Nihon Kohden ZS-940PA Telemetry Medical Transmitter User Manual Cover 2 ZS940PA OM pmd

Nihon Kohden Corporation Telemetry Medical Transmitter Cover 2 ZS940PA OM pmd

User Manual

TRANSMITTERZS-940PA0614-009355
Model: ZS-940PAManual code no.: 0614-009355Reader Comment CardWe welcome your comments about this manual. Your comments and suggestions help usimprove our manuals. Please circle the number for each of the following statementscorresponding to your evaluation and add comments in the space provided.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 5Neutral 3This manual is organized. 12345I can find the information I want. 12345The information is accurate. 12345I can understand the instructions. 12345The illustrations are appropriate and helpful. 12345The manual length is appropriate. 12345Comments:Thank you for your cooperation. We appreciate it very much.Name:Occupation/Position:Hospital/Company:Address:Phone:cutting line
Operator's Manual ZS-940PA iGENERAL HANDLING PRECAUTIONSThis device is intended for use only by qualified medical personnel.Use only Nihon Kohden approved products with this device. Use of non-approvedproducts or in a non-approved manner may affect the performance specifications ofthe device. This includes, but is not limited to, batteries, recording paper, pens,extension cables, electrode leads, input boxes and AC power.Please read these precautions thoroughly before attempting to operate the instrument.1. To safely and effectively use the instrument, its operation must be fully understood.2. When installing or storing the instrument, take the following precautions:(1) Avoid moisture or contact with water, extreme atmospheric pressure, excessivehumidity and temperatures, poorly ventilated areas, and dust, saline or sulphuric air.(2) Place the instrument on an even, level floor. Avoid vibration and mechanical shock,even during transport.(3) Avoid placing in an area where chemicals are stored or where there is danger of gasleakage.(4) The power line source to be applied to the instrument must correspond in frequencyand voltage to product specifications, and have sufficient current capacity.(5) Choose a room where a proper grounding facility is available.3. Before Operation(1) Check that the instrument is in perfect operating order.(2) Check that the instrument is grounded properly.(3) Check that all cords are connected properly.(4) Pay extra attention when the instrument is in combination with other instruments toavoid misdiagnosis or other problems.(5) All circuitry used for direct patient connection must be doubly checked.(6) Check that battery level is acceptable and battery condition is good when using battery-operated models.4. During Operation(1) Both the instrument and the patient must receive continual, careful attention.(2) Turn power off or remove electrodes and/or transducers when necessary to assure thepatient’s safety.(3) Avoid direct contact between the instrument housing and the patient.5. To Shutdown After Use(1) Turn power off with all controls returned to their original positions.(2) Remove the cords gently; do not use force to remove them.
ii Operator's Manual ZS-940PA(3) Clean the instrument together with all accessories for their next use.6. The instrument must receive expert, professional attention for maintenance andrepairs. When the instrument is not functioning properly, it should be clearlymarked to avoid operation while it is out of order.7. The instrument must not be altered or modified in any way.8. Maintenance and Inspection:(1) The instrument and parts must undergo regular maintenance inspection at least every 6months.(2) If stored for extended periods without being used, make sure prior to operation that theinstrument is in perfect operating condition.(3) Technical information such as parts list, descriptions, calibration instructions or otherinformation is available for qualified user technical personnel upon request from yourNihon Kohden distributor.9. When the instrument is used with an electrosurgical instrument, pay carefulattention to the application and/or location of electrodes and/or transducers to avoidpossible burn to the patient.10. When the instrument is used with a defibrillator, make sure that the instrument isprotected against defibrillator discharge. If not, remove patient cables and/ortransducers from the instrument to avoid possible damage.
Operator's Manual ZS-940PA iiiWARRANTY POLICYNihon Kohden Corporation (NKC) shall warrant its products against all defects in materials andworkmanship for one year from the date of delivery. However, consumable materials such asrecording paper, ink, stylus and battery are excluded from the warranty.NKC or its authorized agents will repair or replace any products which prove to be defectiveduring the warranty period, provided these products are used as prescribed by the operatinginstructions given in the operator’s and service manuals.No other party is authorized to make any warranty or assume liability for NKC’s products.NKC will not recognize any other warranty, either implied or in writing. In addition, service,technical modification or any other product change performed by someone other than NKC orits authorized agents without prior consent of NKC may be cause for voiding this warranty.Defective products or parts must be returned to NKC or its authorized agents, along with anexplanation of the failure. Shipping costs must be pre-paid.This warranty does not apply to products that have been modified, disassembled, reinstalled orrepaired without Nihon Kohden approval or which have been subjected to neglect or accident,damage due to accident, fire, lightning, vandalism, water or other casualty, improper installationor application, or on which the original identification marks have been removed.In the USA and Canada other warranty policies may apply.CAUTIONUnited States law restricts this device to sale by or on the order of a physician.Equipment Authorization RequirementOperation of this equipment requires the prior coordination with a frequency coordinatordesignated by FCC for the Wireless Medical Telemetry Service.
iv Operator's Manual ZS-940PAEMC RELATED CAUTIONThis equipment and/or system complies with the International StandardIEC60601-1-2 for electromagnetic compatibility for medical electrical equipmentand/or system. However, an electromagnetic environment that exceeds thelimits or levels stipulated in the IEC60601-1-2, can cause harmful interference tothe equipment and/or system or cause the equipment and/or system to fail toperform its intended function or degrade its intended performance. Therefore,during the operation of the equipment and/or system, if there is any undesireddeviation from its intended operational performance, you must avoid, identifyand resolve the adverse electromagnetic effect before continuing to use theequipment and/or system.The following describes some common interference sources and remedialactions:1.Strong electromagnetic interference from a nearby emitter source such as anauthorized radio station or cellular phone:Install the equipment and/or system at another location if it is interfered withby an emitter source such as an authorized radio station. Keep the emittersource such as cellular phone away from the equipment and/or system.2.Effect of direct or indirect electrostatic discharge:Make sure all users and patients in contact with the equipment and/or systemare free from direct or indirect electrostatic energy before using it.3.Electromagnetic interference with any radio wave receiver such as radio ortelevision:If the equipment and/or system interferes with any radio wave receiver, locatethe equipment and/or system as far as possible from the radio wave receiver.If the above suggested remedial actions do not solve the problem, consult yourNihon Kohden Corporation subsidiary or distributor for additional suggestions.
Operator's Manual ZS-940PA vConventions Used in this Manual and InstrumentWarnings, Cautions and NotesWarnings, cautions and notes are used in this manual to alert or signal the reader to specificinformation.WARNINGA warning alerts the user to the possible injury or death associated with the useor misuse of the instrument.CAUTIONA caution alerts the user to possible injury or problems with the instrumentassociated with its use or misuse such as instrument malfunction, instrumentfailure, damage to the instrument, or damage to other property.NOTEA note provides specific information, in the form of recommendations,prerequirements, alternative methods or supplemental information.
vi Operator's Manual ZS-940PASymbol Description Symbol DescriptionFull battery Replace batteryNIBP cannot be measuredReplace battery Check electrodeSymbol Description Symbol DescriptionDefibrillation proof type BFapplied part Direct currentDefibrillation proof type CFapplied part Serial numberAttention, consult operator’smanual Year of manufactureDirection for attachingbattery cover CSA markOn LCDExplanations of the Symbols in this Manual and InstrumentThe following symbols found in this manual/instrument bear the respective descriptions asgiven.On PanelSymbol Description Symbol DescriptionBattery position Attention, consult operator’smanualInside Battery Case
Operator's Manual ZS-940PA 1IntroductionThe ZS-940PA transmitter transmits ECG, respiration, SpO2, NIBP and pulse waveform from apatient to a Nihon Kohden monitor for continuous monitoring. The transmitter can changechannels when connected to the QI-901PK channel writer. The front LCD displays SpO2%,NIBP, pulse rate, pulse waveform amplitude, electrode condition mark, battery condition andNIBP measuring mode and interval.Read the operator’s manual for the receiving monitor together with this manual before operation.CAUTION• Do not use the same channel for different patients. Otherwise, two patients’data will be lost due to mutual modulation interference, or another patient’sdata may appear on the receiving monitor screen.• Do not use transmitters of adjacent channels in a hospital. Otherwise, radiowaves from one transmitter affect the receiver of the adjacent channel’stransmitter and there may be interference.NOTE• To prevent interference between channels, assign a channel administrator inthe hospital and only he or she should manage channel assignment.• Use Nihon Kohden parts and accessories to assure maximum performancefrom your instrument.• For stable signal reception, it is recommended to use a diversity antennasystem on the receiving monitor. Otherwise, spike noise from transient fadingof electric field strength (for example, people moving) may interfere with thetransmitter signal and may be mistaken as an arrhythmia on the receivingmonitor.• NIBP cannot be measured on a neonate. (ECG, respiration and SpO2 can bemonitored on a neonate.)
2 Operator's Manual ZS-940PAPanel DescriptionFront PanelLCD:Displays measuring data, settings andother information.Battery case:Contains three 1.5 V AA batteries.NIBP START/STOP key:Starts/stops NIBP measurement inselected mode.NIBP INTERVAL key:Selects NIBP measurement mode.WARNINGClose the battery case cover during operation.If the transmitter is used with the battery case cover open, the patient may getan electrical shock when defibrillation is performed, and electrostatic dischargeby the patient may intermittently interfere with the waveform or data.Refer to the WARNING below.(This symbol is attached to the rear of thebattery case cover.)
Operator's Manual ZS-940PA 3Rear PanelLock plate:Fastens the transmitter to an NIBP cuff.Refer to the WARNING below.WARNINGIf detergent or liquid spills into the transmitter, stop using it and contact yourNihon Kohden distributor. If a wet transmitter is used, the patient or anyone incontact with the transmitter may receive an electric shock or patient leakagecurrent over the allowed amount may flow.
4 Operator's Manual ZS-940PATop PanelLRFECG/impedance RESP socket:Connects the electrode lead formeasuring ECG and/or respirationby the impedance method.NIBP socket:Connects the cuff hose.Refer to the symbol page.Refer to the WARNING on thenext page.Refer to the WARNING on thenext page.Refer to the symbolpage.Channel number label:Indicates the channel number of thetransmitter. Attach the channel number labelto the panel of the monitor.SpO2 socket:Connects the SpO2probe.Bottom PanelRefer to the WARNING on the nextpage.Refer to the symbol page.
Operator's Manual ZS-940PA 5WARNING• Before performing defibrillation, check that the electrode leads and SpO2probe attached to the patient are properly connected to the transmitter.Touching the metal parts of disconnected leads and probes causes seriouselectrical shock or injury by discharged energy.• When performing defibrillation, all persons must keep clear of the bed andmust not touch the patient, any equipment connected to the patient or themetal parts of leads and probes connected to the patient. Failure to follow thiswarning may result in serious electrical burn, shock or other injury.• When performing defibrillation, discharge as far as possible from electrodesand medicine on the chest of the patient. If there is a possibility that thedefibrillator paddle could touch electrodes and medicine, remove electrodesand medicine from the patient. If the defibrillator contacts these materials, thedischarged energy may cause serious electrical burn on the patient.• When using this transmitter with an ESU, the ESU return plate and theelectrodes for monitoring must be firmly attached to the patient. If the returnplate is not attached correctly, it may burn the patient’s skin where theelectrodes are attached. Refer to the instruction manual for the ESU.CAUTIONDo not shake or swing the transmitter holding the leads/cables connected to thetransmitter. The transmitter may come off and injure someone or damagesurrounding instruments.
6 Operator's Manual ZS-940PALCDLOCKKEYS1234567891011No. Name Description1 NIBP SYS Displays NIBP systolic value.2 NIBP DIA Displays NIBP diastolic value.3 NIBP MEAN Displays NIBP mean value.“CUFF” is displayed with the cuff inflation pressure duringmeasurement.4 Check electrode mark Appears when an electrode or electrode lead becomesdetached during ECG measurement.5 Battery replacement mark Appears when the batteries are weak. For details, refer tothe “Battery Condition Indication” section.6 Message display area Displays messages.7 NIBP measurement mode Displays NIBP measurement mode. When set to auto mode,the measurement interval is displayed.8 NIBP interval bar graph In auto NIBP measurement, the remaining time from the lastmeasurement to the next measurement is displayed as a bargraph.9 Pulse level bar graph Displays pulse level in 7 steps.10 %SpO2Displays SpO2 data.11 PR Displays pulse rate when NIBP or SpO2 is measured. Whenthe SpO2 probe is attached to the patient, the real time pulserate is displayed. When the SpO2 probe is not attached to thepatient, the pulse rate at the end of NIBP measurement isdisplayed.
Operator's Manual ZS-940PA 7Notes on Parameter SettingsWhen monitoring NIBP and SpO2, the following settings must be set as indicated in the table toproperly transmit the monitoring data to the receiving monitor. Otherwise, data cannot bedisplayed on the receiving monitor even when NIBP and SpO2 are measured on the transmitter.Some monitors require the software to be upgraded. For details, contact your Nihon Kohdendistributor.TYPE setting INHIBIT SpO2 DURING NIBP setting SpO2 probe attachment siteON Probe can be attached to thesame limb as the cuffA*1OFF Probe must be attached to thelimb without cuff*2*1Always set to “A”.*2When the SpO2 probe is attached to the same limb as the NIBP cuff and the cuff is inflated,the SpO2 value becomes unstable and SpO2 or PR alarm may occur.
8 Operator's Manual ZS-940PAOutput SignalWARNINGDo not use the output signal from the receiving monitor as the synchronizationsignal for other equipment such as IABP, MRI, echocardiography or defibrillatorbecause there may be time delay between the monitor and the other equipmentcaused by waveform transmission delay and spike noise may interfere on theoutput signal and be mistaken as a trigger.Important Safety InformationGeneralWARNING• Never use this transmitter in the presence of any flammable anesthetic gas orhigh concentration oxygen atmosphere. Failure to follow this warning maycause explosion or fire.• Never use this transmitter in a high-pressure oxygen medical care tank.Failure to follow this warning may cause explosion or fire.• Do not take this transmitter into the MRI test room. This transmitter is notdesigned to be used during MRI tests.• If detergent or liquid spills into the transmitter, stop using it and contact yourNihon Kohden distributor. If a wet transmitter is used, the patient or anyone incontact with the transmitter may receive an electric shock or patient leakagecurrent over the allowed amount may flow.• Before cleaning or disinfecting the transmitter, remove the batteries from thetransmitter.• The transmitter cannot be sterilized.
Operator's Manual ZS-940PA 9Installing (Replacing) BatteriesWARNING and CAUTION for Battery HandlingWARNING• Do not dispose of the battery in fire because it may explode.• Do not use a disassembled or damaged battery. The contents of the batteryare harmful and the battery may catch fire.• If the contents of the battery contact the skin or clothes, immediately wash itthoroughly with water.• Never short-circuit the + and – terminals. The battery may overheat and catchfire.• Take care that the patient does not swallow batteries.CAUTION• Refer to the battery and battery charger manuals for details on handling thebatteries.• Do not handle the batteries with wet hands.• When the transmitter is not in use, remove batteries. When batteries areinstalled, battery power is consumed even if measurement is not performed.Especially, when NiMH batteries remain in the transmitter when thetransmitter is not in use, the battery may become unusable fromoverdischarge and leak liquid which will damage the transmitter.• The battery charger must be used outside the patient environment.Battery LifetimeUse three AA type alkaline dry cell batteries. NiMH rechargeable batteries can also be used.PreparationType Lifetime (Measuring parameters)ECG, SpO2, NIBP ECG, SpO2ECG onlyNiMH secondary 2 days 2 days 2.5 daysAlkaline primary 1 day 2.5 days 3 daysThe above data is when new batteries are used at room temperature, NIBP is measured in automode at 60 minute intervals and SpO2 is measured on an index finger of a male patient withweight 60 kg.Operation time depends on the thickness of SpO2 probe attachment site.
10 Operator's Manual ZS-940PANOTEWhen using rechargeable NiMH batteries, shallow charging/dischargingshortens battery capacity. For details, refer to the battery operator’s manual.Installing (Replacing) BatteriesCAUTIONBattery replacement must be performed by medical staff. When replacingbatteries of the transmitter currently used for a patient, disconnect electrodeleads from the transmitter before replacing batteries or do not touch the patientduring replacement.If electrode leads are attached to the patient and a person replacing batteries touches the patientduring battery replacement, patient leakage current over the allowed amount may flow.CAUTION• Replace all batteries at the same time.• Do not use different types of batteries together.NOTEInsert the batteries with the correct polarity (+ and –).Procedure1. Remove the battery case cover.2. Insert three new or fully charged batteries into thebattery case observing the correct polarity.
Operator's Manual ZS-940PA 113. Close the cover.NOTERemove the batteries before disposing of thetransmitter.Situations Requiring Battery ReplacementReplace the batteries when any of the following occurs.• The transmitter LCD displays the “ ” or “ ”mark.• The transmitter generates a constant alarm (continuous “peep” sound).• The transmitter LCD does not display anything when the power is turned on.• The monitor displays the battery replacement message on the screen.Battery Condition IndicationThe battery condition is indicated as follows.Indication Condition Receiving MonitorFully charged battery Batteries are full. There is no indication onthe monitor.Batteries are low. Replacebatteries.Batteries are low. NIBP cannotbe measured. Replace batteries.Message requiring battery replacement isdisplayed.Noindication Dead batteries No signal can be transmitted to the monitor.There is no indication on the monitor.
12 Operator's Manual ZS-940PATurning the Transmitter On/OffTurning On the PowerWhen the batteries are installed correctly, the power isturned on. A one second “peep” sounds and the startupscreen appears. (There is no “peep” sound when there isno battery power.)NOTEReplace the batteries when the LCD displaysthe “ ” or “ ”mark.Turning Off the PowerTo turn off the power, remove batteries.PeepCheck Items Before UseBefore turning on the transmitter power, check the following to confirm that the transmitter canbe used in normal and safe condition.Appearance• There are no damaged or dirty parts on the outside of the transmitter (Power switch, LCD,keys, sockets, battery case cover, battery case, lock plate, etc.).• The transmitter is completely dry.• The electrode lead, SpO2 probe and NIBP cuff are not broken.• There are no damaged or dirty parts on the disposable SpO2 probe, disposable electrodes ordisposable NIBP cuff.Batteries• 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.• There is no transmitter in the surrounding area with the same channel.
Operator's Manual ZS-940PA 13Check Items After Power OnAfter turning on the power, check the following.Power On• The Power switch is not broken.• The transmitter generates about a one second “peep” sound and the startup screen appears.• The transmitter does not generate a continuous “peep” sound.• The transmitter does not give excessive heat.• The transmitter LCD displays a “ ” mark.• The transmitter does not interfere with the operation of other medical instruments in use.Basic Operation• The “signal loss” message is not displayed on the receiving monitor when the transmitter isinside the receiving range of the monitor.• The battery replacement message is not displayed on the monitor.• The keys on the transmitter function properly.Check Items After UseTo use the transmitter in safe and optimum condition for next time, check the following.Before Turning Power Off• Temporarily changed settings are changed back to the previous settings.• There was no malfunction on the transmitter.Storage• ECG electrode leads, SpO2 probe and NIBP cuff are cleaned and disinfected.• When the transmitter gets wet, liquid is wiped off and the transmitter is thoroughly dried.• There are enough consumables, such as disposable electrodes.• The transmitter power is turned off.• The batteries are removed from the transmitter when it will not be used for a long time.• Dead batteries are disposed of properly.
14 Operator's Manual ZS-940PAChanging the Transmitter ChannelThe channel of the transmitter can be changed. The optional QI-901PK Channel Writer isrequired.WARNINGThe following action must be taken to properly receive the transmitter signal ofthe correct patient on the receiving instrument. Otherwise, there may be signalloss or signals may mix causing a serious accident, such as monitoring adifferent patient.• Assign a channel administrator in the hospital and only he or she shouldmanage channel assignment on his or her responsibility.• The channel administrator must manage the channels in the facility so thatthere is no signal interference.• When the transmitter channel is changed, the channel administrator mustcheck that the channel on the receiving monitor is also changed and the signalis properly received.• The channel administrator must replace the channel number label on thetransmitter with the new one after changing the channel.NOTEThe software version of the QI-901PK channel writer must be 02-01 or later tochange the channel on the ZS-940PA transmitter.To check the transmitter channel, refer to “CHANNEL/TYPE” in the “Changing System SetupSettings” section.
Operator's Manual ZS-940PA 15Changing Parameter Setup SettingsThe initial settings on the PARAMETER SETUP screen must be changed before monitoring.Changing these settings during monitoring interrupts monitoring.Parameter Setup Setting ListThe factory default settings are underlined.Setting Item Description SettingsSELECTABLEINTERVALSSelect the NIBP measurement modes forthe mode selection.STAT, 5, 10, 15, 30, 60,120, 240INITIALINTERVALSelect the initial NIBP measurementmode at power on.MAN., 5 min, 10 min,15 min, 30 min, 60 min,120 min, 240 minINITIAL CUFFPRESS Select the NIBP cuff inflation pressure.120 mmHg, 150 mmHg,180 mmHg, 210 mmHg,240 mmHgNIBP MODEAFTER STATSelect the NIBP measurement modeafter completing STAT measurement.MAN., 5 min, 10 min,15 min, 30 minSTART/FINISHSOUNDTurn ON or OFF the sound for NIBPmeasurement start/finish. ON, OFF/ON, OFFOLD NIBP DATA AFTERSelect whether to hide or dim the NIBPdata after measurement and how long towait after measurement to dim or hide it.DATA: HIDE, DIMAFTER: 5 min, 10 min,30 minINHIBIT SpO2DURING NIBPTurn SpO2 monitoring on or off duringNIBP measurement. ON, OFF2ND PARAMETER Set SpO2 and PR display order. SpO2, PRDisplaying the PARAMETER SETUP Screen1. Remove one battery.2. While pressing the NIBP START/STOP and NIBP INTERVAL keys, install the battery.The SETUP screen appears.
16 Operator's Manual ZS-940PA3. Press the NIBP START/STOP key to enter the PARAMETER SETUP screen.When the cursor is moved to “EXIT” by pressing the NIBP INTERVAL key and the NIBPSTART/STOP key is pressed, the startup screen appears, then the monitoring screenappears.4. To select or change a setting, press the NIBP START/STOP key.To move the cursor, press the NIBP INTERVAL key.Selects or changes settingMoves cursorWhen the cursor is moved to “RETURN” by pressing the NIBP INTERVAL key and theNIBP START/STOP key is pressed, the SETUP screen appears.Changing SettingsSELECTABLE INTERVALSDuring monitoring, when the NIBP INTERVAL key is pressed, the measurement mode changesaccording to the modes selected in this item. MANUAL mode is already selected for the modeselection.1. Press the NIBP INTERVAL key to move thecursor to the desired mode.2. Press the NIBP START/STOP key to select orunselect the mode. Selectable modes are: STAT,5, 10, 15, 30, 60, 120 and 240 min.
Operator's Manual ZS-940PA 17INITIAL INTERVALSelect the initial NIBP measurement mode at power on.1. Press the NIBP INTERVAL key to move thecursor to “INITIAL INTERVAL”.2. Press the NIBP START/STOP key to selectthe mode. Selectable modes are the modesselected for “SELECTABLE INTERVALS”and “STAT” and “MAN.” (MANUAL).INITIAL CUFF PRESSSelect the NIBP cuff inflation pressure.1. Press the NIBP INTERVAL key to move thecursor to “INITIAL CUFF PRESS”.2. Press the NIBP START/STOP key to selectthe inflation pressure from 120, 150, 180, 210and 240 mmHg.NIBP MODE AFTER STATSelect the NIBP measurement mode after completing the STAT measurement.1. Press the NIBP INTERVAL key to move thecursor to “NIBP MODE AFTER STAT”.2. Press the NIBP START/STOP key to selectthe mode. The selected mode is automaticallyselected for “SELECTABLE INTERVALS”as well.
18 Operator's Manual ZS-940PASTART/FINISH SOUNDTurn on or off the sound for NIBP measurement start and finish.Start sound End sound1. Press the NIBP INTERVAL key to move thecursor to “START/FINISH SOUND”.2. Press the NIBP START/STOP key to turn ONor OFF.OLD NIBP DATA/AFTERSelect whether to dim or hide the NIBP data after measurement and how long to wait after NIBPmeasurement to dim or hide it.1. Press the NIBP INTERVAL key to move thecursor to “OLD NIBP DATA/AFTER”.2. Press the NIBP START/STOP key to select thesetting.DATA: DIM NIBP data is dimmed after the “AFTER” interval.HIDE NIBP data is hidden after the “AFTER” interval. “– – –” is displayed on thescreen.AFTER: Select the interval after NIBP measurement to dim or hide.Dimmed Hidden
Operator's Manual ZS-940PA 19INHIBIT SpO2 DURING NIBPSet whether or not to monitor SpO2 during NIBP measurement.When the SpO2 probe is attached to the same limb as the NIBP cuff and this setting is set toOFF, the pulse may become unstable and SpO2 or PR alarm may occur. It is recommended toset this setting to ON so that SpO2 is not measured during NIBP measurement.When the SpO2 probe is attached to the other limb from the NIBP cuff, this setting can be set toOFF.NOTE• When the “CHANNEL/TYPE” on the SYSTEM SETUP screen is set to “8”, this“INHIBIT SpO2 DURING NIBP” setting becomes invalid and SpO2 is monitoredduring NIBP measurement.• When this “INHIBIT SpO2 DURING NIBP” is set to OFF, refer to the “MonitoringSpO2 during NIBP Measurement” section.1. Press the NIBP INTERVAL key to move thecursor to “INHIBIT SpO2 DURING NIBP”.2. Press the NIBP START/STOP key to select“ON” or “OFF”.ON: Stops SpO2 monitoring during NIBP measurement.OFF: SpO2 is monitored during NIBP measurement.2ND PARAMETERSet the display order of SpO2 and PR.When set to SpO2When set to PR1. Press the NIBP INTERVAL key to move thecursor to “2ND PARAMETER”.2. Press the NIBP START/STOP key to select“SpO2” or “PR”.
20 Operator's Manual ZS-940PAChanging System Setup SettingsNOTEChanging System Setup settings must be done only by a qualified personnel.System Setup Setting ListThe factory default settings are underlined.Setting Item Description SettingsCHANNEL/TYPE Displays the transmitter channel and select theTYPE. A, 8PRESSURE UNIT Select the units for NIBP. mmHg, kPaLANGUAGE Select the language for screen display. JPN, ENGSYSTEMINITIALIZEInitializes all settings to the factory defaultsettings.Displaying the SYSTEM SETUP Screen1. Remove one battery.2. While pressing the NIBP START/STOP and NIBP INTERVAL keys, install the battery.The SETUP screen appears.3. Press the NIBP INTERVAL key to move the cursor to “SYSTEM SETUP”.4. Press the NIBP START/STOP key to enter theSYSTEM SETUP screen.When the cursor is moved to “EXIT” bypressing the NIBP INTERVAL key and theNIBP START/STOP key is pressed, the startupscreen appears, then the monitoring screenappears.
Operator's Manual ZS-940PA 215. To select or change a setting, press the NIBP START/STOP key.To move the cursor, press the NIBP INTERVAL key.Selects or changes settingMoves cursorWhen the cursor is moved to “RETURN” by pressing the NIBP INTERVAL key and theNIBP START/STOP key is pressed, the SETUP screen appears.Changing SettingsCHANNEL/TYPESelect “A” for TYPE. The channel of this transmitter is also displayed.1. On the SYSTEM SETUP screen, press the NIBP START/STOP key to select “A”.Channel of this transmitterNOTEAlways select “A” for TYPE. If “8” is selected,NIBP data cannot be properly transmitted tothe receiving monitor.PRESSURE UNITSelect the unit for NIBP.1. Press the NIBP INTERVAL key to move thecursor to “PRESSURE UNIT”.2. Press the NIBP START/STOP key to select“mmHg” or “kPa”.
22 Operator's Manual ZS-940PALANGUAGESelect the language for screen display.1. Press the NIBP INTERVAL key to move thecursor to “LANGUAGE”.2. Press the NIBP START/STOP key to select thelanguage.SYSTEM INITIALIZEDo the following procedure to initialize the settings to the factory default settings.1. Press the NIBP INTERVAL key to move the cursor to “SYSTEM INITIALIZE”.2. Press the NIBP START/STOP key. The “EXECUTE” message appears.3. Press the NIBP START/STOP key to initialize the settings to the factory default settings.
Operator's Manual ZS-940PA 23Attaching NIBP Cuff, Electrodes and SpO2 Probeto the PatientThe transmitter can be attached to an arm of the patient or placed on the bedside. The requiredlength of the electrode leads and SpO2 probe cable depends on how the transmitter is to beattached to the patient.NOTEMonitoring SpO2 during NIBP MeasurementWhen the SpO2 probe is attached to the same limb as the NIBP cuff, the bloodflow decreases during NIBP measurement and pulse wave cannot be detectedand SpO2 cannot be monitored properly. When “INHIBIT SpO2 DURING NIBP” onthe PARAMETER SETUP screen is set to ON (factory default setting), SpO2monitoring is paused during NIBP measurement to avoid SpO2 alarmoccurrence. However, when monitoring SpO2 on the same limb as NIBP, becareful when reading SpO2 values.When monitoring SpO2 is important, attach the probe to the limb to which theNIBP cuff or catheter is not attached.Attachment ExamplesWhen transmitter is attached on anarmWhen transmitter is placed on a bedsideNOTEWhen placing the transmitter on a bedside,place it on a stable and flat place. If thetransmitter falls off, it may be damaged.
24 Operator's Manual ZS-940PAAttaching the NIBP CuffSelecting the NIBP CuffSelect the NIBP cuff appropriate for the patient.NOTENIBP cannot be measured on neonates using this transmitter.Reusable CuffsWhen attaching the transmitter to the patient arm, a special NIBP cuff is required. An optionalYN-990P extension hose (1.5 m) is available to extend the length between the NIBP socket onthe transmitter and NIBP cuff (e.g. when not attaching the transmitter to the patient arm andplacing the transmitter on a bedside).Reusable cuff Model Width (cm) Air hose length (cm)Standard YP-943P 13 15For adult Large YP-944P 15 15When not attaching the transmitter to the patient arm, the following cuffs can be used. To usethese cuffs, an optional YN-990P extension hose (1.5 m) is required.Reusable cuff Model Width (cm) Air hose length (cm)For infants YP-960T 5Small YP-961T 7Forchildren Standard YP-962T 10Standard YP-963T 13For adults Large YP-964T 1515WidthWidthAir hoseAir hose
Operator's Manual ZS-940PA 25Disposable CuffsCAUTIONThe disposable cuffs are not sterilized. If necessary, sterilize the disposablecuffs using glutaraldehyde solution by following the instructions for theglutaraldehyde.When not attaching the transmitter to the patient arm, the following disposable cuffs can be used.To use these cuffs, an optional YN-990P extension hose (1.5 m) is required.YN-990P extension hose, 150 cmWidthReusable cuff Model Width (cm) Air hose length (cm)For infants YP-910P 6For children YP-912P 9Small YP-913P 12Standard YP-914P 14For adultsLarge YP-915P 1620Extension HoseCAUTIONWhen using an extension hose, check that the extension hose is not bent orsqueezed. Otherwise, the cuff may not inflate or deflate. If the cuff cannotdeflate, it may cause congestion on the patient at the cuff attachment site.Air hose
26 Operator's Manual ZS-940PAReference for selecting a cuffThe AHA (American Heart Association) recommends that the cuff width be 40% of thecircumference of the upper arm. Refer to the following graph and select the cuff which suits thepatient’s arm.NOTE• If a range of arm circumference appropriate for the cuff is prescribed, use acuff within that range.• To obtain accurate measured values, select a wide cuff which can be attachedto the upper arm. Measuring with a very narrow cuff may result in measuredvalues higher than the actual values.• The YP-943P NIBP cuff is for standard size adult. Do not use this cuff when itdoes not fit the patient.1510510 20 30 40 500201510510 20 30 40 50 60060Cuff width (cm)Arm circumference (cm)Infants YP-960TChildren small YP-961TChildren standard YP-962TAdults standard YP-943P (cuff for transmitter) YP-963TAdults large YP-944P (cuff for transmitter) YP-964TCuff Width and Arm CircumferenceReusable CuffsCuff width (cm)Arm circumference (cm)Infants YP-910PChildren standard YP-912PAdults standard YP-914PAdults large YP-915PDisposable CuffsAdults small YP-913P
Operator's Manual ZS-940PA 27Connecting the NIBP Cuff to the TransmitterWhen Using YP-943P/944P NIBP CuffTo attach the YP-943P/944P NIBP cuff to the transmitter, the lock plate is required.D ringBeltAir hoseFront coverFront cover openBelt for the strapLock plate pocketFor attaching the NIBP cuff to the transmitterNOTEDo not roll up or put weight on the cuff with the lockplate attached to it. Otherwise, the lock plate maybreak.Lock plateYP-943P/944P NIBP cuffTop tabBottom tab
28 Operator's Manual ZS-940PA1. Remove the lock plate from thetransmitter.2. Insert the lock plate into the lock platepocket on the NIBP cuff.3. Attach the transmitter to the lock plateby inserting the tabs on the lock plateinto the slots on the transmitter.4. Cover the transmitter with the frontcover of the NIBP cuff.5. Connect the air hose to the NIBP socketon the transmitter. Turn the cuffconnector joint until it clicks.12
Operator's Manual ZS-940PA 29When Using YP-960T series or YP-910P series NIBP CuffTo use these NIBP cuffs, an optional YN-990P extension hose (1.5 m) is required.NOTEConnect the joints properly. If there is an air leak, NIBP cannot be measuredproperly.1. Connect the NIBP cuff to the extension hose.2. Connect the other end of the extension hose tothe NIBP socket on the transmitter. Turn thejoint clockwise until it clicks.To disconnect the cuff from the transmitter,turn the hose joint counterclockwise.Attaching the NIBP Cuff to the PatientWARNINGBe careful when measuring NIBP on a patient with known bleeding disorders orcoagulation. After NIBP measurement, there may be dot hemorrhage, orcirculatory disorder by thrombus where the cuff was attached.CAUTION• Do not wrap the cuff on an arm or thigh which is used for injection. NIBPmeasurement on an arm or thigh which is used for injection may cause areflux of blood and stop injection.• Do not wrap the cuff too tight. It may cause poor blood circulation andcongestion. If the cuff is wrapped too loosely, the NIBP value may beincreased.• If the skin gets irritated or redness appears on the skin from the cuff, changethe attachment site or stop using the cuff.
30 Operator's Manual ZS-940PA• NIBP and SpO2 can be measured on the same limb, but the SpO2 monitoringmay not be accurate during NIBP measurement. Be careful when reading theSpO2 values.*• Do not reuse disposable cuffs.* Monitoring SpO2 during NIBP MeasurementWhen the SpO2 probe is attached to the same limb as the NIBP cuff, the blood flow decreasesduring NIBP measurement and pulse wave cannot be detected and SpO2 cannot be monitoredproperly. When “INHIBIT SpO2 DURING NIBP” on the PARAMETER SETUP screen isset to ON (factory default setting), SpO2 monitoring is paused during NIBP measurement toavoid SpO2 alarm occurrence. However, when monitoring SpO2 on the same limb as theNIBP, be careful when reading SpO2 values.NOTE• Measuring NIBP at a site other than the upper arm gives different values fromthose measured at the upper arm. When making diagnosis based on the NIBPvalues, measure NIBP on an upper arm.• To accurately detect the pulsatile flow of the artery, the cuff should bewrapped around a bare upper arm.• Do not use an abnormal cuff. The cuff deteriorates from use and cleaning.Before use, check the cuff and confirm that there is no flaw, crack or hole in it.Be careful not to damage the inflation bag. If the inflation bag has a hole or aflaw, it may burst during use. Dispose of an abnormal cuff and replace it witha new one.• Refer to the NIBP cuff manual for details.Cuff PositionPlace the cuffed upper arm (brachium) at the same height asthe patient’s heart. If the cuff is not at the same level as theheart, the weight of the blood affects the blood pressurereading. The pressure difference per unit height is 0.7mmHg/cm. The blood pressure reading decreases when thearm is higher than the heart and increases when lower.The best measuring condition is when the patient is lying onhis/her back with arms and legs relaxed. If the cuff positioncannot be on the same level as the heart, the displayed bloodpressure reading must be mathematically adjusted.HeartWhen placing thetransmitter on a bed, makesure that the hose is notbent.
Operator's Manual ZS-940PA 31Using the YP-943P/944P NIBP Cuff1. Attach the NIBP cuff to the transmitter. Refer tothe “Connecting the NIBP Cuff to theTransmitter” section.2. Insert the end of the cuff into the belt and thenthrough the D ring as shown at left.3. Fold back the cuff at the D ring and fasten itusing the velcro tape.Make sure that the cuff is not attached on a joint.NOTEThe cuff must not wrap around the elbow.D ringBeltEnd of cuff
32 Operator's Manual ZS-940PAAttaching the Strap to the TransmitterNOTE• Use the strap to prevent the transmitter from falling.• Do not attach the clip to hard objects such as thick cloth or zipper. It will breakthe clip.Attach a strap provided with the transmitter to the NIBP cuff and patient clothes.To open the clip, firmlypull out the tab indirection of the arrow. To adjust the strap length,push down the tab on theadjuster and slide.1. Adjust the length of the strap.2. Clip one end of the strap to the belt for the strapon the NIBP cuff.3. Clip the other end of the strap to the patient’sclothes as shown left.Belt for the strap on the NIBP cuff
Operator's Manual ZS-940PA 33Attaching ElectrodesSelecting Electrode LeadCAUTIONUse Nihon Kohden specified electrodes and electrode leads. With electrodesand electrode leads other than specified ones, the “CHECK ELECTRODE”message appears and monitoring may stop.The following electrode leads can be used on the transmitter (option).ARTERYRANGEUsing the YP-960T series Reusable Cuffs or YP-910P series Disposable Cuffs1. Put the cuff on the upper arm so that the mark of “ARTERY ” aligns with the arteryof the patient.2. Wrap the cuff so that “INDEX ” comeswithin the “ RANGE ”.If “Index ” is not within the “ RANGE”, change the cuff size.BR-903PA,3 electrodes,clip typeBR-913PA,3 electrodes,snap typeBR-902PA,2 electrodes,clip typeBR-912PA,2 electrodes,snap type
34 Operator's Manual ZS-940PAConnecting the Electrode Lead to the TransmitterConnect the electrode lead to the ECG/RESP socket on the transmitter.When the transmitter is attached on an armCAUTIONHold the connector of the electrode lead when connecting/disconnecting theelectrode lead. If you disconnect the electrode lead by pulling the lead, itdamages 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 patient movement andobtain continuous stable ECG. Following leads are examples. When also monitoringrespiration, refer to the “Electrode Position for Respiration Monitoring” section.NOTEThe optimum electrode positions for ECG measurement of a patient are notalways optimum for respiration measurement of the patient. Select positionssuitable for both ECG and respiration measurements, or positions which havepriority for one measurement.
Operator's Manual ZS-940PA 35Three Electrodes• Lead MII, which is similar to standard lead II, used when ECG measurement has prioritySymbol Lead ColorElectrode Position AHA IEC AHA IECLeft infraclavicular fossa LA L Black YellowRight infraclavicular fossa RA R White RedBelow lowest rib on the leftanterior axillary line LL F Red Green• Lead MI, which is similar to standardlead IChange F/LL and L/LA of the leadMII.• Lead MIII, which is similar to standard leadIII.Change R/RA and L/LA of the lead MII.If the electrode position shown above is not available due to chest surgery, attach the electrodesto the root of the limbs or below the clavicles for stable ECG monitoring.
36 Operator's Manual ZS-940PATwo ElectrodesWith the optional BR-912PA and BR-902PA electrode leads, measurement with two electrodesis available. L/LA electrode is not used.This is effective for a neonate or a patient whose body area is small and difficult to attach threeelectrodes.(ex.) Lead MII, which is similar to standard lead IIDifference between measurement with two electrodes and three electrodesMeasurement with two electrodes is less stable than measurement with three electrodes becauseof noise and body movement. Pay attention to this point. If ECG of necessary quality cannot beobtained, measure with three electrodes.Attaching Electrodes to the Patient and Connecting the Electrode Leads toDisposable ElectrodesPrepare the Patient SkinShave off excessive body hair.To reduce skin impedance, clean the electrode site with cream or with a cotton pad moistenedwith alcohol. Thoroughly dry the skin with a clean cotton pad.NOTE• For a patient with frequent body movement, rub the sites with Skinpure skinpreparation gel. However, do not use Skinpure skin preparation gel onsensitive skin.• Do not place electrodes on a wound or on an inflamed, wrinkled or uneven skinsurface.Symbol Lead ColorElectrode Position AHA IEC AHA IECRight infraclavicular fossa RA R White RedBelow lowest rib on the leftanterior axillary line LL F Red Green
Operator's Manual ZS-940PA 37Attaching Electrodes to the PatientCAUTIONDo not reuse disposable products.NOTE• To maintain good contact between the electrode and skin, check that the pasteof the disposable electrode is not dry.• When contact between the disposable electrode and skin becomes poor,replace electrodes with new ones immediately. Otherwise, contact impedancebetween the skin and the electrode increases and the correct ECG cannot beobtained.Refer to the electrode operator’s manual for details.1. Carefully remove the backing paper from theelectrode. Avoid touching the adhesivesurface.2. Place the electrode on the previously cleanedskin. Pay attention to the electrode lead colorand symbol.3. Clip the electrode lead to the electrode.4. Fasten the electrode lead wire with surgicaltape with an extra length of wire between thetape and the electrode. This lessens themovement of electrode leads by bodymovement and helps stable monitoring.
38 Operator's Manual ZS-940PAElectrode Position for Respiration MonitoringPlace the R/RA and F/LL electrodes so that the lungs are between the electrodes.NOTEThe optimum electrode positions for ECG measurement of a patient are notalways optimum for respiration measurement of the patient. Select positionssuitable for both ECG and respiration measurements, or positions which havepriority for one measurement.Electrode Position ExamplesPosition 1In this position, respiration measurement is available; however, there is a difference in amplitudebetween different patients.R or RA F or LLRight infraclavicularfossaFifth intercostal space on theleft midclavicular line, V4Position 2In this position, the waveform amplitude is usually large and the ECG lead is similar to LeadMII. This position can be generally recommended.R or RA F or LLRight infraclavicularfossaFifth intercostal space on theleft midaxillary line, V6Position 3In this position, the respiration waveform is optimum, but the ECG lead is unusual.R or RA F or LLRight midaxillary at thehorizontal level of V4Fifth intercostal space on theleft midaxillary line, V6
Operator's Manual ZS-940PA 39Position 4In this position, the respiration measurement is influenced by the impedance variation of theabdomen, so the cardiac pulse wave included in the respiration wave is reduced. Note that thewaveform is inverted in phase compared with the chest movement (the waveform goes downduring inspiration). It is difficult to measure the ECG at the same time.Attaching the SpO2 ProbeSelecting the SpO2 ProbeSelect an appropriate probe for the patient.CAUTION• Use Nihon Kohden specified SpO2 probe to assure maximum performancefrom your instrument.• Do not use damaged or disassembled probe. It causes incorrectmeasurement and may hurt the patient.Reusable ProbesWhen using a TL-201T finger probe, choose the appropriate cable length for attachment.R or RA F or LLLowest rib on the rightanterior axillary lineLowest rib on the leftanterior axillary lineProbe Cable Length Patient Attachment site0.6 mFinger probe TL-201T1.6 mAdult or children20 kg or moreFingerAdult or Infant3 kg or moreFinger or toeMulti-site probe TL-220TNeonate3 kg or lessInstep and soleAttachment tape
40 Operator's Manual ZS-940PADisposable ProbesCAUTION• Use the disposable probe only for one patient. Never reuse the disposableprobe for another patient because it causes cross infection.• Disposable probes are not sterilized.Probe Patient Attachment siteTL-251T Adult30 kg or moreFinger or toeTL-252T Child3 to 40 kgFinger or toeTL-253T Neonate3 kg or lessInstep and soleLow birth weight infant1 kg or lessInstep andsoleAttachmenttape SNeonate or Child3 kg or moreFinger or toe Attachmenttape SMulti-site Y probe TL-260TNeonate3 kg or lessInstep andsoleAttachmenttape LAdult50 kg or moreFingerTL-051S/052SCable length TL-051S: 80 cmTL-052S: 160 cmNeonate3 kg or lessInstep and soleChild or Adult15 to 50 kgFingerTL-061S/062SCable length TL-061S: 80 cmTL-062S: 160 cmInfant3 to 15 kgToeAttachment tape40 mm35 mm
Operator's Manual ZS-940PA 41CAUTIONHold the connector when connecting/disconnecting the probe. If you disconnectthe SpO2 probe by pulling the cable, it damages the cable.Attaching the Probe to the PatientAttach the probe to the patient by referring to the probe’s manual. Make sure that the lightemitter and photo detector of the probe face each other at the attachment site.WARNING• When using a TL-201T finger probe, do not fasten it to a finger by wrapping theprobe to the site with some tape. It may cause poor blood circulation,congestion, pressure necrosis or burn.• When using probes other than a TL-201T finger probe, do not wrap the tape tootight. Check the blood 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 pressure necrosis from poor bloodcirculation, especially on neonates or low birth weight infants whose skin isdelicate. Accurate measurement cannot be performed on a site with poorperipheral circulation.Connecting the SpO2 Probe to the TransmitterConnect the probe to the SpO2 socket on the transmitter.When the transmitter is attached on an arm
42 Operator's Manual ZS-940PA• Check the circulation condition by observing the skin color of the measuringsite and the pulse waveform. Change the measuring site every 8 hours fordisposable probes and every 4 hours for reusable probes. The skintemperature may increase at the attached site by 2 or 3°C (4 or 5°F) andcause a burn or pressure necrosis. When using the probe on the followingpatients, take extreme care and change the measurement site morefrequently according to symptoms and degree.• A patient with a fever• A patient with a peripheral circulation insufficiency• Neonate or low birth weight infant with delicate skinCAUTION• If the attachment site is dirty with blood, clean the attachment site beforeattaching the probe. If there is nail polish on the attachment site, remove thepolish. Otherwise, the amount of transmitted light decreases and themeasured data may be incorrect or measurement cannot be performed.• If the skin gets irritated or redness appears on the skin from the probe,change the attachment site or stop using the probe.• When the probe is attached on an appropriate site with sufficient circulation,but the error message confirming the probe attachment repeatedly appears,the probe may be deteriorated. Replace it with a new one.• Do not use a probe that is deteriorated by aging. Accurate measurementcannot be performed.• When using probes other than a TL-201T finger probe on a neonate, be carefulwhen removing the adhesive tape from neonatal skin.• When removing a probe taped to the skin, do not pull the cable. Otherwise thecable may break.• When removing the probe from the attachment tape, do not pull the sensorcable. Otherwise the cable may get damaged.• Before using the TL-260T multi-site Y probe, be sure to attach the probe to thesponge attachment tape S or L. Do not use the probe without the spongeattachment tape attached. It causes incorrect measurement and may damagethe attachment site on the skin.• When fixing the TL-260T multi-site Y probe with the sponge attachment tape,confirm that the adhesive part of the tape is not on the skin. The adhesive maycause oversensitive symptoms on the skin such as redness or itch. If theadhesive touches the skin, remove it carefully and slowly because neonatalskin is very delicate.• Do not use a dirty sponge attachment tape. The measurement value may beincorrect.• Refer to the probe instruction manual for details.
Operator's Manual ZS-940PA 43Locking the Keys on the TransmitterTo prevent the patient from pressing the keys on the transmitter during monitoring, you can lockthe NIBP START/STOP and NIBP INTERVAL keys.1. Press the NIBP INTERVAL key for about 3 seconds.2. A “pip, pip” sounds and the “LOCK KEYS” message is displayed on the LCD.LOCKKEYSPip, pipWhen the NIBP START/STOP key or NIBP INTERVAL key is pressed while the keys arelocked, the “PRESS INT. KEY 3S TO UNLOCK” message appears.To unlock the keys:1. Press the NIBP INTERVAL key for about 3 seconds.2. A “pip, pip” sounds and the keys are unlocked. The “UNLOCK KEYS” message appearsand the keys are unlocked.
44 Operator's Manual ZS-940PAWhen preparation is done, monitoring starts.NIBP Oscillometric MethodNIBP is measured from the change in amplitude pattern of pulsatile oscillation in cuff pressureas the cuff pressure is reduced from above systolic to below diastolic pressure. The occlusive-oscillometry method uses this to determine the systolic, diastolic and mean arterial pressure.NIBP MonitoringSelecting the Initial Cuff Inflation PressureThe initial cuff inflation pressure can be changed on the PARAMETER SETUP screen. Thedefault setting is 180 mmHg. To change the setting, refer to the “Changing Parameter SetupSettings” section.Selecting the Measurement Mode and IntervalMeasurement ModesThere are three measurement modes: manual, auto and STAT. The selected mode or interval isdisplayed at the lower right of the screen.The measurement mode and interval can be changed by pressing the NIBP INTERVAL key.When the key is pressed, the measurement mode changes according to the modes selected at“SELECTABLE INTERVALS” on the PARAMETER SETUP screen. MANUAL mode isalready selected for the mode selection.To select the modes for the mode selection, refer to the “Changing Parameter Setup Settings”section.Manual MeasurementIn Manual mode, a single NIBP measurement is performed when the NIBP START/STOP keyis pressed.STAT (Continuous) MeasurementIn STAT mode, measurement is continuously repeated for 15 minutes after the NIBP START/STOP key is pressed.When the STAT measurement for 15 minutes is completed, the measurement mode automaticallychanges to the Manual mode or Auto mode of selected interval depending on the “NIBP MODEMonitoring
Operator's Manual ZS-940PA 45AFTER STAT” setting on the PARAMETER SETUP screen. The default setting is Manualmode. Refer to the “Changing Parameter Setup Settings” section.The STAT measurement completes within 15 minutes. When more than 12 minutes elapse fromthe start of measurement, there will be no more measurement performed and the measurementmode changes to the mode selected for “NIBP MODE AFTER STAT” on the PARAMETERSETUP screen.Auto MeasurementIn Auto mode, measurement is performed automatically at the preset time intervals.In Auto mode, a single measurement can be performed by pressing the NIBP START/STOP keybetween auto measurements.Measuring NIBPWARNING• Be careful when measuring NIBP on a patient with known bleeding disordersor coagulation. After NIBP measurement, there may be dot hemorrhage, orcirculatory disorder by thrombus where cuff is attached.• NIBP measurement may be incorrect in the following cases.• When using an electrical surgery unit.• When there is body movement.• When the pulse wave is small (insufficient peripheral circulation).• Too many arrhythmia.• When there is vibration.• When there is a rapid blood pressure change.• During CPR.• When performing NIBP measurements in STAT mode or 5 minute intervals,periodically remove the cuff from the patient for ventilation. Otherwise, theskin temperature may increase at the cuff attachment site by 2 or 3°C (4 or5°F). When measuring a patient with a fever or peripheral circulationinsufficiency, it may cause a burn.CAUTIONWhen performing NIBP measurement repeatedly, have a rest betweenmeasurements to recover adequate circulation.
46 Operator's Manual ZS-940PANOTE• When measuring patients who are conscious, help the patient to relax.Measurement may not be accurate if the patient’s arm is tense or if the patienttalks.• The data for measurement on a leg tends to be higher than measurement onthe arm. When making diagnosis based on the NIBP values, measure NIBP onan upper arm.• Do not apply pressure to the cuff or air hose. NIBP may not be measuredcorrectly because of noise or NIBP measurement may stop due to the NIBPsafety circuit.• When the transmitter is attached to the patient arm and the NIBPmeasurement is performed when moving, tell the patient to relax and keepquiet. Otherwise, measurement may be stopped or remeasurement isrepeated due to body movement.• If there is an abnormal noise generated during measurement, stop using thetransmitter and contact your Nihon Kohden distributor.• Do not measure NIBP of a patient on whom an IABP is being used.Measurement may be incorrect due to the mixing of the patient’s own pulseand IABP pulse.• NIBP cannot be measured on a neonate using this transmitter.1. Select the measurement mode by pressing the NIBP INTERVAL key.2. Press the NIBP START/STOP key to perform measurement.
Operator's Manual ZS-940PA 47The cuff is inflated and the inflation pressure is displayed on the screen.In manual mode: Measurement is performed once.In STAT mode: Measurement is performed repeatedly for 15 minutes.In auto mode: The first measurement is performed when the NIBP START/STOP keyis pressed. The second measurement is performed when the current timein the transmitter reaches the selected time interval.To stop measurement during measurement, press the NIBP START/STOP key again.In STAT mode, after completing the STAT measurement, the measurement mode changes tothe mode set for “NIBP MODE AFTER STAT” on the PARAMETER SETUP screen.In auto mode, to stop measurement in auto mode, change the mode to manual. To cancelone measurement, press the NIBP START/STOP key during measurement.After the measurement is complete, the measured data is displayed on the screen and istransmitted to the monitor.Inflation pressureWhen SpO2 is not monitored, the pulse rate at the end of NIBP measurement is displayed.During auto mode measurement, the measurement mode can be changed. During the interval,press the NIBP INTERVAL key to change the mode. When “MANUAL” is displayed for morethan one second, the measurement in auto mode is stopped.A buzzer can be set to sound at the start and end of NIBP measurement. Refer to the “ChangingParameter Setup Settings” section.
48 Operator's Manual ZS-940PAData Display After NIBP MeasurementWhen the time set at “OLD NIBP DATA” on the PARAMETER SETUP screen elapses afterthe last measurement, the NIBP data is dimmed or hidden. Whether to dim or hide the old datacan also be selected at “OLD NIBP DATA”. Refer to the “Changing Parameter Setup Settings”section.Monitoring SpO2 during NIBP MeasurementWhen the SpO2 probe is attached to the same limb as the NIBP cuff, the blood flow decreasesduring NIBP measurement and pulse wave cannot be detected and SpO2 cannot be monitoredproperly. When “INHIBIT SpO2 DURING NIBP” on the PARAMETER SETUP screen is setto ON (factory default setting), SpO2 monitoring is paused during NIBP measurement to avoidSpO2 alarm occurrence. However, when monitoring SpO2 on the same limb as the NIBP, becareful when reading SpO2 values.ECG and Respiration MonitoringWhen the electrodes are attached and the ECG leads are connected to the electrodes, heart rate,ECG, respiration rate and respiration waveform appear on the monitor.WARNINGInteraction Between Minute Ventilation Rate-Adaptive Pacemakers and Cardiacmonitoring and Diagnostic Equipment*The bioelectric impedance measurement sensor of a minute ventilation rate-adaptive implantable pacemaker may be affected by the transmitter which isconnected to the same patient. If this occurs, the pacemaker may pace at itsmaximum rate and the transmitter may give incorrect data to the monitor. If thisoccurs, disconnect the electrode leads from the patient or change the setting onthe pacemaker by referring to the pacemaker’s manual. For more details,contact your pacemaker distributor or Nihon Kohden distributor.* Minute ventilation is sensed in rate-adaptive pacemakers by a technology known as bioelectricimpedance measurement (BIM). Many medical devices in addition to pacemakers use thistechnology. When one of these devices is used on a patient with an active, minute ventilationrate-adaptive pacemaker, the pacemaker may erroneously interpret the mixture of BIM signalscreated in the patient, resulting in an elevated pacing rate.For more information, see the FDA web site.http://www.fda.gov/cdrh/safety.html
Operator's Manual ZS-940PA 49WARNINGWhen using this transmitter with an ESU, the ESU return plate and theelectrodes for monitoring must be firmly attached to the patient. If the returnplate is not attached correctly, it may burn the patient’s skin where theelectrodes are attached. Refer to the instruction manual for the ESU.CAUTIONTurn off the power of cell telephones, small wireless devices and other deviceswhich produce strong electromagnetic interference. Otherwise, the waveformsand measurements are affected by such interference and the displayed datamay be incorrect.NOTE• Noise generated from an electrosurgery unit may interfere on an ECGwaveform, but will not damage it.• If an electric blanket is used and incorrect heart rate is displayed on themonitor, turn off the pacing spike detection on the monitor.• Turn the pacing spike detection to ON on the monitor when monitoring apacemaker patient. Pacing pulse is detected by the transmitter andtransmitted to the monitor. If the pacing spike detection is turned OFF, QRSand pacemaker spike may not be distinguished and pacemaker failure maynot be recognized.Electrode DetachmentThe “ ” mark is displayed on the LCD of the transmitter or the “CHECK ELECTRODE”message is displayed on the screen of the monitor in the following conditions.• 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 is displayedon the receiving monitor, check electrodes and electrode leads and remove thecause. While the “ELECTRODE OFF” or “CHECK ELECTRODE” message isbeing displayed, there is no ECG monitoring and no alarms.
50 Operator's Manual ZS-940PASpO2 MonitoringWhen monitoring starts, SpO2 and pulse waveform are sent to the monitor and SpO2, pulse rateand pulse level bar graph are displayed on the transmitter LCD.WARNING• Measurement may be incorrect in the following cases.• When the patient’s carboxyhemoglobin or methemoglobin increasesabnormally.• When dye is injected in the blood.• When using an electrical surgery unit.• During CPR.• When there is body movement.• When there is vibration.• When measuring at a site where there are venous pulses.• When the pulse wave is small (insufficient peripheral circulation).• When using an IABP (intra-aortic balloon pump).• Check the circulation condition by observing the skin color of the measuringsite and pulse waveform. Change the measuring site every 8 hours fordisposable probes and every 4 hours for reusable probes. The skintemperature may increase at the attached site by 2 or 3°C (4 or 5°F) andcause a burn or pressure necrosis. When using the probe on the followingpatients, take extreme care and change the measurement site morefrequently according 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 the transmitter.Otherwise, noise may interfere from the probe sensor and incorrect data isdisplayed on the screen.CAUTION• Turn off the power of cell telephones, small wireless devices and other deviceswhich produce strong electromagnetic interference. Otherwise, thewaveforms and measurements are affected by such interference and thedisplayed data may be incorrect.• Normally external light does not affect monitoring, however, strong light suchas an operating lamp or sunlight may affect monitoring. If affected, cover themeasuring site with a blanket.• Do not pull or bend the probe cable, and do not run over the probe cable with
Operator's Manual ZS-940PA 51caster feet. Do not immerse the probe cable in detergents or water. Failure tofollow these cautions may cause cable discontinuity, short circuit, skin burnon the patient and incorrect measurement data. Replace any broken probewith a new one.• When the probe is attached on an appropriate site with sufficient circulationand the error message confirming the probe attachment repeatedly appears,the probe may be deteriorated. Replace it with a new one.• When the probe failure message appears on the screen, replace it with a newone. Otherwise SpO2 data may not be accurate.• While a patient is on medication which causes vasodilation, the pulsewaveform may change and in rare cases the SpO2 value may not be displayed.NOTEIn order to maintain sufficient blood circulation, keep the measurement sitewarm by covering it with a blanket or something similar. Warming the site iseffective, especially for a patient with a small pulse amplitude.SpO2 and PR Display OrderYou can select the display order for SpO2 and PR (pulse rate) on the LCD. Refer to the“Changing Parameter Setup Settings” section.Monitoring SpO2 during NIBP MeasurementWhen the SpO2 probe is attached to the same limb as the NIBP cuff, the blood flow decreasesduring NIBP measurement and pulse wave cannot be detected and SpO2 cannot be monitoredproperly. When “INHIBIT SpO2 DURING NIBP” on the PARAMETER SETUP screen is setto ON (factory default setting), SpO2 monitoring is paused during NIBP measurement to avoidSpO2 alarm occurrence. However, when monitoring SpO2 on the same limb as NIBP, be carefulwhen reading SpO2 values.When monitoring SpO2 is important, attach the probe to the limb to which the NIBP cuff orcatheter is not attached.When SpO2 monitoring is paused during NIBP measurement, the SpO2 value just before thestart of NIBP measurement and an mark are displayed on the transmitter for 30 seconds.When NIBP measurement is not completed after 30 seconds, “– – –” is displayed for the SpO2value. The same data also appears on the monitor screen.
52 Operator's Manual ZS-940PANOTE• When continuous SpO2 monitoring is necessary, attach the probe to the limb towhich the NIBP cuff is not attached and set “INHIBIT SpO2 DURING NIBP” onthe PARAMETER SETUP screen to OFF.• When the probe is attached to the same limb as the NIBP cuff, set the syncsource to a parameter other than SpO2 on the receiving monitor.• When monitoring SpO2 during STAT NIBP measurement, attach the probe tothe limb to which the NIBP cuff is not attached.
Operator's Manual ZS-940PA 53Display and Message ListIndication Cause CountermeasureFully charged batteryBatteries are low.Batteries are low. NIBP cannot be measured.Noindication Dead batteriesReplace batteries.Battery IndicationECGIndication Cause CountermeasureElectrode lead is disconnected from theelectrode.Firmly connect the electrodelead to the electrode.Electrode lead is disconnected from thetransmitter.Firmly connect the electrodelead to the transmitter.Electrode lead discontinuity. Replace the electrode leadwith a new one.Electrode is not firmly attached to the skin.Polarization voltage is abnormally high.Replace the electrode with anew one.
54 Operator's Manual ZS-940PAMessage Cause CountermeasureDuring NIBPmeasurementSpO2 monitoring is paused forNIBP measurement.Wait for NIBP measurement tofinish.Considerable body movement.Detectingbodymovement The probe is not attached tothe patient properly.When the message is displayedfrequently, check the patientcondition and, if necessary, changethe attachment site.The probe is not attached tothe patient properly.Attach the probe to the patientproperly.SpO2 CHECKPROBE The probe is disconnectedfrom the SpO2 socket on thetransmitter.Connect the probe to the SpO2socket.The probe is not attached atthe appropriate site.Attach the probe to a site 6 to 14mm thick.SpO2 CHECKPROBE SITE Probe is expired. Replace the probe with a new one.Searching for the correct pulsewave.Wait until the pulse wave isdetected.The SpO2 value cannot beobtained because thewaveform is unstable.SpO2 DETECTINGPULSEThe probe is not attached tothe patient properly.Attach the probe to the patientproperly.SpO2 LIGHTINTERFERENCESpO2 measurement site isunder fluorescent light,surgical light, sunlight, etc.Cover the measurement site with ablanket or cloth.Probe is expired. Replace the probe with a new one.SpO2 PROBEFAILURE Probe is damaged or short-circuited. Replace the probe with a new one.Poor peripheral circulation. Check the patient condition andchange the attachment site.SpO2 WEAK PULSE The probe is attached tootightly and is obstructing theblood circulation.Check the probe attachmentcondition and if necessary,reattach the probe.SpO2
Operator's Manual ZS-940PA 55NIBPMessage Cause CountermeasureThe cuff and extension hose are notproperly connected.The cuff hose (or extension hose) isnot properly connected to the NIBPsocket.Connect them properly.NIBP AIR LEAKThe cuff or extension hose isdamaged. Replace with a new one.The patient’s pulse wave is small. Measure by palpation or auscultation.NIBP CANNOTDETECT PULSE The cuff is not wrapped on thepatient properly. Wrap the cuff on the patient properly.NIBP CUFFOCCLUSION Transmitter malfunction.Immediately remove the cuff from thepatient and contact your Nihon Kohdendistributor.NIBP HIGH CUFFPRESSEnormous pressure was applied bythe pressure of the cuff. Remove the cause.NIBP INFLATIONPRESS LOW Insufficient cuff inflation pressure.Wait for the remeasurement to beperformed with increased cuff inflationpressure.NIBP MEAS TIME-OUTThe measuring time exceeded thespecified time due to arrhythmia,body movement, vibration or, cuffor air hose being squeezed.Remove the cause if the cause is bodymovement, vibration or squeezing ofcuff or hose.NIBP MODULEFAILURE Module malfunction. Contact your Nihon Kohdendistributor.NIBP REMEASURINGNIBP is being remeasured due toarrhythmia, body movement,vibration or, cuff or air hose beingsqueezed.If the message still appears afterremeasurement, remove the cause ifthe cause is body movement, vibrationor squeezing of cuff or hose.Check that the hose is not bent orsqueezed.NIBP SAFETYCIRCUIT RUNNING(When this message isdisplayed, measurementcannot be performed for40 seconds.)Measurement stopped by the safetycircuit.Wait 40 seconds, then performremeasurement. If the message stillappears, contact your Nihon Kohdendistributor.NIBP SYS OUT OFRANGEThe maximum blood pressurecannot be measured even when thecuff inflation pressure exceeded 280mmHg when using adult cuff.Measure by palpation or auscultation.The patient’s pulse wave is toosmall. Measure by palpation or auscultation.The cuff is wrapped too loosely. Wrap the cuff properly.NIBP WEAK PULSEThe cuff size is not appropriate. Use the appropriate cuff.NIBP ZEROING NIBP zero balance is beingadjusted.Do not touch the cuff during zeroing.Wait for the message to disappear.
56 Operator's Manual ZS-940PAIf the problem still remains after checking the following, contact your Nihon Kohden distributor.TransmitterProblem Cause CountermeasureBatteries are not installedcorrectly. The batterypolarity is wrong.Install the batteries correctly.Nothing isdisplayed on theLCD afterturning thepower on.Batteries are completelydischarged.Replace the batteries with new ones.The channel of thetransmitter and monitordoes not match.Set the correct channel on the monitor.Nothing isdisplayed on themonitor afterturning thetransmitterpower on.The “TYPE” on theSYSTEM SETUP screenis not set to “A”.Check that the “TYPE” is set to “A”.Refer to the “Notes on ParameterSettings” and “Changing System SetupSettings” sections.Another transmitter of thesame channel is usednearby.Turn the transmitter power off. If themonitor still receives a signal, there is ahigh probability that another transmitterof the same channel is used nearby.Follow the instruction of your channeladministrator and use another transmitterof a different channel.Signals are mixing. Follow the instructions of your channeladministrator and use another transmitterof a different channel.Signal receivingcondition is poor.The transmitter isdamaged.Contact your Nihon Kohden distributor.Troubleshooting
Operator's Manual ZS-940PA 57ECGProblem Cause CountermeasureThe heart rate isunstable.Pacing detection setting on themonitor is not correct.Turn off the pacing detection settingon the monitor.When monitoring a pacemakerpatient, turn on pacing detection.Electrode lead is disconnectedfrom the electrode.Firmly connect the electrode lead tothe electrode.Electrode lead discontinuity Replace the electrode lead with a newone.Electrode is not firmlyattached to the skin.Replace the electrode with a new one.The “CHECKELECTRODE”message appearson the receivingmonitor.Polarization voltage isabnormally high.Use Nihon Kohden specifiedelectrodes.The gel on the electrode isdried out.The gel on the electrode iscoming off.Replace the electrode with a new one.Electric blanket is used. Cover the blanket with a shield cover.ECG baseline isthick.(Hum isoverlapping)Hum filter is set to OFF on themonitorSet the filter to ON.The gel on the electrode isdried out.Respirationwaveformmeasurement isunstable.The gel on the electrode iscoming off.Replace the electrode with a new one.SpO2Problem Cause CountermeasureThe probe size is notappropriate for the patient.Use the appropriate probe for the patient.Probe attachment conditionis poor. Probe is partlydetached from the skin.External light gets in.Firmly attach the probe according to theprocedure in the probe operator’s manual.Measurement site is dirty.Patient is wearing nailpolish.Remove dirt and nail polish.When the probe and cuff are attached tothe same limb, set “INHIBIT SpO2DURING NIBP” setting on thePARAMETER SETUP screen to ON.SpO2 data isunstable andnot reliable.Probe is attached to thesame limb that is used forNIBP measurement.Attach the probe to the opposite limb.Avoid a site where blood circulationcondition changes greatly.
58 Operator's Manual ZS-940PANIBPProblem Cause CountermeasureThe cuff hose is not connectedto the NIBP socket properly.Connect the cuff hose to the socketproperly.Cuff inflationpressure is less than10 mmHg. The cuff is not wrappedaround the arm or is wrappedtoo loosely.Wrap the cuff around the upperarm.The cuff hose is not connectedto the NIBP socket.Connect the cuff hose to the socketfirmly.The cuff does notinflate when theNIBP START/STOPkey is pressed.The cuff hose or extensionhose may be folded orsqueezed when the cuffpressure display on the screenincreases quickly but theactual cuff does not inflate.Check the cuff hose and air hose.The cuff size is not correct. Select the cuff which fits thepatient’s limb circumference.The cuff is not wrappedaround the arm correctly.Wrap the cuff around the upperarm, not too tightly or too loosely.NIBP data is not correctbecause of body movement.Prevent the patient from movingduring measurement.Check that nothing is touching thecuff during measurement.Abnormalmeasurement resultsare displayed.Vibration on the cuff.Change the measuring site.The cuff is suddenlydeflated duringinflation.The NIBP START/STOP keyis pressed during inflation.Auto modemeasurement doesnot start even whenthe time interval haspassed.The NIBP INTERVAL key ispressed and the measurementmode is changed.Check the measurement mode andinterval.The cuff suddenlyinflates.The measurement mode is setto auto mode.Check the time interval. Ifnecessary, stop measurement.Cannot connect cuffto the air hose.Unspecified cuff is used. Use a cuff specified by NihonKohden.
Operator's Manual ZS-940PA 59Problem Cause CountermeasureVibration on the cuff. Check that nothing is touching thecuff during measurement.The cuff hose or extensionhose is bent or squeezed.Remove the cause.Cannot measureNIBP.The cuff has worn out. Use a new cuff.Increase the measuring interval.Blood congestionoccurs.Measuring over a longperiod of time at shortintervals.Do not measure NIBP over a longtime.Thrombus occurs. Measuring on a patientwith known bleedingdisorders or coagulation.Do not perform NIBP measurementon such a patient.NIBP data on thescreen is --- or dark.The time set for “OLDNIBP DATA” on thePARAMETER SETUPscreen elapsed from the lastmeasurement.When NIBP is measured again, thedata is displayed in normalbrightness.Three loud pipsounds indictingNIBP measurementcannot be started.The cuff is not deflatedenough to start anothermeasurement.Wait 30 seconds and measure again.Numeric data isdisplayed but NIBPmessages are notdisplayed on themonitor.The “TYPE” on theSYSTEM SETUP screen isnot set to “A”.Check that the “TYPE” is set to “A”.Refer to the “Notes on ParameterSettings” and “Changing SystemSetup Settings” sections.
60 Operator's Manual ZS-940PATo use the instrument in safe and optimum condition, perform maintenance check once every sixmonths.CAUTIONDo not disassemble the transmitter when performing maintenance andinspection. Do not repair the transmitter. When there is any problem with thetransmitter after maintenance and inspection, contact your Nihon Kohdendistributor.A maintenance check sheet is provided at the end of this section. Make a copy of this checksheet before performing maintenance check.1. External Check• There are no damaged or dirty parts on the outside of the transmitter.• The battery case cover is not damaged, the spring is firmly fixed and the battery case covercan be closed firmly.• NIBP socket is not damaged.• Keys are not damaged.• Electrode leads are not damaged.• There is no blood or chemicals on the transmitter.2. Transmitter ChannelCheck that the channel of the transmitter and the label match.1. Check that the channel number label attached to the transmitter is not torn or removed.MaintenanceChannel label
Operator's Manual ZS-940PA 612. Remove one battery.3. While pressing the NIBP START/STOP and NIBP INTERVAL keys, install the battery.The SETUP screen appears.4. Press the NIBP INTERVAL key to move the cursor to “SYSTEM SETUP”.5. Press the NIBP START/STOP key to enterthe SYSTEM SETUP screen. The channel ofthis transmitter is displayed.6. Check that the channel displayed on the LCDmatches the label on the transmitter.Channel
62 Operator's Manual ZS-940PA3. LCD DisplayCheck that there are no dots missing on the LCD.1. Remove one battery.2. While pressing the NIBP START/STOP and NIBP INTERVAL keys, install the battery.The SETUP screen appears.3. Press the NIBP INTERVAL key twice to move the cursor to “MANUAL CHECK”.4. Press the NIBP START/STOP key toenter the MANUAL CHECK screen.5. Check that the cursor is on “LCDTEST” and press the NIBP START/STOP key.
Operator's Manual ZS-940PA 636. Every time the NIBP INTERVAL key is pressed, the screen changes as below. Check thatthere are no dots missing.When the NIBP START/STOP key is pressed, the screen returns to the MANUALCHECK screen.4. Switch and Key OperationPower SwitchCheck that the Power switch turns the power on and off.NIBP START/STOP Key1. Attach the NIBP cuff to your upper arm.2. Press the NIBP START/STOP key. Check that the cuff inflates and deflates properly.3. Press the NIBP START/STOP key again. During inflation, press the NIBP START/STOPkey to check that the cuff deflates properly.NIBP INTERVAL Key1. Press the NIBP INTERVAL key and check that the NIBP measuring mode can be changed.2. Select any interval and press the NIBP START/STOP key to perform auto measurement.Check that the NIBP is measured at the selected interval.
64 Operator's Manual ZS-940PA5. NIBP Cuff for Attaching Transmitter to Patient ArmThe NIBP cuff is a consumable. Check the following and when necessary, replace it with a newone.Appearance• There are no dirty parts.• There are no broken stitches on the cuff.• The label on the cuff is readable.• The velcro tape on the cuff is not removed and there are no broken stitches.• The lock plate is not damaged and functions properly.Inflation bag• The inflation bag is not torn or damaged.• There is no water inside the inflation bag.• The connector on the inflation bag is not damaged.
Operator's Manual ZS-940PA 65Maintenance Check SheetHospital/Organization:Service Personnel:Instrument Name: TransmitterInstrument Model: ZS-940PAInstrument Serial Number:Hardware Revision Number:Software Revision Number:1. External Check OK No2. Transmitter Channel OK No3. LCD Display OK No4. Switch and Key Operation OK No5. NIBP Cuff for Attaching Transmitter to Patient Arm OK NoOverall JudgementOKCan be used but needs maintenanceMaintenance required. Cannot be used.
66 Operator's Manual ZS-940PARepair Parts Availability PolicyNihon Kohden Corporation (NKC) shall stock repair parts (parts necessary to maintain theperformance of the instrument) for a period of 8 years from the date of delivery. In that periodNKC or its authorized agents will repair the instrument. This period may be shorter than 8 yearsif the board or part necessary for the faulty section is not available.
Operator's Manual ZS-940PA 67Disposing of Used BatteriesBattery LifetimeReplace the batteries when the battery replacement indication appears on the transmitter. Whenusing rechargeable batteries, recharge them.Lifetime and DisposalType Lifetime (Measuring parameters)ECG, SpO2, NIBP ECG, SpO2ECG onlyNiMH secondary 2 days 2 days 2.5 daysAlkaline primary 1 day 2.5 days 3 daysThe above data is when new batteries are used at room temperature, NIBP is measured in automode at 60 minute intervals and SpO2 is measured on an index finger of a male patient withweight 60 kg.Operation time depends on the thickness of SpO2 probe attachment site.DisposalNOTERemove the batteries before disposing of the transmitter.Before disposing of the batteries, check with your local solid waste officials for details in yourarea for proper disposal. It may be illegal to dispose of these batteries in the municipal wastestream.Disposing of Electrodes, SpO2 Probes and NIBP CuffsRefer to the manual of each item.
68 Operator's Manual ZS-940PATransmitter and Electrode LeadsCAUTION• If detergent or liquid spills into the transmitter, stop using it and contact yourNihon Kohden distributor. If a wet transmitter is used, the patient or anyone incontact with the transmitter may receive an electric shock or patient leakagecurrent over the allowed amount may flow.• Before cleaning or disinfecting the transmitter, remove the batteries from thetransmitter.• The transmitter cannot be sterilized.CleaningWipe the transmitter and electrode leads with a soft cloth moistened with disinfecting alcohol orneutral detergent diluted with water. After cleaning, dry them 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-abrasive clothmoistened with any of the disinfectants listed below. Use the recommended concentration.Disinfectant Concentration (%)Glutaraldehyde solution 2.0Hydrochloric alkyl diaminoethylglycine 0.5Benzalkonium chloride 0.2Benzethonium chloride solution 0.2Chlorohexidine gluconate solution 0.5Cleaning, Disinfection and Sterilization
Operator's Manual ZS-940PA 69SpO2 ProbeRefer to the probe manual.YP-943P/944P NIBP CuffsCAUTION• Do not autoclave.• Use only glutaraldehyde solution.• Never allow liquid to get inside the rubber cuff.• Do not sterilize or disinfect the cuff with ultraviolet light or ozone.CleaningTo clean the cuff, remove the lock plate and carefully pull out the inflation bag from the clothcover.Cloth cover: Wash with neutral detergent and water. Thoroughly dry it. When washing in awashing machine, put it in a net.Inflation bag: Wipe with a soft cloth or cotton moistened with disinfecting alcohol.Thoroughly dry it.DisinfectionTo disinfect the cuff, use glutaraldehyde solution. Use the recommended concentration of thedisinfectant. Refer to the disinfectant manual for details. After disinfection, clean the cuff asdescribed above.
70 Operator's Manual ZS-940PAMeasuring ParametersMeasuring waveforms: ECG, Respiration in impedance method, pulseMeasuring numeric data: SpO2, NIBP, pulse rateTransmitting DataWaveform data: ECG, respiration, pulse waveNumeric data: SpO2 and NIBPStatus information: Battery replacement, channel ID, type of transmitter, checkelectrodes, abnormal polarization voltage, pacing data, SpO2light interferenceDisplayed DataSpO2, NIBP, pulse rate, pulse wave bar graph, check electrode, battery replacement, NIBPmeasurement mode and status informationECG MeasurementChannels: 1Input 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 rejection CapabilityRespiration MeasurementMeasuring method: Impedance methodImpedance range: 0 to 2 kΩ or lessSpO2 MeasurementDisplay range: Depends on the receiving monitorMeasuring range: 0 to 100%, in 1% stepsMinimum display range: 1%Measuring accuracy (When the measuring accuracy of the SpO2 probe is not considered):±1 (80% ≤ SpO2 ≤ 100%)±2 (50% ≤ SpO2 < 80%)Less than 50% is not specified.(When considering the measuring accuracy of the SpO2 probe):±2 (80% ≤ SpO2 ≤ 100%)±3 (70% ≤ SpO2 < 80%)Less than 70% is not specified.Specifications
Operator's Manual ZS-940PA 71NIBP MeasurementDisplayed items: Systolic, diastolic, meanCuff pressure display range: 0 to 300 mmHgMeasurement modes: Manual, STAT, auto at 5, 10, 15, 30, 60, 120 or 240 minuteintervalPulse RateMeasuring range: 30 to 200 beats/minute ±8 beats/min (NIBP)30 to 200 beats/min ±3% ±1 beat/min (SpO2)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)Antenna: InternalTransmission channel: indicated on the transmitterTransmission frequency range: 608.0125 to 613.9875 MHzChannel spacing: 25 kHz (12.5 kHz when interleave)Type of emission: F1DOccupied bandwidth: <8.5 kHzEffective radiated power: 1.0 mW (conducted)Power RequirementsOperating voltage: 3.2 to 4.8 VBattery type: Three AA type NiMH secondary batteriesThree AA type alkaline dry cell primary batteriesBattery lifetime:Type Lifetime (Measuring parameters)ECG, SpO2, NIBP ECG, SpO2ECG onlyNiMH secondary 2 days 2 days 2.5 daysAlkaline primary 1 day 2.5 days 3 daysThe above data is when new batteries are used at room temperature, NIBP ismeasured in auto mode at 60 minute intervals and SpO2 is measured on an indexfinger of a male patient with weight 60 kg.Operation time depends on the thickness of SpO2 probe attachment site.Dimension and WeightDimension: 114 W × 103 H × 58 D (mm)Weight: about 350 g (including batteries)
72 Operator's Manual ZS-940PAEnvironmentOperating environmentOperating temperature: 5 to 40°C, 41 to 104°FWhen using NIBP cuff, 10 to 40°C, 50 to 104°FOperating humidity: 30 to 85% (non-condensing)Operating atmospheric pressure: 70 to 106 kPaStorage environmentStorage temperature: −20 to 65°C, −4 to 149°FStorage humidity: 10 to 95%Storage atmospheric pressure: 70 to 106 kPaElectromagnetic CompatibilityIEC 60601-1-2 (1993) - Collateral Standard: Electromagnetic compatibility - Requirement andtestsEmissions: CISPR11 Group 1, Class BSafety StandardsSafety standard: CAN/CSA-C22.2 No. 601-1 M90 (1990)CAN/CSA-C22.2 No. 601-1. 1S1-94 (1994)CAN/CSA-C22.2 No. 601-1. 1B-90 (R2002)IEC 60601-1 (1988)IEC 60601-1 Amendment1 (1991)IEC 60601-1 Amendment2 (1995)IEC 60601-1-2 (1993)IEC 60601-2-27 (1994)IEC 60601-2-30 (1999)According to the type of protectionagainst electrical shock: INTERNALLY POWERED EQUIPMENTAccording to the degree of protectionagainst electrical shock:ECG and impedance method respiration: DEFIBRILLATION-PROOF TYPE CF APPLIEDPARTSpO2 and NIBP: DEFIBRILLATION-PROOF TYPE BF APPLIEDPARTAccording 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 the presence ofFLAMMABLE ANAESTHETIC MIXTURE WITHAIR, OR WITH OXYGEN OR NITROUS OXIDEAccording to the mode of operation: CONTINUOUS OPERATION
Operator's Manual ZS-940PA 7312Standard AccessoriesNo. Name Model Q’ty Supply Code No.1 NIBP cuff for adult, standard YP-943P 1 S938B2 Strap --- 1 Y23634No. Name Model Q’ty Supply Code No.3 Battery case cover 1 6144-0120044 Lock plate 1 6113-049585The following parts are available for replacement.Lock plate is astandard accessory ofthe YP-943P/944PNIBP cuff.
74 Operator's Manual ZS-940PACAUTIONUse only Nihon Kohden electrodes, electrode leads, SpO2 probes and NIBP cuffsto assure maximum performance from your instrument.TransmitterChannel writer, QI-901PKECG/RESPOptionsName Application Model Q’ty Supply Code No.3 electrodes,clip type,lead length 80 cm BR-903PA 1 K911A3 electrodes, snap type,lead length 80 cm BR-913PA 1 K910B2 electrodes,clip type,lead length 80 cm BR-902PA 1 K907BElectrodelead2 electrodes,snap type,lead length 80 cm BR-912PA 1 K908B
Operator's Manual ZS-940PA 75SpO2Name CablelengthModel/Code No. Q’ty SupplyCode No.0.6 m P225HFinger probe (reusable) 1.6 mTL-201T P225FMulti-site probe (reusable) TL-220T1P225GSpO2 probe (for adult, disposable) TL-251T P201ASpO2 probe (for child, disposable) TL-252T P201BSpO2 probe (for neonate,disposable) TL-253T P201CMulti-site Y probe(for low birth weight infant/child/neonate, disposable)1.6 mTL-260T P205A0.8 m TL-051S P228ASpO2 probe(for adult/neonate,disposable) 1.6 m TL-052S P228B0.8 m TL-061S P229ASpO2 probe (for child/infant,disposable) 1.6 mTL-062S5P229BCOTTONY tape 340703 20 P259Foam tape for TL-051S/052S/061S/062S 4 × 25 package P260Attachment tape for TL-220T/251T/252T/253T 3 × 30 package P263Attachment tape S for TL-260T P260AAttachment tape L for TL-260T--- ---24 P260BName Width(cm)Air HoseLength(cm)Model Q’tySupplyCodeNo.Standard 13 YP-943P* S938BCuff for adult, forattaching transmitter topatient arm Large 15 15 YP-944P* 1S938CCuff for infants 5 YP-960T S943ASmall 7 YP-961T S943BCuff for children Standard 10 YP-962T S943CStandard 13 YP-963T S944BCuff for adult Large 1515YP-964T1S944CDisposable cuff for infants 6 YP-910P ---Disposable cuff for children 9 YP-912P ---Small 12 YP-913P ---Standard 14 YP-914P ---Disposable cuff for adultsLarge 1620YP-915P20---Extension hose 150 YN-990P 1 S903NIBP* The lock plate is provided with these NIBP cuffs.
76 Operator's Manual ZS-940PATransmission FrequenciesUSABANDCHANNELSPACINGAUSABANDCHANNELSPACINGAUSABANDCHANNELSPACINGATransmissionfrequency(MHz)12.5kHz stepChannel No.Transmissionfrequency(MHz)12.5kHz stepChannel No.Transmissionfrequency(MHz)12.5kHz stepChannel No.608.0000 --- 608.3750 9030 608.7500 9060608.0125 9001 608.3875 9031 608.7625 9061608.0250 9002 608.4000 9032 608.7750 9062608.0375 9003 608.4125 9033 608.7875 9063608.0500 9004 608.4250 9034 608.8000 9064608.0625 9005 608.4375 9035 608.8125 9065608.0750 9006 608.4500 9036 608.8250 9066608.0875 9007 608.4625 9037 608.8375 9067608.1000 9008 608.4750 9038 608.8500 9068608.1125 9009 608.4875 9039 608.8625 9069608.1250 9010 608.5000 9040 608.8750 9070608.1375 9011 608.5125 9041 608.8875 9071608.1500 9012 608.5250 9042 608.9000 9072608.1625 9013 608.5375 9043 608.9125 9073608.1750 9014 608.5500 9044 608.9250 9074608.1875 9015 608.5625 9045 608.9375 9075608.2000 9016 608.5750 9046 608.9500 9076608.2125 9017 608.5875 9047 608.9625 9077608.2250 9018 608.6000 9048 608.9750 9078608.2375 9019 608.6125 9049 608.9875 9079608.2500 9020 608.6250 9050 609.0000 9080608.2625 9021 608.6375 9051 609.0125 9081608.2750 9022 608.6500 9052 609.0250 9082608.2875 9023 608.6625 9053 609.0375 9083608.3000 9024 608.6750 9054 609.0500 9084608.3125 9025 608.6875 9055 609.0625 9085608.3250 9026 608.7000 9056 609.0750 9086608.3375 9027 608.7125 9057 609.0875 9087608.3500 9028 608.7250 9058 609.1000 9088608.3625 9029 608.7375 9059 609.1125 9089
Operator's Manual ZS-940PA 77USABANDCHANNELSPACINGAUSABANDCHANNELSPACINGAUSABANDCHANNELSPACINGATransmissionfrequency(MHz)12.5kHz stepChannel No.Transmissionfrequency(MHz)12.5kHz stepChannel No.Transmissionfrequency(MHz)12.5kHz stepChannel No.609.1250 9090 609.5375 9123 609.9500 9156609.1375 9091 609.5500 9124 609.9625 9157609.1500 9092 609.5625 9125 609.9750 9158609.1625 9093 609.5750 9126 609.9875 9159609.1750 9094 609.5875 9127 610.0000 9160609.1875 9095 609.6000 9128 610.0125 9161609.2000 9096 609.6125 9129 610.0250 9162609.2125 9097 609.6250 9130 610.0375 9163609.2250 9098 609.6375 9131 610.0500 9164609.2375 9099 609.6500 9132 610.0625 9165609.2500 9100 609.6625 9133 610.0750 9166609.2625 9101 609.6750 9134 610.0875 9167609.2750 9102 609.6875 9135 610.1000 9168609.2875 9103 609.7000 9136 610.1125 9169609.3000 9104 609.7125 9137 610.1250 9170609.3125 9105 609.7250 9138 610.1375 9171609.3250 9106 609.7375 9139 610.1500 9172609.3375 9107 609.7500 9140 610.1625 9173609.3500 9108 609.7625 9141 610.1750 9174609.3625 9109 609.7750 9142 610.1875 9175609.3750 9110 609.7875 9143 610.2000 9176609.3875 9111 609.8000 9144 610.2125 9177609.4000 9112 609.8125 9145 610.2250 9178609.4125 9113 609.8250 9146 610.2375 9179609.4250 9114 609.8375 9147 610.2500 9180609.4375 9115 609.8500 9148 610.2625 9181609.4500 9116 609.8625 9149 610.2750 9182609.4625 9117 609.8750 9150 610.2875 9183609.4750 9118 609.8875 9151 610.3000 9184609.4875 9119 609.9000 9152 610.3125 9185609.5000 9120 609.9125 9153 610.3250 9186609.5125 9121 609.9250 9154 610.3375 9187609.5250 9122 609.9375 9155 610.3500 9188
78 Operator's Manual ZS-940PAUSABANDCHANNELSPACINGAUSABANDCHANNELSPACINGAUSABANDCHANNELSPACINGATransmissionfrequency(MHz)12.5kHz stepChannel No.Transmissionfrequency(MHz)12.5kHz stepChannel No.Transmissionfrequency(MHz)12.5kHz stepChannel No.610.3625 9189 610.7750 9222 611.1875 9255610.3750 9190 610.7875 9223 611.2000 9256610.3875 9191 610.8000 9224 611.2125 9257610.4000 9192 610.8125 9225 611.2250 9258610.4125 9193 610.8250 9226 611.2375 9259610.4250 9194 610.8375 9227 611.2500 9260610.4375 9195 610.8500 9228 611.2625 9261610.4500 9196 610.8625 9229 611.2750 9262610.4625 9197 610.8750 9230 611.2875 9263610.4750 9198 610.8875 9231 611.3000 9264610.4875 9199 610.9000 9232 611.3125 9265610.5000 9200 610.9125 9233 611.3250 9266610.5125 9201 610.9250 9234 611.3375 9267610.5250 9202 610.9375 9235 611.3500 9268610.5375 9203 610.9500 9236 611.3625 9269610.5500 9204 610.9625 9237 611.3750 9270610.5625 9205 610.9750 9238 611.3875 9271610.5750 9206 610.9875 9239 611.4000 9272610.5875 9207 611.0000 9240 611.4125 9273610.6000 9208 611.0125 9241 611.4250 9274610.6125 9209 611.0250 9242 611.4375 9275610.6250 9210 611.0375 9243 611.4500 9276610.6375 9211 611.0500 9244 611.4625 9277610.6500 9212 611.0625 9245 611.4750 9278610.6625 9213 611.0750 9246 611.4875 9279610.6750 9214 611.0875 9247 611.5000 9280610.6875 9215 611.1000 9248 611.5125 9281610.7000 9216 611.1125 9249 611.5250 9282610.7125 9217 611.1250 9250 611.5375 9283610.7250 9218 611.1375 9251 611.5500 9284610.7375 9219 611.1500 9252 611.5625 9285610.7500 9220 611.1625 9253 611.5750 9286610.7625 9221 611.1750 9254 611.5875 9287
Operator's Manual ZS-940PA 79USABANDCHANNELSPACINGAUSABANDCHANNELSPACINGAUSABANDCHANNELSPACINGATransmissionfrequency(MHz)12.5kHz stepChannel No.Transmissionfrequency(MHz)12.5kHz stepChannel No.Transmissionfrequency(MHz)12.5kHz stepChannel No.611.6000 9288 612.0125 9321 612.4250 9354611.6125 9289 612.0250 9322 612.4375 9355611.6250 9290 612.0375 9323 612.4500 9356611.6375 9291 612.0500 9324 612.4625 9357611.6500 9292 612.0625 9325 612.4750 9358611.6625 9293 612.0750 9326 612.4875 9359611.6750 9294 612.0875 9327 612.5000 9360611.6875 9295 612.1000 9328 612.5125 9361611.7000 9296 612.1125 9329 612.5250 9362611.7125 9297 612.1250 9330 612.5375 9363611.7250 9298 612.1375 9331 612.5500 9364611.7375 9299 612.1500 9332 612.5625 9365611.7500 9300 612.1625 9333 612.5750 9366611.7625 9301 612.1750 9334 612.5875 9367611.7750 9302 612.1875 9335 612.6000 9368611.7875 9303 612.2000 9336 612.6125 9369611.8000 9304 612.2125 9337 612.6250 9370611.8125 9305 612.2250 9338 612.6375 9371611.8250 9306 612.2375 9339 612.6500 9372611.8375 9307 612.2500 9340 612.6625 9373611.8500 9308 612.2625 9341 612.6750 9374611.8625 9309 612.2750 9342 612.6875 9375611.8750 9310 612.2875 9343 612.7000 9376611.8875 9311 612.3000 9344 612.7125 9377611.9000 9312 612.3125 9345 612.7250 9378611.9125 9313 612.3250 9346 612.7375 9379611.9250 9314 612.3375 9347 612.7500 9380611.9375 9315 612.3500 9348 612.7625 9381611.9500 9316 612.3625 9349 612.7750 9382611.9625 9317 612.3750 9350 612.7875 9383611.9750 9318 612.3875 9351 612.8000 9384611.9875 9319 612.4000 9352 612.8125 9385612.0000 9320 612.4125 9353 612.8250 9386
80 Operator's Manual ZS-940PAUSABANDCHANNELSPACINGAUSABANDCHANNELSPACINGAUSABANDCHANNELSPACINGATransmissionfrequency(MHz)12.5kHz stepChannel No.Transmissionfrequency(MHz)12.5kHz stepChannel No.Transmissionfrequency(MHz)12.5kHz stepChannel No.612.8375 9387 613.2500 9420 613.6625 9453612.8500 9388 613.2625 9421 613.6750 9454612.8625 9389 613.2750 9422 613.6875 9455612.8750 9390 613.2875 9423 613.7000 9456612.8875 9391 613.3000 9424 613.7125 9457612.9000 9392 613.3125 9425 613.7250 9458612.9125 9393 613.3250 9426 613.7375 9459612.9250 9394 613.3375 9427 613.7500 9460612.9375 9395 613.3500 9428 613.7625 9461612.9500 9396 613.3625 9429 613.7750 9462612.9625 9397 613.3750 9430 613.7875 9463612.9750 9398 613.3875 9431 613.8000 9464612.9875 9399 613.4000 9432 613.8125 9465613.0000 9400 613.4125 9433 613.8250 9466613.0125 9401 613.4250 9434 613.8375 9467613.0250 9402 613.4375 9435 613.8500 9468613.0375 9403 613.4500 9436 613.8625 9469613.0500 9404 613.4625 9437 613.8750 9470613.0625 9405 613.4750 9438 613.8875 9471613.0750 9406 613.4875 9439 613.9000 9472613.0875 9407 613.5000 9440 613.9125 9473613.1000 9408 613.5125 9441 613.9250 9474613.1125 9409 613.5250 9442 613.9375 9475613.1250 9410 613.5375 9443 613.9500 9476613.1375 9411 613.5500 9444 613.9625 9477613.1500 9412 613.5625 9445 613.9750 9478613.1625 9413 613.5750 9446 613.9875 9479613.1750 9414 613.5875 9447 614.0000 ---613.1875 9415 613.6000 9448613.2000 9416 613.6125 9449613.2125 9417 613.6250 9450613.2250 9418 613.6375 9451613.2375 9419 613.6500 9452

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