Nihon Kohden ZM-540PA Medical Telemetry Transmitter User Manual OM ZM 540 541PA

Nihon Kohden Corporation Medical Telemetry Transmitter OM ZM 540 541PA

Users Manual

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Copyright NoticeThe entire contents of this manual are copyrighted by Nihon Kohden. All rights are reserved. No part of this document may be reproduced, stored, or transmitted in any form or by any means (electronic, mechanical, photocopied, recorded, or otherwise) without the prior written permission of Nihon Kohden.
Operator’s Manual ZM-540PA/541PA iGENERAL HANDLING PRECAUTIONSThis device is intended for use only by qualified medical personnel.Use only Nihon Kohden approved products with this device. Use of non-approved products or in a non-approved manner may affect the performance specifications of the device. This includes, but is not limited to, batteries, recording paper, pens, extension cables, electrode leads, input boxes and AC power.Please read these precautions thoroughly before attempting to operate the instrument.1. To safely and effectively use the instrument, its operation must be fully understood.2. When installing or storing the instrument, take the following precautions:(1) Avoid moisture or contact with water, extreme atmospheric pressure, excessive humidity and temperatures, poorly ventilated areas, and dust, saline or sulphuric air.(2) Place the instrument on an even, level floor. Avoid vibration and mechanical shock, even during transport.(3) Avoid placing in an area where chemicals are stored or where there is danger of gas leakage.(4) The power line source to be applied to the instrument must correspond in frequency and voltage to product specifications, and have sufficient current capacity.(5) Choose a room where a proper grounding facility is available.3. Before Operation(1) Check that the instrument is in perfect operating order.(2) Check that the instrument is grounded properly.(3) Check that all cords are connected properly.(4) Pay extra attention when the instrument is in combination with other instruments to avoid misdiagnosis or other problems.(5) All circuitry used for direct patient connection must be doubly checked.(6) Check that battery level is acceptable and battery condition is good when using batteryoperated models.4. During Operation(1) Both the instrument and the patient must receive continual, careful attention.(2) Turn power off or remove electrodes and/or transducers when necessary to assure the patient’s safety.(3) Avoid direct contact between the instrument housing and the patient.5. To Shutdown After Use(1) Turn power off with all controls returned to their original positions.(2) Remove the cords gently; do not use force to remove them.(3) Clean the instrument together with all accessories for their next use.
ii Operator’s Manual ZM-540PA/541PA6. The instrument must receive expert, professional attention for maintenance and repairs. When the instrument is not functioning properly, it should be clearly marked to avoid operation while it is out of order.7. The instrument must not be altered or modified in any way.8. Maintenance and Inspection(1) The instrument and parts must undergo regular maintenance inspection at least every 6 months.(2) If stored for extended periods without being used, make sure prior to operation that the instrument is in perfect operating condition.(3) Technical information such as parts list, descriptions, calibration instructions or other information is available for qualified user technical personnel upon request from your Nihon Kohden representative.9. When the instrument is used with an electrosurgical instrument, pay careful attention to the application and/or location of electrodes and/or transducers to avoid possible burn to the patient.10. When the instrument is used with a defibrillator, make sure that the instrument is protected against defibrillator discharge. If not, remove patient cables and/or transducers from the instrument to avoid possible damage.
Operator’s Manual ZM-540PA/541PA iiiWARRANTY POLICYNihon Kohden Corporation (NKC) shall warrant its products against all defects in materials and workmanship for one year from the date of delivery. However, consumable materials such as recording paper, ink, stylus and battery are excluded from the warranty.NKC or its authorized agents will repair or replace any products which prove to be defective during the warranty period, provided these products are used as prescribed by the operating instructions given in the operator’s and service manuals.No other party is authorized to make any warranty or assume liability for NKC’s products.NKC will not recognize any other warranty, either implied or in writing. In addition, service, technical modification or any other product change performed by someone other than NKC or its authorized agents without prior consent of NKC may be cause for voiding this warranty.Defective products or parts must be returned to NKC or its authorized agents, along with an explanation of the failure. Shipping costs must be pre-paid.This warranty does not apply to products that have been modified, disassembled, reinstalled or repaired without Nihon Kohden approval or which have been subjected to neglect or accident, damage due to accident, fire, lightning, vandalism, water or other casualty, improper installation or application, or on which the original identification marks have been removed.In the USA and Canada other warranty policies may apply.CAUTIONUnited States law restricts this product to sale by or on the order of a physician.
iv Operator’s Manual ZM-540PA/541PAEquipment Authorization RequirementThis device complies with Part 15 of the FCC (Federal Communications Commission) Rules. Operation is subject to the following two conditions:(1) this device may not cause harmful interference, and(2) this device must accept any interference received, including interference that may cause undesired operation.This device complies with Part 95 Subpart H of the FCC Rules to be used in wireless medical telemetry service.Operation of this equipment requires the prior coordination with a frequency coordinator designated by FCC for the Wireless Medical Telemetry Service.CAUTIONTo comply with the FCC radio frequency (RF) exposure compliance requirements, no change to the antenna or the device is permitted. Any change to the antenna or the device could result in the device, exceeding the RF exposure requirements and void user’s authority to operate this device.NOTE• Use this device only indoors.• This device has been tested and complies with FCC radiation exposure limits set forth for an uncontrolled environment. The RF transmission power from the antenna conforms to the general public FCC RF Exposure Guidelines in Supplement C to OET65 limit of Specific Absorption Rate (SAR) 1.6 W/kg. The maximum SAR value measured from this device was extremely smaller than 1.6 W/kg. This device must not be located together with or operated in conjunction with any other unspecified antenna or transmitter.• The devices require registration and deployment by an authorized frequency coordinator. The ASHE (American Society for Healthcare Engineering) has been designated by the FCC to manage the WMTS frequencies. This device has frequency bands which may not be used in some areas. For details, contact your Nihon Kohden representative. For details on the guidelines, refer to the ASHE home page.
Operator’s Manual ZM-540PA/541PA vEMC RELATED CAUTIONThis equipment and/or system complies with IEC 60601-2 International Standard for electromagnetic compatibility for medical electrical equipment and/or system. However, an electromagnetic environment that exceeds the limits or levels stipulated in IEC 60601-1-2, can cause harmful interference to the equipment and/or system or cause the equipment and/or system to fail to perform its intended function or degrade its intended performance. Therefore, during the operation of the equipment and/or system, if there is any undesired deviation from its intended operational performance, you must avoid, identify and resolve the adverse electromagnetic effect before continuing to use the equipment and/or system.The following describes some common interference sources and remedial actions:1. Strong electromagnetic interference from a nearby emitter source such as an authorized radio station or cellular phone: Install the equipment and/or system at another location. Keep the emitter source such as cellular phone away from the equipment and/or system, or turn off the cellular phone.2. Radio-frequency interference from other equipment through the AC power supply of the equipment and/or system: Identify the cause of this interference and if possible remove this interference source. If this is not possible, use a different power supply.3. Effect of direct or indirect electrostatic discharge: Make sure all users and patients in contact with the equipment and/or system are free from direct or indirect electrostatic energy before using it. A humid room can help lessen this problem.4. Electromagnetic interference with any radio wave receiver such as radio or television: If the equipment and/or system interferes with any radio wave receiver, locate the equipment and/or system as far as possible from the radio wave receiver.5. Interference of lightning: When lightning occurs near the location where the equipment and/or system is installed, it may induce an excessive voltage in the equipment and/or system. In such a case, disconnect the AC power cord from the equipment and/or system and operate the equipment and/or system by battery power, or use an uninterruptible power supply.
vi Operator’s Manual ZM-540PA/541PA6. Use with other equipment: When the equipment and/or system is adjacent to or stacked with other equipment, the equipment and/or system may affect the other equipment. Before use, check that the equipment and/or system operates normally with the other equipment. 7. Use of unspecified accessory, transducer and/or cable: When an unspecified accessory, transducer and/or cable is connected to this equipment and/or system, it may cause increased electromagnetic emission or decreased electromagnetic immunity. The specified configuration of this equipment and/or system complies with the electromagnetic requirements with the specified configuration. Only use this equipment and/or system with the specified configuration.8. Use of unspecified configuration: When the equipment and/or system is used with the unspecified system configuration different than the configuration of EMC testing, it may cause increased electromagnetic emission or decreased electromagnetic immunity. Only use this equipment and/or system with the specified configuration.9. Measurement with excessive sensitivity: The equipment and/or system is designed to measure bioelectrical signals with a specified sensitivity. If the equipment and/or system is used with excessive sensitivity, artifact may appear by electromagnetic interference and this may cause mis-diagnosis. When unexpected artifact appears, inspect the surrounding electromagnetic conditions and remove this artifact source.If the above suggested remedial actions do not solve the problem, consult your Nihon Kohden representative for additional suggestions.
Operator’s Manual ZM-540PA/541PA viiConventions Used in this Manual and InstrumentWarnings, Cautions and NotesWarnings, cautions and notes are used in this manual to alert or signal the reader to specific information.WARNINGA warning alerts the user to the possible injury or death associated with the use or misuse of the instrument.CAUTIONA caution alerts the user to possible injury or problems with the instrument associated with its use or misuse such as instrument malfunction, instrument failure, damage to the instrument, or damage to other property.NOTEA note provides specific information, in the form of recommendations, prerequirements, alternative methods or supplemental information.
viii Operator’s Manual ZM-540PA/541PAExplanations of the Symbols in this Manual and InstrumentThe following symbols found in this manual/instrument bear the respective descriptions as given.On PanelSymbol Description Symbol DescriptionChange screen Defibrillation proof type BF applied partAttention, consult operator’s manualDefibrillation proof type CF applied partMoves cursor, scrolls data Serial numberDirection for attaching battery cover Year of manufactureDirection for inserting battery RF transmitterNon-ionizing radiationDirect current CSA markOn LCDSymbol Description Symbol DescriptionFull battery Battery very weakReplace batteryBattery 2/3 full Alarm suspendedLow batteryNIBP cannot be measured QRS/pulse sync mark
Operator’s Manual ZM-540PA/541PA 1Intended UseGeneralThe ZM-540PA and ZM-541PA transmitter transmits ECG, respiration and pulse waveforms, SpO2 and NIBP data from a patient to a Nihon Kohden monitor for continuous monitoring. The front LCD displays ECG (or pulse wave), numeric values of monitoring parameters, NIBP measuring mode and interval, messages and battery condition.* It also displays the compressed waveform and numeric data of the latest 10 minutes.* Essential performance of this transmitter.The difference between the ZM-540PA and ZM-541PA is the transmission frequency range.ZM-540PA: 608.0250 MHz (channel number 9002) to 613.9750 MHz (channel number 9478)ZM-541PA: 1395.0250 MHz (channel number E002) to 1399.9750 MHz (channel number E398) 1427.0250 MHz (channel number E502) to 1431.9750 MHz (channel number E898)The transmitter channel can be changed with a QI-901PK channel writer.Read the operator’s manual for the receiving monitor together with this manual before use.WARNINGDo not use the same transmitter on more than one patient at the same time. Do not connect different sensors on different patients to the same transmitter.CAUTION• Do not use the same channel for different patients. If the same channel is used for two patients, the two patients’ data will be lost due to mutual modulation interference, or another patient’s data may appear on the receiving monitor screen.• Do not use two transmitters with adjacent channels in the same hospital. If transmitters with adjacent channels are used, their radio waves interfere with each other.CAUTIONBe aware that signal loss and artifact may occur because of the multipath cancellation* when using a transmitter.* Multipath Cancellation (Standing Wave Interference) When a radio wave reflects off a surface, there may be some points in the room where the
2 Operator’s Manual ZM-540PA/541PAreflected and direct waves are exactly out of phase. At these points in the room, the reflected and direct waves cancel each other out so that the signal strength is 0. This is called “multipath cancellation” or “standing wave interference”. Locations where signal loss occurs are called “null spots”. If the transmitter is moving or nearby people or objects are moving, null spots can occur anytime and anywhere.NOTE• To prevent interference between channels, assign a channel administrator in the hospital and only he or she should manage channel assignment.• Use Nihon Kohden parts and accessories to assure maximum performance from your instrument.• For stable signal reception, it is recommended to use a diversity antenna system on the receiving monitor. Otherwise, spike noise from transient fading of electric field strength (for example, people moving) may interfere with the transmitter signal and may be mistaken as an arrhythmia on the receiving monitor.• For details on antennas and antenna construction, contact your Nihon Kohden representative. You can also refer to the Telemetry System Installation Guide.• Do not diagnose a patient based on only part of the monitoring data on the transmitter or only on the data acquired by the transmitter. Overall judgment must be performed by a physician who understands the features, limitations and characteristics of the transmitter by reading this operator’s manual thoroughly and by reading the biomedical signals acquired by other instruments.Receiving MonitorAny Nihon Kohden receiving monitor (central monitor with multiple patient receiver) can receive signals from this transmitter as long as the protocol version and channel setting are the same on the receiving monitor and transmitter.NOTE• For details on the receiving monitor and upgrade information, contact your Nihon Kohden representative.• The transmitter does not give any patient alarm, only a “no battery” alarm. Patient alarms must be managed on the receiving monitor.
Operator’s Manual ZM-540PA/541PA 3Panel DescriptionFront Panel12345678Refer to the WARNING on the next page.No. Name Description 1 LCD Displays numeric values, ECG or pulse wave, NIBP measuring mode and interval, messages and battery status. For details, refer to the “Screen Descriptions” section. 2 Infrared receiver Used for upgrading the transmitter software. 3 Screen key Toggles the screen in the following order. After power on: Start up → Check electrodes → Numeric and waveform → Waveform review → Numeric review → Display off → Check electrodes … After auto display off: Numeric and waveform → Waveform review → Numeric review → Display off → Check electrodes → Numeric and waveform … On a SETUP or CHECK screen, this key cancels changing setting or exits the screen.
4 Operator’s Manual ZM-540PA/541PA12345678Refer to the WARNING below.No. Name Description 4 Function key Depending on the setting on the transmitter, this key suspends alarms, pauses monitoring on the receiving monitor or transmits “Patient confirmed” message. On a SETUP screen, this key registers the selected setting and moves the cursor to the next setting item. On a CHECK screen, this key starts or stops maintenance test. 5 NIBP Start/Stop key Starts/stops NIBP measurement in selected mode. 6 NIBP Interval key Selects NIBP measurement mode. 7 Lead/Scroll keys On the numeric and waveform screen, these keys change the ECG lead. On the waveform review screen, these keys scroll data. On a SETUP screen, these keys move the cursor. 8 Battery case Contains three 1.5 V dry cell batteries (AA TYPE).WARNINGClose the battery case cover during operation. If the transmitter is used with the battery case cover open, anyone who touches the opened battery case may receive an electrical shock when defibrillation is performed. Touching the opened battery case may cause electrostatic discharge and intermittently interfere with the waveform or data.
Operator’s Manual ZM-540PA/541PA 5Rear PanelRefer to the symbol page.Refer to the WARNING below.Lock plateFastens the transmitter to an NIBP cuff.WARNINGThis transmitter is not waterproof. If detergent or liquid spills into the transmitter, stop using it and contact your Nihon Kohden representative. If a wet transmitter is used, the patient or operator may receive an electrical shock or injury.
6 Operator’s Manual ZM-540PA/541PATop PanelNIBP socket:Connects the cuff hose.Refer to the WARNING on the next page.Refer to the symbol page.Refer to the WARNING on the next page.Refer to the symbol page.ECG/impedance RESP socket: Connects the electrode lead for measuring ECG and/or respiration (impedance).Bottom PanelRefer to the WARNING on the next page.Refer to the symbol page.SpO2 socket: Connects the SpO2 probe.Channel number label:Indicates the channel number of the transmitter. Attach the channel number label to the panel of the receiving monitor.
Operator’s Manual ZM-540PA/541PA 7WARNINGBefore defibrillation, all persons must keep clear of the bed and must not touch the patient or any equipment or cord connected to the patient. Failure to follow this warning may cause electrical shock or injury.WARNINGWhen performing defibrillation, discharge as far as possible from electrodes, patches and any gel, cream or medicine on the chest of the patient. If there is a possibility that the defibrillator paddle could touch these materials, remove them from the patient. If the defibrillator paddle directly contacts these materials, the discharged energy may cause skin burn to the patient.WARNINGWhen the transmitter is used with an electrosurgical unit (ESU), firmly attach the entire area of the ESU return plate. Otherwise, the current from the ESU flows into the electrodes of the transmitter, causing electrical burn where the electrodes are attached. For details, refer to the ESU manual.CAUTIONDo not shake or swing the transmitter while holding the leads or cables connected to the transmitter. The transmitter may come off and injure someone or damage surrounding instruments.
8 Operator’s Manual ZM-540PA/541PAImportant Safety InformationGeneralWARNINGNever use the transmitter in the presence of any flammable anesthetic gas or high concentration oxygen atmosphere. Failure to follow this warning may cause explosion or fire.WARNINGNever use the transmitter in a hyperbaric oxygen chamber. Failure to follow this warning may cause explosion or fire.WARNINGDo not take this transmitter into the MRI test room. This transmitter is not designed to be used during MRI tests.WARNINGWhen performing MRI test, remove all electrodes, probe and cuff from the patient which are used with this transmitter. Failure to follow this warning may cause skin burn on the patient. For details, refer to the MRI manual.WARNINGBefore defibrillation, all persons must keep clear of the bed and must not touch the patient or any equipment or cord connected to the patient. Failure to follow this warning may cause electrical shock or injury.WARNINGWhen performing defibrillation, discharge as far as possible from electrodes, patches and any gel, cream or medicine on the chest of the patient. If there is a possibility that the defibrillator paddle could touch these materials, remove them from the patient. If the defibrillator paddle directly contacts these materials, the discharged energy may cause skin burn to the patient.
Operator’s Manual ZM-540PA/541PA 9WARNINGWhen the transmitter is used with an electrosurgical unit (ESU), firmly attach the entire area of the ESU return plate. Otherwise, the current from the ESU flows into the electrodes of the transmitter, causing electrical burn where the electrodes are attached. For details, refer to the ESU manual.WARNINGThis transmitter is not waterproof. If detergent or liquid spills into the transmitter, stop using it and contact your Nihon Kohden representative. If a wet transmitter is used, the patient or operator may receive an electrical shock or injury.WARNINGClose the battery case cover during operation. If the transmitter is used with the battery case cover open, anyone who touches the opened battery case may receive an electrical shock when defibrillation is performed. Touching the opened battery case may cause electrostatic discharge and intermittently interfere with the waveform or data.WARNINGDo not use the same transmitter on more than one patient at the same time. Do not connect different sensors on different patients to the same transmitter.CAUTIONOnly use Nihon Kohden specified electrodes, electrode leads, SpO2 probes, and NIBP cuffs. Otherwise, the maximum performance from the transmitter cannot be guaranteed.CAUTIONDo not reuse disposable parts and accessories.CAUTIONThe measurement values and displayed waveforms on the transmitter and receiving monitor may be different due to timing delay of the display or difference in detection settings.CAUTIONDo not shake or swing the transmitter while holding the leads or cables connected to the transmitter. The transmitter may come off and injure someone or damage surrounding instruments.
10 Operator’s Manual ZM-540PA/541PACAUTIONBe aware that signal loss and artifact may occur because of the multipath cancellation* when using a transmitter.* Multipath Cancellation (Standing Wave Interference) When a radio wave reflects off a surface, there may be some points in the room where the reflected and direct waves are exactly out of phase. At these points in the room, the reflected and direct waves cancel each other out so that the signal strength is 0. This is called “multipath cancellation” or “standing wave interference”. Locations where signal loss occurs are called “null spots”. If the transmitter is moving or nearby people or objects are moving, null spots can occur anytime and anywhere.CAUTIONTurn off the power of mobile phones, small wireless devices and other devices which produce strong electromagnetic interference around a patient (except for devices allowed by the hospital administrator). Radio waves from devices such as mobile phones or small wireless devices may be mistaken as pulse waves and the displayed data may be incorrect.CAUTION• Do not use the same channel for different patients. If the same channel is used for two patients, the two patients’ data will be lost due to mutual modulation interference, or another patient’s data may appear on the receiving monitor screen.• Do not use two transmitters with adjacent channels in the same hospital. If transmitters with adjacent channels are used, their radio waves interfere with each other.Output SignalWARNINGDo not use the output signal from the receiving monitor as the synchronization signal for other equipment such as IABP, MRI, echocardiography or defibrillator. There may be time delay between the monitor and the other equipment caused by waveform transmission delay and spike noise may interfere on the output signal and be mistaken as a trigger.
Operator’s Manual ZM-540PA/541PA 11BatteryCAUTIONBattery replacement must be performed by the operator. When replacing the batteries of a transmitter that is currently used for a patient, disconnect the electrode leads from the transmitter before replacing batteries or do not touch the patient during replacement.CAUTIONRefer to the battery and battery charger manuals for details on handling the batteries.Transmitter Channel ManagementWARNINGThe following actions must be taken to properly receive the transmitter signal of the correct patient on the receiving instrument. Otherwise, there may be signal loss or signals may mix causing a serious accident, such as monitoring a different patient.• Assign a channel administrator in the hospital and only he or she should manage channel assignment.• The channel administrator must manage the channels in the facility so that there is no signal interference.• When the transmitter channel is changed, the channel administrator must check that the channel on the receiving monitor is also changed and the signal is properly received.• The channel administrator must replace the channel number label on the transmitter with the new one after changing the channel.
12 Operator’s Manual ZM-540PA/541PAFor Patients Using Implantable PacemakerWARNINGInteraction Between Minute Ventilation Rate-Adaptive Pacemakers and Cardiac Monitoring and Diagnostic Equipment*The bioelectric impedance measurement sensor of a minute ventilation rate-adaptive implantable pacemaker may be affected by transmitter which is connected to the same patient. If this occurs, the pacemaker may pace at its maximum rate and the transmitter may give incorrect data to the monitor. If this occurs, disconnect the electrode leads from the patient or change the setting on the pacemaker by referring to the pacemaker’s manual. For more details, contact your pacemaker representative or Nihon Kohden representative.* Minute ventilation is sensed in rate-adaptive pacemakers by a technology known as bioelectric impedance measurement (BIM). Many medical devices in addition to pacemakers use this technology. When one of these devices is used on a patient with an active, minute ventilation rate-adaptive pacemaker, the pacemaker may erroneously interpret the mixture of BIM signals created in the patient, resulting in an elevated pacing rate. For more information, see the FDA web site. http://www.fda.gov/cdrh/safety.htmlECG MonitoringCAUTIONOnly use Nihon Kohden specified electrodes and electrode leads. When other electrodes or electrode leads are used, the “CHECK ELECTRODES” message may appear and monitoring may stop.CAUTIONWhen the “ELECTRODE OFF” or “CHECK ELECTRODES” message is displayed on the receiving monitor, ECG is not monitored properly and the ECG alarm does not function. Check the electrode, electrode leads, and if necessary, replace with new ones.
Operator’s Manual ZM-540PA/541PA 13SpO2 MonitoringWARNINGSpO2 measurement may be incorrect in the following cases.• When the patient’s carboxyhemoglobin or methemoglobin increases abnormally.• When dye is injected in the blood.• When using an electrosurgical unit.• During CPR.• When measuring at a site with venous pulse.• When there is body movement.• When the pulse wave is small (insufficient peripheral circulation).WARNINGWhen not monitoring SpO2, disconnect the SpO2 cable from the transmitter. Otherwise, noise from the probe sensor may interfere and incorrect data is displayed on the screen.WARNING• When using the TL-201T finger probe, do not fasten the probe and cable to the finger by wrapping with tape. This may cause burn, congestion or pressure necrosis from poor blood circulation.• When using probes other than the TL-201T finger probe, to avoid poor circulation, do not wrap the tape too tight. Check the blood circulation condition by observing the skin color and congestion at the skin peripheral to the probe attachment site. Even for short-term monitoring, there may be burn or pressure necrosis from poor blood circulation, especially on neonates or low birth weight infants whose skin is delicate. Accurate measurement cannot be performed on a site with poor peripheral circulation.WARNINGCheck the circulation condition by observing the skin color at the measurement site and pulse waveform. Change the measurement site every 8 hours for disposable probes and every 4 hours for reusable probes (every 8 hours for TL-630T/TL-631T series probe). The skin temperature may increase at the attached site by 2 or 3°C (4 or 5°F) and cause a burn or pressure necrosis. When using the probe on the following patients, take extreme care and change the measurement site more frequently according to symptoms and degree.• Patient with a fever• Patient with peripheral circulation insufficiency• Neonate or low birth weight infant with delicate skin
14 Operator’s Manual ZM-540PA/541PAWARNINGWhen monitoring SpO2 of a patient who is receiving photodynamic therapy, the light from the finger probe sensor may cause a burn. Photodynamic therapy uses a photosensitizing agent that has a side effect of photosensitivity.CAUTIONRefer to the probe instruction manual for details.CAUTIONThe disposable probe is not sterilized. Use the disposable probe only for a single patient. Never reuse the disposable probe for another patient because it causes cross infection.CAUTIONNIBP and SpO2 can be measured on the same limb, but the SpO2 monitoring might not be accurate during NIBP measurement. Be careful when reading the SpO2 values.** Monitoring SpO2 during NIBP Measurement When the SpO2 probe is attached to the same limb as the NIBP cuff, the blood flow decreases during NIBP measurement and pulse wave cannot be detected and SpO2 cannot be monitored properly. When “INHIBIT SpO2 DURING NIBP” on the PARAMETER SETUP screen is set to ON (factory default setting), SpO2 monitoring is paused during NIBP measurement to avoid SpO2 alarm occurrence. However, when monitoring SpO2 on the same limb as the NIBP, be careful when reading SpO2 values.CAUTIONWhile a patient is on medication which causes vasodilation, the pulse waveform may change and in rare cases the SpO2 value might not be displayed.CAUTIONNormal external light does not affect monitoring but strong light such as a surgical light or sunlight may affect monitoring. If affected, cover the measuring site with a blanket.CAUTIONWhen a message indicates a faulty probe, stop monitoring and replace the probe with a new one.
Operator’s Manual ZM-540PA/541PA 15CAUTIONDo not use a damaged or disassembled probe. It causes incorrect measurement and may injure the patient.CAUTIONDo not use a probe which is deteriorated by aging. Accurate measurement cannot be performed.CAUTIONIf the attachment site is dirty with blood or bodily fluids, clean the attachment site before attaching the probe. If there is nail polish on the attachment site, remove the polish. Otherwise, the amount of transmitted light decreases, and measured value may be incorrect or measurement cannot be performed.CAUTIONIf the skin gets irritated or redness appears on the skin from the probe, change the attachment site or stop using the probe. Take extreme care for the patients with delicate skin.CAUTIONDo not pull or bend the probe cable, and do not put caster feet on the probe cable. Do not immerse the disposable probe cable in chemical solutions or water. Failure to follow these instructions may cause cable discontinuity, short circuit, skin burn on the patient and incorrect measurement data. Replace any broken probe with a new one.CAUTIONWhen the probe is attached on an appropriate site with sufficient circulation and the error message confirming the probe attachment repeatedly appears, the probe may be deteriorated. Replace it with a new one.
16 Operator’s Manual ZM-540PA/541PANIBP MonitoringWARNINGBe careful when measuring NIBP on a patient with known bleeding disorders or coagulation. After NIBP measurement, there may be dot hemorrhage, or circulatory disorder by thrombus where the cuff is attached.WARNINGNIBP measurement may be incorrect in the following cases.• When using an electrosurgical unit• When there is body movement• When the pulse wave is small (insufficient peripheral circulation)• Too many arrhythmias• When there is vibration• When there is a rapid blood pressure change• During CPRWARNINGWhen performing NIBP measurements in STAT mode or 5 minute intervals, periodically remove the cuff from the patient for ventilation. The skin temperature may increase at the cuff attachment site by 2 or 3°C (4 or 5°F). When measuring a patient with a fever or peripheral circulation insufficiency, it may cause a burn.CAUTIONDo not wrap the cuff on an arm or thigh which is used for injection. NIBP measurement on an arm or thigh which is used for injection may cause reflux of blood and stop injection.CAUTIONDo not wrap the cuff too tight. It may cause poor blood circulation and congestion. If the cuff is wrapped too loosely, the NIBP value may increase.CAUTIONDo not attach the cuff to the site where there is injury or inflammation. If the skin gets irritated or redness appears on the skin from the cuff, change the attachment site or stop using the cuff. Take extreme care on the patients with delicate skin.CAUTIONWhen using an extension hose, check that the extension hose is not bent or squeezed. Otherwise, the cuff might not inflate or deflate. If the cuff cannot deflate, it may cause congestion on the patient at the cuff attachment site.
Operator’s Manual ZM-540PA/541PA 17CAUTIONWhen performing NIBP measurement repeatedly, have a rest between measurements to recover adequate circulation.MaintenanceCAUTIONThis transmitter is not waterproof. If detergent or liquid spills into the transmitter, stop cleaning or disinfecting it and contact your Nihon Kohden representative. The transmitter needs to be checked for safety and function before use.CAUTIONNever disassemble or repair the transmitter. Disassembly and repair must be performed by qualified service personnel.
18 Operator’s Manual ZM-540PA/541PAPreparation on TransmitterBatteriesWARNING and CAUTION for Handling BatteriesCAUTIONRefer to the battery and battery charger manuals for details on handling the batteries.CAUTIONWhen the transmitter is not in use, remove the batteries. When the batteries are installed, battery power is consumed even when measurement is not performed. When NiMH batteries are left in the transmitter when it is not used, the batteries may overdischarge and leak liquid which makes the batteries unusable and damages the transmitter.CAUTIONDo not handle the batteries with wet hands.NOTERemove the batteries from the transmitter before disposing of it.Battery LifetimeUse three AA type alkaline dry cell batteries. NiMH batteries can also be used but the lifetime of alkaline batteries is longer. The lifetime of NiMH batteries is about 1/2 of alkaline batteries (when fully charged).With new Nihon Kohden recommended alkaline batteries, the transmitter can continuously measure ECG, respiration, SpO2 and NIBP for approximately 1 day. The measurement is performed at room temperature, NIBP is measured in auto mode at 60 minute intervals and SpO2 is measured on an index finger of a male patient with weight 60 kg. Operation time depends on the thickness of the SpO2 probe attachment site.Recommended batteriesNiMH secondary: SANYO HR-3UF (W) Battery charger: SANYO NC-M55Alkaline primary: Nihon Kohden Medipower (equivalent to Panasonic LR6 (G))
Operator’s Manual ZM-540PA/541PA 19Installing (Replacing) BatteriesCAUTIONBattery replacement must be performed by the operator. When replacing the batteries of a transmitter that is currently used for a patient, disconnect the electrode leads from the transmitter before replacing batteries or do not touch the patient during replacement.If electrode leads are attached to the patient and the person replacing batteries touches the patient during battery replacement, excess patient leakage current may flow into the patient.NOTE• Replace all batteries at the same time.• Do not use different types of batteries together.• Insert the batteries with the correct polarity (+ and –).• The capacity of rechargeable NiMH batteries is reduced if the batteries are recharged before they are fully discharged. For details, refer to the battery operator’s manual.1. Remove the battery case cover.2. Insert three new or fully charged batteries into the battery case observing the correct polarity.
20 Operator’s Manual ZM-540PA/541PA3. Close the cover.The transmitter is automatically turned on when the batteries are installed and the cover is closed.Situations Requiring Battery ReplacementReplace the batteries when any of the following occurs:• The transmitter displays the “BATTERY WEAK” message or “ ” icon.• The transmitter generates a constant alarm (continuous “peep” sound).• The transmitter LCD does not display anything when the power is turned on.• The receiving monitor displays a battery replacement message.Battery Level IndicationThe following icons on the LCD indicate the battery level. When “PROTOCOL” on the SYSTEM SETUP screen is set to 57, the battery level indication is transmitted to the receiving monitor.Indication Battery Level Message on the Receiving MonitorFully charged batteriesThere is no message on the monitor.Batteries are 2/3 full.Batteries are low. NIBP cannot be measured. Replace batteries.Batteries are very weak. Message requiring battery replacement is displayed.No indication Dead batteries No signal can be transmitted to the monitor.There is no indication on the monitor.Turning On the TransmitterWhen the batteries are installed correctly, the power is turned on. A one second “peep” sounds and the startup screen appears, then the check electrodes screen appears. (There is no “peep” sound when there is no battery power.)
Operator’s Manual ZM-540PA/541PA 21 After checking that the ECG is stable on the check electrodes screen, press the Screen key to display the numeric and waveform screen.For details on the screen, refer to the “Screen Descriptions” section.Check Items Before UseBefore turning on the transmitter power, check the following to confirm that the transmitter can be used in normal and safe condition.Appearance• There are no damaged or dirty parts on the outside of the transmitter (LCD, keys, sockets, battery case cover, battery case, lock plate, etc.).• The transmitter is completely dry.• The electrodes, electrode lead, SpO2 probe and NIBP cuff are not broken.Batteries• The battery polarity is correct.• The battery case spring is firmly attached and the battery is not loose.• The battery case cover is firmly closed.Channel Setting• The transmitter channel matches the receiving monitor channel.• There is no nearby transmitter with the same channel.
22 Operator’s Manual ZM-540PA/541PACheck Items After Power OnAfter turning on the power, check the following.Power On• The transmitter generates a one second “peep” sound and the startup screen appears.• The transmitter displays the check electrodes screen.• The transmitter is not too hot.• The transmitter does not display the “BATTERY WEAK” message.• The transmitter does not interfere with the operation of other medical instruments.Daily Check• The “signal loss” message is not displayed on the receiving monitor when the transmitter is inside the receiving range of the monitor.• The battery replacement message is not displayed on the monitor.• The keys on the transmitter function properly.• The LCD brightness is appropriate. To adjust brightness, refer to the “Changing SYSTEM SETUP Settings” section.Check Items After UseTo use the transmitter in safe and optimum condition for next time, check the following.Before Turning Power Off• Temporarily changed settings are changed back to the previous settings.• There was no malfunction on the transmitter.Storage• ECG electrode leads, SpO2 probe and NIBP cuff are cleaned and disinfected.• If the transmitter got wet, liquid is wiped off and the transmitter is thoroughly dried.• There are enough consumables, such as disposable electrodes.• The transmitter power is turned off by removing batteries from the transmitter.• Dead batteries are disposed of properly.Turning Off the TransmitterTo turn off the power, remove batteries. When the power is turned off, the saved waveform and numeric data are deleted.
Operator’s Manual ZM-540PA/541PA 23Changing the Transmitter ChannelThe channel of the transmitter can be changed with an optional QI-901PK Channel Writer.WARNINGThe following actions must be taken to properly receive the transmitter signal of the correct patient on the receiving instrument. Otherwise, there may be signal loss or signals may mix causing a serious accident, such as monitoring a different patient.• Assign a channel administrator in the hospital and only he or she should manage channel assignment.• The channel administrator must manage the channels in the facility so that there is no signal interference.• When the transmitter channel is changed, the channel administrator must check that the channel on the receiving monitor is also changed and the signal is properly received.• The channel administrator must replace the channel number label on the transmitter with the new one after changing the channel.NOTE• The software version of the QI-901PK channel writer must be 02-01 or later to change the channel on the transmitter.• The channel writer must be used outside the patient environment.The channel is displayed in the upper left corner of the screen.Channel
24 Operator’s Manual ZM-540PA/541PAChanging Parameter and System Setup SettingsThe initial settings on the PARAMETER SETUP and SYSTEM SETUP screens can only be changed before monitoring. Changing these settings during monitoring interrupts monitoring.NOTEChanging Parameter and System Setup settings must be done by qualified personnel.Notes on Parameter SettingsWhen monitoring NIBP and SpO2, the following setting must be set as indicated in the table to properly transmit the monitoring data to the receiving monitor. Otherwise, SpO2 cannot be monitored properly during NIBP measurement.Some receiving monitors require the software to be upgraded. For details, contact your Nihon Kohden representative.SpO2 probe attachment site INHIBIT SpO2 DURING NIBP settingProbe attached to the same limb as the cuff* ONProbe attached to the limb without cuff OFF* When the SpO2 probe is attached to the same limb as the NIBP cuff and the cuff is inflated, the SpO2 value becomes unstable and SpO2 or PR alarm may occur.
Operator’s Manual ZM-540PA/541PA 25Changing PARAMETER SETUP SettingsParameter Setup Setting ListThe factory default settings are underlined.Setting Item Description SettingsECG ELECTRODES Select the electrode lead type. IEC, AHALEAD TYPE Select the type of ECG leads. AUTO, 6 LEADSECG MEASUREMENTTurn ECG monitoring on or off. When electrodes are attached to the patient and ECG leads are connected, ECG monitoring starts even when this setting is set to OFF.If this setting is set to OFF, the same setting on the receiving monitor must also be set to OFF.NOTEWhen “PROTOCOL” on the transmitter is set to 57 and the receiving monitor is able to receive protocol 57, ECG measurement on the receiving monitor is automatically set to OFF when this setting is set to OFF on the transmitter.ON, OFFRESP MEASUREMENTTurn respiration monitoring on or off.When this setting is set to OFF, the same setting on the receiving monitor is automatically set to OFF.ON, OFFSpO2 RESPONSESelect the SpO2 response mode.FAST: Select this for special applications that require a fast response. FAST is suitable for detecting short apnea.NORMAL: For normal monitoring.SLOW: Select this when you need to suppress a rapid change in SpO2.FAST, NORMAL, SLOWINHIBIT SpO2 DURING NIBPTurn SpO2 monitoring on or off during NIBP measurement. ON, OFFSELECTABLE INTERVALS (min)Select the NIBP measurement modes for the mode selection.STAT, 5, 10, 15, 30, 60, 120, 240INITIAL INTERVAL (min)Select the initial NIBP measurement mode at power on.MANUAL, 5, 10, 15, 30, 60, 120, 240NIBP MODE AFTER STAT (min)Select the NIBP measurement mode after completing STAT measurement.MANUAL, 5, 10, 15, 30, 60, 120, 240START/FINISH SOUNDTurn ON or OFF the sound for NIBP measurement start/finish.START: ON, OFFFINISH: ON, OFF
26 Operator’s Manual ZM-540PA/541PASetting Item Description SettingsOLD NIBP DATA/AFTER (min)Select whether to hide or dim the NIBP data after measurement and how long to wait after measurement to dim or hide it.DATA: HIDE, DIMAFTER: 5, 10, 30INITIAL CUFF PRESSURE (mmHg) Select the NIBP cuff inflation pressure. 120, 150, 180, 210, 240Displaying the PARAMETER SETUP Screen1. Turn off the transmitter by removing one battery.2. While pressing the Function key, turn on the transmitter (install the battery). The MENU screen appears.3. Press the ▼ key to move the cursor to “PARAMETER SETUP”.4. Press the Function key to enter PARAMETER SETUP. The current settings are highlighted.5. Change settings:• To move the cursor and select the setting item, press the ▼ or ▼ key then press the Function key.• To select and register the setting, press the ▼ or ▼ key then press the Function key.• To cancel changing the setting of the selected item, press the Screen key.6. When changing settings on the PARAMETER SETUP screen is complete, press the Screen key to return to the MENU screen. CursorMENU screenSetting itemPARAMETER SETUP screen - page 1SettingCursor7. Press the ▼ or ▼ key to move the cursor to “EXIT”.8. Press the Function key. The numeric and waveform screen appears.
Operator’s Manual ZM-540PA/541PA 271. On the PARAMETER SETUP screen, press the ▼ key to move the cursor to “ECG ELECTRODES”.2. Press the Function key. The cursor moves to the selection item.3. Press the ▼ key to select “IEC” or “AHA”.4. Press the Function key to register the selected setting. The cursor returns to “ECG ELECTRODES”.Changing Parameter Setup SettingsECG ELECTRODESSelect the electrode lead type.Selected settingCursorLEAD TYPESelect the type of ECG leads. In normal use, select “AUTO”. When using DIN type lead with 6 electrodes, select “6 LEADS”.1. On the PARAMETER SETUP screen, press the ▼ key to move the cursor to “LEAD TYPE”.2. Press the Function key.3. Press the ▼ key to select “AUTO” or “6 LEADS”.4. Press the Function key to register the selected setting. The cursor returns to “LEAD TYPE”.Setting itemCursor
28 Operator’s Manual ZM-540PA/541PAECG MEASUREMENTTurn ECG monitoring on or off. When electrodes are attached to the patient and ECG leads are connected, ECG monitoring starts even when this setting is set to OFF.If this setting is set to OFF, the same setting on the receiving monitor must also be set to OFF.NOTEWhen “PROTOCOL” on the transmitter is set to 57 and the receiving monitor is able to receive protocol 57, ECG measurement on the receiving monitor is automatically set to OFF when this setting is set to OFF on the transmitter.1. On the PARAMETER SETUP screen, press the ▼ key to move the cursor to “ECG MEASUREMENT”.2. Press the Function key.3. Press the ▼ key to select “ON” or “OFF”.4. Press the Function key to register the selected setting. The cursor returns to “ECG MEASUREMENT”.RESP MEASUREMENTTurn respiration monitoring on or off. When this setting is set to OFF, the same setting on the receiving monitor is automatically set to OFF.1. On the PARAMETER SETUP screen, press the ▼ key to move the cursor to “RESP MEASUREMENT”.2. Press the Function key.3. Press the ▼ key to select “ON” or “OFF”.4. Press the Function key to register the selected setting. The cursor returns to “RESP MEASUREMENT”.
Operator’s Manual ZM-540PA/541PA 29SpO2 RESPONSESelect the SpO2 response mode.FAST: Select this for special applications that require a fast response. FAST is suitable for detecting short apnea.NORMAL: For normal monitoring.SLOW: Select this when you need to suppress a rapid change in SpO2.1. On the PARAMETER SETUP screen, press the ▼ key to move the cursor to “SpO2 RESPONSE”. “SpO2 RESPONSE” is on the second page of the PARAMETER SETUP screen.2. Press the Function key.3. Press the ▼ key to select “FAST”, “NORMAL” or “SLOW”.4. Press the Function key to register the selected setting. The cursor returns to “SpO2 RESPONSE”.PARAMETER SETUP screen - page 2INHIBIT SpO2 DURING NIBPTurn SpO2 monitoring on or off during NIBP measurement.When the SpO2 probe is attached to the same limb as the NIBP cuff and this setting is set to OFF, the pulse may become unstable and SpO2 or PR alarm may occur. It is recommended to set this setting to ON so that SpO2 is not measured during NIBP measurement.When the SpO2 probe is attached to the other limb from the NIBP cuff, this setting can be set to OFF.NOTEWhen this “INHIBIT SpO2 DURING NIBP” is set to OFF, refer to the “Monitoring SpO2 during NIBP Measurement” section.1. On the PARAMETER SETUP screen, press the ▼ key to move the cursor to “INHIBIT SpO2 DURING NIBP”. “INHIBIT SpO2 DURING NIBP” is on the second page of the PARAMETER SETUP screen.2. Press the Function key.3. Press the ▼ key to select “ON” or “OFF”.
30 Operator’s Manual ZM-540PA/541PA4. Press the Function key to register the selected setting. The cursor returns to “INHIBIT SpO2 DURING NIBP”.SELECTABLE INTERVALS (min)When the NIBP INTERVAL key is pressed, the measurement mode changes according to the modes selected in this item. MANUAL mode is already selected for the mode selection.PARAMETER SETUP screen - page 31. On the PARAMETER SETUP screen, press the ▼ key to move the cursor to “SELECTABLE INTERVALS”. “SELECTABLE INTERVALS” is on the third page of the PARAMETER SETUP screen.2. Press the Function key.3. Press the ▼ key to select or unselect the mode. The selected modes are highlighted.4. Press the Function key to register the selected setting. The cursor returns to “SELECTABLE INTERVALS”.INITIAL INTERVAL (min)Select the initial NIBP measurement mode at power on.1. On the PARAMETER SETUP screen, press the ▼ key to move the cursor to “INITIAL INTERVAL”. “INITIAL INTERVAL” is on the third page of the PARAMETER SETUP screen.2. Press the Function key.3. Press the ▼ key to select the mode. Only the mode or interval selected for “SELECTABLE INTERVALS” are available.4. Press the Function key to register the selected setting. The cursor returns to “INITIAL INTERVAL”.NIBP MODE AFTER STAT (min)Select the NIBP measurement mode after completing the STAT measurement.1. On the PARAMETER SETUP screen, press the ▼ key to move the cursor to “NIBP MODE AFTER STAT”. “NIBP MODE AFTER STAT” is on the third page of the PARAMETER SETUP screen.
Operator’s Manual ZM-540PA/541PA 312. Press the Function key.3. Press the ▼ key to select the mode. Only the mode or interval selected for “SELECTABLE INTERVALS” are available.4. Press the Function key to register the selected setting. The cursor returns to “NIBP MODE AFTER STAT”.START/FINISH SOUNDTurn on or off the sound for NIBP measurement start and finish.PARAMETER SETUP screen - page 41. On the PARAMETER SETUP screen, press the ▼ key to move the cursor to “START/FINISH SOUND”. “START/FINISH SOUND” is on the fourth page of the PARAMETER SETUP screen.2. Press the Function key. The cursor moves to “START”.3. Press the ▼ key to turn “ON” or “OFF” the sound for NIBP measurement start.4. Press the Function key to register the setting for “START”. The cursor moves to “FINISH”.5. Press the ▼ key to turn “ON” or “OFF” the sound for NIBP measurement finish.6. Press the Function key to register the selected setting. The cursor returns to “START/FINISH SOUND”.OLD NIBP DATA/AFTER (min)Select whether to dim or hide the NIBP data after measurement and how long to wait after NIBP measurement to dim or hide it.1. On the PARAMETER SETUP screen, press the ▼ key to move the cursor to “OLD NIBP DATA/AFTER”. “OLD NIBP DATA/AFTER” is on the fourth page of the PARAMETER SETUP screen.2. Press the Function key. The cursor moves to “DATA”.
32 Operator’s Manual ZM-540PA/541PA3. Press the ▼ key to select “HIDE” or “DIM” the NIBP data.4. Press the Function key to register the setting for “DATA”. The cursor moves to “AFTER”.5. Press the ▼ key to select the interval after NIBP measurement to dim or hide.6. Press the Function key to register the selected setting. The cursor returns to “OLD NIBP DATA/AFTER”.INITIAL CUFF PRESSURE (mmHg)Select the NIBP cuff inflation pressure.1. On the PARAMETER SETUP screen, press the ▼ key to move the cursor to “INITIAL CUFF PRESSURE”. “INITIAL CUFF PRESSURE” is on the fourth page of the PARAMETER SETUP screen.2. Press the Function key.3. Press the ▼ key to select the inflation pressure.4. Press the Function key to register the selected setting. The cursor returns to “INITIAL CUFF PRESSURE”.Changing SYSTEM SETUP SettingsSystem Setup Setting ListThe factory default settings are underlined.Setting Item Description SettingsPROTOCOLSelect the transmitting protocol.57: New protocol. A central monitor with ORG-9100A/9110A/9700A multiple patient receiver whose software version 02-01 or later can receive this protocol.42: Old protocol. A central monitor with ORG-9100A/9110A/9700A multiple patient receiver can receive this protocol.NOTEWhen 57 is set, the receiving monitor must be able to receive protocol 57. Otherwise, signals from the transmitter cannot be received.57, 42
Operator’s Manual ZM-540PA/541PA 33Setting Item Description SettingsBRIGHTNESS Select the screen brightness. DARK, BRIGHTPRESSURE UNIT Select the unit for NIBP. mmHg, kPaFUNCTION KEYSelect the function of the Function key.SUSPEND ALARM & PAUSE: Suspends alarm on the receiving monitor for 2 minutes. Pauses monitoring on the transmitter and receiving monitor.SUSPEND ALARM: Suspends alarm on the receiving monitor for 2 minutes.CONFIRM: Displays the “PATIENT CONFIRMED” message on the transmitter screen and transmits the message to the receiving monitor.OFF: No function.NOTE“SUSPEND ALARM & PAUSE” and “CONFIRM” can only be set when PROTOCOL is set to 57.SUSPEND ALARM & PAUSE, SUSPEND ALARM, CONFIRM, OFFAUTO RESUME AFTER PAUSE Select the interval to resume monitoring after PAUSE.10 s, 30 s, 1 min, 2 min, 3 min, OFF
34 Operator’s Manual ZM-540PA/541PA1. Turn off the transmitter by removing one battery.2. While pressing the Function key, turn on the transmitter (install the battery). The MENU screen appears.3. Press the ▼ key to move the cursor to “SYSTEM SETUP”.4. Press the Function key to enter SYSTEM SETUP. The current settings are highlighted.5. Change settings. • To move the cursor and select the setting item, press the ▼ or ▼ key then press the Function key.• To select and register the setting, press the ▼ or ▼ key then press the Function key.• To cancel changing the setting of the selected item, press the Screen key. The SYSTEM SETUP screen has two pages. To display the second page, press the ▼ key when the cursor is at “PRESSURE UNIT”.6. When changing settings on the SYSTEM SETUP screen is complete, press the Screen key to return to the MENU screen.7. Press the ▼ or ▼ key to move the cursor to “EXIT”.8. Press the Function key. The numeric and waveform screen appears.CursorMENU screenSetting itemSYSTEM SETUP screen - page 1SettingDisplaying the SYSTEM SETUP Screen
Operator’s Manual ZM-540PA/541PA 35Changing System Setup SettingsPROTOCOLSelect the transmitting protocol. For differences between protocols, refer to the table below.57: New protocol. A central monitor with ORG-9100A/9110A/9700A multiple patient receiver whose software version 02-01 or later can receive this protocol.42: Old protocol. A central monitor with ORG-9100A/9110A/9700A multiple patient receiver can receive this protocol.NOTEWhen 57 is set, the receiving monitor must be able to receive protocol 57. Otherwise, signals from the transmitter cannot be received.Differences Between ProtocolsFunction Protocol 42 Protocol 57Setting ECG MEASUREMENT to OFF on the transmitter automatically turns off the ECG measurement setting on the receiving monitor No (ECG measurement must be turned off on the receiving monitor)YesPause monitoring on the receiving monitor from the transmitter No YesTransmit “PATIENT CONFIRMED” message No YesDisplay battery level of the transmitter on the receiving monitor No YesTransmit SpO2 messages Some messages (refer to the “Indication and Message List” section)All messagesSettingCursor 1. Press the ▼ key to move the cursor to “PROTOCOL”.2. Press the Function key.3. Press the ▼ key to select “57” or “42”.
36 Operator’s Manual ZM-540PA/541PANOTEFUNCTION KEY (on the second page of the SYSTEM SETUP screen) can be set to “SUSPEND ALARM & PAUSE” or “CONFIRM” only when PROTOCOL is “57”. If PROTOCOL is changed to “42”, FUNCTION KEY is automatically changed to “OFF”.4. Press the Function key to register the selected setting. The cursor returns to “PROTOCOL”.BRIGHTNESSSelect the screen brightness.1. Press the ▼ key to move the cursor to “BRIGHTNESS”.2. Press the Function key.3. Press the ▼ key to select “DARK” or “BRIGHT”.4. Press the Function key to register the selected setting. The cursor returns to “BRIGHTNESS”.PRESSURE UNITSelect the unit for NIBP.1. Press the ▼ key to move the cursor to “PRESSURE UNIT”.2. Press the Function key.3. Press the ▼ key to select “mmHg” or “kPa”.4. Press the Function key to register the selected setting. The cursor returns to “PRESSURE UNIT”.
Operator’s Manual ZM-540PA/541PA 37FUNCTION KEYSelect the function of the Function key.SUSPEND ALARM & PAUSE: Suspends alarm on the receiving monitor for 2 minutes. Pauses monitoring on the transmitter and receiving monitor.SUSPEND ALARM: Suspends alarm on the receiving monitor for 2 minutes.CONFIRM: Displays the “PATIENT CONFIRMED” message on the transmitter screen and transmits the message to the receiving monitor.OFF: No function.NOTE“SUSPEND ALARM & PAUSE” and “CONFIRM” can only be set when PROTOCOL is set to 57.SYSTEM SETUP screen - page 21. On the SYSTEM SETUP screen, press the ▼ key to move the cursor to “FUNCTION KEY”. “FUNCTION KEY” is on the second page of the SYSTEM SETUP screen.2. Press the Function key.3. Press the ▼ key to select the function.4. Press the Function key to register the selected setting. The cursor returns “FUNCTION KEY”.AUTO RESUME AFTER PAUSESelect the interval to resume monitoring after PAUSE.1. Press the ▼ key to move the cursor to “AUTO RESUME AFTER PAUSE”. “AUTO RESUME AFTER PAUSE” is on the second page of the SYSTEM SETUP screen.2. Press the Function key.3. Press the ▼ key to select interval.4. Press the Function key to register the selected setting. The cursor returns to “AUTO RESUME AFTER PAUSE”.
38 Operator’s Manual ZM-540PA/541PACursor 1. Turn off the transmitter by removing a battery.2. While pressing the Function key, turn on the transmitter (put back the battery). The MENU screen appears.3. Press the ▼ key to move the cursor to “SYSTEM INITIALIZE”.4. Press the Function key to enter SYSTEM INITIALIZE screen.5. Press the Function key to initialize settings. The confirmation message appears. To return to the MENU screen without initializing, press the Screen key.6. Press the Function key to initialize settings. To cancel initializing, press the ▼ key. The screen returns to the MENU screen.Initializing SettingsDo the following procedure to initialize all settings, except for channel, to the factory default settings.
Operator’s Manual ZM-540PA/541PA 39Attaching Electrodes, SpO2 Probe and NIBP Cuff to the PatientThe transmitter can be attached to an arm of the patient or placed on the bedside. The required length of the electrode leads and SpO2 probe cable depends on how the transmitter is to be attached to the patient.NOTEMonitoring SpO2 during NIBP MeasurementWhen the SpO2 probe is attached to the same limb as the NIBP cuff, the blood flow decreases during NIBP measurement and pulse wave cannot be detected and SpO2 cannot be monitored properly. When “INHIBIT SpO2 DURING NIBP” on the PARAMETER SETUP screen is set to ON (factory default setting), SpO2 monitoring is paused during NIBP measurement to avoid SpO2 alarm occurrence. However, when monitoring SpO2 on the same limb as NIBP, be careful when reading SpO2 values.When monitoring SpO2 is important, attach the probe to the limb to which theNIBP cuff or catheter is not attached.Attachment ExamplesWhen transmitter is attached on an arm When transmitter is placed on a bedsideNOTEWhen placing the transmitter on a bedside, place it on a stable and flat place. If the transmitter falls off, it may be damaged.
40 Operator’s Manual ZM-540PA/541PAAttaching ElectrodesSelecting Electrode LeadCAUTIONOnly use Nihon Kohden specified electrodes and electrode leads. When other electrodes or electrode leads are used, the “CHECK ELECTRODES” message may appear and monitoring may stop.The following electrode leads can be used on the transmitter (option).BR-903PA, 3 electrodes, clip type BR-906PA, 6 electrodes, clip typeConnecting the Electrode Lead to the TransmitterConnect the electrode lead to the ECG/RESP socket on the transmitter.When transmitter is attached on an armCAUTIONDo not shake or swing the transmitter while holding the leads or cables connected to the transmitter. The transmitter may come off and injure someone or damage surrounding instruments.CAUTIONHold the connector of the electrode lead when connecting/disconnecting the electrode lead. If you disconnect the electrode lead by pulling the lead, it damages the electrode lead.
Operator’s Manual ZM-540PA/541PA 41Electrode PositionFollow the physician’s instructions for electrode placement when available.For ECG monitoring, electrodes are attached only on the chest to allow patient movement and obtain continuous stable ECG. The following leads are examples. When also monitoring respiration, refer to the “Electrode Position for Respiration Monitoring” section.NOTEThe optimum electrode positions for ECG measurement are not always optimum for respiration measurement. Select positions that are suitable for both ECG and respiration measurement or positions which give priority to either ECG or respiration measurement.Electrode Positions for ECG MonitoringSix ElectrodesThe 6-electrode method with lead II and lead V5 is effective for monitoring myocardial ischemia.You can improve monitoring accuracy considerably by adding lead V4 to this combination. Va and Vb can be at any position of the standard 12 leads V1 to V6, but V4 and V5 are most appropriate for myocardial ischemic monitoring.RA/R LA/LRL/RF LL/FVa/CaVb/CbElectrode Position Symbol Lead ColorAHA IEC AHA IECLeft infraclavicular fossa LA L Black YellowRight infraclavicular fossa RA R White RedBelow lowest rib on the left anterior axillary line LL F Red GreenRight anterior axillary line at the same level as LL/F RL RF Green BlackFifth intercostal space on the left midclavicular line. (V4 position of standard 12 leads) Va Ca Brown-blue White-brownLeft anterior axillary line at the same level as Va. (V5 position of standard 12 leads) Vb Cb Brown-orange White-black
42 Operator’s Manual ZM-540PA/541PALead PositionStandard limb leadsMonopolar limb leadsMonopolar chest leadsLead ILead I Lead II Lead IIIaVR lead aVL lead aVF leadV1 to V6 leadsV1 to V6 leadstoRARARA RA RARARALALALALALALALALLLLLLLL LLLLLLN (RL)N (RL)N (RL) N (RL) N (RL)N (RL)N (RL)Three Electrodes• Lead MII, which is similar to standard lead II, used when ECG measurement has priorityElectrode Position Symbol Lead ColorAHA IEC AHA IECLeft infraclavicular fossa LA L Black YellowRight infraclavicular fossa RA R White RedBelow lowest rib on the left anterior axillary lineLL F Red Green
Operator’s Manual ZM-540PA/541PA 43• Lead MI, which is similar to standard lead I Change F/LL and L/LA of lead MII.• Lead MIII, which is similar to standard lead III Change R/RA and L/LA of lead MII.If the electrode positions above are not available due to chest surgery, attach the electrodes to the root of the limbs or below the clavicles for stable ECG monitoring.Electrode Positions for Respiration MonitoringPlace the R/RA and F/LL electrodes so that the lungs are between the electrodes.Position 1In this position, respiration measurement is available; however, there is a difference in amplitude between different patients.R or RA F or LLRight infraclavicular fossa Fifth intercostal space on the left midclavicular line, V4Position 2In this position, the waveform amplitude is usually large and the ECG lead is similar to Lead MII. This position can be generally recommended.R or RA F or LLRight infraclavicular fossa Fifth intercostal space on the left midaxillary line, V6NNNN
44 Operator’s Manual ZM-540PA/541PAPosition 3In this position, the respiration waveform is optimum, but the ECG lead is unusual.R or RA F or LLRight midaxillary at the horizontal level of V6Fifth intercostal space on the left midaxillary line, V6Position 4In this position, the respiration measurement is influenced by the impedance variation of the abdomen, so the cardiac pulse wave included in the respiration wave is reduced. Note that the waveform is inverted in phase compared with the chest movement (the waveform goes down during inspiration). It is difficult to measure the ECG at the same time.R or RA F or LLLowest rib on the right anterior axillary lineLowest rib on the left anterior axillary lineAttaching Electrodes to the Patient and Connecting the Electrode Leads to Disposable ElectrodesPrepare the Patient SkinShave off excessive body hair.To reduce skin impedance, clean the electrode site with cream or with a cotton pad moistened with alcohol. Thoroughly dry the skin with a clean cotton pad.NOTE• For a patient with frequent body movement, rub the sites with Skinpure skin preparation gel. However, do not use Skinpure skin preparation gel on sensitive skin.• Do not place electrodes on a wound or on an inflamed, wrinkled or uneven skin surface.Attaching Electrodes to the PatientCAUTIONDo not reuse disposable parts and accessories.NOTE• To maintain good contact between the electrode and skin, check that the paste of the NNNN
Operator’s Manual ZM-540PA/541PA 45disposable electrode is not dry.• When contact between the disposable electrode and skin becomes poor, replace electrodes with new ones immediately. Otherwise, contact impedance between the skin and the electrode increases and accurate ECG cannot be obtained.Refer to the electrode operator’s manual for details.1. Carefully remove the backing paper from the electrode. Avoid touching the adhesive surface.2. Place the electrode on the previously cleaned skin. Pay attention to the electrode lead color and symbol.3. Clip the electrode lead to the electrode.4. Fasten the electrode lead wire with surgical tape with an extra length of wire between the tape and the electrode. This lessens the movement of electrode leads by body movement and helps stable monitoring.Checking ECG on the Transmitter ScreenAfter attaching electrodes and connecting ECG leads, check that the electrodes are properly attached to the patient and the ECG waveform is acquired on the check electrodes screen. For details on the screen, refer to the “Screen Descriptions” section.Attaching the SpO2 ProbeSelecting the SpO2 ProbeSelect an appropriate probe for the patient.CAUTIONOnly use Nihon Kohden specified electrodes, electrode leads, SpO2 probes, and NIBP cuffs. Otherwise, the maximum performance from the transmitter cannot be guaranteed.CAUTIONDo not use a damaged or disassembled probe. It causes incorrect measurement and may injure the patient.
46 Operator’s Manual ZM-540PA/541PAReusable ProbesWhen using a TL-201T finger probe, choose the appropriate cable length for attachment.Probe Cable Length Patient Attachment SiteFinger probe TL-201T0.6 mAdult or child20 kg or moreFinger1.6 mMulti-site probe TL-220TAttachment tapeAdult or infant3 kg or moreFinger or toeNeonate3 kg or lessInstep and soleFinger probeTL-630T1, TL-630T3, TL-631T1, TL-631T3Attachment tapeTL-630T1, TL-631T1: 0.6 mTL-630T1/630T3: Adult or child 50 kg or moreTL-631T1/631T3:Adult or child20 kg or moreFinger or toeTL-630T3, TL-631T3: 1.6 mDisposable ProbesCAUTIONThe disposable probe is not sterilized. Use the disposable probe only for a single patient. Never reuse the disposable probe for another patient because it causes cross infection.
Operator’s Manual ZM-540PA/541PA 47Probe Patient Attachment SiteTL-251T Adult30 kg or moreFinger or toeTL-252T Child3 to 40 kgFinger or toeTL-253T Neonate3 kg or lessInstep and soleTL-051S, TL-052S40 mmCable length TL-051S: 0.8 m TL-052S: 1.6 mAdult50 kg or moreFingerNeonate3 kg or lessInstep and soleTL-061S, TL-062S35 mmCable length TL-061S: 0.8 m TL-062S: 1.6 mAdult or child15 to 50 kgFingerInfant3 to 15 kgToe
48 Operator’s Manual ZM-540PA/541PAProbe Patient Attachment SiteTL-271T, TL-271T3Cable length TL-271T: 0.8 m TL-271T3: 1.6 mAdult30 kg or moreFinger or toeTL-272T, TL-272T3Cable length TL-272T: 0.8 m TL-272T3: 1.6 mChild10 to 50 kgTL-273T, TL-273T3Cable length TL-273T: 0.8 m TL-273T3: 1.6 mNeonate3 kg or lessInstep and soleAdult40 kg or moreFinger or toeTL-274T, TL-274T3Cable length TL-274T: 0.8 m TL-274T3: 1.6 mInfant3 to 20 kg
Operator’s Manual ZM-540PA/541PA 49Connecting the SpO2 Probe to the TransmitterConnect the probe to the SpO2 socket on the transmitter.When transmitter is attached on an armCAUTIONDo not shake or swing the transmitter while holding the leads or cables connected to the transmitter. The transmitter may come off and injure someone or damage surrounding instruments.CAUTIONDo not use a damaged or disassembled probe. It causes incorrect measurement and may injure the patient.Attaching the Probe to the PatientAttach the probe to the patient by referring to the probe’s manual. Make sure that the light emitter and photo detector of the probe face each other at the attachment site.
50 Operator’s Manual ZM-540PA/541PAWARNING• When using the TL-201T finger probe, do not fasten the probe and cable to the finger by wrapping with tape. This may cause burn, congestion or pressure necrosis from poor blood circulation.• When using probes other than the TL-201T finger probe, to avoid poor circulation, do not wrap the tape too tight. Check the blood circulation condition by observing the skin color and congestion at the skin peripheral to the probe attachment site. Even for short-term monitoring, there may be burn or pressure necrosis from poor blood circulation, especially on neonates or low birth weight infants whose skin is delicate. Accurate measurement cannot be performed on a site with poor peripheral circulation.WARNINGCheck the circulation condition by observing the skin color at the measurement site and pulse waveform. Change the measurement site every 8 hours for disposable probes and every 4 hours for reusable probes (every 8 hours for TL-630T/TL-631T series probe). The skin temperature may increase at the attached site by 2 or 3°C (4 or 5°F) and cause a burn or pressure necrosis. When using the probe on the following patients, take extreme care and change the measurement site more frequently according to symptoms and degree.• Patient with a fever• Patient with peripheral circulation insufficiency• Neonate or low birth weight infant with delicate skinWARNINGWhen monitoring SpO2 of a patient who is receiving photodynamic therapy, the light from the finger probe sensor may cause a burn. Photodynamic therapy uses a photosensitizing agent that has a side effect of photosensitivity.
Operator’s Manual ZM-540PA/541PA 51CAUTIONIf the attachment site is dirty with blood or bodily fluids, clean the attachment site before attaching the probe. If there is nail polish on the attachment site, remove the polish. Otherwise, the amount of transmitted light decreases, and measured value may be incorrect or measurement cannot be performed.CAUTIONWhen the probe is attached on an appropriate site with sufficient circulation and the error message confirming the probe attachment repeatedly appears, the probe may be deteriorated. Replace it with a new one.CAUTIONIf the skin gets irritated or redness appears on the skin from the probe, change the attachment site or stop using the probe. Take extreme care for the patients with delicate skin.CAUTIONDo not use a probe which is deteriorated by aging. Accurate measurement cannot be performed.CAUTIONRefer to the probe instruction manual for details.
52 Operator’s Manual ZM-540PA/541PAAttaching the NIBP CuffSelecting the NIBP CuffSelect the NIBP cuff appropriate for the patient.NOTENIBP cannot be measured on neonates using this transmitter.Reusable CuffsWhen attaching the transmitter to the patient arm, a special NIBP cuff is required. An optional YN-990P extension hose (1.5 m) is available to extend the length between the NIBP socket on the transmitter and NIBP cuff (e.g. when not attaching the transmitter to the patient arm and placing the transmitter on a bedside).Reusable Cuff Model Width (cm) Air Hose Length (cm)For adult Standard YP-503P 13 15Large YP-504P 15 15WidthAir hoseWhen not attaching the transmitter to the patient arm, the following cuffs can be used. To use these cuffs, an optional YN-990P extension hose (1.5 m) is required.Reusable Cuff Model Width (cm) Air Hose Length (cm)For infant YP-960T 515For child Small YP-961T 7Standard YP-962T 10For adult Standard YP-963T 13Large YP-964T 15WidthAir hose
Operator’s Manual ZM-540PA/541PA 53Disposable CuffsCAUTIONDisposable cuffs are not sterilized. If necessary, sterilize the cuff using glutaraldehyde solution.When not attaching the transmitter to the patient arm, the following disposable cuffs can be used.To use these cuffs, an optional YN-990P extension hose (1.5 m) is required.Reusable Cuff Model Width (cm) Air Hose Length (cm)For infant YP-810P 6 17For child YP-811P 8 17For adultSmall YP-812P 10 17Standard YP-813P 14 20Medium large YP-814P 15 20Large YP-815P 17 20WidthAir hoseExtension HoseCAUTIONWhen using an extension hose, check that the extension hose is not bent or squeezed. Otherwise, the cuff might not inflate or deflate. If the cuff cannot deflate, it may cause congestion on the patient at the cuff attachment site.YN-990P extension hose, 150 cm
54 Operator’s Manual ZM-540PA/541PAReference for selecting a cuffThe AHA (American Heart Association) recommends that the cuff width be 40% of the circumference of the upper arm. Refer to the following graph and select the cuff which suits the patient’s arm.NOTE• If a range of arm circumference appropriate for the cuff is prescribed, use a cuff within that range.• To obtain accurate measured values, select a wide cuff which can be attached to the upper arm. Measuring with a very narrow cuff may result in measured values higher than the actual values.• The YP-503P NIBP cuff is for standard size adult. Do not use this cuff when it does not fit the patient.1510510 20 30 40 500201510510 20 30 40 50 60060Cuff width (cm)Arm circumference (cm)Infants YP-960TChildren small YP-961TChildren standard YP-962TAdults standard YP-503P (cuff for transmitter) YP-963TAdults large YP-504P (cuff for transmitter) YP-964TCuff Width and Arm CircumferenceReusable CuffsCuff width (cm)Arm circumference (cm)Children standard YP-811PAdults large YP-815PDisposable CuffsInfants YP-810PAdults small YP-812PAdults standard YP-813PAdults medium large YP-814P
Operator’s Manual ZM-540PA/541PA 55Connecting the NIBP Cuff to the TransmitterWhen Using YP-503P/YP-504P NIBP CuffTo attach the YP-503P/YP-504P NIBP cuff to the transmitter, the lock plate is required.YP-503P/YP-504P NIBP cuffFront cover Air hoseD ringBeltBelt for the strapLock plate pocket Front cover openLock plateFor attaching the NIBP cuff to the transmitterNOTEDo not roll up or put weight on the cuff when the lock plate is attached to it. The lock plate may break if the cuff is rolled up or weight is put on it when the lock plate attached.Top tabBottom tabTop tabBottom tab
56 Operator’s Manual ZM-540PA/541PA1. Remove the lock plate from the transmitter.2. Insert the lock plate into the lock plate pocket on the NIBP cuff.3. Attach the transmitter to the lock plate by inserting the tabs on the lock plate into the slots on the transmitter.4. Cover the transmitter with the front cover of the NIBP cuff.5. Connect the air hose to the NIBP socket on the transmitter. Turn the cuff connector joint until it clicks.1212
Operator’s Manual ZM-540PA/541PA 57When Using Disposable Cuffs or YP-960T series Reusable CuffsTo use these NIBP cuffs, an optional YN-990P extension hose (1.5 m) is required.NOTEConnect the joints properly. If there is an air leak, NIBP cannot be measured properly.1. Connect the NIBP cuff to the extension hose.2. Connect the other end of the extension hose to the NIBP socket on the transmitter. Turn the joint clockwise until it clicks. To disconnect the cuff from the transmitter, turn the hose joint counterclockwise.Attaching the NIBP Cuff to the PatientWARNINGBe careful when measuring NIBP on a patient with known bleeding disorders or coagulation. After NIBP measurement, there may be dot hemorrhage, or circulatory disorder by thrombus where the cuff is attached.CAUTIONDo not wrap the cuff on an arm or thigh which is used for injection. NIBP measurement on an arm or thigh which is used for injection may cause reflux of blood and stop injection.CAUTIONDo not attach the cuff to the site where there is injury or inflammation. If the skin gets irritated or redness appears on the skin from the cuff, change the attachment site or stop using the cuff. Take extreme care on the patients with delicate skin.CAUTIONDo not wrap the cuff too tight. It may cause poor blood circulation and congestion. If the cuff is wrapped too loosely, the NIBP value may increase.CAUTIONDo not reuse disposable parts and accessories.
58 Operator’s Manual ZM-540PA/541PACAUTIONNIBP and SpO2 can be measured on the same limb, but the SpO2 monitoring might not be accurate during NIBP measurement. Be careful when reading the SpO2 values.** Monitoring SpO2 during NIBP Measurement When the SpO2 probe is attached to the same limb as the NIBP cuff, the blood flow decreases during NIBP measurement and pulse wave cannot be detected and SpO2 cannot be monitored properly. When “INHIBIT SpO2 DURING NIBP” on the PARAMETER SETUP screen is set to ON (factory default setting), SpO2 monitoring is paused during NIBP measurement to avoid SpO2 alarm occurrence. However, when monitoring SpO2 on the same limb as the NIBP, be careful when reading SpO2 values.NOTE• Measuring NIBP at a site other than the upper arm gives different values from those measured at the upper arm. When making diagnosis based on the NIBP values, measure NIBP on an upper arm.• To accurately detect the pulsatile flow of the artery, the cuff should be wrapped around a bare upper arm.• Do not use an abnormal cuff. The cuff deteriorates from use and cleaning. Before use, check the cuff and confirm that there is no flaw, crack or hole in it. Be careful not to damage the inflation bag. If the inflation bag has a hole or a flaw, it may burst during use. Dispose of an abnormal cuff and replace it with a new one.• Refer to the NIBP cuff manual for details.Cuff PositionPlace the cuffed upper arm (brachium) at the same height as the patient’s heart. If the cuff is not at the same level as the heart, the weight of the blood affects the blood pressure reading. The pressure difference per unit height is 0.7 mmHg/cm. The blood pressure reading decreases when the arm is higher than the heart and increases when lower.The best measuring condition is when the patient is lying on his/her back with arms and legs relaxed. If the cuff position cannot be on the same level as the heart, the displayed blood pressure reading must be mathematically adjusted.When placing the transmitter on a bed, make sure that the hose is not bent.HeartWhen placing the transmitter on a bed, make sure that the hose is not bent.Heart
Operator’s Manual ZM-540PA/541PA 59Attaching the Transmitter on an Arm (Using the YP-503P/504P NIBP Cuff)1. Attach the NIBP cuff to the transmitter. Refer to the “Connecting the NIBP Cuff to the Transmitter” section.2. Before putting the cuff over the arm, insert the end of the cuff into the belt and then through the D ring as shown at left.3. Put the patient arm through the cuff. Fold back the cuff at the D ring and fasten it using the velcro tape. Make sure that the cuff is not attached on a joint.NOTEThe cuff must not wrap around the elbow.BeltD ring End of cuffBeltD ring End of cuff
60 Operator’s Manual ZM-540PA/541PAAttaching the Strap to the TransmitterNOTE• Use the strap to prevent the transmitter from falling.• Do not attach the clip to hard objects such as thick cloth or zipper. It will break the clip.Attach a strap provided with the transmitter to the NIBP cuff and patient clothes.To open the clip, firmly pull out the tab in direction of the arrow. To adjust the strap length, push down the tab on the adjuster and slide.1. Adjust the length of the strap.2. Clip one end of the strap to the belt for the strap on the NIBP cuff.3. Clip the other end of the strap to the patient’s clothes as shown left.Belt for the strap on the NIBP cuff
Operator’s Manual ZM-540PA/541PA 61Placing the Transmitter on the Bed (Using the Disposable Cuffs or YP-960T series Reusable Cuffs)1. Put the cuff on the upper arm so that the ▼ mark of “ARTERY ▼” aligns with the artery of the patient.ARTERY ▼2. Wrap the cuff so that “INDEX ” comes within the “ RANGE ”. If “Index ” is not within the “ RANGE”, change the cuff size.RANGERANGE
62 Operator’s Manual ZM-540PA/541PALocking the Keys on the TransmitterTo prevent the patient from pressing the keys on the transmitter during monitoring, you can lock the keys.Press the ▼ and ▼ keys at the same time and hold for more than 3 seconds. The key lock screen appears.When there is no key operation for one minute after locking the keys, the display turns off.To unlock the keys:Press the ▼ and ▼ keys at the same time and hold for more than 3 seconds.
Operator’s Manual ZM-540PA/541PA 63MonitoringCAUTIONThe measurement values and displayed waveforms on the transmitter and receiving monitor may be different due to timing delay of the display or difference in detection settings.Screen DescriptionsWhen the transmitter is turned on, the startup screen appears, then the check electrodes screen appears to check the electrode attachment.The screen changes in the following order each time the Screen key is pressed.Check electrodes → numeric and waveform → waveform review → numeric review → display off→ numeric and waveform → waveform review → numeric review → display off numeric and waveform → waveform review → numeric review → display off→ waveform review → numeric review → display off waveform review → numeric review → display off→ numeric review → display off numeric review → display off→ display off display off → check electrodes . . . check electrodes . . . Screen keyThe screen automatically turns off when there is no key operation for 2 minutes on the check electrodes screen or 1 minute on other screens.When the display is off and the Screen key is pressed, the numeric and waveform screen appears. When the Screen key is pressed within 5 minutes after the display off, the screen before the display off appears.
64 Operator’s Manual ZM-540PA/541PACheck Electrodes ScreenYou can check whether the electrodes are properly attached to the patient and the ECG waveform is acquired.When 6 leads are used, I, II, Va and Vb lead waveforms are displayed.When 3 leads are used, only II lead waveform is displayed.Channel numberBattery levelECG waveformFilter: offSweep speed: 12.5 mm/sWaveform sensitivity: 0.5 cm/1 mVLeadDetached electrode positionMessage When electrodes are detached, the “CHECK ELECTRODES” message and detached electrode position appear on the screen.NOTEWhen ECG measurement is set to OFF on the PARAMETER SETUP screen, the check electrodes screen does not appear.
Operator’s Manual ZM-540PA/541PA 65Numeric and Waveform ScreenNumeric values and waveforms of the monitoring parameters are displayed. You can change the ECG lead with the ▼ and ▼ keys.Heart rateQRS sync markPulse bar graphSpO2Respiration rateNIBP valuesECG waveformFilter: onSweep speed: 12.5 mm/sWaveform sensitivity: autoWaveform sensitivityECG leadNIBP measurement modeWhen ECG and respiration measurement is turned offPulse ratePulse sync markPulse bar graphSpO2Pulse wave sensitivityPulse waveformSweep speed: 12.5 mm/sWaveform sensitivity: autoNIBP valuesNIBP measurement mode
66 Operator’s Manual ZM-540PA/541PANOTEThe pulse wave amplitude varies according to the ratio of the pulsation component to the entire transmitted IR signal. When the pulsation component ratio is 1%, the pulse wave amplitude is about 5 mm at ×1 sensitivity on the screen.Waveform Review ScreenECG full disclosure for up to 10 minutes can be saved and reviewed. When ECG measurement is turned off and SpO2 is monitored, the pulse waveform is saved.When ECG lead is changed on the numeric and waveform screen, the ECG full disclosure of the changed lead is saved.The saved data is deleted when the transmitter is turned off.ECG leadDisplayed pageCompressed ECG waveform7.5 s x 4 traces per page, total of 20 pagesOlder dataNewer dataTime range of the displayed waveform (time before the waveform review screen is displayed)Waveform sensitivityTo scroll the waveform, press the ▼ or ▼ key. The waveform is scrolled by 30 seconds.
Operator’s Manual ZM-540PA/541PA 67Numeric Review ScreenNumeric data of heart rate (or pulse rate when ECG is turned off), SpO2 and respiration rate for up to 10 minutes are saved at 1 minute intervals.NOTENIBP measured values are not saved.The saved data is deleted when the transmitter is turned off.Time before the numeric review screen is displayedOlder dataNewer dataDisplay OffThe display can be turned off any time. To turn off the display, press the Screen key several times until the following screen appears then wait 5 seconds.
68 Operator’s Manual ZM-540PA/541PABasic Monitoring OperationUsing the Function KeyFunction keyOne of the following functions can be assigned to the Function key on the SYSTEM SETUP screen. Refer to the “Changing SYSTEM SETUP Settings” section.SUSPEND ALARM: Suspends alarms on the receiving monitor before they occur for 2 minutes. PAUSE: Pauses monitoring on the transmitter and receiving monitor.CONFIRM: Transmits the signal that the patient is confirmed and displays the “PATIENT CONFIRMED” message on the transmitter.NOTETo use the Function key for PAUSE or CONFIRM, you must set “PROTOCOL” on the SYSTEM SETUP screen of the transmitter to 57 and the receiving monitor must be able to receive protocol 57.
Operator’s Manual ZM-540PA/541PA 69Suspending Alarms on the Receiving MonitorWhen the FUNCTION KEY is set to “SUSPEND ALARM” or “SUSPEND ALARM & PAUSE” on the SYSTEM SETUP screen, alarms can be suspended for 2 minutes on the receiving monitor before they occur.To suspend alarms:1. Press the Function key. The “Suspend alarms” confirmation screen appears.2. Press the ▼ key to suspend alarms. To cancel suspending alarms and return to the previous screen, press the Screen key.When the alarms are suspended, the “ALARMS SUSPENDED” message and alarm suspended icon with the remaining minutes in alarm suspension appear on the transmitter screen.Message IconTo cancel suspending alarms during 2 minute alarm suspension:1. Press the Function key while the “ALARMS SUSPENDED” message is displayed. The confirmation screen appears.
70 Operator’s Manual ZM-540PA/541PA2. Press the ▼ key to cancel alarm suspension. Press the Screen key to not cancel alarm suspension.Pause MonitoringWhen the FUNCTION KEY is set to “SUSPEND ALARM & PAUSE” on the SYSTEM SETUP screen, you can pause monitoring on the receiving monitor from the transmitter when the patient cannot be monitored, such as during X-ray examination.NOTETo use the Function key for PAUSE, you must set “PROTOCOL” on the SYSTEM SETUP screen of the transmitter to 57 and the receiving monitor must be able to receive protocol 57.To pause monitoring:1. Press the Function key. The “Suspend alarms” confirmation screen appears.2. Press the Function key for 3 seconds to display the “Pause monitoring” confirmation screen.
Operator’s Manual ZM-540PA/541PA 713. Press the ▼ key to pause monitoring. To cancel pause monitoring, press the Screen key.4. Wait about 5 seconds until the “Turn power off” screen appears.5. Turn off the transmitter. If the transmitter is not turned off and monitoring continues for the interval set for “AUTO RESUME AFTER PAUSE” on the SYSTEM SETUP screen, pause monitoring is cancelled and monitoring continues.Resume Monitoring after PauseTo resume monitoring after pause, check that the electrodes, electrode leads and probe are attached to the patient then turn on the transmitter.
72 Operator’s Manual ZM-540PA/541PAConfirming PatientWhen the FUNCTION KEY is set to “CONFIRM” on the SYSTEM SETUP screen, you can transmit signal to the receiving monitor to indicate that the patient is confirmed by a medical staff by pressing the Function key.MessageTurning the Display OffThe display can be turned off any time. To turn off the display, press the Screen key several times until the following screen appears then wait 5 seconds.5 second time bar until the display turns offTurning the Display On after It was Turned OffPress the Screen key. The numeric and waveform screen appears. If the screen is turned off on the “Keys locked” screen, the “Keys locked” screen appears.When the Screen key is pressed within 5 minutes after the display was turned off, the previous screen appears.
Operator’s Manual ZM-540PA/541PA 73ECG and Respiration MonitoringWhen the electrodes are attached and the ECG leads are connected, the heart rate, ECG waveform, respiration rate and respiration waveform appear on the receiving monitor. Refer to the operator’s manual of the receiving monitor for details.When 6 leads are used on this transmitter, up to 8 lead (I, II, III, aVR, aVL, aVF, Va and Vb) of ECG waveforms can be displayed on the receiving monitor. The heart rate is also measured.When 3 leads are used, one channel ECG waveform of lead II can be displayed on the receiving monitor. Refer to the operator’s manual of the monitor for details.Heart rateQRS sync mark Respiration rateECG leadYou can change the ECG lead with the ▼ and ▼ keys.ECG waveform Filter: onSweep speed: 12.5 mm/sWaveform sensitivity: autoWARNINGInteraction Between Minute Ventilation Rate-Adaptive Pacemakers and Cardiac Monitoring and Diagnostic Equipment*The bioelectric impedance measurement sensor of a minute ventilation rate-adaptive implantable pacemaker may be affected by transmitter which is connected to the same patient. If this occurs, the pacemaker may pace at its maximum rate and the transmitter may give incorrect data to the monitor. If this occurs, disconnect the electrode leads from the patient or change the setting on the pacemaker by referring to the pacemaker’s manual. For more details, contact your pacemaker representative or Nihon Kohden representative.* Minute ventilation is sensed in rate-adaptive pacemakers by a technology known as bioelectric
74 Operator’s Manual ZM-540PA/541PAimpedance measurement (BIM). Many medical devices in addition to pacemakers use this technology. When one of these devices is used on a patient with an active, minute ventilation rate-adaptive pacemaker, the pacemaker may erroneously interpret the mixture of BIM signals created in the patient, resulting in an elevated pacing rate.For more information, see the FDA web site.http://www.fda.gov/cdrh/safety.htmlWARNINGWhen the transmitter is used with an electrosurgical unit (ESU), firmly attach the entire area of the ESU return plate. Otherwise, the current from the ESU flows into the electrodes of the transmitter, causing electrical burn where the electrodes are attached. For details, refer to the ESU manual.CAUTIONTurn off the power of mobile phones, small wireless devices and other devices which produce strong electromagnetic interference around a patient (except for devices allowed by the hospital administrator). Radio waves from devices such as mobile phones or small wireless devices may be mistaken as pulse waves and the displayed data may be incorrect.NOTE• Noise generated from an electrosurgical unit may interfere on an ECG waveform, but will not damage it.• If an electric blanket is used and incorrect heart rate is displayed on the monitor, turn off the pacing spike detection on the monitor.• Turn the pacing spike detection to ON on the receiving monitor when monitoring a pacemaker patient. Pacing pulse is detected by the transmitter and transmitted to the monitor. If the pacing spike detection is turned OFF, QRS and pacemaker spike might not be distinguished and pacemaker failure might not be recognized.• ECG cannot be monitored on a neonate using this transmitter.
Operator’s Manual ZM-540PA/541PA 75Turning ECG Measurement On/OffECG measurement can be turned on or off on the PARAMETER SETUP screen. When electrodes are attached to the patient and ECG leads are connected, ECG monitoring starts even when ECG is turned off.When PROTOCOL on the SYSTEM SETUP screen is set to 57:ECG measurement on the receiving monitor is automatically set to off.NOTEECG measurement on the transmitter cannot be turned on or off from the receiving monitor.When PROTOCOL on the SYSTEM SETUP screen is set to 42:If ECG measurement is turned off on the transmitter, ECG measurement on the receiving monitor must also be turned off.Turning Respiration Measurement On/OffRespiration measurement can be turned on or off on the PARAMETER SETUP screen. If respiration measurement is turned off, respiration measurement on the receiving monitor is also turned off.Electrode DetachmentIn the following conditions, the “CHECK ELECTRODES” message is displayed on the transmitter and receiving monitor.• Electrode is detached from skin.• Electrode lead is disconnected from the electrode.• Polarization voltage between the electrode and skin is excessively high.In these cases, check the cause and if necessary, replace electrodes with new ones.CAUTIONWhen the “ELECTRODE OFF” or “CHECK ELECTRODES” message is displayed on the receiving monitor, ECG is not monitored properly and the ECG alarm does not function. Check the electrode, electrode leads, and if necessary, replace with new ones.
76 Operator’s Manual ZM-540PA/541PASpO2 MonitoringWhen monitoring starts, SpO2 and pulse waveform are sent to the monitor and SpO2 and pulse level bar graph are displayed on the transmitter screen. When ECG is not measured, pulse waveform and pulse rate are also displayed.Pulse bar graphSpO2Filter: onSweep speed: 12.5 mm/sWaveform sensitivity: auto
Operator’s Manual ZM-540PA/541PA 77WARNINGSpO2 measurement may be incorrect in the following cases.• When the patient’s carboxyhemoglobin or methemoglobin increases abnormally.• When dye is injected in the blood.• When using an electrosurgical unit.• During CPR.• When measuring at a site with venous pulse.• When there is body movement.• When the pulse wave is small (insufficient peripheral circulation).WARNINGCheck the circulation condition by observing the skin color at the measurement site and pulse waveform. Change the measurement site every 8 hours for disposable probes and every 4 hours for reusable probes (every 8 hours for TL-630T/TL-631T series probe). The skin temperature may increase at the attached site by 2 or 3°C (4 or 5°F) and cause a burn or pressure necrosis. When using the probe on the following patients, take extreme care and change the measurement site more frequently according to symptoms and degree.• Patient with a fever• Patient with peripheral circulation insufficiency• Neonate or low birth weight infant with delicate skinWARNINGWhen monitoring SpO2 of a patient who is receiving photodynamic therapy, the light from the finger probe sensor may cause a burn. Photodynamic therapy uses a photosensitizing agent that has a side effect of photosensitivity.WARNINGWhen not monitoring SpO2, disconnect the SpO2 cable from the transmitter. Otherwise, noise from the probe sensor may interfere and incorrect data is displayed on the screen.
78 Operator’s Manual ZM-540PA/541PACAUTIONTurn off the power of mobile phones, small wireless devices and other devices which produce strong electromagnetic interference around a patient (except for devices allowed by the hospital administrator). Radio waves from devices such as mobile phones or small wireless devices may be mistaken as pulse waves and the displayed data may be incorrect.CAUTIONDo not pull or bend the probe cable, and do not put caster feet on the probe cable. Do not immerse the disposable probe cable in chemical solutions or water. Failure to follow these instructions may cause cable discontinuity, short circuit, skin burn on the patient and incorrect measurement data. Replace any broken probe with a new one.CAUTIONNormal external light does not affect monitoring but strong light such as a surgical light or sunlight may affect monitoring. If affected, cover the measuring site with a blanket.CAUTIONWhen the probe is attached on an appropriate site with sufficient circulation and the error message confirming the probe attachment repeatedly appears, the probe may be deteriorated. Replace it with a new one.CAUTIONWhen a message indicates a faulty probe, stop monitoring and replace the probe with a new one.CAUTIONWhile a patient is on medication which causes vasodilation, the pulse waveform may change and in rare cases the SpO2 value might not be displayed.NOTEIn order to maintain sufficient blood circulation, keep the measurement site warm by covering it with a blanket or something similar. Warming the site is effective, especially for a patient with a small pulse amplitude.
Operator’s Manual ZM-540PA/541PA 79Monitoring SpO2 during NIBP MeasurementCAUTIONNIBP and SpO2 can be measured on the same limb, but the SpO2 monitoring might not be accurate during NIBP measurement. Be careful when reading the SpO2 values.When the SpO2 probe is attached to the same limb as the NIBP cuff, the blood flow decreases during NIBP measurement and pulse wave cannot be detected and SpO2 cannot be monitored properly. When “INHIBIT SpO2 DURING NIBP” on the PARAMETER SETUP screen is set to ON (factory default setting), SpO2 monitoring is paused during NIBP measurement to avoid SpO2 alarm occurrence. However, when monitoring SpO2 on the same limb as NIBP, be careful when reading SpO2 values.When monitoring SpO2 is important, attach the probe to the limb to which the NIBP cuff or catheter is not attached.When SpO2 monitoring is paused during NIBP measurement, the SpO2 value just before the start of NIBP measurement and an mark are displayed on the transmitter for 30 seconds.When NIBP measurement is not completed after 30 seconds, “– – –” is displayed for the SpO2 value. The same data also appears on the monitor screen.NOTE• When continuous SpO2 monitoring is necessary, attach the probe to the limb to which the NIBP cuff is not attached and set “INHIBIT SpO2 DURING NIBP” on the PARAMETER SETUP screen to OFF.• When the probe is attached to the same limb as the NIBP cuff, set the sync source to a parameter other than SpO2 on the receiving monitor.• When monitoring SpO2 during STAT NIBP measurement, attach the probe to the limb to which the NIBP cuff is not attached.
80 Operator’s Manual ZM-540PA/541PANIBP MonitoringSelecting the Initial Cuff Inflation PressureThe initial cuff inflation pressure can be changed on the PARAMETER SETUP screen. The default setting is 180 mmHg. To change the setting, refer to the “Changing PARAMETER SETUP Settings” section.Selecting the Measurement Mode and IntervalMeasurement ModesThere are three measurement modes: manual, auto and STAT. The selected mode or interval is displayed on the screen.The measurement mode and interval can be changed by pressing the NIBP Interval key.When the key is pressed, the NIBP mode setting screen appears. The measurement modes selected at “SELECTABLE INTERVALS” on the PARAMETER SETUP screen are displayed (key color: white). Select the measurement mode with the ▼ and ▼ keys or NIBP Interval key and press the Function key.Selected mode (key color: blue)Modes selected at “SELECTABLE INTERVALS” on the PARAMETERS SETUP screen (key color: white)To select the modes to be displayed on the NIBP mode setting screen, refer to the “Changing PARAMETER SETUP Settings” section.Manual MeasurementIn Manual mode, a single NIBP measurement is performed when the NIBP Start/Stop key is pressed.STAT (Continuous) MeasurementIn STAT mode, measurement is continuously repeated for 15 minutes after the NIBP Start/Stop key is pressed.When the STAT measurement for 15 minutes is completed, the measurement mode automatically changes to the Manual mode or Auto mode of selected interval depending on the “NIBP MODE
Operator’s Manual ZM-540PA/541PA 81AFTER STAT” setting on the PARAMETER SETUP screen. The default setting is Manual mode. Refer to the “Changing Parameter Setup Settings” section.The STAT measurement completes within 15 minutes. When more than 12 minutes elapse from the start of measurement, there will be no more measurement performed and the measurement mode changes to the mode selected for “NIBP MODE AFTER STAT” on the PARAMETER SETUP screen.Auto MeasurementIn Auto mode, measurement is performed automatically at the preset time intervals.In Auto mode, a single measurement can be performed by pressing the NIBP Start/Stop key between auto measurements.Measuring NIBPWARNINGBe careful when measuring NIBP on a patient with known bleeding disorders or coagulation. After NIBP measurement, there may be dot hemorrhage, or circulatory disorder by thrombus where the cuff is attached.WARNINGNIBP measurement may be incorrect in the following cases.• When using an electrosurgical unit• When there is body movement• When the pulse wave is small (insufficient peripheral circulation)• Too many arrhythmias• When there is vibration• When there is a rapid blood pressure change• During CPRWARNINGWhen performing NIBP measurements in STAT mode or 5 minute intervals, periodically remove the cuff from the patient for ventilation. The skin temperature may increase at the cuff attachment site by 2 or 3°C (4 or 5°F). When measuring a patient with a fever or peripheral circulation insufficiency, it may cause a burn.CAUTIONWhen performing NIBP measurement repeatedly, have a rest between measurements to recover adequate circulation.
82 Operator’s Manual ZM-540PA/541PANOTE• When measuring patients who are conscious, help the patient to relax. Measurement may not be accurate if the patient’s arm is tense or if the patient talks.• The data for measurement on a leg tends to be higher than measurement on the arm. When making diagnosis based on the NIBP values, measure NIBP on an upper arm.• Do not apply pressure to the cuff or air hose. NIBP may not be measured correctly because of noise or NIBP measurement may stop due to the NIBP safety circuit.• When the transmitter is attached to the patient arm and the NIBP measurement is performed when moving, tell the patient to relax and keep quiet. Otherwise, measurement may be stopped or remeasurement is repeated due to body movement.• If there is an abnormal noise generated during measurement, stop using the transmitter and contact your Nihon Kohden representative.• Do not measure NIBP of a patient on whom an IABP is being used. Measurement may be incorrect due to the mixing of the patient’s own pulse and IABP pulse.• NIBP cannot be measured on a neonate using this transmitter.1. Press the NIBP Interval key to display the NIBP mode setting screen.NIBP Interval key2. Select the measurement mode by pressing the NIBP Interval key or ▼ and ▼ keys.Selected mode (key color: blue)3. Press the Function key.4. Press the NIBP Start/Stop key to perform measurement.
Operator’s Manual ZM-540PA/541PA 83NIBP Start/Stop key The cuff is inflated and the inflation pressure is displayed on the screen.Inflation pressure In manual mode: Measurement is performed once. In STAT mode: Measurement is performed repeatedly for 15 minutes. In auto mode: The first measurement is performed when the NIBP Start/Stop key is pressed. The second measurement is performed when the current time in the transmitter reaches the selected time interval. To stop measurement during measurement, press the NIBP Start/Stop key again. In STAT mode, after completing the STAT measurement, the measurement mode changes to the mode set for “NIBP MODE AFTER STAT” on the PARAMETER SETUP screen. In auto mode, to stop measurement in auto mode, change the mode to manual. To cancel one measurement, press the NIBP Start/Stop key during measurement.After the measurement is complete, the measured data is displayed on the screen and is transmitted to the monitor.
84 Operator’s Manual ZM-540PA/541PASystolic value Diastolic valueMAP valueNIBP measurement modeWhen ECG and SpO2 are not monitored (ECG measurement is turned off and SpO2 probe is not connected to the transmitter), the pulse rate at the end of NIBP measurement is displayed.A buzzer can be set to sound at the start and end of NIBP measurement. Refer to the “Changing PARAMETER SETUP Settings” section.Auto Mode MeasurementWhen auto mode measurement is selected, “STANDBY” message is displayed on the screen until the NIBP Start key is pressed for the first time.STANDBY message
Operator’s Manual ZM-540PA/541PA 85A time bar appears to indicate the interval between auto mode measurements.Time bar indicating the interval between measurementsDuring auto mode measurement, the measurement mode can be changed. During the interval, press the NIBP Interval key to change the mode. When “MANUAL” is displayed for more than one second, the measurement in auto mode is stopped.Data Display After NIBP MeasurementWhen the time set at “OLD NIBP DATA” on the PARAMETER SETUP screen elapses after the last measurement, the NIBP data is dimmed or hidden. Whether to dim or hide the old data can also be selected at “OLD NIBP DATA”. Refer to the “Changing PARAMETER SETUP Settings” section.Data Display on the Receiving MonitorWhen the “BATTERY” message is displayed on the receiving monitor, NIBP might not have been measured according to the NIBP interval setting. Therefore, the NIBP data displayed on the receiving monitor might not be updated. In this case, check the measurement time of the NIBP data displayed on the receiving monitor.Monitoring SpO2 during NIBP MeasurementWhen the SpO2 probe is attached to the same limb as the NIBP cuff, the blood flow decreases during NIBP measurement and pulse wave cannot be detected and SpO2 cannot be monitored properly. When “INHIBIT SpO2 DURING NIBP” on the PARAMETER SETUP screen is set to ON (factory default setting), SpO2 monitoring is paused during NIBP measurement to avoid SpO2 alarm occurrence. However, when monitoring SpO2 on the same limb as the NIBP, be careful when reading SpO2 values.
86 Operator’s Manual ZM-540PA/541PAIndication and Message ListIndicationIndication Cause CountermeasureFully charged batteries——Batteries are 2/3 full. Batteries are low. NIBP cannot be measured. Replace batteries.Batteries are very weak.Alarms on the receiving monitor were suspended by pressing the Function key on the transmitter.Alarms resume when the suspend interval elapses. To cancel alarm suspension, press the Function key again.MessagesWhen PROTOCOL on the SYSTEM SETUP screen is set to 57, all messages are transmitted.When PROTOCOL is set to 42, the messages marked with * are not transmitted.Message Cause CountermeasureAIR LEAKThe cuff and extension hose are not properly connected.Connect them properly.The cuff hose (or extension hose) is not properly connected to the NIBP socket.The cuff or extension hose is damaged. Replace with a new one.ALARMS SUSPENDEDAlarms on the receiving monitor is suspended by pressing the Function key on the transmitter.Alarms resume when the 2 minute suspend interval elapses. To cancel alarm suspension, press the Function key again.BATTERY WEAK Dead batteries Replace batteries.
Operator’s Manual ZM-540PA/541PA 87Message Cause CountermeasureCANNOT DETECT PULSE*(displayed in blue)Poor blood circulation for measuring the SpO2 value.Check the patient condition, probe attachment or change the attachment site.The probe is attached too tightly and is obstructing the blood circulation. Reattach the probe.The probe is not attached to the patient properly.Attach the probe to the patient properly.“LIGHT INTERFERENCE”, “CHECK PROBE SITE” or “DETECTING PULSE” message is displayed for more than 30 seconds.Refer to the cause and countermeasure for each message in this Messages table and remove the cause.CANNOT DETECT PULSE(displayed in pink)The patient’s pulse wave is too small to measure NIBP. Measure by palpation or auscultation.The cuff is not wrapped on the patient properly. Wrap the cuff on the patient properly.CHECK ELECTRODESElectrode lead is disconnected from the electrode.Firmly connect the electrode lead to the electrode.Electrode lead is disconnected from the transmitter.Firmly connect the electrode lead to the transmitter.Electrode lead discontinuity. Replace the electrode lead with a new one.Electrode is not firmly attached to the skin. Replace the electrode with a new one.Polarization voltage is abnormally high.CHECK PROBEThe probe is not attached to the patient properly.Attach the probe to the patient properly.The probe is not attached at the appropriate site.Attach the probe to an appropriate site indicated in the probe manual.The probe is disconnected from the transmitter.Connect the probe cable to the transmitter.The probe is past its expiration date. Replace the probe with a new one.CHECK PROBE SITE*The probe is not attached at the appropriate site.Attach the probe to an appropriate site indicated in the probe manual.The probe is deteriorated. Replace the probe with a new one.The probe is past its expiration date.CUFF OCCLUSION Transmitter malfunction.Immediately remove the cuff from the patient and contact your Nihon Kohden representative.
88 Operator’s Manual ZM-540PA/541PAMessage Cause CountermeasureDETECTING PULSESearching for the correct pulse wave for SpO2 monitoring. Wait until the pulse wave is detected.The SpO2 value cannot be obtained because the waveform is unstable. Attach the probe to the patient properly.The probe is not attached to the patient properly.HIGH CUFF PRESSEnormous pressure was applied by the pressure of the cuff. Remove the cause.INFLATION PRESS LOW Insufficient cuff inflation pressure.Wait for the remeasurement to be performed with increased cuff inflation pressure.LIGHT INTERFERENCEThe SpO2 measurement site is under fluorescent light, surgical light, sunlight, or other strong light.Cover the measurement site with a blanket or cloth.Considerable body movement.When the message is displayed frequently, check the patient condition and, if necessary, change the attachment site.The probe is not attached to the patient properly.SpO2 monitoring is paused for NIBP measurement. Wait for NIBP measurement to finish.MEAS TIME-OUTThe NIBP measuring time exceeded the specified time due to arrhythmia, body movement, vibration or, cuff or air hose being squeezed.Remove the cause if the cause is body movement, vibration or squeezing of cuff or hose.NIBP MODULE ERROR Module malfunction. Contact your Nihon Kohden representative.NO NIBP CHANGE BATTERIESNIBP cannot be measured due to low battery. Replace batteries with new ones.PATIENT CONFIRMED*Function key is pressed and the “PATIENT CONFIRMED” signal is transmitted to the receiving monitor. (When “PATIENT” is assigned as the function for the Function key on the SYSTEM SETUP screen.) ——PROBE FAILURE*The probe is past its expiration date. Replace the probe with a new one.Probe is damaged or short-circuited.
Operator’s Manual ZM-540PA/541PA 89Message Cause CountermeasureREMEASURINGNIBP is being remeasured due to arrhythmia, body movement, vibration or, cuff or air hose being squeezed.If the message still appears after remeasurement, remove the cause if the cause is body movement, vibration or squeezing of cuff or hose.SAFETY CIRCUIT ERROR The NIBP safety circuit error.Immediately remove the cuff from the patient and contact your Nihon Kohden representative.SAFETY CIRCUIT RUNNING(When this message is displayed, measurement cannot be performed for 40 seconds.)NIBP measurement stopped by the safety circuit.Check that the hose is not bent or squeezed.Wait 40 seconds, then perform remeasurement. If the message still appears, contact your Nihon Kohden representative.SpO2 MODULE ERROR* Transmitter failure. Contact your Nihon Kohden representative.SYS OUT OF RANGEThe maximum blood pressure cannot be measured even when the cuff inflation pressure exceeded 280 mmHg when using adult cuff.Measure by palpation or auscultation.WEAK PULSE*(displayed in blue)Poor peripheral circulation. Check the patient condition and change the probe attachment site.The probe is attached too tightly and is obstructing the blood circulation.Check the probe attachment condition and if necessary, reattach the probe.WEAK PULSE(displayed in pink)The patient’s pulse wave is too small to measure NIBP.Measure NIBP by palpation or auscultation.The cuff is wrapped too loosely. Wrap the cuff properly.The cuff size is not appropriate. Use the appropriate cuff.ZEROING NIBP zero balance is being adjusted. Do not touch the cuff during zeroing. Wait for the message to disappear.
90 Operator’s Manual ZM-540PA/541PAMessage Display PriorityWhen more than one message condition occurs on the transmitter, only the message with the highest priority is displayed.Priority MessageHighest PATIENT CONFIRMEDSAFETY CIRCUIT RUNNINGCUFF OCCLUSIONPROBE FAILURECHECK ELECTRODESNIBP MODULE ERRORSYS OUT OF RANGEHIGH CUFF PRESSAIR LEAKMEAS TIME OUTCANNOT DETECT PULSE (NIBP)SpO2 MODULE ERRORCHECK PROBECHECK PROBE SITECANNOT DETECT PULSE (SpO2)LIGHT INTERFERENCEREMEASURINGINFLATION PRESS LOWWEAK PULSE (NIBP)ZEROINGNO NIBP CHANGE BATTERIESDETECTING PULSEWEAK PULSE (SpO2)ALARMS SUSPENDEDLowest BATTERY WEAK
Operator’s Manual ZM-540PA/541PA 91TroubleshootingIf a problem occurs, use the following to find and fix it. If the problem still remains after checking the following, contact your Nihon Kohden representative.TransmitterProblem Cause CountermeasureNothing is displayed on the LCD after turning the power on.Batteries are not installed correctly. The battery polarity is wrong.Install the batteries correctly.Batteries are completely discharged.Replace the batteries with new ones.LCD is difficult to see (too dark or too light).LCD brightness is not appropriate.Change the LCD brightness on the SYSTEM SETUP screen. Refer to the “Changing SYSTEM SETUP Settings” section.Nothing is displayed on the receiving monitor after turning the transmitter power on.The channel of the transmitter and monitor does not match.Set the correct channel on the monitor.The software version of the multiple patient receiver or central monitor is old.Upgrade the multiple patient receiver or central monitor software to receive signal from the transmitter. The software version must be 01-09 or later.Protocol on the transmitter and monitor does not match.Set the same protocol on the transmitter and monitor.Protocol on the transmitter is set to 57 but the monitor cannot receive protocol 57.Set the protocol on the transmitter to 42. Refer to the “System Setup Setting List” section.Signal receiving condition is poor.Another transmitter with the same channel is used nearby.Turn the transmitter power off. If the monitor still receives a signal, there is a high probability that another transmitter of the same channel is used nearby.Follow the instruction of your channel administrator and use another transmitter with a different channel.Signals of another patient are mixing.Follow the instructions of your channel administrator and use another transmitter of a different channel.The transmitter is damaged. Contact your Nihon Kohden representative.
92 Operator’s Manual ZM-540PA/541PAECG/RespirationProblem Cause CountermeasureThe heart rate is unstable.Pacing detection setting on the monitor is not correct.Turn off the pacing detection setting on the monitor. When monitoring a pacemaker patient, turn on pacing detection.The “CHECK ELECTRODES” message appears on the receiving monitor.Electrode lead is disconnected from the electrode.Firmly connect the electrode lead to the electrode.Electrode lead discontinuity Replace the electrode lead with a new one.Electrode is not firmly attached to the skin.Replace the electrode with a new one.Polarization voltage is abnormally high.Use Nihon Kohden specified electrodes.ECG baseline is thick (AC hum)The gel on the electrode is dried out.Replace the electrode with a new one.The gel on the electrode is coming off.An electric blanket is used. Cover the blanket with a shield cover.The hum filter is set to OFF on the monitorSet the filter to ON.The heart rate of a patient who is using an electric blanket is unstable on the receiving monitor.Pacing pulse detection is turned ON on the receiving monitor.Turn OFF the pacing pulse detection on the receiving monitor.No heart rate or ECG is displayed.“ECG MEASUREMENT” on the PARAMETER SETUP screen is set to OFF.If ECG monitoring is necessary, set “ECG MEASUREMENT” to ON.Respiration waveform measurement is unstable.The gel on the electrode is dried out.Replace the electrode with a new one.The gel on the electrode is coming off.No respiration rate is displayed.“RESP MEASUREMENT” on the PARAMETER SETUP screen is set to OFF.If respiration monitoring is necessary, set “RESP MEASUREMENT” to ON.
Operator’s Manual ZM-540PA/541PA 93SpO2 Problem Cause CountermeasureSpO2 data is unstable and not reliable.The probe size is not appropriate for the patient.Use the appropriate probe for the patient.Probe attachment condition is poor. The probe is partly detached from the skin. External light is entering the probe.Firmly attach the probe according to the procedure in the probe operator’s manual.Measurement site is dirty. Patient is wearing nail polish.Remove dirt and nail polish.The probe is attached to the same limb that is used for NIBP measurement.Attach the probe to the opposite limb. Avoid a site where blood circulation condition changes greatly.NIBPProblem Cause CountermeasureCuff inflation pressure is less than 10 mmHg.The cuff hose is not connected to the NIBP socket properly.Connect the cuff hose to the socket properly.The cuff is not wrapped around the arm or is wrapped too loosely.Wrap the cuff around the upper arm.The cuff does not inflate when the NIBP Start/Stop key is pressed.The cuff hose is not connected to the NIBP socket.Connect the cuff hose to the socket firmly.The cuff hose or extension hose may be folded or squeezed when the cuff pressure display on the screen increases quickly but the actual cuff does not inflate.Check the cuff hose and air hose.Abnormal measurement results are displayed.The cuff size is not correct. Select the cuff which fits the patient’s limb circumference.The cuff is not wrapped around the arm correctly.Wrap the cuff around the upper arm, not too tightly or too loosely.NIBP data is not correct because of body movement.Prevent the patient from moving during measurement.Vibration on the cuff. Check that nothing is touching the cuff during measurement.Change the measuring site.
94 Operator’s Manual ZM-540PA/541PAProblem Cause CountermeasureThe cuff is suddenly deflated during inflation.The NIBP Start/Stop key is pressed during inflation. —Auto mode measurement does not start even when the time interval has passed.The NIBP Interval key is pressed and the measurement mode is changed.Check the measurement mode and interval.The cuff suddenly inflates.The measurement mode is set to auto mode.Check the time interval. If necessary, stop measurement.Cannot connect cuff to the air hose.Unspecified cuff is used. Use a cuff specified by Nihon Kohden.Cannot measure NIBP. Vibration on the cuff. Check that nothing is touching the cuff during measurement.The cuff hose or extension hose is bent or squeezed.Remove the cause.The cuff has worn out. Use a new cuff.Blood congestion occurs.Measuring over a long period of time at short intervals.Increase the measuring interval.Do not measure NIBP over a long time.Thrombus occurs. Measuring on a patient with known bleeding disorders or coagulation.Do not perform NIBP measurement on such a patient.NIBP data on the screen is --- or dark.The time set for “OLD NIBP DATA” on the PARAMETER SETUP screen elapsed from the last measurement.When NIBP is measured again, the data is displayed in normal brightness.Three loud pip sounds indicating NIBP measurement cannot be started.The cuff is not deflated enough to start another measurement.Wait 30 seconds and measure again.
Operator’s Manual ZM-540PA/541PA 95MaintenanceTo use the transmitter in safe and optimum condition, perform maintenance check every six months.The following units are necessary for some checking items.• AX-400G Vital Sign Simulator• AX-300T SpO2 Checker• Electric or mercury manometer• 700 mL dummy cuff• Receiving monitorCAUTIONNever disassemble or repair the transmitter. Disassembly and repair must be performed by qualified service personnel.NOTE• The measurement accuracy of the above units must be managed to perform accurate maintenance check.• For details on the operation of the above units, refer to the manuals provided with these units.A maintenance check sheet is provided at the end of this section. Make a copy of this check sheet before performing maintenance check.1. External Check• There is no damage or dirt on the outside of the transmitter.• The battery case cover is not damaged, the spring is firmly attached and the battery case cover can be closed firmly.• No keys are damaged.• NIBP socket is not damaged.• No electrode leads are damaged.• There are no blood or chemicals on the transmitter.2. Transmitter Channel• The channel number label on the transmitter is not torn or removed.• The channel of the transmitter matches the label. The transmitter channel is displayed in the upper left corner of the screen. The channel number also appears on the startup screen.
96 Operator’s Manual ZM-540PA/541PAChannel numberStartup screen Numeric and waveform screen3. Transmitting/Receiving SignalUse the AX-400G vital sign simulator and receiving monitor.1. Connect the vital sign simulator to the transmitter.AX-400G2. Place the transmitter 2 to 3 m from the receiving monitor.3. Set the channel on the receiving monitor to the channel of the transmitter.4. Turn on the transmitter and vital sign simulator.5. Check that the ECG of the transmitter appears on the receiving monitor.6. Turn off the transmitter.7. Check that the ECG disappears from the receiving monitor.4. DisplayCheck that there are no dots missing on the screen.1. Turn off the transmitter.2. While pressing the Function key, turn on the transmitter. The MENU screen appears.
Operator’s Manual ZM-540PA/541PA 973. Press the ▼ key to move the cursor to “MANUAL CHECK” and press the Function key.Cursor4. Press the ▼ or ▼ key to move the cursor to “LCD TEST” and press the Function key. 5. Each time the ▼ key is pressed, the screen changes as below. Check that no dots are missing. → → → → red → green → blue → → . . .6. Press the Screen key to return to the MANUAL CHECK screen.7. Press the Screen key again to return to the MENU screen.
98 Operator’s Manual ZM-540PA/541PA5. Key Operation1. Turn off the transmitter.2. While pressing the Function key, turn on the transmitter. The MENU screen appears.3. Press the ▼ key to move the cursor to “MANUAL CHECK” and press the Function key.Cursor4. Press the ▼ or ▼ key to move the cursor to “KEY CHECK” and press the Function key.5. Press each key one at a time and check that the pressed key is highlighted on the screen.Example: when the Function key is pressed, the key name is highlighted6. After checking, press and hold the Screen key to return to the MANUAL CHECK screen.
Operator’s Manual ZM-540PA/541PA 996. ECG Check1. Connect the vital sign simulator to the transmitter.AX-400G2. Place the transmitter 1 m from the receiving monitor.3. Turn on the transmitter and vital sign simulator.4. Check that the ECG of the transmitter appears on the receiving monitor.7. Respiration Check1. Connect the vital sign simulator to the transmitter.AX-400G2. Place the transmitter 1 m from the receiving monitor.3. Turn on the transmitter and vital sign simulator.4. Check that the respiration waveform of the transmitter appears on the receiving monitor.
100 Operator’s Manual ZM-540PA/541PA8. SpO2 Check1. Connect the SpO2 checker to the transmitter.AX-300T2. Place the transmitter 1 m from the receiving monitor.3. Turn on the transmitter and SpO2 checker.4. Check that the pulse bar graph appears on the transmitter screen.5. Check that SpO2 and pulse rate on the transmitter is within the following range.SpO2 on the SpO2 Checker RangeSpO297% 95 to 99%SpO2 (±2 digit)80% 78 to 82%SpO2 (±2 digit)70% 67 to 73%SpO2 (±3 digit)Pulse rate 60 beats/min 57 to 62 beats/min (±3%/±1 beat/min)120 beats/min 115 to 124 beats/min (±3%/±1 beat/min)NOTEThe above range includes the error margin of the SpO2 checker. Therefore, the range is ±1 digit outside the SpO2 measuring accuracy of the transmitter in the “Specifications” section.6. Check that the SpO2 and pulse waveform of the transmitter appear on the receiving monitor.
Operator’s Manual ZM-540PA/541PA 1019. NIBP CheckCheck that the transmitter displays the correct cuff pressure and that there is no air leak. The following procedure uses an electric manometer.1. Connect the electric manometer and dummy cuff to the transmitter.NOTEAir leaks from the rubber ball during inflation. Use a clip on the air hose of the rubber ball to stop air leaking.Electric manometer Dummy cuff (700 cc)ClipRubber ball2. Turn on the electric manometer.3. While pressing the Function key, turn on the transmitter. The MENU screen appears.4. Press the ▼ key to move the cursor to “MANUAL CHECK” and press the Function key.Cursor
102 Operator’s Manual ZM-540PA/541PA5. Press the ▼ or ▼ key to move the cursor to “NIBP HARDWARE TEST” and press the Function key.6. Press the ▼ or ▼ key to move the cursor to “AIR LEAK TEST” and press the Function key.7. Press the ▼ or ▼ key to move the cursor to “AIR LEAK (AUTO)” and press the Function key. The transmitter inflates the cuff up to about 250 mmHg and measures air leakage from 60 seconds to 120 seconds after inflation.
Operator’s Manual ZM-540PA/541PA 1038. Check the following.• The value for “AIR LEAK (AUTO)” is below 10 mmHg.• The difference between the pressure value displayed on the manometer and transmitter is within ±6 mmHg.10. NIBP Cuff for Attaching Transmitter to Patient ArmThe NIBP cuff is a consumable. Check the following and when necessary, replace it with a new one.Appearance• There are no dirty parts.• There are no broken stitches on the cuff.• The label on the cuff is readable.• The velcro tape on the cuff is not removed and there are no broken stitches.• The lock plate is not damaged and functions properly.Inflation bag• The inflation bag is not torn or damaged.• There is no water inside the inflation bag.• The connector on the inflation bag is not damaged.
104 Operator’s Manual ZM-540PA/541PAMaintenance Check SheetHospital/Organization: Service Personnel: Instrument Name: TransmitterInstrument Model: ZM-540PA/ZM-541PAInstrument Serial Number: Hardware Revision Number: Software Revision Number: 1. External Check OK No2. Transmitter Channel OK No3. Transmitting/Receiving Signal OK No4. Display OK No5. Key Operation OK No6. ECG Check OK No7. Respiration Check OK No8. SpO2 Check OK No9. NIBP Check OK No10. NIBP Cuff for Attaching Transmitter to Patient Arm OK NoOverall Judgement□ OK□ Can be used but needs maintenance□ Maintenance required. Cannot be used.
Operator’s Manual ZM-540PA/541PA 105Lifetime and DisposalCAUTIONDispose of the transmitter, options and accessories as specified by Nihon Kohden. Otherwise, it causes infection or environmental contamination.Disposing of Used BatteriesBattery LifetimeReplace the batteries when the battery replacement indication appears on the transmitter. When using rechargeable batteries, recharge them.DisposalNOTERemove the batteries before disposing of the transmitter.Before disposing of the batteries, check with your local solid waste officials for details in your area for proper disposal. It may be illegal to dispose of these batteries in the municipal waste stream.Disposing of Electrodes, SpO2 Probes and NIBP CuffsRefer to the manual for each item.Disposing of TransmitterRemove the batteries from the transmitter and dispose of the transmitter following your local laws for disposal.
106 Operator’s Manual ZM-540PA/541PACleaning, Disinfection and SterilizationTransmitter and Electrode LeadsCAUTIONThis transmitter is not waterproof. If detergent or liquid spills into the transmitter, stop cleaning or disinfecting it and contact your Nihon Kohden representative. The transmitter needs to be checked for safety and function before use.NOTEThe transmitter cannot be sterilized. Sterilizing the transmitter may damage it.Before cleaning or disinfecting, remove the batteries from the transmitter. Be careful not to let any liquid get inside the transmitter.CleaningWipe the transmitter and electrode leads with a soft cloth moistened with disinfecting alcohol or neutral detergent diluted with water. After cleaning, dry them completely.Use cotton swab moistened with neutral detergent diluted with water to clean inside the battery compartment. DisinfectionCAUTIONDo not immerse the electrode lead connector in liquid.Wipe the outside surface of the transmitter and electrode lead with a non-abrasive cloth moistened with any of the disinfectants listed below. For details on the disinfectants, refer to the instruction provided with the disinfectants. Use the recommended concentration. Disinfectant Concentration (%)Glutaraldehyde solution 2.0Alkyldiaminoethylglycine hydrochloride 0.5Benzalkonium chloride 0.2Benzethonium chloride solution 0.2Chlorhexidine gluconate solution 0.5
Operator’s Manual ZM-540PA/541PA 107SpO2 ProbeRefer to the probe manual.YP-503P/YP-504P NIBP CuffsNOTE• Do not autoclave the cuff.• Use only glutaraldehyde solution.• Never allow liquid to get inside the inflation bag.• Do not sterilize or disinfect the cuff with ultraviolet light or ozone.CleaningTo clean the cuff, remove the lock plate and carefully pull out the inflation bag from the cloth cover.Cloth cover: Wash with neutral detergent and water. Thoroughly dry it. When washing in a washing machine, put it in a net.Inflation bag: Wipe with a soft cloth or cotton moistened with isopropyl alcohol. Thoroughly dry it.DisinfectionTo disinfect the cuff, use glutaraldehyde solution. Use the recommended concentration of the disinfectant. Refer to the disinfectant manual for details. After disinfection, clean the cuff as described above.Repair Parts Availability PolicyNihon Kohden Corporation (NKC) shall stock repair parts (parts necessary to maintain the performance of the instrument) for a period of 8 years from the date of delivery. In that period NKC or its authorized agents will repair the instrument. This period may be shorter than 8 years if a board or part necessary for the faulty section is not available.
108 Operator’s Manual ZM-540PA/541PASpecificationsZM-540PAMeasuring ParametersMeasuring waveforms: ECG, respiration in impedance method, pulseMeasuring numeric data: Heart rate, respiration rate, SpO2, NIBP, pulse rateTransmitting DataWaveform data: ECG, respiration, pulse waveNumeric data: SpO2, NIBP, pulse rateStatus information: Battery replacement, battery level*, alarm suspended, pause monitoring*, patient confirmed*, ECG lead, pacing detection, electrode detachment, electrode impedance*, ECG off*, respiration method (impedance)*, SpO2 status, NIBP status, channel ID, time constant (3.2 s), type of transmitter, transmitter code number*, transmitter serial number** The items marked with * are transmitted only when the protocol is “57”.DisplayDisplay size: 2.2 inch TFT color LCDViewing area: 44.16 (H) × 33.12 (V) mmResolution: 320 (H) × 240 (V) dotsDisplayed DataNumeric and waveform screen: ECG (one waveform from lead I, II, III, Va or Vb), heart rate, pulse rate, respiration rate, SpO2, NIBP (systolic, diastolic, MAP), message, battery level, QRS/pulse sync mark, pulse bar graph, NIBP measurement mode and status information, ECG leadWaveform review screen: ECG or pulse wave of past 10 minutesNumeric review screen: Heart rate or pulse rate, respiration rate and SpO2 at 1 minute interval for past 10 minutesCheck electrodes screen: ECG for checking electrode attachmentECGECG measurementChannels: 4
Operator’s Manual ZM-540PA/541PA 109Input dynamic range: ±10 mV or moreElectrode offset potential tolerance: ±500 mV or moreInput impedance: 5 MΩ or moreCommon mode rejection ratio: 95 dB or more IEC 60601-2-27 50.102.10 compliedPacing pulse detection: amplitude ±2 to 700 mV, duration 0.1 to 2 ms IEC 60601-2-27: 2005 complied Based upon pacemaker pulse rejection capabilityDefibrillation-proof: ECG input protected against 400 Ws/DC 5 kV IEC 60601-2-27 17.101 compliedECG recovery time after defibrillation: within 10 sElectrode condition: Displays CHECK ELECTRODES messageTall T-wave rejection capability: Complies with the heights of T-waves from 0 to 1.6 mV IEC 60601-2-27: 2005 50.102.17 compliedPacemaker pulse rejection capability, without overshoot: Complies with the amplitudes of pacemaker pulses ±2 to ±700 mV and widths 0.1 to 2 ms (As defined by method B of IEC 60601-2-27: 2005 50.102.13, this corresponds to the pacemaker pulses amplitudes and widths of ±2.8 mV/2 ms to amplitudes ±45.6 mV/0.1 ms.)Pacemaker pulse rejection capability, with overshoot:Overshoot amplitudes and time constants of ±0.12 mV/100 ms to ±2 mV/4 ms (As defined by method B of IEC 60601-2-27: 2005 50.102.13, this corresponds to the pacemaker pulses amplitudes and widths of ±2.8 mV/2 ms to amplitudes ±45.6 mV/0.1 ms.)ECG display and heart rate countFrequency characteristic: filter on: 1 to 18 Hz, filter off: 0.05 to 60 HzHeart rate detection method: AverageQRS detection: 70 to 120 ms: amplitude ≥ 0.5 mV, rate 30 to 200 beats/min 40 to 120 ms: amplitude ≥ 0.5 mV, rate 30 to 250 beats/minHeart rate counting range: 0, 15 to 300 beats/minHeart rate counting accuracy*: ±2 beats/min, (0, 15 to 300 beats/min)* Essential performance of this transmitterRespiration MeasurementMeasuring method: Impedance methodMeasuring lead: Between R and FImpedance range: 2 kΩ or lessRespiration rate measuring accuracy*: ±2 counts/min (at 0 to 150 counts/min)Respiration rate counting range: 0 to 150 counts/min* Essential performance of this transmitter
110 Operator’s Manual ZM-540PA/541PASpO2 Measurement (ISO 9919: 2005 complied)Measuring range: 0 to 100%SpO2 Declared range: 70 to 100%SpO2Minimum display range: 1%SpO2Display update cycle: Every 3 secondsMeasuring accuracy (rms)*: Accuracy assurance temperature: 18 to 40ºCTotal accuracy including probe: 80%SpO2 ≤ %SpO2 ≤ 100%SpO2: ±2%SpO2 70%SpO2 ≤ %SpO2 < 80%SpO2: ±3%SpO2 under 70%SpO2: not specifiedAccuracy of the transmitter: 80%SpO2 ≤ %SpO2 ≤ 100%SpO2: ±1%SpO2 50%SpO2 ≤ %SpO2 < 80%SpO2: ±2%SpO2 under 50%SpO2: not specifiedPulse rate measuring range: 30 to 300 bpmPulse rate display range: 30 to 300 bpmPulse rate accuracy (rms)*: ±3% ±1 bpm* Essential performance of this transmitterNOTE• The SpO2 measuring accuracy was tested using the TL-201T, TL-260T, TL-271T and TL-631T SpO2 probes. The testing was performed during induced hypoxia on healthy volunteers (Ethnicity: 10 Caucasians, 2 Africans, 1 Asian and 3 Indians), (Skin: 8 light, 4 medium, 4 dark), (Age: 21 to 34), (5 women and 11 men) under the condition of no motion. Arterial blood was sampled and measured by a CO-oximeter. The difference between SpO2 measured by the SpO2 probe and functional SaO2 measured by a CO-oximeter was calculated using the root-mean-square (rms) method according to ISO 9919: 2005. This measurement accuracy figure represents 2/3 of all test measurements.• A pulse oximeter tester that generates simulated signals can be used to check the difference from the design specification, but it cannot be used as a replacement for human signals for testings accuracy.Response time: Selectable from “Slow”, “Normal” and “Fast”. The following graphs show the response time example when SpO2 changes 0.6%/s.
Operator’s Manual ZM-540PA/541PA 111Pulse Rate = 70 bpm60657075808590951000 10 20 30 40 50 60 70 80 90 100 110 120 130 140Time (seconds)SpO2 (%)SpO2 Reference SpO2 Fast SpO2 Normal SpO2 Slow60657075808590951000 10 20 30 40 50 60 70 80 90 100 110 120 130 140SpO2 Reference SpO2 Fast SpO2 NormalPulse Rate = 140 bpmTime (seconds)SpO2 (%)SpO2 Slow The following graph shows the response time example when pulse rate changes 10 bpm/s.SpO2 = 97607080901001101201301401500 102030405060708090100110120Time (seconds)PR (bpm)PR ReferencePR
112 Operator’s Manual ZM-540PA/541PANon Invasive Blood Pressure, NIBP (IEC 60601-2-30: 1999 complied)Measuring method: OscillometricMeasurement mode: Manual, STAT (≤ 15 min), PeriodicIntended patient type: Adult, childMeasuring range: 0 to 300 mmHgPressure display range: 0 to 300 mmHgMeasuring accuracy*: ±3 mmHg (0 mmHg ≤ NIBP ≤ 300 mmHg) AAMI SP-10: 2002 compliedCuff inflation time: ≤ 20 s (700 cc), 0 to 200 mmHg ≤ 15 s (70 cc), 0 to 200 mmHgPressure retention: ≤ 5 mmHg (250 cc at 250 mmHg inflation for 10 seconds)Air leakage: ≤ 3 mmHg/min (700 cc at 300 mmHg inflation)Power discontinuity: Deflate immediately after power downSafety Maximum pressurization value cuff inflation limiter: 300 to 330 mmHg Cuff inflation time limiter: ≤ 180 s Interval time limiter: ≤ 30 s* Essential performance of this transmitterTransmitterFCC regulation: FCC part 95 Subpart H Wireless Medical Telemetry Service (WMTS)Field strength limits: < 200 mV/m (at 3 m)Undesired emissions: below 960 MHz: < 200 μV/m (at 3 m) above 960 MHz: < 500 μV/m (at 3 m)Antenna: InternalTransmission channel: Indicated on the transmitterTransmission frequency range: 608.0250 to 613.9750 MHzChannel spacing: 50 kHz or 37.5 kHz (12.5 kHz when interleaved)Modulation: FSK (frequency shift keying)Type of emission: F1DOccupied bandwidth: < 20 kHzEffective radiated power: 1.0 mWPower RequirementsRated voltage: 3.6 VOperating voltage: 3.2 to 4.8 VBattery type: Three AA (R6) type NiMH secondary batteries Three AA (R6) type alkaline dry cell primary batteriesBattery lifetime (with alkaline batteries, at room temperature): approximately 1 day (measuring ECG, respiration, SpO2 of approximately 60 kg weight adult male patient at the index finger, NIBP at 60 minute intervals)
Operator’s Manual ZM-540PA/541PA 113Dimension and WeightDimension: 114 W × 125 H × 63 D (mm)Weight: about 340 g (excluding batteries and other accessories) about 410 g (including batteries, excluding other accessories)EnvironmentOperating environmentTemperature: 5 to 40°C, 41 to 104°FHumidity: 30 to 85% (noncondensing)Atmospheric pressure: 700 to 1060 hPaStorage and transport environmentTemperature: −20 to +65°C, −4 to +149°FHumidity: 10 to 95%Atmospheric pressure: 700 to 1060 hPaSafety StandardsSafety standard: CAN/CSA-C22.2 No. 601-1 M90 CAN/CSA-C22.2 No. 601-1. 1S1-94 CAN/CSA-C22.2 No. 601-1. 1B-90 CAN/CSA-C22.2 No. 60601-2-49-04 CAN/CSA-C22.2 No. 60601-2-27-06 CAN/CSA-C22.2 No. 60601-2-30-02 IEC 60601-1:1988 IEC 60601-1 Amendment 1: 1991 IEC 60601-1 Amendment 2: 1995 IEC 60601-2-27: 2005 IEC 60601-2-30: 1999 IEC 60601-2-49: 2001 ISO 9919: 2005Type of protection against electrical shock: INTERNALLY POWERED EQUIPMENTDegree of protection against electrical shock:ECG and impedance method respiration: DEFIBRILLATION-PROOF TYPE CF APPLIED PARTSpO2 and NIBP: DEFIBRILLATION-PROOF TYPE BF APPLIED PARTDegree of protection against harmful ingress of water: IPX0 (Ordinary equipment)Degree of safety of application in the presence of a FLAMMABLE ANAESTHETIC MIXTURE WITH AIR, OR WITH OXYGEN OR NITROUS OXIDE: Equipment not suitable for use in the presence of FLAMMABLE ANAESTHETIC MIXTURE WITH AIR, OR WITH OXYGEN OR NITROUS OXIDE
114 Operator’s Manual ZM-540PA/541PAMode of operation: CONTINUOUS OPERATIONElectromagnetic CompatibilityIEC 60601-1-2: 2001IEC 60601-1-2 Amendment 1: 2004Electromagnetic EmissionsThis Model ZM-540PA is intended for use in the electromagnetic environment specified below.The customer or the user of the ZM-540PA should assure that it is used in such an environment.Emissions test Compliance Electromagnetic environment - guidanceRF emissionsCISPR 11Group 1 The ZM-540PA uses RF energy only for its internal function. Therefore, its RF emissions are very low and are not likely to cause any interference in nearby electronic equipment.RF emissionsCISPR 11Class B The ZM-540PA is suitable for use in all establishments, including domestic establishments.Harmonic emissionsIEC 61000-3-2Not applicableVoltage fluctuations/flicker emissionsIEC 61000-3-3Not applicable
Operator’s Manual ZM-540PA/541PA 115Electromagnetic ImmunityThis Model ZM-540PA is intended for use in the electromagnetic environment specified below.The customer or the user of the ZM-540PA should assure that it is used in such an environment.Immunity test IEC 60601 test levelCompliance levelElectromagnetic environment - guidanceElectrostatic discharge (ESD)IEC 61000-4-2±6 kV contact±8 kV air±6 kV contact±8 kV airFloors should be wood, concrete or ceramic tile. If floors are covered with synthetic material, the relative humidity should be at least 30%.Electrical fast transient/ burstIEC 61000-4-4±2 kV for power supply lines±1 kV for input/output linesNot applicable—SurgeIEC 61000-4-5±1 kV differential mode±2 kV common modeNot applicable—Voltage dips, short interruptions and voltage variations on power supply input linesIEC 61000-4-11<5% UT (>95% dip in UT) for 0.5 cycle40% UT (60% dip in UT) for 5 cycles70% UT (30% dip in UT) for 25 cycles<5% UT (>95% dip in UT) for 5 sNot applicable—Power frequency(50/60 Hz)magnetic fieldIEC 61000-4-83 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.NOTE: UT is the AC mains voltage prior to application of the test levelAvoiding Electromagnetic Interference (Impedance Respiration)Impedance respiration measurement is very sensitive and affected by electromagnetic interference. Technological limitations do not allow immunity levels higher than 1 V/m for radiated RF electromagnetic fields. Electromagnetic fields with field strengths above 1 V/m may cause measurement error. Do not use electrically radiating equipment near the impedance respiration measurements.
116 Operator’s Manual ZM-540PA/541PAImmunity test IEC 60601 test levelCompliance levelElectromagnetic environment - guidanceConducted RF IEC 61000-4-6Radiated RFIEC 61000-4-33 Vrms150 kHz to 80 MHz3 V/m 80 MHz to 2.5 GHz3 Vrms3 V/m 80 MHz to 2.5 GHz(1 V/m 80 MHz to 2.5 GHz for respiration)Portable and mobile RF communications equipment should be used no closer to any part of the ZM-540PA, including cables, than the recommended separation distance calculated from the equation applicable to the frequency of the transmitter. Recommended separation distanced = 1.2㺕P d = 1.2㺕P 80 MHz to 800 MHzd = 2.3㺕P 800 MHz to 2.5 GHz(d = 3.5㺕P 80 MHz to 800 MHz for respirationd = 7.0㺕P 800 MHz to 2.5 GHz for respiration)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 deter mined by an electromagnetic site survey*1, should be less than the compliance level in each frequency range*2.Interference may occur in the vicinity of equipment marked with the following symbol:NOTE 1: At 80 MHz and 800 MHz, the higher frequency range applies.NOTE 2: These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects and people. *1 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 considered. If the measured field strength in the location in which the ZM-540PA is used exceeds the applicable RF compliance level above, the ZM-540PA should be observed to verify normal operation. If abnormal performance is observed, additional measures may be necessary, such as re-orienting or relocating the ZM-540PA.*2 Over the frequency range 150 kHz to 80 MHz, field strengths should be less than 1 V/m for respiration and 3 V/m for all other functions.
Operator’s Manual ZM-540PA/541PA 117Recommended Separation Distances between Portable and Mobile RF Communications EquipmentThe ZM-540PA is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled. The customer or the user of the ZM-540PA can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment (transmitters) and the ZM-540PA as recommended below, according to the maximum output power of the communications equipment.Rated maximum output power of transmitter(W)Separation distance according to frequency of transmitter (m)150 kHz to 80 MHzd = 1.2㺕P80 MHz to 800 MHzd = 1.2㺕P(For respiration:d = 3.5㺕P)800 MHz to 2.5 GHzd = 2.3㺕P(For respiration:d = 7.0㺕P)0.01 0.12 0.12 (0.35*) 0.23 (0.7*)0.1 0.38 0.38 (1.1*) 0.73 (2.2*)1 1.2 1.2 (3.5*) 2.3 (7.0*)10 3.8 3.8 (11*) 7.3 (22*)100 12 12 (35*) 23 (70*)For transmitters rated at a maximum output power not listed above, the recommended separation distance d in meters (m) can be estimated using the equation applicable to the frequency of the transmitter, where P is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer. (* For respiration)NOTE 1 At 80 MHz and 800 MHz, the separation distance for the higher frequency range applies. NOTE 2 These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects and people.Recovery Time after DefibrillationThe transmitter returns to the normal operating mode within 10 seconds after defibrillation. The stored settings are not affected.System Composition for EMC TestThe ZM-540PA bedside monitor is tested to comply with IEC 60601-1-2: 2001 with the following composition.Units Cable lengthZM-540PA transmitter —YP-503P NIBP cuff 0.15 mBR-906P ECG electrode lead 0.8 mTL-201T finger probe 1.6 m
118 Operator’s Manual ZM-540PA/541PAZM-541PAMeasuring ParametersMeasuring waveforms: ECG, respiration in impedance method, pulseMeasuring numeric data: Heart rate, respiration rate, SpO2, NIBP, pulse rateTransmitting DataWaveform data: ECG, respiration, pulse waveNumeric data: SpO2, NIBP, pulse rateStatus information: Battery replacement, battery level*, alarm suspended, pause monitoring*, patient confirmed*, ECG lead, pacing detection, electrode detachment, electrode impedance*, ECG off*, respiration method (impedance)*, SpO2 status, NIBP status, channel ID, time constant (3.2 s), type of transmitter, transmitter code number*, transmitter serial number** The items marked with * are transmitted only when the protocol is “57”.DisplayDisplay size: 2.2 inch TFT color LCDViewing area: 44.16 (H) × 33.12 (V) mmResolution: 320 (H) × 240 (V) dotsDisplayed DataNumeric and waveform screen: ECG (one waveform from lead I, II, III, Va or Vb), heart rate, pulse rate, respiration rate, SpO2, NIBP (systolic, diastolic, MAP), message, battery level, QRS/pulse sync mark, pulse bar graph, NIBP measurement mode and status information, ECG leadWaveform review screen: ECG or pulse wave of past 10 minutesNumeric review screen: Heart rate or pulse rate, respiration rate and SpO2 at 1 minute interval for past 10 minutesCHECK ELECTRODE screen: ECG for checking electrode attachmentECGECG measurementChannels: 4Input dynamic range: ±10 mV or moreElectrode offset potential tolerance: ±500 mV or moreInput impedance: 5 MΩ or moreCommon mode rejection ratio: 95 dB or more IEC 60601-2-27 50.102.10 complied
Operator’s Manual ZM-540PA/541PA 119Pacing pulse detection: amplitude ±2 to 700 mV, duration 0.1 to 2 ms IEC 60601-2-27: 2005 complied Based upon pacemaker pulse rejection capabilityDefibrillation-proof: ECG input protected against 400 Ws/DC 5 kV IEC 60601-2-27 17.101 compliedECG recovery time after defibrillation: within 10 sElectrode condition: Displays CHECK ELECTRODES messageTall T-wave rejection capability: Complies with the heights of T-waves from 0 to 1.6 mV IEC 60601-2-27: 2005 50.102.17 compliedPacemaker pulse rejection capability, without overshoot: Complies with the amplitudes of pacemaker pulses ±2 to ±700 mV and widths 0.1 to 2 ms (As defined by method B of IEC 60601-2-27: 2005 50.102.13, this corresponds to the pacemaker pulses amplitudes and widths of ±2.8 mV/2 ms to amplitudes ±45.6 mV/0.1 ms.)Pacemaker pulse rejection capability, with overshoot:Overshoot amplitudes and time constants of ±0.12 mV/100 ms to ±2 mV/4 ms (As defined by method B of IEC 60601-2-27: 2005 50.102.13, this corresponds to the pacemaker pulses amplitudes and widths of ±2.8 mV/2 ms to amplitudes ±45.6 mV/0.1 ms.)ECG display and heart rate countFrequency characteristic: filter on: 1 to 18 Hz, filter off: 0.05 to 60 HzHeart rate detection method: AverageQRS detection: 70 to 120 ms: amplitude ≥ 0.5 mV, rate 30 to 200 beats/min 40 to 120 ms: amplitude ≥ 0.5 mV, rate 30 to 250 beats/minHeart rate counting range: 0, 15 to 300 beats/minHeart rate counting accuracy*: ±2 beats/min, (0, 15 to 300 beats/min)* Essential performance of this transmitterRespiration MeasurementMeasuring method: Impedance methodMeasuring lead: Between R and FImpedance range: 2 kΩ or lessRespiration rate measuring accuracy*: ±2 counts/min (at 0 to 150 counts/min)Respiration rate counting range: 0 to 150 counts/min* Essential performance of this transmitterSpO2 Measurement (ISO 9919: 2005 complied)Measuring range: 0 to 100%SpO2 Declared range: 70 to 100%SpO2Minimum display range: 1%SpO2
120 Operator’s Manual ZM-540PA/541PADisplay update cycle: Every 3 secondsMeasuring accuracy (rms)*: Accuracy assurance temperature: 18 to 40ºCTotal accuracy including probe: 80%SpO2 ≤ %SpO2 ≤ 100%SpO2: ±2%SpO2 70%SpO2 ≤ %SpO2 < 80%SpO2: ±3%SpO2 under 70%SpO2: not specifiedAccuracy of the transmitter: 80%SpO2 ≤ %SpO2 ≤ 100%SpO2: ±1%SpO2 50%SpO2 ≤ %SpO2 < 80%SpO2: ±2%SpO2 under 50%SpO2: not specifiedPulse rate measuring range: 30 to 300 bpmPulse rate display range: 30 to 300 bpmPulse rate accuracy (rms)*: ±3% ±1 bpm* Essential performance of this transmitterNOTE• The SpO2 measuring accuracy was tested using the TL-201T, TL-260T, TL-271T and TL-631T SpO2 probes. The testing was performed during induced hypoxia on healthy volunteers (Ethnicity: 10 Caucasians, 2 Africans, 1 Asian and 3 Indians), (Skin: 8 light, 4 medium, 4 dark), (Age: 21 to 34), (5 women and 11 men) under the condition of no motion. Arterial blood was sampled and measured by a CO-oximeter. The difference between SpO2 measured by the SpO2 probe and functional SaO2 measured by a CO-oximeter was calculated using the root-mean-square (rms) method according to ISO 9919: 2005. This measurement accuracy figure represents 2/3 of all test measurements.• A pulse oximeter tester that generates simulated signals can be used to check the difference from the design specification, but it cannot be used as a replacement for human signals for testings accuracy.Response time: Selectable from “Slow”, “Normal” and “Fast”. The following graphs show the response time example when SpO2 changes 0.6%/s.Pulse Rate = 70 bpm60657075808590951000 10 20 30 40 50 60 70 80 90 100 110 120 130 140Time (seconds)SpO2 (%)SpO2 Reference SpO2 Fast SpO2 Normal SpO2 Slow
Operator’s Manual ZM-540PA/541PA 12160657075808590951000 10 20 30 40 50 60 70 80 90 100 110 120 130 140SpO2 Reference SpO2 Fast SpO2 NormalPulse Rate = 140 bpmTime (seconds)SpO2 (%)SpO2 Slow The following graph shows the response time example when pulse rate changes 10 bpm/s.SpO2 = 97607080901001101201301401500 102030405060708090100110120Time (seconds)PR (bpm)PR ReferencePRNon Invasive Blood Pressure, NIBP (IEC 60601-2-30: 1999 complied)Measuring method: OscillometricMeasurement mode: Manual, STAT (≤ 15 min), PeriodicIntended patient type: Adult, childMeasuring range: 0 to 300 mmHgPressure display range: 0 to 300 mmHgMeasuring accuracy*: ±3 mmHg (0 mmHg ≤ NIBP ≤ 300 mmHg) AAMI SP-10: 2002 compliedCuff inflation time: ≤ 20 s (700 cc), 0 to 200 mmHg ≤ 15 s (70 cc), 0 to 200 mmHgPressure retention: ≤ 5 mmHg (250 cc at 250 mmHg inflation for 10 seconds)Air leakage: ≤ 3 mmHg/min (700 cc at 300 mmHg inflation)Power discontinuity: Deflate immediately after power down
122 Operator’s Manual ZM-540PA/541PASafety Maximum pressurization value cuff inflation limiter: 300 to 330 mmHg Cuff inflation time limiter: ≤ 180 s Interval time limiter: ≤ 30 s* Essential performance of this transmitterTransmitterFCC regulation: FCC part 95 Subpart H Wireless Medical Telemetry Service (WMTS)Field strength limits: < 740 mV/m (at 3 m)Undesired emissions: below 960 MHz: < 200 μV/m (at 3 m) above 960 MHz: < 500 μV/m (at 3 m)Antenna: InternalTransmission channel: Indicated on the transmitterTransmission frequency range: 1395.0250 to 1399.9750 MHz 1427.0250 to 1431.9750 MHzChannel spacing: 50 kHz or 37.5 kHz (12.5 kHz when interleaved)Modulation: FSK (frequency shift keying)Type of emission: F1DOccupied bandwidth: < 20 kHzEffective radiated power: 5.0 mW Can be changed to 1.0 mW if requiredPower RequirementsRated voltage: 3.6 VOperating voltage: 3.2 to 4.8 VBattery type: Three AA (R6) type NiMH secondary batteries Three AA (R6) type alkaline dry cell primary batteriesBattery lifetime (with alkaline batteries, at room temperature): approximately 1 day (measuring ECG, respiration, SpO2 of approximately 60 kg weight adult male patient at the index finger, NIBP at 60 minute intervals)Dimension and WeightDimension: 114 W × 125 H × 63 D (mm)Weight: about 340 g (excluding batteries and other accessories) about 410 g (including batteries, excluding other accessories)
Operator’s Manual ZM-540PA/541PA 123EnvironmentOperating environmentTemperature: 5 to 40°C, 41 to 104°FHumidity: 30 to 85% (noncondensing)Atmospheric pressure: 700 to 1060 hPaStorage and transport environmentTemperature: −20 to +65°C, −4 to +149°FHumidity: 10 to 95%Atmospheric pressure: 700 to 1060 hPaSafety StandardsSafety standard: CAN/CSA-C22.2 No. 601-1 M90 CAN/CSA-C22.2 No. 601-1. 1S1-94 CAN/CSA-C22.2 No. 601-1. 1B-90 CAN/CSA-C22.2 No. 60601-2-49-04 CAN/CSA-C22.2 No. 60601-2-27-06 CAN/CSA-C22.2 No. 60601-2-30-02 IEC 60601-1:1988 IEC 60601-1 Amendment 1: 1991 IEC 60601-1 Amendment 2: 1995 IEC 60601-2-27: 2005 IEC 60601-2-30: 1999 IEC 60601-2-49: 2001 ISO 9919: 2005Type of protection against electrical shock: INTERNALLY POWERED EQUIPMENTDegree of protection against electrical shock:ECG and impedance method respiration: DEFIBRILLATION-PROOF TYPE CF APPLIED PARTSpO2 and NIBP: DEFIBRILLATION-PROOF TYPE BF APPLIED PARTDegree of protection against harmful ingress of water: IPX0 (Ordinary equipment)Degree of safety of application in the presence of a FLAMMABLE ANAESTHETIC MIXTURE WITH AIR, OR WITH OXYGEN OR NITROUS OXIDE: Equipment not suitable for use in the presence of FLAMMABLE ANAESTHETIC MIXTURE WITH AIR, OR WITH OXYGEN OR NITROUS OXIDEMode of operation: CONTINUOUS OPERATIONElectromagnetic CompatibilityIEC 60601-1-2: 2001IEC 60601-1-2 Amendment 1: 2004
124 Operator’s Manual ZM-540PA/541PAElectromagnetic EmissionsThis Model ZM-541PA is intended for use in the electromagnetic environment specified below.The customer or the user of the ZM-541PA should assure that it is used in such an environment.Emissions test Compliance Electromagnetic environment - guidanceRF emissionsCISPR 11Group 1 The ZM-541PA uses RF energy only for its internal function. Therefore, its RF emissions are very low and are not likely to cause any interference in nearby electronic equipment.RF emissionsCISPR 11Class B The ZM-541PA is suitable for use in all establishments, including domestic establishments.Harmonic emissionsIEC 61000-3-2Not applicableVoltage fluctuations/flicker emissionsIEC 61000-3-3Not applicable
Operator’s Manual ZM-540PA/541PA 125Electromagnetic ImmunityThis Model ZM-541PA is intended for use in the electromagnetic environment specified below.The customer or the user of the ZM-541PA should assure that it is used in such an environment.Immunity test IEC 60601 test levelCompliance levelElectromagnetic environment - guidanceElectrostatic discharge (ESD)IEC 61000-4-2±6 kV contact±8 kV air±6 kV contact±8 kV airFloors should be wood, concrete or ceramic tile. If floors are covered with synthetic material, the relative humidity should be at least 30%.Electrical fast transient/ burstIEC 61000-4-4±2 kV for power supply lines±1 kV for input/output linesNot applicable—SurgeIEC 61000-4-5±1 kV differential mode±2 kV common modeNot applicable—Voltage dips, short interruptions and voltage variations on power supply input linesIEC 61000-4-11<5% UT (>95% dip in UT) for 0.5 cycle40% UT (60% dip in UT) for 5 cycles70% UT (30% dip in UT) for 25 cycles<5% UT (>95% dip in UT) for 5 sNot applicable—Power frequency(50/60 Hz)magnetic fieldIEC 61000-4-83 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.NOTE: UT is the AC mains voltage prior to application of the test levelAvoiding Electromagnetic Interference (Impedance Respiration)Impedance respiration measurement is very sensitive and affected by electromagnetic interference. Technological limitations do not allow immunity levels higher than 1 V/m for radiated RF electromagnetic fields. Electromagnetic fields with field strengths above 1 V/m may cause measurement error. Do not use electrically radiating equipment near the impedance respiration measurements.
126 Operator’s Manual ZM-540PA/541PAImmunity test IEC 60601 test levelCompliance levelElectromagnetic environment - guidanceConducted RF IEC 61000-4-6Radiated RFIEC 61000-4-33 Vrms150 kHz to 80 MHz3 V/m 80 MHz to 2.5 GHz3 Vrms3 V/m 80 MHz to 2.5 GHz(1 V/m 80 MHz to 2.5 GHz for respiration)Portable and mobile RF communications equipment should be used no closer to any part of the ZM-541PA, including cables, than the recommended separation distance calculated from the equation applicable to the frequency of the transmitter. Recommended separation distanced = 1.2㺕P d = 1.2㺕P 80 MHz to 800 MHzd = 2.3㺕P 800 MHz to 2.5 GHz(d = 3.5㺕P 80 MHz to 800 MHz for respirationd = 7.0㺕P 800 MHz to 2.5 GHz for respiration)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 deter mined by an electromagnetic site survey*1, should be less than the compliance level in each frequency range*2.Interference may occur in the vicinity of equipment marked with the following symbol:NOTE 1: At 80 MHz and 800 MHz, the higher frequency range applies.NOTE 2: These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects and people. *1 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 considered. If the measured field strength in the location in which the ZM-541PA is used exceeds the applicable RF compliance level above, the ZM-541PA should be observed to verify normal operation. If abnormal performance is observed, additional measures may be necessary, such as re-orienting or relocating the ZM-541PA.*2 Over the frequency range 150 kHz to 80 MHz, field strengths should be less than 1 V/m for respiration and 3 V/m for all other functions.
Operator’s Manual ZM-540PA/541PA 127Recommended Separation Distances between Portable and Mobile RF Communications EquipmentThe ZM-541PA is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled. The customer or the user of the ZM-541PA can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment (transmitters) and the ZM-541PA as recommended below, according to the maximum output power of the communications equipment.Rated maximum output power of transmitter(W)Separation distance according to frequency of transmitter (m)150 kHz to 80 MHzd = 1.2㺕P80 MHz to 800 MHzd = 1.2㺕P(For respiration:d = 3.5㺕P)800 MHz to 2.5 GHzd = 2.3㺕P(For respiration:d = 7.0㺕P)0.01 0.12 0.12 (0.35*) 0.23 (0.7*)0.1 0.38 0.38 (1.1*) 0.73 (2.2*)1 1.2 1.2 (3.5*) 2.3 (7.0*)10 3.8 3.8 (11*) 7.3 (22*)100 12 12 (35*) 23 (70*)For transmitters rated at a maximum output power not listed above, the recommended separation distance d in meters (m) can be estimated using the equation applicable to the frequency of the transmitter, where P is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer. (* For respiration)NOTE 1 At 80 MHz and 800 MHz, the separation distance for the higher frequency range applies. NOTE 2 These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects and people.Recovery Time after DefibrillationThe transmitter returns to the normal operating mode within 10 seconds after defibrillation. The stored settings are not affected.System Composition for EMC TestThe ZM-541PA bedside monitor is tested to comply with IEC 60601-1-2: 2001 with the following composition.Units Cable lengthZM-541PA transmitter —YP-503P NIBP cuff 0.15 mBR-906P ECG electrode lead 0.8 mTL-201T finger probe 1.6 m
128 Operator’s Manual ZM-540PA/541PAStandard Accessories12No. Name Model Q’ty Supply Code No.1 NIBP cuff for adult, standard YP-503P 1 S937C2 Strap — 1 Y236The following parts are available for replacement.3 4Lock plate is a standard accessory of the YP-503P and YP504P NIBP cuff.No. Name Model Q’ty Supply Code No.3 Battery case cover — 1 6143-901517A4 Lock plate — 1 6113-049585
Operator’s Manual ZM-540PA/541PA 129OptionsCAUTIONOnly use Nihon Kohden specified electrodes, electrode leads, SpO2 probes, and NIBP cuffs. Otherwise, the maximum performance from the transmitter cannot be guaranteed.Transmitter• Channel writer, QI-901PK• NIBP cuff for adult, large (width 15 cm) (for attaching transmitter to patient arm), YP-504P, supply code no. S937DECG/RESPName Application Model Q’ty Supply Code No.Electrode lead3 electrodes, clip type,lead length 80 cm BR-903PA 1 K911A6 electrodes, clip type, lead length 80 cm BR-906PA 1 K912A
130 Operator’s Manual ZM-540PA/541PASpO2 Name Cable lengthModel/Code No. Q’ty Supply Code No.Finger probe (reusable) 0.6 m TL-201T1P225H1.6 m P225FMulti-site probe (reusable) 1.6 m TL-220T P225GFinger probe (reusable)0.6 m TL-630T1 P310A1.6 m TL-630T3 P310C0.6 m TL-631T1 P311A1.6 m TL-631T3 P311CSpO2 probe (for adult, disposable)1.6 mTL-251T5P201ASpO2 probe (for child, disposable) TL-252T P201BSpO2 probe (for neonate, disposable) TL-253T P201CSpO2 probe (for adult, disposable) 0.8 m TL-271T24P203A1.6 m TL-271T3 P203ESpO2 probe (for child, disposable) 0.8 m TL-272T P203B1.6 m TL-272T3 P203FSpO2 probe (for neonate/adult, disposable)0.8 m TL-273T P203C1.6 m TL-273T3 P203GSpO2 probe (for child/infant, disposable)0.8 m TL-274T P203D1.6 m TL-274T3 P203HSpO2 probe (for adult/neonate, disposable)0.8 m TL-051S5P228A1.6 m TL-052S P228BSpO2 probe (for child/infant, disposable)0.8 m TL-061S P229A1.6 m TL-062S P229BCOTTONY tape—340703 20 P259Foam tape for TL-051S/052S/ 061S/062S —4 × 25 packages P260Attachment tape for TL-220T/ 251T/252T/253T/630T/631T 3 × 30 packages P263Probe fastener YS-093P2 30 P267
Operator’s Manual ZM-540PA/541PA 131NIBPName Width (cm)Air Hose Length (cm)Model Q’ty Supply Code No.Cuff for adult, for attaching transmitter to patient armStandard 1315YP-503P*1S937CLarge 15 YP-504P* S937DCuff for infant 515YP-960T1S943ACuff for child Small 7 YP-961T S943BStandard 10 YP-962T S943CCuff for adult Standard 13 YP-963T S944BLarge 15 YP-964T S944CDisposable cuff for infant 6 17 YP-810P20S945CDisposable cuff for child 8 17 YP-811P S945DDisposable cuff for adultSmall 10 17 YP-812P S946EStandard 14 20 YP-813P S946FMedium large 15 20 YP-814P S946GLarge 17 20 YP-815P S946HExtension hose — 150 YN-990P 1 S903* The lock plate is provided with these NIBP cuffs.
132 Operator’s Manual ZM-540PA/541PATransmission FrequenciesChannel: 9002 to 9478Transmissionfrequency(MHz)Channel No.Transmissionfrequency(MHz)Channel No.Transmissionfrequency(MHz)Channel No.608.0250 9002 608.4375 9035 608.8500 9068608.0375 9003 608.4500 9036 608.8625 9069608.0500 9004 608.4625 9037 608.8750 9070608.0625 9005 608.4750 9038 608.8875 9071608.0750 9006 608.4875 9039 608.9000 9072608.0875 9007 608.5000 9040 608.9125 9073608.1000 9008 608.5125 9041 608.9250 9074608.1125 9009 608.5250 9042 608.9375 9075608.1250 9010 608.5375 9043 608.9500 9076608.1375 9011 608.5500 9044 608.9625 9077608.1500 9012 608.5625 9045 608.9750 9078608.1625 9013 608.5750 9046 608.9875 9079608.1750 9014 608.5875 9047 609.0000 9080608.1875 9015 608.6000 9048 609.0125 9081608.2000 9016 608.6125 9049 609.0250 9082608.2125 9017 608.6250 9050 609.0375 9083608.2250 9018 608.6375 9051 609.0500 9084608.2375 9019 608.6500 9052 609.0625 9085608.2500 9020 608.6625 9053 609.0750 9086608.2625 9021 608.6750 9054 609.0875 9087608.2750 9022 608.6875 9055 609.1000 9088608.2875 9023 608.7000 9056 609.1125 9089608.3000 9024 608.7125 9057 609.1250 9090608.3125 9025 608.7250 9058 609.1375 9091608.3250 9026 608.7375 9059 609.1500 9092608.3375 9027 608.7500 9060 609.1625 9093608.3500 9028 608.7625 9061 609.1750 9094608.3625 9029 608.7750 9062 609.1875 9095608.3750 9030 608.7875 9063 609.2000 9096608.3875 9031 608.8000 9064 609.2125 9097608.4000 9032 608.8125 9065 609.2250 9098608.4125 9033 608.8250 9066 609.2375 9099608.4250 9034 608.8375 9067 609.2500 9100
Operator’s Manual ZM-540PA/541PA 133Transmissionfrequency(MHz)Channel No.Transmissionfrequency(MHz)Channel No.Transmissionfrequency(MHz)Channel No.609.2625 9101 609.7125 9137 610.1625 9173609.2750 9102 609.7250 9138 610.1750 9174609.2875 9103 609.7375 9139 610.1875 9175609.3000 9104 609.7500 9140 610.2000 9176609.3125 9105 609.7625 9141 610.2125 9177609.3250 9106 609.7750 9142 610.2250 9178609.3375 9107 609.7875 9143 610.2375 9179609.3500 9108 609.8000 9144 610.2500 9180609.3625 9109 609.8125 9145 610.2625 9181609.3750 9110 609.8250 9146 610.2750 9182609.3875 9111 609.8375 9147 610.2875 9183609.4000 9112 609.8500 9148 610.3000 9184609.4125 9113 609.8625 9149 610.3125 9185609.4250 9114 609.8750 9150 610.3250 9186609.4375 9115 609.8875 9151 610.3375 9187609.4500 9116 609.9000 9152 610.3500 9188609.4625 9117 609.9125 9153 610.3625 9189609.4750 9118 609.9250 9154 610.3750 9190609.4875 9119 609.9375 9155 610.3875 9191609.5000 9120 609.9500 9156 610.4000 9192609.5125 9121 609.9625 9157 610.4125 9193609.5250 9122 609.9750 9158 610.4250 9194609.5375 9123 609.9875 9159 610.4375 9195609.5500 9124 610.0000 9160 610.4500 9196609.5625 9125 610.0125 9161 610.4625 9197609.5750 9126 610.0250 9162 610.4750 9198609.5875 9127 610.0375 9163 610.4875 9199609.6000 9128 610.0500 9164 610.5000 9200609.6125 9129 610.0625 9165 610.5125 9201609.6250 9130 610.0750 9166 610.5250 9202609.6375 9131 610.0875 9167 610.5375 9203609.6500 9132 610.1000 9168 610.5500 9204609.6625 9133 610.1125 9169 610.5625 9205609.6750 9134 610.1250 9170 610.5750 9206609.6875 9135 610.1375 9171 610.5875 9207609.7000 9136 610.1500 9172 610.6000 9208
134 Operator’s Manual ZM-540PA/541PATransmissionfrequency(MHz)Channel No.Transmissionfrequency(MHz)Channel No.Transmissionfrequency(MHz)Channel No.610.6125 9209 611.0625 9245 611.5125 9281610.6250 9210 611.0750 9246 611.5250 9282610.6375 9211 611.0875 9247 611.5375 9283610.6500 9212 611.1000 9248 611.5500 9284610.6625 9213 611.1125 9249 611.5625 9285610.6750 9214 611.1250 9250 611.5750 9286610.6875 9215 611.1375 9251 611.5875 9287610.7000 9216 611.1500 9252 611.6000 9288610.7125 9217 611.1625 9253 611.6125 9289610.7250 9218 611.1750 9254 611.6250 9290610.7375 9219 611.1875 9255 611.6375 9291610.7500 9220 611.2000 9256 611.6500 9292610.7625 9221 611.2125 9257 611.6625 9293610.7750 9222 611.2250 9258 611.6750 9294610.7875 9223 611.2375 9259 611.6875 9295610.8000 9224 611.2500 9260 611.7000 9296610.8125 9225 611.2625 9261 611.7125 9297610.8250 9226 611.2750 9262 611.7250 9298610.8375 9227 611.2875 9263 611.7375 9299610.8500 9228 611.3000 9264 611.7500 9300610.8625 9229 611.3125 9265 611.7625 9301610.8750 9230 611.3250 9266 611.7750 9302610.8875 9231 611.3375 9267 611.7875 9303610.9000 9232 611.3500 9268 611.8000 9304610.9125 9233 611.3625 9269 611.8125 9305610.9250 9234 611.3750 9270 611.8250 9306610.9375 9235 611.3875 9271 611.8375 9307610.9500 9236 611.4000 9272 611.8500 9308610.9625 9237 611.4125 9273 611.8625 9309610.9750 9238 611.4250 9274 611.8750 9310610.9875 9239 611.4375 9275 611.8875 9311611.0000 9240 611.4500 9276 611.9000 9312611.0125 9241 611.4625 9277 611.9125 9313611.0250 9242 611.4750 9278 611.9250 9314611.0375 9243 611.4875 9279 611.9375 9315611.0500 9244 611.5000 9280 611.9500 9316
Operator’s Manual ZM-540PA/541PA 135Transmissionfrequency(MHz)Channel No.Transmissionfrequency(MHz)Channel No.Transmissionfrequency(MHz)Channel No.611.9625 9317 612.4125 9353 612.8625 9389611.9750 9318 612.4250 9354 612.8750 9390611.9875 9319 612.4375 9355 612.8875 9391612.0000 9320 612.4500 9356 612.9000 9392612.0125 9321 612.4625 9357 612.9125 9393612.0250 9322 612.4750 9358 612.9250 9394612.0375 9323 612.4875 9359 612.9375 9395612.0500 9324 612.5000 9360 612.9500 9396612.0625 9325 612.5125 9361 612.9625 9397612.0750 9326 612.5250 9362 612.9750 9398612.0875 9327 612.5375 9363 612.9875 9399612.1000 9328 612.5500 9364 613.0000 9400612.1125 9329 612.5625 9365 613.0125 9401612.1250 9330 612.5750 9366 613.0250 9402612.1375 9331 612.5875 9367 613.0375 9403612.1500 9332 612.6000 9368 613.0500 9404612.1625 9333 612.6125 9369 613.0625 9405612.1750 9334 612.6250 9370 613.0750 9406612.1875 9335 612.6375 9371 613.0875 9407612.2000 9336 612.6500 9372 613.1000 9408612.2125 9337 612.6625 9373 613.1125 9409612.2250 9338 612.6750 9374 613.1250 9410612.2375 9339 612.6875 9375 613.1375 9411612.2500 9340 612.7000 9376 613.1500 9412612.2625 9341 612.7125 9377 613.1625 9413612.2750 9342 612.7250 9378 613.1750 9414612.2875 9343 612.7375 9379 613.1875 9415612.3000 9344 612.7500 9380 613.2000 9416612.3125 9345 612.7625 9381 613.2125 9417612.3250 9346 612.7750 9382 613.2250 9418612.3375 9347 612.7875 9383 613.2375 9419612.3500 9348 612.8000 9384 613.2500 9420612.3625 9349 612.8125 9385 613.2625 9421612.3750 9350 612.8250 9386 613.2750 9422612.3875 9351 612.8375 9387 613.2875 9423612.4000 9352 612.8500 9388 613.3000 9424
136 Operator’s Manual ZM-540PA/541PATransmissionfrequency(MHz)Channel No.Transmissionfrequency(MHz)Channel No.Transmissionfrequency(MHz)Channel No.613.3125 9425 613.5375 9443 613.7625 9461613.3250 9426 613.5500 9444 613.7750 9462613.3375 9427 613.5625 9445 613.7875 9463613.3500 9428 613.5750 9446 613.8000 9464613.3625 9429 613.5875 9447 613.8125 9465613.3750 9430 613.6000 9448 613.8250 9466613.3875 9431 613.6125 9449 613.8375 9467613.4000 9432 613.6250 9450 613.8500 9468613.4125 9433 613.6375 9451 613.8625 9469613.4250 9434 613.6500 9452 613.8750 9470613.4375 9435 613.6625 9453 613.8875 9471613.4500 9436 613.6750 9454 613.9000 9472613.4625 9437 613.6875 9455 613.9125 9473613.4750 9438 613.7000 9456 613.9250 9474613.4875 9439 613.7125 9457 613.9375 9475613.5000 9440 613.7250 9458 613.9500 9476613.5125 9441 613.7375 9459 613.9625 9477613.5250 9442 613.7500 9460 613.9750 9478
Operator’s Manual ZM-540PA/541PA 137Channel: E002 to E398Transmission frequency (MHz)Channel No.Transmission frequency (MHz)Channel No.Transmission frequency (MHz)Channel No.1395.0250 E002 1395.4625 E037 1395.9000 E0721395.0375 E003 1395.4750 E038 1395.9125 E0731395.0500 E004 1395.4875 E039 1395.9250 E0741395.0625 E005 1395.5000 E040 1395.9375 E0751395.0750 E006 1395.5125 E041 1395.9500 E0761395.0875 E007 1395.5250 E042 1395.9625 E0771395.1000 E008 1395.5375 E043 1395.9750 E0781395.1125 E009 1395.5500 E044 1395.9875 E0791395.1250 E010 1395.5625 E045 1396.0000 E0801395.1375 E011 1395.5750 E046 1396.0125 E0811395.1500 E012 1395.5875 E047 1396.0250 E0821395.1625 E013 1395.6000 E048 1396.0375 E0831395.1750 E014 1395.6125 E049 1396.0500 E0841395.1875 E015 1395.6250 E050 1396.0625 E0851395.2000 E016 1395.6375 E051 1396.0750 E0861395.2125 E017 1395.6500 E052 1396.0875 E0871395.2250 E018 1395.6625 E053 1396.1000 E0881395.2375 E019 1395.6750 E054 1396.1125 E0891395.2500 E020 1395.6875 E055 1396.1250 E0901395.2625 E021 1395.7000 E056 1396.1375 E0911395.2750 E022 1395.7125 E057 1396.1500 E0921395.2875 E023 1395.7250 E058 1396.1625 E0931395.3000 E024 1395.7375 E059 1396.1750 E0941395.3125 E025 1395.7500 E060 1396.1875 E0951395.3250 E026 1395.7625 E061 1396.2000 E0961395.3375 E027 1395.7750 E062 1396.2125 E0971395.3500 E028 1395.7875 E063 1396.2250 E0981395.3625 E029 1395.8000 E064 1396.2375 E0991395.3750 E030 1395.8125 E065 1396.2500 E1001395.3875 E031 1395.8250 E066 1396.2625 E1011395.4000 E032 1395.8375 E067 1396.2750 E1021395.4125 E033 1395.8500 E068 1396.2875 E1031395.4250 E034 1395.8625 E069 1396.3000 E1041395.4375 E035 1395.8750 E070 1396.3125 E1051395.4500 E036 1395.8875 E071 1396.3250 E106
138 Operator’s Manual ZM-540PA/541PATransmission frequency (MHz)Channel No.Transmission frequency (MHz)Channel No.Transmission frequency (MHz)Channel No.1396.3375 E107 1396.7875 E143 1397.2375 E1791396.3500 E108 1396.8000 E144 1397.2500 E1801396.3625 E109 1396.8125 E145 1397.2625 E1811396.3750 E110 1396.8250 E146 1397.2750 E1821396.3875 E111 1396.8375 E147 1397.2875 E1831396.4000 E112 1396.8500 E148 1397.3000 E1841396.4125 E113 1396.8625 E149 1397.3125 E1851396.4250 E114 1396.8750 E150 1397.3250 E1861396.4375 E115 1396.8875 E151 1397.3375 E1871396.4500 E116 1396.9000 E152 1397.3500 E1881396.4625 E117 1396.9125 E153 1397.3625 E1891396.4750 E118 1396.9250 E154 1397.3750 E1901396.4875 E119 1396.9375 E155 1397.3875 E1911396.5000 E120 1396.9500 E156 1397.4000 E1921396.5125 E121 1396.9625 E157 1397.4125 E1931396.5250 E122 1396.9750 E158 1397.4250 E1941396.5375 E123 1396.9875 E159 1397.4375 E1951396.5500 E124 1397.0000 E160 1397.4500 E1961396.5625 E125 1397.0125 E161 1397.4625 E1971396.5750 E126 1397.0250 E162 1397.4750 E1981396.5875 E127 1397.0375 E163 1397.4875 E1991396.6000 E128 1397.0500 E164 1397.5000 E2001396.6125 E129 1397.0625 E165 1397.5125 E2011396.6250 E130 1397.0750 E166 1397.5250 E2021396.6375 E131 1397.0875 E167 1397.5375 E2031396.6500 E132 1397.1000 E168 1397.5500 E2041396.6625 E133 1397.1125 E169 1397.5625 E2051396.6750 E134 1397.1250 E170 1397.5750 E2061396.6875 E135 1397.1375 E171 1397.5875 E2071396.7000 E136 1397.1500 E172 1397.6000 E2081396.7125 E137 1397.1625 E173 1397.6125 E2091396.7250 E138 1397.1750 E174 1397.6250 E2101396.7375 E139 1397.1875 E175 1397.6375 E2111396.7500 E140 1397.2000 E176 1397.6500 E2121396.7625 E141 1397.2125 E177 1397.6625 E2131396.7750 E142 1397.2250 E178 1397.6750 E214
Operator’s Manual ZM-540PA/541PA 139Transmission frequency (MHz)Channel No.Transmission frequency (MHz)Channel No.Transmission frequency (MHz)Channel No.1397.6875 E215 1398.1375 E251 1398.5875 E2871397.7000 E216 1398.1500 E252 1398.6000 E2881397.7125 E217 1398.1625 E253 1398.6125 E2891397.7250 E218 1398.1750 E254 1398.6250 E2901397.7375 E219 1398.1875 E255 1398.6375 E2911397.7500 E220 1398.2000 E256 1398.6500 E2921397.7625 E221 1398.2125 E257 1398.6625 E2931397.7750 E222 1398.2250 E258 1398.6750 E2941397.7875 E223 1398.2375 E259 1398.6875 E2951397.8000 E224 1398.2500 E260 1398.7000 E2961397.8125 E225 1398.2625 E261 1398.7125 E2971397.8250 E226 1398.2750 E262 1398.7250 E2981397.8375 E227 1398.2875 E263 1398.7375 E2991397.8500 E228 1398.3000 E264 1398.7500 E3001397.8625 E229 1398.3125 E265 1398.7625 E3011397.8750 E230 1398.3250 E266 1398.7750 E3021397.8875 E231 1398.3375 E267 1398.7875 E3031397.9000 E232 1398.3500 E268 1398.8000 E3041397.9125 E233 1398.3625 E269 1398.8125 E3051397.9250 E234 1398.3750 E270 1398.8250 E3061397.9375 E235 1398.3875 E271 1398.8375 E3071397.9500 E236 1398.4000 E272 1398.8500 E3081397.9625 E237 1398.4125 E273 1398.8625 E3091397.9750 E238 1398.4250 E274 1398.8750 E3101397.9875 E239 1398.4375 E275 1398.8875 E3111398.0000 E240 1398.4500 E276 1398.9000 E3121398.0125 E241 1398.4625 E277 1398.9125 E3131398.0250 E242 1398.4750 E278 1398.9250 E3141398.0375 E243 1398.4875 E279 1398.9375 E3151398.0500 E244 1398.5000 E280 1398.9500 E3161398.0625 E245 1398.5125 E281 1398.9625 E3171398.0750 E246 1398.5250 E282 1398.9750 E3181398.0875 E247 1398.5375 E283 1398.9875 E3191398.1000 E248 1398.5500 E284 1399.0000 E3201398.1125 E249 1398.5625 E285 1399.0125 E3211398.1250 E250 1398.5750 E286 1399.0250 E322
140 Operator’s Manual ZM-540PA/541PATransmission frequency (MHz)Channel No.Transmission frequency (MHz)Channel No.Transmission frequency (MHz)Channel No.1399.0375 E323 1399.4625 E357 1399.8875 E3911399.0500 E324 1399.4750 E358 1399.9000 E3921399.0625 E325 1399.4875 E359 1399.9125 E3931399.0750 E326 1399.5000 E360 1399.9250 E3941399.0875 E327 1399.5125 E361 1399.9375 E3951399.1000 E328 1399.5250 E362 1399.9500 E3961399.1125 E329 1399.5375 E363 1399.9625 E3971399.1250 E330 1399.5500 E364 1399.9750 E3981399.1375 E331 1399.5625 E3651399.1500 E332 1399.5750 E3661399.1625 E333 1399.5875 E3671399.1750 E334 1399.6000 E3681399.1875 E335 1399.6125 E3691399.2000 E336 1399.6250 E3701399.2125 E337 1399.6375 E3711399.2250 E338 1399.6500 E3721399.2375 E339 1399.6625 E3731399.2500 E340 1399.6750 E3741399.2625 E341 1399.6875 E3751399.2750 E342 1399.7000 E3761399.2875 E343 1399.7125 E3771399.3000 E344 1399.7250 E3781399.3125 E345 1399.7375 E3791399.3250 E346 1399.7500 E3801399.3375 E347 1399.7625 E3811399.3500 E348 1399.7750 E3821399.3625 E349 1399.7875 E3831399.3750 E350 1399.8000 E3841399.3875 E351 1399.8125 E3851399.4000 E352 1399.8250 E3861399.4125 E353 1399.8375 E3871399.4250 E354 1399.8500 E3881399.4375 E355 1399.8625 E3891399.4500 E356 1399.8750 E390
Operator’s Manual ZM-540PA/541PA 141Channel: E502 to E898Transmission frequency (MHz)Channel No.Transmission frequency (MHz)Channel No.Transmission frequency (MHz)Channel No.1427.0250 E502 1427.4500 E536 1427.8750 E5701427.0375 E503 1427.4625 E537 1427.8875 E5711427.0500 E504 1427.4750 E538 1427.9000 E5721427.0625 E505 1427.4875 E539 1427.9125 E5731427.0750 E506 1427.5000 E540 1427.9250 E5741427.0875 E507 1427.5125 E541 1427.9375 E5751427.1000 E508 1427.5250 E542 1427.9500 E5761427.1125 E509 1427.5375 E543 1427.9625 E5771427.1250 E510 1427.5500 E544 1427.9750 E5781427.1375 E511 1427.5625 E545 1427.9875 E5791427.1500 E512 1427.5750 E546 1428.0000 E5801427.1625 E513 1427.5875 E547 1428.0125 E5811427.1750 E514 1427.6000 E548 1428.0250 E5821427.1875 E515 1427.6125 E549 1428.0375 E5831427.2000 E516 1427.6250 E550 1428.0500 E5841427.2125 E517 1427.6375 E551 1428.0625 E5851427.2250 E518 1427.6500 E552 1428.0750 E5861427.2375 E519 1427.6625 E553 1428.0875 E5871427.2500 E520 1427.6750 E554 1428.1000 E5881427.2625 E521 1427.6875 E555 1428.1125 E5891427.2750 E522 1427.7000 E556 1428.1250 E5901427.2875 E523 1427.7125 E557 1428.1375 E5911427.3000 E524 1427.7250 E558 1428.1500 E5921427.3125 E525 1427.7375 E559 1428.1625 E5931427.3250 E526 1427.7500 E560 1428.1750 E5941427.3375 E527 1427.7625 E561 1428.1875 E5951427.3500 E528 1427.7750 E562 1428.2000 E5961427.3625 E529 1427.7875 E563 1428.2125 E5971427.3750 E530 1427.8000 E564 1428.2250 E5981427.3875 E531 1427.8125 E565 1428.2375 E5991427.4000 E532 1427.8250 E566 1428.2500 E6001427.4125 E533 1427.8375 E567 1428.2625 E6011427.4250 E534 1427.8500 E568 1428.2750 E6021427.4375 E535 1427.8625 E569 1428.2875 E603
142 Operator’s Manual ZM-540PA/541PATransmission frequency (MHz)Channel No.Transmission frequency (MHz)Channel No.Transmission frequency (MHz)Channel No.1428.3000 E604 1428.7500 E640 1429.2000 E6761428.3125 E605 1428.7625 E641 1429.2125 E6771428.3250 E606 1428.7750 E642 1429.2250 E6781428.3375 E607 1428.7875 E643 1429.2375 E6791428.3500 E608 1428.8000 E644 1429.2500 E6801428.3625 E609 1428.8125 E645 1429.2625 E6811428.3750 E610 1428.8250 E646 1429.2750 E6821428.3875 E611 1428.8375 E647 1429.2875 E6831428.4000 E612 1428.8500 E648 1429.3000 E6841428.4125 E613 1428.8625 E649 1429.3125 E6851428.4250 E614 1428.8750 E650 1429.3250 E6861428.4375 E615 1428.8875 E651 1429.3375 E6871428.4500 E616 1428.9000 E652 1429.3500 E6881428.4625 E617 1428.9125 E653 1429.3625 E6891428.4750 E618 1428.9250 E654 1429.3750 E6901428.4875 E619 1428.9375 E655 1429.3875 E6911428.5000 E620 1428.9500 E656 1429.4000 E6921428.5125 E621 1428.9625 E657 1429.4125 E6931428.5250 E622 1428.9750 E658 1429.4250 E6941428.5375 E623 1428.9875 E659 1429.4375 E6951428.5500 E624 1429.0000 E660 1429.4500 E6961428.5625 E625 1429.0125 E661 1429.4625 E6971428.5750 E626 1429.0250 E662 1429.4750 E6981428.5875 E627 1429.0375 E663 1429.4875 E6991428.6000 E628 1429.0500 E664 1429.5000 E7001428.6125 E629 1429.0625 E665 1429.5125 E7011428.6250 E630 1429.0750 E666 1429.5250 E7021428.6375 E631 1429.0875 E667 1429.5375 E7031428.6500 E632 1429.1000 E668 1429.5500 E7041428.6625 E633 1429.1125 E669 1429.5625 E7051428.6750 E634 1429.1250 E670 1429.5750 E7061428.6875 E635 1429.1375 E671 1429.5875 E7071428.7000 E636 1429.1500 E672 1429.6000 E7081428.7125 E637 1429.1625 E673 1429.6125 E7091428.7250 E638 1429.1750 E674 1429.6250 E7101428.7375 E639 1429.1875 E675 1429.6375 E711
Operator’s Manual ZM-540PA/541PA 143Transmission frequency (MHz)Channel No.Transmission frequency (MHz)Channel No.Transmission frequency (MHz)Channel No.1429.6500 E712 1430.1000 E748 1430.5500 E7841429.6625 E713 1430.1125 E749 1430.5625 E7851429.6750 E714 1430.1250 E750 1430.5750 E7861429.6875 E715 1430.1375 E751 1430.5875 E7871429.7000 E716 1430.1500 E752 1430.6000 E7881429.7125 E717 1430.1625 E753 1430.6125 E7891429.7250 E718 1430.1750 E754 1430.6250 E7901429.7375 E719 1430.1875 E755 1430.6375 E7911429.7500 E720 1430.2000 E756 1430.6500 E7921429.7625 E721 1430.2125 E757 1430.6625 E7931429.7750 E722 1430.2250 E758 1430.6750 E7941429.7875 E723 1430.2375 E759 1430.6875 E7951429.8000 E724 1430.2500 E760 1430.7000 E7961429.8125 E725 1430.2625 E761 1430.7125 E7971429.8250 E726 1430.2750 E762 1430.7250 E7981429.8375 E727 1430.2875 E763 1430.7375 E7991429.8500 E728 1430.3000 E764 1430.7500 E8001429.8625 E729 1430.3125 E765 1430.7625 E8011429.8750 E730 1430.3250 E766 1430.7750 E8021429.8875 E731 1430.3375 E767 1430.7875 E8031429.9000 E732 1430.3500 E768 1430.8000 E8041429.9125 E733 1430.3625 E769 1430.8125 E8051429.9250 E734 1430.3750 E770 1430.8250 E8061429.9375 E735 1430.3875 E771 1430.8375 E8071429.9500 E736 1430.4000 E772 1430.8500 E8081429.9625 E737 1430.4125 E773 1430.8625 E8091429.9750 E738 1430.4250 E774 1430.8750 E8101429.9875 E739 1430.4375 E775 1430.8875 E8111430.0000 E740 1430.4500 E776 1430.9000 E8121430.0125 E741 1430.4625 E777 1430.9125 E8131430.0250 E742 1430.4750 E778 1430.9250 E8141430.0375 E743 1430.4875 E779 1430.9375 E8151430.0500 E744 1430.5000 E780 1430.9500 E8161430.0625 E745 1430.5125 E781 1430.9625 E8171430.0750 E746 1430.5250 E782 1430.9750 E8181430.0875 E747 1430.5375 E783 1430.9875 E819
144 Operator’s Manual ZM-540PA/541PATransmission frequency (MHz)Channel No.Transmission frequency (MHz)Channel No.Transmission frequency (MHz)Channel No.1431.0000 E820 1431.4375 E855 1431.8750 E8901431.0125 E821 1431.4500 E856 1431.8875 E8911431.0250 E822 1431.4625 E857 1431.9000 E8921431.0375 E823 1431.4750 E858 1431.9125 E8931431.0500 E824 1431.4875 E859 1431.9250 E8941431.0625 E825 1431.5000 E860 1431.9375 E8951431.0750 E826 1431.5125 E861 1431.9500 E8961431.0875 E827 1431.5250 E862 1431.9625 E8971431.1000 E828 1431.5375 E863 1431.9750 E8981431.1125 E829 1431.5500 E8641431.1250 E830 1431.5625 E8651431.1375 E831 1431.5750 E8661431.1500 E832 1431.5875 E8671431.1625 E833 1431.6000 E8681431.1750 E834 1431.6125 E8691431.1875 E835 1431.6250 E8701431.2000 E836 1431.6375 E8711431.2125 E837 1431.6500 E8721431.2250 E838 1431.6625 E8731431.2375 E839 1431.6750 E8741431.2500 E840 1431.6875 E8751431.2625 E841 1431.7000 E8761431.2750 E842 1431.7125 E8771431.2875 E843 1431.7250 E8781431.3000 E844 1431.7375 E8791431.3125 E845 1431.7500 E8801431.3250 E846 1431.7625 E8811431.3375 E847 1431.7750 E8821431.3500 E848 1431.7875 E8831431.3625 E849 1431.8000 E8841431.3750 E850 1431.8125 E8851431.3875 E851 1431.8250 E8861431.4000 E852 1431.8375 E8871431.4125 E853 1431.8500 E8881431.4250 E854 1431.8625 E889

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