Nihon Kohden ZM-541PAA TRANSMITTER User Manual

Nihon Kohden Corporation TRANSMITTER

(Short-Term Confidential) User Manual

TransmitterZM-540PA, ZM-541PAOPERATOR’S MANUAL0614-902754HPrinted:1st Edition: 01 Jul 20099th Edition: XX Oct 2015Transmitter ZM-540PA, ZM-541PA
About This ManualIn order to use this product safely and fully understand all its functions, read this manual before using the product. Keep this manual near the instrument or in the reach of the operator and refer to it whenever the operation is unclear.The Transmitter ZM-540P comes with the following manuals. Refer to the manual depending on your needs.Operator’s Manual (this manual)Describes the operation and settings of Transmitter ZM-540P. Read this manual before use.Administrator’s GuideFor administrators. Describes advanced settings and installation procedure of Product Name. Read the Operator’s Manual together with this guide.Service Manual)RUTXDOL¿HGVHUYLFHSHUVRQQHO'HVFULEHVLQIRUPDWLRQRQVHUYLFLQJ7UDQVPLWWHU=032QO\TXDOL¿HGVHUYLFHSHUVRQQHOFDQVHUYLFH7UDQVPLWWHU=03Accompanying DocumentationCopyright 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.This product stores personal patient information. Manage the information appropriately. 3DWLHQWQDPHVRQWKHVFUHHQVKRWVDQGUHFRUGLQJH[DPSOHVLQWKLVPDQXDODUH¿FWLRQDODQGDQ\resemblance to any person living or dead is purely coincidental.The contents of this manual are subject to change without notice.If you have any comments or suggestions on this manual, please contact us at:www.nihonkohden.com
Contents-1ZM-540PA, ZM-541PA Operator’s ManualContentsUnpacking......................................................................................................iGENERAL HANDLING PRECAUTIONS .......................................................IWARRANTY POLICY ...................................................................................IIEMC RELATED CAUTION ........................................................................ VIConventions Used in this Manual and Instrument .................................... VIIIIntended Use ................................................................................................1General ...................................................................................................1Receiving Monitor ...................................................................................3Panel Description .........................................................................................4Front Panel .............................................................................................4Rear Panel ..............................................................................................6Top Panel ................................................................................................7Bottom Panel ..........................................................................................7Important Safety Information ........................................................................9General ...................................................................................................9Output Signal ........................................................................................15Battery ..................................................................................................15Transmitter Channel Management .......................................................16For Patients Using Implantable Pacemaker .........................................17ECG Monitoring ....................................................................................17SpO2 Monitoring ....................................................................................18NIBP Monitoring ....................................................................................23Maintenance .........................................................................................26Preparation on Transmitter .........................................................................27Batteries ................................................................................................ 27Handling Batteries ..........................................................................27Battery Lifetime ...............................................................................27Installing and Replacing Batteries ..................................................28Situations Requiring Battery Replacement ....................................29Battery Level Indication ..................................................................30Turning On the Transmitter ...................................................................31Check Items Before Use .................................................................31Check Items After Power On ..........................................................32Check Items After Use ....................................................................33Turning Off the Transmitter ...................................................................33Changing the Transmitter Channel .......................................................34
Contents-2ZM-540PA, ZM-541PA Operator’s ManualChanging Parameter and System Setup Settings ......................................35Notes on Parameter Settings ................................................................35Changing PARAMETER SETUP Settings ............................................36Parameter Setup Setting List ..........................................................36Displaying the PARAMETER SETUP Screen ................................37Changing Parameter Setup Settings ..............................................38Changing SYSTEM SETUP Settings ....................................................44System Setup Setting List ...............................................................44Displaying the SYSTEM SETUP Screen ........................................45Changing System Setup Settings ...................................................46Initializing Settings ................................................................................50Attaching Electrodes, SpO2 Probe and NIBP Cuff to the Patient ...............51Attachment Examples ...........................................................................51Selecting Electrode Leads and Disposable Electrodes ........................52Connecting the Electrode Lead to the Transmitter .........................53Electrode Position ...........................................................................53Attaching Electrodes to the Patient and Connecting the Electrode Leads to Disposable Electrodes.....................................57Checking ECG on the Transmitter Screen .....................................58Attaching the SpO2 Probe .....................................................................59Selecting the SpO2 Probe ...............................................................59Connecting the SpO2 Probe to the Transmitter ..............................62Attaching the Probe to the Patient ..................................................63Attaching the NIBP Cuff ........................................................................65Selecting the NIBP Cuff ..................................................................65Connecting the NIBP Cuff to the Transmitter .................................69Attaching the NIBP Cuff to the Patient ...........................................71Locking the Keys on the Transmitter ..........................................................77Monitoring ...................................................................................................78Screen Descriptions ..............................................................................78Check Electrodes Screen ...............................................................79Numeric and Waveform Screen ......................................................80Waveform Review Screen ..............................................................81Numeric Review Screen .................................................................82Display Off ......................................................................................82Basic Monitoring Operation ..................................................................83Using the Function Key ...................................................................83Suspending Alarms on the Receiving Monitor ...............................84Pausing Monitoring .........................................................................85Resuming Monitoring after Pause ..................................................87&RQ¿UPLQJWKH3DWLHQW ....................................................................87Turning the Display Off ...................................................................88
Contents-3ZM-540PA, ZM-541PA Operator’s ManualTurning the Display On after It was Turned Off ..............................89ECG and Respiration Monitoring ..........................................................89Turning ECG Measurement On/Off ................................................92Turning Respiration Measurement On/Off......................................92Electrode Detachment ....................................................................92SpO2 Monitoring ....................................................................................93Monitoring SpO2 during NIBP Measurement ..................................98NIBP Monitoring ....................................................................................996HOHFWLQJWKH,QLWLDO&XII,QÀDWLRQ3UHVVXUH ....................................99Selecting the Measurement Mode and Interval ..............................99Measuring NIBP ............................................................................101Monitoring SpO2 during NIBP Measurement ................................106Indication and Message List .....................................................................107Indication ............................................................................................107Messages ...........................................................................................107Message Display Priority .............................................................. 111Troubleshooting ........................................................................................ 112Transmitter ..........................................................................................112ECG/Respiration .................................................................................113SpO2 ..................................................................................................114NIBP....................................................................................................114Maintenance ............................................................................................. 1161. External Check ...............................................................................1162. Transmitter Channel .......................................................................1173. Transmitting/Receiving Signal ........................................................1174. Display ............................................................................................1185. Key Operation .................................................................................1196. ECG Check .....................................................................................1207. Respiration Check ..........................................................................1218. SpO2 Check ....................................................................................1219. NIBP Check ....................................................................................12310. NIBP Cuff for Attaching Transmitter to Patient Arm ......................127Maintenance Check Sheet ..................................................................128Lifetime and Disposal ...............................................................................129Disposing of Used Batteries ...............................................................129Battery Lifetime .............................................................................129Disposal ........................................................................................129Disposing of Electrodes, SpO2 Probes and NIBP Cuffs ......................129Disposing of Transmitter .....................................................................129Cleaning, Disinfection and Sterilization ....................................................130Transmitter and Electrode Leads ........................................................130
Contents-4ZM-540PA, ZM-541PA Operator’s ManualCleaning ........................................................................................130Disinfection ...................................................................................130SpO2 Probe .........................................................................................131NIBP Cuff ............................................................................................131Periodic Inspection ...................................................................................132Repair Parts Availability Policy .................................................................1326SHFL¿FDWLRQV ...........................................................................................133ZM-540PA ...........................................................................................133Measured Parameters ..................................................................133Transmitted Data...........................................................................133Displayed Data ..............................................................................133ECG ..............................................................................................133ECG Display and Heart Rate Count .............................................134Respiration Measurement .............................................................134SpO2 Measurement (ISO 9919: 2005 compliant) .........................134Noninvasive Blood Pressure, NIBP (IEC 60601-2-30: 1999 compliant) .....................................................................................136Transmitter ....................................................................................137Power Requirements ....................................................................137Dimensions and Weight ................................................................137Environment .................................................................................. 137Safety Standards ..........................................................................138Electromagnetic Compatibility ......................................................138Electromagnetic Emissions ..........................................................139Electromagnetic Immunity ............................................................139Recommended Separation Distances between Portable and Mobile RF Communications Equipment .......................................1415HFRYHU\7LPHDIWHU'H¿EULOODWLRQ ................................................142System Composition for EMC Test ...............................................142ZM-541PA ...........................................................................................143Measured Parameters ..................................................................143Transmitted Data...........................................................................143Display ..........................................................................................143Displayed Data ..............................................................................143ECG ..............................................................................................143Respiration Measurement .............................................................144SpO2 Measurement (ISO 9919: 2005 compliant) .........................144Noninvasive Blood Pressure, NIBP (IEC 60601-2-30: 1999 compliant) .....................................................................................146Transmitter .................................................................................... 147Power Requirements ....................................................................147Dimensions and Weight ................................................................147
Contents-5ZM-540PA, ZM-541PA Operator’s ManualEnvironment .................................................................................. 147Safety Standards ..........................................................................148Electromagnetic Compatibility ......................................................148Electromagnetic Emissions ..........................................................149Electromagnetic Immunity ............................................................149Recommended Separation Distances between Portable and Mobile RF Communications Equipment .......................................1515HFRYHU\7LPHDIWHU'H¿EULOODWLRQ ................................................152System Composition for EMC Test ...............................................152Standard Accessories ...............................................................................153Options .....................................................................................................154Transmitter ..........................................................................................154ECG/RESP .........................................................................................154SpO2 ..................................................................................................155NIBP....................................................................................................156Transmission Frequencies .......................................................................157
iZM-540PA, ZM-541PA Operator’s ManualCheck that all the items are included in the package. If there are any missing items, contact your Nihon Kohden representative.The name and quantity are described under the illustration.ZM-540PA or ZM-541PAtransmitter (1)NIBP cuff for adult, standard (1) Strap (1)CertificationOperator’s manual (1) &HUWL¿FDWLRQFor the standard accessories and consumables, only use Nihon Kohden VSHFL¿HGSDUWVDQGDFFHVVRULHVWRVDWLVI\WKHVDIHW\DQGSHUIRUPDQFH)RUWKHPRGHOFRGHQXPEHUDQGVXSSO\FRGHRIWKHVWDQGDUGDFFHVVRULHVUHIHUWR³6WDQGDUG$FFHVVRULHV´SLQWKLVRSHUDWRU¶VPDQXDOUnpacking
IZM-540PA, ZM-541PA Operator’s ManualGENERAL HANDLING PRECAUTIONS7KLVGHYLFHLVLQWHQGHGIRUXVHRQO\E\TXDOL¿HGPHGLFDOSHUVRQQHOUse only Nihon Kohden approved products with this device. Use of non-approved SURGXFWVRULQDQRQDSSURYHGPDQQHUPD\DIIHFWWKHSHUIRUPDQFHVSHFL¿FDWLRQV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. $YRLGPRLVWXUHRUFRQWDFWZLWKZDWHUH[WUHPHDWPRVSKHULFSUHVVXUHH[FHVVLYHKXPLGLW\DQGWHPSHUDWXUHVSRRUO\YHQWLODWHGDUHDVDQGGXVWVDOLQHRUVXOSKXULFDLU 3ODFHWKHLQVWUXPHQWRQDQHYHQOHYHOÀRRU$YRLGYLEUDWLRQDQGPHFKDQLFDOVKRFNHYHQGXULQJWUDQVSRUW $YRLGSODFLQJLQDQDUHDZKHUHFKHPLFDOVDUHVWRUHGRUZKHUHWKHUHLVGDQJHURIJDVOHDNDJH 7KHSRZHUOLQHVRXUFHWREHDSSOLHGWRWKHLQVWUXPHQWPXVWFRUUHVSRQGLQIUHTXHQF\DQGYROWDJHWRSURGXFWVSHFL¿FDWLRQVDQGKDYHVXI¿FLHQWFXUUHQWFDSDFLW\ &KRRVHDURRPZKHUHDSURSHUJURXQGLQJIDFLOLW\LVDYDLODEOH3. Before Operation &KHFNWKDWWKHLQVWUXPHQWLVLQSHUIHFWRSHUDWLQJRUGHU &KHFNWKDWWKHLQVWUXPHQWLVJURXQGHGSURSHUO\ &KHFNWKDWDOOFRUGVDUHFRQQHFWHGSURSHUO\ 3D\H[WUDDWWHQWLRQZKHQWKHLQVWUXPHQWLVLQFRPELQDWLRQZLWKRWKHULQVWUXPHQWVWRDYRLGPLVGLDJQRVLVRURWKHUSUREOHPV $OOFLUFXLWU\XVHGIRUGLUHFWSDWLHQWFRQQHFWLRQPXVWEHGRXEO\FKHFNHG &KHFNWKDWEDWWHU\OHYHOLVDFFHSWDEOHDQGEDWWHU\FRQGLWLRQLVJRRGZKHQXVLQJEDWWHU\RSHUDWHGPRGHOV4. During Operation %RWKWKHLQVWUXPHQWDQGWKHSDWLHQWPXVWUHFHLYHFRQWLQXDOFDUHIXODWWHQWLRQ 7XUQSRZHURIIRUUHPRYHHOHFWURGHVDQGRUWUDQVGXFHUVZKHQQHFHVVDU\WRDVVXUHWKHSDWLHQW¶VVDIHW\ $YRLGGLUHFWFRQWDFWEHWZHHQWKHLQVWUXPHQWKRXVLQJDQGWKHSDWLHQW5. To Shutdown After Use 7XUQSRZHURIIZLWKDOOFRQWUROVUHWXUQHGWRWKHLURULJLQDOSRVLWLRQV 5HPRYHWKHFRUGVJHQWO\GRQRWXVHIRUFHWRUHPRYHWKHP &OHDQWKHLQVWUXPHQWWRJHWKHUZLWKDOODFFHVVRULHVIRUWKHLUQH[WXVH6. The instrument must receive expert, professional attention for maintenance and repairs. When the instrument is not functioning properly, it should be clearly marked to avoid operation while it is out of order. 7KHLQVWUXPHQWPXVWQRWEHDOWHUHGRUPRGL¿HGLQDQ\ZD\
IIZM-540PA, ZM-541PA Operator’s Manual8. Maintenance and Inspection 7KHLQVWUXPHQWDQGSDUWVPXVWXQGHUJRUHJXODUPDLQWHQDQFHLQVSHFWLRQDWWKHLQWHUYDOZKLFKLVVSHFL¿HGDIWHUWKH*(1(5$/+$1'/,1*35(&$87,216VHFWLRQ ,IVWRUHGIRUH[WHQGHGSHULRGVZLWKRXWEHLQJXVHGPDNHVXUHSULRUWRRSHUDWLRQWKDWWKHLQVWUXPHQWLVLQSHUIHFWRSHUDWLQJFRQGLWLRQ 7HFKQLFDOLQIRUPDWLRQVXFKDVSDUWVOLVWGHVFULSWLRQVFDOLEUDWLRQLQVWUXFWLRQVRURWKHULQIRUPDWLRQLVDYDLODEOHIRUTXDOL¿HGXVHUWHFKQLFDOSHUVRQQHOXSRQUHTXHVWIURP\RXU1LKRQ.RKGHQUHSUHVHQWDWLYH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.:KHQWKHLQVWUXPHQWLVXVHGZLWKDGH¿EULOODWRUPDNHVXUHWKDWWKHLQVWUXPHQWLVSURWHFWHGDJDLQVWGH¿EULOODWRUGLVFKDUJH,IQRWUHPRYHSDWLHQWFDEOHVDQGRUtransducers from the instrument to avoid possible damage.WARRANTY POLICY1LKRQ.RKGHQ&RUSRUDWLRQ1.&VKDOOZDUUDQWLWVSURGXFWVDJDLQVWDOOGHIHFWVLQPDWHULDOVDQGZRUNPDQVKLSIRURQH\HDUIURPWKHGDWHRIGHOLYHU\+RZHYHUFRQVXPDEOHPDWHULDOVVXFKDVUHFRUGLQJSDSHULQNVW\OXVDQGEDWWHU\DUHH[FOXGHGIURPWKHZDUUDQW\1.&RULWVDXWKRUL]HGDJHQWVZLOOUHSDLURUUHSODFHDQ\SURGXFWVZKLFKSURYHWREHGHIHFWLYHGXULQJWKHZDUUDQW\SHULRGSURYLGHGWKHVHSURGXFWVDUHXVHGDVSUHVFULEHGE\WKHRSHUDWLQJLQVWUXFWLRQVJLYHQLQWKHRSHUDWRU¶VDQGVHUYLFHPDQXDOV1RRWKHUSDUW\LVDXWKRUL]HGWRPDNHDQ\ZDUUDQW\RUDVVXPHOLDELOLW\IRU1.&¶VSURGXFWV1.&ZLOOQRWUHFRJQL]HDQ\RWKHUZDUUDQW\HLWKHULPSOLHGRULQZULWLQJ,QDGGLWLRQVHUYLFHWHFKQLFDOPRGL¿FDWLRQRUDQ\RWKHUSURGXFWFKDQJHSHUIRUPHGE\VRPHRQHRWKHUWKDQ1.&RULWVDXWKRUL]HGDJHQWVZLWKRXWSULRUFRQVHQWRI1.&PD\EHFDXVHIRUYRLGLQJWKLVZDUUDQW\'HIHFWLYHSURGXFWVRUSDUWVPXVWEHUHWXUQHGWR1.&RULWVDXWKRUL]HGDJHQWVDORQJZLWKDQH[SODQDWLRQRIWKHIDLOXUH6KLSSLQJFRVWVPXVWEHSUHSDLG7KLVZDUUDQW\GRHVQRWDSSO\WRSURGXFWVWKDWKDYHEHHQPRGL¿HGGLVDVVHPEOHGUHLQVWDOOHGRUUHSDLUHGZLWKRXW1LKRQ.RKGHQDSSURYDORUZKLFKKDYHEHHQVXEMHFWHGWRQHJOHFWRUDFFLGHQWGDPDJHGXHWRDFFLGHQW¿UHOLJKWQLQJYDQGDOLVPZDWHURURWKHUFDVXDOW\LPSURSHULQVWDOODWLRQRUDSSOLFDWLRQRURQZKLFKWKHRULJLQDOLGHQWL¿FDWLRQPDUNVKDYHEHHQUHPRYHG,QWKH86$DQG&DQDGDRWKHUZDUUDQW\SROLFLHVPD\DSSO\CAUTIONUnited States law restricts this product to sale by or on the order of a physician.
IIIZM-540PA, ZM-541PA Operator’s ManualEquipment Authorization RequirementCompliance with FCC/IC Requirements7KLVGHYLFHFRPSOLHVZLWK3DUWRIWKH)&&)HGHUDO&RPPXQLFDWLRQV&RPPLVVLRQ5XOHV2SHUDWLRQLVVXEMHFWWRWKHIROORZLQJWZRFRQGLWLRQV WKLVGHYLFHPD\QRWFDXVHKDUPIXOLQWHUIHUHQFHDQG WKLVGHYLFHPXVWDFFHSWDQ\LQWHUIHUHQFHUHFHLYHGLQFOXGLQJLQWHUIHUHQFHWKDWPD\FDXVHXQGHVLUHGRSHUDWLRQ7KLVGHYLFHFRPSOLHVZLWK3DUW6XESDUW+RIWKH)&&5XOHVWREHXVHGLQZLUHOHVVPHGLFDOWHOHPHWU\VHUYLFH2SHUDWLRQRIWKLVHTXLSPHQWUHTXLUHVWKHSULRUFRRUGLQDWLRQZLWKDIUHTXHQF\FRRUGLQDWRUGHVLJQDWHGE\)&&IRUWKH:LUHOHVV0HGLFDO7HOHPHWU\6HUYLFHCAUTION(English)To comply with the FCC/IC 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.(Français)Pour respecter les normes relatives aux radiofréquences FCC/IC, ce dispositif ne doit pas être situé ou utilisé à proximité d’une autre antenne ou d’un autre émetteur si ce n’est selon les procédures mentionnées pour le multi-transmetteur FCC/IC ou décrites dans la documentation.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 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.
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VZM-540PA, ZM-541PA Operator’s ManualO¶2NDQDJDQ&RORPELH%ULWDQQLTXHGRLWVHFRQFHUWHUDYHFOHGLUHFWHXUGHO¶2)5HWREWHQLUGHVDSDUWXQHDXWRULVDWLRQpFULWHDYDQWTXHO¶pTXLSHPHQWQHSXLVVHrWUHLQVWDOOpRXPLVHQPDUFKH/HGLUHFWHXUGHO¶2)5SHXWrWUHFRQWDFWpDXWpORXDXWpOpFRSLHXU/H'LUHFWHXUGHV1RUPHVUpJOHPHQWDLUHVG¶,QGXVWULH&DQDGDSHXWpJDOHPHQWrWUHFRQWDFWpZM-541PA only(QJOLVK“This equipment shall not be operated in the areas of Sydney, Nova Scotia, or Gander, 1HZIRXQGODQGDQG/DEUDGRU3OHDVHFRQWDFWWKHORFDO,QGXVWU\&DQDGD2I¿FHIRUIXUWKHUinformation.”)UDQoDLV« L’utilisation de cet équipement est interdite à Sydney, Nouvelle-Écosse de même qu’à Gander, Terre-Neuve et Labrador. Veuillez contacter le bureau local d’Industrie Canada pour de plus amples renseignements ».
VIZM-540PA, ZM-541PA Operator’s ManualEMC RELATED CAUTION This equipment and/or system complies with IEC 60601-1-2 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.6. 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. 8VHRIXQVSHFL¿HGDFFHVVRU\WUDQVGXFHUDQGRUFDEOH :KHQDQXQVSHFL¿HGDFFHVVRU\WUDQVGXFHUDQGRUFDEOHLVFRQQHFWHGWRWKLVequipment and/or system, it may cause increased electromagnetic emission or GHFUHDVHGHOHFWURPDJQHWLFLPPXQLW\7KHVSHFL¿HGFRQ¿JXUDWLRQRIWKLVHTXLSPHQWDQGRUV\VWHPFRPSOLHVZLWKWKHHOHFWURPDJQHWLFUHTXLUHPHQWVZLWKWKHVSHFL¿HGFRQ¿JXUDWLRQ2QO\XVHWKLVHTXLSPHQWDQGRUV\VWHPZLWKWKHVSHFL¿HGFRQ¿JXUDWLRQ
VIIZM-540PA, ZM-541PA Operator’s ManualCaution - continued 8VHRIXQVSHFL¿HGFRQ¿JXUDWLRQ :KHQWKHHTXLSPHQWDQGRUV\VWHPLVXVHGZLWKWKHXQVSHFL¿HGV\VWHPFRQ¿JXUDWLRQGLIIHUHQWWKDQWKHFRQ¿JXUDWLRQRI(0&WHVWLQJLWPD\FDXVHincreased electromagnetic emission or decreased electromagnetic immunity. Only XVHWKLVHTXLSPHQWDQGRUV\VWHPZLWKWKHVSHFL¿HGFRQ¿JXUDWLRQ9. Measurement with excessive sensitivity: The equipment and/or system is designed to measure bioelectrical signals with DVSHFL¿HGVHQVLWLYLW\,IWKHHTXLSPHQWDQGRUV\VWHPLVXVHGZLWKH[FHVVLYH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.
VIIIZM-540PA, ZM-541PA Operator’s ManualWarnings and CautionsLevel Description WARNING $ZDUQLQJDOHUWVWKHXVHUWRSRVVLEOHLQMXU\RUGHDWKDVVRFLDWHGZLWKWKHXVHRUPLVXVHRIWKHLQVWUXPHQW CAUTION$FDXWLRQDOHUWVWKHXVHUWRSRVVLEOHLQMXU\RUSUREOHPVZLWKWKHLQVWUXPHQWDVVRFLDWHGZLWKLWVXVHRUPLVXVHVXFKDVLQVWUXPHQWPDOIXQFWLRQLQVWUXPHQWIDLOXUHGDPDJHWRWKHLQVWUXPHQWRUGDPDJHWRRWKHUSURSHUW\Conventions Used in this Manual and Instrument
IXZM-540PA, ZM-541PA Operator’s ManualExplanations of the Symbols in this Manual and Instrument7KHIROORZLQJV\PEROVIRXQGLQWKLVPDQXDOLQVWUXPHQWEHDUWKHUHVSHFWLYHGHVFULSWLRQVDVJLYHQOn PanelSymbol Description Symbol Description&KDQJHVFUHHQ 'H¿EULOODWLRQSURRIW\SH%)applied part$WWHQWLRQFRQVXOWRSHUDWRU¶Vmanual'H¿EULOODWLRQSURRIW\SH&)applied part0RYHVFXUVRUVFUROOVGDWD Serial number'LUHFWLRQIRUDWWDFKLQJEDWWHU\FRYHU 'DWHRIPDQXIDFWXUH'LUHFWLRQIRULQVHUWLQJEDWWHU\ 5)WUDQVPLWWHU1RQLRQL]LQJUDGLDWLRQ'LUHFWFXUUHQW &6$PDUNOn LCDSymbol Description Symbol DescriptionFull battery%DWWHU\YHU\ZHDN&DQQRWPHDVXUH1,%35HSODFHEDWWHU\%DWWHU\IXOO Alarm suspended%DWWHU\ZHDN5HSODFHEDWWHU\ 456SXOVHV\QFPDUN
1ZM-540PA, ZM-541PA Operator’s ManualIntended UseGeneral7KH=03$DQG=03$WUDQVPLWWHUVWUDQVPLW(&*UHVSLUDWLRQDQGSXOVHZDYHIRUPV6S22DQG1,%3GDWDIURPDSDWLHQWWRD1LKRQ.RKGHQPRQLWRUIRUFRQWLQXRXVPRQLWRULQJ7KHIURQW/&'GLVSOD\V(&*RUSXOVHZDYHQXPHULFYDOXHVRIPRQLWRULQJSDUDPHWHUV1,%3PHDVXULQJPRGHDQGLQWHUYDOPHVVDJHVDQGEDWWHU\FRQGLWLRQ*7KH\DOVRGLVSOD\WKHFRPSUHVVHGZDYHIRUPDQGQXPHULFGDWDRIWKHODWHVWPLQXWHV7KLVWUDQVPLWWHULVGHVLJQHGIRUXVHE\TXDOL¿HGPHGLFDOSHUVRQQHOLQDPHGLFDOIDFLOLW\VXFKDVDKRVSLWDORUFOLQLF,WLVQRWGHVLJQHGIRUXVHRXWGRRUVRULQDKRPHHQYLURQPHQWDQGLVQRWGHVLJQHGWREHRSHUDWHGE\WKHSDWLHQWWKHPVHOYHV (VVHQWLDOSHUIRUPDQFHRIWKLVWUDQVPLWWHU7KHGLIIHUHQFHEHWZHHQWKH=03$DQG=03$LVWKHWUDQVPLVVLRQIUHTXHQF\UDQJH=03$ WR0+]FKDQQHOQXPEHUWR=03$WR0+]FKDQQHOQXPEHU(WR(  WR0+]FKDQQHOQXPEHU(WR(  )RU&DQDGD WR0+]FKDQQHOQXPEHU(WR(    WR0+]FKDQQHOQXPEHU(WR(NOTE • 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 diagnose a patient based only on data acquired by the transmitter. Overall judgement must be performed by a physician who understands the features, limitations and characteristics of the transmitter and by reading the biomedical signals acquired by other instruments.WARNINGDo not use this transmitter for monitoring a patient. Monitor the patient on a receiving monitor. This transmitter displays the waveforms and measured values but does not have an alarm function.
2ZM-540PA, ZM-541PA Operator’s ManualWARNINGDo not use the same transmitter for more than one patient at the same time. Do not connect different sensors from different patients to the same transmitter.• 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.CAUTIONSignal loss and artifact may occur because of the multipath cancellation* when using a transmitter.CAUTION 0XOWLSDWK&DQFHOODWLRQ6WDQGLQJ:DYH,QWHUIHUHQFH:KHQDUDGLRZDYHUHÀHFWVRIIDVXUIDFHWKHUHPD\EHVRPHSRLQWVLQWKHURRPZKHUHWKHUHÀHFWHGDQGGLUHFWZDYHVDUHH[DFWO\RXWRISKDVH$WWKHVHSRLQWVLQWKHURRPWKHUHÀHFWHGDQGGLUHFWZDYHVFDQFHOHDFKRWKHURXWVRWKDWWKHVLJQDOVWUHQJWKLVGHFUHDVHG/RFDWLRQVZKHUHVLJQDOORVVRFFXUVDUHFDOOHG³QXOOVSRWV´,IWKHWUDQVPLWWHULVPRYLQJRUQHDUE\SHRSOHRUREMHFWVDUHPRYLQJQXOOVSRWVFDQRFFXUDQ\WLPHDQGDQ\ZKHUHNOTE • To prevent interference between channels, assign a channel administrator in the hospital and only he or she should manage channel assignment.• Use Nihon Kohden parts and accessories to assure maximum performance from your instrument.• For stable signal reception, it is recommended to use a diversity antenna system on the receiving monitor. Otherwise, spike noise from transient IDGLQJRIHOHFWULF¿HOGVWUHQJWKIRUH[DPSOHSHRSOHPRYLQJPD\LQWHUIHUHwith the transmitter signal and may be mistaken as an arrhythmia on the receiving monitor.• ,IWKHWUDQVPLWWHULVXVHGRXWVLGHWKHVSHFL¿HGHQYLURQPHQWLWVSHUIRUPDQFHcannot be guaranteed.
3ZM-540PA, ZM-541PA Operator’s Manual• For details on antennas and antenna construction, contact your Nihon Kohden representative. You can also refer to the Telemetry System Installation Guide.Receiving Monitor$Q\1LKRQ.RKGHQUHFHLYLQJPRQLWRUFHQWUDOPRQLWRUZLWKPXOWLSOHSDWLHQWUHFHLYHUFDQUHFHLYHVLJQDOVIURPWKLVWUDQVPLWWHUDVORQJDVWKHSURWRFROYHUVLRQDQGFKDQQHOVHWWLQJDUHWKHVDPHRQWKHUHFHLYLQJPRQLWRUDQGWUDQVPLWWHU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.
4ZM-540PA, ZM-541PA Operator’s ManualPanel DescriptionFront Panel123456785HIHUWRWKH:$51,1*RQWKHQH[WSDJH1 LCD'LVSOD\VQXPHULFYDOXHV(&*RUSXOVHZDYH1,%3PHDVXULQJPRGHDQGLQWHUYDOPHVVDJHVDQGEDWWHU\VWDWXV)RUGHWDLOVUHIHUWRWKH³6FUHHQ'HVFULSWLRQV´VHFWLRQ2 Infrared receiver8VHGIRUXSJUDGLQJWKHWUDQVPLWWHUVRIWZDUH3 Screen key7RJJOHVWKHVFUHHQLQWKHIROORZLQJRUGHU$IWHUSRZHURQ6WDUWXSĺ&KHFNHOHFWURGHVĺ1XPHULFDQGZDYHIRUPĺ:DYHIRUPUHYLHZĺ1XPHULFUHYLHZĺ'LVSOD\RIIĺ&KHFNHOHFWURGHV«$IWHUDXWRGLVSOD\RII1XPHULFDQGZDYHIRUPĺ:DYHIRUPUHYLHZĺ1XPHULFUHYLHZĺ'LVSOD\RIIĺ&KHFNHOHFWURGHVĺ1XPHULFDQGZDYHIRUP«2QD6(783RU&+(&.VFUHHQWKLVNH\FDQFHOVFKDQJLQJVHWWLQJRUH[LWVWKHVFUHHQ4 Function key'HSHQGLQJRQWKHVHWWLQJRQWKHWUDQVPLWWHUWKLVNH\VXVSHQGVDODUPVSDXVHVPRQLWRULQJRQWKHUHFHLYLQJPRQLWRURUWUDQVPLWV³3DWLHQWFRQ¿UPHG´PHVVDJH2QD6(783VFUHHQWKLVNH\UHJLVWHUVWKHVHOHFWHGVHWWLQJDQGPRYHVWKHFXUVRUWRWKHQH[WVHWWLQJLWHP2QD&+(&.VFUHHQWKLVNH\VWDUWVRUVWRSVPDLQWHQDQFHWHVW
5ZM-540PA, ZM-541PA Operator’s Manual123456785HIHUWRWKH:$51,1*RQWKHQH[WSDJH5 NIBP Start/Stop key6WDUWVVWRSV1,%3PHDVXUHPHQWLQVHOHFWHGPRGH6 NIBP Interval key6HOHFWV1,%3PHDVXUHPHQWPRGH7 Lead/Scroll keys2QWKHQXPHULFDQGZDYHIRUPVFUHHQWKHVHNH\VFKDQJHWKH(&*OHDG2QWKHZDYHIRUPUHYLHZVFUHHQWKHVHNH\VVFUROOGDWD2QD6(783VFUHHQWKHVHNH\VPRYHWKHFXUVRU8 Battery case&RQWDLQVWKUHH9GU\FHOOEDWWHULHV$$7<3(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.
6ZM-540PA, ZM-541PA Operator’s ManualRear Panel5HIHUWRWKH³([SODQDWLRQVRIWKH6\PEROVLQWKLV0DQXDODQG,QVWUXPHQW´VHFWLRQ5HIHUWRWKH:$51,1*EHORZLock plate)DVWHQVWKHWUDQVPLWWHUWRDQ1,%3FXII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.
7ZM-540PA, ZM-541PA Operator’s ManualTop PanelLARALLRLVaVbNIBP socket&RQQHFWVWKHFXIIKRVH5HIHUWRWKH:$51,1*RQWKHQH[WSDJH5HIHUWRWKH³([SODQDWLRQVRIWKH6\PEROVLQWKLV0DQXDODQG,QVWUXPHQW´VHFWLRQ5HIHUWRWKH:$51,1*RQWKHQH[WSDJH5HIHUWRWKH³([SODQDWLRQVRIWKH6\PEROVLQWKLV0DQXDODQG,QVWUXPHQW´VHFWLRQECG/impedance RESP socket&RQQHFWVWKHHOHFWURGHOHDGIRUPHDVXULQJ(&*DQGRUUHVSLUDWLRQLPSHGDQFHBottom Panel5HIHUWRWKH:$51,1*RQWKHQH[WSDJH5HIHUWRWKH³([SODQDWLRQVRIWKH6\PEROVLQWKLV0DQXDODQG,QVWUXPHQW´VHFWLRQSpO2 socket&RQQHFWVWKH6S22 SUREHChannel number label,QGLFDWHVWKHFKDQQHOQXPEHURIWKHWUDQVPLWWHU
8ZM-540PA, ZM-541PA Operator’s ManualWARNINGBefore 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.Do 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.CAUTION
9ZM-540PA, ZM-541PA Operator’s ManualImportant 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.WARNINGWhen performing MRI test, remove all electrodes and probe from the patient which are connected to this transmitter. Failure to follow this warning may cause skin burn on the patient. For details, refer to the MRI manual.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.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.
10ZM-540PA, ZM-541PA Operator’s ManualWARNINGWhen 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.WARNINGDo not use the same transmitter for more than one patient at the same time. Do not connect different sensors from different patients to the same transmitter.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.
11ZM-540PA, ZM-541PA Operator’s ManualWARNINGClose 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.WARNINGWhen the signal is unstable, keep the patient under close observation. When the signal is unstable, the monitoring and alarm are not reliable and the receiving monitor cannot detect a sudden change of the patient’s condition. This may cause critical changes in the patient condition to be overlooked. Install an appropriate antenna system to ensure stable signal condition.WARNINGWhile the “ALARMS SUSPENDED” message is displayed on the transmitter, all alarms on the receiving monitor are suspended so keep the patient under close observation.WARNINGWhen the patient returns to the bed, turn on the transmitter and check that the monitoring is resumed on the receiving monitor.WARNINGIf the transmitter is not turned off and monitoring continues for the selected interval, pause monitoring is canceled and monitoring continues. Check that the monitoring is resumed on the receiving monitor.
12ZM-540PA, ZM-541PA Operator’s ManualWARNINGDo not allow the conductive part of the connector which is connected to the patient to contact other conductive parts including earth. This causes leakage current and incorrect measurement value and leads to wrong diagnosis.WARNINGAfter admitting a patient on the central monitor and attaching electrodes and sensors on the patient and connecting cables to the transmitter, check that there is no error messages and that the waveforms and numeric data are appropriately displayed on the transmitter and central monitor screen. If there is an error message, or waveform or numeric data is not appropriate, check the electrodes and sensors attachment, patient condition and settings on the transmitter and remove the cause.Only 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.CAUTIONFor handling and precautions on electrodes, electrode leads, SpO2 probes and NIBP cuffs, refer to the manual.CAUTION
13ZM-540PA, ZM-541PA Operator’s ManualThe 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.CAUTIONSignal loss and artifact may occur because of the multipath cancellation* when using a transmitter.CAUTION 0XOWLSDWK&DQFHOODWLRQ6WDQGLQJ:DYH,QWHUIHUHQFH:KHQDUDGLRZDYHUHÀHFWVRIIDVXUIDFHWKHUHPD\EHVRPHSRLQWVLQWKHURRPZKHUHWKHUHÀHFWHGDQGGLUHFWZDYHVDUHH[DFWO\RXWRISKDVH$WWKHVHSRLQWVLQWKHURRPWKHUHÀHFWHGDQGGLUHFWZDYHVFDQFHOHDFKRWKHURXWVRWKDWWKHVLJQDOVWUHQJWKLVGHFUHDVHG/RFDWLRQVZKHUHVLJQDOORVVRFFXUVDUHFDOOHG³QXOOVSRWV´,IWKHWUDQVPLWWHULVPRYLQJRUQHDUE\SHRSOHRUREMHFWVDUHPRYLQJQXOOVSRWVFDQRFFXUDQ\WLPHDQGDQ\ZKHUHTurn 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 or respiration waves and the displayed data may be incorrect.CAUTION
14ZM-540PA, ZM-541PA Operator’s ManualWhen monitoring respiration is needed, measure respiration with an instrument. The transmitter calculates SpO2 of arterial blood based on the principle of pulse oximeter and does not measure respiration.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.CAUTIONWhen monitoring SpO2 only, detection of arrhythmia and asystole is not available and arrhythmia alarms such as ASYSTOLE, VF or VT are not available. If the patient requires ECG monitoring, monitor the ECG.CAUTIONWhen monitoring SpO2 only (without ECG monitoring), turn on both the upper and lower limit alarms for PR and SpO2 on the receiving monitor. If the patient’s pulse is not detected during asystole or other condition, a “CANNOT DETECT PULSE” or “CHECK PROBE” alarm occurs instead of an SpO2 limit alarm. Furthermore, if the patient has no pulse, noise from probe movement could be misjudged as a pulse and cause an incorrect PR or SpO2 value to be displayed.CAUTION
15ZM-540PA, ZM-541PA Operator’s ManualAlways lock the battery cover while using the transmitter. Otherwise the battery cover may come off and correct measurement might not be performed.CAUTIONOutput 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.BatteryBattery 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.CAUTION
16ZM-540PA, ZM-541PA Operator’s ManualTransmitter 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.
17ZM-540PA, ZM-541PA Operator’s ManualFor Patients Using Implantable PacemakerWARNINGThe 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.ECG MonitoringWARNINGTurn the pacing pulse detection to ON on the receiving monitor when monitoring a pacemaker patient. Otherwise the pacemaker pulse is not rejected. However, even when the pacing pulse detection is set to ON, the pacemaker pulse might not be rejected. When the pacemaker pulse is not rejected, the pacemaker pulse is detected as QRS and false heart rate may be indicated or critical arrhythmia such as asystole may be overlooked. Keep pacemaker patients under close observation. )RUWKHSDFHPDNHUSXOVHUHMHFWLRQFDSDELOLW\RIWKH=03$DQG=03$WUDQVPLWWHUVUHIHUWRWKH³6SHFL¿FDWLRQV(&*´VHFWLRQWARNINGEven when the pacing pulse detection is set to ON on the receiving monitor, the pacemaker pulse can be overlooked or detected as QRS. You cannot confirm the pacemaker operation only from the detected pacemaker pulse.
18ZM-540PA, ZM-541PA Operator’s ManualOnly use Nihon Kohden specified electrodes and electrode leads. When other type of electrodes or electrode leads are used, the “CHECK ELECTRODES” message may be displayed and ECG monitoring may stop.CAUTIONWhen the “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.CAUTIONSpO2 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.• 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 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.7KH6S22SUREHVPDQXIDFWXUHGE\1LKRQ.RKGHQKDYHWZRZDYHOHQJWKVZLWKSHDNVLQWKHUDQJHRIDQGQP7KHPD[LPXPOLJKWLQWHQVLW\LVOHVVWKDQP:
19ZM-540PA, ZM-541PA Operator’s ManualWARNINGWhen 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.
20ZM-540PA, ZM-541PA Operator’s ManualWARNINGCheck 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-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 insufficient peripheral circulation• Neonate or low birth weight infant with delicate skinThe 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.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.CAUTION
21ZM-540PA, ZM-541PA Operator’s ManualWhile a patient is on medication which causes vasodilation, the pulse waveform may change and in rare cases the SpO2 value might not be displayed.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.*CAUTION 0RQLWRULQJ6S22GXULQJ1,%30HDVXUHPHQW :KHQWKH6S22SUREHLVDWWDFKHGWRWKHVDPHOLPEDVWKH1,%3FXIIWKHEORRGÀRZGHFUHDVHVGXULQJ1,%3PHDVXUHPHQWDQGSXOVHZDYHFDQQRWEHGHWHFWHGDQG6S22 cannot EHPRQLWRUHGSURSHUO\:KHQ³,1+,%,76S22'85,1*1,%3´RQWKH3$5$0(7(56(783VFUHHQLVVHWWR21IDFWRU\GHIDXOWVHWWLQJ6S22PRQLWRULQJLVSDXVHGGXULQJ1,%3PHDVXUHPHQWWRDYRLG6S22DODUPRFFXUUHQFH+RZHYHUZKHQPRQLWRULQJ6S22 on the same OLPEDVWKH1,%3EHFDUHIXOZKHQUHDGLQJ6S22YDOXHVNormal 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.CAUTION
22ZM-540PA, ZM-541PA Operator’s ManualHandle the probe cable according to the following cautions. Failure to follow these cautions may cause cable discontinuity or short circuit of the probe cable which may cause incorrect measurement data or inability to perform measurement. Also in rare cases, the probe temperature may increase and cause skin burn on the patient. If the probe cable is damaged, replace the probe with a new one. 'RQRWSXOORUEHQGWKHSUREHFDEOH 'RQRWOHWFDVWHUIHHWUXQRYHUWKHSUREHFDEOHCAUTIONDo not use a probe which is deteriorated by aging. Accurate measurement cannot be performed.CAUTIONDo not use a damaged or disassembled probe. It causes incorrect measurement and may injure the patient.CAUTIONWhen the probe is attached on an appropriate site with sufficient thickness and the error message confirming the probe attachment repeatedly appears, the probe may be deteriorated. Replace it with a new one.CAUTION
23ZM-540PA, ZM-541PA Operator’s ManualNIBP 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 situations.• When using an ESU• Body movement• Small pulse wave• Too many arrhythmias• Shaking from an external source• Rapid blood pressure change• During CPR• Slow pulse• Low blood pressure• Small pulse pressure• Cuff is too tight or too loose• Cuff does not fit the arm• Cuff is wrapped over thick clothing• Cuff is deteriorated• Arterial sclerosis• Poor perfusion• Diabetes• Age• Pregnancy• Pre-eclampsia• Renal disease• Shivering• Trembling
24ZM-540PA, ZM-541PA Operator’s ManualWARNINGWhen 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.WARNINGDo not attach the NIBP cuff on a limb which is being used for intravascular access or therapy, or an arterio-venous (A-V) shunt. It may cause reflux of blood or medicinal solution or block injection of medicinal solution due to poor blood circulation.WARNINGDo not attach the NIBP cuff on an arm which is the same side as a mastectomy. It may cause circulatory disorder such as swelling from poor blood circulation.WARNINGWhile measuring NIBP, if the NIBP cuff and other medical equipment are attached to the same limb, the medical equipment might not function temporarily.WARNINGWhile measuring NIBP, check the patient condition and confirm that the NIBP cuff does not affect blood circulation.
25ZM-540PA, ZM-541PA Operator’s ManualWARNINGWhen performing long term measurement at intervals less than 5 minutes, perform measurements while observing the state of the patient, blood vessels and limb to ensure adequate circulation. Congestion may occur at the measurement site. When performing periodic measurement for a long time, periodically check the circulation condition.Do 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.CAUTION
26ZM-540PA, ZM-541PA Operator’s ManualWhen performing NIBP measurement repeatedly, have a rest between measurements to recover adequate circulation.CAUTIONMaintenanceIf 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.CAUTIONBefore maintenance, cleaning or disinfection, turn the transmitter power off and remove the batteries. Failure to follow this instruction may result in electrical shock and transmitter malfunction.CAUTIONNever disassemble or repair the transmitter. If there is any problem with the transmitter, contact your Nihon Kohden representative.CAUTIONDispose of Nihon Kohden products according to your local laws and your facility’s guidelines for waste disposal. Otherwise, it may affect the environment. If there is a possibility that the product may have been contaminated with infection, dispose of it as medical waste according to your local laws and your facility’s guidelines for medical waste. Otherwise, it may cause infection.CAUTION
27ZM-540PA, ZM-541PA Operator’s ManualPreparation on TransmitterBatteriesHandling BatteriesWARNINGDo not handle the batteries with wet hands.WARNINGWhen 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.Refer to the battery and battery charger manuals for details on handling the batteries.CAUTIONNOTE • Remove the batteries from the transmitter before disposing of it.• Use either new alkaline batteries or fully charged rechargeable NiMH EDWWHULHV8VLQJXQVSHFL¿HGEDWWHULHVSUHYLRXVO\XVHGEDWWHULHVRUEDWWHULHVthat have been stored for long periods may result in short battery life or reduced performance resulting in unstable measurement.Battery Lifetime8VHWKUHH$$W\SHDONDOLQHGU\FHOOEDWWHULHV1L0+EDWWHULHVFDQDOVREHXVHGEXWWKHOLIHWLPHRIDONDOLQHEDWWHULHVLVORQJHU7KHOLIHWLPHRI1L0+EDWWHULHVLVDERXWRIDONDOLQHEDWWHULHVZKHQIXOO\FKDUJHG:LWKQHZ1LKRQ.RKGHQUHFRPPHQGHGDONDOLQHEDWWHULHVWKHWUDQVPLWWHUFDQFRQWLQXRXVO\PHDVXUH(&*UHVSLUDWLRQ6S22DQG1,%3IRUDSSUR[LPDWHO\GD\7KHPHDVXUHPHQWLVSHUIRUPHGDWURRPWHPSHUDWXUH1,%3LVPHDVXUHGLQDXWRPRGHDWPLQXWHLQWHUYDOVDQG6S22LVPHDVXUHGRQDQLQGH[¿QJHURIDPDOHSDWLHQWZLWKZHLJKWNJ2SHUDWLRQWLPHGHSHQGVRQWKHWKLFNQHVVRIWKH6S22SUREHDWWDFKPHQWVLWH
28ZM-540PA, ZM-541PA Operator’s ManualRecommended batteries1L0+VHFRQGDU\ 3DQDVRQLFHQHORRS$ONDOLQHSULPDU\ 1LKRQ.RKGHQ0HGLSRZHUHTXLYDOHQWWR3DQDVRQLF/5*Installing and Replacing BatteriesBattery 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.CAUTION,IHOHFWURGHOHDGVDUHDWWDFKHGWRWKHSDWLHQWDQGWKHSHUVRQUHSODFLQJEDWWHULHVWRXFKHVWKHSDWLHQWGXULQJEDWWHU\UHSODFHPHQWH[FHVVSDWLHQWOHDNDJHFXUUHQWPD\ÀRZLQWRWKHSDWLHQWNOTE • Replace all batteries at the same time.• Do not use different types of batteries together.• ,QVHUWWKHEDWWHULHVZLWKWKHFRUUHFWSRODULW\DQGí• 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 5HPRYHWKHEDWWHU\FDVHFRYHU2 ,QVHUWWKUHHQHZRUIXOO\FKDUJHGEDWWHULHVLQWRWKHEDWWHU\FDVHREVHUYLQJWKHFRUUHFWSRODULW\
29ZM-540PA, ZM-541PA Operator’s ManualNOTE: ,QVHUWWKHíHQGRIWKHEDWWHU\¿UVWDQGpress it against the spring. If you try to force WKHHQGRIWKHEDWWHU\LQ¿UVWDVVKRZQit will deform the spring and damage the battery and transmitter.3 &ORVHWKHFRYHU7KHWUDQVPLWWHULVDXWRPDWLFDOO\WXUQHGRQZKHQWKHEDWWHULHVDUHLQVWDOOHGDQGWKHFRYHULVFORVHGAlways lock the battery cover while using the transmitter. Otherwise the battery cover may come off and correct measurement might not be performed.CAUTIONSituations Requiring Battery Replacement5HSODFHWKHEDWWHULHVZKHQDQ\RIWKHIROORZLQJRFFXUV• 7KHWUDQVPLWWHUGLVSOD\VWKH³%$77(5<:($.´PHVVDJHRU LFRQ• 7KHWUDQVPLWWHUJHQHUDWHVDFRQVWDQWDODUPFRQWLQXRXV³SHHS´VRXQG• 7KHWUDQVPLWWHU/&'GRHVQRWGLVSOD\DQ\WKLQJZKHQWKHSRZHULVWXUQHGRQ• 7KHUHFHLYLQJPRQLWRUGLVSOD\VDEDWWHU\UHSODFHPHQWPHVVDJHNOTE: The battery replacement message or icon on the transmitter disappears after a short time depending on the type of battery. When the battery replacement indication appears, immediately replace the transmitter battery with a new one.SpringSpringGood Bad
30ZM-540PA, ZM-541PA Operator’s ManualBattery Level Indication7KHIROORZLQJLFRQVRQWKHGLVSOD\LQGLFDWHWKHEDWWHU\OHYHO:KHQWKHVFUHHQLVWXUQHGRIISUHVVWKH6FUHHQNH\WRFKHFNWKHEDWWHU\OHYHO:KHQ³35272&2/´RIWKH6<67(06(783VFUHHQLVVHWWRWKHEDWWHU\OHYHOLQGLFDWLRQLVWUDQVPLWWHGWRWKHUHFHLYLQJPRQLWRUIndication Battery Level Message on the Receiving Monitor)XOO\FKDUJHGEDWWHULHV 7KHUHLVQRPHVVDJHRQWKHPRQLWRU%DWWHULHVDUHIXOO%DWWHULHVDUHZHDN5HSODFHEDWWHULHV0HVVDJHUHTXLULQJEDWWHU\UHSODFHPHQWLVGLVSOD\HG%DWWHULHVDUHYHU\ZHDN&DQQRWPHDVXUH1,%35HSODFHEDWWHULHVNo indication 'HDGEDWWHULHV 1RVLJQDOFDQEHWUDQVPLWWHGWRWKHPRQLWRU7KHUHLVQRLQGLFDWLRQRQWKHPRQLWRU
31ZM-540PA, ZM-541PA Operator’s ManualTurning On the Transmitter:KHQWKHEDWWHULHVDUHLQVWDOOHGFRUUHFWO\WKHSRZHULVWXUQHGRQ$³SHHS´VRXQGVIRURQHVHFRQGWKHVWDUWXSVFUHHQDSSHDUVWKHQWKHFKHFNHOHFWURGHVVFUHHQDSSHDUV7KHUHLVQR³SHHS´VRXQGZKHQWKHUHLVQREDWWHU\SRZHUNOTE: Check that the “COMMUNICATION LOSS” message is not displayed on the central monitor.$IWHUFKHFNLQJWKDWWKH(&*LVVWDEOHRQWKHFKHFNHOHFWURGHVVFUHHQSUHVVWKH6FUHHQNH\WRGLVSOD\WKHQXPHULFDQGZDYHIRUPVFUHHQ)RUGHWDLOVRQWKHVFUHHQUHIHUWRWKH³6FUHHQ'HVFULSWLRQV´VHFWLRQCheck Items Before Use%HIRUHWXUQLQJRQWKHWUDQVPLWWHUSRZHUFKHFNWKHIROORZLQJWRFRQ¿UPWKDWWKHWUDQVPLWWHUFDQEHXVHGLQQRUPDODQGVDIHFRQGLWLRQOperating Environment,IWKHWUDQVPLWWHUKDVEHHQVWRUHGLQFRQGLWLRQVVXFKDVORZWHPSHUDWXUHVWKDWDUHRXWVLGHWKHXVDJHHQYLURQPHQWUDQJHSODFHWKHWUDQVPLWWHULQWKHXVDJHHQYLURQPHQWIRUVXI¿FLHQWWLPHIRULWWRDGMXVWWRWKHURRPWHPSHUDWXUHEHIRUHXVH,IWKHWUDQVPLWWHUPD\EHXVHGFRQVWDQWO\VWRUHLWZLWKLQWKHXVDJHHQYLURQPHQWUDQJH
32ZM-540PA, ZM-541PA Operator’s ManualAppearance• 7KHUHDUHQRGDPDJHGRUGLUW\SDUWVRQWKHRXWVLGHRIWKHWUDQVPLWWHU/&'NH\VVRFNHWVEDWWHU\FDVHFRYHUEDWWHU\FDVHORFNSODWHHWF• 7KHWUDQVPLWWHULVFRPSOHWHO\GU\• 7KHHOHFWURGHVHOHFWURGHOHDG6S22SUREHDQG1,%3FXIIDUHQRWEURNHQBatteries• 7KHEDWWHU\SRODULW\LVFRUUHFW• 7KHEDWWHU\FDVHVSULQJLV¿UPO\DWWDFKHGDQGWKHEDWWHU\LVQRWORRVH• 7KHEDWWHU\FDVHFRYHULV¿UPO\FORVHGChannel Setting• 7KHWUDQVPLWWHUFKDQQHOPDWFKHVWKHUHFHLYLQJPRQLWRUFKDQQHO• 7KHUHLVQRQHDUE\WUDQVPLWWHUZLWKWKHVDPHFKDQQHOOther7KHWUDQVPLWWHULQIRUPDWLRQLVFRUUHFWO\VHQWWRWKHUHFHLYLQJPRQLWRUZKHQWKHWUDQVPLWWHULVWXUQHGRQRURIICheck Items After Power On$IWHUWXUQLQJRQWKHSRZHUFKHFNWKHIROORZLQJPower On• 7KHWUDQVPLWWHUJHQHUDWHVDRQHVHFRQG³SHHS´VRXQGDQGWKHVWDUWXSVFUHHQDSSHDUV• 7KHWUDQVPLWWHUGLVSOD\VWKHFKHFNHOHFWURGHVVFUHHQ• 7KHWUDQVPLWWHULVQRWWRRKRW• 7KHWUDQVPLWWHUGRHVQRWGLVSOD\WKH³%$77(5<:($.´PHVVDJH• 7KHWUDQVPLWWHUGRHVQRWLQWHUIHUHZLWKWKHRSHUDWLRQRIRWKHUPHGLFDOLQVWUXPHQWVDaily Check• 7KH³VLJQDOORVV´PHVVDJHLVQRWGLVSOD\HGRQWKHUHFHLYLQJPRQLWRUZKHQWKHWUDQVPLWWHULVLQVLGHWKHUHFHLYLQJUDQJHRIWKHPRQLWRU• 7KHEDWWHU\UHSODFHPHQWPHVVDJHLVQRWGLVSOD\HGRQWKHPRQLWRU• 7KHNH\VRQWKHWUDQVPLWWHUIXQFWLRQSURSHUO\• 7KH/&'EULJKWQHVVLVDSSURSULDWH7RDGMXVWEULJKWQHVVUHIHUWRWKH³&KDQJLQJ6<67(06(7836HWWLQJV´VHFWLRQ
33ZM-540PA, ZM-541PA Operator’s ManualCheck Items After Use7RXVHWKHWUDQVPLWWHULQVDIHDQGRSWLPXPFRQGLWLRQIRUQH[WWLPHFKHFNWKHIROORZLQJBefore Turning Power Off• 7HPSRUDULO\FKDQJHGVHWWLQJVDUHFKDQJHGEDFNWRWKHSUHYLRXVVHWWLQJV• 7KHUHZDVQRPDOIXQFWLRQRQWKHWUDQVPLWWHUStorage• (&*HOHFWURGHOHDGV6S22SUREHDQG1,%3FXIIDUHFOHDQHGDQGGLVLQIHFWHG• ,IWKHWUDQVPLWWHUJRWZHWOLTXLGLVZLSHGRIIDQGWKHWUDQVPLWWHULVWKRURXJKO\GULHG• 7KHUHDUHHQRXJKFRQVXPDEOHVVXFKDVGLVSRVDEOHHOHFWURGHV• 7KHWUDQVPLWWHUSRZHULVWXUQHGRIIE\UHPRYLQJEDWWHULHVIURPWKHWUDQVPLWWHU• 'HDGEDWWHULHVDUHGLVSRVHGRISURSHUO\Turning Off the Transmitter7RWXUQRIIWKHSRZHUUHPRYHWKHEDWWHULHV:KHQWKHSRZHULVWXUQHGRIIWKHVDYHGZDYHIRUPDQGQXPHULFGDWDDUHGHOHWHG
34ZM-540PA, ZM-541PA Operator’s ManualChanging the Transmitter Channel7KHFKDQQHORIWKHWUDQVPLWWHUFDQEHFKDQJHGZLWKDQRSWLRQDO4,3.FKDQQHOZULWHU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.7KHFKDQQHOLVGLVSOD\HGLQWKHXSSHUOHIWFRUQHURIWKHVFUHHQChannel
35ZM-540PA, ZM-541PA Operator’s ManualChanging Parameter and System Setup Settings7KHLQLWLDOVHWWLQJVRQWKH3$5$0(7(56(783DQG6<67(06(783VFUHHQVFDQRQO\EHFKDQJHGEHIRUHPRQLWRULQJ&KDQJLQJWKHVHVHWWLQJVGXULQJPRQLWRULQJLQWHUUXSWVPRQLWRULQJNOTE: &KDQJLQJ3DUDPHWHUDQG6\VWHP6HWXSVHWWLQJVPXVWEHGRQHE\TXDOL¿HGpersonnel.Notes on Parameter Settings:KHQPRQLWRULQJ1,%3DQG6S22WKHIROORZLQJVHWWLQJPXVWEHVHWDVLQGLFDWHGLQWKHWDEOHWRSURSHUO\WUDQVPLWWKHPRQLWRULQJGDWDWRWKHUHFHLYLQJPRQLWRU2WKHUZLVH6S22 cannot be PRQLWRUHGSURSHUO\GXULQJ1,%3PHDVXUHPHQW6RPHUHFHLYLQJPRQLWRUVUHTXLUHWKHVRIWZDUHWREHXSJUDGHG)RUGHWDLOVFRQWDFW\RXU1LKRQ.RKGHQUHSUHVHQWDWLYHSpO2 Probe Attachment Site INHIBIT SpO2 DURING NIBP SETTING3UREHDWWDFKHGWRWKHVDPHOLPEDVWKHFXII1213UREHDWWDFKHGWRWKHOLPEZLWKRXWFXII 2))1 :KHQWKH6S22SUREHLVDWWDFKHGWRWKHVDPHOLPEDVWKH1,%3FXIIDQGWKHFXIILVLQÀDWHGWKH6S22YDOXHEHFRPHVXQVWDEOHDQG6S22RU35DODUPPD\RFFXU
36ZM-540PA, ZM-541PA Operator’s ManualChanging PARAMETER SETUP SettingsParameter Setup Setting List7KHIDFWRU\GHIDXOWVHWWLQJVDUHXQGHUOLQHGSetting Item Description Settings(&*(/(&752'(6 6HOHFWWKHHOHFWURGHOHDGW\SH ,(&$+$/($'7<3( 6HOHFWWKHW\SHRI(&*OHDGV $872/($'6(&*0($685(0(177XUQ(&*PRQLWRULQJRQRURII:KHQHOHFWURGHVDUHDWWDFKHGWRWKHSDWLHQWDQG(&*OHDGVDUHFRQQHFWHG(&*PRQLWRULQJVWDUWVHYHQZKHQWKLVVHWWLQJLVVHWWR2)),IWKLVVHWWLQJLVVHWWR2))WKHVDPHVHWWLQJRQWKHUHFHLYLQJPRQLWRUPXVWDOVREHVHWWR2))NOTE: When “PROTOCOL” of 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.212))5(630($685(0(177XUQUHVSLUDWLRQPRQLWRULQJRQRURII:KHQWKLVVHWWLQJLVVHWWR2))WKHVDPHVHWWLQJRQWKHUHFHLYLQJPRQLWRULVDXWRPDWLFDOO\VHWWR2))212))6S225(63216( 6HOHFWWKH6S22UHVSRQVHPRGH )$671250$/6/2:,1+,%,76S22 '85,1*1,%37XUQ6S22PRQLWRULQJRQRURIIGXULQJ1,%3PHDVXUHPHQW 212))6(/(&7$%/(,17(59$/6PLQ6HOHFWWKH1,%3PHDVXUHPHQWPRGHVIRUWKHPRGHVHOHFWLRQ0$18$/, 67$7, , , , 60,1,7,$/,17(59$/PLQ6HOHFWWKHLQLWLDO1,%3PHDVXUHPHQWPRGHDWSRZHURQ0$18$/, 67$71,%302'($)7(567$7PLQ6HOHFWWKH1,%3PHDVXUHPHQWPRGHDIWHUFRPSOHWLQJ67$7PHDVXUHPHQW0$18$/, 67$57),1,6+6281'7XUQ21RU2))WKHVRXQGIRU1,%3PHDVXUHPHQWVWDUW¿QLVK67$57212))),1,6+212))2/'1,%3'$7$$)7(5PLQ6HOHFWZKHWKHUWRKLGHRUGLPWKH1,%3GDWDDIWHUPHDVXUHPHQWDQGKRZORQJWRZDLWDIWHUPHDVXUHPHQWWRGLPRUKLGHLW'$7$+,'(, ',0$)7(5,1,7,$/&8))35(6685(PP+J 6HOHFWWKH1,%3FXIILQÀDWLRQSUHVVXUH , 
37ZM-540PA, ZM-541PA Operator’s ManualDisplaying the PARAMETER SETUP Screen1 7XUQRIIWKHWUDQVPLWWHUE\UHPRYLQJRQHEDWWHU\2 :KLOHSUHVVLQJWKH)XQFWLRQNH\WXUQRQWKHWUDQVPLWWHUE\LQVHUWLQJWKHEDWWHU\7KH0(18VFUHHQDSSHDUV3 3UHVVWKHŹNH\WRPRYHWKHFXUVRUWR³3$5$0(7(56(783´4 3UHVVWKH)XQFWLRQNH\WRHQWHU3$5$0(7(56(7837KHFXUUHQWVHWWLQJVDUHKLJKOLJKWHG5 &KDQJHVHWWLQJV• 7RPRYHWKHFXUVRUDQGVHOHFWWKHVHWWLQJLWHPSUHVVWKHŻRUŹNH\WKHQSUHVVWKH)XQFWLRQNH\• 7RVHOHFWDQGUHJLVWHUWKHVHWWLQJSUHVVWKHŻRUŹNH\WKHQSUHVVWKH)XQFWLRQNH\• 7RFDQFHOFKDQJLQJWKHVHWWLQJRIWKHVHOHFWHGLWHPSUHVVWKH6FUHHQNH\6 :KHQFKDQJLQJVHWWLQJVRQWKH3$5$0(7(56(783VFUHHQLVFRPSOHWHSUHVVWKH6FUHHQNH\WRUHWXUQWRWKH0(18VFUHHQ7 3UHVVWKHŻ or ŹNH\WRPRYHWKHFXUVRUWR³(;,7´8 3UHVVWKH)XQFWLRQNH\7KHQXPHULFDQGZDYHIRUPVFUHHQDSSHDUVMENU screenCursorSettingPARAMETER SETUP screen - page 1Setting itemCursor
38ZM-540PA, ZM-541PA Operator’s ManualChanging Parameter Setup SettingsECG ELECTRODES6HOHFWWKHHOHFWURGHOHDGW\SH1 2QWKH3$5$0(7(56(783VFUHHQSUHVVWKHŹNH\WRPRYHWKHFXUVRUWR³(&*(/(&752'(6´2 3UHVVWKH)XQFWLRQNH\7KHFXUVRUPRYHVWRWKHVHOHFWLRQLWHP3 3UHVVWKHŹNH\WRVHOHFW³,(&´RU³$+$´4 3UHVVWKH)XQFWLRQNH\WRUHJLVWHUWKHVHOHFWHGVHWWLQJ7KHFXUVRUUHWXUQVWR³(&*(/(&752'(6´LEAD TYPE6HOHFWWKHW\SHRI(&*OHDGV,QQRUPDOXVHVHOHFW³$872´:KHQXVLQJ',1W\SHOHDGZLWKHOHFWURGHVVHOHFW³/($'6´1 2QWKH3$5$0(7(56(783VFUHHQSUHVVWKHŹNH\WRPRYHWKHFXUVRUWR³/($'7<3(´2 3UHVVWKH)XQFWLRQNH\3 3UHVVWKHŹNH\WRVHOHFW³$872´RU³/($'6´4 3UHVVWKH)XQFWLRQNH\WRUHJLVWHUWKHVHOHFWHGVHWWLQJ7KHFXUVRUUHWXUQVWR³/($'7<3(´Setting itemCursorSelected settingCursor
39ZM-540PA, ZM-541PA Operator’s ManualECG MEASUREMENT7XUQ(&*PRQLWRULQJRQRURII:KHQHOHFWURGHVDUHDWWDFKHGWRWKHSDWLHQWDQG(&*OHDGVDUHFRQQHFWHG(&*PRQLWRULQJVWDUWVHYHQZKHQWKLVVHWWLQJLVVHWWR2)),IWKLVVHWWLQJLVVHWWR2))WKHVDPHVHWWLQJRQWKHUHFHLYLQJPRQLWRUPXVWDOVREHVHWWR2))NOTE: When “PROTOCOL” of 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 2QWKH3$5$0(7(56(783VFUHHQSUHVVWKHŹNH\WRPRYHWKHFXUVRUWR³(&*0($685(0(17´2 3UHVVWKH)XQFWLRQNH\3 3UHVVWKHŹNH\WRVHOHFW³21´RU³2))´4 3UHVVWKH)XQFWLRQNH\WRUHJLVWHUWKHVHOHFWHGVHWWLQJ7KHFXUVRUUHWXUQVWR³(&*0($685(0(17´RESP MEASUREMENT7XUQUHVSLUDWLRQPRQLWRULQJRQRURII:KHQWKLVVHWWLQJLVVHWWR2))WKHVDPHVHWWLQJRQWKHUHFHLYLQJPRQLWRULVDXWRPDWLFDOO\VHWWR2))1 2QWKH3$5$0(7(56(783VFUHHQSUHVVWKHŹNH\WRPRYHWKHFXUVRUWR³5(630($685(0(17´2 3UHVVWKH)XQFWLRQNH\3 3UHVVWKHŹNH\WRVHOHFW³21´RU³2))´4 3UHVVWKH)XQFWLRQNH\WRUHJLVWHUWKHVHOHFWHGVHWWLQJ7KHFXUVRUUHWXUQVWR³5(630($685(0(17´
40ZM-540PA, ZM-541PA Operator’s ManualSpO2 RESPONSE6HOHFWWKH6S22UHVSRQVHPRGHIURP)$671250$/RU6/2:)RUGHWDLOVRQWKHUHVSRQVHWLPHUHIHUWRWKH³6SHFL¿FDWLRQV6S220HDVXUHPHQW,62FRPSOLDQW´VHFWLRQLQWKLVPDQXDONOTE: When measurement condition is unstable due to strenuous movement of the patient, etc., response may become slower in all modes.1 2QWKH3$5$0(7(56(783VFUHHQSUHVVWKHŹNH\WRPRYHWKHFXUVRUWR³6S22 5(63216(´³6S225(63216(´LVRQWKHVHFRQGSDJHRIWKH3$5$0(7(56(783VFUHHQ2 3UHVVWKH)XQFWLRQNH\3 3UHVVWKHŹNH\WRVHOHFW³)$67´³1250$/´RU³6/2:´4 3UHVVWKH)XQFWLRQNH\WRUHJLVWHUWKHVHOHFWHGVHWWLQJ7KHFXUVRUUHWXUQVWR³6S22 5(63216(´INHIBIT SpO2 DURING NIBP7XUQ6S22PRQLWRULQJRQRURIIGXULQJ1,%3PHDVXUHPHQW:KHQWKH6S22SUREHLVDWWDFKHGWRWKHVDPHOLPEDVWKH1,%3FXIIDQGWKLVVHWWLQJLVVHWWR2))WKHSXOVHPD\EHFRPHXQVWDEOHDQG6S22RU35DODUPPD\RFFXU,WLVUHFRPPHQGHGWRVHWWKLVVHWWLQJWR21VRWKDW6S22LVQRWPHDVXUHGGXULQJ1,%3PHDVXUHPHQW:KHQWKH6S22SUREHLVDWWDFKHGWRWKHRWKHUOLPEIURPWKH1,%3FXIIWKLVVHWWLQJFDQEHVHWWR2))NOTE: When this “INHIBIT SpO2 DURING NIBP” is set to OFF, refer to the “Monitoring SpO2 during NIBP Measurement” section.1 2QWKH3$5$0(7(56(783VFUHHQSUHVVWKHŹNH\WRPRYHWKHFXUVRUWR³,1+,%,76S22'85,1*1,%3´³,1+,%,76S22'85,1*1,%3´LVRQWKHVHFRQGSDJHRIWKH3$5$0(7(56(783VFUHHQ2 3UHVVWKH)XQFWLRQNH\3 3UHVVWKHŹNH\WRVHOHFW³21´RU³2))´4 3UHVVWKH)XQFWLRQNH\WRUHJLVWHUWKHVHOHFWHGVHWWLQJ7KHFXUVRUUHWXUQVWR³,1+,%,76S22'85,1*1,%3´PARAMETER SETUP screen - page 2
41ZM-540PA, ZM-541PA Operator’s ManualSELECTABLE INTERVALS (min):KHQWKH1,%3,17(59$/NH\LVSUHVVHGWKHPHDVXUHPHQWPRGHFKDQJHVDFFRUGLQJWRWKHPRGHVVHOHFWHGLQWKLVLWHP0$18$/PRGHLVDOUHDG\VHOHFWHGIRUWKHPRGHVHOHFWLRQ1 2QWKH3$5$0(7(56(783VFUHHQSUHVVWKHŹNH\WRPRYHWKHFXUVRUWR³6(/(&7$%/(,17(59$/6´³6(/(&7$%/(,17(59$/6´LVRQWKHWKLUGSDJHRIWKH3$5$0(7(56(783VFUHHQ2 3UHVVWKH)XQFWLRQNH\3 3UHVVWKHŹNH\WRVHOHFWRUXQVHOHFWWKHPRGH7KHVHOHFWHGPRGHVDUHKLJKOLJKWHG4 3UHVVWKH)XQFWLRQNH\WRUHJLVWHUWKHVHOHFWHGVHWWLQJ7KHFXUVRUUHWXUQVWR³6(/(&7$%/(,17(59$/6´INITIAL INTERVAL (min)6HOHFWWKHLQLWLDO1,%3PHDVXUHPHQWPRGHDWSRZHURQ1 2QWKH3$5$0(7(56(783VFUHHQSUHVVWKHŹNH\WRPRYHWKHFXUVRUWR³,1,7,$/,17(59$/´³,1,7,$/,17(59$/´LVRQWKHWKLUGSDJHRIWKH3$5$0(7(56(783VFUHHQ2 3UHVVWKH)XQFWLRQNH\3 3UHVVWKHŹNH\WRVHOHFWWKHPRGH2QO\WKHPRGHRULQWHUYDOVHOHFWHGIRU³6(/(&7$%/(,17(59$/6´DUHDYDLODEOH4 3UHVVWKH)XQFWLRQNH\WRUHJLVWHUWKHVHOHFWHGVHWWLQJ7KHFXUVRUUHWXUQVWR³,1,7,$/,17(59$/´PARAMETER SETUP screen - page 3
42ZM-540PA, ZM-541PA Operator’s ManualNIBP MODE AFTER STAT (min)6HOHFWWKH1,%3PHDVXUHPHQWPRGHDIWHUFRPSOHWLQJWKH67$7PHDVXUHPHQW1 2QWKH3$5$0(7(56(783VFUHHQSUHVVWKHŹNH\WRPRYHWKHFXUVRUWR³1,%302'($)7(567$7´³1,%302'($)7(567$7´LVRQWKHWKLUGSDJHRIWKH3$5$0(7(56(783VFUHHQ2 3UHVVWKH)XQFWLRQNH\3 3UHVVWKHŹNH\WRVHOHFWWKHPRGH2QO\WKHPRGHRULQWHUYDOVHOHFWHGIRU³6(/(&7$%/(,17(59$/6´DUHDYDLODEOH4 3UHVVWKH)XQFWLRQNH\WRUHJLVWHUWKHVHOHFWHGVHWWLQJ7KHFXUVRUUHWXUQVWR³1,%302'($)7(567$7´START/FINISH SOUND7XUQRQRURIIWKHVRXQGIRU1,%3PHDVXUHPHQWVWDUWDQG¿QLVK1 2QWKH3$5$0(7(56(783VFUHHQSUHVVWKHŹNH\WRPRYHWKHFXUVRUWR³67$57),1,6+6281'´³67$57),1,6+6281'´LVRQWKHIRXUWKSDJHRIWKH3$5$0(7(56(783VFUHHQ2 3UHVVWKH)XQFWLRQNH\7KHFXUVRUPRYHVWR³67$57´3 3UHVVWKHŹNH\WRWXUQ³21´RU³2))´WKHVRXQGIRU1,%3PHDVXUHPHQWVWDUW4 3UHVVWKH)XQFWLRQNH\WRUHJLVWHUWKHVHWWLQJIRU³67$57´7KHFXUVRUPRYHVWR³),1,6+´5 3UHVVWKHŹNH\WRWXUQ³21´RU³2))´WKHVRXQGIRU1,%3PHDVXUHPHQW¿QLVK6 3UHVVWKH)XQFWLRQNH\WRUHJLVWHUWKHVHOHFWHGVHWWLQJ7KHFXUVRUUHWXUQVWR³67$57),1,6+6281'´PARAMETER SETUP screen - page 4
43ZM-540PA, ZM-541PA Operator’s ManualOLD NIBP DATA/AFTER (min)6HOHFWZKHWKHUWRGLPRUKLGHWKH1,%3GDWDDIWHUPHDVXUHPHQWDQGKRZORQJWRZDLWDIWHU1,%3PHDVXUHPHQWWRGLPRUKLGHLW1 2QWKH3$5$0(7(56(783VFUHHQSUHVVWKHŹNH\WRPRYHWKHFXUVRUWR³2/'1,%3'$7$$)7(5´³2/'1,%3'$7$$)7(5´LVRQWKHIRXUWKSDJHRIWKH3$5$0(7(56(783VFUHHQ2 3UHVVWKH)XQFWLRQNH\7KHFXUVRUPRYHVWR³'$7$´3 3UHVVWKHŹNH\WRVHOHFW³+,'(´RU³',0´WKH1,%3GDWD4 3UHVVWKH)XQFWLRQNH\WRUHJLVWHUWKHVHWWLQJIRU³'$7$´7KHFXUVRUPRYHVWR³$)7(5´5 3UHVVWKHŹNH\WRVHOHFWWKHLQWHUYDODIWHU1,%3PHDVXUHPHQWWRGLPRUKLGH6 3UHVVWKH)XQFWLRQNH\WRUHJLVWHUWKHVHOHFWHGVHWWLQJ7KHFXUVRUUHWXUQVWR³2/'1,%3'$7$$)7(5´INITIAL CUFF PRESSURE (mmHg)6HOHFWWKH1,%3FXIILQÀDWLRQSUHVVXUH1 2QWKH3$5$0(7(56(783VFUHHQSUHVVWKHŹNH\WRPRYHWKHFXUVRUWR³,1,7,$/&8))35(6685(´³,1,7,$/&8))35(6685(´LVRQWKHIRXUWKSDJHRIWKH3$5$0(7(56(783VFUHHQ2 3UHVVWKH)XQFWLRQNH\3 3UHVVWKHŹNH\WRVHOHFWWKHLQÀDWLRQSUHVVXUH4 3UHVVWKH)XQFWLRQNH\WRUHJLVWHUWKHVHOHFWHGVHWWLQJ7KHFXUVRUUHWXUQVWR³,1,7,$/&8))35(6685(´
44ZM-540PA, ZM-541PA Operator’s ManualChanging SYSTEM SETUP SettingsSystem Setup Setting List7KHIDFWRU\GHIDXOWVHWWLQJVDUHXQGHUOLQHGSetting Item Description Settings35272&2/6HOHFWWKHWUDQVPLWWLQJSURWRFRO1HZSURWRFRO$FHQWUDOPRQLWRUZLWKDQ 25*$25*$RU25*$PXOWLSOHSDWLHQWUHFHLYHUZKRVHVRIWZDUHYHUVLRQRUODWHUFDQUHFHLYHWKLVSURWRFRO2OGSURWRFRO$FHQWUDOPRQLWRUZLWKDQ 25*$25*$RU25*$PXOWLSOHSDWLHQWUHFHLYHUFDQUHFHLYHWKLVSURWRFRONOTE: When 57 is set, the receiving monitor must be able to receive protocol 57. Otherwise, signals from the transmitter cannot be received., 42%5,*+71(66 6HOHFWWKHVFUHHQEULJKWQHVV '$5., %5,*+735(6685(81,7 6HOHFWWKHXQLWIRU1,%3 PP+JN3D)81&7,21.(<6HOHFWWKHIXQFWLRQRIWKH)XQFWLRQNH\6863(1'$/$503$86( 6XVSHQGVDODUPRQWKHUHFHLYLQJPRQLWRUIRU PLQXWHV3DXVHVPRQLWRULQJRQWKHWUDQVPLWWHUDQGUHFHLYLQJPRQLWRU6863(1'$/$50 6XVSHQGVDODUPRQWKHUHFHLYLQJPRQLWRUIRU PLQXWHV&21),50 'LVSOD\VWKH³3$7,(17&21),50('´PHVVDJHRQWKHWUDQVPLWWHUVFUHHQDQGWUDQVPLWVWKHPHVVDJHWRWKHUHFHLYLQJPRQLWRU2)) 1RIXQFWLRQNOTE: “SUSPEND ALARM & PAUSE” and “CONFIRM” can only be set when PROTOCOL is set to 57.6863(1'$/$503$86(, 6863(1'$/$50&21),502))$8725(680($)7(53$86( 6HOHFWWKHLQWHUYDOWRUHVXPHPRQLWRULQJDIWHU3$86(VV, PLQPLQPLQ6(/(&7$%/(6&5((17,0(2873(5,2'PLQ6HOHFWWKHGLVSOD\WLPHRXWSHULRG , 
45ZM-540PA, ZM-541PA Operator’s ManualDisplaying the SYSTEM SETUP Screen1 7XUQRIIWKHWUDQVPLWWHUE\UHPRYLQJRQHEDWWHU\2 :KLOHSUHVVLQJWKH)XQFWLRQNH\WXUQRQWKHWUDQVPLWWHUE\LQVHUWLQJWKHEDWWHU\7KH0(18VFUHHQDSSHDUV3 3UHVVWKHŹNH\WRPRYHWKHFXUVRUWR³6<67(06(783´4 3UHVVWKH)XQFWLRQNH\WRHQWHU6<67(06(7837KHFXUUHQWVHWWLQJVDUHKLJKOLJKWHG5 &KDQJHVHWWLQJV• 7RPRYHWKHFXUVRUDQGVHOHFWWKHVHWWLQJLWHPpress the Ż or ŹNH\WKHQSUHVVWKH)XQFWLRQNH\• 7RVHOHFWDQGUHJLVWHUWKHVHWWLQJSUHVVWKHŻ or ŹNH\WKHQSUHVVWKH)XQFWLRQNH\• 7RFDQFHOFKDQJLQJWKHVHWWLQJRIWKHVHOHFWHGLWHPSUHVVWKH6FUHHQNH\7KH6<67(06(783VFUHHQKDVWZRSDJHV7RGLVSOD\WKHVHFRQGSDJHSUHVVWKHŹNH\ZKHQWKHFXUVRULVDW³35(6685(81,7´6 :KHQFKDQJLQJVHWWLQJVRQWKH6<67(06(783VFUHHQLVFRPSOHWHSUHVVWKH6FUHHQNH\WRUHWXUQWRWKH0(18VFUHHQ7 3UHVVWKHŻRUŹNH\WRPRYHWKHFXUVRUWR³(;,7´8 3UHVVWKH)XQFWLRQNH\7KHQXPHULFDQGZDYHIRUPVFUHHQDSSHDUVCursorMENU screenSYSTEM SETUP screen - page 1SettingSetting item
46ZM-540PA, ZM-541PA Operator’s ManualChanging System Setup SettingsPROTOCOL6HOHFWWKHWUDQVPLWWLQJSURWRFRO)RUGLIIHUHQFHVEHWZHHQSURWRFROVUHIHUWRWKHWDEOHEHORZ1HZSURWRFRO$FHQWUDOPRQLWRUZLWKDQ25*$25*$RU25*$PXOWLSOHSDWLHQWUHFHLYHUZKRVHVRIWZDUHYHUVLRQRUODWHUFDQUHFHLYHWKLVSURWRFRO2OGSURWRFRO$FHQWUDOPRQLWRUZLWK25*$25*$RU25*$PXOWLSOHSDWLHQWUHFHLYHUFDQUHFHLYHWKLVSURWRFRONOTE: When 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 576HWWLQJ(&*0($685(0(17WR2))RQWKHWUDQVPLWWHUDXWRPDWLFDOO\WXUQVRIIWKH(&*PHDVXUHPHQWVHWWLQJRQWKHUHFHLYLQJPRQLWRU1R(&*PHDVXUHPHQWPXVWEHWXUQHGRIIRQWKHUHFHLYLQJPRQLWRU<HV3DXVHPRQLWRULQJRQWKHUHFHLYLQJPRQLWRUIURPthe transmitter No <HV7UDQVPLW³3$7,(17&21),50('´PHVVDJH No <HV'LVSOD\EDWWHU\OHYHORIWKHWUDQVPLWWHURQWKHUHFHLYLQJPRQLWRU No <HV7UDQVPLW6S22PHVVDJHV 6RPHPHVVDJHVUHIHUWRWKH³,QGLFDWLRQDQG0HVVDJH/LVW´VHFWLRQ$OOPHVVDJHV1 3UHVVWKHŹNH\WRPRYHWKHFXUVRUWR³35272&2/´2 3UHVVWKH)XQFWLRQNH\3 3UHVVWKHŹNH\WRVHOHFW³´RU³´SettingCursor
47ZM-540PA, ZM-541PA Operator’s ManualNOTE: FUNCTION 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 3UHVVWKH)XQFWLRQNH\WRUHJLVWHUWKHVHOHFWHGVHWWLQJ7KHFXUVRUUHWXUQVWR³35272&2/´BRIGHTNESS6HOHFWWKHVFUHHQEULJKWQHVV1 3UHVVWKHŹNH\WRPRYHWKHFXUVRUWR³%5,*+71(66´2 3UHVVWKH)XQFWLRQNH\3 3UHVVWKHŹNH\WRVHOHFW³'$5.´RU³%5,*+7´4 3UHVVWKH)XQFWLRQNH\WRUHJLVWHUWKHVHOHFWHGVHWWLQJ7KHFXUVRUUHWXUQVWR³%5,*+71(66´PRESSURE UNIT6HOHFWWKHXQLWIRU1,%31 3UHVVWKHŹNH\WRPRYHWKHFXUVRUWR³35(6685(81,7´2 3UHVVWKH)XQFWLRQNH\3 3UHVVWKHŹNH\WRVHOHFW³PP+J´RU³N3D´4 3UHVVWKH)XQFWLRQNH\WRUHJLVWHUWKHVHOHFWHGVHWWLQJ7KHFXUVRUUHWXUQVWR³35(6685(81,7´
48ZM-540PA, ZM-541PA Operator’s ManualFUNCTION KEY6HOHFWWKHIXQFWLRQRIWKH)XQFWLRQNH\)RUGHWDLOVRQXVLQJWKHVHIXQFWLRQVUHIHUWR³%DVLF0RQLWRULQJ2SHUDWLRQ´LQWKH³0RQLWRULQJ´VHFWLRQ6863(1'$/$503$86( 6XVSHQGVDODUPRQWKHUHFHLYLQJPRQLWRUIRUPLQXWHV3DXVHVPRQLWRULQJRQWKHWUDQVPLWWHUDQGUHFHLYLQJPRQLWRU6863(1'$/$50 6XVSHQGVDODUPRQWKHUHFHLYLQJPRQLWRUIRUPLQXWHV&21),50 'LVSOD\VWKH³3$7,(17&21),50('´PHVVDJHRQWKHWUDQVPLWWHUVFUHHQDQGWUDQVPLWVWKHPHVVDJHWRWKHUHFHLYLQJPRQLWRU2)) 1RIXQFWLRQNOTE: “SUSPEND ALARM & PAUSE” and “CONFIRM” can only be set when PROTOCOL is set to 57.1 2QWKH6<67(06(783VFUHHQSUHVVWKHŹ NH\WRPRYHWKHFXUVRUWR³)81&7,21.(<´³)81&7,21.(<´LVRQWKHVHFRQGSDJHRIWKH6<67(06(783VFUHHQ2 3UHVVWKH)XQFWLRQNH\3 3UHVVWKHŹNH\WRVHOHFWWKHIXQFWLRQ4 3UHVVWKH)XQFWLRQNH\WRUHJLVWHUWKHVHOHFWHGVHWWLQJ7KHFXUVRUUHWXUQVWR³)81&7,21.(<´AUTO RESUME AFTER PAUSE6HOHFWWKHLQWHUYDOWRUHVXPHPRQLWRULQJDIWHU3$86(:KHQHLWKHURIWKHIROORZLQJFRQGLWLRQVLVPHWPRQLWRULQJUHVXPHVRQWKHUHFHLYLQJPRQLWRU• +HDUWUDWHLVSURSHUO\PRQLWRUHGIRUWKHVHOHFWHGLQWHUYDO• 6 S 2 2LVSURSHUO\PRQLWRUHGIRUWKHVHOHFWHGLQWHUYDO• 1,%3LVSURSHUO\PHDVXUHGDQGWKH6<6',$RU0$3YDOXHLVGLVSOD\HG1 3UHVVWKHŹNH\WRPRYHWKHFXUVRUWR³$8725(680($)7(53$86(´³$8725(680($)7(53$86(´LVRQWKHVHFRQGSDJHRIWKH6<67(06(783VFUHHQ2 3UHVVWKH)XQFWLRQNH\3 3UHVVWKHŹNH\WRVHOHFWWKHLQWHUYDO4 3UHVVWKH)XQFWLRQNH\WRUHJLVWHUWKHVHOHFWHGVHWWLQJ7KHFXUVRUUHWXUQVWR³$8725(680($)7(53$86(´SYSTEM SETUP screen - page 2
49ZM-540PA, ZM-541PA Operator’s ManualSELECTABLE SCREEN TIME OUT PERIOD (min)6HOHFWWKHGLVSOD\WLPHRXWSHULRG,IQRNH\LVSUHVVHGIRUWKHVHOHFWHGWLPHWKHGLVSOD\LVDXWRPDWLFDOO\WXUQHGRII7KHVHOHFWHGWLPHLVVKRZQRQWKH6HOHFW6FUHHQ7LPH2XW3HULRGVFUHHQ5HIHUWRWKH³7XUQLQJWKH'LVSOD\2II´VHFWLRQIRUGHWDLOV1 3UHVVWKHŹNH\WRPRYHWKHFXUVRUWR³6(/(&7$%/(6&5((17,0(2873(5,2'PLQ´,WLVRQWKHWKLUGSDJHRIWKH6<67(06(783VFUHHQ2 3UHVVWKH)XQFWLRQNH\3 3UHVVWKHŻRUŹNH\WRVHOHFWWLPHRXWSHULRG4 3UHVVWKH)XQFWLRQNH\WRUHJLVWHUWKHVHOHFWHGVHWWLQJ7KHFXUVRUUHWXUQVWR³6(/(&7$%/(6&5((17,0(2873(5,2'PLQ´SYSTEM SETUP screen - page 2
50ZM-540PA, ZM-541PA Operator’s ManualInitializing Settings'RWKHIROORZLQJSURFHGXUHWRLQLWLDOL]HDOOVHWWLQJVH[FHSWIRUFKDQQHOWRWKHIDFWRU\GHIDXOWVHWWLQJV1 7XUQRIIWKHWUDQVPLWWHUE\UHPRYLQJDEDWWHU\2 :KLOHSUHVVLQJWKH)XQFWLRQNH\WXUQRQWKHWUDQVPLWWHUE\LQVHUWLQJWKHEDWWHU\7KH0(18VFUHHQDSSHDUV3 3UHVVWKHŹNH\WRPRYHWKHFXUVRUWR³6<67(0,1,7,$/,=(´4 3UHVVWKH)XQFWLRQNH\WRHQWHUWKH6<67(0,1,7,$/,=(VFUHHQ5 3UHVVWKH)XQFWLRQNH\$FRQ¿UPDWLRQPHVVDJHDSSHDUV7RUHWXUQWRWKH0(18VFUHHQZLWKRXWLQLWLDOL]LQJSUHVVWKH6FUHHQNH\6 3UHVVWKH)XQFWLRQNH\WRLQLWLDOL]HVHWWLQJV7RFDQFHOLQLWLDOL]LQJSUHVVWKHŹNH\7KHVFUHHQUHWXUQVWRWKH0(18VFUHHQCursor
51ZM-540PA, ZM-541PA Operator’s ManualAttaching Electrodes, SpO2 Probe and NIBP Cuff to the Patient7KHWUDQVPLWWHUFDQEHDWWDFKHGWRDQDUPRIWKHSDWLHQWRUSODFHGRQWKHEHGVLGH7KHUHTXLUHGOHQJWKRIWKHHOHFWURGHOHDGVDQG6S22SUREHFDEOHGHSHQGVRQKRZWKHWUDQVPLWWHULVWREHDWWDFKHGWRWKHSDWLHQWNOTE: Monitoring SpO2 during NIBP MeasurementWhen the SpO2 probe is attached to the same limb as the NIBP cuff, the EORRGÀRZGHFUHDVHVGXULQJ1,%3PHDVXUHPHQWDQGSXOVHZDYHFDQQRW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.Attachment ExamplesWhen transmitter is attached on an arm When transmitter is placed on a bedNOTE: When placing the transmitter on a bedside, place it on a stable and ÀDWSODFH,IWKHWUDQVPLWWHUIDOOVoff, it may be damaged.
52ZM-540PA, ZM-541PA Operator’s ManualSelecting Electrode Leads and Disposable ElectrodesOnly use Nihon Kohden specified electrodes and electrode leads. When other type of electrodes or electrode leads are used, the “CHECK ELECTRODES” message may be displayed and ECG monitoring may stop.CAUTION7KHIROORZLQJRSWLRQDOHOHFURGHVDQGHOHFWURGHOHDGVFDQEHXVHGZLWKWKHWUDQVPLWWHUDisposable Electrode Electrode Lead NoteVitrode7KHH[DPSOHLV9LWURGH&%53$7KUHHHOHFWURGHV&OLSW\SH%53$7KUHHHOHFWURGHV&OLSW\SH%53$6L[HOHFWURGHV&OLSW\SH%53$6L[HOHFWURGHVSnap type5HIHUWRWKH³2SWLRQV´VHFWLRQZKHQRUGHULQJWKHGLVSRVDEOHHOHFWURGHVDQGHOHFWURGHOHDGV
53ZM-540PA, ZM-541PA Operator’s ManualConnecting the Electrode Lead to the Transmitter&RQQHFWWKHHOHFWURGHOHDGWRWKH(&*5(63VRFNHWRQWKHWUDQVPLWWHUNOTE: Hold the sides of the transmitter when connecting or disconnecting the electrode lead. Pressing the display while holding the transmitter may damage the transmitter.When transmitter is attached on an armDo not shake or swing the transmitter while holding the leads or cables connected to the transmitter. The transmitter may come off and injure someone or damage surrounding instruments.CAUTIONHold the connector of the electrode lead when connecting/disconnecting the electrode lead. If you disconnect the electrode lead by pulling the lead, it damages the electrode lead.CAUTIONElectrode Position)ROORZWKHSK\VLFLDQ¶VLQVWUXFWLRQVIRUHOHFWURGHSODFHPHQWZKHQDYDLODEOH)RU(&*PRQLWRULQJHOHFWURGHVDUHDWWDFKHGRQO\RQWKHFKHVWWRDOORZSDWLHQWPRYHPHQWDQGREWDLQFRQWLQXRXVVWDEOH(&*7KHIROORZLQJOHDGVDUHH[DPSOHV:KHQDOVRPRQLWRULQJUHVSLUDWLRQUHIHUWRWKH³(OHFWURGH3RVLWLRQIRU5HVSLUDWLRQ0RQLWRULQJ´VHFWLRQNOTE: The optimum electrode positions for ECG measurement are not always optimum for respiration measurement. Select positions that are suitable for both ECG and respiration measurement or positions which give priority to either ECG or respiration measurement.
54ZM-540PA, ZM-541PA Operator’s ManualElectrode Positions for ECG MonitoringSix Electrodes7KHHOHFWURGHPHWKRGZLWKOHDG,,DQGOHDG9LVHIIHFWLYHIRUPRQLWRULQJP\RFDUGLDOLVFKHPLD<RXFDQLPSURYHPRQLWRULQJDFFXUDF\FRQVLGHUDEO\E\DGGLQJOHDG9WRWKLVFRPELQDWLRQ9DDQG9EFDQEHDWDQ\SRVLWLRQRIWKHVWDQGDUGOHDGV9WR9EXW9DQG9DUHPRVWDSSURSULDWHIRUP\RFDUGLDOLVFKHPLFPRQLWRULQJRA/R LA/LRL/RF LL/FVa/CaVb/CbElectrode Position Symbol Lead ColorAHA IEC AHA IEC/HIWLQIUDFODYLFXODUIRVVD /$ / %ODFN <HOORZ5LJKWLQIUDFODYLFXODUIRVVD 5$ 5 :KLWH 5HG%HORZORZHVWULERQWKHOHIWDQWHULRUD[LOODU\OLQH // F5HG *UHHQ5LJKWDQWHULRUD[LOODU\OLQHDWWKHVDPHOHYHODV//) 5/ 5) *UHHQ %ODFN)LIWKLQWHUFRVWDOVSDFHRQWKHOHIWPLGFODYLFXODUOLQH9SRVLWLRQRIVWDQGDUGOHDGV Va &D %URZQblue :KLWHEURZQ/HIWDQWHULRUD[LOODU\OLQHDWWKHVDPHOHYHODV9D9SRVLWLRQRIVWDQGDUGOHDGV Vb &E %URZQRUDQJH:KLWHEODFN
55ZM-540PA, ZM-541PA Operator’s Manual/HDG3RVLWLRQStandard limb leadsMonopolar limb leadsMonopolar chest leadsLead ILead I Lead II Lead IIIaVR lead aVL lead aVF leadV1 to V6 leadstoV1 to V6 leadsRARARA RA RARARALALALALALALALALLLLLLLL LLLLLLN (RL)N (RL)N (RL) N (RL) N (RL)N (RL)N (RL)Three Electrodes• /HDG0,,ZKLFKLVVLPLODUWRVWDQGDUGOHDG,,XVHGZKHQ(&*PHDVXUHPHQWKDVSULRULW\Electrode Position Symbol Lead ColorAHA IEC AHA IEC/HIWLQIUDFODYLFXODUIRVVD /$ / %ODFN <HOORZ5LJKWLQIUDFODYLFXODUIRVVD 5$ 5 :KLWH 5HG%HORZORZHVWULERQWKHOHIWDQWHULRUD[LOODU\OLQH // F5HG *UHHQL/LA (N)R/RA (−)F/LL (+)
56ZM-540PA, ZM-541PA Operator’s Manual• /HDG0,ZKLFKLVVLPLODUWRVWDQGDUGOHDG,• &KDQJH)//DQG//$RIOHDG0,,R/RA (−)L/LA (N)F/LL (+)• /HDG0,,,ZKLFKLVVLPLODUWRVWDQGDUGOHDG,,,• &KDQJH55$DQG//$RIOHDG0,,L/LA (N)R/RA (−)F/LL (+),IWKHHOHFWURGHSRVLWLRQVDERYHDUHQRWDYDLODEOHGXHWRFKHVWVXUJHU\DWWDFKWKHHOHFWURGHVWRWKHURRWRIWKHOLPEVRUEHORZWKHFODYLFOHVIRUVWDEOH(&*PRQLWRULQJElectrode Positions for Respiration Monitoring3ODFHWKH55$DQG)//HOHFWURGHVVRWKDWWKHOXQJVDUHEHWZHHQWKHHOHFWURGHV3RVLWLRQ,QWKLVSRVLWLRQUHVSLUDWLRQPHDVXUHPHQWLVDYDLODEOHKRZHYHUWKHUHLVDGLIIHUHQFHLQDPSOLWXGHEHWZHHQGLIIHUHQWSDWLHQWVR or RA F or LL5LJKWLQIUDFODYLFXODUIRVVD )LIWKLQWHUFRVWDOVSDFHRQWKHOHIWPLGFODYLFXODUOLQH93RVLWLRQ,QWKLVSRVLWLRQWKHZDYHIRUPDPSOLWXGHLVXVXDOO\ODUJHDQGWKH(&*OHDGLVVLPLODUWR/HDG0,,7KLVSRVLWLRQFDQEHJHQHUDOO\UHFRPPHQGHGR or RA F or LL5LJKWLQIUDFODYLFXODUIRVVD )LIWKLQWHUFRVWDOVSDFHRQWKHOHIWPLGD[LOODU\OLQH9R/RA (−)F/LL (+)NR/RA (−)F/LL (+)N
57ZM-540PA, ZM-541PA Operator’s Manual3RVLWLRQ,QWKLVSRVLWLRQWKHUHVSLUDWLRQZDYHIRUPLVRSWLPXPEXWWKH(&*OHDGLVXQXVXDOR or RA F or LL5LJKWPLGD[LOODU\DWWKHKRUL]RQWDOOHYHORI9)LIWKLQWHUFRVWDOVSDFHRQWKHOHIWPLGD[LOODU\OLQH93RVLWLRQ,QWKLVSRVLWLRQWKHUHVSLUDWLRQPHDVXUHPHQWLVLQÀXHQFHGE\WKHLPSHGDQFHYDULDWLRQRIWKHDEGRPHQVRWKHFDUGLDFSXOVHZDYHLQFOXGHGLQWKHUHVSLUDWLRQZDYHLVUHGXFHG1RWHWKDWWKHZDYHIRUPLVLQYHUWHGLQSKDVHFRPSDUHGZLWKWKHFKHVWPRYHPHQWWKHZDYHIRUPJRHVGRZQGXULQJLQVSLUDWLRQ,WLVGLI¿FXOWWRPHDVXUHWKH(&*DWWKHVDPHWLPHR or RA F or LL/RZHVWULERQWKHULJKWDQWHULRUD[LOODU\OLQH/RZHVWULERQWKHOHIWDQWHULRUD[LOODU\OLQHAttaching Electrodes to the Patient and Connecting the Electrode Leads to Disposable ElectrodesPrepare the Patient Skin6KDYHRIIH[FHVVLYHERG\KDLU7RUHGXFHVNLQLPSHGDQFHFOHDQWKHHOHFWURGHVLWHZLWKFUHDPRUZLWKDFRWWRQSDGPRLVWHQHGZLWKDOFRKRO7KRURXJKO\GU\WKHVNLQZLWKDFOHDQFRWWRQSDG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.• 'RQRWSODFHHOHFWURGHVRQDZRXQGRURQDQLQÀDPHGZULQNOHGRUXQHYHQskin surface.Attaching Electrodes to the PatientDo not reuse disposable parts and accessories.CAUTIONNR/RA (−)F/LL (+)NR/RA (−)F/LL (+)
58ZM-540PA, ZM-541PA Operator’s ManualNOTE • To maintain good contact between the electrode and skin, check that the paste of the disposable 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.5HIHUWRWKHHOHFWURGHRSHUDWRU¶VPDQXDOIRUGHWDLOV1 &DUHIXOO\UHPRYHWKHEDFNLQJSDSHUIURPWKHHOHFWURGH$YRLGWRXFKLQJWKHDGKHVLYHVXUIDFH2 3ODFHWKHHOHFWURGHRQWKHSUHYLRXVO\FOHDQHGVNLQ3D\DWWHQWLRQWRWKHHOHFWURGHOHDGFRORUDQGV\PERO3 &OLSWKHHOHFWURGHOHDGWRWKHHOHFWURGH4 )DVWHQWKHHOHFWURGHOHDGZLUHZLWKVXUJLFDOWDSHZLWKDQH[WUDOHQJWKRIZLUHEHWZHHQWKHWDSHDQGWKHHOHFWURGH7KLVOHVVHQVWKHPRYHPHQWRIHOHFWURGHOHDGVE\ERG\PRYHPHQWDQGKHOSVVWDEOHPRQLWRULQJChecking ECG on the Transmitter Screen$IWHUDWWDFKLQJHOHFWURGHVDQGFRQQHFWLQJ(&*OHDGVFKHFNWKDWWKHHOHFWURGHVDUHSURSHUO\DWWDFKHGWRWKHSDWLHQWDQGWKH(&*ZDYHIRUPLVDFTXLUHGRQWKHFKHFNHOHFWURGHVVFUHHQ)RUGHWDLOVRQWKHVFUHHQUHIHUWRWKH³6FUHHQ'HVFULSWLRQV´VHFWLRQ
59ZM-540PA, ZM-541PA Operator’s ManualAttaching the SpO2 ProbeSelecting the SpO2 Probe6HOHFWDQDSSURSULDWHSUREHIRUWKHSDWLHQWOnly use Nihon Kohden specified electrodes, electrode leads and SpO2 probes. 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.CAUTIONReusable Probes:KHQXVLQJD7/7¿QJHUSUREHFKRRVHWKHDSSURSULDWHFDEOHOHQJWKIRUDWWDFKPHQWProbe Cable Length Patient Attachment Site)LQJHUSUREH7/7 PAdult or childNJRUPRUH)LQJHUP)LQJHUSUREH7/77/7Attachment tape7/7PAdult or child NJRUPRUH7/7P
60ZM-540PA, ZM-541PA Operator’s ManualProbe Cable Length Patient Attachment Site)LQJHUSUREH7/77/7Attachment tape7/7PAdult or childNJRUPRUH )LQJHURUWRH7/7P0XOWLVLWHSUREH7/7Attachment tapeP$GXOWRULQIDQWNJRUPRUH )LQJHURUWRHNeonateNJRUOHVV ,QVWHSDQGVROHDisposable ProbesThe disposable probe is not sterilized. Use the disposable probe only for a single patient. Never reuse the disposable probe for another patient because it causes cross infection.CAUTIONProbe Patient Attachment Site6S22SUREH7/67/6Attachment tape40 mm&DEOHOHQJWK 7/6 P 7/6 PAdultNJRUPRUH )LQJHUNeonateNJRUOHVV ,QVWHSDQGVROH
61ZM-540PA, ZM-541PA Operator’s ManualProbe Patient Attachment Site6S22SUREH7/67/635 mmAttachment tape&DEOHOHQJWK 7/6 P 7/6 PAdult or childWRNJ )LQJHU,QIDQWWRNJ 7RH6S22SUREH7/77/7&DEOHOHQJWK 7/7 P 7/7PAdultNJRUPRUH )LQJHURUWRH6S22SUREH7/77/7&DEOHOHQJWK 7/7 P 7/7P&KLOGWRNJ )LQJHURUWRH6S22SUREH7/77/7&DEOHOHQJWK 7/7 P 7/7PNeonateNJRUOHVV ,QVWHSDQGVROHAdultNJRUPRUH )LQJHURUWRH6S22SUREH7/77/7&DEOHOHQJWK 7/7 P 7/7P,QIDQWWRNJ )LQJHURUWRH
62ZM-540PA, ZM-541PA Operator’s ManualConnecting the SpO2 Probe to the Transmitter&RQQHFWWKHSUREHWRWKH6S22VRFNHWRQWKHWUDQVPLWWHUNOTE: Hold the connector of the probe cable when connecting or disconnecting the probe. Pulling the cable may damage the probe.When transmitter is attached on an armDo not shake or swing the transmitter while holding the leads or cables connected to the transmitter. The transmitter may come off and injure someone or damage surrounding instruments.CAUTIONDo not use a damaged or disassembled probe. It causes incorrect measurement and may injure the patient.CAUTION
63ZM-540PA, ZM-541PA Operator’s ManualAttaching the Probe to the Patient$WWDFKWKHSUREHWRWKHSDWLHQWE\UHIHUULQJWRWKHSUREH¶VPDQXDO0DNHVXUHWKDWWKHOLJKWHPLWWHUDQGSKRWRGHWHFWRURIWKHSUREHIDFHHDFKRWKHUDWWKHDWWDFKPHQWVLWH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-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 insufficient peripheral circulation• Neonate or low birth weight infant with delicate skin
64ZM-540PA, ZM-541PA Operator’s ManualWARNINGWhen 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.7KH6S22SUREHVPDQXIDFWXUHGE\1LKRQ.RKGHQKDYHWZRZDYHOHQJWKVZLWKSHDNVLQWKHUDQJHRIDQGQP7KHPD[LPXPOLJKWLQWHQVLW\LVOHVVWKDQP:If 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 thickness 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.CAUTION
65ZM-540PA, ZM-541PA Operator’s ManualAttaching the NIBP CuffSelecting the NIBP Cuff6HOHFWWKH1,%3FXIIDSSURSULDWHIRUWKHSDWLHQWNOTE: NIBP cannot be measured on neonates using this transmitter.Reusable Cuffs:KHQDWWDFKLQJWKHWUDQVPLWWHUWRWKHSDWLHQWDUPDVSHFLDO1,%3FXIILVUHTXLUHG$QRSWLRQDO<13H[WHQVLRQKRVHPLVDYDLODEOHWRH[WHQGWKHOHQJWKEHWZHHQWKH1,%3VRFNHWRQWKHWUDQVPLWWHUDQG1,%3FXIIHJZKHQQRWDWWDFKLQJWKHWUDQVPLWWHUWRWKHSDWLHQWDUPDQGSODFLQJWKHWUDQVPLWWHURQDEHGVLGHReusable Cuff Model Width (cm) Air Hose Length (cm)For adult Standard <33 /DUJH <33 WidthAir hose
66ZM-540PA, ZM-541PA Operator’s Manual:KHQQRWDWWDFKLQJWKHWUDQVPLWWHUWRWKHSDWLHQWDUPWKHIROORZLQJFXIIVFDQEHXVHG7RXVHWKHVHFXIIVDQRSWLRQDO<13H[WHQVLRQKRVHPLVUHTXLUHGReusable Cuff Model Width (cm) Air Hose Length (cm))RULQIDQW <37 For childSmall <37 Standard <37 <37For adult Standard <37 <37/DUJH <37 WidthAir hose
67ZM-540PA, ZM-541PA Operator’s ManualDisposable CuffsDisposable cuffs are not sterilized. If necessary, sterilize the cuff using glutaraldehyde solution.CAUTIONDisposable Cuff Model Width (cm) Air Hose Length (cm))RULQIDQW <33 6For child <33 8For adultSmall <33 Standard <33 0HGLXPODUJH <33 /DUJH <33 ([WUDODUJH <33 WidthAir hoseExtension HoseWhen using an extension hose, check that the extension hose is not bent or squeezed. Otherwise, the cuff might not inflate or deflate. If the cuff cannot deflate, it may cause congestion on the patient at the cuff attachment site.CAUTIONYN-990P extension hose, 150 cm
68ZM-540PA, ZM-541PA Operator’s ManualReference for selecting a cuff7KH$+$$PHULFDQ+HDUW$VVRFLDWLRQUHFRPPHQGVWKDWWKHFXIIZLGWKEHRIWKHFLUFXPIHUHQFHRIWKHXSSHUDUP5HIHUWRWKHIROORZLQJJUDSKDQGVHOHFWWKHFXIIZKLFKVXLWVWKHSDWLHQW¶VDUP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 LWGRHVQRW¿WWKHSDWLHQW1510510 20 30 40 500201510510 20 30 40 50 60060Cuff width (cm)Arm circumference (cm)Infants YP-960TChildren small YP-961TChildren standard YP-962T YP-702TAdults standard YP-503P (cuff for transmitter) YP-963T, YP-703TAdults 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-814PAdults extra large YP-816P
69ZM-540PA, ZM-541PA Operator’s ManualConnecting the NIBP Cuff to the TransmitterWhen Using YP-503P/YP-504P NIBP Cuff7RDWWDFKWKH<33<331,%3FXIIWRWKHWUDQVPLWWHUWKHORFNSODWHLVUHTXLUHGYP-503P/YP-504P NIBP cuffFront cover Air hoseD ringBeltBelt for the strapLock plate pocket Front cover openLock plate7KHORFNSODWHLVIRUDWWDFKLQJWKH1,%3FXIIWRWKHWUDQVPLWWHUNOTE: Do 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 tab
70ZM-540PA, ZM-541PA Operator’s Manual1 5HPRYHWKHORFNSODWHIURPWKHWUDQVPLWWHU2 ,QVHUWWKHORFNSODWHLQWRWKHORFNSODWHSRFNHWRQWKH1,%3FXII3 $WWDFKWKHWUDQVPLWWHUWRWKHORFNSODWHE\LQVHUWLQJWKHWDEVRQWKHORFNSODWHLQWRWKHVORWVRQWKHWUDQVPLWWHU4 &RYHUWKHWUDQVPLWWHUZLWKWKHIURQWFRYHURIWKH1,%3FXII5 &RQQHFWWKHDLUKRVHWRWKH1,%3VRFNHWRQWKHWUDQVPLWWHU7XUQWKHFXIIFRQQHFWRUMRLQWXQWLOLWFOLFNV12
71ZM-540PA, ZM-541PA Operator’s ManualWhen Using YP-810P series Disposable Cuffs or YP-702T/703T or YP-960T series Reusable CuffsTo use these NIBP cuffs, an optional YN-990P extension hose (1.5 m) is required.NOTE: Connect 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.Do 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.CAUTION
72ZM-540PA, ZM-541PA Operator’s ManualDo 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.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.*CAUTION 0RQLWRULQJ6S22GXULQJ1,%30HDVXUHPHQW :KHQWKH6S22SUREHLVDWWDFKHGWRWKHVDPHOLPEDVWKH1,%3FXIIWKHEORRGÀRZGHFUHDVHVGXULQJ1,%3PHDVXUHPHQWDQGSXOVHZDYHFDQQRWEHGHWHFWHGDQG6S22 cannot EHPRQLWRUHGSURSHUO\:KHQ³,1+,%,76S22'85,1*1,%3´RQWKH3$5$0(7(56(783VFUHHQLVVHWWR21IDFWRU\GHIDXOWVHWWLQJ6S22PRQLWRULQJLVSDXVHGGXULQJ1,%3PHDVXUHPHQWWRDYRLG6S22DODUPRFFXUUHQFH+RZHYHUZKHQPRQLWRULQJ6S22 on the same OLPEDVWKH1,%3EHFDUHIXOZKHQUHDGLQJ6S22YDOXHV
73ZM-540PA, ZM-541PA Operator’s ManualNOTE • 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.• 7RDFFXUDWHO\GHWHFWWKHSXOVDWLOHÀRZRIWKHDUWHU\WKHFXIIVKRXOGEHwrapped around a bare upper arm.• Do not use an abnormal cuff. The cuff deteriorates from use and cleaning. %HIRUHXVHFKHFNWKHFXIIDQGFRQ¿UPWKDWWKHUHLVQRÀDZFUDFNRUKROHLQLW%HFDUHIXOQRWWRGDPDJHWKHLQÀDWLRQEDJ,IWKHLQÀDWLRQEDJKDVDKROHRUDÀDZLWPD\EXUVWGXULQJXVH'LVSRVHRIDQDEQRUPDOFXIIDQGUHSODFHit with a new one.• Refer to the NIBP cuff manual for details.Cuff Position3ODFHWKHFXIIHGXSSHUDUPEUDFKLXPDWWKHVDPHKHLJKWDVWKHSDWLHQW¶VKHDUW,IWKHFXIILVQRWDWWKHVDPHOHYHODVWKHKHDUWWKHZHLJKWRIWKHEORRGDIIHFWVWKHEORRGSUHVVXUHUHDGLQJ7KHSUHVVXUHGLIIHUHQFHSHUXQLWKHLJKWLVPP+JFP7KHEORRGSUHVVXUHUHDGLQJGHFUHDVHVZKHQWKHDUPLVKLJKHUWKDQWKHKHDUWDQGLQFUHDVHVZKHQORZHU7KHEHVWPHDVXULQJFRQGLWLRQLVZKHQWKHSDWLHQWLVO\LQJRQKLVKHUEDFNZLWKDUPVDQGOHJVUHOD[HG,IWKHFXIISRVLWLRQFDQQRWEHRQWKHVDPHOHYHODVWKHKHDUWWKHGLVSOD\HGEORRGSUHVVXUHUHDGLQJPXVWEHPDWKHPDWLFDOO\DGMXVWHGWhen placing the transmitter on a bed, make sure that the hose is not bent.Heart
74ZM-540PA, ZM-541PA Operator’s ManualAttaching the Transmitter on an Arm (Using the YP-503P/YP-504P NIBP Cuff)1 $WWDFKWKH1,%3FXIIWRWKHWUDQVPLWWHU5HIHUWRWKH³&RQQHFWLQJWKH1,%3&XIIWRWKH7UDQVPLWWHU´VHFWLRQ2 %HIRUHSXWWLQJWKHFXIIRYHUWKHDUPLQVHUWWKHHQGRIWKHFXIILQWRWKHEHOWDQGWKHQWKURXJKWKH'ULQJDVVKRZQDWOHIW3 3XWWKHSDWLHQWDUPWKURXJKWKHFXII)ROGEDFNWKHFXIIDWWKH'ULQJDQGIDVWHQLWXVLQJWKHYHOFURWDSH0DNHVXUHWKDWWKHFXIILVQRWDWWDFKHGRQDMRLQWNOTE: The cuff must not wrap around the elbow.BeltD ring End of cuff
75ZM-540PA, ZM-541PA Operator’s ManualAttaching the Strap to the TransmitterNOTE • Use the strap to prevent the transmitter from falling.• Do not attach the clip to hard objects such as thick cloth or zipper. It will break the clip.$WWDFKDVWUDSSURYLGHGZLWKWKHWUDQVPLWWHUWRWKH1,%3FXIIDQGSDWLHQWFORWKHV7RRSHQWKHFOLS¿UPO\SXOORXWWKHWDELQGLUHFWLRQRIWKHDUURZ 7RDGMXVWWKHVWUDSOHQJWKSXVKGRZQWKHWDERQWKHDGMXVWHUDQGVOLGH1 $GMXVWWKHOHQJWKRIWKHVWUDS2 &OLSRQHHQGRIWKHVWUDSWRWKHEHOWIRUWKHVWUDSRQWKH1,%3FXII3 &OLSWKHRWKHUHQGRIWKHVWUDSWRWKHSDWLHQW¶VFORWKHVDVVKRZQOHIWBelt for the strap on the NIBP cuff
76ZM-540PA, ZM-541PA Operator’s ManualPlacing the Transmitter on the Bed (Using the YP-810P series Disposable Cuffs or YP-702T/703T or YP-960T series Reusable Cuffs)1 3XWWKHFXIIRQWKHXSSHUDUPVRWKDWWKHźPDUNRI³$57(5<ź´DOLJQVZLWKWKHDUWHU\RIWKHSDWLHQW2 :UDSWKHFXIIVRWKDW³,1'(; ” comes ZLWKLQWKH³ 5$1*( ´,I³,QGH[ ´LVQRWZLWKLQWKH³ 5$1*(´FKDQJHWKHFXIIVL]HARTERY źRANGE
77ZM-540PA, ZM-541PA Operator’s ManualLocking the Keys on the Transmitter7RSUHYHQWWKHSDWLHQWIURPSUHVVLQJWKHNH\VRQWKHWUDQVPLWWHUGXULQJPRQLWRULQJ\RXFDQORFNWKHNH\V7RORFNWKHNH\V3UHVVWKHŻ and ŹNH\VDWWKHVDPHWLPHDQGKROGIRUPRUHWKDQVHFRQGV7KH³.H\ORFNHG´VFUHHQDSSHDUV:KHQWKHVFUHHQWLPHRXWSHULRGLVVHWWR³PLQ´IDFWRU\GHIDXOWWKH³.H\ORFNHG´VFUHHQLVGLVSOD\HGIRUVHFRQGVWKHQWKHGLVSOD\WXUQVRIILIWKHUHLVQRNH\RSHUDWLRQ:KHQWKHVFUHHQWLPHRXWSHULRGLVVHWWRDFHUWDLQQXPEHURIPLQXWHVWKH³.H\ORFNHG´VFUHHQLVGLVSOD\HGIRUVHFRQGVWKHQLWFKDQJHVWRWKHQXPHULFDQGZDYHIRUPVFUHHQ,IWKHUHLVQRNH\RSHUDWLRQWKHGLVSOD\WXUQVRIIZKHQWKHUHPDLQLQJWLPHHODSVHV5HIHUWRWKH³7XUQLQJWKH'LVSOD\2II´VHFWLRQIRUGHWDLOV7RXQORFNWKHNH\V3UHVVWKHŻ and ŹNH\VDWWKHVDPHWLPHDQGKROGIRUPRUHWKDQVHFRQGV
78ZM-540PA, ZM-541PA Operator’s ManualMonitoringThe 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.CAUTIONNOTE • The waveforms displayed on the check electrodes screen are just to check that the electrode or probe is attached to the patient properly. Do not use the displayed waveforms for other purposes.• Do not let the transmitter directly touch the patient’s skin. The transmitter temperature rises and this may cause burn to the patient.Screen Descriptions:KHQWKHWUDQVPLWWHULVWXUQHGRQWKHVWDUWXSVFUHHQDSSHDUVWKHQWKHFKHFNHOHFWURGHVVFUHHQDSSHDUVWRFKHFNWKHHOHFWURGHDWWDFKPHQW7KHVFUHHQFKDQJHVLQWKHIROORZLQJRUGHUZKHQWKH6FUHHQNH\LVSUHVVHG&KHFNHOHFWURGHVĺQXPHULFDQGZDYHIRUPĺZDYHIRUPUHYLHZĺQXPHULFUHYLHZĺGLVSOD\RIIĺFKHFNHOHFWURGHVScreen key
79ZM-540PA, ZM-541PA Operator’s ManualCheck Electrodes Screen<RXFDQFKHFNZKHWKHUWKHHOHFWURGHVDUHSURSHUO\DWWDFKHGWRWKHSDWLHQWDQGWKH(&*ZDYHIRUPLVDFTXLUHG:KHQOHDGVDUHXVHGWKH,,,9DDQG9EOHDGZDYHIRUPVDUHGLVSOD\HG:KHQOHDGVDUHXVHGRQO\WKHOHDG,,ZDYHIRUPLVGLVSOD\HGChannel numberBattery levelECG waveformFilter: OffSweep speed: 12.5 mm/sWaveform sensitivity: 0.5 cm/1 mVLeadDetached electrode positionMessage :KHQHOHFWURGHVDUHGHWDFKHGWKH³&+(&.(/(&752'(6´PHVVDJHDQGGHWDFKHGelectrode position appear RQWKHVFUHHQNOTE: When ECG measurement is set to OFF on the PARAMETER SETUP screen, the check electrodes screen does not appear.
80ZM-540PA, ZM-541PA Operator’s ManualNumeric and Waveform Screen1XPHULFYDOXHVDQGZDYHIRUPVRIWKHPRQLWRULQJSDUDPHWHUVDUHGLVSOD\HG<RXFDQFKDQJHWKH(&*OHDGZLWKWKHŻDQGŹNH\V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 markSpO2Pulse wave sensitivityPulse waveformSweep speed: 12.5 mm/sWaveform sensitivity: AutoNIBP valuesNIBP measurement mode
81ZM-540PA, ZM-541PA Operator’s ManualNOTE: The 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 Screen(&*IXOOGLVFORVXUHIRUXSWRPLQXWHVFDQEHVDYHGDQGUHYLHZHG:KHQ(&*PHDVXUHPHQWLVWXUQHGRIIDQG6S22LVPRQLWRUHGWKHSXOVHZDYHIRUPLVVDYHG:KHQ(&*OHDGLVFKDQJHGRQWKHQXPHULFDQGZDYHIRUPVFUHHQWKH(&*IXOOGLVFORVXUHRIWKHFKDQJHGOHDGLVVDYHG7KHVDYHGGDWDLVGHOHWHGZKHQWKHWUDQVPLWWHULVWXUQHGRIIECG leadDisplayed pageCompressed ECG waveform7.5 s × 4 traces per page, total 20 pagesOlder dataNewer dataTime range of the displayed waveform (time before the waveform review screen is displayed)Waveform sensitivity7RVFUROOWKHZDYHIRUPSUHVVWKHŻRUŹNH\7KHZDYHIRUPLVVFUROOHGE\VHFRQGV
82ZM-540PA, ZM-541PA Operator’s ManualNumeric Review Screen1XPHULFGDWDRIKHDUWUDWHRUSXOVHUDWHZKHQ(&*LVWXUQHGRII6S22DQGUHVSLUDWLRQUDWHIRUXSWRPLQXWHVDUHVDYHGDWPLQXWHLQWHUYDOVNOTE: NIBP measured values are not saved.7KHVDYHGGDWDLVGHOHWHGZKHQWKHWUDQVPLWWHULVWXUQHGRII7LPHEHIRUHWKHQXPHULFUHYLHZVFUHHQLVGLVSOD\HGOlder dataNewer dataDisplay Off7KHGLVSOD\FDQEHWXUQHGRIIDQ\WLPH5HIHUWRWKH³7XUQLQJWKH'LVSOD\2II´VHFWLRQIRUGHWDLOV10-second time bar
83ZM-540PA, ZM-541PA Operator’s ManualBasic Monitoring OperationUsing the Function KeyFunction key2QHRIWKHIROORZLQJIXQFWLRQVFDQEHDVVLJQHGWRWKH)XQFWLRQNH\RQWKH6<67(06(783VFUHHQ5HIHUWRWKH³&KDQJLQJ6<67(06(7836HWWLQJV´VHFWLRQ6863(1'$/$50 6XVSHQGVDODUPVRQWKHUHFHLYLQJPRQLWRUEHIRUHWKH\RFFXUIRU PLQXWHV3$86( 3DXVHVPRQLWRULQJRQWKHWUDQVPLWWHUDQGUHFHLYLQJPRQLWRU&21),50 7UDQVPLWVWKHVLJQDOWKDWWKHSDWLHQWLVFRQ¿UPHGDQGGLVSOD\VWKH³3$7,(17&21),50('´PHVVDJHRQWKHWUDQVPLWWHUNOTE: 7RXVHWKH)XQFWLRQNH\IRUSDXVHRUFRQ¿UP³35272&2/´RQWKH6<67(0SETUP screen of the transmitter must be set to 57 and the receiving monitor must be able to receive protocol 57. A central monitor with an ORG-9100A series multiple patient receiver whose software version 02-01 or later can receive this protocol.
84ZM-540PA, ZM-541PA Operator’s ManualSuspending Alarms on the Receiving MonitorWARNINGWhile the “ALARMS SUSPENDED” message is displayed on the transmitter, all alarms on the receiving monitor are suspended so keep the patient under close observation.:KHQWKH)81&7,21.(<LVVHWWR³6863(1'$/$50´RU³6863(1'$/$503$86(´RQWKH6<67(06(783VFUHHQDODUPVFDQEHVXVSHQGHGIRUPLQXWHVRQWKHUHFHLYLQJPRQLWRUEHIRUHWKH\RFFXU7RVXVSHQGDODUPV1 3UHVVWKH)XQFWLRQNH\7KH³6XVSHQGDODUPV´FRQ¿UPDWLRQVFUHHQDSSHDUV2 3UHVVWKHŹNH\WRVXVSHQGDODUPV7RFDQFHOVXVSHQGLQJDODUPVDQGUHWXUQWRWKHSUHYLRXVVFUHHQSUHVVWKH6FUHHQNH\:KHQWKHDODUPVDUHVXVSHQGHGWKH³$/$5066863(1'('´PHVVDJHDQGDODUPVXVSHQGHGLFRQZLWKWKHUHPDLQLQJPLQXWHVLQDODUPVXVSHQVLRQDSSHDURQWKHWUDQVPLWWHUVFUHHQMessage Icon
85ZM-540PA, ZM-541PA Operator’s Manual7RFDQFHOVXVSHQGLQJDODUPVGXULQJPLQXWHDODUPVXVSHQVLRQ1 3UHVVWKH)XQFWLRQNH\ZKLOHWKH³$/$5066863(1'('´PHVVDJHLVGLVSOD\HG7KHFRQ¿UPDWLRQVFUHHQDSSHDUV2 3UHVVWKHŹNH\WRFDQFHODODUPVXVSHQVLRQ3UHVVWKH6FUHHQNH\WRQRWFDQFHODODUPVXVSHQVLRQPausing Monitoring:KHQ)81&7,21.(<LVVHWWR³6863(1'$/$503$86(´RQWKH6<67(06(783VFUHHQ\RXFDQSDXVHPRQLWRULQJRQWKHUHFHLYLQJPRQLWRUIURPWKHWUDQVPLWWHUZKHQWKHSDWLHQWFDQQRWEHPRQLWRUHGVXFKDVGXULQJ;UD\H[DPLQDWLRQNOTE: To use the Function key for pause, “PROTOCOL” on the SYSTEM screen of the transmitter must be set to 57 and the receiving monitor must be able to receive protocol 57.0RQLWRULQJRQWKHUHFHLYLQJPRQLWRUUHVXPHVZKHQRQHRIWKHIROORZLQJFRQGLWLRQVLVPHW:KHQ2))LVVHOHFWHGIRU³$8725(680($)7(53$86(´RQWKH6<67(06(783VFUHHQPRQLWRULQJGRHVQRWDXWRPDWLFDOO\UHVXPH• +HDUWUDWHLVSURSHUO\PRQLWRUHGRQWKHWUDQVPLWWHUIRUWKHLQWHUYDOVHOHFWHGIRU³$8725(680($)7(53$86(´• 6 S 2 2LVSURSHUO\PRQLWRUHGRQWKHWUDQVPLWWHUIRUWKHLQWHUYDOVHOHFWHGIRU³$8725(680($)7(53$86(´• 1,%3LVSURSHUO\PHDVXUHGDQGWKH6<6',$RU0$3YDOXHLVGLVSOD\HGRQWKHWUDQVPLWWHU
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87ZM-540PA, ZM-541PA Operator’s Manual5 7XUQRIIWKHWUDQVPLWWHU,IWKHWUDQVPLWWHULVQRWWXUQHGRIIDQGPRQLWRULQJFRQWLQXHVIRUWKHLQWHUYDOVHWIRU³$8725(680($)7(53$86(´RQWKH6<67(06(783VFUHHQSDXVHPRQLWRULQJLVFDQFHOOHGDQGPRQLWRULQJFRQWLQXHVResuming Monitoring after Pause7RUHVXPHPRQLWRULQJDIWHUSDXVHFKHFNWKDWWKHHOHFWURGHVHOHFWURGHOHDGVDQGSUREHDUHDWWDFKHGWRWKHSDWLHQWWKHQWXUQRQWKHWUDQVPLWWHUWARNINGWhen the patient returns to the bed, turn on the transmitter and check that the monitoring is resumed on the receiving monitor.WARNINGIf the transmitter is not turned off and monitoring continues for the selected interval, pause monitoring is canceled and monitoring continues. Check that the monitoring is resumed on the receiving monitor.&RQ¿UPLQJWKH3DWLHQW:KHQWKH)81&7,21.(<LVVHWWR³&21),50´RQWKH6<67(06(783VFUHHQ\RXFDQWUDQVPLWVLJQDOWRWKHUHFHLYLQJPRQLWRUWRLQGLFDWHWKDWWKHSDWLHQWLVFRQ¿UPHGE\DPHGLFDOVWDIIE\SUHVVLQJWKH)XQFWLRQNH\Message
88ZM-540PA, ZM-541PA Operator’s ManualTurning the Display Off7KHGLVSOD\FDQEHWXUQHGRIIDQ\WLPH7RWXUQRIIWKHGLVSOD\1 3UHVVWKH6FUHHQNH\VHYHUDOWLPHVXQWLOWKHIROORZLQJVFUHHQDSSHDUV10-second time bar2 6HOHFWWKHWLPLQJIRUWXUQLQJRIIWKHGLVSOD\ZLWKWKHŻRUŹNH\7KHVHOHFWHGLWHPLVKLJKOLJKWHGLQEOXH$VHFRQGFRXQWGRZQVWDUWV<RXFDQVHOHFWDGLIIHUHQWWLPHZLWKLQWKHVHFRQGFRXQWGRZQPLQIDFWRU\GHIDXOW 7XUQVWKHGLVSOD\RIIPLQXWHODWHURUPLQ7XUQVWKHGLVSOD\RIIZKHQWKHVHOHFWHGWLPHHODSVHV 7RVHWWKHWLPHUHIHUWR³6(/(&7$%/(6&5((17,0(2873(5,2'PLQ´LQWKH³&KDQJLQJ6\VWHP6HWXS6HWWLQJV´VHFWLRQ&217,18( .HHSWKHGLVSOD\WXUQHGRQNOTE: If longer than “1 min” is selected, it reduces the battery lifetime.3 :DLWVHFRQGVXQWLOWKHFRXQWGRZQHQGV:KHQWKHFRXQWGRZQHQGVWKHQXPHULFDQGZDYHIRUPVFUHHQDSSHDUV2USUHVVWKH6FUHHQNH\EHIRUHWKHFRXQWGRZQHQGV7KHFKHFNHOHFWURGHVVFUHHQDSSHDUV:KHQWKHVHOHFWHGWLPHHODSVHVZLWKRXWDQ\NH\RSHUDWLRQWKHGLVSOD\WXUQVRIIDXWRPDWLFDOO\,IDNH\LVSUHVVHGWKHFRXQWGRZQUHVHWV• :KHQGLVSOD\LQJWKHFKHFNHOHFWURGHVVFUHHQDIWHUVHOHFWLQJWKHWLPHRXWSHULRGWKHVFUHHQDXWRPDWLFDOO\FKDQJHVWRWKHQXPHULFDQGZDYHIRUPVFUHHQPLQXWHVODWHULIWKHUHLVQRNH\RSHUDWLRQWKHQWKHGLVSOD\WXUQVRIIZKHQWKHUHPDLQLQJWLPHHODSVHV• :KHQGLVSOD\LQJDQRWKHUVFUHHQDIWHUVHOHFWLQJWKHWLPHRXWSHULRGWKHVFUHHQFKDQJHVWRWKHQXPHULFDQGZDYHIRUPVFUHHQPLQXWHODWHULIWKHUHLVQRNH\RSHUDWLRQWKHQWKHGLVSOD\WXUQVRIIZKHQWKHUHPDLQLQJWLPHHODSVHV• :KHQ³PLQ´LVVHOHFWHGWKHGLVSOD\WXUQVRIIZLWKRXWFKDQJLQJWRWKHQXPHULFDQGZDYHIRUPVFUHHQ:KHQWKHGLVSOD\LVWXUQHGRIIDXWRPDWLFDOO\RUWKHSRZHULVWXUQHGRIIWKHVHWWLQJUHWXUQVWR³PLQ´IDFWRU\GHIDXOW
89ZM-540PA, ZM-541PA Operator’s ManualTurning the Display On after It was Turned Off3UHVVWKH6FUHHQNH\2QHRIWKHIROORZLQJVFUHHQDSSHDUV• 7KHSUHYLRXVVFUHHQ 7KH6FUHHQNH\LVSUHVVHGZLWKLQPLQXWHVDIWHUWKHGLVSOD\WXUQHGRII• 1XPHULFDQGZDYHIRUPVFUHHQ 7KH6FUHHQNH\LVSUHVVHGPRUHWKDQPLQXWHVDIWHUWKHGLVSOD\WXUQHGRII• ³.H\ORFNHG´VFUHHQ 7KH6FUHHQNH\LVSUHVVHGDIWHUWKHGLVSOD\WXUQHGRIIDQGthe ³.H\ORFNHG´VFUHHQZDVWKHODVWVFUHHQEHIRUHWKHGLVSOD\WXUQHGRIIECG and Respiration Monitoring:KHQWKHHOHFWURGHVDUHDWWDFKHGDQGWKH(&*OHDGVDUHFRQQHFWHGWKHKHDUWUDWH(&*ZDYHIRUPUHVSLUDWLRQUDWHDQGUHVSLUDWLRQZDYHIRUPDSSHDURQWKHUHFHLYLQJPRQLWRU5HIHUWRWKHRSHUDWRU¶VPDQXDORIWKHUHFHLYLQJPRQLWRUIRUGHWDLOV:KHQOHDGVDUHXVHGRQWKLVWUDQVPLWWHUXSWROHDGV,,,,,,D95D9/D9)9DDQG9ERI(&*ZDYHIRUPVFDQEHGLVSOD\HGRQWKHUHFHLYLQJPRQLWRU7KHKHDUWUDWHLVDOVRPHDVXUHG:KHQOHDGVDUHXVHGRQHFKDQQHO(&*ZDYHIRUPRIOHDG,,FDQEHGLVSOD\HGRQWKHUHFHLYLQJPRQLWRU5HIHUWRWKHRSHUDWRU¶VPDQXDORIWKHPRQLWRUIRUGHWDLOVHeart rateQRS sync mark Respiration rateECG lead<RXFDQFKDQJHWKH(&*OHDGZLWKWKHŻDQGŹNH\VECG waveform Filter: OnSweep speed: 12.5 mm/sWaveform sensitivity: Auto,IWKHUHFHLYLQJPRQLWRUGRHVQRWGHWHFWWKHSDFHPDNHUSXOVHFKDQJHWKHHOHFWURGHSRVLWLRQV$WWDFKWKHHOHFWURGHOHDGFOLSWRFKDQJHWKHPRQLWRULQJHOHFWURGH
90ZM-540PA, ZM-541PA Operator’s ManualWARNINGThe 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.WARNINGTurn the pacing pulse detection to ON on the receiving monitor when monitoring a pacemaker patient. Otherwise the pacemaker pulse is not rejected. However, even when the pacing pulse detection is set to ON, the pacemaker pulse might not be rejected. When the pacemaker pulse is not rejected, the pacemaker pulse is detected as QRS and false heart rate may be indicated or critical arrhythmia such as asystole may be overlooked. Keep pacemaker patients under close observation.)RUWKHSDFHPDNHUSXOVHUHMHFWLRQFDSDELOLW\RIWKH=03$DQG=03$WUDQVPLWWHUVUHIHUWRWKH³6SHFL¿FDWLRQV(&*´VHFWLRQWARNINGEven when the pacing pulse detection is set to ON on the receiving monitor, the pacemaker pulse can be overlooked or detected as QRS. You cannot confirm the pacemaker operation only from the detected pacemaker pulse.
91ZM-540PA, ZM-541PA Operator’s ManualWARNINGWhen 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.Turn 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 or respiration waves and the displayed data may be incorrect.CAUTIONWhen the “NOISE” message is displayed on the receiving monitor, ECG is not monitored and the ECG alarm does not function. Remove the cause by checking the electrodes, electrode leads, patient’s body movement, EMG and peripheral instruments grounding. Also make sure that an electric blanket is not used.CAUTIONNOTE • 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.• ,IGH¿EULOODWLRQPD\EHQHFHVVDU\VHWWKH¿OWHUWR0RQLWRURU0D[LPXPRQWKHUHFHLYLQJPRQLWRU,IGH¿EULOODWLRQLVSHUIRUPHGZKLOHWKHVHWWLQJLV2))the waveform recovery may be slow.• ECG cannot be monitored on a neonate using this transmitter.
92ZM-540PA, ZM-541PA Operator’s ManualTurning ECG Measurement On/Off(&*PHDVXUHPHQWFDQEHWXUQHGRQRURIIRQWKH3$5$0(7(56(783VFUHHQ:KHQHOHFWURGHVDUHDWWDFKHGWRWKHSDWLHQWDQG(&*OHDGVDUHFRQQHFWHG(&*PRQLWRULQJVWDUWVHYHQZKHQ(&*LVWXUQHGRIIWhen “PROTOCOL” on the SYSTEM screen is set to 57:(&*PHDVXUHPHQWRQWKHUHFHLYLQJPRQLWRULVDXWRPDWLFDOO\VHWWR2))$OVR(&*PHDVXUHPHQWRQWKHWUDQVPLWWHUFDQQRWEHWXUQHGRQRURIIIURPWKHUHFHLYLQJPRQLWRUWhen “PROTOCOL” on the SYSTEM screen is set to 42:,I(&*PHDVXUHPHQWLVWXUQHGRIIRQWKHWUDQVPLWWHU(&*PHDVXUHPHQWRQWKHUHFHLYLQJPRQLWRUPXVWDOVREHWXUQHGRIITurning Respiration Measurement On/Off5HVSLUDWLRQPHDVXUHPHQWFDQEHWXUQHGRQRURIIRQWKH3$5$0(7(56(783VFUHHQ,IUHVSLUDWLRQPHDVXUHPHQWLVWXUQHGRIIUHVSLUDWLRQPHDVXUHPHQWRQWKHUHFHLYLQJPRQLWRULVDOVRWXUQHGRIIElectrode Detachment,QWKHIROORZLQJFRQGLWLRQVWKH³&+(&.(/(&752'(6´PHVVDJHLVGLVSOD\HGRQWKHWUDQVPLWWHUDQGUHFHLYLQJPRQLWRU• (OHFWURGHLVGHWDFKHGIURPVNLQ• (OHFWURGHOHDGLVGLVFRQQHFWHGIURPWKHHOHFWURGH• 3RODUL]DWLRQYROWDJHEHWZHHQWKHHOHFWURGHDQGVNLQLVH[FHVVLYHO\KLJK,QWKHVHFDVHVFKHFNWKHFDXVHDQGLIQHFHVVDU\UHSODFHHOHFWURGHVZLWKQHZRQHVWhen the “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.CAUTION
93ZM-540PA, ZM-541PA Operator’s ManualSpO2 Monitoring:KHQPRQLWRULQJVWDUWV6S22DQGWKHSXOVHZDYHIRUPDUHVHQWWRWKHPRQLWRUDQG6S22 and WKHSXOVHOHYHOEDUJUDSKDUHGLVSOD\HGRQWKHWUDQVPLWWHUVFUHHQ:KHQ(&*LVQRWPHDVXUHGWKHSXOVHZDYHIRUPDQGSXOVHUDWHDUHDOVRGLVSOD\HG&KHFNWKDWSXOVHZDYHLVGLVSOD\HGDQGWKDWWKH³&+(&.352%(´PHVVDJHLVQRWGLVSOD\HG,IWKHSUREHLVGHWDFKHG6S22SXOVHUDWHDQGSXOVHZDYHDUHQRWGLVSOD\HGRQWKHGLVSOD\Pulse bar graphSpO2NOTE: During SpO2 monitoring, the transmitter constantly checks the light intensity of the probe and adjusts the light intensity to maintain optimum measurement FRQGLWLRQ'XULQJDGMXVWPHQWWKHSXOVHZDYHEHFRPHVÀDWIRUDERXWseconds.
94ZM-540PA, ZM-541PA Operator’s ManualMeasuring Principle6S22LVPHDVXUHGE\DWWDFKLQJDSUREHWRDSODFHZKHUHOLJKWFDQHDVLO\SHQHWUDWHVXFKDVD¿QJHU7KHSUREHKDVWZROLJKWHPLWWHUGLRGHVDQGRQHSKRWRGHWHFWRU/LJKWRIWZRZDYHOHQJWKVQPDQGQPDUHHPLWWHGIURPWKHHPLWWHUGLRGHV2[\JHQDWHGDQGGHR[\JHQDWHGEORRGDEVRUEGLIIHUHQWZDYHOHQJWKVRIOLJKWDVVKRZQLQ¿J DQG7KHOLJKWDEVRUSWLRQRIWKHVNLQWLVVXHERQHDQGYHQRXVEORRGLVFRQVWDQWDQGFDQEHHOLPLQDWHG7KHSXOVDWLOHFKDQJHUHSUHVHQWVDUWHULDOEORRGRQO\DVVKRZQLQ¿JDQGWKLVLVPHDVXUHGWRGHWHUPLQH6S227KHDPRXQWRIXQDEVRUEHGOLJKWDWHDFKZDYHOHQJWKLVGHWHFWHGE\WKHSKRWRGHWHFWRU6S22LVFDOFXODWHGIURPWKHUDWLRRIDEVRUEHGOLJKWRIWKHWZRZDYHOHQJWKV¿J6S22FDQEHPHDVXUHGFRUUHFWO\ZKHQWKHUHLVDQDUWHULDOSXOVHZKLFKFDXVHVFKDQJHLQWKHWUDQVPLWWHGOLJKWRIERWKZDYHOHQJWKV:KHQWKHSDWLHQWKDVDV\VWROHDQGQRDUWHULDOSXOVHWKHUHLVDFKDQFHWKDWVRPHH[WHUQDOIDFWRUVXFKDVPRYHPHQWRIWKH6S22SUREHPD\FDXVHFKDQJHLQWKHWUDQVPLWWHGOLJKWDQGSURGXFHDSXOVHOLNHVLJQDOZKLFKFDXVHVDQLQFRUUHFW6S22YDOXHWREHGLVSOD\HG7KLVLQFRUUHFW6S22YDOXHGHSHQGVRQWKHRSWLFDOSURSHUWLHVRIWKHFKDQJHLQWUDQVPLWWHGOLJKW300 400 500 600 700 800 900 1,0002001001010.10.05Extinction Coefficient (cm)-1 (mmol/L)-1Wavelength (nm: 10-9m)OxyhemoglobinDeoxyhemoglobinSpO2660 nm940 nm0% 100%Light AbsorptionLight AbsorptionTimeTissue, venous bloodArterial bloodFig. 1Fig. 3Fig. 2
95ZM-540PA, ZM-541PA Operator’s ManualWARNINGSpO2 measurement may be incorrect in the following cases.• When the patient’s carboxyhemoglobin or methemoglobin increases abnormally.• When dye is injected in the blood.• 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-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 insufficient peripheral circulation• 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.7KH6S22SUREHVPDQXIDFWXUHGE\1LKRQ.RKGHQKDYHWZRZDYHOHQJWKVZLWKSHDNVLQWKHUDQJHRIDQGQP7KHPD[LPXPOLJKWLQWHQVLW\LVOHVVWKDQP:
96ZM-540PA, ZM-541PA Operator’s ManualWARNINGWhen 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.Turn 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 or respiration waves and the displayed data may be incorrect.CAUTIONHandle the probe cable according to the following cautions. Failure to follow these cautions may cause cable discontinuity or short circuit of the probe cable which may cause incorrect measurement data or inability to perform measurement. Also in rare cases, the probe temperature may increase and cause skin burn on the patient. If the probe cable is damaged, replace the probe with a new one. 'RQRWSXOORUEHQGWKHSUREHFDEOH 'RQRWOHWFDVWHUIHHWUXQRYHUWKHSUREHFDEOH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.CAUTION
97ZM-540PA, ZM-541PA Operator’s ManualWhen the probe is attached on an appropriate site with sufficient thickness 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.CAUTIONWhen monitoring SpO2 only, detection of arrhythmia and asystole is not available and arrhythmia alarms such as ASYSTOLE, VF or VT are not available. If the patient requires ECG monitoring, monitor the ECG.CAUTIONWhen monitoring SpO2 only (without ECG monitoring), turn on both the upper and lower limit alarms for PR and SpO2 on the receiving monitor. If the patient’s pulse is not detected during asystole or other condition, a “CANNOT DETECT PULSE” or “CHECK PROBE” alarm occurs instead of an SpO2 limit alarm. Furthermore, if the patient has no pulse, noise from probe movement could be misjudged as a pulse and cause an incorrect PR or SpO2 value to be displayed.CAUTION
98ZM-540PA, ZM-541PA Operator’s ManualNOTE  ,QRUGHUWRPDLQWDLQVXI¿FLHQWEORRGFLUFXODWLRQNHHSWKHPHDVXUHPHQWVLWHwarm by covering it with a blanket or something similar. Warming the site is effective, especially for a patient with a small pulse amplitude.• When monitoring a patient who has an IABP and SpO2 cannot be measured, monitor the patient on a wired monitor. If the monitor has a sensitivity mode, set the mode to “MAX”.• Unlike ECG monitoring, detection of arrhythmia and asystole is not available when monitoring SpO2 only. If SpO2 is monitored without ECG, PR and SpO2 alarms do not occur during asystole because PR and SpO2 values are not measured when there is no pulse. Furthermore, if the patient has no pulse, noise from probe movement could be misjudged as a pulse and cause an incorrect PR or SpO2 value to be displayed.Monitoring SpO2 during NIBP MeasurementNIBP 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.*CAUTION :KHQWKH6S22SUREHLVDWWDFKHGWRWKHVDPHOLPEDVWKH1,%3FXIIWKHEORRGÀRZGHFUHDVHVGXULQJ1,%3PHDVXUHPHQWDQGSXOVHZDYHFDQQRWEHGHWHFWHGDQG6S22 cannot EHPRQLWRUHGSURSHUO\:KHQ³,1+,%,76S22'85,1*1,%3´RQWKH3$5$0(7(56(783VFUHHQLVVHWWR21IDFWRU\GHIDXOWVHWWLQJ6S22PRQLWRULQJLVSDXVHGGXULQJ1,%3PHDVXUHPHQWWRDYRLG6S22DODUPRFFXUUHQFH+RZHYHUZKHQPRQLWRULQJ6S22 on the same OLPEDV1,%3EHFDUHIXOZKHQUHDGLQJ6S22YDOXHV:KHQPRQLWRULQJ6S22LVLPSRUWDQWDWWDFKWKHSUREHWRWKHOLPEWRZKLFKWKH1,%3FXIIRUFDWKHWHULVQRWDWWDFKHG:KHQ6S22PRQLWRULQJLVSDXVHGGXULQJ1,%3PHDVXUHPHQWWKH6S22YDOXHMXVWEHIRUHWKHVWDUWRI1,%3PHDVXUHPHQWDQGDQ PDUNDUHGLVSOD\HGRQWKHWUDQVPLWWHUIRUVHFRQGV:KHQ1,%3PHDVXUHPHQWLVQRWFRPSOHWHGDIWHUVHFRQGV³±±±´LVGLVSOD\HGIRUWKH6S22 YDOXH7KHVDPHGDWDDOVRDSSHDUVRQWKHPRQLWRUVFUHHQ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.
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101ZM-540PA, ZM-541PA Operator’s ManualMeasuring 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 situations.• When using an ESU• Body movement• Small pulse wave• Too many arrhythmias• Shaking from an external source• Rapid blood pressure change• During CPR• Slow pulse• Low blood pressure• Small pulse pressure• Cuff is too tight or too loose• Cuff does not fit the arm• Cuff is wrapped over thick clothing• Cuff is deteriorated• Arterial sclerosis• Poor perfusion• Diabetes• Age• Pregnancy• Pre-eclampsia• Renal disease• Shivering• Trembling
102ZM-540PA, ZM-541PA Operator’s ManualWARNINGWhen 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.WARNINGWhen performing long term measurement at intervals less than 5 minutes, perform measurements while observing the state of the patient, blood vessels and limb to ensure adequate circulation. Congestion may occur at the measurement site. When performing periodic measurement for a long time, periodically check the circulation condition.When performing NIBP measurement repeatedly, have a rest between measurements to recover adequate circulation.CAUTIONNOTE • 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.
103ZM-540PA, ZM-541PA Operator’s Manual• 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.For Accurate NIBP Measurement• 0DNHVXUHWKHSDWLHQWLVFRPIRUWDEO\VHDWHG'RQRWSHUIRUPPHDVXUHPHQWLPPHGLDWHO\DIWHUWKHSDWLHQWLVVHDWHG.HHSWKHSDWLHQWLQWKHUHVWLQJVWDWHIRU¿YHPLQXWHVEHIRUHPHDVXUHPHQW• 0DNHVXUHWKHSDWLHQWKDVOHJVXQFURVVHGIHHWGRZQRQWKHÀRRUDQGEDFNDQGEDFNDUPVXSSRUWHGGXULQJPHDVXUHPHQW1 3UHVVWKH1,%3,QWHUYDONH\WRGLVSOD\WKH1,%3PRGHVHWWLQJVFUHHQNIBP Interval key2 6HOHFWWKHPHDVXUHPHQWPRGHE\SUHVVLQJWKH1,%3,QWHUYDONH\RUDQGNH\VSelected mode (key color: blue)3 3UHVVWKH)XQFWLRQNH\
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116ZM-540PA, ZM-541PA Operator’s ManualMaintenance7RXVHWKHWUDQVPLWWHULQVDIHDQGRSWLPXPFRQGLWLRQSHUIRUPPDLQWHQDQFHFKHFNDWOHDVWRQFHHYHU\\HDU7KHWUDQVPLWWHUFRQWDLQVSDUWVZKLFKJUDGXDOO\GHWHULRUDWHZLWKXVH2ULJLQDOSHUIRUPDQFHPLJKWQRWEHGHOLYHUHGLIDQ\SDUWRIWKHWUDQVPLWWHULVGHWHULRUDWHG3HUIRUPUHJXODUPDLQWHQDQFHFKHFNVWRDVVXUHFRQWLQXHGVDIHRSHUDWLRQ7KHIROORZLQJXQLWVDUHQHFHVVDU\IRUVRPHFKHFNLQJLWHPV• $;*YLWDOVLJQVLPXODWRU• $;76S22FKHFNHU• (OHFWULFRUPHUFXU\PDQRPHWHU• P/GXPP\FXII• 5HFHLYLQJPRQLWRUNever disassemble or repair the transmitter. If there is any problem with the transmitter, contact your Nihon Kohden representative.CAUTIONBefore maintenance, cleaning or disinfection, turn the transmitter power off and remove the batteries. Failure to follow this instruction may result in electrical shock and transmitter malfunction.CAUTIONNOTE • The measurement accuracy of the above units must be managed to perform accurate maintenance check.• For details on the operation of the above units, refer to the manuals provided with these units.$PDLQWHQDQFHFKHFNVKHHWLVSURYLGHGDWWKHHQGRIWKLVVHFWLRQ0DNHDFRS\RIWKLVFKHFNVKHHWEHIRUHSHUIRUPLQJPDLQWHQDQFHFKHFN1. External Check• 7KHUHLVQRGDPDJHRUGLUWRQWKHRXWVLGHRIWKHWUDQVPLWWHU• 7KHEDWWHU\FDVHFRYHULVQRWGDPDJHGDQGFDQEHFORVHG¿UPO\
117ZM-540PA, ZM-541PA Operator’s Manual• 1RNH\VDUHGDPDJHG• 1,%3VRFNHWLVQRWGDPDJHG• 1RHOHFWURGHOHDGVDUHGDPDJHG• 7KHUHDUHQREORRGRUFKHPLFDOVRQWKHWUDQVPLWWHU• 7KHVSULQJVLQWKHEDWWHU\FRPSDUWPHQWDUHQRWGDPDJHGRUGHWDFKHG• 7HUPLQDOVLQWKHEDWWHU\FDVHDUHQRWFRUURGHG2. Transmitter Channel• 7KHFKDQQHOQXPEHUODEHORQWKHWUDQVPLWWHULVQRWWRUQRUUHPRYHG• 7KHFKDQQHORIWKHWUDQVPLWWHUPDWFKHVWKHODEHO 7KHWUDQVPLWWHUFKDQQHOLVGLVSOD\HGLQWKHXSSHUOHIWFRUQHURIWKHVFUHHQ7KHFKDQQHOQXPEHUDOVRDSSHDUVRQWKHVWDUWXSVFUHHQChannel numbersStartup screen Numeric and waveform screen3. Transmitting/Receiving Signal8VHWKH$;*YLWDOVLJQVLPXODWRUDQGUHFHLYLQJPRQLWRU1 &RQQHFWWKHYLWDOVLJQVLPXODWRUWRWKHWUDQVPLWWHURQO\ZLWKWKHHOHFWURGHOHDGV2 3ODFHWKHWUDQVPLWWHUWRPIURPWKHUHFHLYLQJPRQLWRU3 6HWWKHFKDQQHORQWKHUHFHLYLQJPRQLWRUWRWKHFKDQQHORIWKHWUDQVPLWWHU
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120ZM-540PA, ZM-541PA Operator’s Manual4 3UHVVWKHŻ or ŹNH\WRPRYHWKHFXUVRUWR³.(<&+(&.´DQGSUHVVWKH)XQFWLRQNH\5 3UHVVHDFKNH\RQHDWDWLPHDQGFKHFNWKDWWKHSUHVVHGNH\LVKLJKOLJKWHGRQWKHVFUHHQExample: :KHQWKH)XQFWLRQNH\LVSUHVVHGWKHNH\QDPHLVKLJKOLJKWHG6 $IWHUFKHFNLQJSUHVVDQGKROGWKH6FUHHQNH\WRUHWXUQWRWKH0$18$/&+(&.VFUHHQ6. ECG Check1 &RQQHFWWKHYLWDOVLJQVLPXODWRUWRWKHWUDQVPLWWHURQO\ZLWKWKHHOHFWURGHOHDGVAX-400G2 3ODFHWKHWUDQVPLWWHUPIURPWKHUHFHLYLQJPRQLWRU
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123ZM-540PA, ZM-541PA Operator’s Manual5 &KHFNWKDW6S22DQG(&*RQWKHWUDQVPLWWHULVZLWKLQWKHIROORZLQJUDQJHVital Sign Simulator Range6S221 WR6S22GLJLWV WR6S22GLJLWV WR6S22GLJLWV(&* 1250$/ WREHDWVPLQEHDWVPLQ17KH6S22FKHFNE\WKHYLWDOVLJQVLPXODWRULVDIIHFWHGE\WKHVLPXODWRU¶VWROHUDQFHWRWKH6S22PHDVXULQJDFFXUDF\RIWKHWUDQVPLWWHU7KHPHDVXUHPHQWDFFXUDF\LVGHVFULEHGLQWKH³6SHFL¿FDWLRQV´VHFWLRQ)RUGHWDLOVUHIHUWRWKHYLWDOVLJQVLPXODWRUPDQXDO6 &KHFNWKDWWKH6S22DQG(&*RIWKHWUDQVPLWWHUDSSHDURQWKHUHFHLYLQJPRQLWRU9. NIBP Check&KHFNWKDWWKHWUDQVPLWWHUGLVSOD\VWKHFRUUHFWFXIISUHVVXUHDQGWKDWWKHUHLVQRDLUOHDN$OVRFKHFNWKHSUHVVXUHVHQVRU7KHIROORZLQJSURFHGXUHXVHVDQHOHFWULFPDQRPHWHU1 &RQQHFWWKHHOHFWULFPDQRPHWHUDQGGXPP\FXIIWRWKHWUDQVPLWWHUNOTE: $LUOHDNVIURPWKHUXEEHUEDOOGXULQJLQÀDWLRQ8VHDFOLSRQWKHDLUKRVHof the rubber ball to stop air leaking.Dummy cuff (700 cc)Electric manometerClipRubber ball2 7XUQRQWKHHOHFWULFPDQRPHWHU3 :KLOHSUHVVLQJWKH)XQFWLRQNH\WXUQRQWKHWUDQVPLWWHU7KH0(18VFUHHQDSSHDUV
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127ZM-540PA, ZM-541PA Operator’s Manual10. NIBP Cuff for Attaching Transmitter to Patient Arm7KH1,%3FXIILVDFRQVXPDEOH&KHFNWKHIROORZLQJDQGZKHQQHFHVVDU\UHSODFHLWZLWKDQHZRQHAppearance• 7KHUHDUHQRGLUW\SDUWV• 7KHUHDUHQREURNHQVWLWFKHVRQWKHFXII• 7KHODEHORQWKHFXIILVUHDGDEOH• 7KHYHOFURWDSHRQWKHFXIILVQRWUHPRYHGDQGWKHUHDUHQREURNHQVWLWFKHV• 7KHORFNSODWHLVQRWGDPDJHGDQGIXQFWLRQVSURSHUO\,QÀDWLRQEDJ• 7KHLQÀDWLRQEDJLVQRWWRUQRUGDPDJHG• 7KHUHLVQRZDWHULQVLGHWKHLQÀDWLRQEDJ• 7KHFRQQHFWRURQWKHLQÀDWLRQEDJLVQRWGDPDJHG
128ZM-540PA, ZM-541PA Operator’s ManualMaintenance Check Sheet+RVSLWDO2UJDQL]DWLRQ 6HUYLFH3HUVRQQHO ,QVWUXPHQW1DPHTransmitter,QVWUXPHQW0RGHOZM-540PA, ZM-541PA,QVWUXPHQW6HULDO1XPEHU +DUGZDUH5HYLVLRQ1XPEHU 6RIWZDUH5HYLVLRQ1XPEHU  ([WHUQDO&KHFN 3DVV )DLO 7UDQVPLWWHU&KDQQHO 3DVV )DLO 7UDQVPLWWLQJ5HFHLYLQJ6LJQDO 3DVV )DLO 'LVSOD\ 3DVV )DLO .H\2SHUDWLRQ 3DVV )DLO (&*&KHFN 3DVV )DLO 5HVSLUDWLRQ&KHFN 3DVV )DLO 6S22&KHFN 3DVV )DLO 1,%3&KHFN 3DVV )DLO1,%3&XIIIRU$WWDFKLQJ7UDQVPLWWHUWR3DWLHQW$UP 3DVV )DLOOverall JudgementƑ2.Ƒ&DQEHXVHGEXWQHHGVPDLQWHQDQFHƑ0DLQWHQDQFHUHTXLUHG&DQQRWEHXVHG
129ZM-540PA, ZM-541PA Operator’s ManualLifetime and DisposalDispose of Nihon Kohden products according to your local laws and your facility’s guidelines for waste disposal. Otherwise, it may affect the environment. If there is a possibility that the product may have been contaminated with infection, dispose of it as medical waste according to your local laws and your facility’s guidelines for medical waste. Otherwise, it may cause infection.CAUTIONDisposing of Used BatteriesBattery Lifetime5HSODFHWKHEDWWHULHVZKHQWKHEDWWHU\UHSODFHPHQWLQGLFDWLRQDSSHDUVRQWKHWUDQVPLWWHU:KHQXVLQJUHFKDUJHDEOHEDWWHULHVUHFKDUJHWKHPDisposalNOTE: Remove the batteries before disposing of the transmitter.%HIRUHGLVSRVLQJRIWKHEDWWHULHVFKHFNZLWK\RXUORFDOVROLGZDVWHRI¿FLDOVIRUGHWDLOVLQ\RXUDUHDIRUSURSHUGLVSRVDO,WPD\EHLOOHJDOWRGLVSRVHRIWKHVHEDWWHULHVLQWKHPXQLFLSDOZDVWHVWUHDPDisposing of Electrodes, SpO2 Probes and NIBP Cuffs5HIHUWRWKHPDQXDOIRUHDFKLWHPDisposing of Transmitter5HPRYHWKHEDWWHULHVIURPWKHWUDQVPLWWHUDQGGLVSRVHRIWKHWUDQVPLWWHUIROORZLQJ\RXUORFDOODZVIRUGLVSRVDO
130ZM-540PA, ZM-541PA Operator’s ManualCleaning, Disinfection and SterilizationTransmitter and Electrode LeadsIf 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.CAUTIONNOTE • The transmitter cannot be sterilized. Sterilizing the transmitter may damage it.• When cleaning or disinfecting the transmitter, disconnect it from the patient and remove the batteries beforehand. Otherwise it may result in malfunction.• Do not let the NIBP socket get wet during cleaning and disinfection.• Do not use a hair dryer etc. to dry the transmitter when it is wet. Doing so may cause the transmitter to deform or become damaged. It may also FDXVHORVVRIWKHZDWHUSURR¿QJIXQFWLRQ• Do not use volatile liquids such as thinner or benzine because these will cause the materials to deform or crack.• $YRLGXVLQJÀDPPDEOHGLVLQIHFWDQWVVXFKDVHWKDQROLQDFORVHGSODFH9HQWLODWHWKHURRPLI\RXXVHÀDPPDEOHGLVLQIHFWDQWV• Wipe the transmitter with a dry cloth before use and dry it completely after cleaning and disinfecting.%HIRUHFOHDQLQJRUGLVLQIHFWLQJWKHWUDQVPLWWHUGLVFRQQHFWLWIURPWKHSDWLHQWDQGUHPRYHWKHEDWWHULHVIURPWKHWUDQVPLWWHU%HFDUHIXOQRWWROHWDQ\OLTXLGJHWLQVLGHWKHWUDQVPLWWHUCleaning:LSHWKHWUDQVPLWWHUDQGHOHFWURGHOHDGVZLWKDVRIWFORWKPRLVWHQHGZLWKGLVLQIHFWLQJDOFRKRORUQHXWUDOGHWHUJHQWGLOXWHGZLWKZDWHU$IWHUFOHDQLQJGU\WKHPFRPSOHWHO\8VHFRWWRQVZDEPRLVWHQHGZLWKQHXWUDOGHWHUJHQWGLOXWHGZLWKZDWHUWRFOHDQLQVLGHWKHEDWWHU\FRPSDUWPHQWDisinfectionDo not immerse the electrode lead connector in liquid.CAUTION
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153ZM-540PA, ZM-541PA Operator’s ManualStandard Accessories12No. Name Model Qty Supply Code 1,%3FXIIIRUDGXOWVWDQGDUG <33  6&2 Strap —  <7KHIROORZLQJSDUWVDUHDYDLODEOHIRUUHSODFHPHQW/RFNSODWHLVDVWDQGDUGDFFHVVRU\RIWKH <33DQG<331,%3FXIIV34No. Name Model Qty Code No. %DWWHU\FDVHFRYHU —4/RFNSODWH 
154ZM-540PA, ZM-541PA Operator’s ManualOptionsOnly use Nihon Kohden specified electrodes, electrode leads and SpO2 probes. Otherwise, the maximum performance from the transmitter cannot be guaranteed.CAUTIONTransmitter• 4,3.FKDQQHOZULWHUECG/RESPApplication Model Qty Supply CodeHOHFWURGHVFOLSW\SHOHDGOHQJWKFP %53$  .$HOHFWURGHVVQDSW\SHOHDGOHQJWKFP %53$  .%HOHFWURGHVFOLSW\SHOHDGOHQJWKFP %53$  .$HOHFWURGHVVQDSW\SHOHDGOHQJWKFP %53$  .$
155ZM-540PA, ZM-541PA Operator’s ManualSpO2 Name Lead Length Model Qty Supply Code)LQJHUSUREHUHXVDEOHP7/73+P 3)0XOWLVLWHSUREHUHXVDEOH P 7/7 3*)LQJHUSUREHUHXVDEOHP 7/7 3$P 7/7 3&6S22SUREHIRUDGXOWGLVSRVDEOHP 7/7243$P 7/7 3(6S22SUREHIRUFKLOGGLVSRVDEOHP 7/7 3%P 7/7 3)6S22 probe IRUQHRQDWHDGXOWGLVSRVDEOHP 7/7 3&P 7/7 3*6S22 probe IRULQIDQWGLVSRVDEOHP 7/7 3'P 7/7 3+6S22 probe IRUQHRQDWHDGXOWGLVSRVDEOHP 7/63$P 7/6 3%6S22 probe IRUFKLOGLQIDQWGLVSRVDEOHP 7/6 3$P 7/6 3%&27721<WDSH——20 3)RDPWDSHIRU7/6666 î 3&$WWDFKPHQWWDSHIRU7/77 î 33UREHIDVWHQHU <63  3
156ZM-540PA, ZM-541PA Operator’s ManualNIBPName Width (cm)Air Hose Length (cm)Model Qty Supply Code&XIIIRUDGXOWIRUDWWDFKLQJWUDQVPLWWHUWRpatient armStandard   <331 6&/DUJH   <331 6'&XIIIRULQIDQW   <37  6$&XIIIRUFKLOGSmall   <37  6%Standard   <37  6$ <37  6&&XIIIRUDGXOW Standard   <37  6% <37  6%/DUJH   <37  6&'LVSRVDEOHFXIIIRULQIDQW 6 <33 20 6&'LVSRVDEOHFXIIIRUFKLOG 8 <33 20 6''LVSRVDEOHFXIIIRUDGXOWSmall   <33 20 6(Standard   <33 20 6)0HGLXPODUJH   <33 20 6*/DUJH   <33 20 6+([WUDODUJH   <33 20 6,([WHQVLRQKRVH — <13  61 7KHORFNSODWHLVSURYLGHGZLWKWKHVH1,%3FXIIV
157ZM-540PA/ZM-541PA Operator’s ManualTransmission Frequencies&KDQQHOWRChannel (HEX) Frequency (MHz)                                   Channel (HEX) Frequency (MHz)                                   Channel (HEX) Frequency (MHz)                                   
158ZM-540PA/ZM-541PA Operator’s ManualChannel (HEX) Frequency (MHz)                                       Channel (HEX) Frequency (MHz)                                       Channel (HEX) Frequency (MHz)                                       
159ZM-540PA/ZM-541PA Operator’s ManualChannel (HEX) Frequency (MHz)                                       Channel (HEX) Frequency (MHz)                                       Channel (HEX) Frequency (MHz)                                       
160ZM-540PA/ZM-541PA Operator’s ManualChannel (HEX) Frequency (MHz)                                       Channel (HEX) Frequency (MHz)                                       Channel (HEX) Frequency (MHz)                                       
161ZM-540PA/ZM-541PA Operator’s ManualChannel (HEX) Frequency (MHz)                     
162ZM-540PA/ZM-541PA Operator’s ManualChannel (HEX) Frequency (MHz)( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( Channel (HEX) Frequency (MHz)( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( Channel (HEX) Frequency (MHz)( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( &KDQQHO(WR(
163ZM-540PA/ZM-541PA Operator’s ManualChannel (HEX) Frequency (MHz)( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( Channel (HEX) Frequency (MHz)( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( Channel (HEX) Frequency (MHz)( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 
164ZM-540PA/ZM-541PA Operator’s ManualChannel (HEX) Frequency (MHz)( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( Channel (HEX) Frequency (MHz)( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( Channel (HEX) Frequency (MHz)( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 
165ZM-540PA/ZM-541PA Operator’s ManualChannel (HEX) Frequency (MHz)( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( Channel (HEX) Frequency (MHz)( ( ( ( ( ( ( ( ( ( 
166ZM-540PA/ZM-541PA Operator’s ManualChannel (HEX) Frequency (MHz)( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( Channel (HEX) Frequency (MHz)( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( Channel (HEX) Frequency (MHz)( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( &KDQQHO(WR(NOTE: In Canada, transmission frequencies from 1429.5 MHz to 1431.9750 MHz cannot be used due to the IC (Industry Canada) regulations. ZM-541PA can only use channels up to E698 in Canada.
167ZM-540PA/ZM-541PA Operator’s ManualChannel (HEX) Frequency (MHz)( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( Channel (HEX) Frequency (MHz)( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( Channel (HEX) Frequency (MHz)( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 
168ZM-540PA/ZM-541PA Operator’s ManualChannel (HEX) Frequency (MHz)( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( Channel (HEX) Frequency (MHz)( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( Channel (HEX) Frequency (MHz)( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 
169ZM-540PA/ZM-541PA Operator’s ManualChannel (HEX) Frequency (MHz)( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( Channel (HEX) Frequency (MHz)( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 
Serial NumberModelYour RepresentativeContact information is accurate as of Jan 2015. Visit www.nihonkohden.com for the latest information.The model and serial number of your instrument are identified on the rear or bottom of the unit.Write the model and serial number in the spaces provided below. Whenever you call your representative concerningthis instrument, mention these two pieces of information for quick and accurate service. ManufacturerNIHON KOHDEN CORPORATION1-31-4 Nishiochiai, Shinjuku-ku Tokyo 161-8560, JapanPhone +81 3-5996-8036 Fax +81 3-5996-8100 North and South AmericaNIHON KOHDEN AMERICA, INC.15353 Barranca Parkway, Irvine, CA 92618, U.S.A.Toll-free +1-800-325-0283 Phone +1 949-580-1555 Fax +1 949-580-1550NIHON KOHDEN LATIN AMERICA S.A.S Carrera 16 No.93A-36 Of. 802. Bogota D.C., ColombiaPhone +57 1-300-1742 Fax +57 1-300-1825NIHON KOHDEN DO BRASIL LTDA. Rua Gomes de Carvalho1507-Bloco A 9 andar-cjto 91A Vila OlimpiaCEP 04547-005 Sao Paulo-SP. BrasilPhone +55 11-3841-9943 Fax +55 11-3044-0463Europe European RepresentativeNIHON KOHDEN EUROPE GmbHRaiffeisenstrasse 10, D-61191 Rosbach, GermanyPhone +49 6003-827-0 Fax +49 6003-827-599NIHON KOHDEN FRANCE SARL8, rue Francois Delage, 94 230 Cachan, FrancePhone +33 1-49-08-05-50 Fax +33 1-49-08-93-32NIHON KOHDEN IBERICA S.L.C/Ulises 75A, E-28043 Madrid, SpainPhone +34 91-7-161080 Fax +34 91-3-004676NIHON KOHDEN ITALIA S.r.l.Via Fratelli Bronzetti 28, 24124 Bergamo, Italy Phone +39 035-219543 Fax +39 035-232546NIHON KOHDEN UK LTDTrident Court 118, 1 Oakcroft RoadChessington, Surrey KT9 1BD, UKPhone +44 20-8391-6800 Fax +44 20-8391-6809AsiaSHANGHAI KOHDEN MEDICAL ELECTRONIC INSTRUMENT CORP. 567 Huancheng Bei RoadShanghai Comprehensive Industrial Development ZoneShanghai 201401, ChinaPhone +86 21-5743-6998Fax +86 21-5743-6939 NIHON KOHDEN SINGAPORE PTE LTD1 Maritime Square, #10-34 HarbourFront CentreSingapore 099253Phone +65 6376-2210 Fax +65 6376-2264NIHON KOHDEN INDIA PVT. LTD. 308, Tower A, Spazedge, Sector 47, Sohna RoadGurgaon-122 002 Haryana, IndiaToll-free +91 1800-103-8182 Phone +91 124-493-1000 Fax +91 124-493-1029NIHON KOHDEN MIDDLE EAST FZE P.O.Box 261516, JAFZA View 19Room 308 Jebel Ali Free Zone, Dubai, U.A.EPhone +971 4-884-0080 Fax +971 4-880-0122NIHON KOHDEN KOREA, INC.5F Miso Bldg.890-47 Daechi-dong, Gangnam-gu, Seoul, 135-280 KoreaPhone +82 2-3273-2310 Fax +82 2-3273-2352 ZM-540PA, ZM-541PA_0614-902754H

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