troubleshooting

Problem: Inaccurate pacemaker

detection

Solution: Use pacemaker processing:

1. Click on the patient’s ECG tab.

2. In the Detect Pace section, select either Pace 1 or Pace 2.

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.

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.

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ECG Monitoring: ST Troubleshooting

ST Troubleshooting

Problem: ST numerics changed to

Solution: 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.

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ECG Monitoring: ST Troubleshooting

For your notes

Revision D ApexPro Telemetry System 12-1

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12 SpO2 Monitoring

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For your notes

Revision D ApexPro Telemetry System 12-3

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SpO2 Monitoring: Introduction

Introduction

NOTE

SpO2 and SPO2 are used interchangeably throughout this manual to

refer to pulse oximetry.

The ApexPro transmitter supports the Apex Oximeter and the Xpod

Oximeter. Unless specified, “oximeter” refers to both units.

The Xpod Oximeter connects to the ApexPro transmitter and provides

the following oximetry vital signs for display at the CIC Pro:

arterial oxygen saturation (SpO2)

peripheral pulse rate (PPR)

perfusion quality indicator

The 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 ApexPro transmitter, digital values for SpO2 and pulse

rate are also displayed at the CIC Pro.

NOTE

When monitoring SpO2 using an ApexPro transmitter, an SpO2

waveform is neither generated nor displayed on the Apex Oximeter

or CIC Pro. Additionally, no alarm histories are generated or stored.

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SpO2 Monitoring: Introduction

SpO2 Probe Safety

Be sure to read all literature accompanying probes for specific safety

information. Be aware of the following safety precautions when using

SpO2 probes.

WARNINGS

DATA VALIDITY—Do not expose probe detector to

strong ambient light while monitoring a patient. A poor

signal may result.

DATA VALIDITY—Do not allow tape to block the probe

light detector.

PATIENT 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.

PATIENT SAFETY—If a probe is damaged in any way,

discontinue use immediately.

CAUTION

Use 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.

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SpO2 Monitoring: Infants and Pulse Oximetry

Infants and Pulse Oximetry

WARNING

The 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.

Precautions

We 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, and

2. the SPO2 signal strength indicator must have 2 or 3 asterisks

displayed, and

3. stable SPO2 values are displayed for six seconds.

Procedures 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.

CAUTION

Do not use the Apex Oximeter on neonatal patients. It is

not designed for use on neonates.

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SpO2 Monitoring: Signal and Data Validity

Signal and Data Validity

It 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 are

of assistance.

Signal Strength Indicator

A signal strength (perfusion) indicator is displayed on the Apex Oximeter

display and at the CIC Pro 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, 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.

WARNING

In 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.

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SpO2 Monitoring: Signal and Data Validity

Error Messages

If 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:

SPO2 PROBE OFF

SPO2 PROBE

If either of the above messages appears, check the position of the probe or

replace the probe. If the problem persists, call GE Medical Systems

Information Technologies Service or contact your sales/service

representative.

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SpO2 Monitoring: SPO2 Monitoring

SPO2 Monitoring

SPO2 in the Multiple Patient Viewer

In the multiple 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 multiple patient viewer.

Signal Strength

Indicator

SPO2 Value

Pulse Rate Value

346B

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SpO2 Monitoring: SPO2 Monitoring

SPO2 in the Single Patient Viewer

In the single patient viewer, SpO2 data appears in the View Patient tab

sheet in the same format and location as it does in the multiple patient

viewer.

To access the View Patient tab sheet, follow the steps below.

1. Click in the desired patient’s bed window in the multiple patient

viewer. The display rearranges to accommodate the single patient

viewer for that patient.

2. If it is not already visible at the front of the tabs, click on the View

Patient tab to bring the tab sheet to the front.

For more information about the View Patient tab sheet, refer to Chapter

7, Admit/View a Patient, in this manual.

SPO2 Limits

You can adjust alarm limits for SPO2 and rate in the Alarm Control tab

sheet for each patient. SPO2 alarm limits cannot be set as unit defaults.

For more information on how to set the alarm limits, refer to Chapter 8,

Alarm Control, in this manual.

348D

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SpO2 Monitoring: SPO2 Tab Sheet

SPO2 Tab Sheet

The SpO2/Respiration tab sheet allows you to view and modify settings

specific to the viewed patient’s SpO2 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.

NOTE

The 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.

Accessing the SPO2 Tab Sheet

To access a patient’s SpO2 tab sheet in the single patient viewer, follow

this procedure.

1. Click in the desired patient’s bed window in the multiple patient

viewer. The display rearranges to accommodate the single patient

viewer for that patient.

2. Click on the SpO2/Respiration tab in the single patient viewer. The

SpO2 tab sheet moves to the front.

347B

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SpO2 Monitoring: SPO2 Tab Sheet

Rate

A pulse rate is derived from the SPO2 signal and is displayed in the

parameter window. You can turn this displayed rate off and on. Simply

click On to turn rate on, or Off to turn rate off.

Size

Because no waveform is displayed when SpO2 is monitored via

telemetry, the Size option does not function for telemetry patients. Size

and its selections appear dimmed when monitoring telemetry patients.

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SpO2 Monitoring: Troubleshooting

Troubleshooting

SpO2 Messages

Below 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.

NOTE

The 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

ApexPro transmitter and therefore does not support this message.

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. Refer to Chapter 4, Connection, for

information about changing batteries.

Message displayed, no SPO2 data displayed—The batteries in the Apex

Oximeter are depleted. Replace the batteries. Refer to Chapter 4,

Connection, for information about changing batteries. This is a system

advisory alarm. The alarm will sound, and a red alarm button will

appear on the CIC Pro 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.

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SpO2 Monitoring: Troubleshooting

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 Medical Systems Information Technologies

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 for three minutes. If no data is

detected after three minutes, the message changes to NO DATA.

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SpO2 Monitoring: Troubleshooting

For your notes

Revision D ApexPro Telemetry System 13-1

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13 NBP Monitoring

13-2 ApexPro Telemetry System Revision D

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For your notes

Revision D ApexPro Telemetry System 13-3

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NBP Monitoring: Introduction

Introduction

NOTE

The Accutracker DX noninvasive blood pressure monitor is available

in the United States only. This model, available from GE Medical

Systems Information Technologies, has been modified by SunTech

Medical Instruments to operate with the ApexPro telemetry system.

NBP monitoring via telemetry is done with an Accutracker DX

noninvasive blood pressure monitor connected to the ApexPro

transmitter. The blood pressure cuff is connected to the Accutracker DX

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 ApexPro transmitter, digital values

are also displayed at the CIC Pro.

WARNING

The 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.

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NBP Monitoring: Safety Considerations

Safety Considerations

Keep the following warnings and cautions in mind when using the

Accutracker DX noninvasive blood pressure monitor.

WARNINGS

The Accutracker DX noninvasive 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.

CAUTIONS

The 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 noninvasive 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

Deg. C” and ship appropriately. Failure to follow these

instructions can result in device failure due to improper

shipping/storage conditions.

Revision D ApexPro Telemetry System 13-5

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NBP Monitoring: Programming the Blood Pressure Monitor

Programming the Blood Pressure Monitor

The blood pressure measurement interval, the maximum and minimum

inflation pressures, dynamic or fixed inflate, and the deflate rate can all

be adjusted on the Accutracker DX blood pressure monitor. Follow the

instructions below to set these options.

Setting the Measurement Interval

When the blood pressure monitor is turned on, it performs a battery

voltage check, then the display shows the following:

INT= 5 (***)

INCR DECR START?

NOTE

The 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.

When 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.

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NBP Monitoring: Programming the Blood Pressure Monitor

The patient’s blood pressure is displayed for one minute on the blood

pressure monitor and for two hours on the CIC Pro. 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 Parameters

The 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 TEST

PARAMETERS?

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.

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NBP Monitoring: Programming the Blood Pressure Monitor

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.

Dynamic 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.

NOTE

A 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?

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NBP Monitoring: Programming the Blood Pressure Monitor

Setting Limits

It 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 (refer to “How to Reach Us” at

the beginning of this manual) for more information about setting these

limits.

Software and Hardware Versions

To verify what software and hardware versions your Accutracker DX

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/ZZ

K3: 0 PR: 0

Your 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.

NOTE

Although it is not shown on the Accutracker DX 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.

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NBP Monitoring: Patient Preparation

Patient Preparation

Blood 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:

1. Place the K-sound microphone in the microphone pad (or blood

pressure cuff). For more information on microphone placement, refer

to the Microphone Placement section in this chapter.

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.

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NBP Monitoring: Patient Preparation

When attached, the blood pressure cuff and hoses should be positioned

like those in the following illustration.

Patient with Cuff and Hoses Attached

Hoses Routed Over

Shoulder

Cuff Anchor Clip

Cuff/Microphone

Connections

408A

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NBP Monitoring: Patient Preparation

Microphone Placement

A 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 the blood pressure cuff, or

alternatively, it can be placed directly into the microphone pocket inside

the blood pressure cuff.

Placement in the Microphone Pad

Using 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.

Placing the Microphone in the Microphone Pad

Microphone Cable

K-sound Microphone

Microphone Pad

410A

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NBP Monitoring: Patient Preparation

Placement in the Blood Pressure Cuff

As 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.

NOTE

Blood 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.

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NBP Monitoring: NBP Monitoring

NBP Monitoring

NBP in the Multiple Patient Viewer

In the multiple patient viewer, the bed window for a telemetry patient

being monitored for NBP displays an NBP label, along with the systolic

and diastolic values from the most recent measurement.

NOTE

The mean blood pressure value is not measured or calculated when

monitoring blood pressure via telemetry. Therefore, an X always

remains on the display in place of a mean value when a telemetry

patient’s blood pressure is being monitored.

NBP in the Single Patient Viewer

In the single patient viewer, NBP data appears in the View Patient tab

sheet in the same format and location as it does in multiple patient

viewer.

To access the View Patient tab sheet, follow the steps below.

1. Click in the desired patient’s bed window in the multiple patient

viewer. The display rearranges to accommodate the single patient

viewer for that patient.

2. If it is not already visible at the front of the tabs, click on the View

Patient tab to bring the tab sheet to the front.

For more information about the View Patient tab sheet, refer to

Chapter 7, Admit/View a Patient, in this manual.

Systolic Value

Diastolic Value

401C

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NBP Monitoring: NBP Monitoring

NBP Limits

You can adjust alarm limits for NBP in the Alarm Control tab sheet for

each patient. For more information on how to set the alarm limits, refer

to Chapter 8, Alarm Control, in this manual.

NOTE

The mean pressure limits can be changed, but there will be no effect

on alarms for telemetry patients because the mean pressure is not

measured or calculated for telemetry patients.

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NBP Monitoring: Pressures Tab Sheet

Pressures Tab Sheet

The 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.

NOTE

The 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.

Accessing the Pressures Tab Sheet

To access a patient’s Pressures tab sheet in the single patient viewer,

follow this procedure.

1. Click in the desired patient’s bed window in the multiple patient

viewer. The display rearranges to accommodate the single patient

viewer for that patient.

2. Click on the Pressures tab in the single patient viewer. The Pressures

tab sheet moves to the front.

402B

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NBP Monitoring: Pressures Tab Sheet

Auto

The interval for automatic NBP measurements is controlled at the blood

pressure monitor, not at the CIC Pro. Because the control is in the blood

pressure monitor, the Auto option is inactive for telemetry patients and

appears dimmed.

Cuff Size

The Cuff Size option is inactive for telemetry patients and appears

dimmed.

Clear Message

If you want to remove the displayed NBP values, use the mouse to click

on the Clear Message button. The values are replaced with Xs. In

addition, this action removes those values from vital signs history. Any

Message, Advisory, and Warning level NBP alarms are also cleared.

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NBP Monitoring: Troubleshooting

Troubleshooting

Problem: Erroneous NBP

measurement

Solution:

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.

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.

7. Patient may have a weak pulse.

8. Calibration may be necessary.

NBP Status Messages

Below is a list of system status alarm messages that may be displayed in

the patient’s bed window during monitoring.

NBP 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.

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 United States, contact GE Medical Systems Information

Technologies Service. Outside the United States, contact your local sales/

service representative.

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NBP Monitoring: Troubleshooting

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. Refer to the

Setting Test Parameters section in this chapter for more information. 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. Refer to Setting Test Parameters in

this chapter for more information. 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.

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AMessage Glossary

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For your notes

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Message Glossary: Message Glossary

Message Glossary

Alarm Messages

The following messages appear in the patient’s bed window at the

Clinical Information Center.

ALARM PAUSE All alarms for this patient have been turned off

for five minutes. This is initiated from the

transmitter. 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.

NOTE

Refer to the Arrhythmia section in

Chapter 11, ECG Monitoring.

ARR OFF The arrhythmia program for a selected patient

has been turned off. No arrhythmia messages

are displayed, 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.

Level 2—Arrhythmia monitoring is

suspended in this condition. Heart rate and

PVC values change to X, an additional

message, ARR SUSPEND, is displayed.

LEADS FAIL All leads have 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

display.

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Message Glossary: Message Glossary

NO TELEM The NO TELEM alarm occurs in two situations:

NOTE

Refer to the Suspended Analysis

warning in the Arrhythmia

section of Chapter 11, ECG

Monitoring.

1. The patient moves out of range.

Transmitter is out of range. A repeating,

low-pitched foghorn tone sounds after

sensing NO TELEM for 30 seconds. The

Silence Alarms button silences this alarm

for 60 seconds. If, after one minute, the NO

TELEM alarm condition is still present, the

alarm sounds again. Use the Alarm Off

Reason option when extended alarm

silencing is desired. Refer to Chapter 8,

Alarm Control, for more information about

this feature. 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.

NOTE

Patient must be within antenna

range to receive a CHANGE

BATTERY 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.

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Message Glossary: Message Glossary

Graph Messages

The following messages appear in the patient’s bed window on the

Clinical Information Center display. These relate to running graphs at

the printer.

OFF NETWORK In the Combo mode, telemetry patient data is

provided from the bedside monitor to the

Clinical Information Center. If the bedside

monitor is removed from the network or

becomes otherwise unavailable, the OFF

NETWORK alarm is generated. The Clinical

Information Center will then display patient

data directly from the telemetry bed along with

this message in that Clinical Information

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, or the writer is out of paper. The

request is saved and will run as soon as the

writer is available.

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Message Glossary: Message Glossary

Transmitter-Related Messages

The following messages appear in the patient’s bed window on the

Clinical Information Center display.

System Status Messages

System status alarms (generated by mechanical conditions) are

displayed in the lower left corner of the Clinical Information 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. If necessary, call service (refer to

“How to Reach Us” at the front of the manual).

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. If set to Warning or

Advisory level, a system alarm is heard. This

will self-silence if condition is corrected, or

user can silence for one minute with Silence

Alarms button.

RA (LA, LL, V) FAIL One of these may appear, indicating failure of

a lead.

NO TELEM When the receiver can no longer reliably

receive patient signals from the programmed

transmitter, patient waveforms and heart

rate are removed from the display. If this

condition persists, call service.

DUPLICATE TOWER

NAME

A network problem exists. Restart the system.

Call service to correct this problem.

DUPLICATE NAME A network problem exists. Restart the system.

Call service to correct this problem.

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Message Glossary: Message Glossary

Patient Status Messages

Patient status messages are also displayed in the lower left corner of the

Clinical Information Center screen. They are not, however, preceded by

the receiver system name or Ethernet address.

“Unit/Bed” IS

UNMONITORED

A telemetry patient is admitted but is not

displayed (and therefore is unmonitored) on

any Clinical Information 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. (Refer to

Chapter 7, Admit/View a Patient for more

information on viewing a patient.)

“Unit/Bed”:

DUPLICATE NAME

There is another device on the network with

the same bed name. The duplicate device

must be renamed.

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Message Glossary: Message Glossary

For your notes

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BSupplies

B-2 ApexPro Telemetry System Revision D

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For your notes

Revision D ApexPro Telemetry System B-3

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Supplies: Contact Information

Contact Information

To ensure patient safety, use only supplies manufactured or

recommended by GE Medical Systems Information Technologies. Your

local sales representative can provide current supplies lists, or you can

contact GE Medical Systems Information Technologies Supplies. (Refer

to “How to Reach Us” at the front of this manual.)

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Supplies: Contact Information

For your notes

Revision D ApexPro Telemetry System C-1

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CAbbreviations and

Symbols

C-2 ApexPro Telemetry System Revision D

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For your notes

Revision D ApexPro Telemetry System C-3

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Abbreviations and Symbols: Abbreviations and Symbols

Abbreviations and Symbols

Abbreviations and symbols which you may encounter while reading this

manual or using the Clinical Information Center are listed below with

their meanings.

Abbreviations

ABG arterial blood gas

AHA American Heart Association

APIC Association for Professionals in Infection Control and

Epidemiology, Inc.

AR arterial

ARRHY arrhythmia

ART arterial

AVF left foot augmented lead

AVL left arm augmented lead

AVR right arm augmented lead

BP blood pressure

Btu British thermal unit

CCelsius

Card Calc cardiac calculations

CCU critical care unit

CD coherent digital

CD-ROM compact disk-read only memory

CDT coherent digital telemetry

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Abbreviations and Symbols: Abbreviations and Symbols

CE Conformité Européene

CH channelized

CIC clinical information center

CISPR International Special Committee on Radio Interference

cm centimeter

COMM communication

CPP cerebral perfusion pressure

CRT cathode ray tube

CSA Canadian Standards Association

CV central venous

CVP central venous pressure

DDW direct digital writer

DIA diastolic

ECG electrocardiograph

EEC European Economic Community

EN European Norm (European standard)

EMC electromagnetic compatibility

F Fahrenheit

FE, FEM femoral

GB gigabyte

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Abbreviations and Symbols: Abbreviations and Symbols

HRS hours

Hz hertz

IABP intra-aortic balloon pump

ICU intensive care unit

IEC International Electrotechnical Commission

in inch

ISO International Organization for Standardization

LA left arm

MAX maximum

MB megabyte

MCL modified chest lead

Mhz megahertz

mmHg millimeters of mercury

mm/S millimeters per second

MSDS Material Data Safety Specifications

NBP noninvasive blood pressure

OEM original equipment manufacturer

OR operating room

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Abbreviations and Symbols: Abbreviations and Symbols

PA pulmonary artery

PC personal computer

PDS Patient Data Server

PPM parts per million

Pulm Calc pulmonary calculations

PVC premature ventricular contraction

QRS interval of ventricular depolarization

RA right arm

RAM random access memory

RESP respiration

SP special

SpO2 arterial oxygen saturation

ST interval of ventricular repolarization

STD VGA standard graphics array

SYS systolic

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Abbreviations and Symbols: Abbreviations and Symbols

T1 temperature site 1

T2 temperature site 2

Temp, TMP temperature

TTX transmitter

UA umbilical artery

UAC umbilical artery catheter

UL Underwriters’ Laboratories

UV umbilical venous

V-Fib, V-FIB ventricular fibrillation

VAC voltage alternating current

VENT ventilator

Symbols

" inches

° degrees

±plus or minus

–minus

% percent

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Abbreviations and Symbols: Abbreviations and Symbols

For your notes

Revision D ApexPro Telemetry System D-1

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DApexPro FH Transceiver

(Not for sale outside of the United States)

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For your notes

Revision D ApexPro Telemetry System D-3

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ApexPro FH Transceiver: The Basics

The Basics

About the ApexPro FH Transceiver

The Wireless Medical Telemetry Services (WMTS) ambulatory

transceiver provides the link between the patient and the CIC Pro (or

other display) through the 608 - 614 MHz Medical Telemetry frequency

band. The ambulatory transceiver communicates data to the CIC Pro

through the Access Point transceiver. In addition, the ambulatory

transceiver is capable of receiving control commands for self-use or

connection transfer.

The ApexPro FH ambulatory transceiver is worn by the patient and

usually carried in a gown pocket or pouch. It is used with a 3, 5, or 6-wire

leadset that is connected to the electrodes on the patient. The ApexPro

FH transceiver is designed to be IPX7 compliant, so it can survive

inadvertent submersion.

The Access Point transceiver collects data from the ambulatory

transceiver, sends that data to the CIC Pro, and transmits control data to

the transceiver device.

WARNING

Remove transceivers from patients before MRI, CAT

scan, or X-Ray procedures, and store the transceivers

outside the room where such equipment is located. Close

proximity to MRI, CAT scan, or X-Ray equipment may

result in damage to transceivers.

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ApexPro FH Transceiver: The Basics

Programming Transceivers

Before a transceiver can be used with the ApexPro FH Telemetry

System, it must first be programmed with a Network Key and TTX ID to

match the corresponding CIC Pro. Each ApexPro FH transceiver TTX ID

number must be entered at the corresponding CIC Pro. To enter the TTX

ID on the CIC Pro, refer to the CIC Pro Clinical Information Center

Operator’s Manual.

WARNING

When connected to a non-patient external device, such as a PC

for programming or Diagnostics, the ApexPro FH transceiver

must be removed from the patient. The I/O connector must be

covered, or used with an approved patient accessory, whenever

the ApexPro FH transceiver is connected to the patient.

Failure to keep the port covered when in use could lead to

excessive voltages and currents being applied to the

patient, resulting in cardiac arrest.

The transceiver TTX ID is located on the back label of the transceiver.

Transceiver TTX ID

Deactivate Mode

If two transceivers on the network have the same TTX ID, then the

second transceiver to be powered on will enter Deactivate Mode. In

Deactivate Mode, all LEDs on the front panel will illuminate and flash in

a rotating pattern and the device will not be operational. If the

transceiver enters this condition, contact your system administrator

immediately.

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ApexPro FH Transceiver: Safety

Safety

Warnings, Cautions, and Notes

Before operating the ApexPro FH transceiver, read and follow all

warnings and cautions presented in this section.

Warnings

WARNING

Do not use the output of the ApexPro FH transceiver as a

synchronization source for cardiac defibrillation. Delays

in presentation of the R-Wave exist.

Do not monitor pacer patients with a 3-wire leadset when

reliable pacer detection is required. Pacer pulse detection

can be erratic when only a single vector is monitored.

Always use a 5-wire or 6 leadset when reliable pacer

detection is required.

The ApexPro FH transceiver is a type CF patient applied

device. However it is not suitable for direct cardiac

application, for use in the operating room, or during

cardiac surgery. Use in these environments could cause

hazardous voltages and currents to be applied to the

patient’s heart, resulting in cardiac arrest.

Only allow approved accessories to be connected to the

I/O port of the ApexPro FH transceiver when connected

to a patient. Do not have the I/O port connected to a

computer for programming or for any other means, while

connected to a patient, as it could result in serious injury.

Only authorized devices can be plugged into the

accessory connector of the ApexPro FH transceiver when

it is applied to the patient. The accessory connector must

be kept covered when not in use with the supplied

accessory connector cover. Failure to follow these

instructions could lead to hazardous voltages and

currents being applied to the patient resulting in cardiac

arrest.

The ApexPro FH transceiver should not be intentionally

immersed. Total submersion of the patient worn

transceiver and/or patient leadset/antenna may severely

limit its transmission range causing loss of patient

monitoring. When subjecting the patient and transceiver

to submersion, he/she should be carefully monitored to

ensure that there is no signal loss.

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ApexPro FH Transceiver: Safety

WARNINGS

Our transceivers have been validated to comply with the

requirements of IEC 60601-1-2. To prevent

electromagnetic interference, please ensure that any

other equipment used within the vicinity of the patient

meets the applicable requirements.

As with all medical telemetry systems, a single point

failure in the infrastructure could result in loss of

monitoring. Therefore, it is vital that the patient

displays be monitored by qualified personnel at all times.

Cautions

CAUTION

Any changes or modifications to the device that are not

expressly approved by the party responsible for

compliance could void the user’s authority to operate this

equipment.

Electromagnetic interference or power overload, due to

electrosurgical or diathermy instruments, may damage

the device. Do not use in the presence of electrosurgical,

diathermy, x-ray, or other generator instruments.

Revision D ApexPro Telemetry System D-7

2001989-134

ApexPro FH Transceiver: Safety

Notes

The ApexPro FH transceiver has been tested and found to comply

with the limits for a digital device, pursuant to Part 95H of the FCC

Rules. These limits are designed to provide reasonable protection

against harmful interference. This equipment generates, uses, and

radiates radio frequency energy, and, if not installed and used in

accordance with the instructions contained in this manual, may

cause harmful interference to other devices. However, there is no

guarantee that interference will not occur in a particular

installation.

If this equipment does cause harmful interference, then the user is

encouraged to try to correct the interference by one or more of the

following measures:

Move the ApexPro FH transceiver, or the device being interfered

with, to increase the separation between the two.

NOTE

Do not attempt to move fixed antennas as this can negatively

impact the ApexPro FH Telemetry System’s operation.

Connect the equipment into an outlet on a different circuit.

Contact your technical service representative for assistance.

To ensure that the use of this product does not contribute to

interference, it is necessary to use only approved cables. Use of non-

approved cables could result in harmful interference to radio or

television reception.

The components of the ApexPro FH Telemetry System (i.e. ApexPro

FH transceiver, Access Points, power cables, etc.) should be disposed

of per applicable regulations at the end of their useful life.

D-8 ApexPro Telemetry System Revision D

2001989-134

ApexPro FH Transceiver: Equipment Overview

Equipment Overview

ApexPro FH Transceiver Operating Instructions

The ApexPro FH transceiver is a battery-operated ambulatory

transceiver worn by the patient and used with a 3, 5, or 6-wire leadset

that is connected to electrodes on the patient.

Push Button Function and Use

See “ApexPro FH transceiver Controls and LED Indicators” on page D-11

for an image of the ApexPro FH transceiver controls and LED indicators.

External Serial Devices (I/O) Connector

The External Serial Device (I/O) connector allows an external serial

device or programming cable to connect and maintain a logical

communication link between the ApexPro FH transceiver, the CIC Pro,

and accessory devices. See “Programming Transceivers” on page D-4 for

details on programming the ApexPro FH transceiver through the I/O

connector.

ECG Leadset Connector

The ECG leadset connector allows the ECG leadset to attach to the

ApexPro FH transceiver and maintain a logical communication link

between the ApexPro FH transceiver and the CIC Pro. See “Attaching

and Removing a Leadset from the Transceiver” on page D-23 for details

on attaching the ECG leadset to the ApexPro FH transceiver through the

ECG leadset connector.

Remote Record

When depressed, the Remote Record function button will initiate a strip

chart recording at the CIC Pro.

Event Marker

When depressed, the Event Marker button marks a patient event. The

CIC Pro responds to an event marker by displaying a blue border around

the event bed and sounding an alarm tone. The message Remote Event

appears under the ECG parameter window for approximately ten

seconds.

The event marker will generate a 20-second graph and alarm history will

be stored. The graph feature can be turned off in the Setup CIC tab sheet,

Event Marker Graph On/Off.

Revision D ApexPro Telemetry System D-9

2001989-134

ApexPro FH Transceiver: Equipment Overview

Attendant Present/Procedure Alarm Silence (PAS) Unlock Button

The Attendant Present/PAS Unlock Buttons consists of two buttons

that are located on either side of the transceiver. (See “ApexPro FH

transceiver Controls and LED Indicators” on page D-11). The Attendant

Present push buttons have three functions. Each function is initiated

based on how long the buttons are pressed.

Lead Quality

Pressing both Attendant Present buttons simultaneously will illuminate

the LED for each lead that has a minimum level of quality.

Initiating an Attendant Present

Pressing the Attendant Present buttons will activate the Attendant

Present function and initiate an event log at the CIC Pro. The

Attendant Present event is not displayed on the CIC Pro. The event is

logged at the CIC Pro as Check Leads.

Unlocking the PAS button

The PAS button must be unlocked or enabled prior to initiating the

Procedure Alarm Silence button. In the “locked” position, the PAS button

is disabled.

To “unlock” the PAS button, press and hold (for about two seconds) the

Attendant Present buttons until the Procedure Alarm Silence Status

Indicator LED begins flashing. Once the LED indicator starts flashing,

the PAS button is in the “unlocked mode” and functional.

NOTE

The PAS button must be pressed while the LED is still flashing. If it

is pressed after the LED has stopped flashing, then the PAS button

will automatically be “re-locked”.

D-10 ApexPro Telemetry System Revision D

2001989-134

ApexPro FH Transceiver: Equipment Overview

Procedure Alarm Silence (PAS) Button

Depressing the PAS button, while the PAS Status Indicator LED is

flashing, informs the clinicians at the CIC Pro location that the

attending nurse will be performing a procedure to the patient that may

cause inadvertent false alarms at the CIC Pro (i.e. changing lead wires,

electrodes, etc.)

Once the PAS button is pressed, the following events occur at the CIC

Pro.

1. A timer is displayed in the fourth patient block configurable field

that displays the length of Procedure Alarm Silence time remaining

on the transceiver.

CAUTION

All non-level one alarms are ignored while the PAS alarm

is active.

2. “Alarm Pause” is denoted in Full Disclosure for the duration of the

PAS period.

Once the PAS button is pressed, the ApexPro FH transceiver enters the

PAS Mode with the following indications:

1. The active time is set for 120 seconds and begins counting down.

2. The active time is transmitted to the CIC Pro.

3. The PAS Status LED indicates the time remaining through its flash

speed. The LED flash speed increases as the PAS time remaining

decreases from 120 seconds to 0 seconds.

4. The attendant can reset the PAS active time to 120 seconds by

pressing both Attendant Present buttons again.

The Procedure Alarm Silence alarm remains active until one of the

following conditions occur:

1. The transceiver no longer sends the procedure alarm silence

indicator to the CIC Pro.

2. A level one alarm is detected and triggered at the CIC Pro.

3. The patient tile alarm text area is clicked on. All alarms are set to

ON once this area is clicked.

4. The attendant presses the PAS button while PAS is active. This will

automatically cancel the 120 second PAS at the CIC Pro, and will re-

enable the audible alarm tone.

NOTE

The PAS feature can be enabled/disabled by the System

Administrator.

Revision D ApexPro Telemetry System D-11

2001989-134

ApexPro FH Transceiver: Equipment Overview

ApexPro FH transceiver Controls and LED Indicators

NOTE

*When connected to a non-patient external device, such as a PC for

programming or Diagnostics, the ApexPro FH transceiver must be removed from

the patient. The I/O connector must be covered, or used with an approved

patient accessory, whenever the ApexPro FH transceiver is connected to the

patient.

Battery Compartment

Electrode Status

Indicators

Remote Record

button

Battery Low, RF, and I/O

Connector Link Status Indicators

Procedure Alarm Silence button

Procedure Alarm Silence

Status Indicator

Event Marker button

Attendant Present / Procedure

Alarm Silence Unlock buttons

ECG Leadset and connector

cover

*External Serial Device (I/O)

Cable

ECG Leadset Connector

*External Serial Device (I/O)

Connector

D-12 ApexPro Telemetry System Revision D

2001989-134

ApexPro FH Transceiver: Equipment Overview

LED Indicators Function

Upon Power-On, all LED indicators are illuminated for a brief period.

After the specified time period, only those LEDs displaying positive (or

negative) transceiver functions, as described in each section below,

remain illuminated.

Procedure Alarm Silence Status Indicator

The Procedure Alarm Silence Status Indicator is illuminated when the

PAS function is active. The LED flashes while the Procedure Alarm

Silence button is unlocked or the PAS active time is running low. The

PAS button can only be pressed and activated during this unlocked

phase. Refer to the section on “Procedure Alarm Silence (PAS) Button” on

page D-10 for more information.

External Serial Devices (I/O)

The External Serial Device (I/O) LED is illuminated when an external

serial device is connected, detected and maintaining a logical

communication link.

WARNING

Only allow approved accessories to be connected to the

I/O port of the ApexPro FH transceiver when connected

to a patient. Do not have the I/O port connected to a

computer for programming, or for any other means, while

connected to a patient, as it could result in serious injury.

Low Battery (BATT)

The Low Battery (BATT) LED is illuminated while the battery voltage

remains good.The LED flashes will flash when the battery voltage is low.

When the battery power falls below a predetermined value, the

transceiver will automatically power itself off.

NOTE

If the ApexPro FH transceiver is powered on with a battery that

contains very low voltage, then all of the LEDs on the device will

flash on and off simultaneously. Replace the battery in the

transceiver to restore proper transceiver function.

Revision D ApexPro Telemetry System D-13

2001989-134

ApexPro FH Transceiver: Equipment Overview

RF link (RF)

The RF link indicator is illuminated while there is RF communication

between the ApexPro FH transceiver and the CIC Pro. The LED flashes

if there is communication between the ApexPro FH transceiver and the

Access point, but not the CIC Pro.

Electrode Status Indicators (RA, LA, RL, LL, Va, Vb)

Each ECG electrode wire is named, color coded (Table 2), and

represented by an LED indicator. Each LED is illuminated with a solid

light when the electrode is fully active, and is off when no electrode

signal is present.

Table 2. Electrode Colors

Electrode Name Wire Color

RA White

LA Black

RL Green

LL Red

V1 Brown

V2 Violet

D-14 ApexPro Telemetry System Revision D

2001989-134

ApexPro FH Transceiver: Connections

Connections

Connecting the ApexPro FH Transceiver to Accessory Devices

WARNING

Our transceivers have been validated to comply with the

requirements of IEC 60601-1-2. To prevent

electromagnetic interference, please ensure that any

other equipment used within the vicinity of the patient

meets the applicable requirements

The ApexPro FH transceiver can be connected to external, accessory

devices, and will transmit data from those devices to the Central Station.

The transceiver can connect to only the following accessory devices:

Apex Oximeter

Nonin XPod Assembly

Dinamap Pro

WARNINGS

Do not use accessory cables that exhibit signs of wear or

damage, such as cracking or degradation of the

connectors or cable insulation.

Make sure that the accessory cables are not

inadvertently pinched in the bed rails. This may cut the

cable insulation or break the connectors.

Revision D ApexPro Telemetry System D-15

2001989-134

ApexPro FH Transceiver: Connections

Apex Oximeter

To attach the ApexPro FH transceiver to the Apex Oximeter:

1. Plug the ApexPro FH Accessory Cable host connector into the

ApexPro FH transceiver I/O port, and the other end into the Apex

Oximeter I/O port.

2. Plug the Nonin SPO2 Sensor cable connector into the Apex Oximeter

accessory port.

Connecting to the Apex Oximeter Accessory Device

ApexPro FH

Transceiver

Apex Oximeter

Nonin SPO2

Sensor

ECG Leadset

Connector

I/O Port

Connector

ApexPro FH

Accessory Cable

Nonin SPO2

Sensor Cable

434A

D-16 ApexPro Telemetry System Revision D

2001989-134

ApexPro FH Transceiver: Connections

Nonin XPod Assembly

To attach the ApexPro FH transceiver to the Nonin XPod Assembly:

1. Plug the Nonin XPod Accessory Cable host connector into the

ApexPro FH transceiver I/O port.

2. Plug the Nonin SPO2 Sensor cable connector into the Nonin XPod

assembly accessory port.

Connecting to the Nonin XPod Assembly Accessory Device

ApexPro FH

Transceiver

ECG Leadset

Connector

I/O Port

Connector

Nonin SPO2

Sensor Cable

Nonin SPO2

Sensor

Nonin XPod

Accessory Cable

Nonin XPod

Assembly

435A

Revision D ApexPro Telemetry System D-17

2001989-134

ApexPro FH Transceiver: Connections

Dinamap Pro

To attach the ApexPro FH transceiver to the Dinamap Pro:

1. Plug the ApexPro FH Accessory Cable host connector into the

ApexPro FH transceiver I/O port, and the other end into the

DinaLink device.

2. Plug the DinaLink cable connector into the Data Interface Device

Connector on the back of the Dinamap Pro device, and the other end

into the DinaLink device.

ApexPro FH

Transceiver

Dinamap Pro

ECG Leadset

Connector

I/O Port Connector

ApexPro FH Accessory

Cable

Data Interface

Connector

DinaLink Cable

DinaLink

436A

D-18 ApexPro Telemetry System Revision D

2001989-134

ApexPro FH Transceiver: Maintenance

Maintenance

General Cleaning/Disinfecting

This section provides cleaning and maintenance instructions for ApexPro

FH transceivers.

Read and follow all precautions when cleaning transceivers.

WARNING

No claims are made concerning the sterility of the

ApexPro FH transceiver.

CAUTION

Do not sterilize any part of the transceivers. Gas

sterilization, autoclaving, liquid immersion, and other

sterilization methods can cause serious damage to the

devices that may not be obvious to the user.

NOTE

Do NOT use abrasive cleaners.

Revision D ApexPro Telemetry System D-19

2001989-134

ApexPro FH Transceiver: Maintenance

Cleaning the Chassis

CAUTION

Prior to cleaning the battery compartment and

transceiver chassis, remove the battery from the unit.

The following applies to cleaning the ApexPro FH transceiver.

The ApexPro FH transceiver can be cleaned with the patient cable

attached, however please ensure that the cleaning agents used to

clean the ApexPro FH transceiver are compatible with the cleaning

agents listed for the ECG cable on “Cleaning the ECG Leadsets” on

page D-21, or else ensure that the ECG cable does not come into

contact with the cleaning agents for the ApexPro FH transceiver.

To clean around the ECG connector, remove the ECG cable from the

unit.

1. Remove the battery from the transceiver and inspect the battery

compartment after each use. Close the battery door.

CAUTION

Prior to rinsing the ApexPro FH transceiver, make sure

that the battery compartment door is properly closed and

sealed.

2. Transceivers can be cleaned with a gauze pad or soft, lint-free cloth,

using the following solution, as recommended in the APIC Guideline

for Selection and Use of Disinfectants (1996):

Sodium hypochlorite (5.2% household bleach) 1:500 dilution (100

ppm free chlorine)

3. Use a cloth moistened with distilled water to rinse away the cleaning

solution.

4. Dry thoroughly with a lint-free cloth.

NOTE

Once a month, or whenever the ApexPro FH transceiver is

submersed or subjected to a stream of liquid, remove the accessory

connector cover and remove any moisture that may have collected

inside.

D-20 ApexPro Telemetry System Revision D

2001989-134

ApexPro FH Transceiver: Maintenance

Cleaning the Battery Compartment

CAUTIONS

The battery compartment is not waterproof.

Make certain fluids do not enter the electronics

through the air holes in the batter compartment

floor.

Cleaning the battery compartment in a manner other

than that specified below may cause the unit to

malfunction and void the warranty

Under normal operation, the battery compartment should not require

cleaning. If the battery compartment does require cleaning, then use the

following instructions.

1. Remove the battery from the battery compartment.

2. Clean the transceiver with a gauze pad or cloth lightly moistened

with one of the following agents:

Water

Soap

3. Use a cloth lightly moistened with distilled water to rinse away the

cleaning solution. Make certain that moisture does not enter the

electronics area below the battery compartment floor.

4. Dry thoroughly with a lint-free cloth. Allow the battery compartment

to air dry completely prior to closing the compartment door.

Revision D ApexPro Telemetry System D-21

2001989-134

ApexPro FH Transceiver: Maintenance

Cleaning the ECG Leadsets

The transceiver ECG Leadsets are manufactured by Affinity Medical.

Contact your technical support representative for additional leadsets.

WARNINGS

ECG lead wires must be dressed and secured to the

patient to prevent the possibility of them encircling

the patient’s neck and causing strangulation.

Do not use leadsets which exhibit signs of wear or

damage such as cracking or degradation of the

connectors or cable insulation.

Do not sterilize using steam or gamma radiation.

Damage to the leadsets will result.

CAUTIONS

To increase the life of the leadsets, do not pull on the

leadsets to disconnect. Pull gently by grasping the

connectors.

Do not immerse the leadsets in water or other liquid

to clean. Immersion may cause damage to the

leadsets.

Repeated exposure to EtO sterilization will shorten

the effective life of the leadset. The leadsets should be

sterilized only when indicated by specific patient or

hospital requirements.

Make sure that the wires are not twisted around each

other; since, this can interfere with transmission and

produce noise.

Make sure that the lead wires are not inadvertently

pinched in the bed rails. This may cut the insulation

or break the leadset.

D-22 ApexPro Telemetry System Revision D

2001989-134

ApexPro FH Transceiver: Maintenance

General Cleaning

1. Wipe the leadset with a solution of soap and water.

2. Use a cloth moistened with distilled water to rinse away the cleaning

solution.

3. Dry thoroughly with a lint-free cloth.

Disinfecting

Refer to the disinfecting instructions provided by the manufacturer.

Cleaning the Accessory Cables

General Cleaning

1. Wipe the accessory cable with a solution of soap and water.

2. Use a cloth moistened with distilled water to rinse away the cleaning

solution.

3. Dry thoroughly with a lint-free cloth.

Disinfecting

Refer to the disinfecting instructions provided by the manufacturer.

Revision D ApexPro Telemetry System D-23

2001989-134

ApexPro FH Transceiver: Maintenance

Storage and Usage

Transceiver Storage

Store the transceiver with the leadset attached and hanging freely. If

that is not possible, then wrap the leadset loosely around the transceiver.

Wrapping the leadset tightly around the transceiver can damage the

wires.

NOTE

The ApexPro FH transceiver contains no user-serviceable parts.

Thus, maintenance service is not needed.

Attaching and Removing a Leadset from the Transceiver

To attach, carefully grasp the leadset connector cover, holding it with the

small knob facing upward, and push the leadset into the ECG lead wire

connector. Make sure that the leadset is completely inserted into the

connector and is flush with the ApexPro FH transceiver chassis.

To remove the leadset, grasp hold of the sides of the leadset connector

cover and pull straight out. If the leadset is difficult to remove, then you

can slightly move the leadset cover side-to-side until it is released.

Internal Antenna

The ApexPro FH transceiver transmits in the 608-614 MHz frequency

range. The omnidirectional antenna is a part of the leadset system, with

each lead wire paired with an antenna wire. Transceiver output power

and system operation requirements are defined by the FCC. Therefore,

it is essential that the leadset provided not be modified or

altered in any way.

D-24 ApexPro Telemetry System Revision D

2001989-134

ApexPro FH Transceiver: Maintenance

Installing and Removing a Battery

NOTE

Battery service life can be substantially improved by using nine-volt

lithium batteries.

CAUTION

Do not attempt to insert the 9V battery into the battery

compartment in the opposite direction of that which is

specified. Incorrect battery insertion may result in

additional stress on the door hinge and battery contacts.

This may result in hinge breakage, poor battery contact,

and a decrease in transceiver performance.

To install a 9V battery, first open the transceiver battery compartment

by placing your thumb and forefinger on the compartment latch and

flipping it open. Inspect the battery compartment and insure that there

is no foreign object present that could block the battery contact or short

the battery terminals. Next, place a 9V battery inside the compartment

with the prongs touching the compartment contacts. The orientation of

the battery prongs against the contacts does not matter, so long as the

prongs and contacts are touching. Finally, close the battery compartment

door by pressing it until the latch clicks into place and the compartment

is secure.

To remove a battery, simply follow the installation steps listed above and

discard the used battery per applicable regulations.

NOTE

If a weak battery is inserted into a ApexPro FH transceiver, then all

of the LED indicators will continuously flash On and Off. Replace the

weak battery with a fully charged battery.

CAUTION

Prior to closing the battery compartment door, make sure

that the battery compartment latch is in the open

position. If the door is closed on the latch, then the

increased pressure could cause undue stress on the latch,

which may cause latch breakage.

Revision D ApexPro Telemetry System D-25

2001989-134

ApexPro FH Transceiver: Maintenance

WARNINGS

When installing or replacing the battery, visually

inspect the battery compartment and ensure that

there are no foreign objects inside. A conductive

object making contact with the battery contacts could

cause the battery and battery compartment to

overheat, resulting in burns to the patient and to the

attendant removing the battery.

A foreign object blocking battery contact with the

ApexPro FH transceiver could prevent its operation

resulting in failure to monitor the patient.

Always perform a battery check procedure after

installing or replacing the battery by pressing the

Attendant Present buttons.

Lithium Batteries may explode if mistreated. DO

NOT recharge, disassemble, or dispose of batteries in

fire.

D-26 ApexPro Telemetry System Revision D

2001989-134

ApexPro FH Transceiver: Compliance

Compliance

Compliance Statement

Table 3. Device UL and FCC Compliance

ApexPro FH Telemetry System equipment complying with part 15 of the

FCC rules: Operation is subject to the following conditions: (1) this device

may not cause harmful interference, and (2) this device must not accept

any interference received, including interference that may cause

undesired operation.

ApexPro FH Telemetry System equipment complying with Part 95H of

the FCC rules: Operation requires the prior coordination with a

frequency coordinator designated by the FCC for the Wireless Medical

Telemetry Service.

WARNING

Accessory equipment connected to the analog or digital

interface of the ApexPro FH Telemetry System must be

certified according to UL Electrical Safety Standards (UL

60950 for data processing equipment and UL 60601-1 for

medical equipment). You are responsible for making sure

that devices you connect to the ApexPro FH Telemetry

System comply with UL standards.

Device UL Compliance FCC Compliance Other

ApexPro FH Ambulatory

Transceiver

UL 60601-1 Part 95 Subpart H

(WMTS)

IPX7 Compliant

IEC 60601-1-2

DR-10000/ETAP UL 60950 Part 95 Subpart H

(WMTS) or Part 15

N/A

Revision D ApexPro Telemetry System D-27

2001989-134

ApexPro FH Transceiver: Compliance

UL Classification

The ApexPro FH transceiver is classified in accordance with UL 2601-1,

Type CF with Defibrillator Proof (5000V per AAMI EC-13-1992), and

IPX7 (according to IEC 60529-1989). The ApexPro FH transceiver has

been designed to withstand the effects of EMI and meets the EMC

requirements of IEC 60601-1-2 (April 1993). However, extremely high

levels of electromagnetic energy (above the levels of IEC 60601-1-2) may

still produce interference.

EMC Compliance and Requirements

The ApexPro FH transceiver is intended for use in the electromagnetic

environment specified in the table below. The customer or user of the

device should ensure that is used in such an environment.

Table 4. Electromagnetic Emissions for all equipment and systems.

ApexPro FH

WITH RESPECT TO ELECTRIC SHOCK, FIRE,

AND MECHANICAL HAZARDS ONLY

IN ACCORDANCE WITH UL2601-1/CAN/CSA

C22.2 NO. 601.1

4P41

Emissions Test Compliance Electromagnetic Environment Guidance

RF Emissions The device intensionally transmits energy in the 608-614

MHz range. Nearby electronic equipment may be

affected. Outside the range on intentional transmission,

the device emissions are very low and are not likely to

cause any interference.

Out of Band - CISPR 11 Group 1, Class B

In Band - 47 CFR 47 CFR 95 H

Harmonic Emissions

IEC 61000-3-2

Class A --

Voltage Fluctuations/Flicker

Emissions

IEC 61000-3-3

N/A The ApexPro FH Transceiver runs only on battery power.

D-28 ApexPro Telemetry System Revision D

2001989-134

ApexPro FH Transceiver: Compliance

The ApexPro FH transceiver is intended for use in the electromagnetic

environment specified in the table below. The customer or user of the

device should ensure that is used in such an environment

Table 5. Electromagnetic Immunity for all equipment and systems.

Immunity Test IEC 60601 Test Level Compliance Level Electromagnetic Environment Guidance

Electrostatic

Discharge (ESD)

IEC 61000-4-2

± 6 kV contact

± 8 kV air

± 6 kV contact

± 8 kV air

Floors should be wood, concrete, or ceramic

tile. If floors are covered with

synthetic material, then the relative humidity

should be at least 30%.

Electrical Fast Transient/Burst

IEC 61000-4-4

± 2 kV for power supply

lines

± 1 kV for input/output

lines

N/A The ApexPro FH transceiver runs only on

battery power.

Surge

IEC 61000-4-5

± 1 kV differential mode

± 2 kV common mode

N/A The ApexPro FH transceiver runs only on

battery power.

Voltage Dips, Short

Interruptions, and Voltage

Variations on Power Supply

Input Lines

IEC 61000-4-11

<5% UTa

(>95% dip in UT) for 0.5

cycle

N/A The ApexPro FH transceiver runs only on

battery power.

40% UT

(60% dip in UT) for 5

cycles

70% UT

(30% dip in UT) for 25

cycles

<5% UT

(>95% dip in UT) for 5

seconds

Power Frequency

(40/60 Hz) Magnetic Fields

IEC 61000-4-8

3 A/m 3 A/m Power frequency magnetic fields should be at

levels characteristic of a typical location in a

typical commercial or hospital

environment.

a. UT is the AC mains voltage prior to the application of the test level.

Revision D ApexPro Telemetry System D-29

2001989-134

ApexPro FH Transceiver: Compliance

The ApexPro FH transceiver is intended for use in the electromagnetic

environment specified in the table below. The customer or user of the

device should ensure that is used in such an environment.

Table 6. Electromagnetic Immunity for all non-life-supporting equipment and systems

NOTE

At 80 MHz and 800 MHz, the higher frequency range applies.

These guidelines may not apply in all situations. Electromagnetic propagation is affected by

absorption and reflection from structures, objects, and people.

Immunity Test IEC 60601

Test Level

Compliance

Level Electromagnetic Environment Guidance

Conducted RF

IEC 61000-4-6

3 Vrms

150 kHz to

80 MHz

0.5V = V1Portable and mobile RF communications equipment should be used no closer to any

part of the devices, including cables, than the recommended separation distance

calculated from the equation that is applicable to the frequency of the transmitter.

Recommended Separation Distance

Radiated RF

CFR 47

IEC 61000-4-3

3 V/m

80 MHz to

2.5 GHz

0.5V/m = V1

26 mHz to 1 GHz d =

d =

where P is the maximum output power rating of the transmitter in watts (W) according

to the transmitter manufacturer and d is the recommended separation distance in

meters (m).

Field strengths from fixed RF transmitters, as determined by an electromagnetic site

surveya, should be less than the compliance level in each frequency rangeb.

Interference may occur in the vicinity of equipment marked with the following

symbol:

a. Field strengths from fixed transmitters, such as base stations for radio (cellular/cordless) telephones and land mobile

radios, amateur radio, AM and FM radio broadcast, and TV broadcast cannot be predicted theoretically with accuracy.

To assess the electromagnetic environment due to fixed RF transmitters, an electromagnetic site survey should be con-

sidered. If the measured field strength in the location in which the device is used exceeds the applicable RF compliance

level above, then the device should be observed to verify normal operation. If abnormal performance is observed, then

additional measures may be necessary, such as reorienting or relocating the device.

b. Over the frequency range 150 kHz to 80 MHz, field strengths should be less than 3 V/m for the DT-4500 and less

than 10 V/m for the DT-7000/DT-7001.

V











5.3

E











5.3

V











5.3

D-30 ApexPro Telemetry System Revision D

2001989-134

ApexPro FH Transceiver: Compliance

The ApexPro FH transceiver is intended for use in the electromagnetic

environment in which RF disturbances are controlled. The customer or

user of the device can help prevent electromagnetic interference by

maintaining a minimum distance between portable and mobile RF

communications equipment (transmitters) and the device, as

recommended below, according to the maximum power of the

communications equipment.

Table 7. Recommended Distances Between Portable and Mobile RF Communications

Equipment and the ApexPro FH transceiver

Rated Maximum Output Power

of Transmitter (W) Separation Distance According to Frequency of Transmitter (m)

150 to 80 MHz 80 Mz to 800 MHz 800 MHz to 2.5 GHz

d = d = d =

0.01 0.12 0.12 0.23

0.1 0.37 0.37 0.74

1 1.17 1.17 2.33

10 3.69 3.69 7.38

100 11.67 11.67 23.33













5.3 P













5.3 P













Revision D ApexPro Telemetry System D-31

2001989-134

ApexPro FH Transceiver: Compliance

FCC Compliance in the 608-614 MHz bands

1. The marketing and operation of intentional radiators, under the

provisions of the FCC rules, is restricted to biomedical telemetry

devices that are employed on health care facilities premises.

a. A health care facility includes hospitals and other

establishments that offer services, facilities, and beds for use

beyond 24 hours in rendering medical treatment, as well as

institutions and organizations that are regularly engaged in

providing medical services through clinics, public health

facilities, and similar establishments, including governmental

entities and agencies for their own medical activities.

b. This authority to operate does not extend to mobile vehicles, such

as ambulances, even if those vehicles are associated with a

health care facility.

2. The user and the installer of a biomedical telemetry device that is

operating within the frequency range 608-614 MHz, and that will be

located within 32 km of the very long baseline array (VLBA) stations

or within 80 km of any of the other radio astronomy observatories

noted in footnote US311 of 2.106 of this chapter, must coordinate

with, and obtain the written concurrence of, the director of the

affected radio astronomy observatory before the equipment can be

installed or operated. The National Science Foundation point of

contact for coordination is: Spectrum Manager, Division of

Astronomical Sciences, NSF Rm 1045, 4201 Wilson Blvd., Arlington,

VA 22230; tel: 703.306.1823.

3. Biomedical telemetry devices must not cause harmful interference to

licensed radio astronomy operation in the 608-614 MHz band. If

harmful interference occurs, then the interference must either be

corrected or the device must immediately cease operation on the

occupied frequency. Further, the operator of the biomedical

telemetry device must accept whatever level of interference is

received from other radio operations. The operator, i.e., the health

care facility, is responsible for resolving any interference that occurs

subsequent to the installation of these devices.

D-32 ApexPro Telemetry System Revision D

2001989-134

ApexPro FH Transceiver: Compliance

4. The manufacturers, installers, and users of biomedical telemetry

devices are reminded that they must ensure that biomedical

telemetry transceivers, which are operating under the provisions of

this section, avoid operating in close proximity to authorized services

using this spectrum. Sufficient separation distance, which is

necessary to avoid causing or receiving harmful interference, must be

maintained from co-channel operations.

PatientNet Component FCC Identifiers and Specifications

Model Number

Part Number

FCC ID

Max EPR (dBm)

Modulation

Receiver Predetection

Bandwidth (MHz)

Receiver Sensitivity (dBm)

Emission Designator

Lower Freq.

Upper Freq

Note

DR-10000 Z10020-001 BQI01DR-10000 16 GFSK 0.7 -87 300KFXD 608 614 Part 95H

ETAP Z10020-005 BQI02DR-10100 16 GFSK 0.7 -87 300KFXD 608 614 Part 95H

ApexPro FH APRO-FH-US-

ENG-AHA-4

BQI01DT-4500 3.5 GFSK 0.7 -87 230KFXD 608 614 Part 95H

Index

Index-2 ApexPro Telemetry System Revision D

2001989-134

For your notes

Revision D ApexPro Telemetry System Index-3

2001989-134

Index

Abbreviations and symbols C-1

Accutracker DX noninvasive blood pressure monitor 3-

14, 13-3

Battery installation 4-10

Buttons and switches 3-15

Connections 4-12

Setup 13-5

Admit

HL7 admit data 7-6

Admitting 7-5–7-7

Alarm condition indicators 7-17

Alarm control 8-5–8-13

Alarm defaults 8-16

Alarm help 8-12

Alarm history

Deleting events 10-7

Print directory 10-6

Scanning events 10-6

Viewing events 10-6

Alarm off reason 8-10

Alarm pause breakthrough 8-14

Alarm volume 6-16

Apex Oximeter 4-7

Apex Oximeter connections 4-8

Battery installation 4-7

Buttons and LEDs 3-12

ApexPro CH transmitter 3-10

ApexPro FH transceiver 3-11, D-1

Basics D-3

Compliance D-26

Connections D-14

Equipment overview D-8

Maintenance D-18

Safety D-5

ApexPro telemetry system 3-4

ApexPro transmitter

Battery installation 4-3

Buttons and LEDs 3-7

Dust covers 3-9

Pausing alarms 3-8

Arrhythmia 11-24–11-29

Full arrhythmia conditions 11-26

Lethal arrhythmia conditions 11-29

Asystole 11-29

Brady 11-29

V Tach 11-29

VFib/VTach 11-29

Troubleshooting 11-33

Artifact 11-14

Battery installation

Accutracker DX noninvasive blood pressure

monitor 4-10

Apex Oximeter 4-7

ApexPro transmitter 4-3

Blood pressure monitor 3-14, 13-3

Cautions 2-8

CE marking information CE-1

Compliance CE-1, CE-7

Exceptions CE-2

Check box controls 1-8

CIC defaults 6-14

CIC setup 6-3

Classifications 2-13

Click 1-7

Controls

check boxes 1-8

radio buttons 1-7

scroll bars 1-8

Conventions

Buttons 1-5

Messages/Prompts 1-6

Multiple patient viewer 1-6

Single patient viewer 1-6

Tab options 1-6

Tab sheets 1-6

Tabs 1-6

Current telemetry listings 6-16

Dangers 2-4

Default settings 6-4

Unit defaults worksheet 1-10

Discharge instructions 7-8

ECG

Electrode placement 11-4

In the multiple patient viewer 11-11

In the single patient viewer 11-12

Patient preparation 11-4

Signal quality 11-9

Skin preparation 11-4

ECG tab sheet

Accessing 11-15

Detect pace 11-17–11-20

Einthoven + V lead electrode placement 11-5

Electrode placement 11-4

3-leadwire 11-6

5-leadwire 11-5

6-leadwire 11-5

Einthoven + V lead electrode 11-5

Modified chest lead (MCL) 11-7

Index

Index-4 ApexPro Telemetry System Revision D

2001989-134

Pacemaker patients 11-8

Pediatric patients 11-6

Equipment inspection 5-4

False asystole 11-33

False ventricular calls 11-34

FCC compliance CE-7, 2-15

RF exposure 2-14

Full arrhythmia 11-25

Graph all patients 9-6

Graph button

IMPACT.wf paging system 3-8, 9-4

Graph control menu 9-12

Graph location defaults 9-8

Graph on alarm 9-14

Graphic trends

Scanning 10-11

Select parameters for graphic trends 10-11

Time resolution 10-10

Trend directory 10-8

Graphing 9-3–9-10

Automatic alarm graphs 9-3

Graph all patients 9-6

Graph location defaults 9-8

Graph messages 9-5

Graph paper out 9-10

Manual graphs 9-4

Stopping a graph 9-9

Transmitter initiated graphs 9-4

HL7 admit data 7-6

IMPACT.wf paging system

View on demand 3-8, 9-4

Inaccurate pacemaker detection 11-36

Laser printer 9-16

Lead analysis 11-22

Multi-lead analysis 11-22

Single lead analysis 11-22

Leadwires

Multi-Link leadwire sets 4-6

Lethal arrhythmia 11-29

Manual graphs 9-4

Monitoring

6-lead 11-10

MUSE system

admit information from 7-6

NBP monitoring

In the multiple patient viewer 13-13

In the single patient viewer 13-13

Patient preparation 13-9

Microphone placement 13-11

Pacemaker pulse detection 11-19

False calls 11-17

Pace 1 11-19

Pace 2 11-19

Pace help 11-21

Rate meters 11-17

Pacemaker spike 11-17

Pacemaker troubleshooting 11-35

Patient preparation 11-4

Patient status alarms 8-3

Popup lists 1-9

Pressures tab sheet

Accessing 13-15

Clear message 13-16

QS system

admit information from 7-6

Radio button control 1-7

Reference Literature 2-12

Relearn 7-13, 10-7, 11-16

Scroll bar controls 1-8

Service password 6-5

Six lead monitoring 11-10

SpO2 monitoring

In the multiple patient viewer 12-8

In the single patient viewer 12-9

Signal strength 12-6

SPO2 tab sheet

Accessing 12-10

Rate 12-11

Size 12-11

ST analysis 11-31

ST deviation alarm 11-32

ST measurement 11-31

ST troubleshooting 11-37

Supplies B-1

System status alarms 8-4

Technical maintenance 5-11

Telemetry transmitters

Apex transmitter battery installation 4-5

Setup 3-6

Storage 5-10

Revision D ApexPro Telemetry System Index-5

2001989-134

Index

Telemetry unit defaults

Changing 6-8

Viewing 6-7

Transmitter graph 9-14

Troubleshooting

NBP 13-17

Pacemaker 11-35

SpO2 messages 12-12

ST 11-37

Underwriters Laboratories, Inc 2-13

Unit defaults worksheet 1-10

User mode 6-3

Ventricular arrhythmia 11-24

View on demand 3-8, 9-4

Viewing a patient 7-12

Viewing another patient 7-14

In the multiple patient viewer 7-15

In the single patient viewer 7-14

Vital signs

Printing 10-15

Warnings 2-4

Index

Index-6 ApexPro Telemetry System Revision D

2001989-134

For your notes

World Headquarters

GE Medical Systems

Information Technologies, Inc.

8200 West Tower Avenue

Milwaukee, WI 53223 USA

Tel: + 1 414 355 5000

1 800 558 5120 (US only)

Fax: + 1 414 355 3790

European Representative

GE Medical Systems

Information Technologies GmbH

Munzinger Straße 3-5

D-79111 Freiburg

Germany

Tel: + 49 761 45 43 - 0

Fax: + 49 761 45 43 - 233

Asia Headquarters

GE Medical Systems

Information Technologies Asia; GE (China) Co., Ltd.

24th Floor, Shanghai MAXDO Center,

8 Xing Yi Road, Hong Qiao Development Zone

Shanghai 200336, P.R. China

Tel: + 86 21 5257 4650

Fax: + 86 21 5208 2008

0459

gemedical.com

GE Medical Systems Information Technologies SHU-WMTS EA-WMTS-SHU-4 User Manual 2001989 134B

GE Medical Systems Information Technologies Inc. EA-WMTS-SHU-4 2001989 134B

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