Nihon Kohden ZM-920PA WMTS Transmitter User Manual Cover2 ZM920PA 930PA OM A pmd

Nihon Kohden Corporation WMTS Transmitter Cover2 ZM920PA 930PA OM A pmd

Contents

Manual

TRANSMITTERZM-920PA/930PA0614-007205AIf you have any comments or suggestions onthis manual, please contact us at:www.nihonkohden.com
Operator's Manual ZM-920PA/930PA iContentsGENERAL HANDLING PRECAUTIONS ......................................... iWARRANTY POLICY .................................................................... iiiEMC RELATED CAUTION ............................................................. vConventions Used in this Manual and Instrument ....................... viiWarnings, Cautions and Notes ............................................... viiExplanations of the Symbols in this Manual and Instrument viiiIntroduction ......................................................................................... 1Panel Description ............................................................................... 3Top Panel ...................................................................................... 3Front Panel .................................................................................... 4ZM-920PA ................................................................................ 4ZM-930PA ................................................................................ 5Important Safety Information .............................................................. 6General ......................................................................................... 6Battery ........................................................................................... 8Transmitter Channel Management ............................................... 8For Patients Using Implantable Pacemaker ................................. 9Output Signal ................................................................................ 9ECG Monitoring .......................................................................... 10SpO2 Monitoring .......................................................................... 10Maintenance ............................................................................... 13Preparation ....................................................................................... 14Installing (Replacing) Batteries .................................................. 14Procedure .............................................................................. 15WARNING and CAUTION for Battery Handling .......................... 15Situations Requiring Battery Replacement ................................ 16Attaching a Strap to the Transmitter ............................................ 16Turning On/Off the Transmitter .................................................... 17Check Items Before Turning On the Power ........................... 17Turning On/Off the Power ...................................................... 17
ii Operator's Manual ZM-920PA/930PACheck Items After Turning On the Power............................... 17Check Items After the Power Off ............................................ 18ECG Monitoring ................................................................................ 19ECG Measurement Procedure ................................................... 20Selecting Electrode Lead and Disposable Electrode ................ 21Option .................................................................................... 21Connecting the Electrode Lead to the Transmitter ..................... 22Selecting the Electrode Position ................................................. 22Six Electrodes ....................................................................... 23When Using 4 to 6 DIN Type Leads to Monitor 6 Lead ECG 24Three Electrodes ................................................................... 25Connecting the Electrode Lead and Disposable Electrodes ..... 26Preparing the Patient Skin .................................................... 26Attaching Electrodes to the Patient ....................................... 26Detection and Display of Measurement Condition .................... 27Electrode Detachment .......................................................... 27Respiration Monitoring ..................................................................... 28Respiration Measurement Procedure ........................................ 29Electrode Position for Respiration Monitoring ............................ 29Electrode Position Examples ................................................ 29SpO2 Monitoring ............................................................................... 31Measurement Procedure ............................................................ 33Selecting SpO2 Probe ................................................................. 33Reusable Probes .................................................................. 34Disposable Probes................................................................ 35Connecting SpO2 Probe to the Transmitter ................................. 38Attaching the Probe to the Patient .............................................. 39Starting Measurement ................................................................ 40Turning SpO2 Data and Pulse Level Bar Graph Display On/Off . 41Detecting and Displaying Measurement Condition ................... 41External Light Noise Alarm ................................................... 41Insufficient Light Alarm .......................................................... 42Probe Malfunction Alarm ....................................................... 42When Measurement Condition is Unstable .......................... 42Alarm List .......................................................................................... 43Troubleshooting ................................................................................ 45
Operator's Manual ZM-920PA/930PA iiiChanging the Transmitter Channel .................................................. 47Lifetime and Disposal ....................................................................... 48Disposing of Used Batteries ....................................................... 48Replacement ......................................................................... 48Disposal ................................................................................ 48Disposing of Electrodes and SpO2 Probes ................................. 48Cleaning, Disinfection and Sterilization ........................................... 49Transmitter and Electrode Lead ................................................. 49Cleaning ................................................................................ 49Disinfection............................................................................ 49SpO2 Probe ................................................................................. 50Replacing the Battery Case Cover ................................................... 51Repair Parts Availability Policy ......................................................... 51Specifications ................................................................................... 52ECG measurement................................................................ 52Respiration measurement .................................................... 52SpO2 measurement ............................................................... 52Transmitter ............................................................................. 52Safety standards ................................................................... 53Water resistance ................................................................... 54Power requirements .............................................................. 54Environment .......................................................................... 54Dimension and Weight.......................................................... 54Standard Accessories ...................................................................... 55Options ............................................................................................. 56ECG/RESP ............................................................................ 56SpO2...................................................................................... 57
Operator's Manual ZM-920PA/930PA iGENERAL HANDLING PRECAUTIONSThis device is intended for use only by qualified medical personnel.Use only Nihon Kohden approved products with this device. Use ofnon-approved products or in a non-approved manner may affect theperformance specifications of the device. This includes, but is notlimited to, batteries, recording paper, pens, extension cables,electrode leads, input boxes and AC power.Please read these precautions thoroughly before attempting to operatethe instrument.1. To safely and effectively use the instrument, its operation must befully understood.2. When installing or storing the instrument, take the followingprecautions:(1) Avoid moisture or contact with water, extreme atmosphericpressure, excessive humidity and temperatures, poorly ventilatedareas, and dust, saline or sulphuric air.(2) Place the instrument on an even, level floor. Avoid vibration andmechanical shock, even during transport.(3) Avoid placing in an area where chemicals are stored or where thereis danger of gas leakage.(4) The power line source to be applied to the instrument mustcorrespond in frequency and voltage to product specifications, andhave sufficient current capacity.(5) Choose a room where a proper grounding facility is available.3. Before Operation(1) Check that the instrument is in perfect operating order.(2) Check that the instrument is grounded properly.(3) Check that all cords are connected properly.(4) Pay extra attention when the instrument is in combination withother instruments to avoid misdiagnosis or other problems.
ii Operator's Manual ZM-920PA/930PA(5) All circuitry used for direct patient connection must be doublychecked.(6) Check that battery level is acceptable and battery condition is goodwhen using battery-operated models.4. During Operation(1) Both the instrument and the patient must receive continual, carefulattention.(2) Turn power off or remove electrodes and/or transducers whennecessary to assure the patient’s safety.(3) Avoid direct contact between the instrument housing and thepatient.5. To Shutdown After Use(1) Turn power off with all controls returned to their original positions.(2) Remove the cords gently; do not use force to remove them.(3) Clean the instrument together with all accessories for their nextuse.6. The instrument must receive expert, professional attention formaintenance and repairs. When the instrument is not functioningproperly, it should be clearly marked to avoid operation while it isout of order.7. The instrument must not be altered or modified in any way.8. Maintenance and Inspection:(1) The instrument and parts must undergo regular maintenanceinspection at least every 6 months.(2) If stored for extended periods without being used, make sure priorto operation that the instrument is in perfect operating condition.(3) Technical information such as parts list, descriptions, calibrationinstructions or other information is available for qualified usertechnical personnel upon request from your Nihon Kohdenrepresentative.
Operator's Manual ZM-920PA/930PA iii9. When the instrument is used with an electrosurgical instrument,pay careful attention to the application and/or location of electrodesand/or transducers to avoid possible burn to the patient.10. When the instrument is used with a defibrillator, make sure that theinstrument is protected against defibrillator discharge. If not,remove patient cables and/or transducers from the instrument toavoid possible damage.WARRANTY POLICYNihon Kohden Corporation (NKC) shall warrant its products against alldefects in materials and workmanship for one year from the date of delivery.However, consumable materials such as recording paper, ink, stylus andbattery are excluded from the warranty.NKC or its authorized agents will repair or replace any products whichprove to be defective during the warranty period, provided these productsare used as prescribed by the operating instructions given in the operator’sand service manuals.No other party is authorized to make any warranty or assume liability forNKC’s products. NKC will not recognize any other warranty, either impliedor in writing. In addition, service, technical modification or any otherproduct change performed by someone other than NKC or its authorizedagents without prior consent of NKC may be cause for voiding thiswarranty.Defective products or parts must be returned to NKC or its authorizedagents, along with an explanation of the failure. Shipping costs must be pre-paid.This warranty does not apply to products that have been modified,disassembled, reinstalled or repaired without Nihon Kohden approval orwhich have been subjected to neglect or accident, damage due to accident,
iv Operator's Manual ZM-920PA/930PAfire, lightning, vandalism, water or other casualty, improper installation orapplication, or on which the original identification marks have been removed.In the USA and Canada other warranty policies may apply.CAUTIONUnited States law restricts this device to sale by or on the orderof a physician.Equipment Authorization RequirementOperation of this equipment requires the prior coordination with a frequencycoordinator designated by the FCC for the Wireless Medical TelemetryService.
Operator's Manual ZM-920PA/930PA vEMC RELATED CAUTIONThis equipment and/or system complies with the InternationalStandard IEC60601-1-2 for electromagnetic compatibility formedical electrical equipment and/or system. However, anelectromagnetic environment that exceeds the limits or levelsstipulated in the IEC60601-1-2, can cause harmful interference tothe equipment and/or system or cause the equipment and/orsystem to fail to perform its intended function or degrade itsintended performance. Therefore, during the operation of theequipment and/or system, if there is any undesired deviationfrom its intended operational performance, you must avoid,identify and resolve the adverse electromagnetic effect beforecontinuing to use the equipment and/or system.The following describes some common interference sources andremedial actions:1.Strong electromagnetic interference from a nearby emittersource such as an authorized radio station or cellular phone:Install the equipment and/or system at another location if it isinterfered with by an emitter source such as an authorizedradio station. Keep the emitter source such as cellular phoneaway from the equipment and/or system.2.Effect of direct or indirect electrostatic discharge:Make sure all users and patients in contact with the equipmentand/or system are free from direct or indirect electrostaticenergy before using it. A humid room can help lessen thisproblem.3.Electromagnetic interference with any radio wave receiversuch as radio or television:If the equipment and/or system interferes with any radio wavereceiver, locate the equipment and/or system as far aspossible from the radio wave receiver.
vi Operator's Manual ZM-920PA/930PAIf the above suggested remedial actions do not solve theproblem, consult your Nihon Kohden representative for additionalsuggestions.
Operator's Manual ZM-920PA/930PA viiConventions Used in this Manual and InstrumentWarnings, Cautions and NotesWarnings, cautions and notes are used in this manual to alert or signal thereader to specific information.WARNINGA warning alerts the user to the possible injury or deathassociated with the use or misuse of the instrument.CAUTIONA caution alerts the user to possible injury or problems with theinstrument associated with its use or misuse such as instrumentmalfunction, instrument failure, damage to the instrument, ordamage to other property.NOTEA note provides specific information, in the form ofrecommendations, prerequirements, alternative methods orsupplemental information.
viii Operator's Manual ZM-920PA/930PASymbol Description Symbol DescriptionPower On Attention, consultoperator’s manualPower Off Nurse callDefibrillation prooftype BF applied partReplace batteryDefibrillation prooftype CF applied partCheck electrodeDirect currentExplanations of the Symbols in this Manual and InstrumentThe following symbols found in this manual/instrument bear the respectivedescriptions as given.
Operator's Manual ZM-920PA/930PA 1IntroductionThe ZM-920PA/930PA transmitter transmits ECG and other data from a patient toa Nihon Kohden monitor for continuous monitoring. Available parameters andfunctions vary between the models. Read the operator’s manual for the monitorbefore operation.Model Parameters Functions ZM-920PA • ECG • Impedance respiration The following information is indicated by LED. • Check ECG electrodes • Replace batteries ZM-930PA • ECG • Impedance respiration • SpO2 The following information is indicated on LCD. • SpO2 value • Pulse wave amplitude • Replace batteries The following information is indicated by LED. • Check ECG electrodes The transmitter channel can be changed by the QI-901PK Channel Writer. Tochange the channel number, refer to the channel writer manual.WARNINGThe following actions must be taken to properly receive thetransmitter signal of the correct patient on the receiving instrument,otherwise, there may be signal loss or signals may mix causing aserious accident, such as monitoring a different patient.•••••Assign a channel administrator in the hospital and only he or sheshould manage channel assignments.•••••The channel administrator must manage the channels in thefacility so that there is no signal interference.•••••When the transmitter channel is changed, the channeladministrator must check that the channel on the receivingmonitor is also changed and the signal is properly received.
2 Operator's Manual ZM-920PA/930PA•••••The channel administrator must replace the channel number labelon the transmitter with the new one after changing the channel.CAUTION• Do not use the same channel for different patients. If the samechannel is used for two patients, the two patients’ data will be lostdue to mutual modulation interference, or another patient’s datamay appear on the receiving monitor screen.• Do not use transmitters of adjacent channels in a hospital. If atransmitter of an adjacent channel is used, radio waves from onetransmitter affects the receiver of the adjacent channel’stransmitter and there may be interference.• Do not use the same transmitter on more than one patient at thesame time. Do not connect different sensors on different patientsto the same transmitter.NOTE• To prevent interference between channels, assign a channeladministrator in the hospital and only he or she should managechannel assignment.• Use Nihon Kohden parts and accessories to assure maximumperformance from your instrument.• For stable signal reception, it is recommended to use a diversityantenna system on the receiving monitor. Otherwise, spike noisefrom transient fading of electric field strength (for example, peoplemoving) may interfere with the transmitter signal and may bemistaken as an arrhythmia on the receiving monitor.• For details on the receiving monitor and upgrade information,contact your Nihon Kohden representative.
Operator's Manual ZM-920PA/930PA 3Panel DescriptionTop PanelRefer to the warnings belowRefer to the symbol pageECG/RESP socketConnects to the electrode lead for measuring ECGand/or respiration by the impedance method.Refer to the warnings belowRefer to the symbol pageSpO2 socketConnects to the SpO2 probe.For attaching a strapZM-930PA onlyWARNING• Before defibrillation, check that the electrode leads and SpO2probe attached to the patient are properly connected to thetransmitter. Touching the metal parts of disconnected leads andprobes may cause electrical shock or injury by discharged energy.• When performing defibrillation, discharge as far as possible fromelectrodes, patches and any gel, cream or medicine on the chestof the patient. If there is a possibility that the defibrillator paddlecould touch these materials, remove them from the patient. If thedefibrillator paddle directly contacts these materials, thedischarged energy may cause skin burn to the patient.• Before defibrillation, all persons must keep clear of the bed andmust not touch the patient or any equipment connected to thepatient. Failure to follow this warning may cause electrical shockor injury.
4 Operator's Manual ZM-920PA/930PAFront PanelCAUTIONOnly use your finger to press the CALL key. Do not press the keywith a sharp object, otherwise the key may be damaged.Power switchTurns transmitter power on or off.CALL keyWhen this key is pressed,a "peep" sounds at the transmitter, and "CALL" message appears at the monitor. Depending on the settings on the monitor, an ECG waveform is recorded when this key is pressed.Channel lableReplace batteries LEDLights when the batteries need replacement.Check electrodes LEDLights when the electrode is detached from the patient.Battery caseContains two 1.5 V dry cell batteries (AA).Refer to the warning below.RA LA LL Va VbUSAch9002608.025 MHzWARNINGClose the battery case cover during operation. If the transmitter isused with the battery case cover open, anyone who touches theopened battery case may receive an electrical shock whendefibrillation is performed. Touching the opened battery case maycause electrostatic discharge and intermittently interfere with thewaveform or data.ZM-920PA
Operator's Manual ZM-920PA/930PA 5ZM-930PABattery replacement mark:Appears when the batteriesare weak. Immediatelyreplace the batteries when thisappears.%SpO2:Displayed when the power is turnedon. This indication is not displayedwhen SpO2 display is turned off.Pulse level bar graph:Displays pulse level in 7steps.SpO2 data:Displays SpO2 data.When SpO2 is 41 to 100%, the value is displayed. (ex. )When SpO2 is under 40%, “ ” is displayed.When the detected pulse is too small to measure, “ ” is displayed.RA LA LL Va VbUSAch9002608.025 MHzLCDFor the descriptions except for the LCD,refer to the “ZM-920PA” section on theprevious page.
6 Operator's Manual ZM-920PA/930PAImportant Safety InformationGeneralWARNING• Never use the transmitter in the presence of any flammableanesthetic gas or high concentration oxygen atmosphere. Failureto follow this warning may cause explosion or fire.• Never use the transmitter in a hyperbaric oxygen chamber.Failure to follow this warning may cause explosion or fire.• Never take this transmitter into an MRI test room.• When performing MRI test, remove all electrodes from the patientwhich are connected to this instrument. Failure to follow thiswarning may cause skin burn on the patient. For details, refer tothe MRI manual.• Before defibrillation, check that the electrode leads and SpO2probe attached to the patient are properly connected to thetransmitter. Touching the metal parts of disconnected leads andprobes may cause electrical shock or injury by discharged energy.• When performing defibrillation, discharge as far as possible fromelectrodes, patches and any gel, cream or medicine on the chestof the patient. If there is a possibility that the defibrillator paddlecould touch these materials, remove them from the patient. If thedefibrillator paddle directly contacts these materials, thedischarged energy may cause skin burn to the patient.• Before defibrillation, all persons must keep clear of the bed andmust not touch the patient or any equipment connected to thepatient. Failure to follow this warning may cause electrical shockor injury.• When 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 thetransmitter, causing electrical burn where the electrodes areattached. For details, refer to the ESU manual.
Operator's Manual ZM-920PA/930PA 7CAUTION• Only use Nihon Kohden specified electrodes, electrode leads andSpO2 probes. Otherwise, the maximum performance from theinstrument cannot be guaranteed.• Do not reuse disposable items.• Do not shake or swing the transmitter while holding the leads orcables connected to the transmitter. The transmitter may come offand injure someone or damage surrounding instruments.• Attach a strap to the transmitter to prevent the transmitter fromfalling.• Turn off the power of mobile phones, small wireless devices andother devices which produce strong electromagnetic interferencearound a patient (except for devices allowed by the hospitaladministrator). Radio waves from devices such as mobile phonesor small wireless devices may be mistaken as respiration or pulsewaves and the displayed data may be incorrect.• Do not use the same channel for different patients. If the samechannel is used for two patients, the two patients’ data will be lostdue to mutual modulation interference, or another patient’s datamay appear on the receiving monitor screen.• Do not use transmitters of adjacent channels in a hospital. If atransmitter of an adjacent channel is used, radio waves from onetransmitter affects the receiver of the adjacent channel’stransmitter and there may be interference.• Close the battery case cover during operation. If the transmitter isused with the battery case cover open, anyone who touches theopened battery case may receive an electrical shock whendefibrillation is performed. Touching the opened battery case maycause electrostatic discharge and intermittently interfere with thewaveform or data.
8 Operator's Manual ZM-920PA/930PACAUTION• Battery replacement must be performed by the operator. Whenreplacing batteries of the transmitter currently used for a patient,disconnect electrode leads from the transmitter before replacingbatteries or do not touch the patient during replacement.• The battery charger must be used outside the patient environment.• Refer to the battery and battery charger manuals for details onhandling the batteries.WARNING• Keep the battery pack away from fire. It may explode.• Do not damage, disassemble, drop or give impact to the battery. Ifthe battery is damaged and substance inside the battery contactsthe skin or clothes, wash immediately and thoroughly with water.• Never short-circuit the + and – terminals on the battery. It maycause overheating and fire.• Take care that the patient does not swallow batteries.BatteryTransmitter Channel ManagementWARNINGThe following actions must be taken to properly receive thetransmitter signal of the correct patient on the receiving instrument,otherwise, there may be signal loss or signals may mix causing aserious accident, such as monitoring a different patient.•••••Assign a channel administrator in the hospital and only he or sheshould manage channel assignments.•••••The channel administrator must manage the channels in thefacility so that there is no signal interference.•••••When the transmitter channel is changed, the channeladministrator must check that the channel on the receivingmonitor is also changed and the signal is properly received.
Operator's Manual ZM-920PA/930PA 9WARNINGInteraction Between Minute Ventilation Rate-Adaptive Pacemakersand Cardiac Monitoring and Diagnostic Equipment.The bioelectric impedance measurement sensor of a minuteventilation rate-adaptive implantable pacemaker, may be affectedby the transmitter which is connected to the same patient. If thisoccurs, the pacemaker may pace at its maximum rate and thetransmitter may give incorrect data to the monitor. If this occurs,disconnect the electrode leads from the patient or change thesetting on the pacemaker by referring to the pacemaker’s manual.For more details, contact your pacemaker distributor or NihonKohden representative.For Patients Using Implantable PacemakerOutput SignalCAUTIONDo not use the output signal from the receiving monitor as thesynchronization signal for other equipment such as IABP, MRI,echocardiography or defibrillator, there may be time delay betweenthe monitor and the other equipment caused by waveformtransmission delay and spike noise may interfere on the outputsignal and be mistaken as a trigger.•••••The channel administrator must replace the channel number labelon the transmitter with the new one after changing the channel.
10 Operator's Manual ZM-920PA/930PAECG MonitoringCAUTION• Only use Nihon Kohden specified electrodes and electrode leads.When other type of electrodes or electrode leads are used, the“CHECK ELECTRODE” message may be displayed and monitoringmay stop.• When the “ELECTRODE OFF” or “CHECK ELECTRODE” messageis displayed on the receiving monitor, ECG is not monitoredproperly and the ECG alarm does not function. Check theelectrode and electrode leads, and if necessary, replace with newones.SpO2 MonitoringWARNING•SpO2 measurement may be incorrect in the following cases.• When the patient’s carboxyhemoglobin or methemoglobinincreases abnormally.• When dye is injected in the blood.• When using an electrosurgical unit.• During CPR.• When measuring at a site with venous pulse.• When there is body movement.• When the pulse wave is small (insufficient peripheralcirculation).• Check the circulation condition by observing the skin color of themeasuring site and pulse waveform. Change the measuring siteevery 8 hours for disposable probes and every 4 hours forreusable probes. The skin temperature may increase at theattached site by 2 or 3°C (4 or 5°F) and cause a burn or pressurenecrosis. When using the probe on the following patients, takeextreme care and change the measurement site more frequentlyaccording to symptoms and degree.• A patient with a fever
Operator's Manual ZM-920PA/930PA 11CAUTION• NIBP and SpO2 can be measured on the same limb, but the SpO2monitoring may not be accurate during NIBP measurement. Becareful when reading the SpO2 values.• While a patient is on medication which causes vasodilation, thepulse waveform may change and in rare cases the SpO2 valuemay not be displayed.• Normal external light does not affect monitoring but strong lightsuch as a surgical light or sunlight may affect monitoring. Ifaffected, cover the measuring site with a blanket.• If the attachment site is dirty with blood or bodily fluids, clean theattachment site before attaching the probe. If there is nail polishon the attachment site, remove the polish. Otherwise, the amountof transmitted light decreases, and measured value may beincorrect or measurement cannot be performed.• The disposable probe is not sterilized. Use the disposable probeonly for a single patient. Never reuse the disposable probe foranother patient because it causes cross infection.• A patient with peripheral circulation insufficiency• Neonate or low birth weight infant with delicate skin• When not monitoring SpO2, disconnect the SpO2 cable from thetransmitter. Otherwise, noise from the probe sensor may interfereand incorrect data is displayed on the screen.• When using the TL-201T finger probe, do not fasten the probe andcable 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 avoidpoor circulation, do not wrap the tape too tight. Check the bloodcirculation condition by observing the skin color and congestion atthe skin peripheral to the probe attachment site. Even for short-term monitoring, there may be burn or pressure necrosis frompoor blood circulation, especially on neonates or low birth weightinfants whose skin is delicate. Accurate measurement cannot beperformed on a site with poor peripheral circulation.
12 Operator's Manual ZM-920PA/930PA• Do not use a probe that is deteriorated by aging. Accuratemeasurement cannot be performed.• Do not use damaged or disassembled probe. It causes incorrectmeasurement and may injure the patient.• If the skin gets irritated or redness appears on the skin from theprobe, change the attachment site or stop using the probe. Takeextreme care for the patients with delicate skin.• Do not pull or bend the probe cable, and do not put caster feet onthe probe cable. Do not immerse the probe cable in chemicalsolutions or water. Failure to follow these instructions may causecable discontinuity, short circuit, skin burn on the patient andincorrect measurement data. Replace any broken probe with anew one.• When the probe is attached on an appropriate site with sufficientcirculation and the error message confirming the probeattachment repeatedly appears, the probe may be deteriorated.Replace it with a new one.• When a message indicates a faulty SpO2 probe, stop monitoringand replace the probe with a new one.• When removing a probe that is taped to the skin, do not pull theprobe cable because this can damage the cable.• Neonatal skin is delicate. Remove the probe and tape carefullyand slowly.• Do not immerse the disposable probe in detergents or water. If theprobe adhesive surface gets wet, adhesiveness becomes weakand the probe cannot be attached to the skin.• Before using the TL-260T multi-site Y probe, be sure to attach theprobe to the sponge attachment tape S or L. Do not use the probewithout the sponge attachment tape attached. Using the probewithout the sponge attachment tape causes incorrectmeasurement and may injure the skin at the attachment site.• When fixing the TL-260T multi-site Y probe with the spongeattachment tape, confirm that the adhesive part of the tape is noton the skin. The adhesive may cause oversensitive symptoms onthe skin such as redness or itch. If the adhesive touches the skin,remove it carefully and slowly because neonatal skin is verydelicate.
Operator's Manual ZM-920PA/930PA 13CAUTIONNever disassemble or repair the transmitter. When there is anyproblem with the transmitter after maintenance and inspection,contact your Nihon Kohden representative.MaintenanceWARNINGIf detergents or dirty liquid spills into the transmitter, clean it and dryit completely before use. If the wet transmitter is used, the patient oranyone in contact with the transmitter may receive an electricshock.• Do not use a dirty sponge attachment tape. The measurementvalue may be incorrect.• When removing the probe from the attachment tape, do not pull thesensor cable because this can damage the cable.• Use the sponge attachment tape S and L only with the specifiedproducts.• Refer to the probe instruction manual for details.• When any of the following occurs, the probe may be broken.Replace it with a new one and check the probe.•••••The transmitter generates “pip” sound every 0.25 seconds.•••••SpO2 data is 85% and blinking.
14 Operator's Manual ZM-920PA/930PAType Lifetime Manganese About 1/2 of alkaline batteries NiCd About 1/3 of alkaline batteries (when fully charged) NiMH About 1/2 of alkaline batteries (when fully charged) PreparationInstalling (Replacing) BatteriesUse two AA(R6) type alkaline dry cell batteries, manganese dry cell batteries,NiCd rechargeable batteries or NiMH batteries.With new alkaline batteries, the transmitter can continuously measure ECG,respiration and SpO2 for approximately 3 days or ECG and respiration forapproximately 4 days. Operation time depends on the thickness of SpO2 probeattachment site.NOTEThe capacity of manganese, NiCd and NiMH batteries is less thanthat of alkaline batteries, therefore the lifetime of the battery isshorter.CAUTIONBattery replacement must be performed by the operator. Whenreplacing batteries of the transmitter currently used for a patient,disconnect electrode leads from the transmitter before replacingbatteries, or do not touch the patient during replacement.If electrode leads are attached to the patient and the person replacing the batteriestouches the patient, the patient leakage current over the amount allowed mayoccur.CAUTION• Replace both batteries at the same time.• Do not use different types of batteries together.
Operator's Manual ZM-920PA/930PA 15WARNING and CAUTION for Battery HandlingWARNING• Keep the battery pack away from fire. It may explode.• Do not damage, disassemble, drop or give impact to the battery. Ifthe battery is damaged and substance inside the battery contactsthe skin or clothes, wash immediately and thoroughly with water.• Never short-circuit the + and – terminals on the battery. It maycause overheating and fire.• Take care that the patient does not swallow batteries.CAUTIONWhen the transmitter is not in use, remove batteries or turn thepower OFF. With the power ON, battery power is consumed even ifmeasurement is not performed. The batteries may becomeunusable from overdischarge, and leakage from the battery maydamage the transmitter.Procedure1. Open the battery case cover.2. Insert two dry cell batteries (LR6)into the battery case observing thecorrect polarity.3. Close the cover and press it gentlyuntil it clicks.123NOTEInsert the batteries with the correct polarity (+++++ and − − − − −).
16 Operator's Manual ZM-920PA/930PATo open the clip, firmly pull outthe tab in direction of the arrow.NOTE•••••When using rechargeable NiCd batteries or NiMH batteries,shallow charging/discharging shortens battery capacity. Fordetails, refer to the battery operator’s manual.•••••Remove the batteries from the transmitter before disposing of thetransmitter.Situations Requiring Battery ReplacementReplace the batteries when any of the following occurs.•The “ ” LED lights (ZM-920PA) or the “ ” mark is displayed on the LCD(ZM-930PA) on the transmitter.•The transmitter generates a constant alarm (continuous “peep” sound).•The monitor displays the battery replacement message on the screen.•When the power of the LCD transmitter is turned on, no message or icon isdisplayed. (Only the ZM-930PA).Attaching a Strap to the TransmitterNOTE•••••Attach a strap to the transmitter to prevent the transmitter fromfalling.•••••Do not attach the clip to hard objects such as thick cloths orzippers, or the clip may break.Attach a strap to the transmitter and fasten the clip to the patients’ clothes or bedsheets.If the transmitter falls off, the battery cover may be opened. If the patient touchesthe terminals of the batteries, patient leakage current over the allowable amountcan occur.
Operator's Manual ZM-920PA/930PA 17Turning On/Off the TransmitterCheck Items Before Turning On the PowerTo use the instrument in a safe and optimum condition, before turning on thetransmitter power switch, check the following.Appearance•There is no damage or dirt on the outside of the transmitter. (Power switch,LED, LCD, CALL key, junction, battery case cover, battery case, etc.)•The transmitter is completely dry.•The electrode lead is not broken.•There is no damage or dirt on the SpO2 probe or on the disposable electrodes.Battery•The battery polarity is correct.•The battery case spring is firmly fixed and the battery is not loose.•The battery case cover is firmly closed.Channel Setting•The transmitter channel corresponds to those of the receiving monitor.•The same channel is not being used on a different transmitter in thesurrounding area.Turning On/Off the PowerONOFFTo turn on the power, turn the power switch to the right. Aftera “peep” sound for about one second, the power is turned on.(There is no “peep” sound when the “ ” LED light or the“” are blinking on the LCD).To turn off the power, turn the power switch to the left.Check Items After Turning On the PowerAfter turning on the power, check the following items.Power On•The power switch is not damaged.•The transmitter generates a “peep” sound for about one second.
18 Operator's Manual ZM-920PA/930PA•All LEDs light and values are displayed on the LCD for about one second.•The transmitter does not generate a continuous “pip” sound.•The transmitter does not liberate excessive heat.•The “ ” LED does not light or the “ ” mark is not displayed on the LCD.•The transmitter does not interfere with the operation of medical instrumentsused near it.Basic Operation•The “signal loss” message is not displayed on the monitor when the transmitteris inside the receiving range of the monitor.•A “peep” sounds at the transmitter and “CALL” message appears at thereceiving monitor when the CALL key is pressed and the transmitter is insidethe receiving range of the monitor.•The battery replacement message is not displayed on the monitor.Check Items After the Power Off•ECG electrode leads and SpO2 probe are cleaned and disinfected.•When the transmitter gets wet, liquid is wiped off and the transmitter isthoroughly dried.•There are enough consumables, such as disposable electrodes.•The power is turned off.•The batteries are removed from the transmitter when it will not be used for along time.•Dead batteries are disposed of properly.
Operator's Manual ZM-920PA/930PA 19ECG MonitoringWhen 6 leads are used on this transmitter, up to 8 lead (I, II, III, aVR, aVL, aVF, Vaand Vb) of ECG waveforms can be displayed on the receiving monitor. The heartrate is also measured. When 3 leads are used, one channel ECG waveform of leadII can be displayed on the receiving monitor. Refer to the operator’s manual of themonitor for details.WARNINGInteraction Between Minute Ventilation Rate-Adaptive Pacemakersand Cardiac Monitoring and Diagnostic Equipment*The bioelectric impedance measurement sensor of a minuteventilation rate-adaptive implantable pacemaker may be affected bythe transmitter which is connected to the same patient. If thisoccurs, the pacemaker may pace at its maximum rate and thetransmitter may give incorrect data to the monitor. If this occurs,disconnect the electrode leads from the patient or change thesetting on the pacemaker by referring to the pacemaker’s manual.For more details, contact your pacemaker distributor or NihonKohden representative.* Minute ventilation is sensed in rate-adaptive pacemakers by a technologyknown as bioelectric impedance measurement (BIM). Many medical devices inaddition to pacemakers use this technology. When one of these devices is usedon a patient with an active, minute ventilation rate-adaptive pacemaker, thepacemaker may erroneously interpret the mixture of BIM signals created in thepatient, resulting in an elevated pacing rate.For more information, see the FDA web site.http://www.fda.gov/cdrh/safety.html
20 Operator's Manual ZM-920PA/930PAWARNINGWhen the transmitter is used with an electrosurgical unit (ESU),firmly attach the entire area of the ESU return plate. Otherwise, thecurrent from the ESU flows into the electrodes of the transmitter,causing electrical burn where the electrodes are attached. Fordetails, refer to the ESU manualNOTE•••••This transmitter is not protected against noise generated from anelectrosurgery unit.•••••If an electric blanket is used and incorrect heart rate is displayedon the monitor, turn off the pacing pulse detection on the monitor.ECG Measurement Procedure1. Select the type of electrode lead and disposable electrode according to thepurpose.2. Connect the electrode lead to the ECG/RESP socket.3. Connect disposable electrodes to the electrode lead and attach electrodes tothe patient.After steps 1 to 3 are finished, ECG monitoring automatically starts.
Operator's Manual ZM-920PA/930PA 21Selecting Electrode Lead and Disposable ElectrodeCAUTIONOnly Use Nihon Kohden specified electrodes and electrode leads.When other type of electrodes or electrode leads are used, theCHECK ELECTRODE message may be displayed and monitoringmay stop.OptionElectrode lead BR-916PA 6 electrodes, snap type BR-906PA 6 electrodes, clip type BR-913PA 3 electrodes, snap type BR-903PA 3 electrodes, clip type
22 Operator's Manual ZM-920PA/930PAConnecting the Electrode Lead to the TransmitterConnect the electrode lead to the ECG/RESP socket on the transmitter.CAUTION•••••Do not shake or swing the transmitter holding the leads or cablesconnected to the transmitter. The transmitter may come off andinjure someone or damage surrounding instruments.•••••Hold the connector of the electrode lead when connecting/disconnecting the electrode lead. If you disconnect the electrodelead by pulling the lead, it damages the electrode lead.Selecting the Electrode PositionFollow the physician’s instructions for electrode placement when available.For ECG monitoring, electrodes are attached only on the chest to allow patientmovement and obtain continuous stable ECG. Following leads are examples.When also monitoring respiration, refer to the “Electrode Position for RespirationMonitoring” section.NOTEThe optimum electrode positions for ECG measurement of a patientare not always optimum for respiration measurement of the patient.Select positions suitable for both ECG and respirationmeasurements, or positions which have priority for onemeasurement.
Operator's Manual ZM-920PA/930PA 23RA LAN (RL) LLVa VbSix ElectrodesElectrode PositionThe 6-electrode method with lead II and lead V5 is effective for monitoringmyocardial ischemia. You can improve monitoring accuracy considerably byadding lead V4 to this combination. Va and Vb can be at any position of thestandard 12 leads V1 to V6, but V4 and V5 are most appropriate for myocardialischemic monitoring.Symbol Lead Color (Clip Color) Electrode Position RA White (White) Right infraclavicular fossa LA Black (Black) Left infraclavicular fossa LL Red (Red) Lowest rib on the left anterior axillary line N (RL) Green (Green) Right anterior axillary line at the same level as LL Va Brown (Brown) (BR-906PA) Brown-blue (BR-916PA) Fifth intercostal space on the left midclavicular line. (V4 position of standard 12 leads) Vb Brown (Brown) (BR-906PA) Brown-orange (BR-916PA) Left anterior axillary line at the same level as Va. (V5 position of standard 12 leads)
24 Operator's Manual ZM-920PA/930PAONCALL keyRA LA LL Va VbUSAch9002608.025 MHzWhen the BR-906PA/916PA electrodeleads are not used, the transmitter is fixedto 3 lead ECG monitoring. To monitor 6lead ECG using 4 to 6 DIN type leads, thetransmitter must be fixed to 6 leadmonitoring. To fix transmitter to the 6 leadECG monitoring, turn off the transmitterpower, press and hold the CALL key andturn on the transmitter power.When the transmitter power is turned offand on again, the monitoring mode returnsto the original mode.Standard limb leadsMonopolar limb leadsMonopolar chest leadsLead I Lead II Lead IIIaVR lead aVL lead aVF leadV1 to V6 leadstoRARARA RA RARARALALALALALALALALLLLLLLL LLLLLLN (RL)N (RL)N (RL) N (RL) N (RL)N (RL)N (RL)Lead PositionWhen Using 4 to 6 DIN Type Leads to Monitor 6 Lead ECG
Operator's Manual ZM-920PA/930PA 25If the electrode position shown above is not available due to chest surgery, attachthe electrodes to the root of the limbs or below the clavicles for stable ECGmonitoring.Three ElectrodesBy using the optional BR-913PA/903PA electrode lead, 3 lead ECG monitoring isavailable.Electrode Position•Lead MII, which is similar to standard lead II, used when ECG measurementhas priority•Lead MI, which is similar to standardlead IChange LL and LA of the lead MII.•Lead MIII, which is similar tostandard lead IIIChange RA and LA of the lead MII.Electrode Position Symbol Lead Color Left infraclavicular fossa LA (N) Black Right infraclavicular fossa RA (−) White Below lowest rib on the left anterior axillary line LL (+) Red
26 Operator's Manual ZM-920PA/930PAConnecting the Electrode Lead and DisposableElectrodesPreparing the Patient SkinShave off excessive body hair.To reduce skin impedance, clean the electrode site with cream or with a cotton padmoistened with the electrode site with cream or with a cotton pad moistened withalcohol. Thoroughly dry the skin with a clean cotton pad.NOTE•••••For a patient with frequent body movement, rub the sites withSkinpure skin preparation gel. However, do not use Skinpure skinpreparation gel for sensitive skin.•••••Do not place electrodes on a wound or on an inflamed, wrinkled oruneven skin surface.Attaching Electrodes to the PatientCAUTIONDo not reuse disposable items.NOTE•••••To maintain good contact between the electrode and skin, checkthat the paste of the disposable electrode is not dry.•••••When contact between the disposable electrode and skin becomespoor, replace electrodes with new ones immediately. Otherwise,contact impedance between the skin and the electrode increasesand the correct ECG cannot be obtained.Refer to the electrode operator’s manual for details.1. Connect the electrode lead to the electrode.
Operator's Manual ZM-920PA/930PA 272. Carefully remove the backing paper fromthe electrode. Avoid touching the adhesivesurface.3. Place the electrode on the previouslycleaned skin. Pay attention to the electrodelead color and symbol.4. Fasten the electrode lead wire with surgicaltape with an extra length of wire betweenthe tape and the electrode. This lessens themovement of electrode leads by bodymovement and helps stable monitoring.Detection and Display of Measurement ConditionElectrode DetachmentThe “ ” LED lights on the transmitter or the “CHECK ELECTRODE” messageis displayed on the screen of the monitor in the following cases.•Electrode is detached from skin.•Electrode lead is disconnected from the electrode.•Polarization voltage between the electrode and skin is excessively high.In these cases, check the cause and if necessary, replace electrodes with new ones.CAUTIONWhen the “ELECTRODE OFF” or “CHECK ELECTRODE” message isdisplayed on the receiving monitor, ECG is not monitored properlyand the ECG alarm dose not function. Check the electrode andelectrode leads, and if necessary, replace with new ones.
28 Operator's Manual ZM-920PA/930PARespiration MonitoringRespiration is monitored by measuring changes in impedance between the RA andLL ECG electrodes. This transmitter sends the changes in impedance to themonitor as a respiration waveform. The monitor displays the respirationwaveform and calculates respiration rate. Refer to the operator’s manual of themonitor for details.WARNINGInteraction Between Minute Ventilation Rate-Adaptive Pacemakersand Cardiac Monitoring and Diagnostic Equipment*The bioelectric impedance measurement sensor of a minuteventilation rate-adaptive implantable pacemaker may be affected bythe transmitter which is connected to the same patient. If thisoccurs, the pacemaker may pace at its maximum rate and thetransmitter may give incorrect data to the monitor. If this occurs,disconnect the electrode leads from the patient or change thesetting on the pacemaker by referring to the pacemaker’s manual.For more details, contact your pacemaker distributor or NihonKohden representative.* Minute ventilation is sensed in rate-adaptive pacemakers by a technologyknown as bioelectric impedance measurement (BIM). Many medical devices inaddition to pacemakers use this technology. When one of these devices is usedon a patient with an active, minute ventilation rate-adaptive pacemaker, thepacemaker may erroneously interpret the mixture of BIM signals created in thepatient, resulting in an elevated pacing rate.For more information, see the FDA web site.http://www.fda.gov/cdrh/safety.html
Operator's Manual ZM-920PA/930PA 29Respiration Measurement Procedure1. Select the electrode lead and disposable electrodes.2. Connect the electrode lead to the ECG/RESP socket.3. Connect disposable electrodes to the electrode lead and attach electrodes tothe patient.After steps 1 to 3 are finished, respiration monitoring automatically starts.Electrode Position for Respiration MonitoringPlace the RA and LL electrodes so that the lungs are between the electrodes.NOTEThe optimum electrode positions for ECG measurement of a patientare not always optimum for respiration measurement of the patient.Select positions suitable for both ECG and respirationmeasurements, or positions which have priority for onemeasurement.Electrode Position ExamplesNOTEThe following examples are when monitoring with 3 electrodes. ECGcannot be monitored correctly when electrodes are attached as thefollowing examples when monitoring with 6 electrodes.Position 1In this position, respiration measurement is available; however, there is adifference in amplitude between different patients.RA LL Right infraclavicular fossa Fifth intercostal space on the left midclavicular line, V4
30 Operator's Manual ZM-920PA/930PAPosition 3In this position, the respiration waveform is optimum, but the ECG lead isunusual.Position 4In this position, the respiration measurement is influenced by the impedancevariation of the abdomen, so the cardiac pulse wave included in the respirationwave is reduced. Note that the waveform is inverted in phase compared with thechest movement (the waveform goes down during inspiration). It is difficult tomeasure the ECG at the same time.Position 2In this position, the waveform amplitude is usually large and the ECG lead issimilar to Lead MII. This position can be generally recommended.RA LL Right infraclavicular fossa Fifth intercostal space on the left midaxillary line, V6RA LL Right midaxillary at the horizontal level of V4 Fifth intercostal space on the left midaxillary line, V6 RA LL Lowest rib on the right anterior axillary line Lowest rib on the left anterior axillary line
Operator's Manual ZM-920PA/930PA 31SpO2 MonitoringThe SpO2 monitoring is only available on the ZM-930PA transmitter.This transmitter sends SpO2 and pulse waveform to the monitor and displaysSpO2 data and pulse level bar graph on the LCD.Refer to the operator’s manual of the monitor for details.WARNING•SpO2 measurement may be incorrect in the following cases.• When the patient’s carboxyhemoglobin or methemoglobinincreases abnormally.• When dye is injected in the blood.• When using an electrosurgical unit.• During CPR.• When measuring at a site with venous pulse.• When there is body movement.• When the pulse wave is small (insufficient peripheralcirculation).• Check the circulation condition by observing the skin color of themeasuring site and pulse waveform. Change the measuring siteevery 8 hours for disposable probes and every 4 hours forreusable probes. The skin temperature may increase at theattached site by 2 or 3°C (4 or 5°F) and cause a burn or pressurenecrosis. When using the probe on the following patients, takeextreme care and change the measurement site more frequentlyaccording to symptoms and degree.• A patient with a fever• A patient with peripheral circulation insufficiency• Neonate or low birth weight infant with delicate skin• When not monitoring SpO2, disconnect the SpO2 cable from thetransmitter. Otherwise, noise from the probe sensor may interfereand incorrect data is displayed on the screen.
32 Operator's Manual ZM-920PA/930PACAUTION• Turn off the power of mobile phones, small wireless devices andother devices which produce strong electromagnetic interferencearound a patient (except for devices allowed by the hospitaladministrator). Radio waves from devices such as mobile phonesor small wireless devices may be mistaken as respiration or pulsewaves and the displayed data may be incorrect.• Normal external light does not affect monitoring but strong lightsuch as a surgical light or sunlight may affect monitoring. Ifaffected, cover the measuring site with a blanket.• Do not pull or bend the probe cable, and do not put caster feet onthe probe cable. Do not immerse the probe cable in chemicalsolutions or water. Failure to follow these instructions may causecable discontinuity, short circuit, skin burn on the patient andincorrect measurement data. Replace any broken probe with anew one.• When the probe is attached on an appropriate site with sufficientcirculation and the error message confirming the probeattachment repeatedly appears, the probe may be deteriorated.Replace it with a new one.• While a patient is on medication which causes vasodilation, thepulse waveform may change and in rare cases the SpO2 valuemay not be displayed.NOTEWhen monitoring SpO2, monitor ECG at the same time. The ECGelectrode lead works as an antenna for transmitting data from thetransmitter to the receiving monitor. If ECG is not measured, thetelemetry signal may not be received.
Operator's Manual ZM-920PA/930PA 33Measurement Procedure1. Select the SpO2 probe.2. Connect the SpO2 probe to the SpO2 socket.3. Attach the SpO2 probe to the patient.After steps 1 to 3 are finished, SpO2 monitoring automatically starts.Selecting SpO2 ProbeSelect an appropriate probe for the patient.CAUTION•••••Only use Nihon Kohden specified electrodes, electrode lead, SpO2probe. Otherwise, the maximum performance from the instrumentcannot be guaranteed.•••••Do not use damaged or disassembled probe. It causes incorrectmeasurement and may injure tha patient.
34 Operator's Manual ZM-920PA/930PAModel Subject (Weight) Attachment SiteFinger Probe TL-201T Adults, children (Weight more than 20 kg) Finger Adult or Infant 3 kg or more Finger or toe Multi-site probe TL-220T Neonate 3 kg or less Instep and sole Reusable ProbesAttachment tape
Operator's Manual ZM-920PA/930PA 35Model Subject (Weight) Attachment Site TL-251T Adults (Weight more than 30 kg) Finger or toe TL-252T Children (Weight from 3 to 40 kg) Finger or toe TL-253T Neonates (Weight less than 3 kg) Instep and sole Adults, children (Weight more than 3 kg) Finger or toe TL-260T Neonates (Weight less than 3 kg) Instep and sole Disposable ProbesCAUTIONThe disposable probe is not sterilized. Use the disposable probeonly for a single patient. Never reuse the disposable probe foranother patient because it causes cross infection.
36 Operator's Manual ZM-920PA/930PAModel Subject (Weight) Attachment SiteAdults (Weight more than 50 kg) Finger TL-051S/052S Cable length TL-051S: 80 cm TL-052S: 160 cm Neonates (Weight less than 3 kg) Instep and sole Adults, children (Weight from 15 to 50 kg) Finger TL-061S/062S Cable length TL-061S: 80 cm TL-062S: 160 cm Children, infants (Weight from 3 to 15 kg) Toe
Operator's Manual ZM-920PA/930PA 37Model Subject (Weight) Attachment SiteTL-271T/271T3 Cable length TL-271T: 0.8 m TL-271T3: 1.6 m Adult 30 kg or more TL-272T/272T3 Cable length TL-272T: 0.8 m TL-272T3: 1.6 m Child 10 to 50 kg Finger or toe Neonate 3 kg or less Instep TL-273T/273T3 Cable length TL-273T: 0.8 m TL-273T3: 1.6 m Adult 40 kg or more TL-274T/274T3 Cable length TL-274T: 0.8 m TL-274T3: 1.6 m Infant 3 to 20 kg Finger or toe
38 Operator's Manual ZM-920PA/930PAConnecting SpO2 Probe to the TransmitterConnect the probe to the SpO2 socket on the transmitter.CAUTION•••••Do not shake or swing thetransmitter while holding the cablesconnected to the transmitter. Thetransmitter may come off and injuresomeone or damage surroundinginstruments.•••••Hold the connector whenconnecting/disconnecting theprobe. If you disconnect the SpO2probe pulling the cable, it damagesthe cable.Attaching the Probe to the PatientFor details, refer to the operator’s manual of each probe.WARNING• When using the TL-201T finger probe, do not fasten the probe andcable 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 avoidpoor circulation, do not wrap the tape too tight. Check the bloodcirculation condition by observing the skin color and congestion atthe skin peripheral to the probe attachment site. Even for short-term monitoring, there may be burn or pressure necrosis frompoor blood circulation, especially on neonates or low birth weightinfants whose skin is delicate. Accurate measurement cannot beperformed on a site with poor peripheral circulation.
Operator's Manual ZM-920PA/930PA 39• Check the circulation condition by observing the skin color of themeasuring site and pulse waveform. Change the measuring siteevery 8 hours for disposable probes and every 4 hours forreusable probes. The skin temperature may increase at theattached site by 2 or 3°C (4 or 5°F) and cause a burn or pressurenecrosis. When using the probe on the following patients, takeextreme care and change the measurement site more frequentlyaccording to symptoms and degree.• A patient with a fever• A patient with peripheral circulation insufficiency• Neonate or low birth weight infant with delicate skinCAUTION• NIBP and SpO2 can be measured on the same limb, but the SpO2monitoring may not be accurate during NIBP measurement. Becareful when reading the SpO2 values.• If the attachment site is dirty with blood or bodily fluids, clean theattachment site before attaching the probe. If there is nail polishon the attachment site, remove the polish. Otherwise, the amountof transmitted light decreases, and measured value may beincorrect or measurement cannot be performed.• If the skin gets irritated or redness appears on the skin from theprobe, change the attachment site or stop using the probe. Takeextreme care for the patients with delicate skin.• When the probe is attached on an appropriate site with sufficientcirculation and the error message confirming the probeattachment repeatedly appears, the probe may be deteriorated.Replace it with a new one.• Do not use a probe that is deteriorated by aging. Accuratemeasurement cannot be performed.• Neonatal skin is delicate. Remove the probe and tape carefullyand slowly.• When removing a probe that is taped to the skin, do not pull theprobe cable because this can damage the cable.• When removing the probe from the attachment tape, do not pull the
40 Operator's Manual ZM-920PA/930PAsensor cable because this can damage the cable.• Do not immerse the disposable probe in detergents or water. If theprobe adhesive surface gets wet, adhesiveness becomes weakand the probe cannot be attached to the skin.• Before using the TL-260T multi-site Y probe, be sure to attach theprobe to the sponge attachment tape S or L. Do not use the probewithout the sponge attachment tape attached. Using the probewithout the sponge attachment tape causes incorrectmeasurement and may injure the skin at the attachment site.• When fixing the TL-260T multi-site Y probe with the spongeattachment tape, confirm that the adhesive part of the tape is noton the skin. The adhesive may cause oversensitive symptoms onthe skin such as redness or itch. If the adhesive touches the skin,remove it carefully and slowly because neonatal skin is verydelicate.• Do not use a dirty sponge attachment tape. The measurementvalue may be incorrect.• Use the sponge attachment tape S and L only with the specifiedproducts.• Refer to the probe instruction manual for details.Starting MeasurementWhen monitoring starts, SpO2 and pulse waveform are sent to the monitors andSpO2 data and pulse level bar graph are displayed on the transmitter LCD.You can turn off the display of SpO2 data and pulse level bar graph on the LCD.Refer to the “Turning SpO2 Data and Pulse Level Bar Graph Display On/Off”section.CAUTIONWhen the probe is attached on an appropriate site with sufficientcirculation and the error message confirming the probe attachmentrepeatedly appears, the probe may be deteriorated. Replace it witha new one.
Operator's Manual ZM-920PA/930PA 41Detecting and Displaying Measurement ConditionExternal Light Noise AlarmCAUTIONWhen measuring under strong light (surgical light, bilirubin light,sunlight, etc.), cover the probe with a blanket or cloth. Otherwise,noise may interfere.Strong external light (surgical light or inverter type fluorescent lamp, etc.), mayaffect SpO2 monitoring. When external light is too strong to correctly measureSpO2, the transmitter generates an alarm tone (“pip” sound every 0.5 seconds).Cover the probe attachment site with blanket or cloth.Press the CALL key for more than 3seconds within 10 seconds after turningtransmitter power on (after a “peep” sound).“%SpO2” is not displayed. When SpO2monitoring starts, SpO2 data and pulse levelbar graph are not displayed on the LCD.To turn SpO2 display on, turn the transmitterpower off and turn the power on again.RA LA LL Va VbUSAch9002608.025 MHzCALLkeySpO2 display offTurning SpO2 Data and Pulse Level Bar GraphDisplay On/OffYou can turn off the display of SpO2 data and pulse level bar graph on the LCD.
42 Operator's Manual ZM-920PA/930PAInsufficient Light AlarmWhen sufficient light cannot be obtained from the photo emitter of the probe, thetransmitter generates the following sound and indication.(1) “peep” sound (every 1 second)(2) pulse level bar graph is maximum(all bars are lit.)(3) SpO2 data is displayed as “ ”(4) %SpO2 is blinking.In this case, change the attachment site to the appropriate site. Refer to theoperator’s manual of the SpO2 probe.Probe Malfunction AlarmCAUTIONWhen any of the following occurs, the probe may be broken.Replace it with a new one and check the probe.•••••The transmitter generates “pip” sound every 0.25 seconds.•••••SpO2 data is 85% and blinking.When Measurement Condition is UnstableSpO2 data blinks every 1 second when SpO2 signal stability decreases and thetransmitter cannot detect correct pulse waveform because of patient bodymovement, poor attachment condition or poor circulation condition at the probeattachment site.CAUTIONSpO2 data blinking every second indicates an unstable pulsewaveform and displayed SpO2 value may be inaccurate. Thedisplayed data may not reflect sudden SpO2 changes.(3)(4)(2)
Operator's Manual ZM-920PA/930PA 43Sound Display Cause Countermeasure Single “peep” sound for 4 s --- The CALL key is pressed. The sound lasts while the key is pressed. --- (1) The battery voltage decreases and battery charge is almost zero.Replace the batteries with new ones. Continuous “peep” sound All lights are off Battery is completely discharged. Replace the batteries with new ones. To stop the sound, turn off the power. Electrode lead is disconnected from the electrode. Firmly connect the electrode lead to the electrode. Electrode lead is disconnected from the transmitter. Firmly connect the electrode lead to the transmitter. Electrode lead discontinuity Replace the electrode lead with a new one. Electrode is not firmly attached to the skin. --- (2) Polarization voltage is abnormally high. Replace the electrode with a new one. Intermittent “pip” sound every 0.5 s --- SpO2 measurement site is under fluorescent light, surgical light, sunlight, etc. Cover the measurement site with a blanket or cloth. (1)Displayed as LED on ZM-920PARA LA LL Va VbAlarm List(2)(5) %SpO2 indication(4) pulse level bar graph(3) SpO2 data
44 Operator's Manual ZM-920PA/930PASound Display Cause Countermeasure Intermittent “peep” sound every 1 s (3) (4) all lit (5) blinking Cannot receive sufficient light from the probe photo emitter. Attach probe to a site with 6 to 14 mm thickness where sufficient light can be received. Intermittent “pip” sound every 0.25 s (3) 85%, blinking Broken probe Replace the probe with a new one. Patient body movement Remove the cause by checking the patient condition and changing the attachment site. --- (3) blinking Probe is not attached securely. Securely attach the probe.
Operator's Manual ZM-920PA/930PA 45TroubleshootingIf the problem still remains after checking the following, contact your NihonKohden distributor.Problem Cause Countermeasure Batteries are not installed correctly. The battery polarity is wrong. Install the batteries correctly. The power cannot be turned on. Batteries are completely discharged. Replace the batteries with new ones. Nothing is displayed on the LCD after turning the power on. (ZM-930PA only) SpO2 display is turned off. Turn off the power, and turn on the power again. Nothing is displayed on the monitor after turning the transmitter power on. The channel of the transmitter and monitor does not match. Set the correct channel on the monitor. Electrode lead is not connected to the transmitter. Connect the electrode lead to the transmitter. ECG electrode lead works as an antenna for transmitting data to the receiving monitor. If ECG is not measured, the signal may not be received. Another transmitter of the same channel is used near by. Turn the transmitter power off. If the monitor still receives a signal, there is a high probability that another transmitter of the same channel is used nearby. Follow the instruction of your channel administrator and use another transmitter of a different channel. Signals are mixing. Follow the instruction of your channel administrator and use another transmitter of a different channel. Signal receiving condition is poor. The transmitter is damaged. Contact your Nihon Kohden distributor.
46 Operator's Manual ZM-920PA/930PAProblem Cause Countermeasure 3 electrode leads are properly attached to the patient but LEDs light. The transmitter is fixed to 6 lead monitoring. Turn off and on the transmitter power. Heart rate of the patient who is using an electric blanket cannot be monitored on the receiving monitor. Pacing pulse detection is set to ON on the monitor. Turn off the pacing pulse detection. The gel on the electrode is dried out. The gel on the electrode is coming off. Replace the electrode with a new one. Electric blanket is used. Cover the blanket with a shield cover. ECG baseline is thick. (Hum is overlapping) Hum filter is set to OFF on the monitor Set the filter to ON. The gel on the electrode is dried out. Respiration waveform measurement is unstable. The gel on the electrode is coming off. Replace the electrode with a new one. The probe size is not appropriate for the patient.Use the appropriate probe for the patient. Probe is attached to the same limb that is used for NIBP measurement. Attach the probe to the opposite limb. Avoid a site where blood circulation condition changes greatly. Probe attachment condition is poor. Probe is about to detach from the skin. External light gets in.Firmly attach the probe according to the procedure in the probe operator’s manual. SpO2 data is unstable and not reliable. Measurement site is dirty. Patient is wearing nail polish. Remove dirt and nail polish.
Operator's Manual ZM-920PA/930PA 47The transmitter channel can be changed by the QI-901PK Channel Writer. Tochange the channel number, refer to the channel writer manual.WARNINGThe following actions must be taken to properly receive thetransmitter signal of the correct patient on the receiving instrument.Otherwise, there may be signal loss or signals may mix causing aserious accident, such as monitoring a different patient.•••••Assign a channel administrator in the hospital and only he or sheshould manage channel assignments.•••••The channel administrator must manage the channels in thefacility so that there is no signal interference.•••••When the transmitter channel is changed, the channeladministrator must check that the channel on the receivingmonitor is also changed and the signal is properly received.•••••The channel administrator must replace the channel number labelon the transmitter with the new one after changing the channel.Changing the Transmitter Channel
48 Operator's Manual ZM-920PA/930PALifetime and DisposalDisposing of Used BatteriesReplacementWhen the “ ” LED is lit or the “ ” is displayed on the LCD during operation,the batteries are running out.Replace the batteries with new ones. When using rechargeable batteries, rechargethem.DisposalBefore disposing of the batteries, check with your local solid waste officials fordetails in your area for proper disposal. It may be illegal to dispose of thesebatteries in the municipal waste stream.Disposing of Electrodes and SpO2 ProbesRefer to the manual of each item.
Operator's Manual ZM-920PA/930PA 49Transmitter and Electrode LeadWARNINGIf detergents or dirty liquid spills into the transmitter, clean it and dryit completely before use. If the wet transmitter is used, the patient oranyone in contact with the transmitter may receive an electricshock.CAUTION•••••Before cleaning or disinfecting the transmitter, remove thebatteries from the transmitter.•••••The transmitter cannot be sterilized.CleaningWipe the transmitter and electrode leads with a soft cloth moistened withdisinfecting alcohol or neutral detergent diluted with water. After cleaning, drythem completely.DisinfectionCAUTION•••••Do not immerse the electrode lead connector in liquid.•••••Do not disinfect with hypochlorous acid.•••••Use the recommended concentration.Wipe the outside surface of the transmitter and electrode lead with a non-abrasivecloth moistened with any of the disinfectants listed on the next page. Use therecommended concentration.Cleaning, Disinfection and Sterilization
50 Operator's Manual ZM-920PA/930PADisinfectant Concentration (%)Glutaraldehyde solution 2.0Alkyldiaminoethylglycine hydrochloride 0.5Benzalkonium chloride 0.2Benzethonium chloride solution 0.2Chlorohexidine gluconate solution 0.5SpO2 ProbeRefer to the probe manual.
Operator's Manual ZM-920PA/930PA 51Replacing the Battery Case CoverWhen the battery case cover is damaged, replace it with a new one.Battery case cover, code no. 6113-046365C.Other than the battery case cover, there are no serviceable parts for the transmitter.Repair Parts Availability PolicyNihon Kohden Corporation (NKC) shall stock repair parts (parts necessary tomaintain the performance of the instrument) for a period of 6 years after NKCannounces discontinuation of the instrument. In that period, NKC or itsdistributors will repair the instrument. This period may be shorter than 6 years ifthe necessary board or part is not available. For discontinuation announcements,contact your Nihon Kohden distributor or representative.
52 Operator's Manual ZM-920PA/930PASpecificationsECG measurementChannels: 4Input range: ±5 mV or moreDC offset: ±500 mV or moreInput impedance: 5 MΩ or more (5 Hz)Pacing pulse detection: ANSI/AAMI EC13Based upon Pacemaker pulse rejectionCapabilityRespiration measurementMeasuring method: Impedance methodImpedance range: 0 to 2 kΩSpO2 measurementMeasuring range: 0 to 100%, in 1% stepsMeasuring accuracyWhen the measuring accuracy of theSpO2 probe is not considered: ±1 digit (80% ≤ SpO2 ≤ 100%)±2 digit (50% ≤ SpO2 ≤ 80%)Less than 50% is not specified.When the measuring accuracy of theSpO2 probe is considered: ±2 digit (80% ≤ SpO2 ≤ 100%)±3 digit (70% ≤ SpO2 ≤ 80%)Less than 70% is not specified.TransmitterFCC regulation: FCC part 95 Subpart-HWireless Medical Telemetry Service(WMTS)Field strength limits: <200 mV/m (at 3 m)Undesired emission: below 960 MHz: 200 μV/m (at 3 m)above 960 MHz: 500 μV/m (at 3 m)
Operator's Manual ZM-920PA/930PA 53Antenna: ECG electrode leadTransmission channel: indicated on the transmitterTransmission frequency range: 608.0250 to 613.9750 MHzChannel spacing: 50 kHz or 37.5 kHz (12.5 kHz wheninterleaved)Modulation scheme: FSK (Frequency Shift Keying)Occupied bandwidth: <20 kHzEffective radiated power: 1.0 mW (conducted)Safety standardsSafety standard: CSA C22.2 No. 601-1 M90: 1994IEC 60601-1: 1988IEC 60601-1 Amendment 1: 1991IEC 60601-1 Amendment 2: 1995IEC 60601-1-2: 1993IEC 60601-2-27: 1994According to the type of protectionagainst electrical shock: INTERNALLY POWEREDEQUIPMENTAccording to the degree of protectionagainst electrical shock:ECG/impedance method respiration: DEFIBRILLATION-PROOFTYPE CF APPLIED PARTSpO2: DEFIBRILLATION-PROOFTYPE BF APPLIED PARTAccording to the degree of protectionagainst harmful ingress of water: IPX0 (Ordinary equipment)According to the degree of safety ofapplication in the presence of aFLAMMABLE ANAESTHETICMIXTURE WITH AIR, OR WITHOXYGEN OR NITROUS OXIDE: Equipment not suitable for use in thepresence of FLAMMABLEANAESTHETIC MIXTURE WITH AIR,OR WITH OXYGEN OR NITROUSOXIDEAccording to the mode of operation: CONTINUOUS OPERATION
54 Operator's Manual ZM-920PA/930PAWater resistanceWater does not get inside the transmitter except for the battery case whenimmersed in water up to 30 cm deep for 3 minutes.Power requirementsBattery type: two AA type alkaline dry cell batteries,manganese dry cell batteries, NiCdrechargeable batteries, NiMH batteriesBattery lifetime:ZM-930PA: approximately 3 days(with alkaline batteries, measuring ECG,respiration and SpO2 of approximately 60kg weight adult male patient at the pointingfinger)approximately 4 days(with alkaline batteries, measuring ECGand respiration only)ZM-920PA: approximately 4 daysEnvironmentOperating environmentOperating temperature: 5 to 40°C, 41 to 104°FOperating humidity: 30 to 85% (non-condensing)Operating atmospheric pressure: 70 to 106 kPaOperating voltage: 1.6 to 3.2 VStorage environmentStorage temperature: −20 to 65°C, −4 to 149°FStorage humidity: 15 to 95% (non-condensing)Storage atmospheric pressure: 70 to 106 kPaDimension and WeightDimension: 78 W × 122 H × 26 D (mm)Weight (without batteries): ZM-930PA: about 180 gZM-920PA: about 165 g
Operator's Manual ZM-920PA/930PA 55Standard AccessoriesName Q’ty Supply code Strap 1 Y233
56 Operator's Manual ZM-920PA/930PAOptionsCAUTIONUse only Nihon Kohden electrodes, electrode leads and SpO2probes to assure maximum performance from your instrument.ECG/RESPName Application Model Q’ty Supply code 3 electrodes, clip type, lead length 80 cm BR-903PA 1 K911A 3 electrodes, snap type, lead length 80 cm BR-913PA 1 K910B 6 electrodes, clip type, lead length 80 cm BR-906PA 1 K912A Electrode lead 6 electrodes, snap type, lead length 80 cm BR-916PA 1 K915A
Operator's Manual ZM-920PA/930PA 57SpO2Name Cable length Model/ Code No. Q’ty Supply Code No. 0.6 m P225H Finger probe (reusable) 1.6 m TL-201T P225F Multi-site probe (reusable) TL-220T 1 P225G SpO2 probe (for adult, disposable) TL-251T P201A SpO2 probe (for child, disposable) TL-252T P201B SpO2 probe (for neonate, disposable) TL-253T P201C Multi-site Y probe (for low birth weight infant/child/ neonate, disposable) 1.6 m TL-260T 5 P205A 0.8 m TL-271T P203A SpO2 probe (for adult, disposable) 1.6 m TL-271T3 P203E 0.8 m TL-272T P203B SpO2 probe (for child, disposable) 1.6 m TL-272T3 P203F 0.8 m TL-273T P203C SpO2 probe (for neonate/adult, disposable) 1.6 m TL-273T3 P203G 0.8 m TL-274T P203D SpO2 probe (for child/infant, disposable) 1.6 m TL-274T324 P203H 0.8 m TL-051S P228A SpO2 probe (for adult/neonate, disposable) 1.6 m TL-052S P228B 0.8 m TL-061S P229A SpO2 probe (for child/infant, disposable) 1.6 m TL-062S 5 P229B COTTONY tape 340703 20 P259 Foam tape for TL-051S/052S/ 061S/062S 4 × 25 packages P260 Attachment tape for TL-220T/ 251T/252T/253T 3 × 30 packages P263 Attachment tape S for TL-260T P260A Attachment tape L for TL-260T 24 P260B

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