Nihon Kohden ZB-101AA Telemetry Unit User Manual WEE 1000A OM Part 2

Nihon Kohden Corporation Telemetry Unit WEE 1000A OM Part 2

Contents

Manual 2

Operator's Manual WEE-1000 3C.1Section 3 EEG/PSGMeasurementGeneral ................................................................................................................................ 3.1EEG Waveform Acquisition .......................................................................................3.4About Polysomnography ............................................................................................ 3.4Flowchart of Waveform Measurement ....................................................................... 3.5Attaching the Electrodes (EEG Measurement) ....................................................................3.6Guidelines for Input Jack Use ...................................................................................3.6Required Electrodes ........................................................................................3.6Input Jack Z ....................................................................................................3.6Input Jacks C3 and C4....................................................................................3.6Input Jacks A1 and A2....................................................................................3.6Checking Original Electrode Potentials for All Active Electrodes .................... 3.6Introduction to Electrode Position, Derivation and Montage ......................................3.7Electrode Position ...........................................................................................3.7Derivation ........................................................................................................3.7Monopolar Derivations (Referential Derivation) ................................................3.7Bipolar Derivation ............................................................................................3.8Montage (Pattern) ............................................................................................3.8Attaching the Electrodes to the Patient ..................................................................... 3.9EEG Scalp Disk Electrodes .......................................................................... 3.10Electrode Positions ....................................................................................... 3.10Earlobe Electrodes ........................................................................................ 3.11Attaching the Electrodes and Sensors (PSG Measurement) ............................................. 3.12Measurement Parameters and Attachment Sites .................................................... 3.12Electroencephalogram (EEG) ........................................................................ 3.12Electrooculogram (EOG) ............................................................................... 3.12Electromyogram (EMG) ................................................................................ 3.12Electrocardiogram (ECG) .............................................................................. 3.12Attaching the Electrode ................................................................................. 3.13Respiration (Airflow, Chest, Abdomen) .......................................................... 3.15Snore ............................................................................................................ 3.16Body Position ................................................................................................ 3.16Periodic Limb Movements (PLM) .................................................................. 3.16Oxygen Saturation (SpO2) ............................................................................. 3.17Connecting the Electrodes and Sensors to the Electrode Junction Box ............................ 3.19
3C.2 Operator's Manual WEE-1000EEG Measurement .................................................................................................. 3.20PSG Measurement .................................................................................................. 3.20Attaching the Telemetry Unit to the Patient ............................................................. 3.21Changing the Measurement Settings ................................................................................. 3.22Measuring Waveforms ....................................................................................................... 3.23
3. EEG/PSG MEASUREMENTOperator's Manual WEE-1000 3.1OperationWARNINGWhen using the NE-224S Sub-dermal Straight Needle Electrode• Do not use the NE-224S sub-dermal straight needle electrode as ameasurement electrode for the EEG or evoked potentialmeasurement for any longer than one hour. When measuring theEEG or evoked potential for over one hour, use the EEG diskelectrode.• Do not check the skin-electrode impedance when using a needleelectrode or intracranial electrode. Failure to follow this warninginjures the patient because these electrodes will be damaged byelectrolyzation inside the body.• When measuring the patient with the implantable pacemaker, leavethe instrument (telemetry unit and access point) more than 22 cmfrom the patient. Otherwise, the radio wave from the telemetry unitor access point may interfere with the pacemaker.• Do not delete any system file in the hard disk of theelectroencephalograph. Otherwise the system may malfunction.• Periodically back up the EEG data files to prevent loss of data if thehard disk or MO disk is damaged.General
3. EEG/PSG MEASUREMENT3.2 Operator's Manual WEE-1000CAUTION• Do not use a device which uses Bluetooth® wireless technology andwireless LAN device which complies with IEEE 802.11b near thewireless input unit at the same time. If they are used together, theradio waves interfere with each other. This may prevent thecommunication between the telemetry unit and access point byreducing transmission speed and transmission distance.• Do not give impact to the telemetry unit. Spike noise may besuperimposed on the waveform.• Use the provided pochette to hold the telemetry unit, electrodejunction box and/or isolator when they are attached to the patient.• When moving the patient, make sure that the cable connectedbetween the isolator and access point is disconnected. Otherwise,the patient may fall over the cable, or the cable may be broken.• Do not shake or swing the telemetry unit holding the cableconnected to the telemetry unit. The telemetry unit may come off andit may injure somebody or damage surrounding instruments.• Do not shake or swing the electrode junction box holding the cableor EEG lead connected to the electrode junction box. The electrodejunction box may come off and it may injure somebody or damagesurrounding instruments.• During measurement, do not change the date and time. This makesthe order of the saved event data and the time of the savedwaveforms incorrect.NOTETurn off any screen saver and close all application programs beforeopening the Acquisition program. Otherwise, the Acquisitionprogram may not function properly.
3. EEG/PSG MEASUREMENTOperator's Manual WEE-1000 3.3WARNING• Do not connect the Z electrode lead plug on the electrode junctionbox to a ground or equipotential ground. Otherwise, leakage currentfrom another instrument cause electrical shock to the patient.• Only connect a BF type instrument to the DC connector on thetelemetry unit. Otherwise, leakage current from the other instrumentcauses electrical shock to the patient.• Before disconnecting or connecting the cable from/to a connecter onthe telemetry unit, while the telemetry unit is turned on, dischargeelectrostatic charge from your body. Otherwise, the telemetry unitmay malfunction due to electrostatic energy.• When connecting the electrode junction box cable to the electrodejunction box, align the marks on the electrode junction box cableconnector and electrode junction box. Otherwise, leakage currentmay cause electrical shock to the patient.CAUTIONUsing a collodion electrode or EEG paste• If rash, redness or itch appears on the patient skin from the use ofcollodion or EEG paste, immediately remove the collodion or EEGpaste from the skin and perform medical treatment.• Never allow collodion or acetone to get in the patient’s eyes. Ifcollodion or acetone accidentally gets in the eyes, immediately andthoroughly wash eyes with clean water and perform medicaltreatment immediately.• If chemical solution is swallowed, have the person drink water andvomit the chemical solution. Perform medical treatment immediately.• Collodion is a volatile solvent. Both patients and medical staff musttake extreme care not to inhale collodion. When using collodion,make sure there is adequate ventilation. If too much collodion isinhaled, have the person lie quietly and keep warm in fresh air.Perform medical treatment immediately.Electrode Attachment/Cable Connection
3. EEG/PSG MEASUREMENT3.4 Operator's Manual WEE-1000Polysomnography is an examination to measure the electrical signals in the bodyduring sleep. Many different activities are measured during a sleep study. Thebasic measurement parameters are electroencephalogram (EEG), eye movement(EOG), muscle activity (EMG), heartbeat (ECG), oxygen saturation (SpO2) andrespiration. These measurement parameters can help determine what is going onduring sleep. In addition to the basic measurement parameters, we can find thecause of a sleep disorder by measuring the activity which is suspected to becausing the sleep disorderParameter Electrode/SensorEEG Disk electrodeEOG Disk electrodeECG Disk electrodeEMG Chin Disk electrodeRespirationAir flow TR-101A /TR-102A Respiration pickupor Airflow sensor*Chest/ Abdomen TR-111A/TR-112A Respiration pickupor Effort sensor*Periodic limb movements PLM sensor*Snore Dynamic snoring microphone*SpO2SpO2 probe**Sleep position Sleep position indicator*Basic Measurement Parameters* Pro-Tech Service Inc.** Nonin Medical Inc., JL-101A SpO2 sensor adapter is required.The Acquisition program acquires the EEG/PSG waveforms and can display up to64 channels of EEG/PSG waveforms. You can save the acquired waveforms withthe patient information, annotations, amplifier settings and display settings in ahard disk or MO disk as an EEG data file. For the operation of the Acquisitionprogram, refer to the operator’s manual of the electroencephalograph.The communication between the telemetry unit and the access point can bechecked on the Acquisition screen. You can also change the configuration settingsof the telemetry unit and access point on the Acquisition screen.EEG Waveform AcquisitionAbout Polysomnography
3. EEG/PSG MEASUREMENTOperator's Manual WEE-1000 3.5Flowchart of WaveformMeasurementAfter measurement, use the Review program to review and print the waveforms.1. Put the telemetry unit in the pochette and attach it to the patient.2. Attach the EEG electrodes and sensors to the patient.3. Connect the electrode junction box to the telemetry unit4. Turn on the telemetry unit and access point.5. Start the Acquisition program (New file automatically opens).6. Select the telemetry unit and access point.7. Enter the patient information.8. Check skin-electrode contact impedance.9. Start EEG/PSG measurement (recording).10. Display and record the calibration waveforms. 11. Measure the waveforms.12. End the measurement and close (save) the EEG data file.13. Close the Acquisition program.14. Review the saved EEG/PSG waveforms.
3. EEG/PSG MEASUREMENT3.6 Operator's Manual WEE-1000Attaching the Electrodes (EEG Measurement)Guidelines for Input JackUseYou must follow these guidelines to obtain correct EEG recordings.Required ElectrodesDo not perform EEG measurement without the Z, C3, C4, A1 and A2 electrodes.Input Jack ZConnect the lead from the electrode (Z electrode) attached on the patient’s nasionto input jack Z on the electrode junction box. This input jack is used to eliminateAC interference.The input jack Z is also used for checking electrode impedance.Input Jacks C3 and C4The C3 and C4 electrodes are the system reference electrodes for EEGmeasurement. Input jacks C3 and C4 must be used for EEG measurement even ifC3 and C4 are not programmed in any montage.Connect the leads from the electrodes on positions C3 and C4 to input jacks C3 andC4, respectively.Input Jacks A1 and A2The A1 and A2 electrodes are the reference electrodes for skin-electrode impedancecheck. Input jacks A1 and A2 in addition to Z, C3 and C4 must be used for theelectrode impedance check.When checking electrode impedance, connect the leads from the electrodes onpositions A1 and A2 to input jacks A1 and A2, respectively.Checking Original Electrode Potentials for All Active ElectrodesCheck the original electrode potential for all active electrodes by programming amontage with the system reference (Use the pattern VA (factory default setting) orselect the 0 V button for reference electrode on the Montage dialog box). Refer to“Programming Patterns” in Section 4 of the electroencephalograph operator’smanual.The digital EEG displays the EEG waveform in each channel by subtracting twoelectrode potentials selected to a montage. The subtracted result will be incorrect, ifthe electrode attachment is not correct, the original electrode potential is flat, orunstable or artifact is superimposed on the original electrode potential. Omit themeasurement result if the displayed EEG waveform is incorrect.
3. EEG/PSG MEASUREMENTOperator's Manual WEE-1000 3.7Introduction to ElectrodePosition, Derivation andMontageF3F4F8F7FP1FP2FZCZPZP3P4C4C3T3A2A1T4T6T5O2O113 31219 414121662420 81857171511910NasionInion10-20 system electrode positionsElectrode PositionThere are various systems of electrode position, such as Illinois, Montreal, Aird,Cohn, etc. Of these, the International 10-20 system, shown below, is currently themost common. Each system has a different number of electrodes and differentelectrode locations. To compensate for different sized heads, the distances betweenelectrodes are given as ratios.After determining the electrode position system, measure the head of the patientand calculate the electrode positions according to the distance ratio between eachelectrode position. The number of electrodes should be reduced for EEG recordingon infants and little children.DerivationDerivation is the electrode combination for one channel. All derivations have twoelectrodes: reference and active. In monopolar derivation, one “electrode” can beseveral physical electrodes connected together. There are 3 kinds of derivations.Monopolar Derivations (Referential Derivation)In the monopolar derivation, one electrode is common to all channels and regardedas electrically inactive (“reference electrode”). Each amplifier has two inputs (G1and G2). The reference electrode is connected to the G2 (+) input of the amplifierand the active electrode is connected to the G1 (−) input.Monopolar Derivations Using Ear Reference Electrodes:•Normal Monopolar DerivationLeft ear for left hemispheric derivation and the right ear for right hemisphericderivation.•A1 + A2Shorting both ears (in the electrode junction box).•A1 → A2 or A1 ← A2Only one ear.•A1 ↔ A2Left ear for right hemispheric and right ear for left hemispheric derivation.
3. EEG/PSG MEASUREMENT3.8 Operator's Manual WEE-1000Monopolar Derivations Using Other Site Reference Electrodes:•Vx (Vertex reference derivation)Mid-line central position Cz as the reference electrode.•AV (Average reference derivation)The potential of all electrodes on the scalp, except for the extra electrodes, areaveraged point and used for the AV reference electrode.If one or more of the electrodes in the AV electrode contain ECG artifact, or twoor more electrodes show simultaneous abnormal potentials, you need to excludeany unstable electrodes.•AavThe potential of A1 and A2 electrodes are averaged and used for the Aavreference electrode.Bipolar DerivationElectrode pairs are connected to the G1 and G2 inputs of channels. The potentialdifference between two electrodes is recorded on each channel.Montage (Pattern)Montage is the combination of derivations for all channels. The instrumentcontains 36 patterns per set file and you can program a different montage and othersettings for each pattern.
3. EEG/PSG MEASUREMENTOperator's Manual WEE-1000 3.9Attaching the Electrodes tothe Patient WARNING• Do not connect the Z electrode lead plug on the electrode junctionbox to a ground or equipotential ground. Otherwise, leakage currentfrom another instrument cause electrical shock to the patient.• Only connect a BF type instrument to the DC connector on thetelemetry unit. Otherwise, leakage current from the other instrumentcauses electrical shock to the patient.CAUTIONUsing a collodion electrode or EEG paste• If rash, redness or itch appears on the patient skin from the use ofcollodion or EEG paste, immediately remove the collodion or EEGpaste from the skin and perform medical treatment.• Never allow collodion or acetone to get in the patient’s eyes. Ifcollodion or acetone accidentally gets in the eyes, immediately andthoroughly wash eyes with clean water and perform medicaltreatment immediately.• If chemical solution is swallowed, have the person drink water andvomit the chemical solution. Perform medical treatment immediately.• Collodion is a volatile solvent. Both patients and medical staff musttake extreme care not to inhale collodion. When using collodion,make sure there is adequate ventilation. If too much collodion isinhaled, have the person lie quietly and keep warm in fresh air.Perform medical treatment immediately.For the collodion electrode attachment, refer to its operator’s manual.
3. EEG/PSG MEASUREMENT3.10 Operator's Manual WEE-1000EEG Scalp Disk Electrodes1. Clean the area where the electrodes are to be mounted with a gauze padmoistened in alcohol or a medical soap solution to remove oil from the skin.Wipe the site with dry gauze.2. Apply a small amount of EEG paste to a 1 cm diameter circle on the cleanedskin. Avoid spreading the paste too thin or creating too large a space.3. Apply a small amount of paste to the disk electrode, and press the electrodedown gently on the previously pasted skin spot.4. Cover the electrode with a small gauze pad and press the pad around theelectrode. Attach the electrode with surgical tape.Electrode PositionsThis procedure is for the Ten Twenty System.1. Divide the longitudinal line of the head into halves and attach an electrode atthe Cz point (Fig. 1).2. Divide the distance between Cz and the nasion in proportions as shown in Fig.1 and attach an electrode at Fz and Pz. (Do not attach electrodes at Fpz andOz.)3. Divide the transverse line of the head into proportions of 10%, 20%, 20%,20%, 20% and 10% as shown in Fig. 2 and attach electrodes at T3, T4, C3 andC4.4. Divide the peripheral line passing over Fpz, T4, Oz and T3 into proportions asshown in Fig. 3 and attach electrodes at Fp2, F8, T6, O2, Fp1, F7, T5 and O1.Fig. 1Fig. 2Fig. 3CZFZFPZPZOZT3T4C3CZC4FP2FP1FPZF8T4T3T5O1O2OZT6F7Disk electrode LeadPasteScalpScalp Disk Electrode PlacementCorrect Wrong
3. EEG/PSG MEASUREMENTOperator's Manual WEE-1000 3.115. Take the line passing over F7, Fz and F8 and attach an electrode at the mid-point (F3) between F7 and Fz as shown in Fig. 4. Attach another electrode atthe mid-point (F4) between F8 and Fz.6. Take the line passing over T5, Pz and T6 and attach an electrode at the mid-point (P3) between T5 and PZ. Attach another electrode at the mid-point (P4)between T6 and PZ.Earlobe Electrodes1. Apply a small amount of EEG paste to both earlobes. Gently clip on theearlobe electrodes.2. Secure the electrode lead to the neck with surgical tape to prevent electrodelead movement.CAUTIONDo not apply excessive pressure to the electrode because this maycause direct skin-electrode contact (not through the paste), andgenerate unnecessary polarization voltage.Fig. 4F3F4F8F7FP1FP2FZCZPZP3P4C4C3T3A2A1T4T6T5O2O113 31219 414121662420 81857171511910
3. EEG/PSG MEASUREMENT3.12 Operator's Manual WEE-1000Attaching the Electrodes and Sensors (PSG Measurement)Measurement Parametersand Attachment SitesThis section explains the standard attachment sites of the electrodes and sensors formeasuring polysomnogram.Electroencephalogram (EEG)The EEG waveforms are measured with the monopolar derivations from C3-A2 (orC4-A1) and O1-A2 (or O2-A1). The reference electrodes are the respectiveopposite earlobes to obtain large amplitude EEG waveforms. The centralderivations can measure alpha waves, theta waves, hump waves, spindle waves andK complexes simultaneously and the occipital derivations can precisely detect theexact appearance of alpha waves. Arousals can be scored from either the central oroccipital derivation EEG.To attach the electrodes, refer to "Attaching the Electrodes".Electrooculogram (EOG)The EOG waveforms are measured with the monopolar derivations from E1 (LOC)/A1 (or E1/A2) and E2 (ROC) /A1 (or E2/A2). The E1 and E2 electrodes shouldbe attached 1 cm from the outer corner of the eye. The left electrode should beplaced 1 cm above the corner of the eye and the right electrode 1 cm below thecorner of the eye. Use A1 or A2 as a reference electrode.To attach the electrodes, refer to "Attaching the Electrodes".Electromyogram (EMG)The EMG waveforms are measured with the bipolar derivation from the pair ofdisk electrodes on the musculus mentalis or submental muscle. The two diskelectrodes are attached several cm apart along the jaw bone from the center of thechin. For male patients, select a site where there is no beard because beard growsduring measurement.To attach the electrodes, refer to "Attaching the Electrodes".Electrocardiogram (ECG)The ECG waveforms are measured with the CS5 lead, or modified bipolar lead(MI). To reduce the electrodes to be used, the A2 electrode is used instead of theminus electrode.C3C4A2 A1EEGEOGEOGG1: R/RAG2: C5/V5E2 E1A2 A1EMG
3. EEG/PSG MEASUREMENTOperator's Manual WEE-1000 3.13Attaching the ElectrodeYou must follow these guidelines to obtain correct EEG recordings.Required ElectrodesDo not perform EEG measurement without the Z, C3, C4, A1 and A2 electrodes.Input Jack ZConnect the lead from the electrode (Z electrode) attached on the patient’s nasion to input jack Zon the electrode junction box. This input jack is used to eliminate AC interference.The input jack Z is also used for checking electrode impedance.Input Jacks C3 and C4The C3 and C4 electrodes are the system reference electrodes for EEG measurement. Input jacksC3 and C4 must be used for EEG measurement even if C3 and C4 are not programmed in anymontage.Connect the leads from the electrodes on positions C3 and C4 to input jacks C3 and C4,respectively.Input Jacks A1 and A2The A1 and A2 electrodes are the reference electrodes for skin-electrode impedance check. Inputjacks A1 and A2 in addition to Z, C3 and C4 must be used for the electrode impedance check.When checking electrode impedance, connect the leads from the electrodes on positions A1 andA2 to input jacks A1 and A2, respectively.Checking Original Electrode Potentials for All Active ElectrodesCheck the original electrode potential for all active electrodes by programming a montage with thesystem reference (Select the 0 V button for reference electrode on the Montage dialog box). Referto “Programming Patterns” in Section 4 of the electroencephalograph operator’s manual..The digital EEG displays the EEG waveform in each channel by subtracting two electrodepotentials selected to a montage. The subtracted result will be incorrect, if the electrode attachmentis not correct, the original electrode potential is flat, or unstable or artifact is superimposed on theoriginal electrode potential. Omit the measurement result if the displayed EEG waveform isincorrect.WARNING• Do not connect the Z electrode lead plug on the electrode junction box to aground or equipotential ground. Otherwise, leakage current from anotherinstrument cause electrical shock to the patient.• Only connect a BF type instrument to the DC connector on the telemetry unit.Otherwise, leakage current from the other instrument causes electrical shock tothe patient.
3. EEG/PSG MEASUREMENT3.14 Operator's Manual WEE-1000ProcedureThis section explains how to attach the disk electrodes. When using collodion diskelectrodes, refer to its operator’s manual.1. Clean the skin where the electrodes are attached with a cotton swab moistenedwith alcohol or SkinPure (skin preparation gel) to remove oil from the skin.Wipe the skin with a dry cotton swab. When attaching the electrodes for theEEG measurement, make sure that the skin-electrode contact impedance is 5kΩ or less.2. Apply a small amount of EEG paste to a 1 cm diameter circle on the cleanedskin. Avoid spreading the paste too thin or creating too large a space.3. Apply a small amount of EEG paste to the disk electrode and press theelectrode down gently on the previously pasted skin spot so that the electrodeleads are toward the ear as shown below.4. Cover the electrode with a small gauze pad and press the pad around theelectrode.5. Secure the electrode lead with surgical tape.6. Hang the electrode leads behind the ear. For an earlobe electrode, the leadsshould go up, over and behind the ear.Disk electrode LeadPasteScalpScalp Disk Electrode PlacementCorrect Wrong7. Secure the electrodes with the elastic bandage. Bind the elastic bandagearound the jaw so that the bandage does not come off when the bandageloosens. This prevents AC interference and the electrodes from detachingwhen the patient stands up.Hang the electrode leadsbehind the ear Elastic bandage
3. EEG/PSG MEASUREMENTOperator's Manual WEE-1000 3.15For attaching procedure and cautions/note, refer to the operator’s manual of eachsensor.CAUTIONBefore attaching a sensor, check whether it contains dry naturalrubber or not. Natural rubber may cause allergic reaction withsymptoms such as itching, redness, urticaria, swelling, fever,dyspnea, symptoms similar to asthma, reduced blood pressure andshock. If the patient shows any of the above symptoms, immediatelystop using the chest movement sensor and perform appropriatemedical treatment.Airflow SensorRespiration (Airflow, Chest, Abdomen)Airflow (nostril and mouse respiration)The respiration waveforms are measured from the nostril and mouth bytemperature variation between inspiration and expiration. The TR-101A/102A Pro-Tech Airflow Sensor is recommended for themeasurement.• The airflow sensor are easy to damage. Take care when attachingthem.• Attach the airflow sensor where large respiration waveforms aredetected.• Do not let the thermistor of the airflow sensor contact the patientskin. Otherwise, amplitudes of the respiration waveforms arereduced.Chest, AbdomenThe respiration waveforms are measured from the chest and abdomenby their movement. The TR-111A/112A Pro-Tech Effort Sensor isrecommended for the measurement.• Take care to bind the strap around the patient body properly so thatthe patient does not become uncomfortable. If you bind the strap tootightly, this prevents the patient entering sleep. If you bind the straptoo loosely, the respiration waveform cannot be detected when thepatient lies on his or her side.SensorSlack the sensor lead.Electrode junction boxStrap
3. EEG/PSG MEASUREMENT3.16 Operator's Manual WEE-1000Surgical tapeWrist strapLoopSlack in the sensor leadPocket for thePLM sensorPeriodic Limb Movements (PLM)The PLM are measured from the limb or leg (heel) bythe disk electrode or PRO-Tech PLM sensor.Body PositionThe sleeping body position is measured by the bodyposition sensor attached on the clothing or surface ofthe body. The Pro-Tech Sleep Position Indicator isrecommended for the measurement.• Take care to attach the sensor to the patient so thatthe patient dose not become uncomfortable.Sleep Position SensorTop-HeadThis Side Out--Surgical tapeSensor leadBody position sensorattached to the chestrespiration sensor strapSnoreThe snore is measured from the neck by the airway vibration. The Pro-TechDynamic Snoring Microphone is recommended for the measurement.• Take care to attach the sensor because the carotid artery pulse waveforms aremeasured as artifact if the sensor is attached around the carotid artery.Surgical tapeSnoring sensorSlack in the sensor leadElectrode junction boxPLM Sensor PocketPLM StrapLead WireStress LoopMedical Tape Strain ReliefRectangularLoop
3. EEG/PSG MEASUREMENTOperator's Manual WEE-1000 3.17Oxygen Saturation (SpO2)The oxygen saturation is measured from the finger or earlobe with the SpO2 probemanufactured by Ninon Medical Inc. through the JL-101A SpO2 Adapter.WARNING• Measurement may be incorrect in the following cases.- When the patient’s carboxyhemoglobin or methemoglobinincreases abnormally- When dye is injected in the blood- When using an electrical surgery unit- During CPR- When there is body movement- When there is vibration- When measuring at a site with venous pulse- When the pulse wave is small (insufficient peripheral circulation)- When using an IABP (intra-aortic balloon pump)• To avoid poor circulation, do not wrap the tape too tight when fixingthe probe with surgical tape. Check the blood circulation conditionby observing the skin color and congestion at the skin peripheral tothe probe attachment site. Even for short-term monitoring, theremay be burn or pressure necrosis from poor blood circulation.• When using the probe on the following patients, take extreme careand change the measurement site more frequently according tosymptoms and degree.- A patient with a fever- A patient with a peripheral circulation insufficiency- Neonate or low birth weight infant with delicate skinFor a patient with a peripheral circulation insufficiency, themeasurement result may be incorrect.• When the SpO2 probe is used on a neonate, low birth weight infant orpatient with a fever or peripheral circulation insufficiency, a slightburn may result from the probe increasing the skin temperature atthe attached site by 2 or 3°C (4 or 5°F). Periodically check theattached state of the probe and change the attachment site.• When not measuring SpO2, disconnect the SpO2 adapter cable fromthe telemetry unit. Otherwise, noise from the SpO2 probe mayinterfere and incorrect data is displayed on the screen.CAUTION• Only use the specified probes and JL-101A SpO2 Adapter. OtherwiseSpO2 cannot be monitored properly and instrument performance maybe degraded.• Do not use a probe which is past the expiration date on the package.• Do not use a damaged or disassembled probe.• Disposable probes are not sterilized.
3. EEG/PSG MEASUREMENT3.18 Operator's Manual WEE-1000• Use the disposable probe only once and for one patient only. Do notreuse the disposable probe for another patient. It will cause crossinfection.• When the attachment site is wet with blood or when the patient hasnail polish on, remove the dirt and nail polish before attaching theprobe. The transmitted light may decrease due to the blood or nailpolish and the measurement data may be incorrect.• Turn off the power of cellular telephones, small wireless devices andother devices which produce strong electromagnetic interference.Otherwise, the waveforms and measurements are affected byinterference and the displayed data may be incorrect.• Under normal conditions, normal light has negligible effect on thisprobe. However, when measuring under strong light (surgical light,bilirubin light, sunlight, etc.), cover the probe with a blanket or cloth.Otherwise, the measurement result may be incorrect.• If the skin gets irritated or redness appears on the skin by the probe,change the attachment site or stop using the probe.• For long term monitoring, check the circulation condition byobserving the skin color of the measuring site. To avoid circulationinsufficiency and skin burn, change the measurement site everyspecified number of hours. Refer to the operator’s manual of theprobe.• Do not pull or bend the probe cable, and do not let caster feet runover the probe cable. Do not immerse the probe cable in chemicalsolutions or water. Failure to follow these cautions may cause cablediscontinuity, short circuit, skin burn on the patient and incorrectmeasurement data. Replace any broken probe with a new one.• When removing a probe that is taped to the skin, do not pull thecable part of the probe because this can damage the probe’s cableconnection.• While a patient is on medication which causes vasodilation, the pulsewaveform may change and in rare case SpO2 value may not bedisplayed.Attaching the ProbeFor the attaching procedure, refer to the operator’s manual of the probe.Caution - continued
3. EEG/PSG MEASUREMENTOperator's Manual WEE-1000 3.19Connect the electrodes and sensors to the electrode junction box. Two types ofelectrode junction box can be used.• JE-011A Electrode Junction Box30 channels of EEG waveforms or 22 channels of EEG waveforms, 8 channels ofbipolar signals and 2 channels of DC input signals.• JE-012A Electrode Junction BoxFor polysomnogram (PSG) measurementNOTE• Do not bend or pull the lead or cables. This may damage them.• The following extra jacks can be used as bipolar jacks. To selectextra jacks or bipolar jacks, refer to the System Program.- JE-011A Electrode Junction Box: X2 to X9- JE-012A Electrode Junction Box: X17 to X24When using the extra jack as the extra jack, only the (+) jack isavailable. When using the extra jack as the bipolar jack the (+) and (-)jacks are available.For electrode combination (montage), refer to “Changing System Settings -Programming Pattern” in Section 4 of the operator’s manual for eachelectroencephalograph .Connecting the Electrodes and Sensors to the Electrode JunctionBox
3. EEG/PSG MEASUREMENT3.20 Operator's Manual WEE-1000EEG MeasurementPSG MeasurementParameter Sensor Electrode jack Montage G1 (-) G2 (+)EEG EEG disk electrode Electrode jack:Fp1 to Cz and ZExample: Fp1 – Fp2Bioelectricalsignal otherthan EEGExtra jack:X1 (+) to X9 (+)Example: X1 – X2For bipolardeviationBipolar jack:X2 (+/-) to X9 (+/-)Example: 0V – X2Parameter Sensor Electrode jack Montage G1 (-) G2 (+)EEG EEG disk electrode Z, A1, A2, C3, C4, O1, O2and/or X5 (+) to X16 (+)C3 – A2O1 – A2EOG• Left• RightX1 (+)X2 (+)X1 – A1X2 – A1EMG (Chin) X3 (+) and X4 (+) X3 –X4ECG (V5) X17 (+) and X17 (-)(bipolar connection)0V –X17Respiration• Airflow• Chest• AbdomenAirflow sensor*Effect sensor*Effect sensor*X18 (+/-) to X24 (+/-)(bipolar connection)+:Blue lead, -: White leadG1: X18 to X24G2: 0VPLM PLM sensor*Snore Snoring sensor*X18 (+/-) to X24 (+/-)(bipolar connection)+/-: Either lead is available.G1: X18 to X24G2: 0VBody Position Sleep positionsensor*DC connector on telemetryunit (DC2/DC3)-SpO2SpO2 probe** SpO2 connector on telemetryunit-When measuring the EEG waveforms, use the JE-011A (EEG 32 ch) ElectrodeJunction BoxExample: JE-011AWhen measuring the polysomnogram, use the JE-012A (PSG) Electrode JunctionBox and connect the electrodes and sensors as shown below.* Manufactured by Pro-Tech Service Inc.** Manufactured by Ninon Medical Inc.When measuring the body position and/or SpO2, select the “TC” to DC (bodyposition: DC2 or DC3, SpO2: DC1).
3. EEG/PSG MEASUREMENTOperator's Manual WEE-1000 3.21Attaching the TelemetryUnit to the PatientWhen attaching the telemetry unit to the patient use the provided, pochette, beltand strap.Electrode junction boxEvent markerSpO2 probeTelemetry unitStrapIsolatorPochetteBelt
3. EEG/PSG MEASUREMENT3.22 Operator's Manual WEE-1000Changing the Measurement SettingsBefore starting measurement, check and change the following system settings inthe System Program. The changed settings are saved in memory. The Acquisitionprogram and the Review program use these settings.• Electrode junction box setting (Select the JE-011A or JE-012A)• Pattern settings• AC line frequency setting• Contents of the table list of the Patient Information• Contents of the Annotation dialog box when annotating waveforms or addingannotations.• The electrodes that are used for waveform acquisition and saved in a file with theEEG waveformsYou can save the changed system settings in a file. Each electrode junction box hasits own system settings for the above settings other than the AC line frequency. Forexample, when the system settings which use the JE-011A electrode junction boxare saved in a file, next time you can select the JE-011A electrode junction box bycalling up a system settings file which uses the JE-011A electrode junction box.Refer to “Changing the System Settings” in Section 2. For detailed informationabout the system settings, refer to the operator’s manual of eachelectroencephalograph.NOTE• It is not possible to change System Program settings while theAcquisition, Review or any other EEG application program is open.• Before selecting another electrode junction box in the ElectrodeJunction Box menu, save the current system settings in a file.Otherwise, the current system settings listed above are lost.
3. EEG/PSG MEASUREMENTOperator's Manual WEE-1000 3.23Measuring WaveformsExample: EEG-1100This section explains the general procedure how to measure the waveforms.1. Start the communication between the telemetry unit and access point.Wireless communication:1) Turn on the access point2) Press the START/OK key on the telemetry unit. Blinking “O” is displayedon the LCD display.Wired communication:1) Turn on the access point2) Connect the telemetry unit and access point with the isolator. The channel“CL” is displayed on the LCD display.2. Open the Acquisition program.NOTETurn off any screen saver and close all application programs beforeopening the Acquisition program. Otherwise, the Acquisitionprogram may not function properly.Double-click the acquisition program shortcut icons on an EEG window. Anew EEG file automatically opens with the Room Selection dialog box.3. Select the access point and telemetry unit.1) On the Room Selection dialog box, select the access point by selecting theroom.2) On the Telemetry Unit Selection dialog box, select the telemetry unit.3) Start communication.When communication between the telemetry unit and access point isestablished, the Patient Information dialog box opens.4. Enter the patient information. The patient ID and name must be entered.
3. EEG/PSG MEASUREMENT3.24 Operator's Manual WEE-10005. Select the pattern. You can select the pattern (montage and amplifier settingsincluding sensitivity, high-cut filter, time constant, etc.) for the measurementwith the Pattern dialog box. You can program the pattern for the measurementin the System Program. For the detailed pattern settings, refer to"Programming Pattern” in Section 4 of the operator’s manual of theelectroencephalograph.6. Check the skin-electrode contact impedance for disk electrodes.When using the EEG disk electrodes, clean the measurement sites with a cottonswab moistened with alcohol or SkinPure (skin preparation gel) to reduce theskin-electrode contact impedance to less than 5 kΩ.WARNINGDo not check the skin-electrode contact impedance when using aneedle electrode or intracranial electrode. Failure to follow thiswarning injures the patient because these electrodes will bedamaged by electrolyzation inside the body.NOTE• The Z, C3 and C4, A1 and A2 electrodes must be attached to thepatient. Otherwise, the impedance check result may be incorrect.The instrument checks the skin-electrode impedance for the followingelectrodes.• When calibration waveforms are displayed, the electrodes that are includedin all patterns are checked.• When the EEG waveforms are displayed, the electrodes that are included inthe currently selected pattern are checked.On the telemetry unit:1) Select “IP” by pressing the FUNCTION key.2) Press the START/OK key The impedance check result is displayed onLCD display. The electrode number that exceeds the threshold level andits impedance are displayed. You can display the next electrode impedancecheck result by pressing the FUNCTION key.To change the impedance threshold, press the MARK/kΩ key. Every timethe MARK/kΩ key is pressed the threshold changes as follows:50 → 20 → 10 → 5 → 2 kΩ3) Press the START/OK key to end the impedance checkPattern dialog box
3. EEG/PSG MEASUREMENTOperator's Manual WEE-1000 3.257. Check that the waveforms are acquired correctly and that the amplitude of eachwaveform is proper.Click the EEG Signal button on the tool bar and check that all waveforms aremeasured correctly (i.e. there is no waveform distortion and the amplitude ofeach waveform is proper). To change the sensitivity, select a channel number,then click the Sens button on the amp bar or Sensitivity dialog box or use thepattern table.On the screen:1) Move the mouse pointer to the Impedance Check button on the toolbar.2) Press and hold the left mouse button for about two seconds to start theskin-electrode impedance check. The Impedance Check dialog box openson the screen. The currently selected montage is displayed on the dialogbox.The impedance check result is displayed on the screen with measuredimpedance and color. If an electrode’s impedance exceeds the preset value(threshold) on the System program, it is highlighted on the ImpedanceCheck dialog box.3) Click the OK button to close the Impedance Check dialog box.Pattern tableClick the Display Pattern Table buttonto open the pattern tableSelect a channel andadjust the sensitivity.Acquisition screen
3. EEG/PSG MEASUREMENT3.26 Operator's Manual WEE-10008. Start filing.Click the Start/Stop Filing button on the tool bar to start saving the acquiredwaveforms in an EEG data file.9. Save the file and end the measurement.1) Click the Start/Stop Filing button to stop saving.2) From the File menu, select Close. The Close dialog box opens to let youcheck the patient information.3) Click the OK button to close the data file.4) From the File menu, select Exit to close the Acquisition program. Thecommunication between the telemetry unit and access point stops.10. Turn off the telemetry unit.

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