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

Nihon Kohden Corporation WMTS Transmitter Cover2 ZM920PA 930PA OM pmd

Contents

Users Manual

TRANSMITTERZM-920PA/930PA0614-007205
Model: ZM-920PA/930PAManual code no.: 0614-007205Reader Comment CardWe welcome your comments about this manual. Your comments and suggestionshelp us improve our manuals. Please circle the number for each of the followingstatements corresponding to your evaluation and add comments in the spaceprovided.Fax or send your completed comment card to:Fax: +81 (3) 5996-8100International Div., Sales Promotion Section, Nihon Kohden Corp., 1-31-4, NishiochiaiShinjuku-ku, Tokyo 161-8560, JapanStrongly Agree 1 Disagree 4Agree 2 Strongly Disagree 5Nuetral 3This manual is organized. 1 2 3 4 5I can find the information I want. 1 2 3 4 5The information is accurate. 1 2 3 4 5I can understand the instructions. 1 2 3 4 5The illustrations are appropriate and helpful. 1 2 3 4 5The manual length is appropriate. 1 2 3 4 5Comments:Thank you for your cooperation. We appreciate it very much.Name:Occupation/Position:Hospital/Company:Address:Phone:cutting line
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 ................................. 36Attaching the Probe to the Patient .............................................. 37Starting Measurement ................................................................ 38Turning SpO2 Data and Pulse Level Bar Graph Display On/Off . 39Detecting and Displaying Measurement Condition ................... 39External Light Noise Alarm ................................................... 39Insufficient Light Alarm .......................................................... 40Probe Malfunction Alarm....................................................... 40When Measurement Condition is Unstable .......................... 40Alarm List .......................................................................................... 41Troubleshooting ................................................................................ 43
Operator's Manual ZM-920PA/930PA iiiChanging the Transmitter Channel .................................................. 45Lifetime and Disposal ....................................................................... 46Disposing of Used Batteries ....................................................... 46Replacement ......................................................................... 46Disposal ................................................................................ 46Disposing of Disposable Electrodes .......................................... 46Lifetime .................................................................................. 46Disposal ................................................................................ 46Disposing of the SpO2 Probe ...................................................... 47Lifetime .................................................................................. 47Disposal ................................................................................ 47Cleaning, Disinfection and Sterilization ........................................... 48Transmitter and Electrode Lead ................................................. 48Cleaning ................................................................................ 48Disinfection............................................................................ 48SpO2 Probe ................................................................................. 49Replacing the Battery Case Cover ................................................... 50Repair Parts Availability Policy......................................................... 50Specifications ................................................................................... 51ECG measurement ................................................................ 51Respiration measurement .................................................... 51SpO2 measurement ............................................................... 51Transmitter ............................................................................. 51Safety standards ................................................................... 52Water resistance ................................................................... 53Power requirements .............................................................. 53Environment .......................................................................... 53Dimension and Weight .......................................................... 53Standard Accessories ...................................................................... 54Options ............................................................................................. 55ECG/RESP ............................................................................ 55SpO2...................................................................................... 56
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 Kohdendistributor.
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 beenremoved.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 Corporation subsidiary ordistributor for additional suggestions.
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 FunctionsZM-920PA • ECG• Impedance respirationThe following information isindicated by LED.• Check ECG electrodes• Replace batteriesZM-930PA• ECG• Impedance respiration• SpO2The following information isindicated on LCD.• SpO2 value• Pulse wave amplitude• Replace batteriesThe following information isindicated by LED.• Check ECG electrodesThe 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, otherwise, twopatients’ data will be lost due to mutual modulation interference, orthe wrong patient’s data may appear on the receiving monitorscreen.•••••Do not use transmitters of adjacent channels in a hospital,otherwise, radio waves from one transmitter affect the receiver ofthe adjacent channel’s in the transmitter and there may beinterference.NOTE•••••Use Nihon Kohden parts and accessories to assure maximumperformance from your instrument.•••••It is recommended to use a diversity antenna system on thereceiving monitor for stable signal reception, otherwise, spikenoise from transient fading of electric field strength (for example,people moving) may interfere with the transmitter signal and maybe mistaken as an arrhythmia on the receiving monitor.
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 performing defibrillation, check that the electrode leadsand SpO2 probe attached to the patient are properly connected tothe transmitter. Touching the metal parts of disconnected leadsand probes may cause serious electrical shock or injury bydischarged energy.•••••When performing defibrillation, all persons must keep clear of thebed and must not touch the patient, any equipment connected tothe patient or the metal parts of leads and probes connected to thepatient. Failure to follow this warning may result in seriouselectrical burn, shock or other 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 is used with the battery case cover open, thepatient may get an electrical shock when defibrillation is performed,and electrostatic discharge by the patient may intermittentlyinterfere with the waveform 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 this transmitter in the presence of any flammableanesthetic gas or high concentration oxygen atmosphere. Failureto follow this warning may cause explosion or fire.•••••Never use this transmitter in a high-pressure oxygen medical caretank. Failure to follow this warning may cause explosion or fire.•••••Never take this transmitter into an MRI test room.•••••Before performing defibrillation, check that the electrode leadsand SpO2 probe attached to the patient are properly connected tothe transmitter. Touching the metal parts of disconnected leadsand probes may cause serious electrical shock or injury bydischarged energy.•••••When performing defibrillation, all persons must keep clear of thebed and must not touch the patient, the equipment connected tothe patient, nor the metal parts of leads and probes connected tothe patient. Failure to follow this warning may result in seriouselectrical burn, shock or other injury.•••••When performing defibrillation, discharge as far as possible fromelectrodes on the patient. If there is a possibility that thedefibrillator paddle could touch electrodes, remove electrodesfrom the patient. If the defibrillator directly contacts theelectrodes, the discharged energy may cause serious electricalburn to the patient.•••••When using this transmitter with an electrosurgery unit, its returnplate and the electrodes for monitoring must be firmly attached tothe patient. If the return plate is not attached correctly, it may burnthe patient’s skin where the electrodes are attached. Refer to theinstruction manual for the ESU.•••••Close the battery case cover during operation. If the transmitter isused with the battery case cover open, the patient may get anelectrical shock when defibrillation is performed, and electrostatic
Operator's Manual ZM-920PA/930PA 7CAUTION•••••Use Nihon Kohden specified electrode leads and SpO2 probes toassure maximum performance from your instrument.•••••Do not reuse disposable products.•••••Do not shake or swing the transmitter holding the leads/cablesconnected to the transmitter. The transmitter may come off andcause injury to a person or damage surrounding instruments.•••••Attach a strap to the transmitter to prevent the transmitter fromfalling.•••••Turn off the power of cellular telephones, small wireless devicesand other devices which produce strong electromagneticinterference around a patient. Radio waves from devices such ascellular telephones or small wireless devices may be mistaken aspulse waves and incorrect data may be displayed.•••••Do not use the same channel for different patients. This couldproduce a mutual modulation interference resulting in loss of datafrom both patients or the incorrect patient’s data can appear on thereceiving monitor screen.•••••Do not use transmitters of adjacent channels in a hospital,otherwise, radio waves from one transmitter may affect thereceiver of the adjacent channel’s transmitter and can causeinterference.discharge by the patient may intermittently interfere with thewaveform or data.
8 Operator's Manual ZM-920PA/930PACAUTIONBattery replacement must be performed by medical staff. Whenreplacing batteries in the transmitter currently used for a patient,disconnect electrode leads from the transmitter before replacingbatteries. Do not touch the patient during replacement.WARNING•••••Do not dispose of the battery in fire, or it may explode.•••••Do not disassemble the battery. The contents of the battery areharmful and flammable.•••••Never short-circuit the + + + + + and −−−−− terminals. This can produceoverheating and with its flammable capabilities can produce a fire.•••••Make sure that the patient does not touch the 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.•••••The channel administrator must replace the channel number labelon the transmitter with the new one after changing the channel.
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 distributor.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 and spike noise may interferewith the output signal and be mistaken as a trigger.
10 Operator's Manual ZM-920PA/930PAECG MonitoringCAUTION•••••Use Nihon Kohden specified consumables. With electrodes otherthan specified ones, the CHECK ELECTRODE message appearsand monitoring may stop.•••••When the “ELECTRODE OFF” or “CHECK ELECTRODE” messageis displayed on the receiving monitor, check electrodes andelectrode leads. While “ELECTRODE OFF” or “CHECKELECTRODE” message is being displayed, there is no ECGmonitoring or alarms.SpO2 MonitoringWARNING•••••Measurement may be incorrect in the following cases.· When the oxyhemoglobin or methemoglobin (HbCO, Met Hb)increases abnormally.· When dye is injected in the blood.· When using an electrosurgical unit.· During CPR.· When measuring at a site where there are venous pulses.· When there is body movement.· When the pulse wave is small.•••••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
Operator's Manual ZM-920PA/930PA 11CAUTION•••••Do not pull or bend the probe cable or put caster feet on the probecable. Do not immerse the probe cable in detergents or water.Failure to follow these cautions may cause cable discontinuity,short circuit, skin burn on the patient or incorrect measurementdata. Replace any broken probe with a new one.•••••When the attachment site is wet with blood or when the patient hasnail polish on, remove the dirt and nail polish before attaching theprobe. The transmitted light may decrease due to the blood or nailpolish and the measurement data may be incorrect.•••••If the skin gets irritated or redness appears on the skin by theprobe, change the attachment site.•••••When the probe is attached to an appropriate site with sufficientcirculation and an error message confirming the probe attachmentrepeatedly appears, the probe may be deteriorated. Replace itwith a new one.•••••Do not use the probe over its stated lifetime. Otherwise the SpO2measurement accuracy cannot be guaranteed.•••••Use the disposable probe only for one patient. Never reuse thedisposable probe for another patient because it causes crossinfection.•••••Do not use damaged or disassembled probe. Measured data maybe incorrect.•••••To avoid poor circulation, do not wrap the tape too tight. Check theblood circulation condition by observing the skin color andcongestion at the skin peripheral to the probe attachment site.Even for short-term monitoring, there may be burn or pressurenecrosis from poor blood circulation, especially on neonates orlow birth weight infants whose skin is delicate. Accuratemeasurement cannot be performed on a site with poor peripheralcirculation.•••••When not monitoring SpO2, disconnect the SpO2 probe cord fromthe transmitter. Otherwise, noise may interfere from the probesensor and cause incorrect data to be displayed on the transmitterand receiving monitor.
12 Operator's Manual ZM-920PA/930PA•••••When measuring under strong light (surgical light, bilirubin light,sunlight, etc.), cover the probe with a blanket or cloth. Otherwise,noise may interfere.•••••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.Disposable SpO2 ProbesCAUTION•••••Replace the probe with a new one as specified in the probemanual. If the probe is deteriorated, correct SpO2 monitoringcannot be performed.•••••When using a disposable probe, be careful when removing theadhesive tape from neonatal skin.•••••When removing a disposable probe taped to the skin, do not pullfrom the cable of the probe because this can damage the probe’scable connection.TL-260T Multi-site Y ProbeCAUTION•••••Before use, be sure to attach the probe to the sponge attachmenttape S or L. Do not use the probe without the sponge attachmenttape attached. It causes incorrect measurement and may damagethe attachment site on the skin.•••••When fixing the probe with the sponge attachment tape, confirmthat the adhesive part of the tape is not on the skin. The adhesivemay cause oversensitive symptoms on the skin such as rednessor itch. If the adhesive touches the skin, remove it carefully andslowly because neonatal skin is very delicate.•••••Do not use a dirty sponge attachment tape. The measurementvalue may be incorrect.
Operator's Manual ZM-920PA/930PA 13CAUTIONDo not disassemble the transmitter when performing maintenanceand inspection. If there is a problem with the transmitter aftermaintenance and inspection, contact your Nihon Kohden distributor.Reusable ProbesCAUTION•••••Do not soak the probe in cleaning solution. It is not waterproof.•••••Do not use creosol soap, glutaraldehyde, sodium hypochlorite, orbenzalkonium chloride, as these substances may damage theprobe.Disposable ProbesCAUTION•••••Do not soak the probe in cleaning solution. It is not waterproof.•••••Do not use any disinfecting alcohol. It can damage the probe.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 pull from the cable when removing the probe from thesponge attachment tape because this can damaged the cable.
14 Operator's Manual ZM-920PA/930PAType LifetimeManganese About 1/2 of alkaline batteriesNiCd About 1/3 of alkaline batteries (when fully charged)NiMH About 1/2 of alkaline batteries (when fully charged)PreparationInstalling (Replacing) BatteriesUse two AA type alkaline dry cell batteries, manganese dry cell batteries, NiCdrechargeable 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 medical staff. Whenreplacing batteries in the transmitter currently used for a patient,disconnect electrode leads from the transmitter before replacing thebatteries. 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•••••Do not dispose of the battery in fire, or it may explode.•••••Do not disassemble the battery. The contents of the battery areharmful and flammable.•••••If the contents of the battery contacts the skin or clothes, washimmediately and thoroughly with running water.•••••Never short-circuit the + + + + + and −−−−− terminals. This can produceoverheating and with its flammable capabilities can produce a fire.•••••Make sure that the patient does not touch the 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 distributor.* 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 using the transmitter with an ESU, the ESU return plate andthe electrodes for monitoring must be firmly attached to the patient.If the return plate is not attached correctly, it may burn the patient’sskin where the electrodes are attached. Refer to the instructionmanual for the ESU.NOTE•••••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 ElectrodeCAUTIONUse Nihon Kohden specified consumables. With electrodes otherthan specified ones, the CHECK ELECTRODE message appears andmonitoring may stop.OptionElectrode leadBR-916PA6 electrodes, snap typeBR-906PA6 electrodes, clip typeBR-913PA3 electrodes, snap typeBR-903PA3 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/cablesconnected to the transmitter. The transmitter may come off andcause injury to a person or damage surrounding instruments.•••••Hold the connector of the electrode lead when connecting/disconnecting the electrode lead. If you disconnect the electrodelead holding 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 PositionRA White (White) Right infraclavicular fossaLA Black (Black) Left infraclavicular fossaLL Red (Red) Lowest rib on the left anterioraxillary lineN (RL) Green (Green) Right anterior axillary line at thesame level as LLVa Brown (Brown) (BR-906PA)Brown-blue (BR-916PA)Fifth intercostal space on the leftmidclavicular line. (V4 position ofstandard 12 leads)Vb Brown (Brown) (BR-906PA)Brown-orange (BR-916PA)Left anterior axillary line at thesame level as Va. (V5 position ofstandard 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 ColorLeft infraclavicular fossa LA (N) BlackRight infraclavicular fossa RA (−)WhiteBelow lowest rib on theleft 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 products.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, check electrodes and electrodeleads and remove the cause. While “ELECTRODE OFF” or “CHECKELECTRODE” message is being displayed, there is no ECGmonitoring and no alarms.
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 distributor.* 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 LLRight infraclavicularfossaFifth intercostal space on theleft midclavicular line, V4
30 Operator's Manual ZM-920PA/930PARA LLRight infraclavicularfossaFifth intercostal space onthe left midaxillary line, V6Position 3In this position, the respiration waveform is optimum, but the ECG lead isunusual.RA LLRight midaxillary at thehorizontal level of V4Fifth intercostal space on theleft midaxillary line, V6Position 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.RA LLLowest rib on the rightanterior axillary lineLowest rib on the leftanterior axillary linePosition 2In this position, the waveform amplitude is usually large and the ECG lead issimilar to Lead MII. This position can be generally recommended.
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•••••Measurement may be incorrect in the following cases.· When the oxyhemoglobin or methemoglobin (HbCO, Met Hb)increases abnormally.· When dye is injected in the blood.· When using an electrosurgical unit.· During CPR.· When measuring at a site where there are venous pulses.· When there is body movement.· When the pulse wave is small.•••••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•••••To avoid poor circulation, do not wrap the tape too tight. Check theblood circulation condition by observing the skin color andcongestion at the skin peripheral to the probe attachment site.Even for short-term monitoring, there may be burn or pressurenecrosis from poor blood circulation, especially on neonates or
32 Operator's Manual ZM-920PA/930PAlow birth weight infants whose skin is delicate. Accuratemeasurement cannot be performed on a site with poor peripheralcirculation.•••••When not monitoring SpO2, disconnect the SpO2 probe cord fromthe transmitter. Otherwise, noise may interfere from the probesensor and cause incorrect data to be displayed on the transmitterand receiving monitor.CAUTION•••••Do not pull or bend the probe cable or put caster feet on the probecable. Do not immerse the probe cable in detergents or water.Failure to follow these cautions may cause cable discontinuity,short circuit, skin burn on the patient or incorrect measurementdata. Replace any broken probe with a new one.•••••Turn off the power of cellular telephones, small wireless devicesand other devices which produce strong electromagneticinterference around a patient. Radio waves from devices such ascellular telephones or small wireless devices may be mistaken aspulse waves and the displayed data may be incorrect.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.CAUTIONUse Nihon Kohden specified SpO2 probe to assure maximumperformance from your instrument.
34 Operator's Manual ZM-920PA/930PAModel Subject (Weight) Attachment SiteFinger Probe TL-201T Adults, children(Weight more than20 kg)FingerFinger Probe TL-101T Adults, children(Weight more than20 kg)Finger or toeMulti-site Probe TL-120T Adults, children,infants(Weight more than3 kg)Finger or toeFoot Probe TL-121T Infants, neonates(Weight less than 3kg)Instep and soleReusable Probes
Operator's Manual ZM-920PA/930PA 35Model Subject (Weight) Attachment SiteTL-251T Adults(Weight more than30 kg)Finger or toeTL-252T Children(Weight from 3 to40 kg)Finger or toeTL-253T Neonates(Weight less than 3kg)Instep and soleAdults, children(Weight more than3 kg)Finger or toeTL-260TNeonates(Weight less than 3kg)Instep and soleDisposable ProbesCAUTIONUse the disposable probe only for one patient. Never reuse thedisposable probe for another patient because it causes crossinfection.
36 Operator's Manual ZM-920PA/930PAModel Subject (Weight) Attachment SiteAdults(Weight more than50 kg)FingerTL-051S/052SCable length TL-051S: 80 cm TL-052S: 160 cmNeonates(Weight less than 3kg)Instep and soleAdults, children(Weight from 15 to50 kg)FingerTL-061S/062SCable length TL-061S: 80 cm TL-062S: 160 cmChildren, infants(Weight from 3 to15 kg)ToeConnecting SpO2 Probe to the TransmitterConnect the probe to the SpO2 socket on the transmitter.CAUTION•••••Do not shake or swing thetransmitter holding the cablesconnected to the transmitter.Otherwise, the transmitter maycome off and cause injury to aperson or damage surroundinginstruments.•••••Hold the connector whenconnecting/disconnecting theprobe. If you disconnect the SpO2probe holding the cable, it damagesthe cable.
Operator's Manual ZM-920PA/930PA 37Attaching the Probe to the PatientFor details, refer to the operator’s manual of each probe.WARNINGTo avoid poor circulation, do not wrap the tape too tight. Check theblood circulation condition by observing the skin color andcongestion at the skin peripheral to the probe attachment site. Evenfor short-term monitoring, there may be burn or pressure necrosisfrom poor blood circulation, especially on neonates or low birthweight infants whose skin is delicate. Accurate measurementcannot be performed on a site with poor peripheral circulation.CAUTION•••••When the attachment site is wet with blood or when the patient hasnail polish on, remove the dirt and nail polish before attaching theprobe. The transmitted light may decrease due to the blood or nailpolish and the measurement data may be incorrect.•••••If the skin gets irritated by the tape or redness appears on the skinby the probe, change the attachment site.•••••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 the probe over its stated lifetime. Otherwise the SpO2measurement accuracy cannot be guaranteed.•••••Do not use damaged or disassembled probe.•••••Replace the probe with a new one as specified in the probemanual. If the probe is deteriorated, correct SpO2 monitoringcannot be performed.•••••Do not attach the probe to the same limb that is used for NIBPmeasurement or an IBP catheter.•••••When attached, make sure that the photo emitter and the detectorof the probe face each other. Otherwise, SpO2 cannot bemeasured properly.
38 Operator's Manual ZM-920PA/930PA•••••When using a disposable probe, be careful when removing theadhesive tape from neonatal skin.•••••When removing a disposable probe that is taped to the skin, do notpull the cable part of the probe because this can damage theprobe’s cable connection.•••••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. It causes incorrectmeasurement and may damage the attachment site on the skin.•••••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.•••••Do not pull the cable when removing the TL-260T multi-site Y probefrom the sponge attachment tape. Otherwise the cable may getdamaged.•••••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 39Detecting 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.
40 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 41(1)Displayed as LED on ZM-920PARA LA LL Va VbAlarm ListSound Display Cause CountermeasureSingle“peep” soundfor 4 s--- The CALL key is pressed. The sound lastswhile the key is pressed.--- (1) The battery voltagedecreases and batterycharge is almost zero.Replace thebatteries with newones.Continuous“peep” soundAll lights areoffBattery is completelydischarged.Replace thebatteries with newones. To stop thesound, turn off thepower.Electrode lead isdisconnected from theelectrode.Firmly connect theelectrode lead tothe electrode.Electrode lead isdisconnected from thetransmitter.Firmly connect theelectrode lead tothe transmitter.Electrode leaddiscontinuityReplace theelectrode lead witha new one.Electrode is notfirmly attached to theskin.--- (2)Polarization voltageis abnormally high.Replace theelectrode with anew one.Intermittent“pip” soundevery 0.5 s--- SpO2 measurementsite is underfluorescent light,surgical light,sunlight, etc.Cover themeasurement sitewith a blanket orcloth.(2)(5) %SpO2 indication(4) pulse level bar graph(3) SpO2 data
42 Operator's Manual ZM-920PA/930PASound Display Cause CountermeasureIntermittent“peep” soundevery 1 s(3)(4) all lit(5) blinkingCannot receivesufficient light fromthe probe photoemitter.Attach probe to asite with 6 to 14mm thicknesswhere sufficientlight can bereceived.Intermittent“pip” soundevery 0.25 s(3) 85%,blinkingBroken probe Replace the probewith a new one.Patient bodymovementRemove the causeby checking thepatient conditionand changing theattachment site.--- (3) blinkingProbe is not attachedsecurely.Securely attach theprobe.
Operator's Manual ZM-920PA/930PA 43TroubleshootingIf the problem still remains after checking the following, contact your NihonKohden distributor.Problem Cause CountermeasureBatteries are notinstalled correctly.The batterypolarity is wrong.Install the batteries correctly.The power cannot beturned on.Batteries arecompletelydischarged.Replace the batteries with newones.Nothing is displayedon the LCD afterturning the power on.(ZM-930PA only)SpO2 display isturned off.Turn off the power, and turn onthe power again.Nothing is displayedon the monitor afterturning thetransmitter power on.The channel of thetransmitter andmonitor does notmatch.Set the correct channel on themonitor.Electrode lead isnot connected tothe transmitter.Connect the electrode lead to thetransmitter. ECG electrode leadworks as an antenna fortransmitting data to the receivingmonitor. If ECG is not measured,the signal may not be received.Anothertransmitter of thesame channel isused near by.Turn the transmitter power off. Ifthe monitor still receives a signal,there is a high probability thatanother transmitter of the samechannel is used nearby.Follow the instruction of yourchannel administrator and useanother transmitter of a differentchannel.Signals aremixing.Follow the instruction of yourchannel administrator and useanother transmitter of a differentchannel.Signal receivingcondition is poor.The transmitter isdamaged.Contact your Nihon Kohdendistributor.
44 Operator's Manual ZM-920PA/930PAProblem Cause Countermeasure3 electrode leadsare properlyattached to thepatient but LEDs light.The transmitter is fixed to6 lead monitoring.Turn off and on thetransmitter power.Heart rate of thepatient who isusing an electricblanket cannot bemonitored on thereceiving monitor.Pacing pulse detection isset to ON on the monitor.Turn off the pacing pulsedetection.The gel on the electrode isdried out.The gel on the electrode iscoming off.Replace the electrode witha new one.Electric blanket is used. Cover the blanket with ashield cover.ECG baseline isthick.(Hum isoverlapping)Hum filter is set to OFF onthe monitorSet the filter to ON.The gel on the electrode isdried out.Respirationwaveformmeasurement isunstable.The gel on the electrode iscoming off.Replace the electrode witha new one.The probe size is notappropriate for the patient.Use the appropriate probefor the patient.Probe is attached to thesame limb that is used forNIBP measurement.Attach the probe to theopposite limb. Avoid a sitewhere blood circulationcondition changes greatly.Probe attachmentcondition is poor. Probe isabout to detach from theskin. External light gets in.Firmly attach the probeaccording to the procedurein the probe operator’smanual.SpO2 data isunstable and notreliable.Measurement site is dirty.Patient is wearing nailpolish.Remove dirt and nailpolish.
Operator's Manual ZM-920PA/930PA 45The 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
46 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 Disposable ElectrodesLifetimeReplace the disposable electrodes with new ones 48 hours after the start ofusage. Otherwise, the gel on the electrode gets dry and adhesive propertydecreases. This increases skin electrode contact impedance and causes incorrectmeasurement.Replace the electrodes with new ones even before 48 hours if the contact betweenskin and electrode becomes poor.DisposalFollow your local laws for disposing of medical waste.
Operator's Manual ZM-920PA/930PA 47Disposing of the SpO2 ProbeLifetimeCAUTION•••••Do not use the probe over its stated lifetime. Otherwise the SpO2measurement accuracy cannot be guaranteed.•••••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.Reusable probeDo not use the probe for more than one year after opening the package. If thehours are recorded, you can use the probe for up to 6,000 hours.Warranty for reusable probeNihon Kohden Corporation (NKC) shall warrant this probe against all defects inmaterials and workmanship for a period of 6 months after the package is opened.NKC or its authorized agents will repair or replace any probe which proves to bedefective during the warranty period, provided the probe is used in accordancewith the operator’s manual.Disposable probeReplace the probe with a new one as specified in the probes operator’s manual. Ifthe probe is used beyond this time, it deteriorates and correct measurement cannotbe performed.If the probe is dirty with blood or bodily fluids, replace it with a new one,regardless of the lifetime.DisposalFollow your local laws for disposing of medical waste.
48 Operator's Manual ZM-920PA/930PACleaning, Disinfection and SterilizationTransmitter 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.
Operator's Manual ZM-920PA/930PA 49Disinfectant Concentration (%)Glutaraldehyde solution 2.0Hydrochloric alkyl diaminoethylglycine 0.5Benzalkonium chloride 0.2Benzethonium chloride solution 0.2Chlorohexidine gluconate solution 0.5SpO2 ProbeRefer to the probe manual.
50 Operator's Manual ZM-920PA/930PAReplacing 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.
Operator's Manual ZM-920PA/930PA 51SpecificationsECG 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)
52 Operator's Manual ZM-920PA/930PAAntenna: ECG electrode leadTransmission channel: indicated on the transmitterTransmission frequency range: 608.0250 to 613.9750 MHzChannel spacing: 50 KHz (25 KHz when interleaved)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 (1994)IEC 60601-1 (1988)IEC 60601-1 Amendment1 (1991)IEC 60601-1 Amendment2 (1995)IEC 60601-1-2 (1993)IEC 60601-2-27 (1994)According 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: Ordinary equipmentAccording 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
Operator's Manual ZM-920PA/930PA 53Water 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
54 Operator's Manual ZM-920PA/930PAStandard AccessoriesName Q’ty Supply codeStrap 1 Y233
Operator's Manual ZM-920PA/930PA 55OptionsName Application Model Q’ty Supplycode3 electrodes, clip type,lead length 80 cm BR-903PA 1 K911A3 electrodes, snap type,lead length 80 cm BR-913PA 1 K910B6 electrodes, clip type,lead length 80 cm BR-906PA 1 K912AElectrodelead6 electrodes, snap type,lead length 80 cm BR-916PA 1 K915ACAUTIONUse only Nihon Kohden electrodes, electrode leads and SpO2probes to assure maximum performance from your instrument.ECG/RESP
56 Operator's Manual ZM-920PA/930PASpO2Name CablelengthModel/Code No. Q’ty SupplycodeTL-201T P225FFinger probeTL-101T P224AMulti-site probe TL-120T P225CFoot probe TL-121T1P225DSpO2 probe (disposable,for adult, BLUPRO)TL-251T P201ASpO2 probe (disposable,for child, BLUPRO) TL-252T P201BSpO2 probe (disposable,for neonate, BLUPRO) TL-253T P201CMulti-site Y probe(disposable, for adult,child, neonate, BLUPO)1.6TL-260T5P205A0.8TL-051S P228ASpO2 probe (disposable,for adult, neonate) 1.6 TL-052S P228B0.8 TL-061S P229ASpO2 probe (disposable,for child, infant) 1.6 TL-062S5P229BCOTTONY tape 340703 20 P259Sponge attachment tapeS for TL-260T P260ASponge attachment tapeL for TL-260T24P260BFoam tape--- ---4 × 25 package P260

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