Philips Medical Systems North America M4842A IntelliVue Access Point User Manual Animation IFU

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Date Submitted	2004-08-27 00:00:00
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IntelliVue TRx/TRx+ Transceivers
for the Philips IntelliVue Telemetry System with
Smart-Hopping Technology
Notice
Operation of this equipment in the United States requires the prior coordindation with a frequency coordinator designated by the Federal Communications
Commission (FCC) for the Wireless Medical Telemetry Service.
Instructions for Use
Part Number: M4841-91001
Printed in the U.S.A. November 2004
First Edition
Printing History
Notice
Equipment specifications are subject to alteration without notice. All changes
will be in compliance with regulations governing manufacture of medical
equipment.
Printed in the USA.
Document number: M4841-91001
© Copyright 2004 Koninklijke Philips Electronics N.V. All Rights Reserved.
OxiCliq and OxiMax are registered trademarks of Nellcor® Incorporated.
Printing History
New editions of this document will incorporate all material updated since the
previous edition. Update packages can be issued between editions and contain
replacement and additional pages to be merged by a revision date at the bottom
of the page. Note that pages which are rearranged due to changes on a previous
page are not considered revised.
The documentation printing date and part number indicate its current edition.
The printing date changes when a new edition is printed. (Minor corrections
and updates which are incorporated at reprint do not cause the date to change.)
The document part number changes when extensive technical changes are
incorporated.
First Edition ...............................................................................November 2004
Philips IntelliVue Telemetry System with Smart Hopping Technology is
compatible with:
Philips Information Center, software revision F.00
Philips TeleMon Companion Monitor, #A02/A03
ii
About this Book
About this Book
This book contains operating instructions for use of the IntelliVue TRx and
TRx+ Transceivers as used with the Philips IntelliVue Telemetry System with
Smart-hopping Technology. It also includes operational information for the
Telemetry functions of the IntelliVue Information Center. The intended
audience is the clinician who uses and/or teaches others to use the equipment
in a healthcare environment. For operating information on other functionality
of the Information Center, see IntelliVue Information Center Instructions for
Use. For preventive maintenance, repair, and test methods for verification of
device performance, refer to the Philips IntelliVue Telemetry System Service
Kit.
This book does not address the Philips M2601B Transmitter or the M2600B
Philips Telemetry System. For information on those products, refer to the
manual Philips Telemetry System Instructions for Use.
Note—Use this product in conjunction with Philips IntelliVue Information
Center Instructions for Use and Online Help, and with Philips TeleMon A02/
A03 Companion Monitor Instructions for Use. See also the Philips IntelliVue
Telemetry Training Program.
Document
Conventions
Warnings
Warning
Warnings are information you should know to avoid injuring patients and
personnel.
Cautions
Caution
Cautions are information you should know to avoid damaging your equipment
and software.
iii
Product Safety Information
Notes
Note—Notes contain additional information on use of the Philips IntelliVue
Telemetry System.
Procedures
Procedures are indicated in text by the heading “Task Summary” followed by
the following table:
Step
Action
Bold Typeface
Objects of actions in procedures appear in bold typeface. Note the following
example:
Select the Standby button.
Product Safety Information
The following general warnings and cautions apply to use of the Philips
IntelliVue Transceivers in a Philips IntelliVue Wireless Network. Additional
warnings and cautions specific to a particular feature are provided in the
appropriate section.
General
Warning
For continued safe use of this equipment, it is necessary that the listed
instructions are followed. Instructions in this manual in no way supersede
established medical procedures.
iv
Product Safety Information
Warning
Do not touch the patient, or table, or instruments, during defibrillation.
The battery door must be closed during defibrillation. These steps protect
the clinician from high defibrillator voltage.
Warning
This device is not to be used in the vicinity of electrosurgical units because
use may interrupt or interfere with the transmission of signals from the
transceiver.
Warning
This equipment is not suitable for use in the presence of a flammable
anesthetic mixture with air or with oxygen or nitrous oxide
Warning
Do not use patient cables with detachable lead wires that have exposed
male pins. Electrocution could result if these pins are plugged into AC
power.
Warning
Use of product accessories (e.g., ECG leadsets, SpO2 sensors) other than
those prescribed by Philips could lead to patient injury.
Warning
To avoid strangulation, do not tie a pouch solely around the patient’s
neck.
Product Safety Information
ECG/
Arrhythmia All Patients
Warning
ECG SAFETY FOR ALL PATIENTS
Always confirm Information Center observations with clinical
observation of the patient before administering interventions.
Every lead must be secured to an electrode on the patient.
Conductive parts of electrodes must not contact earth or other conductive
parts.
Philips recommends that you change the lead label only to reflect the
physical placement of electrodes. This will ensure a match between the
monitored lead and the label, and prevent any possible confusion.
When switching between EASI and standard monitoring, there is a loss of
data for 30 seconds.
vi
Product Safety Information
Warning
ST/AR ARRHYTHMIA SAFETY FOR ALL PATIENTS
During complete heart block or pacemaker failure (to pace or capture),
tall P-waves (greater than 1/5 of the average R-wave height) can be
erroneously counted by the arrhythmia algorithm, resulting in missed
detection of cardiac arrest.
Learning/Relearning
- If you initiate learning during ventricular rhythm, the ectopics can be
incorrectly learned as the normal QRS complex. This can result in missed
detection of subsequent events of V-Tach and V-Fib.
- When using EASI ECG monitoring, Relearn happens automatically
when there is a LEADS OFF technical alarm. If learning takes place
during ventricular rhythm, the ectopics can be incorrectly learned as the
normal QRS complex. This can result in missed detection of subsequent
events of V-Tach and V-Fib. Be sure to check the beat labels and initiate a
relearn to correct. Therefore, when a technical alarm is generated:
1. Respond to the technical alarm [for example, reconnect the
electrode(s)].
2. Ensure that the arrhythmia algorithm is labeling beats correctly.
vii
Product Safety Information
ECG/
Arrhythmia Paced
Patients
Warning
ECG SAFETY FOR PACED PATIENTS
The output power of the transceiver and other sources of radio frequency
energy, when used in the proximity of a pacemaker, can be sufficient to
interfere with pacemaker performance. Due to the shielding effects of the
body, internal pacemakers are somewhat less vulnerable than external
pacemakers. However, caution should be exercised when monitoring any
paced patient.
In order to minimize the possibility of interference, position electrodes,
electrode wires, and the transceiver as far away from the pacemaker as
possible.
Consult the pacemaker manufacturer for information on the RF
susceptibility of their products and the use of their products with the
Philips IntelliVue Telemetry System. See the IntelliVue Information Center
Instructions for Use for additional information on monitoring paced
patients.
viii
Product Safety Information
Warning
ST/AR ARRHYTHMIA SAFETY FOR PACED PATIENTS
It is possible that pacemaker pulses will not be detected when the ECG
analog output of a defibrillator or telemetry unit is plugged into a bedside
monitor. This can result in the arrhythmia algorithm’s failure to detect
pacemaker non-capture or asystole.
Some pace pulses can be difficult to reject. When this happens, the pulses
are counted as a QRS complex, and could result in an incorrect HR and
failure to detect cardiac arrest or some arrhythmias. Keep pacemaker
patients under close observation.
-- During complete heart block or pacemaker failure (to pace or capture),
tall P-waves (greater than 1/5 of the average R-wave height) can be
erroneously counted by the arrhythmia algorithm, resulting in missed
detection of cardiac arrest.
-- When arrhythmia monitoring paced patients who exhibit only intrinsic
rhythm, the monitor can erroneously count pace pulses as QRS complexes
when the algorithm first encounters them, resulting in missed detection of
cardiac arrest.
For patients who exhibit intrinsic rhythm only, the risk of missing cardiac
arrest can be reduced by monitoring these patients with the low heart rate
limit at or slightly above the basic/demand pacemaker rate. A low heart
rate alarm alarms you when the patient begins pacing. Proper detection
and classification of the paced rhythm can then be determined.
-- When an external pacemaker is being used on a patient, arrhythmia
monitoring is severely compromised due to the high energy level in the
pacer pulse. This can result in the arrhythmia algorithm’s failure to
detect pacemaker non-capture or asystole.
ix
Product Safety Information
SpO2
Warning
SpO2 SAFETY
Always confirm Information Center observations with clinical
observation of the patient before administering interventions.
Prolonged, continuous monitoring can increase the risk of changes in skin
characteristics, such as irritation, reddening, blistering or pressure
necrosis, particularly on patients with impaired perfusion and varying or
immature skin morphology. Specific attention must be given to sensor site
inspection for changes in skin quality, proper optical path alignment and
attachment. Check the application site at regular intervals and change the
site if any compromise in skin quality should occur. More frequent
checking can be required due to an individual patient's condition.
Using a sensor during MR imaging can cause severe burns. To minimize
this risk, ensure that the cable is positioned so that no inductive loops are
formed. If the sensor does not appear to be operating properly, remove it
immediately from the patient.
Do not use disposable sensors on patients who exhibit allergic reactions to
the adhesive.
Injected dyes such as methylene blue or intravascular dyshemoglobins
such as methemoglobin and carboxyhemoglobin can lead to inaccurate
(over-estimated) measurements.
Interference leading to inaccurate measurements can be caused by:
- High levels of ambient light (Hint: cover application site with opaque
material)
- Electromagnetic interference
- Excessive patient movement and vibration.
Contents
General . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-iv
ECG/ Arrhythmia -All Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-vi
ECG/Arrhythmia - Paced Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-viii
SpO2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-x
1. Basic Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1
The Philips IntelliVue Telemetry System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2
System Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3
The IntelliVue Transceiver. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3
Transceiver Controls - Front . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-7
Transceiver Controls - Back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-11
Turning the Transceiver On . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-15
Turning the Transceiver Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-16
Testing intelliVue Transceiver Functionality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-17
Self Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-17
Status Check. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-18
Battery Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-19
Battery Safety Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-19
Inserting/Removing Batteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-20
Checking the Battery Power Level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-22
Briefing the Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-24
Pouch Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-24
Securing the Pouch. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-25
Showering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-26
Transceiver Use with TeleMon A02/A03 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-27
2. Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1
Alarm Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2
Testing Alarm Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2
Suspending/Pausing Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2
Resuming/ Unsuspending Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-4
Standby Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-5
Alarm Behavior with Own Bed Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-7
Physiologic Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-9
Technical Alarms (INOPs) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-14
Contents-1
3. ECG Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1
ECG Safety Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-2
Measuring ECG. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3
EASI ECG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3
ECG Leadsets. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3
ECG Leads Monitored . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-4
Positioning ECG Electrodes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-8
Electrode Placement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-10
Connecting the ECG Cable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-19
Verifying Electrode Connections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-22
Monitoring during Leads Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-23
ECG Fallback . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-23
Extended Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-24
Relearning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-24
Using EASI Leads to Troubleshoot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-24
Optimizing ECG Measurement Performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-25
The Telemetry Signal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-25
Trouble- shooting Signal Disturbances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-26
Dropouts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-26
Muscle and Movement Artifact . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-27
4. ST/AR Arrhythmia & ST Segment Monitoring. . . . . . . . . . . . . . . . . . . . . . . . 4-1
ST/AR Arrhythmia Algorithm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-2
Safety Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-2
ST/AR Arrhythmia Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-3
ST/AR ST Segment Algorithm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-6
The Measurement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-6
Algorithm Processing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-8
Displayed ST Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-8
EASI ST Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-8
ST Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-9
ST Alarm Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-11
5. SpO2 Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1
SpO2 Safety Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-2
SpO2 Information for the User . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-3
Pulse Oximetry Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-4
Pulse Indication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-5
Selecting a SpO2 Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-5
Applying the Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-9
Contents-2
Sensor Application Safety Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-9
Site Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-9
Sensor Application . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-10
Connecting the SpO2 Cable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-14
Measuring SpO2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-15
Spot Check . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-15
Continuous . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-16
SpO2 Measurement when Connected to TeleMon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-17
Turning SpO2 Monitoring Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-18
Turning the SpO2 Parameter On/Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-19
SpO2 Parameter Auto ON. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-19
Understanding SpO2 Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-20
Optimizing SpO2 Measurement Performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-21
Optimizing Sensor Performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-22
6. Telemetry Functions at the Information Center . . . . . . . . . . . . . . . . . . . . . . . 6-1
Telemetry Controls in the Patient Window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-2
Locating the Transceiver (Find Device) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-3
To locate a transceiver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-3
To silence the sound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-3
Patient-Configurable Settings in Telemetry Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-3
Unit-Configurable Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-7
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-8
7. Maintenance & Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1
Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-2
Basic Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-2
Label Assignment for Replacement Transceiver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-2
Transceiver Cleaning, Disinfection, & Cross-Infection Prevention . . . . . . . . . . . . . . . . . . . . . . .7-4
Cleaning the Transceiver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-5
Disinfecting the Transceiver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-6
Cross-Infection Prevention for the Transceiver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-7
Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-15
Basic Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-15
Testing Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-15
Information Signals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-15
8. Safety Standards & Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-1
Regulatory Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-2
Intended Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-2
Contents-3
Indications for Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-2
Rx . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-2
Patient Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-2
Safety Standards. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-2
Essential Performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3
System Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3
FCC Compliance (USA only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-4
AC Power Source. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-5
Battery Life Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-5
Electromagnetic Compatibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-6
Restrictions for Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-8
Radio Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-8
M4841A Transceiver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-8
WMTS Channel Frequencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-10
Physical Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-11
ECG-only Transceiver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-11
ECG/SpO2 Transceiver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-12
Environmental Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-12
M4841A Transceiver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-12
Measurement Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-13
ECG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-13
SpO2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-15
SpO2 Sensor Accuracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-16
A. Accessory List. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1
Accessory Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
ECG Accessories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Electrodes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Leadsets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Trunk Cables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pouches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Skin Prep Paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Alignment Guides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Gunk Guards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
SpO2 Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Reusable Sensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Disposable Sensors - Single Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Wristband . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
A-2
A-2
A-2
A-2
A-3
A-3
A-3
A-4
A-4
A-4
A-4
A-5
A-6
B. Sales and Support Offices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-1
Contents-4
This chapter introduces the Philips IntelliVue Telemetry System with Smarthopping Technology and the IntelliVue TRx and TRx+ Transceivers. It includes
the following sections:
•
•
•
•
•
•
•
•
The Philips IntelliVue Telemetry System. . . . . . . . . . . . . . . . . . . . . . . 1-2
The IntelliVue Transceiver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3
Turning the Transceiver On . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-15
Testing intelliVue Transceiver Functionality . . . . . . . . . . . . . . . . . . . 1-17
Battery Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-19
Pouch Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-24
Transceiver Use with TeleMon A02/A03. . . . . . . . . . . . . . . . . . . . . . 1-27
Transceiver Use with TeleMon A02/A03. . . . . . . . . . . . . . . . . . . . . . 1-27
Basic Operation
1-1
Introduction
Basic Operation
The Philips IntelliVue Telemetry System
The Philips IntelliVue Telemetry System
The Philips IntelliVue Telemetry System with Smart-hopping Technology
provides ambulatory and bedside monitoring of ECG and SpO2 parameters over
the radio frequency (RF) spectrum newly allocated for medical telemetry
applications by the Federal Communications Commission (FCC). The System
enables clinically significant data and control information for adult and pediatric
patients in healthcare facilities to be received from and sent to the transceiver, a
patient-worn device, via a bi-directional RF link over the Wireless Medical
Telemetry Service (WMTS) spectrums 1395-1400 MHz and 1427-1432 MHz.
The System uses smart-hopping technology to dynamically manage the RF
spectrum utilization per transceiver, thus allowing a virtually unlimited number
of simultaneously operating transceivers within the Philips IntelliVue Telemetry
System. The frequency-agile system changes frequency without user
involvement or awareness whenever interference occurs.
The System encompasses a number of individual units which connect together to
form a complete method of transporting ambulatory patient data to a central
repository for subsequent distribution to clinical staff. An installation typically
consists of the following components:
•
•
•
•
•
•
M4841A Transceivers, bi-directional patient-worn devices
M4842A Access Points (AP), centers for bidirectional communication
between the transceivers and the Information Center.
IntelliVue Wireless Network (IWN) infrastructure (including M4843A
Access Point Controllers, M4844A Sync Units, M4845A Power Supply
Units)
M3150A IntelliVue Information Center for centralized monitoring
M3154A IntelliVue Database Server (optional) for centralized data
management
M2636A TeleMon A02/A03 Companion Monitor (optional) for local
display, NBP measurement and local alarms.
The network interconnects Access Points to the Information Center and other
central equipment via the same network that connects IntelliVue bedsides to the
Information Center. Access points receive signals, and unlike traditional antenna
systems, can communicate bidirectionally. Access Points are powered,
controlled and managed remotely via the IWN.
1-2
Basic Operation
The IntelliVue Transceiver
System
Features
•
•
•
•
•
•
•
•
Full patient mobility within the areas defined by the wireless coverage
provided by multiple Access Points.
Expanded geographic coverage area for a a given patient assigned to an
IntelliVue Clinical Network. Physiological data is transported from the
transceiver; a reverse data channel enables data to be transported to the
transceiver.
3-minute Alarm Pause/Suspend initiated at the transceiver.
Standby mode when a patient is away from the unit and not being
monitored by the Philips IntelliVue Telemetry System.
Find Device feature for locating a lost transceiver within the coverage
area.
Access Points operating concurrently with the networked bedside wireless
capability while sharing some of the ICN infrastructure.
Use of the radio spectrums newly allocated by the FCC specifically for
medical telemetry applications.
Connectivity to TeleMon for display of patient measurements - including
NBP - at the bedside.
diagram to come
System Information Flow/Smart-hopping
The IntelliVue Transceiver
The Philips IntelliVue transceiver is a patient-worm device for monitoring ECG
and SpO2 on adult and pediatric patients in the IntelliVue Telemetry System
Basic Operation
1-3
The IntelliVue Transceiver
with Smart-Hopping Technology, a cellular infrastructure network. The
transceiver combines traditional transmitter features with two-way
communication capability with the IntelliVue Information Center. The
transceiver is designed to be easy for clinicians to use and comfortable for
patients to wear. Colored labels provide departmental identifiers. The leadsets
are optimized for ambulating patients, with a cable length of 79 cm (30 inches).
Protective covers prevent dirt from accessing unused ECG and SpO2 cable ports,
thus simplifying cleaning.
The transceiver is available in two models, the ECG only called the IntelliVue
TRx, and the ECG-SPO2 version, called the IntelliVue TRx+. The models are
listed below and illustrated on the following pages in this chapter. Subsequent
tables describe the buttons, indicators, labels, ports, safety symbols & other
markings, and auditory information signals of the transceiver respectively.
Transceiver Model
(M4841A)
Measurements
IntelliVue TRx
ECG
IntelliVue TRx+
ECG, SpO2
The transceiver comes with a start-up kit of batteries, electrodes, and pouches.
1-4
Basic Operation
The IntelliVue Transceiver
M2601B
IntelliVue
TRx+
M4841A
EASI, 33 5
EASI,
5,6
IntelliVue TRx Transceiver - ECG only
Note— The IntelliVue Transceiver and M2601B Transmitter are similar in
appearance. If your hospital uses both, you can distinguish between them by:
• Name on the front of the device
• Label background color (pale gray for transceivers, dark gray for
transmitters)
Transceiver
Features
•
•
•
•
Clinician-selectable 5-lead Standard or EASI leads in same device, at the
bedside
6-leadset with two V leads for diagnosing multiple cardiac abnormalities,
including wide-QRS complex tachycardias and acute myocardial
ischemia/infarction
Powered by two AA Alkaline batteries
Spot-Check SpO2 without using any control buttons
Basic Operation
1-5
The IntelliVue Transceiver
•
•
•
•
•
•
•
•
•
Use with
Information
Center
FAST-SpO2 (Fourier Artifact Suppression Technology) for improved
motion artifact rejection and low-perfusion performance
Audio feedback for Spot Check SpO2 completion and other common tasks
Simultaneous operation in system with M2601A Transmitter
Two sizes - smaller ECG only version and larger ECG/SpO2 version
Battery gauge on transceiver and, if configured, at Information Center
Colored labels provide clinical unit identifiers.
Leadsets are optimized for ambulating patients, with a cable length of 79
cm (30 in).
Gunk guards prevent debris from accessing unused ECG and SpO2 cable
ports and the unused TeleMon/Service port, thus simplifying cleaning.
Pouch with clear front and flap.
The bi-directional capability enables remote control from the Information Center
of the following transceiver operations:
•
•
•
From the Telemetry Setup Window:
– SpO2 measurement mode (Spot Check, Continuous, or Off)
– Display and storage of real-time pleth wave (enable/disable)
– Volume of audible transceiver information signals
– Find device
– Suppression of SpO2 technical alarms during NBP measurement
From the Patient Window
– Standby mode
– Filter bandwidth for ST measurement on/off
– Alarm Pause/Suspend (enable/disable)
From Unit Settings
– Display of battery gauge (enable/disable)
– 3-wire Lead Selection
The system supports Own Bed Overview, the pairing of a telemetry bed with an
IntelliVue Patient Monitor (Release B or higher) for a single patient. Own Bed
Overview provides the telemetry-monitor data (waveforms, numerics and
alarms) in an integrated form both on the bedside monitor and at the IntelliVue
Information Center.
Use with
TeleMon
A02/A03
1-6
Basic Operation
The transceiver can employ the full functionality of the TeleMon A02/A03
companion monitor, including NBP measurement and local display of alarms.
Connection is made through an interface cable, or tether, at the TeleMon service
The IntelliVue Transceiver
port. Please refer to the TeleMon A02/A03 Instructions for Use for general
operating instructions and “Transceiver Use with TeleMon A02/A03” on page
1-27 for an operational summary.
Transceiver Controls - Front
P1
L1
P2
IntelliVue TRx+
M4841A
EASI, 3
5,6
I1
I2
B1
I3
I4
L2
B2
L3
P3
B3
The labeled items in the diagram include: Buttons (B1-B3);
Indicators (I1-I4); Labels (L1-L4); Ports (P1-P3). Additional
Labels, and Safety Symbols & Other Markings (S1-S12, appear on the back of the transceiver.
IntelliVue TRx+ Transceiver - Front View
Basic Operation
1-7
The IntelliVue Transceiver
Buttons
IntelliVue TRx+
M4841A
EASI, 3 5,6
Callout
B1
B2
Button
B1
Definition
Telemetry Button: Depending on configuration,
directs the Information Center to generate a Nurse
Call alarm, remote recording, Nurse Call alarm
and recording, or none. See “Patient-Configurable
Settings in Telemetry Setup” on page 6-3.
B3
Note—Delayed recordings generated by the
Telemetry button are stored in Alarm Review at
the Information Center.
When pressed simultaneously with the Check
button, turns Alarm Suspend/Pause on/off (not
when tethered to TeleMon). See “Suspending/
Pausing Alarms” on page 2-2.
B2
Check Button. Initiates a Status Check of the
Transceiver. See “Status Check” on page 1-18.
When pressed simultaneously with the Telemetry
Button, turns Alarm Suspend/Pause on/off (not
when tethered to TeleMon). See “Suspending/
Pausing Alarms” on page 2-2.
Silences the Find Device tone.See “Telemetry
Controls in the Patient Window” on page 6-2.
B3
1-8
Basic Operation
Power On/Off
Battery Compartment. Insertion of batteries
turns transceiver power on; removal of batteries
turns power off. See “Turning the Transceiver
On” on page 1-15.
The IntelliVue Transceiver
Indicators
IntelliVue TRx+
I1
I2
I3
I4
M4841A
EASI, 3 5,6
Callout
Indicator
I1
Definition
Lead Indicator.
Illuminates momentarily during leadset
insertion to indicate attached leads.
Illluminates when Check button is pressed to
indicate attached leads.
During a Leads Off condition, illuminates to
indicate the lead(s) that need to be reapplied.
Momentarily illuminates three alternate
lights, indicating the transceiver has no
Equipment Label assigned.
I2
EASI
EASI Indicator. Illuminates momentarily
upon insertion of leadset in EASI position.
Illuminates when Check button is pressed if
EASI is in use.
I3
Alarms Suspend/Pause Indicator.
Illuminates during 3 minute alarm pause
initiated at transceiver or Information Center.
I4
Battery Gauge. Illuminates when the EHck
button is pressed to indicate the amount of
power remaining in the batteries. Valid only
for recommended battery type. See
“Checking the Battery Power Level” on page
1-22.
Basic Operation
1-9
The IntelliVue Transceiver
Labels
L1
IntelliVue TRx+
M4841A
EASI, 3 5,6
Callout
Label
Definition
L1
L2
L3
IntelliVue TRx
M4841A
Leadset Insertion Guide. Assist in aligning
the ECG cable for different leadsets. See
“Connecting the ECG Cable” on page 3-19.
EASI, 3 5,6
Note—If your unit uses only one monitoring
configuration, the transceiver may have
special "lock out" plugs that allow only one
way to insert the leadset.
L2
Device Identification Label. Identifies the
device within the IntelliVue Wireless
Network.
L3
Unit Identification Label. Uses one of
seven color-coded labels to identify a clinical
unit.
Ports
P2
P1
IntelliVue TRx+
M4841A
EASI, 3 5,6
Callout
Definition
P1
ECG Leadset Port. Connection for 3-wire or 5-wire leadset.
P2
SpO2 Sensor Port. Connection for SpO2 sensor. (IntelliVue TRx+
only)
P3
TeleMon/Service Port. Connection for cable to TeleMon
Companion Monitor or to Service Tool.
P3
Note— Ports can be covered with protective covers (gunk guards) when not in
use. See “Gunk Guards” on page -4.
1-10
Basic Operation
The IntelliVue Transceiver
Transceiver Controls - Back
EASI
L4
EASI
EASI
345
S1
FCCID: XXXXXXXX
S7-S11 not shown
(inside battery
compartment)
S6
S2
S4
S3
S5
IntelliVue TRx+ Transceiver - Back View
Basic Operation
1-11
The IntelliVue Transceiver
Labels
L4
EASI
EASI
Callout
Definition
12 6
345
Safety
Symbols &
Other Marks
L4
Callout
S1
Electrode Placement Diagrams (See “Positioning ECG
Electrodes” on page 3-8.)
Label
Definition
FCCID: XXXXXXXX
Federal Communications Commission
(FCC) (PTT) label
S2
Patient connections are protected against
defibrillation (DEFIBRILLATIONPROOF) and are a TYPE CF APPLIED
PART.
S3
Prescription device.
Rx
S4
Non-Ionizing Radiation. Interference to
electronic equipment may occur in the
vicinity of devices marked with this
symbol.
S5
Complies with all applicable Canadian and
American standards.
1-12
Basic Operation
The IntelliVue Transceiver
Callout
Label
Definition
S6
Follow operating instructions.
S7
Philips Catalog Number
REF
S8
SN
S9
Serial Number (inside battery
compartment). Needed to identify the
equipment during a call to the Response
Center.
MAC Address of device
MAC
Auditory
Information
Signals
S10
Date of manufacture
S11
Battery Polarity
The transceiver produces auditory feedback to inform you of measurement and
battery conditions. Adjustable sounds can be set to 5 different volume levels or
turned off per patient at the Information Center (see “Patient-Configurable
Settings in Telemetry Setup” on page 6-3). Adjustable sounds include Check
Basic Operation
1-13
The IntelliVue Transceiver
button Standby functions, SpO2 measurement complete, outside of coverage
area warning, and the pulse detection tone.
1-14
Auditory Information
Signal
Definition
Volume/Mute
Adjustable
Single Tone
Self Test passed
no
SpO2 Spot Check measurement successful
yes
Single Tone, low pitch
Pulse detection successful (when locally
initiated)
yes
Double Tone
Self Test failed
no
SpO2 Spot Check measurement failed
yes
Double Tone repeated
every 5 seconds
Out of range
yes
Continuous Double
Tone, two pitches
Find Device
no
Single Tone (when
Check button pressed)
Transceiver is associated with sector at
Information Center (after Standby).
yes
Double Tone (when
Check button pressed)
Transceiver not associated with sector at
Information Center (after Standby).
yes
Double Tone and all
indicators flashing
No equipment label is assigned from
Information Center. No monitoring.
no
Fast Double Tone and
alternate Leads Off
indicators flashing
Equipment label is received from
Information Center and is awaiting local
acknowledgment by Check button press.
no
Basic Operation
Turning the Transceiver On
Transceiver
Safety
Information
Warning
If another radio medical device is operating at the same frequency as an
IntelliVue Transceiver, it is possible that either device will not function
properly.
Warning
Although the transceiver is shielded against Electromagnetic Interference
(EMI), avoid the use of other electrically radiating devices in close
proximity to the transceiver because they might interfere with transceiver
operation.
Warning
Place the transceiver in a pouch or over clothing, or both, during patient
use. The transceiver should not touch the patient’s skin during use.
Turning the Transceiver On
Warning
Arrhythmia relearning is initiated whenever the transceiver is powered
down for one minute or longer. Be sure to check your patient’s arrhythmia
annotation for accuracy whenever relearn has occurred.
The transceiver is powered by two AA alkaline batteries. To turn the transceiver
on, insert both batteries. Remove the batteries to turn the power off.
The configuration data set by the Service Provider prior to transceiver use is
retained after battery removal.
Basic Operation
1-15
Turning the Transceiver On
When the transceiver is turned on, all indicators illuminate briefly and a
sequence of sounds indicates the instrument is ready for use. You should hear a
single beep indicating that the self test was passed, followed by a series of
double beeps while the transceiver attempts to associate with the Information
Center. The cessation of sounds indicates a successful association. If you hear a
single double beep or any other sound sequence, the automatic self-test of the
device has not passed, or there is another problem. Contact your Service
Provider.
Sounds at successful start-up
Self-test
insert batteries
Turning the
Transceiver
Off
1 beep (pass)
Transceiver looking
for Info Center
Connected
beep beep repeated
every 3 seconds
no beep
Turn off the transceiver by removing the batteries. A NO SIGNAL technical
alarm will be in effect at the Information Center until the device is turned on or
until Standby is initiated.
Telemetry monitoring can be turned off in the following ways:
•
•
Manually, by activating Monitoring Standby at the Information Center
(see “Standby Mode” on page 2-5).
Automatically, if Transceiver RF Auto Shutoff is enabled and there is no
ECG signal for 10 minutes.
Note—Turning off telemetry monitoring does not turn off the transceiver.
Auto Shutoff
1-16
Automatic Shutoff causes the transceiver to stop broadcasting a radio signal if
there is no ECG signal for 10 minutes. This prevents interference with other
transceivers in use. The technical alarm text at the Information Center is
Transmitter Off. To conserve battery power, remove batteries.
Basic Operation
Testing intelliVue Transceiver Functionality
To restart monitoring, insert batteries if necessary, attach leads to the patient and
press the Check button to verify association with the Information Center.
Testing intelliVue Transceiver Functionality
There are two tests of IntelliVue Transceiver functionality:
•
•
Self Test -performed automatically each time the transceiver is turned on
Status Check - initiated manually by the clinician.
Self Test
Warning
Do not use the transceiver for patient monitoring if it fails the Power On
Self Test.
A self test of the transceiver functions is automatically performed each time that
the transceiver is turned on (that is, batteries are inserted).
Auditory
Signal (if
configured on)
Visual Indicators
Passed
Single beep
All indicators illuminate for 3 seconds
Failed
Double beep
One or more indicators do not light up.
Self Test
Status
In Case of
Failure
If any portion of the self test fails, the transceiver will attempt to report the
failure to the monitoring system. In case of failure, use another transceiver, and
contact your Service Provider.
Basic Operation
1-17
Testing intelliVue Transceiver Functionality
Status
Check
You can check the status of the transceiver indicators at any time.
To initiate a Status Check, use the following instructions.
Step
Action
Press the Check button.
The following indicators should illuminate for as long as the Check
button is depressed.
• Battery gauge
• Type of leadset
• EASI (if in use)
1-18
Basic Operation
If one or more of the expected indicators do not light up, check the
following:
• Lead block insertion. Make sure the leadset is correctly
inserted in the transceiver and the orange line at the base of
the cable is not visible (see “Connecting the ECG Cable” on
page 3-19).
• Power and position of batteries (see “Checking the Battery
Power Level” on page 1-22)
• Lead positions and connections (see “Verifying Electrode
Connections” on page 3-22)
If there is still a problem, contact your Service Provider for
assistance.
Battery Information
Battery Information
Battery
Safety
Information
Warning
Use Duracell MN 1500 AA 1.5V Alkaline batteries to ensure specified
performance. Outdated, mismatched or poor-quality batteries can give
unacceptable performance (e.g., insufficient Battery-Low warning time).
The use of fresh high-quality alkaline batteries is strongly recommended.
Batteries should be removed from the transceiver at the end of the battery’s
useful life to prevent leakage.
If battery leakage should occur, use caution in removing the battery. The
leaked substance may cause eye or skin irritation. Avoid contact with skin.
Clean the battery compartment according to instructions in “Chapter 7.
Maintenance & Troubleshooting”. Wash hands.
Certain failure conditions, such as short circuits, can cause a battery to
overheat during normal use. High temperatures can cause burns to the
patient and/or user. If the transceiver becomes hot to the touch, place it
aside until it cools. Then remove the batteries and discard them. Have the
transceiver operation checked by your Service Provider to identify the
cause of overheating.
The battery door must be closed during defibrillation.
If you receive a BATTERY LOW alarm, the batteries must be promptly
replaced. A "Battery Low" condition that is not corrected will result in a
transceiver shutdown and cessation of monitoring.
Basic Operation
1-19
Battery Information
Disposal of
Batteries
Caution
The batteries must be removed if a transceiver will be stored for an extended
period of time.
Important—When disposing of batteries, follow local laws for proper disposal.
Dispose of batteries in approved containers. If local regulations require you to
recycle batteries, recycle batteries in accordance with those regulations.
Battery Life
Battery life is dependent upon:
•
•
Condition of the batteries
Parameters being monitored - ECG only, ECG and Spot Check SpO2, or
ECG and Continuous SpO2.
By observing the following guidelines, you can optimize battery life in the
transceiver:
•
•
Inserting/
Removing
Batteries
REMOVE the batteries when the transceiver is not in use.
Disconnect the SpO2 extender cable (if used). (When the SpO2 sensor is
disconnected, the SpO2 functionality is automatically powered down, but
an extender cable will continue to drain power from the SpO2 electronics.)
Warning
Arrhythmia relearning is initiated whenever the transceiver is powered
down for one minute or longer. Be sure to check your patient’s arrhythmia
annotation for accuracy whenever relearn has occurred.
Caution
Remove the batteries before storing a transceiver for an extended period of time.
1-20
Basic Operation
Battery Information
The battery compartment is located at the bottom of the transceiver behind a
swinging door. It accommodates a pair of AA 1.5V Alkaline batteries. Only this
type of disposable battery shall be used.
Important—Do not use rechargeable batteries. Use of this type of battery will
adversely affect:
•
•
•
Battery gauge performance
Battery low warnings
Battery life performance
Insert batteries into the transceiver using the following procedure.
Step
Action
Open the battery compartment by swinging the compartment door
90o counterclockwise into an open hinged position.
Insert two AA 1.5V Alkaline batteries, matching the polarity with
the +/- indications inside the compartment.
Note— Both batteries are inserted with the + polarity in the same
direction.
Basic Operation
1-21
Battery Information
Step
Action
Close the battery compartment door.
Listen for the start-up sounds.
Watch for the indicators on the front of the transceiver to illuminate
briefly.
Removing the
Batteries
Connect/reconnect the patient cables to the transceiver.
Batteries should be changed in sets, that is, if you change one battery, change
them both. To remove the batteries, simply open the battery compartment door
and push from the opening at the back of the compartment to pop the batteries
out. Transceiver settings (ECG leadset type, SpO2 mode, volume, etc.) are
retained indefinitely when the batteries are removed.
If you remove good batteries to turn off the transceiver, keep them together as a
set for later re-use so that both batteries will have the same level of power
remaining.
Batteries should be removed when the transceiver is not in use or is being stored.
DO NOT "STORE" BATTERIES BY LEAVING THEM IN THE
INCORRECT POLARITY POSITION IN THE TRANSCEIVER.
Be careful not to short circuit the batteries. Short circuits are caused when a
piece of metal touches both the positive and negative terminals simultaneously
(for example, by carrying batteries in a pocket with loose change). More than a
momentary short circuit will generally reduce the battery life. In case of a short
circuit, discard both batteries in a pair, or just the shorted one if the batteries are
new.
Checking
the Battery
Power Level
1-22
When the Check button is pressed, the battery gauge on the transceiver indicates
the battery power level. It is reliable only when specified batteries (i.e., AA 1.5V
Alkaline) are used. The battery gauge is also displayed in the Patient Sector at
the Information Center to enable you to closely monitor battery status, for
example, at change of shift.
Basic Operation
Battery Information
Important— In the following table, battery life times are based on Duracell MN
1500 batteries. Battery life for other brands may be different.
Battery Gauge
Approximate Battery
Life Remaining
Approximate
Operating
Time
Remaining
Functionality
4 green indicators
> 75%
> 34.7 hours
Normal operation
3 green indicators
> 50%
> 23.1 hours
Normal operation
2 green indicators
> 25%
> 11.6 hours
Normal operation
1 green indicator
25% to Low Battery level
> 15 minutes
Normal operation
1 red indicator
Battery Low level to
Replace Battery level
< 15 minutes
SpO2 disabled
no indicator
Replace Battery level
(Check batteries for
correct polarity)
none
Transceiver shutdown/
RF shutdown
To check the power level:
Step
Action
Press the Check button to determine the level.
If no indicators flash:
1. Check that the batteries are inserted properly.
2. Replace both batteries.
3. If there are still no indicators on the battery gauge, contact
your Service Provider.
If the indicators illuminate but do not behave as described above,
the transceiver has malfunctioned. Contact your Service Provider.
Basic Operation
1-23
Briefing the Patient
Briefing the Patient
Warning
Patients should be instructed not to open the battery cover while the
transceiver is in use.
If the Telemetry button has been configured to generate a Nurse Call, remote
recording, or both, instruct the patient to use the button when needed.
Note—If desired, you can turn off patient use of the button at the Information
Center. See “Patient-Configurable Settings in Telemetry Setup” on page 6-3.
Pouch Use
1-24
The transceiver is not designed for direct contact with the patient’s skin. During
normal use, the transceiver should be worn over clothing, in a pocket or,
preferably, in a pouch. The carrying pouch is an appropriate means for holding
the transceiver.
Basic Operation
Briefing the Patient
Securing
the Pouch
Step
Action
Secure the pouch on the patient with upper ties around the patient’s
head and arm, and lower ties around the patient’s lower torso.
Warning
To avoid strangulation, do not tie a pouch solely around the
patient’s neck.
Insert the transceiver into the pouch with lead wires and SpO2
sensor cable, if used, exiting from the same side.
Important—Do not coil the cables inside the pouch. They are part of
the wireless system, and need to be freely exposed.
Basic Operation
1-25
Briefing the Patient
Step
Action
Fold the flap down and snap closed.
Check that the patient is comfortable wearing the pouch with
transceiver.
Showering
Warning
Signal quality and leads off detection may be compromised when showering
due to significant patient movement. Appropriate clinical precautions must
be taken.
The transceiver can be used to monitor a patient in the shower, but only when
placed inside a Philips carrying pouch with the flap closed and the snaps
secured. The combination of the transceiver and pouch will withstand showering
for up to 10 minutes.
1-26
Basic Operation
Transceiver Use with TeleMon A02/A03
Drying the
Transceiver
after
Showering
After showering, perform the following steps to continue monitoring:
1.
2.
3.
4.
5.
Pat dry the leadset connections at the electrodes.
Wipe the lead wires with care.
If wet, dry the outside of the transceiver with a non-lint producing cloth.
If wet, wipe the inside of the battery compartment dry. Dry the batteries.
If wet, disconnect the ECG lead block and shake out any water. Dry the
connector pin area with a cotton swab.
Note—The transceiver should not be used for monitoring if the battery
compartment is wet. Remove the batteries and wipe the compartment dry before
continued monitoring use.
Accidental
Wetting
If the transceiver is accidentally immersed in liquid for up to 5 minutes, no
damage to the device and no electrical safety issues for the patient will result.
Remove the device, dry it off, and follow the procedure for cleaning/disinfection
or cleaning/cross-infection prevention under “Troubleshooting” on page 7-15 as
appropriate.
Transceiver Use with TeleMon A02/A03
When tethered to TeleMon, the following transceiver operational behavior will
be in effect.
Alarms
• 3 minute alarm pause/suspend can be initiated only from TeleMon, not
from the transceiver or from the Information Center. The Alarm Suspend/
Pause indicator on the transceiver will accurately reflect the current state
of alarm pause.
• Standby mode is not available.
ECG Operation
• Vb, the second V-lead in 6-wire lead-set, is not supported.
• After a change in leadset, the TeleMon returns to the default ECG
settings, and arrhythmia relearn occurs automatically. Be sure to check the
monitoring leads after you switch leads.
SpO2 Operation
Basic Operation
1-27
Transceiver Use with TeleMon A02/A03
•
•
SpO2 is always in continuous mode.
Changes in SpO2 mode do not take effect until after the transceiver is
disconnected from TeleMon. Mode settings are defined in the following
table:
Mode at TeleMon
•
Mode at Disconnected Transceiver
Continuous
Continuous
5-min.
Continuous
1-min.
Continuous
Manual
Spot Check
After a change in SpO2 sensor, TeleMon returns to the default ECG
settings, and arrhythmia relearn occurs automatically. Be sure to check the
monitoring leads after you change the sensor.
Transceiver Operational Controls & Indicators
• When you press the Telemetry button, a Nurse Call alarm, recording,
alarm and recording, or neither will be generated, depending on the
configuration at the Information Center.
• When you press the Check button, the transceiver battery gauge indicates
full power, regardless of actual battery strength.
• When you press the Telemetry and Check buttons together, there is no
action; a 3-minute alarm pause/suspend can be initiated only from
TeleMon. The alarm pause indicator on the transceiver will accurately
reflect the current state of alarm pause.
• When the transceiver is connected to TeleMon, the battery gauge on the
transceiver and displayed at the Information Center always indicates "full"
regardless of actual battery power. To update the gauge, disconnect the
transceiver and wait several seconds for the updated battery strength to be
displayed.
Defibrillation
• In the event of patient defibrillation, it may take several seconds for the
ECG trace to reappear on the screen.
1-28
Basic Operation
This chapter describes how to pause/suspend alarms temporarily. It also lists
Physiologic (Patient) Alarms and Technical (Inoperative Conditions) Alarms.
Both types of alarms are listed alphabetically.
•
•
•
•
•
•
Alarm Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2
Suspending/Pausing Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2
Standby Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-5
Alarm Behavior with Own Bed Overview . . . . . . . . . . . . . . . . . . . . . . 2-7
Physiologic Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-9
Technical Alarms (INOPs) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-14
Alarms
2-1
Introduction
Alarms
Alarm Indicators
Alarm Indicators
A description of visual and auditory information signals for patient and technical
alarms on the Information Center is located in the IntelliVue Information Center
Instructions for Use and the Information Center Online Help.The Information
Center documentation also includes the default alarm settings and physiological
alarm limit ranges
Testing
Alarm
Indicators
The visual alarm information signal on the transceiver is the Alarms Suspend
icon. During self test, the Alarm Suspend indicator illuminates, and a single tone
indicates association with the Information Center. These positive test results
indicate that the Alarm Suspend icon on the transceiver is functioning correctly
(see “Status Check” on page 1-18).
Suspending/Pausing Alarms
Warning
If the Alarms Suspend indicator on the transceiver remains illuminated
after the button combination to unsuspend alarms is pressed, a the
transceiver malfunction may have occurred. Alarms resume automatically
after the 3 minute suspension period, or you can resume them manually at
the Information Center. The transceiver should be replaced, and the
malfunctioning unit should be sent to your Service Provider.
All alarms for a patient can be suspended/paused from the Information Center,
from the TeleMon Companion Monitor, or, depending on transceiver
configuration, from the transceiver itself. The Alarm Suspend/Pause duration is
fixed at 3-minutes. Alarms automatically resume after 3 minutes, and can be
reactivated manually earlier.
2-2
Alarms
Suspending/Pausing Alarms
If connected to TeleMon, alarms can be suspended only from TeleMon, and not
from the Information Center, and the Alarms Suspend icon on the transceiver is
lit (see “Transceiver Controls - Front” on page 1-7), and an ALARMS
SUSPENDED message appears at TeleMon and the Information Center.
Important—Patient monitoring (display of patient waveforms and numerics)
continues for the duration of Alarm Suspend/Pause.
Step
Action
To activate Alarm Pause/Suspend at the transceiver, press the
Telemetry and Check buttons simultaneously.
While alarms are suspended:
• The transceiver illuminates the Alarms Suspend icon.
•
The message ALARMS SUSPENDED (or ALARMS
PAUSED) is displayed in the Patient Sector at the
Information Center.
For instructions on how to pause/suspend alarms from the
Information Center, see the IntelliVue Information Center
Instructions for Use and the Information Center Online Help.
Alarms
2-3
Suspending/Pausing Alarms
Resuming/
Unsuspending
Alarms
Alarms will be resumed automatically after 3 minutes. You can cancel alarm
suspend manually before the 3-minute period has expired from the transceiver
(see following directions) or from the Information Center.
Step
Action
Press the Telemetry and Check buttons simultaneously.
•
•
•
2-4
Alarms
Auditory alarm indication at the transceiver is switched on.
The Alarm Suspend icon is turned off.
The message ALARMS SUSPENDED (or ALARMS
PAUSED) is removed from the display.
Alternately, you can unsuspend alarms at the Information Center.
See IntelliVue Information Center Instructions for Use or Online
Help for directions.
Standby Mode
Standby Mode
Standby mode is useful when the transceiver is temporarily removed from a
patient or when a patient is intentionally moved out of range of an Access Point.
Standby suspends monitoring so you won’t get any patient alarms or waveforms.
It also disables the out of range audio signal. Patient data and current settings are
preserved during the Standby period.
Standby also serves to turn telemetry monitoring off when a patient is
discharged. Patient data is not erased and unit default settings are not in effect
until the discharge operation is performed. A bed should be put into Infinite
standby until a new patient is connected to the transceiver. Monitoring can then
be restarted by a click of the Resume Monitoring button.
Note—To discharge a patient:
1.
2.
3.
Disconnect the patient.
Remove batteries from the transceiver.
Put bed in Standby.
You place a patient in standby mode at the Information Center. You can select
the duration of the standby period (Infinite, 4, 3, 2, or 1 hours, 30, 20, or 10
minutes). The approximate time of resumption of monitoring will be displayed.
To restart monitoring, click on Resume Monitoring in the Patient Sector.
Note—Unless you are discharging a patient, keep the leads attached until the
patient is in Standby. If you remove the leads before putting a patient into
Standby, you’ll get an ECG LEADS OFF technical alarm, as well as reminders,
if configured.
Initiating
Standby
Step
Action
In the Patient Window or All Controls at the Information Center,
select the Standby button.
Select the patient destination from the pre-defined list.
Alarms
2-5
Standby Mode
Step
Action
Depending on your equipment configuration, select the duration of
the standby period (30, 20 or 10 minutes; 2, 3 or 4 hours; or
infinite).
Select the Suspend Monitoring button. This suspends all
monitoring and displays the following messages in the Patient
Sector: PATIENT LOCATION:xxx (for example, X-ray) and
TELEMETRY STANDBY. The approximate time of resumption is
also displayed.
Resuming
Monitoring
Step
Action
If the standby period has expired when the patient returns to
the unit, monitoring will resume automatically.
To verify the resumption of monitoring, press the Check button.
You should hear a single beep.
If the standby period has not expired when the patient returns
to the unit, monitoring must be reactivated manually.
Either click Resume Monitoring at the Information Center or
press the Check button on the transceiver to establish
reassociation. The audible tone (single beep) at the transceiver
verifies that monitoring has resumed.
Note—When you take an EASI patient out of Standby, the lead settings will be
reset to the Information Center’s default lead settings.
2-6
Alarms
Alarm Behavior with Own Bed Overview
Alarm Behavior with Own Bed Overview
Both the IntelliVue Patient Monitor and the telemetry system source alarms. The
following tables summarize alarm behavior when Own Bed Overview is used.
For detailed information, see the IntelliVue Patient Monitor Instructions for Use
and the IntelliVue Information Center Instructions for Use.
Alarm Pause/Suspend
When alarms are paused/suspended, the messages and types of alarms affected
depend on where the pause/suspend was initiated.
If alarms are
paused/
suspended
from....
Information
Center
these alarms are
paused/
suspended
both bedside and
telemetry
measurements
IntelliVue
bedside
Patient Monitor measurements only
and this message appears
Information Center: ALARMS
PAUSED or ALARMS
SUSPENDED
Bedside: ALARMS OFF in
Overview window and ALARMS
PAUSED or ALARMS OFF on the
monitor (depending on
configuration)
Information Center: BED
ALARMS PAUSED or BED
ALARMS SUSPEND (depending on
configuration)
Bedside: ALARMS PAUSED or
ALARMS OFF
Alarms
2-7
Alarm Behavior with Own Bed Overview
Alarm Silence
When an active alarm is silenced, the types of alarms that are silenced depend on
the alarm source and where the silence was initiated.
Effect at
Paired
Bedside
Effect at
Information
Center
Bedside
Alarm is
silenced
Bedside alarm is
silenced. There is
no effect on
telemetry alarms
Bedside
No effect on
telemetry
alarms
No effect on
telemetry alarms
Alarm
Source
Where
Silenced
Bedside alarm
Telemetry
alarm
Bedside and/or Overview
Bedside or
Bedside alarm is
telemetry alarm Silence Control telemetry alarm silenced (if
is silenced
Silence
Overview
Alarms is
configured)
Bedside and/or Information
telemetry alarm Center
Bedside or
Bedside or
telemetry alarm telemetry alarm
is silenced
is silenced
Note—If tethered to TeleMon, silencing an active alarm at TeleMon silences the
alarm at TeleMon only. It has no effect on the paired bedside monitor or the
Information Center.
2-8
Alarms
Physiologic Alarms
Alarm/INOPs at the Information Center
The alarms and INOPs that are displayed, recorded and stored at the Information
Center depend on the type of alarm.
Type of Alarm/INOP
Effect at Information Center
All ECG telemetry alarms and
INOPs
Note—ECG is generated from
telemetry when paired.
Displayed, recorded (if
configured), and stored
Bedside ECG INOPs and RESP
INOPs
Ignored. Not displayed, recorded,
or stored
Bedside non-ECG alarms and
non-ECG INOPs
Displayed, recorded (if
configured), and stored
Physiologic Alarms
Physiologic alarms indicate a life-threatening situation or a less urgent situation
such as heart rate beyond limits. There are no physiologic alarm signals
generated by the transceiver. All physiologic alarms are generated at the
IntelliVue Information Center, and all alarm signals must be acknowledged
at the Information Center.
Arrhythmia alarm chaining and other aspects of alarm behavior, such as alarm
levels, setting alarm limits, customizing arrhythmia alarm settings on a per
patient basis, switching individual measurement alarms on/off, and reviewing
alarm messages, are described in IntelliVue Information Center Instructions for
Use.
There are two levels of arrhythmia analysis available at the Information Center:
Basic and Enhanced. Enhanced analysis includes Basic alarms.
Alarms
2-9
Physiologic Alarms
In the table, Red (***) alarms are listed alphabetically, followed by the Yellow
(**) alarms, the Yellow (*) arrhythmia alarms.
Physiologic (Patient) Alarms
Alarm Text
Priority
Condition
Source
***ASYSTOLE
Red
Asystole. No QRS for 4 consecutive
seconds
ST/AR
Basic &
Enhanced
Arrhythmia
*** BRADY yyy < xxx
Red
Extreme Bradycardia. HR less than
extreme Brady HR Limit
ST/AR
Enhanced
Arrhythmia
*** DESAT
Red
Very Low SpO2 Saturation. SpO2 value
below desaturation limit (10% or 10
"points" below low limit).
SpO2
*** EXTREME BRADY
Red
Extreme Bradycardia. HR less than
extreme Brady HR Limit
ST/AR
Basic &
Enhanced
Arrhythmia
*** EXTREME TACHY
Red
Extreme Tachycardia. HR greater than
extreme Tachy HR Limit
ST/AR
Basic &
Enhanced
Arrhythmia
*** TACHY yyy > xxx
Red
Extreme Tachycardia. HR greater than
extreme Tachy HR Limit
ST/AR
Enhanced
Arrhythmia
*** VFIB/TACH
Red
Ventricular Fibrillation. Fibrillatory
waveform for 4 consecutive seconds
ST/AR
Basic &
Enhanced
Arrhythmia
2-10
Alarms
Physiologic Alarms
Physiologic (Patient) Alarms
Alarm Text
Priority
Condition
Source
*** VTACH
Red
Ventricular Tachycardia. Sustained run of
PVCs accompanied by a high heart rate
ST/AR
Basic &
Enhanced
Arrhythmia
** NURSE CALL
Yellow
Patient or nurse button press on the
transceiver (when configured for Nurse
Call operation)
Also initiated if the installation includes a
paging system and if the Information
Center is configured for paging upon
receipt of Nurse Call signal.
Clinicianinitiated at
transceiver
or by
paging
subsystem
** SpO2 HIGH
Yellow
High SpO2. SpO2 value greater than high
SpO2 Limit.
SpO2
** SpO2 LOW
Yellow
Low SpO2. SpO2 value less than low
SpO2 Limit.
SpO2
** SpO2 yyy > xxx or
Yellow
High SpO2. SpO2 value greater than high
SpO2 Limit.
SpO2
** SpO2 yyy < xxx or
Yellow
Low SpO2. SpO2 value less than low
SpO2 Limit.
SpO2
* HR HIGH
Yellow
High Heart Rate. HR greater than high
HR Limit
ST/AR
Basic &
Enhanced
Arrhythmia
* HR LOW
Yellow
Low Heart Rate. HR less than low HR
Limit
ST/AR
Basic &
Enhanced
Arrhythmia
Alarms
2-11
Physiologic Alarms
Physiologic (Patient) Alarms
Alarm Text
Priority
Condition
Source
* HR yyy > xxx
Yellow
High Heart Rate. HR greater than high
HR Limit
ST/AR
Enhanced
Arrhythmia
* HR yyy < xxx
Yellow
Low Heart Rate. HR less than low HR
Limit
ST/AR
Enhanced
Arrhythmia
* IRREGULAR HR
Yellow
Irregular Heart Rate. Constantly irregular
HR.
ST/AR
Enhanced
Arrhythmia
* MISSED BEAT
Yellow
Missed Beat. Beat omitted
ST/AR
Enhanced
Arrhythmia
* MULTI ST Lx, Ly
Yellow
Multi ST Leads exceeding Limit (EASI
mode or when selected). Two ST leads
(Lx=Lead X and Ly=Lead Y) exceed
alarm limit elevation or depression for >
60 seconds
ST/AR
Arrhythmia
* MULTIFORM PVCs
Yellow
Multiform PVCs
ST/AR
Enhanced
Arrhythmia
* NON-SUSTAIN VT
Yellow
Non-Sustained VT. Non-sustained
Ventricular Tachycardia
ST/AR
Enhanced
Arrhythmia
* PACER NOT CAPT
Yellow
Pacer Not Capture. Missed beat with pace
pulse (paced patient).
ST/AR
Basic &
Enhanced
Arrhythmia
2-12
Alarms
Physiologic Alarms
Physiologic (Patient) Alarms
Alarm Text
Priority
Condition
Source
* PACER NOT PACE
Yellow
Pacer Not Pacing. Missed beat without
pace pulse (paced patient).
ST/AR
Basic &
Enhanced
Arrhythmia
* PAIR PVCs
Yellow
Pair of PVCs.
ST/AR
Enhanced
Arrhythmia
* PAUSE
Yellow
Pause. No QRS for more than x seconds
ST/AR
Enhanced
Arrhythmia
* PVC > xx/min
Yellow
PVCs > xx/min. PVCs greater than Rate
Limit
ST/AR
Basic &
Enhanced
Arrhythmia
* R-ON-T PVCs
Yellow
R-on-T PVCs
ST/AR
Enhanced
Arrhythmia
* RUN PVCs
Yellow
Run PVCs. Run of PVCs length >= 2
ST/AR
Enhanced
Arrhythmia
* ST lead > xxx
Yellow
STx > Elevation limit. ST segment is
elevated
ST/AR
Arrhythmia
* ST lead < xxx
Yellow
STx < Depression limit. ST segment is
depressed.
ST/AR
Arrhythmia
* SVT
Yellow
Supra Ventricular Tachycardia. SVT for >
15 seconds
ST/AR
Enhanced
Arrhythmia
Alarms
2-13
Technical Alarms (INOPs)
Physiologic (Patient) Alarms
Alarm Text
Priority
Condition
Source
* VENT BIGEMINY
Yellow
Ventricular Bigeminy. Predominant
Bigeminy rhythm present.
ST/AR
Enhanced
Arrhythmia
* VENT RHYTHM
Yellow
Ventricular Rhythm. Ventricular rhythm
present.
ST/AR
Enhanced
Arrhythmia
* VENT TRIGEMINY
Yellow
Ventricular Trigeminy. Predominant
Trigeminy rhythm present.
ST/AR
Enhanced
Arrhythmia
Notes: xxx = limit that was exceeded; yyy = current value.
* NBP alarms are processed independently at the Information Center.
The alarm delay from TeleMon to the Information Center is not more than 10 seconds.
Technical Alarms (INOPs)
Technical Alarms, or INOPs, are sourced at the transceiver, the ST/AR
algorithm running at the Information Center, or TeleMon Companion Monitor,
and identify inoperative conditions (that is conditions where the system cannot
measure or detect alarm conditions reliably). There are three levels of Technical
Alarms:
•
•
•
2-14
Alarms
Severe - Monitoring and alarms disabled. Audible tone at the Information
Center. Must be acknowledged by a clinician.
Hard - Monitoring and alarms are disabled. Audible tone at the
Information Center.
Soft - Monitoring and alarms remain active. No audible tones are
generated.
Technical Alarms (INOPs)
Technical Alarms (Inoperative Conditions) (in alphabetic order)
Alarm Text
Priority
Condition
What to do
BATTERY LOW
Soft
Power is low.
Replace batteries promptly to
avoid transceiver shutdown
and cessation of monitoring.
CANNOT ANALYZE
ECG
Hard
Arrhythmia algorithm
cannot reliably analyze the
ECG data on any
monitored leads.
Assess the lead selections,
initiate relearn, and validate
analyzed rhythm.
CANNOT ANALYZE ST
Soft
ST algorithm cannot
reliably generate any valid
ST values on any
monitored lead.
Review the ECG signal
quality and correct if
necessary. Reposition the Is
and J points.
CHARGE MON BAT
Hard
TeleMon battery charge is
less than or equal to 25%.
Connect TeleMon to AC
power and charge battery, or
insert battery with charge
greater than 25%.
CUFF NOT DEFLATED
Severe
Cuff pressure is greater
than a specified safety limit
for a period of time.
Remove cuff from patient
and disconnect from tubing.
Gently expel any air. If water
in cuff, replace cuff.
Reconnect, and reapply cuff
to patient.
Note—If the alarms are
suspended, this INOP will
unsuspends them at the
Information Center and
TeleMon. To clear the INOP
message, initiate a new NBP
measurement.
Alarms
2-15
Technical Alarms (INOPs)
Technical Alarms (Inoperative Conditions) (in alphabetic order)
Alarm Text
Priority
Condition
What to do
ECG EQUIPMENT MALF Hard
Failure of the ECG
equipment or failure to
calibrate ECG.
Replace the transceiver or
calibrate ECG with Service
Tool.
ECG LEADS OFF
Hard
Multiple leads off
Reattach ECG leads to
patient.
 LEAD OFF
Hard
Primary lead is off.
Reattach ECG lead to
patient.
Note—If primary lead is
MCL, lead will be
identified as V in INOP
text.
 LEAD OFF
Soft
Non-primary lead is off.
Reattach ECG lead to
patient.
INVALID LEADSET
Hard
Bad lead selection switches
in the transceiver
Replace transceiver case.
Use supported leadset.
Contact Service.
NO SIGNAL
Hard
Patient is out of range,
radio board has failed, ICN
connection failure, or no
batteries in transmitter.
Make sure that the
transceiver is in own caregroup range and has good
batteries. Replace the
transceiver if Power On Self
Test fails, and notify Service
Provider.
REPLACE BATTERY
Dead battery. No
Hard,
Latched monitoring is occurring.
Message
remains
until
acknowle
dged by
clinician.
2-16
Alarms
Replace batteries.
Technical Alarms (INOPs)
Technical Alarms (Inoperative Conditions) (in alphabetic order)
Alarm Text
Priority
Condition
What to do
SOME ECG ALRMS OFF
Soft
Some yellow arrhythmia
alarms have been turned off
for this patient.
For information only.
SpO2T EQUIP MALF
Hard
Malfunction in the SpO2
equipment
SpO2 board needs to be
replaced. Call Service.
SpO2T ERRATIC
Hard
Erratic SpO2
measurements, often due to
a faulty sensor or invalid
SpO2 measurements, or
incorrect transducer
position
Repeat measurement,
reposition sensor on patient,
or finally, replace sensor.
SpO2T EXTD UPDATE
Numeric is replaced by a
-?-.
Soft
The update period of
displayed values is
extended due to an NBP
measurement on the same
limb or an excessively
noisy signal.
If NBP is not active, check
the sensor placement.
Reposition the sensor on
patient, or replace sensor.
SpO2T INTERFERENCE
Hard
Level of ambient light or
level of electrical
interference are so high that
the SpO2 sensor cannot
measure SpO2 and pulse
rate.
Reduce ambient light to
sensor or electrical noise
sources.
SpO2T LOW PERFUSION
Soft
Accuracy may be reduced
due to low perfusion. Data
displayed with ?. Warm the
site.
Increase perfusion. Change
sensor site. Avoid site distal
to BP cuff or intra-arterial
line.
SpO2T NO SENSOR
Hard
No sensor attached to SpO2
device
Attach SpO2 sensor.
Alarms
2-17
Technical Alarms (INOPs)
Technical Alarms (Inoperative Conditions) (in alphabetic order)
Alarm Text
Priority
Condition
What to do
SpO2T NOISY SIGNAL
Hard
Excessive patient
movements or electrical
interference are causing
irregular pulse patterns
Reduce movement or
electrical noise sources.
SpO2T NON-PULSATILE
Hard
Pulse is too weak or not
detectable
Check connection to patient.
Change sensor site. Avoid
site distal to BP cuff or intraarterial line.
SpO2T SENSOR MALF
Hard
Malfunction of the SpO2
sensor/adapter-cable
Replace sensor.
TELEMETRY STANDBY
Soft
Information Center standby
mode timer is active, or
patient was not returned to
telemetry coverage area.
There is no data from bed.
Cancelled when patient is
removed from Standby.
TRANSMITTER MALF
Hard
Transceiver malfunction
Replace and notify Service
Provider.
TRANSMITTER OFF
Hard
RF shut off after 10
minutes of leads off
Reattach ECG leads to
patient.
WEAK SIGNAL
Soft
Patient is at outer range of
the radio coverage area.
Telemetry pack is receiving
a weak signal with high
data loss from the AP.
Return patient to the radio
coverage area. If patient is in
close proximity to AP,
replace telemetry pack. If
condition exists for multiple
devices in a specific area, the
AP in that area is suspect.
Contact Service.
2-18
Alarms
This chapter covers the specifics of ECG measurement. It includes the
following sections:
•
•
•
•
•
•
•
ECG Safety Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-2
Measuring ECG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3
Positioning ECG Electrodes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-8
Connecting the ECG Cable. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-19
Verifying Electrode Connections . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-22
Monitoring during Leads Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-23
Optimizing ECG Measurement Performance . . . . . . . . . . . . . . . . . . . 3-25
ECG Monitoring
3-1
Introduction
ECG Monitoring
ECG Safety Information
ECG Safety Information
Warning
For ALL Patients:
Always confirm Information Center observations with clinical observation
of the patient before administering interventions.
Every lead must be secured to an electrode on the patient.
Conductive parts of electrodes must not contact earth or other conductive
parts.
Philips recommends that you change the lead label only to reflect the
physical placement of electrodes. This will ensure a match between the
monitored lead and the label, and prevent any possible confusion.
When switching from EASI to standard monitoring, there is a loss of data
for 30 seconds.
For PACED Patients:
The output power of the transceiver and other sources of radio frequency
energy, when used in the proximity of a pacemaker, can be sufficient to
interfere with pacemaker performance. Due to the shielding effects of the
body, internal pacemakers are somewhat less vulnerable than external
pacemakers. However, caution should be exercised when monitoring any
paced patient.
In order to minimize the possibility of interference, position electrodes,
electrode wires, and the transceiver as far away from the pacemaker as
possible.
Consult the pacemaker manufacturer for information on the RF
susceptibility of their products and the use of their products with the
Philips IntelliVue Telemetry System. See the IntelliVue Information Center
Instructions for Use for additional information on monitoring paced
patients.
3-2
ECG Monitoring
Measuring ECG
Measuring ECG
The electrocardiogram (ECG) measures the electrical activity of the heart and
displays it on the Information Center as a waveform and a numeric.
There is no cardiotach within the transceiver; cardiotach analysis resides in the
arrhythmia algorithm at the Information Center. Arrhythmia analysis is always
turned on for telemetry patients. Arrhythmia analysis is either basic or enhanced,
depending on the product configuration.
EASI ECG
EASI® derived 12-lead ECGs and their measurements are approximations to
conventional 12-lead ECGs. As the 12-lead ECG derived with EASI is not
exactly identical to the 12-lead conventional ECG obtained from an
electrocardiograph, it should not be used for diagnostic interpretations.
ECG
Leadsets
The IntelliVue Transceiver supports 3-, 5-, and 6-wire leadsets. It detects the
inserted leadset type and automatically determines the ECG measurement and
transmitted leads. The Leadset Insertion Guide on the device will assist you in
ensuring the correct measurement during transceiver usage (see “Connecting the
ECG Cable” on page 3-19). The 5-wire leadset can be used for either standard or
EASI electrode configurations. The leadsets are compatible with the 5- and 3wire leadsets used with the IntelliVue family of monitors and with M2601B
transmitters.
The electrode placements for the illustrations in this chapter use the AAMI
labels and colors and are summarized in the following table.
Leadset
Electrode Color (AAMI)
Electrode Location
3-wire
Black
White
Red
LA
RA
LL
ECG Monitoring
3-3
Measuring ECG
ECG Leads
Monitored
3-4
ECG Monitoring
Leadset
Electrode Color (AAMI)
Electrode Location
5-wire
(Standard mode)
Black
White
Red
Green
Brown
LA
RA
LL
RL
5-wire (EASI
mode)
Black
White
Red
Green
Brown
RL
6-wire
Black
White
Red
Brown
Green
Brown/White
LA
RA
LL
Va
RL
Vb
Depending on the leadset connected to the transceiver, a different set of
viewable leads are available at the Information Center. The transceiver can
Measuring ECG
source up to four raw ECG waves. The transceiver automatically recognizes the
leadset connected.
If you are using ...
these leads can be selected at the
Information Center
3-wire
I, II, III
If lead selection is enabled, sourced waves are
received as:
• Channel 1 - I
• Channel 2 = II
• Channel 3 = III
If lead selection is disabled, the sourced wave is
II.
Default is II.
5-wire (Standard mode)
I, II, III, aVR, aVL, aVF, MCL and V
Sourced waves are received as:
• Channel 1 - I
• Channel 2 = II
• Channel 3 = III
Defaults are II, V, III.
5-wire (EASI mode)
I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5,
V6
In EASI mode, the sourced waves are received
as:
• Channel 1 = Vector 1 (A-I)
• Channel 2 = Vector 2 (A-S)
• Channel 3 = Vector 3 (E-S)
Note—Arrhythmia monitoring is performed only
on the primary and secondary leads selected at
the Information Center, although you can view
and perform ST analysis on all 12 EASI derived
leads.
ECG Monitoring
3-5
Measuring ECG
If you are using ...
these leads can be selected at the
Information Center
6-wire
(not supported in TeleMon)
I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5,
V6, V7, V8, V9, V3R, V4R, V5R.
Sourced waves are received as:
• Channel 1 = II
• Channel 2 = III
• Channel 3 = Va
• Channel 4 = Vb
The two chest leads, Va and Vb, can be placed
on the patient in any of the V lead positions (V1
through V9, V3R, V4R, V5R). Lead assignment
is available at the Information Center. When
unassigned, the chest leads use the defaults.
Defaults are II, III, Va=V2, Vb=V5.
Note—When display of the pleth wave is
enabled at the Information Center, the second
chest lead (Vb) is not available for monitoring
due to bandwidth limit. That is, the lead label
assigned to Vb cannot be selected for Va even
though Vb does not appear to be used.
Reconstructed
Leads
Reconstruction of leads from the sourced wave is defined by the calculations in
the following table. EASI reconstructed leads are a linear combination of all
three raw EASI leads. Default labels/leads are shown in bold text.
ECG Lead
3-6
ECG Monitoring
3-Lead
5-Lead
Standard
6-Lead
Clinical Calculations
in terms of electrodes
LA-RA
Measuring ECG
ECG Lead
3-Lead
5-Lead
Standard
II
II
II
LL-RA
III
III
III
LL-LA
MCL
Va-LA, C=Va (see Note)
aVR
aVR
RA-(LA+LL)/2
aVL
aVL
LA-(RA+LL)/2
aVF
aVF
LL-(LA+RA)/2
6-Lead
Clinical Calculations
in terms of electrodes
C-(RA+LA+LL)/3, where C=V
Va
C-(RA+LA+LL)/3, where
Va=V2 position
Vb
Vb-(RA+LA+LL)/3, where Vb
=V5
ECG Monitoring
3-7
Positioning ECG Electrodes
Positioning ECG Electrodes
Warning
Do not mix and match electrodes of different types. In particular, do not use
electrodes of dissimilar metals. This helps ensure optimal signal quality.
Warning
When you are connecting the electrodes or the patient cable, make sure that
the connectors never come into contact with other conductive parts, or with
earth. In particular, make sure that all of the ECG electrodes are attached
to the patient, to prevent them from contacting conductive parts or earth.
Warning
Non-manufacturer supplied accessories and supplies can corrupt the
performance of the equipment. Use only AAMI EC-12 compliant electrodes
with this device. Use of electrodes that are non-compliant may provide
erroneous results.
Caution
To protect the transceiver from damage during defibrillation, to ensure accurate
ECG information, and to provide protection against signal noise and other
interference, use only ECG electrodes and cables specified by Philips.
To make it possible to compare measured ECG signals, the electrodes (or
leadsets) are placed in standardized positions, forming so-called "leads". To
obtain ECG signals optimized for use in diagnosis and patient management in
different care environments, different leadsets in varying lead placements can be
used. You can use either standard lead placements or EASI lead placements with
the transceiver.
3-8
ECG Monitoring
Positioning ECG Electrodes
When placing electrodes on the patient, choose a flat, non-muscular site where
the signal will not be impacted by either movement or bones. Correct lead
placement is always important for accurate diagnosis. Especially in the
precordial leads, which are close the heart, QRS morphology can be greatly
altered if an electrode if moved away from its correct location.
In addition to correct positioning of the electrodes, optimal skin preparation
prior to electrode placement will help ensure a clear signal for diagnosis.
Step
Action
Prepare the patient’s skin. Good electrode-to-skin contact is
important for a good ECG signal, as the skin is a poor conductor of
electricity.
• Select sites with intact skin, without impairment of any kind.
• Clip or shave hair from the site as necessary.
• Wash site with soap and water, leaving no soap residue.
Note--Philips does not recommend using ether or pure
alcohol, because they dry the skin and increase the resistance.
• Dry thoroughly.
• Use ECG skin preparation paper (abrasive) to remove dead
skin cells and to improve the conductivity of the electrode
site.
ECG Monitoring
3-9
Positioning ECG Electrodes
Step
Action
Check electrodes for moist gel, and attach to the clips. If you are not
using pre-gelled electrodes, apply electrode gel to the electrodes
before placement.
Note—Gel must be moist to provide a good signal.
Place the electrodes on the patient according to the lead placement
you have chosen (see Electrode Placement following). Place the
edge down, then "roll down" the rest of the pad. Press firmly around
the adhesive edge toward the center.
Note—When placing electrodes, choose a flat, non-muscular site
where the signal will not be interfered with by either movement or
bones. Correct lead placement is always important for accurate
measurement, especially in the precordial leads, which are close to
the heart. QRS morphology can be greatly altered if an electrode is
moved away from its correct location.
Electrode
Placement
Diagrams for 5-lead standard and EASI electrode placement are located on the
back of the transceiver. Additional lead placement information is available in the
Online Help in the IntelliVue Information Center.
Philips recommends that electrodes be changed every 24 hours.
3-10
ECG Monitoring
Positioning ECG Electrodes
Locating the
Fourth
Intercostal
Space
Angle of Lewis
For accurate chest electrode placement and measurement, it is important to
locate the fourth intercostal space. This can be done using the Angle of Lewis.
1. Locate the second intercostal space by first palpating the Angle of Lewis
(the bony protuberance where the body of the sternum joins the
manubrium). This rise in the sternum is where the second rib is attached,
and the space just below this is the second intercostal space.
2. Palpate and count down the chest until you locate the fourth intercostal
space.
ECG Monitoring
3-11
Positioning ECG Electrodes
3-Lead
Placement
RA
LA
LL
3-12
ECG Monitoring
Lead
Placement
RA
directly below the clavicle and near the right
shoulder
LA
directly below the clavicle and near the left
shoulder
LL
on the left lower abdomen
Positioning ECG Electrodes
5-Lead
Placement
(Standard
Mode)
RA
LA
V1
V2
V3
V4 V5 V6
RL
LL
Lead
Placement
RA
directly below the clavicle and near the right
shoulder
LA
directly below the clavicle and near the left
shoulder
LL
on the left lower abdomen
RL
on the right lower abdomen
on the chest, the position depends on your
required lead selection. The default position is V2.
V1
on the fourth intercostal space at the right sternal
border
ECG Monitoring
3-13
Positioning ECG Electrodes
3-14
ECG Monitoring
Lead
Placement
V2
on the fourth intercostal space at the left sternal
border
V3
midway between the V2 and V4 electrode
positions
V4
on the fifth intercostal space at the left
midclavicular line
V5
on the left anterior axillary line, horizontal with
the V4 electrode position
V6
on the left anterior axillary line, horizontal with
the V4 electrode position
Positioning ECG Electrodes
5-Lead
Placement
(EASI Mode)
Warning
EASI derived 12-lead ECGs and their measurements are approximations to
conventional 12-lead ECGs. As the 12-lead ECG derived with EASI is not
exactly identical to the 12-lead conventional ECG obtained from an
electrocardiograph, it should not be used for diagnostic interpretations.
EASI lead placement is supported for adult patients only
Lead
Corresponds to
Standard Lead
Placement
on the lower sternum at the level of the
fifth intercostal space
LL
on the left midaxillary line at the same
level as the E electrode
ECG Monitoring
3-15
Positioning ECG Electrodes
Lead
Corresponds to
Standard Lead
Placement
LA
on the upper sternum
RA
on the right midaxillary line at the same
level as the E electrode
Reference
can be anywhere, usually below the sixth
rib on the right hip
Note—Make sure that the D and E electrodes line up vertically on the sternum,
and that the I, E and A electrodes align horizontally.
6-Lead
Placement
A 6-lead placement uses the same four limb leads as 5-lead standard placement,
and two precordial leads - referred to at the Information Center as Va and Vb.
The default position of Va - the brown lead - is at the V2 position.
The default position for Vb - the brown/white lead - is at the V5 position.
Your unit may use other precordial leads for Va and Vb. In that situation, you
need to assign those new positions in the Patient Window at the Information
Center. The Va and Vb default positions can be changed in the configuration at
the Information Center on a per patient basis.
3-16
ECG Monitoring
Positioning ECG Electrodes
RA
LA
V1
V2
V3
V4 V5 V6
RL
LL
Lead
Placement
RA
directly below the clavicle and near the right
shoulder
LA
directly below the clavicle and near the left
shoulder
RL
on the right lower abdomen
LL
on the left lower abdomen
Va
on the chest, the position depends on your
required lead selection. The Philips default
position is V2. For other positions, relabel the lead
at the Information Center.
ECG Monitoring
3-17
Positioning ECG Electrodes
3-18
ECG Monitoring
Lead
Placement
Vb
on the chest, the position depends on your
required lead selection. The Philips default
position is V5. For other positions, relabel the lead
at the Information Center.
V1
on the fourth intercostal space at the right sternal
border
V2
on the fourth intercostal space at the left sternal
border
V3
midway between the V2 and V4 electrode
positions
V4
on the fifth intercostal space at the left
midclavicular line
V5
on the left anterior axillary line, horizontal with
the V4 electrode position
V6
on the left anterior axillary line, horizontal with
the V4 electrode position
Connecting the ECG Cable
Connecting the ECG Cable
Note—Your transceiver may have alignment guides to assist you in leadset
insertion.
Step
Action
Match the arrow on the ECG cable with the arrow on the Lead
Insertion Guide according to the lead type you have chosen, and
insert the ECG cable into the transceiver.
Important—Make sure that the cable is pushed completely into
the transceiver. When correctly inserted, the orange line at the
base of the cable is not visible.
3-wire
Match the arrow on the cable
with the left arrow (labeled
EASI, 3) on the Leadset Insertion Guide.
Note—Leadset is keyed for
IntelliVue TRx+
M4841A
EASI, 3 5.6
only one insertion position.
ECG Monitoring
3-19
Connecting the ECG Cable
Step
Action
5-wire Standard
Match the arrow on the cable
with the right arrow (labeled 5,
6) on the Leadset Insertion
Guide.
IntelliVue TRx+
M4841A
EASI, 3 5.6
5-wire EASI
Match the arrow on the cable
with the left arrow (labeled
EASI, 3) on the Leadset Insertion Guide.
IntelliVue TRx+
M4841A
EASI, 3 5.6
Note—If you are using a 5-wire leadset in both Standard and EASI
modes, insert the protective plug into the open lead port with the
wide lip facing the leads. Then, press down firmly so that the plug is
securely under the leadset and the orange line is not visible.
3-20
ECG Monitoring
Connecting the ECG Cable
Step
Action
6-wire
Match the arrow on the cable
with the right arrow (labeled
5,6) on the Leadset Insertion
Guide.
IntelliVue TRx+
M4841A
Check that the correct Electrode Indicators are lit for the leadset you
are using, and that the EASI indicator light is illuminated
appropriately. See “Verifying Electrode Connections” on page 3-22.
•
•
Cable
Disconnection
EASI, 3 5.6
When using 5-lead standard, the EASI indicator does not
illuminate.
When using EASI, the EASI indicator illuminates
momentarily.
For 3-lead, select the lead label(s) at the Patient Window.
When disconnecting the leadset from the transceiver, grasp the leadset firmly
and pull free. Do not pull on the lead wires.
ECG Monitoring
3-21
Verifying Electrode Connections
Verifying Electrode Connections
The electrode indicators enable you to verify that the leads are available for the
desired monitoring. Each electrode is color-coded. Pressing and holding the
Check button enables you to view the leadset status. During routine use of the
transceiver for monitoring, all lead indicators are off.
To verify electrode connections, use the following procedure:
Step
Action
Press and hold the Check button for 2 seconds
Expected Response:
•
•
•
•
•
If 3-wire cable is attached: Red, White and Black indicators
illuminate, then all turn off.
If 5-wire cable in Standard mode is attached: Red, White,
Black, Green & Brown indicators illuminate, then all turn off.
If 5-wire cable in EASI mode is attached: Red, White, Black,
Green & Brown indicators illuminate, then all turn off. The
EASI indicator also illuminates briefly.
If 6-wire cable is attached: Red, White, Black, Green, Solid
Brown and Brown/White indicators illuminate, then all turn
off.
If no leadset is attached: all indicators are off.
Unexpected Response:
Any other response indicates a problem with the transceiver. Check
the leadset connection and/or use a new leadset. If the problem is
not corrected, contact your Service Provider.
3-22
ECG Monitoring
Monitoring during Leads Off
During routine monitoring, the electrode indicators also notify you if one or
more leads are not functioning. When a LEADS OFF condition occurs, the
transceiver automatically illuminates the indicator corresponding to the missing
lead.
Monitoring during Leads Off
ECG Fallback and Extended monitoring states are supported for the transceiver
when the primary and/or secondary leads are in a Leads Off INOP condition.
Both these states are entered into after 10 seconds of Leads Off in an attempt to
maintain monitoring and arrhythmia analysis.
ECG
Fallback
Multilead
Analysis
ECG Fallback occurs when the primary lead is in Leads Off for 10 seconds and
a secondary lead is available. ECG Fallback must be configured on by your
Service Provider.
If there is a LEADS OFF technical alarm in the primary lead for > 10 seconds,
the active secondary lead becomes the primary lead. The arrhythmia algorithm
switches the leads on the display, but relearn does not occur. When the Leads
Off condition is corrected, the leads are switched back to their original state.
Single Lead
Analysis
For single lead analysis, if there are two leads available, the secondary lead is
made the primary lead until the Leads Off condition is corrected. The arrhythmia
algorithm performs a relearn using the available lead.
Fallback for
EASI
If one of the derived EASI leads is in a technical alarm condition, a flat line is
displayed. After 10 seconds, the directly acquired EASI AI, AS, or ES lead,
depending on which is available, is displayed with the label "ECG". Arrhythmia
relearn is performed with transition to or from EASI Fallback monitoring using
the available lead(s).
ECG Monitoring
3-23
Monitoring during Leads Off
Extended
Monitoring
Extended monitoring occurs when both the primary and secondary leads are in
Leads Off for 10 seconds and another lead is available. It becomes the primary
lead and the arrhythmia algorithm performs a relearn.
Extended Monitoring applies if:
•
•
Relearning
Telemetry is configured for Extended Monitoring ON.
The leas set provides more than two leads (e.g., when using a 5-wire
leadset ).The leadset must provide more than two leads, and Extended
monitoring must be configured on by your Service Provider.
Whenever there is a Leads Off condition, the arrhythmia algorithm performs a
Relearn, using the available leads.
Warning
Since Relearn happens automatically, if learning takes place during
ventricular rhythm, the ectopics can be incorrectly learned as the normal
QRS complex. This can result in missed detection of subsequent events of
V-Tach and V-Fib. For this reason, you should:
1. Respond promptly to any technical alarm.
2. Ensure that the arrhythmia algorithm is labeling beats correctly.
Using EASI Leads to Troubleshoot
If there is artifact in the ECG waves or a CANNOT ANALYZE ECG technical
alarm condition is in effect, you can use the three EASI leads to troubleshoot:
1. Click 12-Lead ECG on the Patient Window, then on 3 EASI Leads.
2. The three directly acquired EASI leads will be displayed so that you can
determine which electrodes are causing the problem and need to be
replaced.
3-24
ECG Monitoring
Optimizing ECG Measurement Performance
Optimizing ECG Measurement Performance
While telemetry monitoring offers many advantages, it can be a challenge. The
reliability and quality of the signal transmission through the air and hospital
walls is governed by a number of variables which can be difficult to control. A
telemetry system cannot be as dependable as a hardwired bedside monitor that
transmits its signal through a wire.
The effect of interference on the Philips IntelliVue Telemetry System ranges
from a momentary loss of ECG to complete inoperability, depending on the
situation. The strength, frequency, and proximity of the source of interference to
the transceiver devices or the access point system are factors that determine the
degree of severity. In cases where the source of interference is known - for
example, cellular phones, magnetic equipment such as MRI, other radio or
motorized equipment - removing or moving away from the source of
interference will increase the equipment's dependability.
Warning
Philips IntelliVue Telemetry System should not be used for primary
monitoring in applications where the momentary loss of the ECG is
unacceptable.
In this section, we'll investigate some of the problems affecting ECG signal
clarity and when possible, show you how you can greatly enhance performance.
Important—Philips IntelliVue Telemetry System also emits radio frequencies
that can affect the operation of other devices. Contact the manufacturer of other
equipment for possible susceptibility to these frequencies.
The
Telemetry
Signal
The transceiver worn by the patient acquires the patient's physiological data,
amplifies and digitizes it, detects pace pulses and broadcasts this information via
radio waves to the Philips IntelliVue Telemetry System. Since the signal passes
through the air, it is susceptible to interference from many sources.
ECG Monitoring
3-25
Optimizing ECG Measurement Performance
Trouble- shooting Signal Disturbances
Dropouts
Because Philips IntelliVue Telemetry System is a wireless system, under certain
conditions RF (Radio Frequency) “dropouts” can occur. Dropouts result from a
weak signal or RF interference. There will be signal drops to the bottom of
channel for a minimum of 200 ms to indicate to the clinical user that it is a nonphysiological event. If dropouts are frequent enough to affect the heart rate
count, the CANNOT ANALYZE ECG or CANNOT ANALYZE ST technical
alarm occurs. The following recording strip is an example of dropouts.
If frequent dropouts are occurring, the following section describes some steps
you can take to improve performance.
Signal
Strength
The Philips IntelliVue Telemetry System is custom designed for your unit, so
reliable signal reception is only possible where there are receiving access points.
When the signal is too low, the following technical alarms occur:
•
•
•
•
CANNOT ANALYZE ECG
CANNOT ANALYZE ST
WEAK SIGNAL
NO SIGNAL
To correct, first check the location of the patient. If the patient is not in the
coverage area, do one of the following.
•
•
•
3-26
ECG Monitoring
Return the patient to the specified coverage area.
Put telemetry in Standby Mode. See “Standby Mode” on page 2-5.
If the patient is in the coverage area and is stationary, try moving the
location of the transceiver from its original location by about 15 cm (6
inches).
Optimizing ECG Measurement Performance
Radio
Frequency
Interference
Muscle and
Movement
Artifact
Radio frequency (RF) interference is caused by anything that intrudes into the
transmitted electrical signal, such as paging transmitters. You are probably
familiar with electrical interference in our homes and cars when it causes signal
loss or static with cell phones. These same types of interference can occur with
the transmitted telemetry signal. Even though the Philips IntelliVue Telemetry
System is designed to resist these effects, interference can occasionally be seen
in the form of “dropouts”. To improve performance, the source of the
interference must be identified and eliminated.
Muscle and movement artifact differ from radio frequency interference since
you can prevent much of the occurrence. Noise on the ECG signal can be caused
by many sources, such as interference from other electrical equipment, muscle
artifact and respiratory variation. It is up to the clinician to use certain
techniques to minimize these types of noise.
Use the following table to help you troubleshoot the most common sources of
ECG noise.
Troubleshooting Common Causes of ECG Noise
Problem
Cause
Remedy
60-Cycle (AC) Interference Poor electrode placement. Apply fresh electrodes after
recommended skin preparation.
Possible non-grounded
Disconnect electrical appliances near
instrument near patient
patient (one at a time) by pulling wall
plugs, to determine faulty grounding.
Have engineering check grounding.
Muscle Artifact
Tense, uncomfortable
patient.
Poor electrode placement.
Tremors.
Diaphoresis
Make sure patient is comfortable.
Check that electrodes are applied on
flat non-muscular areas of the torso;
apply fresh electrodes after
recommended skin preparation if
necessary (see “Positioning ECG
Electrodes” on page 3-8).
ECG Monitoring
3-27
Optimizing ECG Measurement Performance
Troubleshooting Common Causes of ECG Noise
Problem
Irregular Baseline
Cause
Poor electrical contact.
Respiratory interference.
Faulty electrodes.
Baseline Wander
Remedy
Apply fresh electrodes after
recommended skin preparation if
necessary (see “Positioning ECG
Electrodes” on page 3-8).
Dry electrodes.
Move electrodes away from areas with
greatest movement during respiration.
Movement of patient.
Make sure patient is comfortable.
Improperly applied
electrodes.
Apply fresh electrodes after
recommended skin preparation if
necessary (see “Positioning ECG
Electrodes” on page 3-8). Check that
patient cable is not pulling electrodes.
Respiratory interference.
Move electrodes away from areas with
greatest movement during respiration.
Poor Electrode Contact
Loose electrodes.
Defective cables.
Leadset not firmly
connected.
3-28
ECG Monitoring
Apply fresh electrodes after
recommended skin preparation if
necessary (see “Positioning ECG
Electrodes” on page 3-8).
Replace cables.
This chapter describes the ST/AR algorithms used for telemetry at the Philips
Information Center. It includes the following sections:
•
•
•
•
•
•
•
ST/AR Arrhythmia Algorithm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-2
ST/AR provides Heart Rate and PVC Rate numerics and alarm detection
for the conditions listed in the following table. There are two detection
levels: Basic and Enhanced. Enhanced includes the Basic alarms. . . . 4-4
The Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-6
Adjusting ST Measurement Points . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-9
Establishing ST Reference Beats (Baseline) . . . . . . . . . . . . . . . . . . . 4-11
ST Alarm Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-11
ST Alarm Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-11
ST/AR Arrhythmia & ST Segment Monitoring
4-1
Introduction
ST/AR Arrhythmia & ST Segment
Monitoring
ST/AR Arrhythmia Algorithm
ST/AR Arrhythmia Algorithm
Safety
Information
Warning
FOR ALL PATIENTS
During complete heart block or pacemaker failure (to pace or capture), tall
P-waves (greater than 1/5 of the average R-wave height) can be erroneously
counted by the arrhythmia algorithm, resulting in missed detection of
cardiac arrest.
Learning/Relearning
- Learning: If you initiate learning during ventricular rhythm, the ectopics
can be incorrectly learned as the normal QRS complex. This can result in
missed detection of subsequent events of V-Tach and V-Fib.
- Relearning: When using EASI ECG monitoring, Relearn happens
automatically when there is a LEADS OFF technical alarm. If learning
takes place during ventricular rhythm, the ectopics can be incorrectly
learned as the normal QRS complex. This can result in missed detection of
subsequent events of V-Tach and V-Fib. Be sure to check the beat labels
and initiate a relearn to correct.
1. Respond to the technical alarm [for example, reconnect the electrode(s)].
2. Ensure that the arrhythmia algorithm is labeling beats correctly.
4-2
ST/AR Arrhythmia & ST Segment Monitoring
ST/AR Arrhythmia Algorithm
Warning
FOR PACED PATIENTS
It is possible that pacemaker pulses will not be detected when the ECG
analog output of a defibrillator or telemetry unit is plugged into a bedside
monitor. This can result in the arrhythmia algorithm’s failure to detect
pacemaker non-capture or asystole.
Some pace pulses can be difficult to reject. When this happens, the pulses
are counted as a QRS complex, and could result in an incorrect HR and
failure to detect cardiac arrest or some arrhythmias. Keep pacemaker
patients under close observation.
-- During complete heart block or pacemaker failure (to pace or capture),
tall P-waves (greater than 1/5 of the average R-wave height) can be
erroneously counted by the arrhythmia algorithm, resulting in missed
detection of cardiac arrest.
-- When arrhythmia monitoring paced patients who exhibit only intrinsic
rhythm, the monitor can erroneously count pace pulses as QRS complexes
when the algorithm first encounters them, resulting in missed detection of
cardiac arrest.
For patients who exhibit intrinsic rhythm only, the risk of missing cardiac
arrest can be reduced by monitoring these patients with the low heart rate
limit at or slightly above the basic/demand pacemaker rate. A low heart
rate alarm alarms you when the patient begins pacing. Proper detection
and classification of the paced rhythm can then be determined.
-- When an external pacemaker is being used on a patient, arrhythmia
monitoring is severely compromised due to the high energy level in the
pacer pulse. This can result in the arrhythmia algorithm’s failure to detect
pacemaker non-capture or asystole.
ST/AR
Arrhythmia
Analysis
For information on arrhythmia detection, refer to the following documentation:
•
ST/AR Algorithm - Arrhythmia Monitoring Application Note (4522 981
ST/AR Arrhythmia & ST Segment Monitoring
4-3
ST/AR Arrhythmia Algorithm
•
93051)
IntelliVue Information Center Instructions for Use and Online Help
The intended use of the ST/AR basic arrhythmia analysis algorithm is to monitor
the patient’s ECG for heart rate and ventricular arrhythmias and to produce
events/alarms simultaneously for one or more ECG leads. The arrhythmia
algorithm is effective when monitoring both paced and non-paced patients in a
clinical environment.
IntelliVue Telemetry does not have a dedicated cardiotach. Instead, the
arrhythmia cardiotach at the Information Center is used. Therefore, the ST/AR
Arrhythmia algorithm is always on for all IntelliVue Telemetry patients, and
cannot be turned off.
ST/AR provides Heart Rate and PVC Rate numerics and alarm detection for the
conditions listed in the following table. There are two detection levels: Basic and
Enhanced. Enhanced includes the Basic alarms.
Basic & Enhanced Arrhythmia Detection
Basic Arrhythmia
Detection
4-4
Enhanced Arrhythmia Detection
Asystole
Tachy yyy > xxx
Vent Bigeminy
Vent Fib/Tach
Brady yyy < xxx
Vent Trigeminy
V tach
Non-Sustain VT
Multiform PVCs
Extreme Brady
Vent Rhythm
HR yyy > xxx
Extreme Tachy
Run PVCs
HR yyy < xxx
High HR
Pair PVCs
Irregular HR
Low HR
Pause
PVCs > 30/min
Missed Beat
Pacer Not Capturing
SVT
Pacer Not Pacing
R-on-T PVCs
ST/AR Arrhythmia & ST Segment Monitoring
ST/AR Arrhythmia Algorithm
Beat classification determined by the ST/AR algorithm is shown on the primary
delayed wave in the Arrhythmia Analysis window at the Information Center. To
access this window, select Arrhythmia Analysis from the Patient Window.
The annotation requires clinical validation of the analyzed heart rhythm. If the
analysis is inaccurate, perform a relearn of the rhythm.
Annotation
Beat Classification
Color
Artifact
Blue
Inoperative
Red
Learning
Red
Missed Beat
Red
Normal
Blue
Paced
Blue
Supraventricular Premature
Blue
Ventricular Premature
Red
Questionable
Red
‘
Pacer Mark
Blue
When monitoring is initiated, when the Wave 1 lead is changed, or if Relearn is
selected, a question mark (?) is displayed next to HR and the annotation “L”
appears on the annotated wave until the HR is calculated and the rhythm is
learned.
ST/AR Arrhythmia & ST Segment Monitoring
4-5
ST/AR ST Segment Algorithm
ST/AR ST Segment Algorithm
Warning
This device provides ST level change information; the clinical significance
of the ST level change information should be determined by a physician.
The ST/AR ST algorithm at the Information Center (not available for M3153A)
monitors ST segment elevation or depression for each available telemetry ECG
lead and produces events/alarms simultaneously. ST values update with every
measurement period and enunciate, depending upon the severity of the change,
events and alarms as they are detected.
The ST/AR ST algorithm is approved for use only with non-paced and atriallypaced adult telemetry-monitored patients. With EASI monitoring, ST analysis is
performed on up to 12 leads, and an additional value of ST index is calculated
and displayed (see “EASI ST Analysis” on page 4-8). Assessment of EASIderived 12-lead ST measurement is recommended for adult patients that meet
the following parameters:
•
•
•
•
Ages: 33-82 years
Heights: 147 to 185 cm (58 to 73 in)
Weights: 53 to 118 kg (117 to 261 lbs)
Height to Weight Ratios: 1.41 to 2.99 cm/kg (0.25 to 0.54 in/lb)
All ST analysis and ST alarms for telemetry patients are performed by the
Information Center.
For additional information on ST monitoring, refer to the following
documentation:
•
•
The
Measurement
4-6
ST/AR Algorithm - ST Segment Monitoring Application Note (4522 981
92851)
Information Center Online Instructions for Use and Online Help
The ST measurement for each beat complex is the vertical difference between
two measurement points. The isoelectric point provides the baseline for the
ST/AR Arrhythmia & ST Segment Monitoring
ST/AR ST Segment Algorithm
measurement and the ST point provides the other measurement point. It is
positioned with reference to the J-point.
R-WAVE PEAK
AT 0 MSEC
J POINT
DIFFERENCE =
ST VALUE
ST
ISO ELECTRIC
POINT
MEASUREMENT
DEFAULT =
POINT
-80 MSEC
DEFAULT =
J+60 MSEC
ST/AR Arrhythmia & ST Segment Monitoring
4-7
ST/AR ST Segment Algorithm
Algorithm
Processing
ST analysis analyzes ECG signals to classify the heart beats. Only beats
classified as normal or Supraventricular (atrially paced) are used to calculate ST
elevations and depressions.
The ST/AR ST algorithm processing includes special ST filtering, beat selection
and statistical analysis, calculation of ST segment elevations and depressions,
and lead reconstruction and wave generation.
When ST analysis is being performed on two leads, the averaged derived and
reconstructed ST waves and associated ST segment values are given for up to
six leads, depending on the type of patient cable:
•
3-wire: one lead
•
5-wire: up to two leads if monitoring a chest and a limb lead
•
5-wire: up to six leads if monitoring two limb leads with the Philips
Transmitter (without EASI monitoring)
•
5- wire: up to 12 leads if monitoring using EASI
Note—No ST analysis is done on a patient if an electrode falls off.
Displayed
ST Data
ST data displays as values in the Patient Sector and Patient Window. A positive
value indicates ST segment elevation; a negative value indicates ST segment
depression. You can view ST data in ST Review, Trend Review, and Event
Review windows.
EASI ST
Analysis
The Information Center generated ST values presented in the patient sector and
Patient Window for EASI derived leads is STindx (ST Index). STindx is a
summation of three ST segment measurements, using the leads that can indicate
ST segment changes in the different locations of the heart:
•
•
•
anterior lead V2
lateral lead V5
inferior lead aVF
Caution
Be sure not to duplicate the lead labels. This can result in incorrect ST values
being displayed for those leads.
4-8
ST/AR Arrhythmia & ST Segment Monitoring
ST/AR ST Segment Algorithm
ST
Operation
Turning ST
Monitoring On/
Off
The ST Setup Window allows you to turn ST monitoring on or off for all
available ECG leads.
To turn ST monitoring on at the Information Center, perform the following
steps:
Step
Action
From the Patient Window, click the All Controls button.
From the All Controls Window, click the ST Setup button.
From the ST Setup Window, click ST On.
You would turn ST monitoring off if:
•
•
•
•
Adjusting ST
Measurement
Points
You are unable to get any lead that is not noisy.
Arrhythmias such as atrial fib/flutter cause irregular baseline.
The patient is continuously ventricularly paced.
The patient has left bundle branch block.
The ST Setup Window enables you to adjust the ST measurement points to
ensure accurate data.
There are three measurement cursors:
•
•
•
The ISO measurement cursor positions the isoelectric point in relation to
the R-wave peak.
The J-point cursor positions the J-point in relation to the R-wave peak.
The purpose of the J-point is to correctly position the ST measurement
point.
The ST measurement cursor positions the ST point a fixed distance from
the J point.
Note—The ST measurement points may need to be re-adjusted if the patient's
heart rate or ECG morphology changes significantly.
ST/AR Arrhythmia & ST Segment Monitoring
4-9
ST/AR ST Segment Algorithm
Perform the following steps at the Information Center to adjust the ST
measurement points:
Step
Action
Access the ST Setup window by clicking on the All Controls button
in the Patient Window, then clicking on the ST Setup button.
If you need to adjust the ISO (isoelectric) point, place the cursor
over the ISO button to access the adjustment arrows. Then use the
arrows to position the bar in the middle of the flattest part of the
baseline (between the P and Q waves or in front of the P wave).
ISO
point
4-10
ST/AR Arrhythmia & ST Segment Monitoring
ST/AR ST Segment Algorithm
Step
Action
Adjust the J point, if necessary, by placing the cursor over the Jpoint button to access the adjustment arrows. Then use the arrows to
position the bar at the end of the QRS complex and the beginning of
the ST segment.
J point
Adjust the ST point, if necessary, by using the J point as an
“anchor” and placing the bar at the midpoint of the ST segment.
Choices are J+0, J+20, J+40, J+60, or J+80.
Establishing
ST Reference
Beats
(Baseline)
ST point
After adjusting the measurement points, you can establish baseline reference
beats for all available leads in the ST Review window at the Philips Information
Center. Reference beats enable you to compare waveform changes, for example
from admission, or prior to or after treatment. The reference continues to be
saved beyond the 24 hour review window, but you can update it to any beat
within the last 24 hours. Please refer to the Philips Information Center
Instructions for Use18
or on-line Help for directions.
ST Alarm
Settings
All Philips Information Center alarm settings (limits and on/off status) have unit
default settings. The Philips Information Center however, lets you set the high
and low ST alarm limits for individual patients based on:
ST/AR Arrhythmia & ST Segment Monitoring
4-11
ST/AR ST Segment Algorithm
•
•
•
Your assessment of the patient's clinical condition.
Unit protocols.
Physician orders or medication specified limits.
You can make the following adjustments to ST alarm limits to accommodate the
clinical condition of individual patients:
•
•
Turn all alarms off/on.
Adjust the alarm limits:
– to specific high and low limits
– to Smart Limits (see the Philips IntelliVue Information Center
Instructions for Use for information on Smart Limits)
– back to unit default settings.
You adjust the ST alarm limits in the ST Alarms Window. Each ST parameter
has its own alarm limit. The alarm is triggered when the ST value exceeds its
alarm limit for more than 1 minute. The alarm will be a yellow alarm.
When more than one ST parameter is in alarm, only one alarm message displays.
For multilead alarms when using an EASI transmitter, an alarm is generated if
two or more ST leads exceed the alarm limits. The default setting is +/-1.0. The
alarm message indicates the two leads that are in greatest violation of the limits,
for example, “**MULTI ST AVR, V6”. If another lead becomes deviant, the
message changes but it is considered the same alarm (no new alarm sounds and
it is not listed as a new event).
See “Physiologic Alarms” on page 2-9 for a list of all ST alarms.
See IntelliVue Information Center Instructions for Use for specifics on alarm
management and behavior.
Adjusting ST
Alarms
Make adjustments to ST alarms on the ST Alarms window at the Information
Center.
Step
4-12
Action
From the Patient Window, select the All Controls button.
ST/AR Arrhythmia & ST Segment Monitoring
ST/AR ST Segment Algorithm
Step
Action
From the All Controls window, select the ST Alarms button under
Alarm Management and Setup.
In the ST Alarms window, adjust alarms as needed. Choices for
setting the ST alarm limits are:
Unit Settings—Click on this button if want to have the specific
limits that are pre-set for your unit.
Smart Limits—Click on this button to set high and low limits around
your patient's current ST value. The difference above and below the
patient's ST value are pre-set for your unit.
Note—Smart Limits can be configured to automatically be activated
when the patient is connected. See the IntelliVue Information Center
Instructions for Use for additional information on using smart limits.
Specified limits—Use these to set the high and low alarm limits
based on your assessment of the patient's clinical condition, unit
protocols, or physician orders or medication specified limits. A good
guideline is + 1.0 mm or - 1.0 mm from the patient's ST, or follow
your unit protocol.
ST/AR Arrhythmia & ST Segment Monitoring
4-13
ST/AR ST Segment Algorithm
4-14
ST/AR Arrhythmia & ST Segment Monitoring
This chapter provides an introduction to the SpO2 measurement and its
application. It includes the following sections:
•
•
•
•
•
•
•
•
SpO2 Safety Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-2
Pulse Oximetry Measurement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-4
Selecting a SpO2 Sensor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-5
Applying the Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-9
Connecting the SpO2 Cable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-14
Measuring SpO2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-15
Understanding SpO2 Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-20
Optimizing SpO2 Measurement Performance . . . . . . . . . . . . . . . . . . 5-21
SpO2 Monitoring
5-1
Introduction
SpO2 Monitoring
SpO2 Safety Information
SpO2 Safety Information
Warning
Always confirm Information Center observations with clinical observation
of the patient before administering interventions.
Prolonged, continuous monitoring can increase the risk of changes in skin
characteristics, such as irritation, reddening, blistering or pressure
necrosis, particularly on patients with impaired perfusion and varying or
immature skin morphology. Specific attention must be given to sensor site
inspection for changes in skin quality, proper optical path alignment and
attachment. Check the application site at regular intervals and change the
site if any compromise in skin quality should occur. More frequent
checking can be required due to an individual patient's condition.
Using a sensor during MR imaging can cause severe burns. To minimize
this risk, ensure that the cable is positioned so that no inductive loops are
formed. If the sensor does not appear to be operating properly, remove it
immediately from the patient.
Do not use disposable sensors on patients who exhibit allergic reactions to
the adhesive.
Injected dyes such as methylene blue or intravascular dyshemoglobins such
as methemoglobin and carboxyhemoglobin can lead to inaccurate (overestimated) measurements.
Interference leading to inaccurate measurements can be caused by:
- High levels of ambient light (Hint: cover application site with opaque
material)
- Electromagnetic interference
- Excessive patient movement and vibration.
5-2
SpO2 Monitoring
SpO2 Safety Information
Warning
Removal of the SpO2 sensor during Continuous SpO2 monitoring results in
a NO SENSOR technical alarm. There is no technical alarm for a "No
Sensor" condition in Spot Check mode.
SpO2
Information
for the User1
The pulse oximeter is calibrated to indicate fractional oxyhemoglobin, and
displayed results can range from 0 to 100%.
A 10 second averaging filter is used in the calculation of the result. Displayed
results are typically updated every second, but the update period can be
automatically delayed by up to 30 seconds in the presence of noise.
Physiological SpO2 alarm signals will be generated at the central station. The
SpO2 low limit can be set between 50 and 99% inclusive, in 1% increments. The
SpO2 high alarm limit can be set between 51 and 100% inclusive, in 1%
increments. The maximum delay between the physiological alarm condition and
alarm signal generation at the central station is 10 seconds.
Pulse rate is also derived from the pulsatile SpO2 measurement, and displayed
results can range from 30 to 300 bpm. There is no alarm function for pulse rate.
The pleth wave is auto-scaled to maximum display size. It decreases only when
the signal quality becomes marginal. Pleth wave size is NOT directly
proportional to the pulse volume.
1. A functional tester cannot be used to assess the accuracy of a pulse oximeter sensor or a pulse oximeter monitor. If
there is independent demonstration that a particular calibration curve is accurate for the combination of a pulse
oximeter monitor and a pulse oximeter sensor, then a functional tester can measure the contribution of a monitor to
the total error of a monitor/sensor system. The functional tester can then measure how accurately a particular pulse
oximeter monitor is reproducing that calibration curve.
SpO2 Monitoring
5-3
Pulse Oximetry Measurement
Pulse Oximetry Measurement
The ECG-SpO2 TRx+ Transceiver supports an SpO2 sensor connection using
Fourier Artifact Suppression Technology (FAST). The FAST algorithm
overcomes many of the issues associated with traditional pulse oximetry such as
sensitivity to patient movement and intense ambient light. The algorithm offers
improved motion artifact rejection as well as performance improvements for
patients with low perfusion. SpO2 can be measured continuously, where a value
is sent to the Information Center every second, or as a single, individual
measurement (Spot Check). The Spot Check measurement will be removed from
the Information Center display after 24 hours. If 1-minute or 5-minute sampling
rate is selected at TeleMon, the transceiver will provide Continuous SpO2
measurement after disconnection (see “Transceiver Use with TeleMon A02/
A03” on page 1-27).
The SpO2 parameter measures the arterial oxygen saturation, that is, the
percentage of oxygenated hemoglobin in relation to the total hemoglobin.
If, for example, a total of 97% of the hemoglobin molecules in the red blood
cells of the arterial blood combine with oxygen, then the blood has an oxygen
saturation of 97%. The SpO2 numeric that appears on the monitor will read
97%. The SpO2 numeric indicates the percentage of hemoglobin molecules
which have combined with oxygen molecules to form oxyhemoglobin.
•
The oxygen saturation is measured using the pulse oximetry method. This
is a noninvasive method of measuring the arterial hemoglobin oxygen
saturation. It measures how much light, sent from light sources on one
side of the sensor, travels through patient tissue (such as a finger or an
ear), to a receiver on the other side of the sensor.
•
The amount of light passing through depends on many factors, most of
which are constant, such as tissue or venous blood. However one of the
factors, the blood flow in the arterioles, varies with time - because it is
pulsatile.
This measurement principle is used to derive the SpO2 measurement. The
numeric that is displayed at the Information Center is the oxygen
saturation of the arterial blood - the measurement of light absorption
5-4
SpO2 Monitoring
Selecting a SpO2 Sensor
during a pulsation. Correct placement of the sensor is essential for
accurate measurements (see “Applying the Sensor” on page 5-9).
Pulse
Indication
During Spot Check measurement, the pulse signal is detected and communicated
to you via an auditory signal. The indicator is a single low-pitch tone for each
pulse detected. The tone is controlled by the Volume and Mute controls at the
Information Center. The pulse indication stops when a measurement is
complete. However, since it is possible to have a strong pulse but fail an SpO2
measurement, you should listen for the successful completion of a measurement
(single beep), or a double beep if the measurement fails.
The pulse indicator is for information only, and should not be used as an
indication for treatment. The indicator is not functional in Continuous
measurement mode.
Clinical Note: If the transceiver is in Spot Check mode and the sensor light is
illuminated but you do not hear a low-pitch sound synchronized with the pulse,
readjust the sensor, or move the sensor to another site to provide better
detection.
Selecting a SpO2 Sensor
Philips reusable sensors in adult, pediatric and infant models can be used, as
well as Philips and Nellcor disposable sensors.
Use only specified sensors (probes) and cables.
The following chart and figure “Selecting an SpO2 Sensor” on page 5-7
guide you in selecting the correct sensor type. To use the figure, find the
patient’s weight on the vertical axes. On the horizontal axis at this weight, the
shaded areas indicate that the sensor is a "best choice" for the patient. Unshaded
areas indicate a "good choice." For example, the best reusable sensor for a 50 kg
patient is the M1191A, applied to the finger or toe. Alternatively, you could use
M1194A applied to the ear.
Sensor Type
When to Use
SpO2 Monitoring
5-5
Selecting a SpO2 Sensor
Reusable
You can use reusable sensors on different
patients after cleaning and disinfecting them.
For care and cleaning instructions, see the
instructions accompanying the sensors. Reusable
sensors should be changed to another site every
2-3 hours or in accordance with your clinical
practice guidelines.
See the Directions for Use supplied by Nellcor®
Incorporated for instructions on preparation and
application of reusable sensors.
Disposable
Use disposable sensors only once and then
discard. However, you can relocate them to a
different patient-site if the first location does not
give the desired results. Do not reuse disposable
sensors on different patients.
See the Directions for Use supplied by Nellcor®
Incorporated for instructions on preparation and
application of disposable sensors.
Warning
When the specified Nellcor® sensors are used, the application must be
consistent with the sensor manufacturer's own guidelines.
5-6
SpO2 Monitoring
Selecting a SpO2 Sensor
Patient
Weight
( lb )
Patient
Weight
( kg )
Adult
Adult
Adult
Adult
Adult
110
50
40
Pedi
Pedi
Pedi
Pedi
Pedi
30
66
20
44
15
33
Infant
10
Infant
88
Pedi
22
Neo
Philips Part # M1192A M1191A M1194A M1901B M1903B M1904B
Oxisensor
OxiCliq/OxiMax
N-25
Reuseable
sensor
D-20
D-25
Disposable
sensor
Preferred sensor types
Alternative sensor types
Selecting an SpO2 Sensor
SpO2 Monitoring
5-7
Selecting a SpO2 Sensor
Caution
Do not use OxiCliq disposable sensors in a high humidity environment, or in the
presence of fluids. These can contaminate sensor and electrical connections, and
thereby cause unreliable or intermittent measurements.
Do not use disposable sensors on patients who have allergic reactions to the
adhesive.
If you are using Nellcor® sensors, see the directions for use supplied with these
sensors.
5-8
SpO2 Monitoring
Applying the Sensor
Applying the Sensor
Sensor Application Safety Information
Warning
Failure to apply a sensor properly can reduce the accuracy of the SpO2
measurement.
Loose/Tight sensor: If a sensor is too loose, it can compromise the optical
alignment or fall off. If it is too tight, for example because the application site is
too large or becomes too large due to edema, excessive pressure can be applied.
This can result in venous congestion distal from the application site, leading to
interstitial edema, hypoxia and tissue malnutrition. Skin irritations or ulcerations
can occur as a result of the sensor being attached to one location for too long.
To avoid skin irritations and ulcerations, inspect the sensor application site every
2-3 hours, and change the application site at least every 4 hours or according to
clinical practice guidelines.
Venous Pulsation: Do not apply sensor too tightly as this results in venous
pulsation and can severely obstruct circulation and lead to inaccurate
measurements.
Ambient Temperature: Never apply an SpO2 sensor at ambient temperatures
from above 37 oC (99 oF) because this can cause severe burns after prolonged
application.
Extremities to Avoid: Avoid sites distal to BP cuff or intra-arterial line.
Site
Selection
•
Avoid sites with impaired perfusion, skin discoloration, excessive motion
or nail polish.
•
Avoid placing the sensor in an environment with bright lights (if
necessary, cover the sensor with opaque material).
•
Avoid use of excessive pressure at the application site (e.g., sensor applied
too tightly, excessive adhesive tape to secure the sensor, clothing or
SpO2 Monitoring
5-9
Applying the Sensor
restraints that are too tight). These result in venous pulsations and
inaccurate measurement, and may severely obstruct circulation.
Sensor
Application
A minimum pulsatile flow must be present at the application site of your patient
to obtain measurements.
Select an appropriate sensor and apply the sensor properly to avoid incorrect
measurements. Applying a small amount of pressure at the application site can
improve the measurement. Use one of the preferred application sites for your
sensor. Selecting the most suitable sensor and application site will help you to
ensure that:
•
The light emitter and the photo detector are directly opposite each other
and that all the light from the emitter passes through the patient's tissues,
•
The application site is of the correct thickness for light to pass through. If
the application site is too thick or too thin, an SpO2 NON-PULSATILE
technical alarm will occur. You should then select another site as
appropriate.
Light Emitter
Photo Detector
Positioning of the Light Emitters and Photo Detector
Inspect the application site every 2 to 3 hours or according to clinical practice
guidelines to ensure skin integrity and correct optical alignment. If skin integrity
changes, move the sensor to another site.
Follow the sensor’s instructions for use, adhering to all warnings and cautions.
5-10
SpO2 Monitoring
Applying the Sensor
To apply the sensor, use the following directions.
Step
Action
Select the site and appropriate sensor (see “Selecting a SpO2
Sensor” on page 5-5).
Apply the sensor to the appropriate part of the patient’s body.
Note—The application site should match the sensor size so that the
sensor can neither fall off nor apply excessive pressure.
Adult Finger
sensor
(M1191A)
Check that the light emitter and the photo detector are directly
opposite each other. All light from the emitter must pass through the
patient’s tissue.
Push the sensor over the fingertip in such a way that the fingertip touches but
does not protrude from the end of the sensor. The fingertip must be uppermost
and the cable must lie on the back of the hand. This ensures that the light sources
cover the base of the fingertip giving the best measurement results. The cable
can be held in place by the accompanying wristband.
SpO2 Monitoring
5-11
Applying the Sensor
Warning
Failure to apply the sensor properly can cause incorrect measurement of
SpO2. For example, not pushing the sensor far enough over the finger can
result in inaccurate SpO2 readings. Pushing the sensor too far, so that the
finger protrudes from the sensor, can pinch the finger, resulting in
inaccurately low SpO2 readings.
Small Adult/
Pediatric
Finger sensor
(M1192A)
Push the sensor over the fingertip in such a way that the fingertip touches but
does not protrude from the end of the sensor.
Note—When using an M1195A Infant Finger/Toe Sensor, select a finger or toe
with a diameter of between 7 and 8 mm (0.27 and 0.31 inches).
5-12
SpO2 Monitoring
Applying the Sensor
Ear Clip
sensor
(M1194A)
Clip the probe onto the fleshy part of the ear lobe as shown in the diagram
below. The plastic fixing mechanism helps to minimize artifact generated by
patient motion. Do not position the probe on cartilage or where it presses against
the head.
The clip sensor can be used as an alternative if the adult finger sensor does not
provide satisfactory results. The preferred application site is the ear lobe,
although other application sites with higher perfusion (such as the nostril) can be
used. Due to the physiologically lower perfusion in the ear lobe, you should be
aware of the reduced accuracy of the measurement and more frequent technical
alarms.
SpO2 Monitoring
5-13
Connecting the SpO2 Cable
Connecting the SpO2 Cable
Step
Action
Connect the sensor cable to IntelliVue TRx+.
• Connect reusable sensors directly into the transceiver.
• Connect disposable sensors into the adapter cable, then
connect the adapter cable to the transceiver. Remove the
protective backing.
Ensure that the sensor and connector are positioned away from
power cables, to avoid electrical interference.
Adjust SpO2 alarms in the patient Window (see “Telemetry
Controls in the Patient Window” on page 6-2).
Make other adjustments in the Telemetry Setup Window (see
“Patient-Configurable Settings in Telemetry Setup” on page 6-3).
Caution
Extension cables: Do not use extension cables with the IntelliVue TRx+.
5-14
SpO2 Monitoring
Measuring SpO2
Electrical Interference: Position the sensor cable and connector away from
power cables, to avoid electrical interference.
Measuring SpO2
SpO2 measurements can be made continuously in Continuous mode or manually
on an as-needed basis in Spot Check mode, depending on the transceiver
configuration. While operating in continuous mode, you can also measure pulse,
and display the pleth wave at the Information Center. The SpO2 parameter is
turned on by inserting/removing the sensor cable into the transceiver, or by
control from the Information Center. SpO2 monitoring consumes considerable
electrical energy. If the battery power is not at least 25% full, no measurements
of SpO2 can be made.
Setting the mode at Continuous or Spot Check is done at TeleMon or is
configured using the Service Tool.
Spot Check
When the transceiver is configured for Spot Check measurement, use the
following instructions to take an individual, manual SpO2 reading from the
transceiver. You can also initiate a Spot Check measurement in the Patient
Window at the Information Center by selecting the STAT SpO2 icon.
Note—Spot Check measurements from the transceiver are inactive when the
transceiver is connected to TeleMon.
Step
Action
Set SpO2 mode to Spot Check in the Telemetry Setup window.
Attach the sensor to the patient.
SpO2 Monitoring
5-15
Measuring SpO2
Step
Action
Connect the SpO2 cable to IntelliVue TRx+, and check that:
• The SpO2 sensor light turns on.
• A low-pitch tone detecting each pulse is audible (unless
sounds are muted).
After approximately 30 seconds, a tone from the transceiver
indicates that a measurement has been taken.
The value, with the measurement time, is displayed at the
Information Center.
The sensor light extinguishes.
If the measurement was unsuccessful, you’ll hear a double beep.
Remove the sensor cable and reinsert it to retake the measurement.
Note—The SpO2 value and time stamp will remain on the
Information Center for 24 hours or until another measurement is
taken, with one exception. If the batteries are removed from the
transceiver, the Spot Check measurement will be erased from the
display, but the SpO2 measurements will be available in Trend
Review.
Continuous
When the transceiver is configured for Continuous SpO2 measurement, use the
following directions to initiate Continuous SpO2 monitoring.
Step
5-16
To repeat a Spot Check measurement at the bedside, disconnect
then reconnect the SpO2 cable to the transceiver.
SpO2 Monitoring
Action
Set SpO2 mode to Continuous in the Telemetry Setup window.
Insert the SpO2 cable into the IntelliVue TRx+, and check that the
sensor light turns on.
Attach the sensor to the patient.
Measuring SpO2
Step
Action
After approximately 15 seconds, the value, with the measurement
time, is displayed at the Information Center.
Note—There are no sounds associated with continuous SpO2
measurement.
To discontinue monitoring, set SpO2 mode to off at the Information
Center.
Note— If the sensor is removed without discontinuing SpO2 monitoring in the
Telemetry Setup Window at the Information Center, an SpO2 NO SENSOR
technical alarm will result.
Displaying
Pulse
When operating in Continuous mode, you can view pulse measurements at the
Information Center. See “Patient-Configurable Settings in Telemetry Setup” on
page 6-3.
Note—If pulse is turned on, the Patient Sector and Patient Window of the
Information Center display the label with "T" (for example, Pulse T) to indicate
that the measurement was made via telemetry.
Displaying
PlethWave
The transceiver can be configured to transmit the pleth wave for display at the
Information Center. See “Patient-Configurable Settings in Telemetry Setup” on
page 6-3.
SpO2 Measurement when Connected to TeleMon
When the transceiver is connected to TeleMon:
•
The SpO2 measurement mode is always Continuous.
SpO2 Monitoring
5-17
Measuring SpO2
•
You can change the mode. Changes to the mode take effect when the
transceiver is disconnected from TeleMon. The following settings will be
used:
Mode Set at TeleMon
Turning
SpO2
Monitoring
Off
Mode when Transceiver
is Disconnected
Continuous
Continuous
5-minute
Continuous
1-minute
Continuous
Manual
Spot Check
To turn SpO2 monitoring off, disconnect the sensor cable (or adapter cable)
from the transceiver. SpO2 enters a power-down mode after the cable is
disconnected from the transceiver, thereby conserving battery life.
SpO2 should also be turned off at the Information Center. If the transmitter is
configured for Continuous SpO2 measurement and the sensor is removed
without turning SpO2 off, a SpO2 NO TRANSDUCER technical alarm will
result. See
Important—It is important to disconnect the sensor from the transceiver.
Unplugging the sensor from an adapter cable that is connected to the transceiver
does NOT provide SpO2 power-down mode.
5-18
SpO2 Monitoring
Measuring SpO2
Turning the
SpO2
Parameter
On/Off
You can turn SpO2 monitoring on/off at the Information Center. S ee “PatientConfigurable Settings in Telemetry Setup” on page 6-3.
When SpO2 is turned on, the Patient Sector and Patient Window of the
Information Center display a "T" next to the SpO2 numeric (for example, SpO2
T 90%) to indicate that the measurement was made via telemetry.
If the transceiver is connected to the TeleMon Companion Monitor, after you
turn SpO2 on, be sure to adjust the sample rate to match your patient’s acuity.
When SpO2 monitoring is turned off, setting the sample rate to Spot Check at
TeleMon will help you conserve the transmitter’s battery life.
SpO2
Parameter
Auto ON
The SpO2 parameter is automatically turned on at the IntelliVue Information
Center if a manual SpO2 measurement is initiated at the transceiver while in
Spot Check mode or if the SpO2 sensor is inserted into the transceiver while the
transceiver is in Continuous SpO2 mode.
When a patient is discharged and the transceiver is in Continuous mode, the
SpO2 parameter is turned off. To reactivate the SpO2 parameter Auto ON
feature from the transceiver, remember to do one of the following when a patient
is discharged:
– remove the SpO2 cable from the transceiver, wait 15 seconds, then
reinsert the cable
or
– if using TeleMon, reset the transceiver to Manual mode.
Note—The SpO2 parameter Auto ON feature only needs to be reactivated when
the transceiver is in Continuous mode at discharge.
Note— SpO2 can always be turned on and off at the IntelliVue Information
Center.
SpO2 Monitoring
5-19
Understanding SpO2 Alarms
Understanding SpO2 Alarms
Warning
If you measure SpO2 on a limb that has an inflated NBP cuff, a nonpulsatile SpO2 technical alarm can occur. If the monitor is configured to
suppress this alarm, there can be a delay of up to 60 seconds in indicating
critical patient status, such as sudden pulse loss or hypoxia.
Physiologic SpO2 alarms will be generated and displayed at the Information
Center. SpO2 offers high and low limit alarms, and a high priority (red level)
oxygen desaturation alarm. The SpO2 low limit can be set between 50 and 99%
inclusive, in 1% increments. The low alarm limit cannot be set below the desat
alarm limit. The SpO2 high alarm limit can be set between 51 and 100%
inclusive, in 1% increments.
The maximum delay between the physiologic alarm condition and alarm
annunciation at the central station is 10 seconds. This means that the monitor
will generate an alarm if the averaged numeric value on the display exists
beyond the alarm limit for more than 10 seconds.
Setting the high SpO2 alarm limit to 100% is equivalent to switching off the
high alarm limit. Therefore the upper alarm limit for oxygen saturation must be
carefully selected in accordance with accepted clinical practices.
The desaturation limit is set automatically at 10 below the Low Limit.
SpO2 alarms are non-latching. That is, when an SpO2 limit is exceeded, if the
alarm is not silenced, it will reset automatically if the patient’s alarm condition
returns within the limits. This reduces the number of times you will need to reset
alarms at the Information Center when an alarm condition has been corrected at
the patient’s side (for example, movement-induced artifact alarms). See Chapter
2, “Alarms” for a list of all SpO2 alarms.
5-20
SpO2 Monitoring
Optimizing SpO2 Measurement Performance
Optimizing SpO2 Measurement Performance
Refer to this section on problem situations if you have difficulty getting a signal
or obtaining accurate measurements.
Distortion
Ambient light, motion, perfusion or incorrect sensor placement can affect the
accuracy of the derived measurements.
Arterial Blood Flow
The measurement depends on the pulsatile nature of blood flow in the arteries
and arterioles; with the following conditions arterial blood flow can be reduced
to a level at which accurate measurements cannot be made:
•
•
•
•
shock
hypothermia
use of vasoconstrictive drugs
anemia
Wavelength Absorption
The measurement also depends on the absorption of particular light wavelengths
by the oxyhemoglobin and reduced hemoglobin. If other substances are present
which absorb the same wavelengths, they will cause a falsely high, or falsely
low SpO2 value to be measured. For example:
• carboxyhemoglobin
• methemoglobin
• methylene blue
• indocyanine green*
• indiocarmine*
*These chemicals are used in dye dilution cardiac output calculations.
Ambient Light
Very high levels of ambient light can also affect the measurement; an SpO2
INTERFERENCE message will appear on the display. The measurement quality
can be improved by covering the sensor with suitable opaque material.
Care and Cleaning
For care and cleaning instructions, see the instructions accompanying the
sensors.
SpO2 Monitoring
5-21
Optimizing SpO2 Measurement Performance
Optimizing Sensor Performance
To get the best results from your SpO2 reusable sensor:
•
Always handle the sensor and cable with care. The soft finger sleeve
houses a sensitive electronic device that can be damaged by harsh
treatment. Always protect the cable from sharp-edged objects.
•
Use the wristband that is supplied with your M1191A sensor. By keeping
the cable between the finger sensor and the wristband fairly loose, you
will maintain good monitoring conditions.
Normal wear and tear associated with patient movement and regular sensor
cleaning naturally mean that your sensor will have a limited lifetime. However,
provided you handle the sensor and its cable with care, you can expect useful
service from it for up to two years. Harsh treatment will drastically reduce the
lifetime of the sensor. Moreover, Philips Medical Systems’ warranty agreement
shall not apply to defects arising from improper use.
5-22
SpO2 Monitoring
This chapter describes the telemetry-specific functions at the Information
Center. It includes the following sections. For additional information regarding
the operation of the Information Center, consult IntelliVue Information Center
Instructions for Use.
Note—ST functions performed at the IntelliVue Information Center are
described in Chapter 4.
•
•
•
•
Telemetry Controls in the Patient Window . . . . . . . . . . . . . . . . . . . . . 6-2
Telemetry Controls in the Patient Window . . . . . . . . . . . . . . . . . . . . . 6-2
Patient-Configurable Settings in Telemetry Setup . . . . . . . . . . . . . . . . 6-3
Unit-Configurable Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-7
Telemetry Functions at the Information Center
6-1
Introduction
Telemetry Functions at the
Information Center
Telemetry Controls in the Patient Window
Telemetry Controls in the Patient Window
The Patient Window at the Information Center (accessed from the Patient
Window control in the Patient Sector) includes controls for a number of
telemetry operations. For detailed instructions on these operations, see the
IntelliVue Information Center Instructions for Use or the Online Help.
To View ECG, SpO2 or NBP Alarm Limits
Move the cursor over the HR or SpO2 label to display the current high and low
alarm limits.
To Change ECG, SpO2 or NBP Alarm Limits
Move the cursor over the High or Low numeric to display up/down arrow
controls for adjusting the limit. After adjusting the limit, move the cursor away
from the area to dismiss the limit controls.
To Change ECG Waveform Size
Move the cursor over the ECG waveform to display the ECG Waveform Size
popup. Select the label from the label list.
To Select Lead Label
Move the cursor over the ECG waveform to display the Lead Selection popup.
Select the label from the label list.
Important—Do not set the primary and secondary channels to the same lead.
To Change Va and Vb Lead Default Settings (6-lead only)
Move the cursor over the ECG waveform to display the Lead Selection popup.
Select the label from the label list. For Va or Vb, select Va or Vb, then select the
lead to be assigned.
Important—Do not set the primary and secondary channels to the same lead.
To Initiate a Spot Check Measurement
Move the cursor over the SpO2 label. Then click on the Spot Check icon (finger
with sensor).
To Initiate Monitor Standby
See instructions under “Standby Mode” on page 2-5.
6-2
Telemetry Functions at the Information Center
Locating the Transceiver (Find Device)
Locating the Transceiver (Find Device)
The Find Device feature enables you to generate a continuous double tone (two
pitches) at the transceiver to assist in locating a missing device. This function is
initiated in the Telemetry Setup Window at the Information Center. Find Device
requires that the transceiver has good working batteries and is within the
coverage area
To locate a
transceiver
Step
Action
From the Patient Window, select All Controls -> Telemetry
Setup.
Click the Find Device button to generate a repeated tone at the
transceiver.
To silence
the sound
Step
Action
Press both the Check button to turn off the sound.
Patient-Configurable Settings in Telemetry Setup
The Telemetry Setup window enables you to configure the transceiver for
patient-specific settings. To access this window, from the Patient Window click
All Controls, then Telemetry Setup.
Telemetry Functions at the Information Center
6-3
Patient-Configurable Settings in Telemetry Setup
The following settings can be adjusted in this window.
Patient-Configurable Settings in Telemetry Setup
Control
Function
Setting Choices
Default
Telemetry
Button
Determine the Information Center
response when Telemetry Button
is pressed.
Nurse Call - generate nurse
call alarm
Nurse Call
Record - generate a
recording strip
Nurse Call and Record generate nurse call alarm and
recording strip
None
Telemetry
Device
Volume
Set the volume level for all
adjustable sounds on the
transceiver.
1 (low), 2, 3, 4, 5 (high)
enable
enable
Note—This control is grayed out
if configured as such in Unit
settings how is this done?.
Telemetry
Device
Volume Mute
6-4
Enable/disable all adjustable
sounds on the transceiver.
This control is grayed out if
disabled in Unit Settings.
Telemetry Functions at the Information Center
disable (mute)
Patient-Configurable Settings in Telemetry Setup
Patient-Configurable Settings in Telemetry Setup
Control
Function
Setting Choices
Default
SpO2 Mode
Determine the transceiver SpO2
behavior.
Off - Stops monitoring of the
SpO2 parameter
Spot Check
Note—For Off or Spot Check
mode, Pulse is automatically set
to disable.
Spot Check - Provides
manual measurements so the
clinician can check as
needed. Measurement
initiated by plugging the
SpO2 cable into the
transceiver or by selecting
STAT SpO2 icon in the
Patient Window.
Continuous - Sends an SpO2
parameter value to the
Information Center every
second.
Telemetry Functions at the Information Center
6-5
Patient-Configurable Settings in Telemetry Setup
Patient-Configurable Settings in Telemetry Setup
Control
Function
Setting Choices
Default
Suppress
SpO2 INOPs
with NBP
Enable/disable the SpO2
algorithm to detect NBP running
and suppress sending technical
alarms from the transceiver for 60
seconds.
enable
enable
disable
Warning
If you measure SpO2 on a limb
that has an inflated NBP cuff, a
non-pulsatile SpO2 technical
alarm can occur. If the monitor
is configured to suppress this
alarm, there can be a delay of
up to 60 seconds in indicating
critical patient status, such as
sudden pulse loss or hypoxia.
Pleth Wave
Enable/disable the transmission
of the Pleth wave (and its
subsequent display) to the
Information Center. For
Continuous SpO2 mode only.
enable
disable
disable
(Pleth is not
displayed.)
Note—When enabled, the Pleth
wave will replace the Vb wave in
the Patient Window during 6-lead
monitoring
Pulse
6-6
Enable/disable the transmission
of the Pulse parameter (and its
subsequent display) to the
Information Center. For
Continuous SpO2 mode only.
Telemetry Functions at the Information Center
enable
disable
disable
(Pulse is not
displayed.)
Unit-Configurable Settings
Patient-Configurable Settings in Telemetry Setup
Control
Function
Setting Choices
Default
SpO2 Alarm
Enable/disable the display of
SpO2 alarms on the Information
Center
enable
enable
Change current settings back to
last saved clinical unit settings
(none)
Unit Settings
disable
Unit-Configurable Settings
Unit Settings provide access to clinical configuration items that affect all
patients on an Information Center. When unit settings are changed, in general
they do not affect current patient settings. A discharge is needed for the settings
to take effect, with the following exceptions: standby duration and telemetry
frequency. Telemetry specific settings are listed in the following table. They are
accessed through All Controls -> Unit Settings -> Telemetry Setup. All other
unit settings are described in IntelliVue Information Center Instructions for Use.
Unit Settings require a password, and the displays are in English.
Telemetry Functions at the Information Center
6-7
Unit-Configurable Settings
Unit Settings - Telemetry Setup
Control
Function
Settings
Default
Patient Type
Set patient type used for alarm
limits
Adult
Adult
Determine the Information
Center response when Telemetry
Button is pressed.
Nurse Call - generate nurse
call alarm
Telemetry
Button
Pediatric
Nurse Call
Record - generate a recording
strip
Both - generate nurse call
alarm and recording strip
None - ignore button
Telemetry
Device
Volume
Set the volume level for all
adjustable sounds on the
transceiver.
1 (low) to 5 (high)
Telemetry
Device
Volume Mute
Enable/disable all adjustable
sounds on the transceiver.
enable (unchecked) = sound
mute
Standby
Duration
Sets the standby duration on the
device.
Infinite
10 minutes
20 minutes
30 minutes
1 hour
2 hours
3 hours
4 hours
6-8
Telemetry Functions at the Information Center
disable (checked) = mute
Infinite
Unit-Configurable Settings
Unit Settings - Telemetry Setup
Control
Function
Settings
Default
Enable
Remote
Suspend
Enable/disable alarm pause/
suspend at the transceiver.
enable
disable
Battery
Gauge on
Information
Center
Display/disable a battery gauge
for each assigned device on the
Information Center.
enable
SpO2 Mode
Determine the transceiver SpO2
behavior.
Off - Stops monitoring of the
SpO2 parameter
Note—When the mode is set to
Off or Spot Check, Pulse is
automatically set to disable.
Spot Check - Provides
manual measurements so the
clinician can check as
needed. The SpO2
measurement is initiated by
plugging the SpO2 cable into
the transceiver or initiated by
selecting STAT SpO2 icon in
the Patient Window.
disable
disable
Note—Do not enable if
rechargeable batteries are being
used.
enable
(battery
gauge is
displayed)
Spot Check
Continuous - Sends an SpO2
parameter value to the
Information Center every
second.
Telemetry Functions at the Information Center
6-9
Unit-Configurable Settings
Unit Settings - Telemetry Setup
Control
Function
Settings
Default
Suppress
SpO2 Inops
with NBP
Enable/disable the SpO2
algorithm to detect NBP running
and suppress sending technical
alarms from the transceiver for
60 seconds.
enable
enable
disable
Warning
If you measure SpO2 on a limb
that has an inflated NBP cuff,
a non-pulsatile SpO2 technical
alarm can occur. If the
monitor is configured to
suppress this alarm, there can
be a delay of up to 60 seconds
in indicating critical patient
status, such as sudden pulse
loss or hypoxia.
Pleth Wave
Note— When
Pleth Wave
display is
enabled, the
Pleth wave
will replace
the Vb wave
in the Patient
Window
during 6-lead
monitoring.
6-10
Enable/disable the transmission
of the Pleth wave (and its
subsequent display) to the
Information Center. For
Continuous Mode only.
Telemetry Functions at the Information Center
enable
disable
disable
(Pleth is not
displayed.)
Unit-Configurable Settings
Unit Settings - Telemetry Setup
Control
Function
Settings
Default
Pulse
Enable/disable the transmission
of the Pulse parameter (and its
subsequent display) to the
Information Center. For
Continuous Mode only.
enable
disable
disable
(Pulse is not
displayed.)
Enable/disable the display of
SpO2 alarms on the Information
Center
enable
enable
SpO2 Limits
High
Increment/decrement SpO2 high
alarm limit by 1 (in %).
Limit maximum is 100. Limit
minimum is 51 (adult) or 31
(pediatric). High and low
limit must be at least 1%
apart.
100 (adult,
pediatric)
SpO2 Limits
Low
Increment/decrement SpO2 low
alarm limit by 1 (in %).
Limit maximum is 99. Limit
minimum is 50 (adult) or 30
(pediatric). High and low
limit must be at least 1%
apart.
90 (adult,
pediatric)
3-wire
Set the unit default lead label.
I, II, III
II
5-wire, ECG1
Set the unit default lead label.
I, II, III, MCL, AVR, AVL,
AVF, V
II
5-wire, ECG2
Set the unit default lead label.
I, II, III, MCL, AVR, AVL,
AVF, V
5-wire, ECG3
Set the unit default lead label.
I, II, III, V
III
SpO2 Alarm
disable
Telemetry Functions at the Information Center
6-11
Unit-Configurable Settings
Unit Settings - Telemetry Setup
Control
Function
Settings
Default
6-wire, Va
Set the unit default lead label.
V1, V2, V3, V4, V5, V6, V7,
V8, V9, V3R, V4R, V5R
V2
Note—If ECGx matches Va,
then as Va is changed, ECGx
changes also.
6-wire, Vb
Set the unit default lead label.
V1, V2, V3, V4, V5, V6, V7,
V8, V9, V3R, V4R, V5R
V5
Note—If ECGx matches Vb,
then as Vb is changed, ECGx
changes also.
6-wire, ECG1
Set the unit default lead label.
I, II, III, MCL, AVR, AVL,
AVF, V1, V2, V3, V4, V5,
V6, V7, V8, V9, V3R, V4R,
V5R
II; V lead
choice is
determined
by Va and
Vb settings.
6-wire, ECG2
Set the unit default lead label.
I, II, III, MCL, AVR, AVL,
AVF, V1, V2, V3, V4, V5,
V6, V7, V8, V9, V3R, V4R,
V5R
V2; V lead
choice is
determined
by Va and
Vb settings.
6-wire, ECG3
Set the unit default lead label.
I, II, III, MCL, AVR, AVL,
AVF, V1, V2, V3, V4, V5,
V6, V7, V8, V9, V3R, V4R,
V5R
III; V lead
choice is
determined
by Va and
Vb settings.
6-12
Telemetry Functions at the Information Center
Unit-Configurable Settings
Unit Settings - Telemetry Setup
Control
Function
Settings
Default
6-wire, ECG4
Set the unit default lead label.
I, II, III, MCL, AVR, AVL,
AVF, V1, V2, V3, V4, V5,
V6, V7, V8, V9, V3R, V4R,
V5R
V5; V lead
choice is
determined
by Va and
Vb settings.
5-wire EASI,
ECG1
Set the unit default lead label.
I, II, III, AVR, AVL, AVF,
V1, V2, V3, V4, V5, V6
II
5-wire EASI,
ECG2
Set the unit default lead label.
I, II, III, AVR, AVL, AVF,
V1, V2, V3, V4, V5, V6
V2
Telemetry Functions at the Information Center
6-13
Unit-Configurable Settings
6-14
Telemetry Functions at the Information Center
All installation tasks are performedy by Service personel and are described in
detail in the service documentation accompanying the system. This chapter
provides procedures for maintaining the equipment, assigning labels for
replacement transceivers, keeping the transceiver clean, and troubleshooting
common problems. It includes the following sections:
•
•
•
Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2
Transceiver Cleaning, Disinfection, & Cross-Infection Prevention . . . 7-4
Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-15
Maintenance & Troubleshooting
7-1
Introduction
Maintenance & Troubleshooting
Maintenance
Maintenance
Basic
Monitoring
Before beginning monitoring on a patient:
•
•
•
•
Check for any mechanical damage.
Check all the external leads, plug-ins and accessories.
Check all the functions of the instrument which are needed to monitor the
patient.
Ensure that the instrument is in good, working order.
Do not use the Philips IntelliVue Telemetry Monitoring System for any
monitoring procedure on a patient if you identify features which demonstrate
impaired functioning of the instrument. Contact the Service Provider.
Warning
Failure on the part of the responsible individual hospital or institution
employing the use of this equipment to implement a satisfactory
maintenance schedule may cause undue equipment failure and possible
health hazards.
Label Assignment for Replacement Transceiver
In order to operate within the wireless system, each telemetry device must have
an equipment label assigned at the Information Center. The Assign Label
function enables you to unassign a label from a lost transmitter, and re-assign
that label to a replacement transmitter. Labels are limited to those available in an
individual clinical unit. The Label Assignment function requires a password for
access, and its controls are available in English only.
7-2
Maintenance & Troubleshooting
Maintenance
To Re-assign a Label from a (Lost) Device to a Replacement
Transceiver
Step
Action
Clear the sector that the original Equipment Label was assigned to.
(Patient Window -> Sector Setup -> Clear the Sector).
Note—This step ensures that no patient is being monitored by the
original (lost) device.
Select All Controls, then Label Assignment.
Enter password.
Note—The remaining screens will be in English only.
Insert batteries into the replacement device.
You should hear a double beep, indicating that the transceiver has
no Equipment Label assigned.
Select the MAC address of the replacement device from the “New
Devices” list.
Note—The transceiver MAC address is located inside the battery
compartment.
Select the Equipment Label that was assigned to the unit’s former
device from “Devices Labels” list.
Maintenance & Troubleshooting
7-3
Transceiver Cleaning, Disinfection, & Cross-Infection Prevention
Step
Action
Select Assign Label to initiate programming of the Equipment
Label into the replacement telemetry device
- AND within 10 seconds, press the Check button on the telemetry device.
Note—If 10 seconds pass without a button push, then repeat this
step.
What about clicking OK at the prompt? THIS LABEL HAS
ALREADY BEENASSIGNED TO A PWD WITH A DIFFERENT
MAC ADDRESS.
When the telemetry device has completed the normal power-up
sequence, an “Assignment Complete” message is displayed and the
the label is marked as being assigned.
The device is now ready to connect to the wireless network.
Go back into Sector Setup, and select the Bed Label and Equipment
Label, followed by OK. The transceiver is now ready for patient
monitoring.
Transceiver Cleaning, Disinfection, & Cross-Infection
Prevention
The procedures in this section keep the transceiver clean and provide protection
against infectious agents and bloodborne pathogens. Both the outside of the
transceiver and the inside of the battery compartment must be kept free of dirt,
dust, and debris. The procedures in this section cover the following activities:
•
7-4
Cleaning: removing visible surface decontamination from the device
Maintenance & Troubleshooting
Transceiver Cleaning, Disinfection, & Cross-Infection Prevention
•
Disinfection: protecting cleaned devices against infectious agents and
bloodborne pathogens by a chemical agent.
Cross-Infection Prevention: using ETO gas treatment to decontaminate
cleaned equipment.
•
Important—After exposure, the transceiver must be cleaned, followed by
either Disinfection or Cross-Infection Prevention procedures according to
hospital protocols, before continued use in monitoring.
Cleaning the Transceiver
Caution
Do not use any abrasive cleaning materials or overly vigorous cleaning actions
on any part or component of the IntelliVue TRx or TRx+ transceiver. Use of
abrasive cleansers and abrasive cleaning actions will damage the components.
Perform the following steps to clean the transceiver of visible surface
contamination.
Step
Action
Remove the batteries and any cables or accessories.
Soak the transceiver in water for up to 5 minutes to soften any dried
debris, if necessary.
Rinse the transceiver in water.
Flush device orifices with a forceful water stream to remove any
residue in the openings.
Allow to air-dry, or dry with a non-lint producing cloth.
Continue with either Disinfection or Cross-Infection Prevention
procedure, according to your hospital’s protocol.
Maintenance & Troubleshooting
7-5
Transceiver Cleaning, Disinfection, & Cross-Infection Prevention
Disinfecting the Transceiver
Warning
To prevent fire, provide adequate ventilation and do not permit smoking
when disinfecting the device with a flammable liquid, such as alcohol.
Caution
Remove the batteries and any cables or accessories before you disinfect the
transceiver.
The transceiver can be disinfected by two methods: wiping or soaking. If the
device has areas that are difficult to disinfect, soaking for up to five minutes is
recommended. The approved disinfection agents are:
•
•
Isopropryl Alcohol, >70%
Sodium Hypochlorite, 10% solution prepared within 24 hours (for wiping
only)
Equipment must be cleaned (see “Cleaning the Transceiver” on page 7-5) before
this disinfection by wiping or soaking is performed.
Wiping the
Transceiver
Step
Action
Remove the batteries and any cables or accessories.
Wipe the transceiver clean by using a cloth dampened modestly
with one of the following approved cleaning agents:
•
•
7-6
Maintenance & Troubleshooting
Isopropyl Alcohol (> 70%)
Sodium Hypochlorite (chlorine bleach), 10% solution
prepared within 24 hours.
Transceiver Cleaning, Disinfection, & Cross-Infection Prevention
Step
Action
Wipe all disinfected surfaces with distilled water to remove any
residue.
Allow to air-dry, or dry with a non-lint producing cloth.
Soaking the
Transceiver
Caution
Do not soak the equipment in cleansers other than Isopropyl Alcohol, or soak
longer than five minutes. Soaking the transceiver for longer than five minutes or
in cleansers other than Isopropyl Alcohol can severely damage the device.
Step
Action
Remove the batteries and any cables or accessories.
Soak the device in Isopropyl Alcohol (> 70%) for up to five
minutes.
Note—The battery compartment can be closed or open during
soaking.
Dip all cleaned surfaces in bowl of distilled water to remove any
residue.
Dry the equipment with a non-lint producing cloth.
Cross-Infection Prevention for the Transceiver
The transceiver can be subjected to one ETOH cross-infection prevention
process four times per year for 2 years. Completion of this procedure achieves a
cross-infection prevention assurance level of 10E-6.
Equipment must be cleaned (see “Cleaning the Transceiver” on page 7-5) before
this procedure is performed.
Maintenance & Troubleshooting
7-7
Transceiver Cleaning, Disinfection, & Cross-Infection Prevention
Note—If there is concern over cross-contamination due to leadsets or sensors,
new leadsets or sensors should be used.
Equipment and
Materials
Warning
EO is highly explosive, toxic, and a potential occupational carcinogenic and
reproductive hazard. Handle it with extreme care, following U.S.
Occupational Safety and Health Administration (OSHA) standards for EO
(29 CFR 1910.1047)*. Personnel exposure and/or room air must be
monitored per OSHA standards.
Vent sterilizer gas outdoors or to a suitable, evacuated container for
reprocessing, depending upon state, provincial, or country environmental
regulations. Do not vent sterilant indoors.
Vent aerator exhaust only to the outdoors.
7-8
See “References” on page 7-12.
Maintenance & Troubleshooting
Transceiver Cleaning, Disinfection, & Cross-Infection Prevention
Use the following equipment and material to process the transceiver:
1. Ethylene Oxide (Allied Signal Oxyfume-2002™), heretofore referred to
as EO.
2. Gas sterilizer, made by American Sterilizer Company or other
manufacturers.
3. Mechanical aerator. The intake air for the aeration chamber must be
routed through bacterial filters, and the exhaust air must be vented outside
the building.
Note—Available combination sterilizer/aerators bypass the problem of personnel
exposure to EO during transfer of treated material to a separate aeration cabinet.
CrossInfection
Process
The following generic procedure can be used to supplement the sterilizer and
aerator manufacturers’ instructions, although the processing times, temperatures,
and pressure must be the same as those given in this procedure.
Important—In order to complete this stage of the process safely, harmful residue
gas must be dissipated through aeration.
Step
Action
Remove any obvious contamination from the equipment to be
processed using approved cleaners.
Individually package each transceiver in standard central supply
room (CSR) wrapping material secured with EO color-change indicator tape.
Apply -26 inHg +/- 1 (-12.77 psig +/- .49) vacuum to the empty
sterilizer chamber two times, to remove any residual EO or moisture. Vent the vacuum pump to the outdoors to avoid toxic hazards
to personnel.
Insert the equipment to be processed into the gas sterilizer.
Heat the chamber and its contents to 54.4 +/- 2.8oC (130 +/- 5oF).
Apply -26 inHg +/- 1 (-12.77 psig +/- .49) vacuum to the sterilizer
chamber.
Maintenance & Troubleshooting
7-9
Transceiver Cleaning, Disinfection, & Cross-Infection Prevention
Step
Action
Humidify the chamber at 50% +/- 10% relative humidity for 20 to
30 minutes.
Taking a minimum of five minutes, slowly introduce EO sterilant
until the sterilizer unit pressure gauge reaches 11 +/- 1 psig.
Note—At this pressure, the concentration of sterilant in the chamber
will be 600 +/- 50 mg/liter, regardless of the chamber size.
Process the equipment to be processed as follows:
Pressure: 11 +/- 1 psig (established in the preceding step).
Time: 2-3 hours
Temperature: 54.4 +/- 2.8oC (130 +/- 5oF)
10
Extract the gas mixture from the sterilizer as follows:
Warning
Comply with OSHA standards*. Do not vent sterilizer gas to the
room, but vent only outdoors or to a suitable, evacuated
container, depending upon state, provincial, or country environmental regulations. (If the mixture is captured, it can be separated commercially and the component gases re-used.)
* See “References” on page 7-12.
a. Pump the gas mixture out of the chamber until you obtain a vacuum of -26 inHg +/- 1 (-12.77 psig +/-.49), returning the mixture to a suitable evacuated container.
b. Return the sterilizer chamber to ambient pressure by introducing air that has been bacterially filtered.
7-10
Maintenance & Troubleshooting
Transceiver Cleaning, Disinfection, & Cross-Infection Prevention
Step
11
Action
Air-wash the chamber and material as follows:
a. Apply -26 inHg +/- 1 (-12.77 psig +/- .49) vacuum to the
chamber and processed material again, to remove residual EO. The vacuum pump must be vented to the outdoors.
b. Return the sterilized chamber to ambient pressure by introducing air that has been bacterially filtered.
12
Continue with the “Aeration Procedure” (following).
Aeration
Procedure
Warning
To avoid chemical burns and toxic effects, the equipment must be aerated
after sterilization, as described. The aerator must have bacterial filters and
outdoor venting.*
See “References” on page 7-12.
Maintenance & Troubleshooting
7-11
Transceiver Cleaning, Disinfection, & Cross-Infection Prevention
Aerate the processed equipment by performing the following steps:
Step
Action
To dissipate residual EO, aerate the processed equipment with air
that has been bacterially filtered, using a mechanical aerator or
combination sterilizer/aerator as follows:1
Time: 8-9 hours
Temperature: 54.4 +/- 2.8oC (130 +/- 5oF)
Ventilation Frequency: At least 30 air exchanges per hour.
Continue with the “Test Procedure” (following).
1 These
values will produce EO and Ethylene Chlorohydrin residual levels in the
transceiver and patient cable plastic that meet ISO 10993-7 in conjunction with
AAMI Technical Information Report 19, that the FDA currently endorses.
References
OSHA: Standard for acceptable levels of personnel exposure to Ethylene Oxide
Gas: 1 ppm on an eight-hour time-weighted average basis.
Reference: U.S.A. Federal Regulations 49 FR 25734/29 CFR Part 1910.1047,
June 22, 1984; final approval 50 FR 9800/2- CFR Part 1910.1047, March 12,
1985.
Test Procedure
Caution
You must perform this test each time you put a transceiver through the crossinfection prevention procedure.
This test allows you to verify that patient information for both ECG and SpO2 (if
you are monitoring pulse oximetry) appear at the information center and at the
bedside. You can use this procedure with a patient simulator.
7-12
Maintenance & Troubleshooting
Transceiver Cleaning, Disinfection, & Cross-Infection Prevention
Note—This test assumes that the telemetry system and Information Center are
fully installed, and that you have performed the procedure to learn the
transceiver identity code.
Test the transceiver by performing the following steps. If the test indications do
not appear, refer to your Service Provider.
Step
Action
Perform a mechanical inspection of the transceiver (connectors,
battery door opening and closing, Telemetry and Check buttons).
At the Information Center, select the telemetry bedside you are
testing.
Maintenance & Troubleshooting
7-13
Transceiver Cleaning, Disinfection, & Cross-Infection Prevention
Step
Action
Test the transceiver:
a. Put fresh batteries in the transceiver and close the battery door
Result: All six lead lights should flash, and one light
should remain on.
b. Attach a leadset to the ECG port, and attach an SpO2
sensor to the SpO2 port. If an ECG simulator is available, attach the ECG leads to the simulator and the
SpO2sensor to yourself. At TeleMon, set the SpO2 sample rate to Continuous.
Result: An ECG trace and SpO2 information should be
visible on the Information Center display. All transceiver lights should be off.
c. Disconnect the Right Arm lead for standard ECG or the
“I” electrode for EASI.
Result: The RA LED or the “I” lead LED should turn
on, and a Leads Off INOP should appear on the display
at the Information Center.
d. Reconnect the electrode.
7-14
Maintenance & Troubleshooting
a. Connect the transceiver to TeleMon and observe the
ECG waveform and SpO2 numerics on the TeleMon display.
Result: The ECG waveform and SpO2 numerics should
be displayed on the TeleMon screen.
Troubleshooting
Troubleshooting
Basic Troubleshooting
For problems with...
•
ECG measurement
see...
“Optimizing ECG Measurement Performance”
on page 3-25
“Technical Alarms (INOPs)” on page 2-14
•
SpO2 measurement
“Optimizing SpO2 Measurement Performance”
on page 5-21
“Optimizing Sensor Performance” on page 5-22
“Technical Alarms (INOPs)” on page 2-14
•
Batteries
“Battery Information” on page 1-19
“Self Test” on page 1-17
•
Nurse call
Nurse Call may have been turned off for the
patient. See “Patient-Configurable Settings in
Telemetry Setup” on page 6-3 for directions on
how to turn it on.
Testing Alarms
Visual and auditory alarms appear at the Information Center. One method of
verifying visual and auditory alarms at the Information Center is to connect the
transceiver to an ECG or ECG/SpO2 simulator. By varying the ECG rate and
SpO2 value, alarms can be generated and confirmed for proper operation.
Information
Signals
If there is a connection failure within the IWN/Philips IntelliVue Telemetry
System, an information signal will be generated. This information signal will be
displayed on the Information Center where the affected wireless patient
Maintenance & Troubleshooting
7-15
Troubleshooting
monitoring device(s) (transceiver, access point, access point controller, portable
bedside monitor) is assigned, as well as on all other Information Centers
connected to a common Database Server.
The condition causing the failure will be described in the Wireless Status Log,
which is available in Service Mode. See the tables below.
Information Signal
Information
Signal
Wireless
monitoring loss Contact Service
Note—This
information signal
appears on ALL
Information Centers
connected to a
common Database
Server.
Description
What to Do
Intermittent disruption or
failure in communications
between one or more
patient monitoring wireless
devices and the
Information Center.
Contact Service.
Note—Details about the
communication disruption
are available in the
Wireless Status Log (see
following table).
Wireless Status Log Messages
Note: CTS refers to Philips IntelliVue Telemetry System.
Wireless Status Log Text
Cause
Notes
CTS Near Area Capacity 
AP is near usable
capacity.
Alert cleared when number of
connects is below configured
threshold.
CTS Tele AP Malfunction 
Alert sent when AP
DECT processor
fails or when a
software fault is
detected.
No alert is sent when AP ethernet
fails.
7-16
Maintenance & Troubleshooting
Troubleshooting
Wireless Status Log Messages
Note: CTS refers to Philips IntelliVue Telemetry System.
Wireless Status Log Text
Cause
Notes
CTS TELE APC Malfunction 
Alert sent when this
AP detects that its
partnered APC has
failed.
Alert cleared when master APC
sees the keep-alive or registration
message from that APC again.
CTS Tele Duplicate IP Address

Duplicate IP
address has been
detected on the CTS
network.
Alert cleared when all AP have
unique IP address
CTS Excessive ARQ retries 
Sent when the
number of retries at
ARQ level exceeds
the specified
threshold.
CTS Tele Excessive Handover 
Excessive handover
of the transceiver.
Alert cleared when handovers per
minute is below configured
threshold.
CTS Tele Master APC Malfunction
Alert sent when the
AP cannot find a
master APC.
Alert cleared when AP receives an
announcement packet again.
CTS Tele Max Area Capacity 
Alert sent when the
AP reaches
maximum capacity.
Alert cleared when number of
connects is reduced below
maximum limit.
CTS Tele NO SYNC 
Loss of local or
remote sync to
Access Points
Excessive Data Loss 
Excessive data loss
on link.
Alert cleared when data loss is
below configured threshold.
Maintenance & Troubleshooting
7-17
Troubleshooting
7-18
Maintenance & Troubleshooting
This chapter describes the regulatory standards that the product complies with,
along with product and measurement specifications. It includes the following
sections:
•
•
•
•
•
•
Regulatory Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-2
Battery Life Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-5
Electromagnetic Compatibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-6
Radio Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-8
Physical Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-11
Measurement Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-13
Safety Standards & Specifications
8-1
Introduction
Safety Standards & Specifications
Regulatory Information
Regulatory Information
Intended Use
The device is intended to provide ambulatory and bedside monitoring of ECG
and SpO2 parameters of adult and pediatric patients in professional healthcare
facilities. It is intended to be used by trained healthcare personnel. It is not
intended for home use.
This device is a US-only device and is not for use in Canada or the European
Union.
Indications
for Use
Indicated for use by health care professionals whenever there is a need for
monitoring the physiological parameters of patients. Intended for monitoring,
recording and alarming of multiple physiological parameters of adult and
pediatric patients in transport and hospital environments.
Rx
Federal Law restricts this device to sale by or on the order of a physician.
Patient
Population
This device is not for use with infant or neonatal patients.
Use of the transceiver is restricted to one patient at a time.
The transceiver and related accessories are in compliance with the relevant
requirements of EN ISO 10993-1 for Biocompatibility. The transmitter is not
designed for direct contact with the patient’s skin. The accompanying pouch is
the appropriate means for holding the transmitter.
Safety
Standards
The device complies with the following safety requirements for medical
electrical equipment:
•
•
•
•
•
8-2
IEC 601-1:1988 + A1:1991 + A2:1995 General Requirements for Safety
(with worldwide deviations, including U.S. deviations)
IEC 60601-1-1:2000 System Safety
IEC 60601-1-2:2001 Electromagnetic Compliance
IEC 60601-1-4:1996 Safety for Programmable Electrical Medical
Systems
IEC 60601-2-49:2001 Multi-parameter Monitor Safety
Safety Standards & Specifications
Regulatory Information
•
•
•
•
ISO 10993-1:2003 Biocompatibility (for lead wires and pouch)
ISO 9919:1992 Pulse Oximeters
EN 865:1997 Particular Requirements for Pulse Oximeters
AAMI EC 13:2002 Performance Standard, Cardiac Monitors
Essential Performance
The IntelliVue Telemetry System provides Essential Performance (EP) under
normal operating conditions (includes EMC exposure) only as a complete
Medical Electrical System, consisting of the M4841A Transceiver, the M2636
TeleMon with Option A02/A03 Companion Monitor (optional), the IntelliVue
Telemetry Network Infrastructure, and the M3150A Information Center.
The Philips IntelliVue Telemetry System achieves its Essential Performance
exclusively through alarm generation at the M3150 Information Center.
The Philips IntelliVue Telemetry System protects the patient from unacceptable
immediate clinical risk by generating specific Physiological Alarms when
appropriate. If the System cannot generate Physiological Alarms, then relevant
Severe or Hard Technical Alarms (Inoperative Conditions) will be created.
System Classification
The M4841A Transceiver is an FDA Class II device. It has the following
characteristics.
Characteristic
Definition
Internally Powered
Equipment
The M4841A transceiver is an internally powered
device.
Continuous Operation
All equipment is Ordinary Equipment, IPX0, and
provides continuous operation
Type CF
Defibrillation Proof
The M4841A transceiver is Type CF
Defibrillation Proof relative to ECG and SpO2
patient applied parts.
Safety Standards & Specifications
8-3
Regulatory Information
Characteristic
Water Resistance
Definition
When placed inside a Philips carrying pouch with
the flap closed and snaps secured, the M4841A
transceiver is rated IPX3 as per IEC 60529:1989
(+A1:1999): Protected against spraying water.
The combination of the transceiver and pouch will
withstand showering for up to 10 minutes.
The transceiver will not be damaged if it is
accidentally immersed in liquid for up to 5
minutes.
Warning
If the transceiver is used while showering a
patient or is accidentally submerged in liquid,
detection of leads off conditions may be
compromised. Appropriate clinical precautions
must be taken.
FCC
Compliance
(USA only)
Operation of this equipment requires the prior coordination with a frequency
coordinator designated by the FCC for the Wireless Medical Telemetry Service.
The transceiver and the Philips IntelliVue Telemetry System are subject to radio
frequency interference. In the event of suspected radio frequency interference
with your device, contact your Service Provider. The FCC requires the following
statement for this device:
The Philips IntelliVue Telemetry System complies with Part 15 of the Federal
Communications Commission (FCC) Rules. Operation is subject to the
following two conditions:
1. This device may not cause harmful radio frequency interference to a a
primary licensed user (radio and television stations), and
2. This device must accept any interference received from a primary licensed
user, including interference that may cause undesired operation.
8-4
Safety Standards & Specifications
Battery Life Specifications
Pursuant to Part 15.21 of the FCC Rules, any changes or modifications to this
equipment not expressly approved by Philips Medical Systems may cause
harmful radio frequency interference, and void your authority to operate this
equipment.
AC Power
Source
The system is not intended for connection to the public mains as defined in
CISPR11.
Battery Life Specifications
Battery Type
Equipment
Battery Type
Battery Life
Specification
2 fresh AA disposable alkaline batteries
Note—The battery life specifications listed below are based on Duracell MN
1500 batteries. Battery life for other brands may differ.
Operating Mode
Battery Life
ECG Only
48.7 hours
ECG/SpO2 Continuous
16.8 hours
ECG/SpO2 Spot Check
between 16.8 hours and 48.7 hours, depending
on usage rate
Safety Standards & Specifications
8-5
Electromagnetic Compatibility
Battery Gauge
Battery Gauge
Approximate
Battery Life
Remaining
Approximate
Operating
Time
Remaining
Disabled
Functions
4 green indicators
> 75%
> 34.7 hours
___
3 green indicators
> 50%
> 23.1 hours
___
2 green indicators
> 25%
> 11.6 hours
___
1 green indicator
25% to Low
Battery level
> 15 minutes
___
1 red indicator
Low Battery level
to Replace Battery
level
< 15 minutes
SpO2
no indicator
Replace Battery
level
(Check batteries
for correct
polarity)
none
Transceiver
shutdown/
RF
shutdown
Electromagnetic Compatibility
Medical electrical equipment can either generate or receive electromagnetic
interference. This product has been evaluated for electromagnetic compatibility
(EMC) with the appropriate accessories according to IEC 60601-1-2:2001, the
international standard for EMC for medical electrical equipment. This IEC
standard has been adopted in the European Union as the European Norm, EN
60601-1-2:2001.
8-6
Safety Standards & Specifications
Electromagnetic Compatibility
Radio frequency (RF) interference from nearby transmitting devices can degrade
performance of the product. Electromagnetic compatibility with surrounding
devices should be assessed prior to using the product.
Fixed, portable, and mobile radio frequency communications equipment can also
affect the performance of medical equipment. See your Service Provider for
assistance with the minimum recommended separation distance between RF
communications equipment and the product.
The cables, sensors/transducers, and other accessories for which compliance is
claimed are listed in the Service and User documentation accompanying the
product.
Warning
The use of accessories, transducers and cables other than those specified in
the product service and user documentation can result in increased
emissions or decreased immunity of the product.
Warning
The product should not be used next to or stacked with other equipment. If
you must stack the product or , you must check that normal operation is
possible in the necessary configuration before the product is used.
Reducing Electromagnetic Interference
The transceiver and associated accessories can be susceptible to interference
from other RF energy sources and continuous, repetitive, power line bursts.
Examples of other sources of RF interference are other medical electrical
devices, cellular products, information technology equipment, and radio/
television transmission. If interference is encountered, as demonstrated by
artifact on the ECG or dramatic variations in physiological parameter
measurement values, attempt to locate the source. Assess the following:
•
Is the interference due to misplaced or poorly applied electrodes or
sensors? If so, re-apply electrodes and sensors correctly according to
directions in Chapter 3. ECG Monitoring.
Safety Standards & Specifications
8-7
Radio Specifications
•
•
•
•
Is the interference intermittent or constant?
Does the interference occur only in certain locations?
Does the interference occur only when in close proximity to certain
medical electrical equipment?
Do parameter measurement values change dramatically when the AC line
cord is unplugged?
Once the source is located, attempt to attenuate the interference by distancing
the transceiver from the source as much as possible. If assistance is needed,
contact your local service representative.
Restrictions
for Use
Artifact on ECG and other physiological waveforms caused by electromagnetic interference should be evaluated by a physician or physician authorized
personnel to determine if it will negatively impact patient diagnosis or treatment.
Radio Specifications
M4841A
Transceiver
Parameter
Frequency Ranges
Specification
Bands 1395-1400 MHz and 1427-1432 MHz
Channel Spacing: 1.6 MHz
RF Output Power
RF Output Power control
8-8
Safety Standards & Specifications
8 dBM +2/-3 dB (3.2 mW to 10 mW), into
Antenna load @ nominal battery voltage
• Transceiver chain gain shall be calibrated
at time of manufacture (env temp 25+/- 5
oC)
• Over power algorithm deployed to prevent
excess power and also includes
temperature compensation.
Radio Specifications
Parameter
Specification
RF Overpower trip point
> 10 dBm
Transceiver Frequency
Accuracy during normal
operation
+/- 15 kHz relative to channel frequency,
includes temperature compensation and aging
effects
Reference Frequency
Calibration
< 4 ppm set a time of manufacture (env temp
25 +/- 5 oC)
Modulation Type
FSK with Root Raised Cosine filtering
Modulation Deviation
Bit 1: +288 kHz +/- 25 kHz relative to channel
frequency
Bit 0: -288 kHz +/- 25 kHz relative to channel
frequency
Transmitter Output
Broadband Noise
<-58.9 dBm in 1 MHz band, outside channel
in use
Out of Band Spurious
Emission Levels
<= 1394 MHz, >= 1401
MHz
<= 1428 MHz, >= 1433
MHz
<-41 dBm in 1 MHz bandwidth for FCC limit
Limits measured into 50 Ohms load:
(< -43 dBc referred to transceiver power of +8
dBm over 25 oC to 55 oC, excluding duty
cycle effects defined below)
(< -40 dBc over 0 oC to <25 oC, excluding
duty cycle effects defined below)
Transceiver duty cycle reduces effective
spurious emissions:
Transceiver RM at 1/64 duty cycle = 18 dB
reduction
Access Point RM at 16 connections, 50% duty
cycle = 6 dB reduction
Safety Standards & Specifications
8-9
Radio Specifications
WMTS
Channel
Frequencies
1395 to 1400
MHz
Parameter
Specification
Lower band edge
1395 MHz
Channel 1
1395.8977 MHz
Channel 2
1397.4970 MHz
Channel 3
1399.0963 MHz
Upper band edge
1400 MHz
Channel spacing
1.6 MHz
1427 to 1432
MHz
Parameter
8-10
Specification
Lower band edge
1427 MHz
Channel 4
1427.8979 MHz
Channel 4a (*)
1429.2410 MHz
Channel 5 (**)
1429.4972 MHz
Channel 6 (**)
1431.0965
Safety Standards & Specifications
Physical Specifications
Parameter
Upper band edge
Specification
1432 MHz
* Available in special geographic area only
** Not available in special geographic areas
Physical Specifications
ECG-only
Transceiver
Parameter
Specification
Height
140 mm
Width
75 mm
Depth
28.5 mm
Weight
• without batteries or
leadset
• with batteries and 5wire leadset
Volume
•
<165 g (5.8 oz.)
•
<284 g (10 oz.)
215 cm3
Safety Standards & Specifications
8-11
Environmental Specifications
ECG/SpO2
Transceiver
Parameter
Specification
Height
140 mm
Width
88 mm
Depth
37 mm
Weight
• without batteries or
leadset
• with batteries and 5wire leadset
•
<205 g (7.2 oz.)
•
<324 g (11.5 oz.)
300 cm3
Volume
Environmental Specifications
M4841A
Transceiver
Parameter
8-12
Specification
Temperature
• Operating
• Storage
• 0 to 37 oC (32 to 99 oF)
• -40 oC to 60 oC (-40 to 120 oF) without batteries
Humidity
• Operating
• Storage
• < 95% RH at 40 oC (104 oF) non-condensing
• < 90% RH at 60 oC (120 oF) without batteries
Safety Standards & Specifications
Measurement Specifications
Parameter
Altitude
• Operating &
Non-operating
Specification
0 to 3,048 m (10,000 ft)
Measurement Specifications
ECG
Parameter
ECG channel
transmitted Leads
• 3 electrodes
• 5 electrodes
Specification
•
•
•
5 electrodes,
EASI
•
•
6 electrodes
•
Channel #1 - I, II, or III
Channel #1 - II
Channel #2 - III
Channel #3 - MCL
Channel #1 - Vai
Channel #2 - Vas
Channel #3 - Ves
Channel #1 - II
Channel #2 - III
Channel #3 - Va
Channel #4 - Vb
Resolution
5 µV
ECG Input
Differential, defibrillator protected against 400
joules discharge into a 50 ohm load
Input Impedance
> 5 megohms (@ 10 Hz
Safety Standards & Specifications
8-13
Measurement Specifications
Parameter
Input Dynamic Range
+/- 9 mV
DC Offset Range
+/- 320 mV
CMRR
> 90 dB @ 50, 60 Hz
Bandwidth +/- 3 dB
0.05 to 40 Hz
Gain Accuracy
+/- 5% at 25 oC (77 oF)
Noise Referred to ECG
Input
AAMI: 30 µV
Lead Wires
3, 5 or 6-wire leadset. 5-lead compatible with
IntelliVue Patient Monitor, AAMI or IEC color
code
Time to baseline from
Defibrillator
AAMI: 5 s max (until ECG wave is on display
but not yet centered, monitoring bandwidth)
Pacer Rejection
Performance
(Pace pulses with no
tails)
Positive pacers
Amplitude
+2 to +700 mV
+2 to +500 mV
+2 to +400 mV
Negative pacers
Amplitude
-2 to -700 mV
-2 to -500 mV
-2 to -400 mV
EMC Performance
limits, radiated
immunity
8-14
Specification
Safety Standards & Specifications
Width
0.1, 0.2, 0.5 and 1.0 ms
1.5 ms
2 ms
Width
0.1, 0.2, 0.5 and 1.0 ms
1.5 ms
2 ms
46.262 to 55.326 MHz pass at reduced level is
0.4336 V/m.
165 to 195.6 MHz pass at reduced level is 2.4 V/
m.
Measurement Specifications
SpO2
Parameter
SpO2 Measurement
Range
SpO2 Accuracy
Specification
0 to 100%
• +/- 2.5% (1 Standard deviation) with Philips
reusable sensor (M1191A, M1192A): 70 100 %
• +/- 4% (1 Standard deviation) with Philips
reusable sensor (M1194A): 70 - 100 %
• +/- 3% (1 Standard deviation) with Nellcor
Oxisensor D-25 and D-20 sensors: 80 - 100 %
SpO2 Resolution
1%
SpO2 Numerics Averaging
10 seconds
SpO2 & Pulse Numerics
- Update Rate
Transmitted once per second
Pleth Wave - sampling
rate
125 sps
Technical Alarms
(INOPs)
Triggered if the sensor is disconnected, if a pulse
is not detected, if the signal is noisy, if light
interference is detected, if the sensor is defective,
if the measurement is erratic, or if the module is
malfunctioning
Pulse Rate
Measurement
(available only with
Continuous SpO2)
Range: 30 to 300 bpm
Accuracy: +/- 2%
Resolution: 1 bpm
Safety Standards & Specifications
8-15
Measurement Specifications
Parameter
SpO2
Sensor
Accuracy
Display of SpO2
numerics
SpO2 date values are displayed as xxx % SpO2
to meet ISO/EN standard EN 865
NIBP INOP
suppression feature
If enabled, detection of a NIBP measurement on
the same limb and the corresponding suppression
of SpO2 inops (for max of 60 seconds)
Type
Philips
Reusable
Sensors
8-16
Specification
Description
Model
Number
Accuracy%
Arms (70-100%
Range)
Adult Finger
M1191A
2.0
Adult Finger
M1191AL
2.0
Adult Finger
M1191NL
2.0
Pediatric Finger
M1192A
2.0
Pediatric Finger
M1192N
2.0
Adult/Pediatric Ear
M1194A
3.0
Adult/Pediatric Ear
M1194N
3.0
Safety Standards & Specifications
Measurement Specifications
Type
Philips
Disposable
Sensors
Description
Model
Number
Accuracy%
Arms (70-100%
Range)
Adult Finger
M1901B
3.0
Pediatric Finger
M1903B
3.0
Adult Finger
M1904B
3.0
Safety Standards & Specifications
8-17
Measurement Specifications
Model
Number
Accuracy%
Arms (70-100%
Range)
OxiCliq A, Adult
N/A
3.0
OxiCliq N, Adult >40 kg
(88 lb)
N/A
3.0
OxiCliq P, Pediatric
N/A
3.0
OxiMax MAX-A, Adult
>30 kg (66 lb)
N/A
3.0
OxiMax MAX-AL, Adult
>30 kg (>66 lb)
N/A
3.0
OxiMax MAX-N, Adult
>40 kg (>88 lb)
N/A
3.0
OxiMax MAX-P, Pediatric
N/A
3.0
Type
Nellcor
Disposable
Sensors
(not
available
from
Philips)
8-18
Description
Oxisensor II D-20,
Pediatric 10-50 kg (22-110
lb)
N/A
3.0
Oxisensor II D-25, Adult
>30 kg (>66 lb)
N/A
3.0
Oxisensor II N-25, Adult
>40 kg (>88 lb)
N/A
3.0
Safety Standards & Specifications
This appendix lists all accessories that can be used with the transceiver.
For additional information on connecting and using the clinical accessories, see
the individual parameter chapters.
Note—Accessories are subject to change. To get the latest accessories,
visit the Philips Medical Supplies website located at the following
address: http://shop.medical.philips.com.or your local Philips
representative.
Accessory List
A-1
Introduction
Accessory List
Accessory Safety
Accessory Safety
Warning
Philips’s approval: Use only Philips-approved accessories.
Reuse: Never reuse disposable sensors, accessories and so forth that are
intended for single use, or single patient use only.
Packaging: Do not use a sterilized accessory if the packaging is damaged.
ECG Accessories
Electrodes
Order Number
Description
M2202A
Radio Translucent Foam Electrodes, 60 packages of 5
(300 per box)
40489E
Paper Tape Electrodes, 10 packages of 30 (300 per
box)
40493D
Foam Electrodes, 60 packages of 5 (300 per box)
40493E
Foam Electrodes, 10 packages of 30 (300 per box)
Leadsets
Order Number
9898 031 33831
A-2
Accessory List
Description
AAMI 3-wire Leadset, Snap 79 cm (30 ”)
ECG Accessories
Description
9898 031 33841
AAM 3-wire Leadset, Grabber 79 cm (30 ”)
9898 031 33871
AAMI 5-wire Leadset, Snap 79 cm (30 ”)
9898 031 33881
AAMI 5-wire Leadset, Grabber 79 cm (30 ”)
9898 031 37241
AAMI 5-wire Color Leadset, Snap 79 cm (30 ”)
9898 031 37251
AAMI 5-wire Color Leadset, Grabber 79 cm (30 ”)
9898 031 33911
AAMI 6-wire Leadset, Snap 79 cm (30 ”)
9898 031 33921
AAMI 6-wire Leadset Grabber 79 cm (30 ”)
9898 031 37281
AAMI 6-wire Color Leadset, Snap 79 cm (30 ”)
9898 031 37291
AAMI 6-wire Color Leadset, Grabber 79 cm (30 ”)
A Sales and Support
Order Number
Trunk
Cables
Order Number
9898 031 37841
Description
5-lead Trunk Cable
Pouches
Order Number
Description
9898 031 37831
Telemetry Pouch, with flap, box of 50
9898 031 40371
Telemetry Pouch, with flap, case of 200
Order Number
Description
9898 031 34771
Skin Preparation Sheets, 10 preps/sheet, package of
10 sheets
Skin Prep
Paper
Accessory List
A-3
SpO2 Accessories
Alignment
Guides
Order Number
Description
9898 031 40401
Single Alignment Guide, package of 10
9898 031 40411
Single Tethered Alignment Guide, package of 10
9898 031 40421
Double Alighment Guide, package of 10
Order Number
Description
9898 031 40431
ECG Gunk Guard, package of 10
9898 031 40441
SpO2 Gunk Guard, package of 10
9898 03140451
Serial SpO2 Gunk Guard, package of 10
Gunk
Guards
SpO2 Accessories
Reusable
Sensors
Order Number
A-4
Accessory List
Description
M1191A
Philips Adult Finger Sensor, 2 m (6.6 feet)
M1191AL
Philips Adult Finger Sensor, 3 m (9.8 feet)
M1191NL
Philips Adult Finger Sensor, 3 m (9.8 feet)
M1192A
Philips Pediatric Finger Sensor, 1.5 m (4.9 feet)
SpO2 Accessories
Disposable
Sensors Single Use
Description
M1192N
Philips Pediatric Finger Sensor, 1.5 m (4.9 feet)
M1194A
Philips Adult & Pediatric Ear Sensor, 1.5 m (4.9 feet)
M1194N
Philips Adult & Pediatric Ear Sensor, 1.5 m (4.9 feet)
Note—OxiCliq, OxiMax and Oxisensor II sensors are not available from Philips
in the USA or Canada. Adapter cables are not available from Philips in Canada
or Japan. In those countries, contact Nellcor Incorporated directly.
Order Number
Description
M1901B
Philips Adult >40 kg (>88 lb)
M1903B
Philips Pediatric 10-50 kg (22-110 lb)
M1904B
Philips Adult >30 kg (>66 lb)
N/A from Philips
*Nellcor Adhesive OxiCliq A, Adult
N/A from Philips
*Nellcor Adhesive OxiCliq N, Adult >40kg (>88 lb)
N/A from Philips
*Nellcor Adhesive OxiCliq P, Pediatric
N/A from Philips
*Nellcor OxiMax MAX-A, Adult >30 kg (>66 lb)
N/A from Philips
*Nellcor OxiMax MAX-AL, Adult >30 kg (>66 lb)
N/A from Philips
*Nellcor OxiMax MAX-N, Adult >40 kg (>88 kg)
N/A from Philips
*Nellcor OxiMax MAX-P, Pediatric 10-50 kg (22-110 lb)
N/A from Philips
*Nellcor Oxisensor II D-20, Pediatric 10-50 kg (22-110 lb)
N/A from Philips
*Nellcor Oxisensor II D-25, Adult >30 kg (>66 lb)
N/A from Philips
*Nellcor Oxisensor II N-25, Adult >40 kg (>88 lb)
M1943A
Adapter cable for Nellcor SpO2 sensor, 2 m (6.6 ft)
M1943AL
Adapter cable for Nellcor SpO2 sensor, 3 m (9.8 ft)
Accessory List
A-5
A Sales and Support
Order Number
SpO2 Accessories
Order Number
Description
* Uses reusable OC-3 Sensor Cable.
Wristband
Order Number
M1627A
A-6
Accessory List
Description
Wristband, package of 10
Please call your local sales office listed in your telephone directory or a regional
office listed below for the location of your nearest sales office.
CORPORATE HEADQUARTERS:
Philips Medical Systems
Netherlands B.V.
Postbus 10.000
5680 DA Best
Netherlands
UNITED STATES:
Philips Medical Systems
3000 Minuteman Road
Andover, MA 01810
(800) 934-7372
CANADA:
Philips Medical Systems
2660 Matheson Blvd. E.
Mississauga, Ontario L4W 5M2
(800) 291-6743
EUROPE, MIDDLE EAST AND AFRICA:
Philips Medizinsysteme Böblingen GmbH
Cardiac and Monitoring Systems
Hewlett-Packard Str. 2
71034 Böblingen
Germany
Fax: (+49) 7031 463 1552
Sales and Support Offices
B-1
Introduction
Sales and Support Offices
LATIN AMERICA HEADQUARTERS:
Philips Medical Systems
5200 Blue Lagoon Drive
9th Floor
Miami, FL 33126
(305) 267-4220
ASIA PACIFIC HEADQUARTERS:
Philips Medical Systems
24F Cityplaza One
1111 King's Road
Taikoo Shing, Hong Kong
(+852) 3197 7777
B-2
Sales and Support Offices
Index
alarms
behavior with Own Bed Overview
indicators, 2-2
physiologic, 2-10
SpO2, 5-20
technical, 2-15
testing, 7-15
auditory info signals, 1-13
2-7
transceiver use with, 1-6
INOP messages
ST 4-11
INOPs, see technical alarms 2-15
intended use
ST/AR, 4-3
transceiver, 8-2
lead placement, 3-12
battery
life, 1-23, 8-5
safety, 1-19
type, 1-21
noise
eliminating,
on/off, 1-15
ordering information
ECG supplies, A-2
SpO2 supplies, A-4
Own Bed Overview
alarm behavior 2-7
own bed overview, 6-2, 6-3
continuous SpO2, 5-16
Controls 1-28
controls
buttons, 1-8
indicators, 1-9
labels,back, 1-12
labels,front, 1-10
on/off, 1-15
other marks, 1-12
ports, 1-10
volume, 6-4, 6-8
controls, 1-7
pacing safety, 1-ix
patient window, 6-2
pause, 2-2
pleth wave display, 5-17, 6-6, 6-10
pouch, 1-24
pulse on/off, 6-6, 6-11
pulse wave display, 5-17, 6-6, 6-11
dropouts,
3-26
electromagnetic interference,
find device, 6-3
Information Center
3-27
RF interference,
8-6
3-27
safety
battery, 1-19
ECG, 1-vi
general, 1-iv
Index-1
paced, 1-viii, 4-3
pouch, 1-25
SpO2 sensor, 5-9
SpO2, 1-x, 5-2
ST/AR arrhythmia, 1-vii
ST/AR, 1-vii, 4-2
symbols, 1-12
transceiver, 1-15
sensor
ear clip, 5-13
finger, 5-11
sensors
selecting 5-22
service log, 7-16
signal strength, 3-26
sounds
see auditory info signals 1-13
start-up, 1-16
SpO2
auto on/off 5-19
continuous, 5-16
on/off, 5-18
sensor application, 5-9
sensor selection, 5-5
spot check, 5-15
turn parameter on/off 5-19
SpO2 inop suppression, 6-6, 6-10
SpO2 mode, 6-5, 6-9
SpO2 monitoring, 5-4
spot check, 5-15
ST
adjusting measurement points, 4-9
alarm adjustments, 4-12
measurement, 4-6
smart limits, 4-13
turning on/off monitoring, 4-9
ST/AR
intended use, 4-3
STanalysis, 4-6
Index-2
standby mode, 2-5
suspend, 2-2
symbols, 1-11
system messages
see information signals,
7-15
technical alarms, 2-15
telemetry setup, 6-3
TeleMon
SpO2 measurement modes 5-17
transceiver use with, 1-6
testing
alarm indicators, 2-2
alarms, 1-17
self test, 1-17
status check, 1-18
transceiver
auditory info signals, 1-13
controls, 1-7
troubleshooting 3-27
information signals, 7-15
SpO2, 5-21
TRx, TRx+
definition, 1-4
turn on/off
SpO2 parameter 5-19
volume
setup, 6-4, 6-8
volume, 6-4, 6-8

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Source Exif Data:

File Type                       : PDF
File Type Extension             : pdf
MIME Type                       : application/pdf
PDF Version                     : 1.2
Linearized                      : No
Create Date                     : 2004:08:24 20:36:13Z
Modify Date                     : 2004:08:24 16:38:27-04:00
Page Count                      : 184
Creation Date                   : 2004:08:24 20:36:13Z
Mod Date                        : 2004:08:24 16:38:27-04:00
Producer                        : Acrobat Distiller 5.0.5 (Windows)
Author                          : USD03605
Metadata Date                   : 2004:08:24 16:38:27-04:00
Creator                         : USD03605
Title                           : Animation IFU.book

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