Philips Medical Systems North America OBRWRPBV1 Patient Monitoring User Manual ait fm manual

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In stru ctio ns fo r Use
Avalon Fetal Monitor
FM20/30, FM40/50, Avalon CL
R el e a s e L .3 w i t h So f t w a re Re v i s i o n L .3 x . x x
Patient Monitori ng
1
Table of Contents
1 Introduction
Who this Book is For
Confirm Fetal Life Before Using the Monitor
Introducing the Avalon Family of Fetal Monitors
2 What's New
What's New in Release L.3
What's New in Release J.3
3 Basic Operation
Supported Measurements
Avalon FM20 and FM30
Avalon FM40 and FM50
Getting to Know Your Avalon FM20/FM30
Getting to Know Your Avalon FM40/FM50
Connecting the Monitor to AC Mains
Wired Transducers
Operating and Navigating
Operating Modes
Automatic Screen Layouts
Settings
Preparing to Monitor
After Monitoring
Switching the Monitor to the Standby Screen
Disconnecting from Power
Power On/Power Off Behavior
Monitoring After a Power Failure
Troubleshooting
4 Cableless Monitoring
Avalon CL Transducer System
Basics of Cableless Systems
Twins and Triplets Support
Configuration of Cableless Systems
Getting to Know Your Avalon CL
Cableless Transducers
CL Pods
Calling Patients
Telemetry
Preparing to Monitor Cablelessly
10
11
21
21
23
27
28
29
30
31
34
36
36
38
44
45
45
48
70
71
71
71
72
72
73
73
74
75
75
76
84
89
93
94
100
Battery Lifetime Management
Patient Transport Within the Hospital
Underwater Monitoring
5 FM20/30 Battery Option
External Power Supply M8023A
Using Batteries
Optimizing Battery Performance
Storing the Battery
Cableless Monitoring with FM20/30 Battery Option
Patient Transport Within the Hospital
6 Alarms
Alarm Mode
Nurse Call Systems
Visual Alarm Indicators
Audible Alarm Indicators
Acknowledging Alarms
Acknowledging Disconnect INOPs
Alarm Reminder
Pausing or Switching Off Alarms
Alarm Limits
Reviewing Alarms
Latching Alarms
Testing Alarms
Alarm Behavior at Power On
7 Patient Alarms and INOPs
Alarm Messages
Technical Alarm Messages (INOPs)
8 Admitting and Discharging
Admit/Discharge on the Monitor
New Patient Check
OB TraceVue/IntelliSpace Perinatal
106
107
108
109
109
110
113
115
116
116
117
118
118
119
119
121
121
122
122
124
126
126
128
128
129
129
132
147
147
149
149
9 Non-Stress Test Timer
151
Setting NST Autostart/Autostop
Viewing the NST Timer
Timer Expiry Notification
Accessing the NST Setup Pop-up Keys
151
151
151
152
10 Non-Stress Test Report
Setting Up an NST Report
NST Report Status Window
NST Criteria
153
153
154
157
11 Cross-Channel Verification (CCV)
Misidentification of Heart Rates
Cross-Channel Verification Functionality
Overview of Cross-Channel Comparisons
Coincidence Examples
Recommended Actions for Coincidence INOP
12 Monitoring FHR and FMP Using Ultrasound
Technical Description
Limitations of the Technology
Misidentification of Maternal HR as FHR
What You Need
Cableless Monitoring - Important Considerations
Preparing to Monitor
Selecting Fetal Heart Sound
Changing the Fetal Heart Sound Volume
Fetal Movement Profile
Troubleshooting
Additional Information
13 Monitoring Twin FHRs
Important Considerations
Monitoring Twins Externally
Monitoring Twins Internally
Separating FHR Traces
Troubleshooting
14 Monitoring Triple FHRs
Important Considerations
Monitoring Triplets
Separating FHR Traces
"Standard" Separation Order
"Classic" Separation Order
Switching Trace Separation On and Off
When Trace Separation is On
When Trace Separation is Off
Troubleshooting
15 Fetal Heart Rate Alarms
Changing Alarm Settings
Changing Signal Loss Delay
16 Monitoring FHR Using DECG
Misidentification of Maternal HR as FHR
What You Need
Making Connections
159
159
160
161
162
164
165
165
166
166
166
167
168
169
170
170
172
173
183
183
184
185
185
189
191
191
192
192
193
194
195
195
195
196
197
197
198
199
199
200
202
Monitoring DECG
Suppressing Artifacts
Troubleshooting
Testing DECG Mode
17 Monitoring Uterine Activity Externally
What You Need
External Toco Monitoring
Toco Sensitivity
Troubleshooting
18 Monitoring Uterine Activity Internally
What You Need
Internal (IUP) Monitoring
Troubleshooting
19 Monitoring aFHR, aHR, and aToco
Fetal Heart Rate aFHR
Uterine Activity aToco
What You Need
At the Monitor
Troubleshooting
20 Monitoring Maternal Heart / Pulse Rate
Priority for Maternal Heart / Pulse Rate
Misidentification of Maternal HR for FHR
Maternal HR from MECG Electrodes
Monitoring MECG Wave
Pulse Rate from Toco MP
Pulse Rate from SpO2
Adjusting the Heart Rate / Pulse Alarm Limits
Average Pulse Rate from Noninvasive Blood Pressure
Testing MECG Mode
207
207
208
208
208
211
211
213
214
215
215
216
217
217
218
221
221
222
222
225
227
228
228
228
229
21 Printing the ECG Waveform
231
22 Monitoring Noninvasive Blood Pressure
235
Introducing the Oscillometric Noninvasive Blood Pressure Measurement
Preparing to Measure Noninvasive Blood Pressure
Starting and Stopping Measurements
Enabling Automatic Mode and Setting Repetition Time
Enabling Sequence Mode and Setting Up the Sequence
Choosing the Alarm Source
Assisting Venous Puncture
Calibrating NBP
Troubleshooting
202
204
205
205
235
237
239
239
240
240
241
241
242
23 Monitoring SpO2
Selecting an SpO2 Sensor
Applying the Sensor
Connecting SpO2 Cables
Measuring SpO2
SpO2 Signal Quality Indicator (FAST SpO2 only)
Assessing a Suspicious SpO2 Reading
Understanding SpO2 Alarms
Setting Up Tone Modulation
Setting the QRS Volume
24 Monitoring Maternal Temperature
Measuring Tympanic Temperature
Entering Temperature Manually
243
243
243
244
244
245
246
246
247
247
249
249
254
25 Paper Save Mode for Maternal Measurements
255
26 Recovering Data
257
Recovering Traces on Paper
Recovering Traces on an OB TraceVue/IntelliSpace Perinatal System
Manually Recording Stored Data
27 Care and Cleaning
General Points
Cleaning and Disinfecting
Cleaning and Disinfecting Monitoring Accessories
Cleaning and Disinfecting the Tympanic Temperature Accessories
Cleaning and Disinfecting CL Transducers and CL Pods
Sterilizing
28 Maintenance
Inspecting the Equipment and Accessories
Inspecting the Cables and Cords
Maintenance Task and Test Schedule
Recorder Maintenance
Cleaning the Print Head
Returning Equipment for Repair
Disposing of the Monitor
29 Accessories and Supplies
Information on Latex
Avalon CL Base Station
Transducers
Fetal Accessories
Noninvasive Blood Pressure Accessories
SpO2 Accessories
257
258
258
261
261
262
263
264
264
265
267
267
268
268
269
273
273
274
275
275
275
276
276
278
280
Tympanic Temperature Accessories
Recorder Paper
Batteries
30 Specifications and Standards Compliance
285
285
285
287
Environmental Specifications
Physical Specifications
Interface Specifications
Performance Specifications
Recorder Specifications
External Displays: FM40/FM50 Only
Manufacturer's Information
Trademark Acknowledgment
Regulatory and Standards Compliance
Environment
Monitoring After a Loss of Power
ESU, MRI, and Defibrillation
Cardiac Pacemakers and Electrical Stimulators
Fast Transients/Bursts
Symbols on the System
287
289
293
295
308
310
310
310
311
321
321
321
322
322
322
31 Default Settings Appendix
327
Alarm and Measurement Default Settings
Recorder Default Settings
Index
327
330
333
1
Introduction
Who this Book is For
This book is for trained healthcare professionals using the Avalon FM20, FM30, FM40, and FM50
fetal/maternal monitors, and the Avalon CL Transducer System. It describes how to set up and use the
monitor and transducers. Familiarize yourself with all instructions including warnings and cautions
before starting to monitor patients. Read and keep the Instructions for Use that come with any
accessories, as these contain important information about application, care, and cleaning that is not
repeated in this book.
If you have received this Instruction for Use because your fetal monitor has been upgraded to a newer
software version L.3, be aware that the standards compliance information contained in the
Instructions for Use for L.3 does not apply to your fetal monitor. Refer to your original Instructions
for Use for standards compliance information.
You should be:
•
Trained in the use of fetal heart rate (FHR) monitors.
•
Trained in the interpretation of FHR traces.
•
Familiar with using medical devices and with standard fetal monitoring procedures.
For information on how to configure and service the monitor, see the Configuration Guide and the
Service Guides, or contact your authorized service provider.
Your monitor may not have all of the features and options described in this guide. The exact
appearance of the monitor may differ slightly from that shown in the illustrations.
This guide may contain descriptions of functionality and features that are not implemented in the
equipment currently shipped to Japan and/or of products that are not currently sold in Japan due to
limitations and restrictions under the applicable local laws and regulations in Japan. Please contact your
local sales representative and/or Philips Customer Support for details.
In this guide:
•
A warning alerts you to a potential serious outcome, adverse event, or safety hazard. Failure to
observe a warning may result in death or serious injury to the user or patient.
•
A caution alerts you to where special care is necessary for the safe and effective use of the
product. Failure to observe a caution may result in:
– minor or moderate personal injury,
– damage to the product or other property,
– possibly in a remote risk of more serious injury.
1 Introduction
FM30
Avalon CL
Avalon CTS
•
Monitor refers to the entire fetal/maternal monitor. Display refers to the physical display unit.
Screen refers to everything you see on the monitor's display, such as measurements, alarms,
patient data, and so forth.
•
Whenever a monitor’s identifier appears to the left of a heading or paragraph, it means that the
information applies to that monitor only. Where the information applies to all models, no
distinction is made.
Whenever one of these identifiers appear to the left of a heading or paragraph, it means that the
information applies to that cableless transducer system. Where the information applies to both
systems, no distinction is made.
For installation instructions and technical description, see the corresponding Service Guide of the fetal
monitors.
Confirm Fetal Life Before Using the Monitor
Fetal monitoring technology available today is not always able to differentiate a fetal heart rate (FHR)
signal source from a maternal heart rate (MHR) source in all situations. Therefore, you should confirm
fetal life by independent means before starting to use the fetal monitor, for example, by palpation of fetal
movement or auscultation of fetal heart sounds using a fetoscope, stethoscope, or Pinard stethoscope.
If you cannot hear the fetal heart sounds, and you cannot confirm fetal movement by palpation,
confirm fetal life using obstetric ultrasonography. Continue to confirm that the fetus is the signal
source for the FHR during monitoring.
Be aware that:
•
a maternal HR trace can exhibit features that are very similar to those of an FHR trace, even
including accelerations and decelerations. Do not rely solely on trace pattern features to identify a
fetal source.
•
Fetal Movement Profile (FMP) annotations on a fetal trace alone may not always indicate that the
fetus is alive. The body of a deceased fetus can move and cause the monitor to annotate fetal body
movements.
Here are some examples where the maternal HR can be misidentified as the FHR.
When using an ultrasound transducer:
•
It is possible to pick up maternal signal sources, such as the aorta or other large vessels.
•
Misidentification may occur when the maternal HR is higher than normal (especially when it is
over 100 bpm).
When using a fetal scalp electrode:
•
Electrical impulses from the maternal heart can sometimes be transmitted to the fetal monitor
through a recently deceased fetus via the spiral scalp electrode cable, appearing to be a fetal signal
source.
•
The recorded maternal HR (and any artifact) can be misinterpreted as an FHR (especially when it
is over 100 bpm).
When Fetal Movement Profile (FMP) is enabled:
FMP annotations in the absence of fetal life may be a result of:
10
•
Movement of the deceased fetus during or following maternal movement.
•
Movement of the deceased fetus during or following manual palpation of fetal movement
(especially if the pressure applied is too forceful).
1 Introduction
•
Movement of the ultrasound transducer.
•
The ultrasound transducer detecting a maternal movement source, such as the mother coughing.
See also “Monitoring FHR and FMP Using Ultrasound” on page 165 and “Monitoring FHR Using
DECG” on page 199.
To reduce the possibility of mistaking the maternal HR for an FHR, it is recommended that you
monitor both maternal and fetal heart rates. The monitor's cross-channel verification (CCV) feature
can help by automatically detecting when a maternal HR coincides with an FHR. For further details,
see “Cross-Channel Verification (CCV)” on page 159.
Introducing the Avalon Family of Fetal Monitors
The Avalon family of fetal monitors consists of the Avalon FM20, FM30, FM40, and FM50. While the
FM20/FM30 and the FM40/FM50 have different form factors, the method of operation is very
similar for all monitors. The Avalon fetal monitors also share transducers, accessories, software, and
are compatible with the Avalon CL, and Avalon CTS Fetal Transducer Systems.
Intended Use
The Philips Avalon FM20 (M2702A), FM30 (M2703A), FM40 (M2704A), and FM50 (M2705A) fetal/
maternal monitors are intended for:
•
noninvasive monitoring of fetal heart rates and movements.
•
noninvasive monitoring of maternal heart rates, maternal pulse rates, uterine activity, maternal
noninvasive blood pressure, maternal oxygen saturation, and maternal temperature.
•
invasive monitoring of direct fetal heart rate, intrauterine pressure, and for displaying and
recording of fetal and maternal electrocardiogram (ECG) (FM30 and FM50 only).
•
displaying, storing, and recording patient data and parameter values, and for generating alarms
from fetal and maternal parameters.
•
transmitting patient data and parameter values to a patient information and surveillance system.
•
use by trained health care professionals.
•
use in antepartum testing areas, in labor and delivery rooms, and during postpartum recovery in
the hospital environment. They are not intended for use in intensive care units or operating rooms.
•
monitoring in a bath or shower (Avalon CL cableless transducers Toco+ MP, Ultrasound, and
ECG/IUP only).
•
transport situations in healthcare facilities, for healthcare facilities outside hospitals, such as
doctors’ offices, and for use in private households (FM20 and FM30 only).
11
1 Introduction
WARNING
The fetal/maternal monitors are not intended for:
•
use during defibrillation, electro-surgery, or magnetic resonance imaging (MRI).
•
Electrocardiography (ECG) measurements on patients connected to electrical stimulator or with
cardiac pacemakers.
•
use of the invasive measurements IUP and fetal DECG, use of the patient module (M2738A) and
use of the Avalon CL system in domestic establishments, and those connected directly to the
public low-voltage supply network that supplies buildings used for domestic purposes.
•
measuring the maternal temperature using the tympanic thermometer (866149) in private
households.
WARNING
No modification of the fetal monitors, transducers, and the Avalon CL base station is allowed.
CAUTION
U.S. federal law restricts this device to sale by, or on the order of, a physician.
All users must read the Instructions for Use before working with the fetal monitor. Disregarding the
contents of the Instructions for Use is considered abnormal use.
12
1 Introduction
Indications for Use
Avalon Fetal/Maternal Monitor FM20
Indicated for use by trained health care professionals whenever there is a need for monitoring the
physiological parameters uterine activity, heart rate, oxygen saturation, noninvasive blood pressure,
pulse rate, and temperature of pregnant women, and the fetal heart rates of single fetuses, twins, and
triplets in labor and delivery rooms, in antepartum testing areas, in private households and during
transports in healthcare facilities.
Avalon Fetal/Maternal Monitor FM30
Indicated for use by trained health care professionals whenever there is a need for monitoring the
physiological parameters uterine activity, heart rate, electrocardiography (ECG), oxygen saturation,
noninvasive blood pressure, and pulse rate, and temperature of pregnant women, and the fetal heart
rates of single fetuses, twins, and triplets in labor and delivery rooms, in antepartum testing areas, in
private households and during transports in healthcare facilities.
Avalon Fetal/Maternal Monitor FM40
Indicated for use by trained health care professionals whenever there is a need for monitoring the
physiological parameters uterine activity, heart rate, oxygen saturation, noninvasive blood pressure,
and pulse rate, and temperature of pregnant women, and the fetal heart rates of single fetuses, twins,
and triplets in labor and delivery rooms and in antepartum testing areas.
Avalon Fetal/Maternal Monitor FM50
Indicated for use by trained health care professionals whenever there is a need for monitoring the
physiological parameters uterine activity, heart rate, electrocardiography (ECG), oxygen saturation,
noninvasive blood pressure, and pulse rate, and temperature of pregnant women, and the fetal heart
rates of single fetuses, twins, and triplets in labor and delivery rooms and in antepartum testing areas.
Safety Information
In this guide:
•
A warning alerts you to a potential serious outcome, adverse event or safety hazard. Failure to
observe a warning may result in death or serious injury to the user or patient.
•
A caution alerts you to where special care is necessary for the safe and effective use of the product.
Failure to observe a caution may result in minor or moderate personal injury or damage to the
product or other property, and possibly in a remote risk of more serious injury.
13
1 Introduction
Electrical Hazards
WARNING
Electrical shock hazard: Do not open the monitor housing. Refer all servicing to qualified service
personnel.
•
Always use the supplied power cord with the earthed mains plug to connect to an earthed AC
mains socket. Never adapt the mains plug from the fetal monitor to fit an unearthed AC mains
socket.
•
Do not use AC mains extension cords or multiple portable socket-outlets.
•
FM20/FM30 only: The protective earth conductor is required for EMC purposes. It has no
protective function against electric shock. Double and/or reinforced insulation protects this
device against electric shock.
•
Do not connect any devices that are not supported as part of a system.
•
Any non-medical device placed and operated in the patient’s vicinity must be powered with an
approved isolation transformer that ensures mechanical fixing of the power cords, and covering of
any unused power outlets.
•
The fetal/maternal monitor is NOT intended for use during defibrillation, electro-surgery, or
MRI. Remove all transducers, sensors, and accessories before performing electro-surgery,
defibrillation, or MRI, otherwise harm to the patient or the user can result.
•
Do not touch the charging contacts for the cableless transducers at the Avalon CL base station
while you are touching the patient.
Leakage currents: If several items of equipment used to monitor a patient are interconnected, the
resulting leakage current may exceed allowable limits.
Radio Frequency Interference
WARNING
14
•
Short range radio connections are subject to interruption due to interference from other radio
sources in the vicinity, including microwaves, bluetooth devices, WLAN devices (802.11b,g,n), and
cordless phones. Depending on the strength and duration of the interference, the interruption may
occur for an extended period. A loss of connection, due to moving out-of-range, interference, or
for other reasons, is indicated with a No Host Monitoring INOP (here the host is the fetal monitor)
on the IntelliVue CL NBP or CL SpO2 Pods, or a No Host Monitoring, or cl NBP Disconnect, or cl
SpO₂ Disconnect INOP at the fetal monitor. Correct channel configuration is important, refer to
the Service Guides and the Configuration Guide for details.
•
To avoid magnetic interference affecting the mode of the pacemaker, ensure that the
Avalon CL base station does not come into close contact with implanted pacemakers.
•
This equipment generates, uses, and radiates radio-frequency energy, and if it is not installed and
used in accordance with its accompanying documentation, may cause interference to radio
communications. Operation of this equipment in a residential area may cause interference, in
which case the users must take whatever measures may be required to correct the interference.
•
Do not use cordless/mobile phones or any other portable RF communication system within the
patient vicinity, or within a 1.0 m radius of any part of the fetal monitoring system.
1 Introduction
•
For paced patients: The radiated SRR power of the CL SpO2, CL NBP Pods, CL F&M Pod, and
the CL Wide Range Pod, and other sources of radio-frequency energy, when used in very close
proximity of a pacemaker, might be sufficient to interfere with pacemaker performance. Due to
shielding effects of the body, internal pacemakers are somewhat less vulnerable than external
pacemakers. However, caution should be exercised when monitoring paced patients.
•
In order to minimize the possibility of interference, avoid positioning and wearing the Cableless
Measurement Devices in very close proximity to a pacemaker. Consult the pacemaker
manufacturer for information on the RF susceptibility of their products.
Use Environment
WARNING
Explosion Hazard:
•
Do not use in the presence of flammable anesthetics, such as a flammable anesthetic mixture with
air, oxygen, nitrous oxide, or in oxygen rich environment. Use of the devices in such an
environment may present an explosion hazard.
•
Use only Philips batteries part number M4605A with the FM20 or FM30 with battery option. Use
of a different battery may present a risk of fire or explosion.
Environmental Specifications:
•
The performance specifications for the monitors, measurements, and accessories apply only for
use within the temperature, humidity, and altitude ranges specified in “Environmental
Specifications” on page 287.
Liquid Ingress:
•
Do not operate the monitor if it is wet. If you spill liquid on the monitor, contact your service
personnel, or Philips service engineer.
•
Never immerse the fetal monitor or the CL base station in liquid. You must protect them against
water sprays or splashes. Place the fetal monitor and the CL base station where there is no chance
of contact with, or falling into water or other liquids.
•
Do not perform underwater monitoring (for example, in a bath or shower) using wired
transducers.
•
The CL Fetal & Maternal Pod is not intended for underwater monitoring. The contacts between
the CL Fetal & Maternal Pod and the electrode patch have to be kept dry at all times. The CL Fetal
& Maternal Pod mounted on the electrode patch, can be worn underneath a shower, as long as the
CL Fetal & Maternal Pod stays mounted. Radio transmissions in the shower may be compromised.
Heat Exposure:
•
Do not dry equipment using heating devices such as heaters, ovens (including microwave ovens),
hair dryers, and heating lamps.
•
Do not put equipment or accessories in autoclave (for sterilization).
Positioning Equipment:
•
The device should not be used adjacent to, or stacked with, other equipment unless otherwise
specified.
15
1 Introduction
Prohibited Environments:
•
The monitors and their transducers, Pods, and accessories are not intended for use in an MRI
environment or in an oxygen-enriched environment (for example, hyperbaric chambers).
Alarms
WARNING
•
Do not rely exclusively on the audible alarm system for fetal monitoring. Adjustment of alarm
volume to a low level or off during monitoring may result in a dangerous situation. Remember that
the most reliable method of fetal monitoring combines close personal surveillance with correct
operation of monitoring equipment.
•
Alarm systems of the monitor and those of the connected obstetrical information and surveillance
system are independent and not synchronized.
•
In INOP only mode, no fetal/maternal patient alarms are enabled or indicated.
Accessories
WARNING
Philips' approval: Use only Philips-approved accessories. Using non-Philips-approved accessories
may compromise device functionality and system performance, and cause a potential hazard.
Reuse: Never reuse disposable transducers, sensors, accessories, and so forth, that are intended for
single use, or single patient use only. Reuse may compromise device functionality and system
performance, and cause a potential hazard.
Electromagnetic compatibility: The use of accessories, transducers, and cables other than those
specified may result in increased electromagnetic emissions or decreased electromagnetic immunity of
the device.
Damage: Do not use a damaged sensor or one with exposed electrical contacts.
Cables and tubing: When connecting devices for acquiring measurements, always position cables and
NBP tubing carefully to avoid entanglement or potential strangulation.
16
1 Introduction
Security Information
Protecting Personal Information
Protecting personal health information is a primary component of a security strategy. Each facility
using the monitors must provide the protective means necessary to safeguard personal information
consistent with country laws and regulations, and consistent with the facility’s policies for managing
this information. Protection can only be realized if you implement a comprehensive, multi-layered
strategy (including policies, processes, and technologies) to protect information and systems from
external and internal threats.
As per its intended use, the patient monitor operates in the patient vicinity and contains personal and
sensitive patient data. This also includes the trace print-outs at the monitor.
The monitor also includes controls to allow you to adapt the monitor to the patient's care model.
To ensure the patient's safety and protect their personal health information, you need a security
concept that includes:
•
Physical security access measures - access to the monitor must be limited to authorized users.
It is essential that you consider physical security measures to ensure that unauthorized users
cannot gain access.
•
Operational security measures - for example, ensuring that patients are discharged after
monitoring in order to remove their data from the monitor.
•
Procedural security measures - for example, assigning only staff with a specific role the right to
use the monitors.
In addition, any security concept must consider the requirements of local country laws and regulations.
Always consider data security aspects of the network topology and configuration when connecting
patient monitors to shared networks. Your medical facility is responsible for the security of the
network, where sensitive patient data from the monitor may be transferred.
When a monitor is returned for repair, disposed of, or removed from your medical facility for other
reasons, always ensure that all patient data is removed from the monitor by ending monitoring for the
last patient (see “Discharging a Patient” on page 148). Also select Erase All in the Stored Data Recording
menu, to erase all stored data.
NOTE
Log files generated by the monitors and measurement modules are used for system troubleshooting
and do not contain protected health data.
About HIPAA Rules
If applicable, your facility’s security strategy should include the standards set forth in the Health
Insurance Portability and Accountability Act of 1996 (HIPAA), introduced by the United States
Department of Health and Human Services. You should consider both the security and the privacy
rules and the HITECH Act when designing policies and procedures. For more information, please
visit:
http://www.hhs.gov/ocr/privacy/
17
1 Introduction
About the EU Directives
If applicable, your facility’s security strategy should include the practices set forth in the Directive on
the protection of individuals with regard to the processing of personal data and on the free movement
of such data (Directive 95/46/EC of the European Parliament and of the Council of
24 October 1995). In addition, your facility should also take into account any additional, more
stringent standards put forward by any individual EU countries; that is, Germany, France, and so on.
Philips Product Security Policy Statement
Additional security and privacy information can be found on the Philips product security web site at:
http://www.healthcare.philips.com/main/support/equipment-performance/product-security/
index.wpd
Manufacturer Disclosure Statement for Medical Device Security – MDS2
You can view the Manufacturer Disclosure Statements for Medical Device Security (MDS2) for
specific devices at:
http://www.healthcare.philips.com/main/support/equipment-performance/product-security/
index.wpd
Overview of System Components
The Avalon CL system consists of the Avalon CL base station, the Avalon CL transducers, the
Avalon CL Fetal & Maternal Pod, the CL Wide Range Pod, and the IntelliVue CL Pods.
The IntelliVue CL Pods are only used for maternal measurements within the Avalon CL solution.
The following table provides an overview of all the devices.
Avalon FM20/FM30 and FM40/
FM50
Wired Transducers
Avalon CL Base Station
Avalon CL Transducers
FM20/FM30
M2702A and M2703A
FM40/FM50
M2704A and M2705A
18
Avalon CL Base Station
866074
CL Pods
1 Introduction
Avalon FM20/FM30 and FM40/
FM50
Wired Transducers
Avalon CL Base Station
Avalon CL Transducers
CL Pods
US transducer (wired)
Avalon CL US Transducer
(cableless)
Avalon CL Fetal & Maternal Pod
866488
M2736A
866076
Toco/ Toco MP transducer
(wired)
Avalon CL Toco+ MP Transducer Avalon CL Wide Range Pod
(cableless)
866487
M2734A and M2734B
866075
19
1 Introduction
Avalon FM20/FM30 and FM40/
FM50
Wired Transducers
Avalon CL Base Station
Avalon CL Transducers
CL Pods
Toco+ transducer with ECG/IUP Avalon CL ECG/IUP Transducer IntelliVue CL NBP Pod
capability (wired)
(cableless)
(cableless)
865216
M2735A
866077
Patient Module for ECG/IUP
IntelliVue CL SpO2 Pod
(cableless)
M2738A
865215
20
2
What's New
This section lists the most important new features and improvements to the fetal monitors and their
user interface introduced with Release L.3.
You may not have all of these features, depending on the fetal monitor configuration purchased.
What's New in Release L.3
Avalon CL Fetal & Maternal Pod
The Avalon CL Fetal & Maternal Pod is an extension of the Avalon CL solution. The Avalon
CL Fetal & Maternal Pod is used together with a single use patch with five abdominal electrodes. Prior
to use, the Avalon CL Fetal & Maternal Pod is charged and assigned at the Avalon CL base station.
The Avalon CL Fetal & Maternal Pod is used with singleton pregnancies. This solution provides
especially benefits to patients with high body mass index (BMI), although it can be used for all patients.
The Avalon CL Fetal & Maternal Pod includes the following features:
•
The Avalon CL Fetal & Maternal Pod measures fetal heart rate (aFHR), maternal heart rate (aHR),
and uterine activity (aToco) from electrical signals.
•
The cl F&M Electrode Status window at the monitor gives an overview of the current electrode
contact status, when the CL Fetal & Maternal Pod is placed on the electrode patch, and the patch,
and the electrodes are applied to the patient's abdominal skin. The window can be opened by
selecting the new SmartKey cl F&M Status, or selecting the corresponding function in the main
setup menu.
•
The Avalon CL Fetal & Maternal Pod and the CL Wide Range Pod are assigned at the CL base
station in the same easy way as the IntelliVue CL Pods.
•
The functions Finder LED and Call Patient work also with the Avalon CL Fetal & Maternal
Pod.
See “Avalon CL Fetal & Maternal Pod” on page 21, “CL Fetal & Maternal Electrode Patch” on
page 91, “Applying the CL Fetal & Maternal Patch and Pod” on page 100, and “CL Pod Assignment”
on page 99.
21
2 What's New
Avalon CL Wide Range Pod
The Avalon CL Wide Range Pod is an extension of the Avalon CL solution. The Avalon CL Wide
Range Pod extends the signal range of the cableless measurements. It transmits the cableless
measurement signals via the hospital WLAN/WiFi to the fetal monitors. Wearing the CL Wide Range
Pod, the patient can walk freely within the hospital's WLAN/WiFi range during monitoring. Prior to
use, the Avalon CL Wide Range Pod is charged and assigned at the Avalon CL base station.
•
A new WLAN symbol is printed on the trace to indicate the use of an assigned and active Avalon
CL Wide Range Pod.
•
During monitoring with an active Avalon CL Wide Range Pod, the sound from the fetal heart rate
is replaced by an artificial QRS sound (when the patient is monitored with a CL US transducer or
CL F&M Pod).
See “CL Wide Range Pod” on page 91.
Dawes/Redman
Dawes/Redman is a method of fetal monitoring trace interpretation for helping to assess fetal
well-being. The algorithm based on the Dawes/Redman criteria uses the parameters fetal heart rate,
gestational age, fetal movement, accelerations and decelerations, and long, and short term variability to
generate a report.
Not available in the USA and territories relying on FDA market clearance.
Support of XDS Remote Display
The fetal monitor software supports the IntelliVue XDS “Remote Display” functionality only in
combination with IntelliSpace Perinatal revision K or higher. From the user interface of the
IntelliSpace Perinatal system, you can access all screen-operable functions of the currently connected
fetal monitor. These functions include for example, starting and stopping physiological measurements,
changing measurement modes, changing alarm limits, and silencing alarms.
New Alarm Behavior of CL Battery Empty INOP
The CL  Battery Empty INOP issued by the CL devices and the fetal monitor has a new alarm
behavior:
•
At the fetal monitor, it is issued now with a cyan INOP alarm and tone.
•
At CL devices (CL transducers and CL Pods), it is issued now with a tone.
See “Patient Alarms and INOPs” on page 129.
Using CL Pods with FM20/30 #E25
The CL Pods can now also be used with a battery operated FM20 or FM30 (option #E25). The
CL Pods can be assigned and activated. The CL F&M Pod can also be charged.
See “Using Batteries” on page 110.
Entering Notes - Type a Note
In the menu Enter Note, it is now possible to enter a note manually, instead of selecting one of the
pre-configured notes. To enter a note, select the new menu item Type a note. A window with a touch
keypad opens. The typed note can be up to 30 characters long.
See “Typing Notes” on page 70.
22
2 What's New
What's New in Release J.3
Avalon CL Transducer System
The Avalon CL Transducer System provides cableless monitoring with the Avalon FM20/FM30 and
FM40/FM50 with the same functionality and performance as the wired measurement devices (e.g.
twin and triplets monitoring). The Avalon CL Transducer System has a straight-forward handling and
operating concept. The CL transducers are assigned by simply docking them at the CL base station, no
further configuration is necessary.
The Avalon CL Transducer System includes the following features:
•
Cableless monitoring of twins and triplets (see “Monitoring Twin FHRs” on page 183 and
“Monitoring Triple FHRs” on page 191)
•
Cableless maternal measurement Pods CL SpO2 and CL NBP (see “IntelliVue CL Pods” on
page 92)
•
Maternal pulse from a CL Toco+ MP (Smart Pulse) transducer (see “Monitoring Maternal Heart /
Pulse Rate” on page 221)
•
A cableless ECG/IUP transducer measuring IUP or fetal/maternal ECG (see “Monitoring
MECG Wave” on page 225 and “Monitoring FHR Using DECG” on page 199)
•
Watertight cableless transducers that can be used to monitor in water (see “Underwater
Monitoring” on page 108)
•
Patient call that pages an ambulating mother with an audible signal emitted by the worn CL
transducers (see “Calling Patients” on page 93)
•
Out-of-range audible signal emitted by the worn CL transducers to inform an ambulating mother
that she has reached the limit of the active signal area-of-reach (see “Standard Radio Range of CL
Transducers” on page 87)
•
A transducer finder LED on all CL transducers to help identify the assigned transducer (see
“Cableless Transducer LED Indication” on page 86)
Support For Use of Maternal Cableless Measurement Devices
The IntelliVue CL measurement Pods are patient-worn, battery-powered measurement devices for
SpO2 and NBP. The devices provide measurement values on the built-in display and communicate
them to the fetal monitor using the wireless short range radio (SRR) interface of the Avalon CL base
station (see “IntelliVue CL Pods” on page 92).
Maternal Temperature Measurement
To measure maternal temperature, the new optional tympanic thermometer (866149) is available for
the Avalon fetal monitors (“Monitoring Maternal Temperature” on page 249). The measurement data
is:
•
documented and printed out at the local recorder, and transmitted to the obstetrical information
and surveillance system.
•
displayed as a numeric on the screen.
23
2 What's New
Manually Entered Maternal Temperature Measurements
Manually measured temperatures can be entered at the fetal monitor. They are displayed as a numeric
on screen, and are printed out on the recorder trace (“Monitoring Maternal Temperature” on
page 249).
SpO2 Recordings and Transmissions
SpO2 annotation on local recorder
You can now configure the interval for printing the SpO2 numeric values on the recorder trace. With
the new configuration setting Record on Trace, you can set the interval to 1 or 5 minutes.
SpO2 transmission to an obstetrical information and surveillance system
You can now configure the interval for transmitting the SpO2 numeric values to an obstetrical
information and surveillance system. With the new configuration setting Send to OB Sys, you can set the
interval to 1 or 5 minutes.
New Design for the User Interface
The user interface for the fetal monitors has been redesigned to bring the presented information into
the foreground, letting the structural elements such as keys and frames retreat into the background.
Additionally special regard was given to making the "look and feel" similar to that of standard software
products (see “Operating and Navigating” on page 38).
New SmartKeys
•
The Start ECG SmartKey and menu item is renamed to Record ECG.
•
With the Call Patient SmartKey, you can now page patients who are ambulating wearing Avalon CL
transducers.
•
With the Tele Info SmartKey, you can call up the Tele Info window on the fetal monitor display. In
the Tele Info window, you can control and view the status of the cableless transducers from the
connected Avalon CL base station.
•
With the Enter Temp SmartKey, a pop-up window opens showing a numeric pad for entering
manually measured maternal temperature values.
•
With the NBP Modes SmartKey, you can access the NBP Mode selection and setup, and can directly
start and stop a measurement.
•
With the QuickAdmit SmartKey, you can quick admit a patient to the monitor.
All new SmartKeys are optional, and have to be configured in Configuration Mode for use (see
“SmartKeys” on page 42).
Coincidence INOP Tone
When the cross-channel verification detects that the signal of the maternal heart rate coincides with the
fetal heart rate, the Coincidence INOP is now issued with a tone at the fetal monitor. The Coincidence
INOP tone has a configurable delay see “Cross-Channel Verification (CCV)” on page 159.
24
2 What's New
Increased Internal Back-up Memory
The internal back-up memory is now able to store traces and data from at least the last 3.5 hours with
the software revision J.3, and minimum 7 hours with the new mainboard hardware revision A 00.18
(see “Manually Recording Stored Data” on page 258 and “Recovering Data” on page 257).
Dual System Interface Support
If the fetal monitor is connected via a LAN connection to OB TraceVue/IntelliSpace Perinatal, the
RS232 interface can be used independently to connect e.g. an EMR system on read-only basis. The
system connected to the RS232 interface in this case cannot alter any data (such as ADT data, or the
date and time setting), or interfere with functions of the monitor, but is able to read output data. The
obstetrical information and surveillance system connected via LAN has priority.
USB Interface
An optional USB interface allows the use of bar code readers and input devices such as a keyboard, or
mouse (see “Getting to Know Your Avalon FM20/FM30”/“Bottom” on page 32 and “Getting to
Know Your Avalon FM40/FM50”/“Rear” on page 33).
Flexible Nurse Call Interface
An optional Flexible Nurse Call interface allows the connection of a nurse call device to the fetal
monitors (see “Getting to Know Your Avalon FM20/FM30”/“Bottom” on page 32 and “Getting to
Know Your Avalon FM40/FM50”/“Rear” on page 33).
DHCP Support
The DHCP support offers an alternative to BOOTP. DHCP (Dynamic Host Configuration Protocol)
enables the fetal monitors to request an IP address (internet protocol address) from the connected
network (OB TraceVue/IntelliSpace Perinatal) automatically.
Data Export Support
You can now export measurement values from the monitor to other devices via the LAN interface, or
with the optional MIB RS232 interface (see “Getting to Know Your Avalon FM20/FM30”/“Bottom”
on page 32 and “Getting to Know Your Avalon FM40/FM50”/“Rear” on page 33).
NBP Configurable Measurement Sequence
Up to four measurement cycles can be set up which will run consecutively. For each cycle, you can set
the number of measurements and the interval between them. By setting the last cycle to run
continuously, you can have regular measurements continue after the sequence has run (see “Enabling
Sequence Mode and Setting Up the Sequence” on page 240.
Alarms Enhancements
In addition to the standard cyan INOPs, some INOPs can now be configured as red or yellow INOPs
to provide a severity indication (ECG Leads Off, Cuff Overpress, Cuff NotDeflated, Battery Empty, No
Pulse) (see “Alarms” on page 117).
25
2 What's New
Alarm Reminder
In Configuration Mode, you can set now an Alarm Reminder. The Alarm Reminder emits an audible
reminder of alarm conditions that remain active after the alarm is acknowledged. This reminder may
take the form of a repetition of the alarm tone for a limited time, or an unlimited repetition of the
alarm tone (this is the same as a new alarm). The interval between silencing the alarm and sounding the
reminder tone can be set to one, two, or three minutes (see “Alarm Reminder” on page 122).
Auto Free
In Configuration Mode, you can now set an Auto Free setting which discharges a patient automatically
when the fetal monitor has been powered off, or is in standby mode for a set time. Only the
demographic patient data is deleted, the trace data is not affected.
26
3
Basic Operation
This chapter gives you an overview of the monitor and its functions. It tells you how to perform tasks
that are common to all measurements (such as entering data, switching on a measurement, changing
some monitor settings, and setting up the recorder). The alarms section gives an overview of alarms.
The remaining sections tell you how to perform individual measurements, and how to care for and
maintain the equipment.
27
3 Basic Operation
Supported Measurements
Different measurements for the same physiological parameter may have a different appearance on the
trace, due to: variability (HR), averaging, delay, amplitude, or artifacts. Before interpreting the trace,
regard the fetal monitor setup and transducers used.
The following Fetal measurements are supported:
Measurements
FM20
FM30
FM40
FM50
Fetal Heart Rate (FHR) via
US (including Twins)
Standard
Standard
Standard
Standard
Triple FHR via US
Optional
Optional
Optional
Optional
dFHR via Direct ECG
(DECG)
Standard
Standard
aFHR via CL F&M Pod
Optional
Optional
Optional
Optional
Toco
Standard
Standard
Standard
Standard
aToco via CL F&M Pod
Optional
Optional
Optional
Optional
Intrauterine Pressure (IUP)
Standard
Standard
The following Maternal measurements are supported:
Measurements
FM20
FM30
FM40
FM50
Maternal Heart Rate (MHR)
via Maternal ECG Electrodes
Standard
Standard
Standard
Standard
Standard
Standard
Maternal ECG (MECG wave) aHR via CL F&M Pod
Optional
Optional
Optional
Optional
Maternal Pulse from Toco
Standard
Standard
Standard
Standard
Noninvasive Blood Pressure
with Pulse Rate
Optional
Optional
Optional
Optional
Pulse Oximetry (Maternal
SpO2) with Pulse Rate
Optional
Optional
Optional
Optional
Maternal Temperature
Optional
Optional
Optional
Optional
28
3 Basic Operation
Avalon FM20 and FM30
This section outlines the capabilities of your monitor.
Avalon FM20
The Avalon FM20 fetal/maternal monitor provides a solution for external fetal monitoring
applications, and optional noninvasive maternal vital signs.
You can monitor fetal heart rates (FHRs) externally using ultrasound, uterine activity and maternal
pulse using an external Toco transducer, and the maternal heart rate (MHR) with maternal ECG
electrodes, and optionally, noninvasive blood pressure and maternal oxygen saturation (SpO2).
Measurements are displayed on a 6.5 inch color display as numerics. The display is a touchscreen, and
you operate the monitor using this touchscreen interface. The integrated recorder documents fetal and
maternal measurements as well as the user-defined annotations.
You can connect the monitor to an OB TraceVue/IntelliSpace Perinatal system via the RS232
connection, or over a LAN connection (with OB TraceVue Revision E.00.00 and later, or IntelliSpace
Perinatal Revision H.0 and later).
Avalon FM30
The Avalon FM30 fetal/maternal monitor offers a solution for both external and internal fetal
monitoring applications, and optional noninvasive maternal vital signs.
The Avalon FM30 shares all the features and capabilities of the Avalon FM20. In addition, you can
monitor one FHR internally with a direct fetal electrocardiogram (DECG), uterine activity internally
using an intrauterine pressure (IUP) catheter together with a Toco+ transducer or patient module.
The Avalon FM30 carries the IP label, indicating that it is capable of intrapartum monitoring.
29
3 Basic Operation
FM20/30 with
Battery
Option #E25
Only
The battery option for the FM20/30 provides support for the in-transport monitoring of all
measurements when disconnected from a power supply. Existing data storage is automatically
uploaded to OB TraceVue or IntelliSpace Perinatal after reconnecting it to the system. Trace printing
during transport is also possible.
Avalon FM40 and FM50
This section outlines the capabilities of your monitor.
Avalon FM40
The Avalon FM40 fetal/maternal monitor provides a solution for external fetal monitoring
applications, and noninvasive maternal vital signs.
You can monitor fetal heart rates (FHRs) externally using ultrasound, uterine activity using an external
Toco transducer, and the maternal heart rate (MHR) via maternal ECG electrodes, and noninvasive
blood pressure and maternal oxygen saturation (SpO2).
Measurements are displayed on a 6.5 inch color display as numerics. The display is a touchscreen, and
you operate the monitor using this touchscreen interface. The integrated recorder documents fetal and
maternal measurements as well as the user-defined annotations.
You can connect the monitor to an OB TraceVue/IntelliSpace Perinatal system with the RS232
connection, or over a LAN connection (with OB TraceVue Revision E.00.00 and later, or IntelliSpace
Perinatal Revision H.0 and later).
30
3 Basic Operation
Avalon FM50
The Avalon FM50 fetal/maternal monitor offers a solution for both external and internal fetal
monitoring applications, and noninvasive maternal vital signs.
The Avalon FM50 shares all the features and capabilities of the Avalon FM40. In addition, you can
monitor one FHR internally with a direct fetal electrocardiogram (DECG), and uterine activity
internally using an intrauterine pressure (IUP) catheter together with a Toco+ transducer or patient
module.
The Avalon FM50 carries the IP label, indicating that it is capable of intrapartum monitoring.
Getting to Know Your Avalon FM20/FM30
Overview
Touchscreen display (tilt and fold)
Power LED
Paper drawer
Paper drawer release
Connectors
Right Side
On/Off switch
Power connector
31
3 Basic Operation
with Battery
Option
On/Standby button with power LED
MSL connector for external power
supply
SpO2 socket (optional)
Noninvasive Blood Pressure
socket (optional)
Fetal sensor sockets
Left Side
Each of the fetal sensor sockets accepts any fetal transducer, one Avalon CL or one Avalon CTS
Cableless Fetal Transducer System base station, or an event marker.
Bottom
There are five optional interfaces available for the Avalon FM20/30 monitor:
32
•
LAN/RS232 system interface
•
Dual PS/2 interface
•
Dual MIB/RS232 interface
•
Flexible Nurse Call interface
•
USB ports interface
3 Basic Operation
You can use two of the five optional interfaces at the same time.
Optional Interfaces
LAN/RS232 system
interface
Dual PS/2 system
interface
Description
Flexible nurse call interface card
Quad. USB ports
Dual MIB/RS232
Rear
Display release
Carrying handle
Built-in stand
33
3 Basic Operation
Getting to Know Your Avalon FM40/FM50
Front
Touchscreen color display
Transparent paper guide with tear-off
edge
Paper eject button
Power LED
On/Standby button
Recorder paper table
Fetal sensor sockets
Noninvasive blood pressure socket
(optional)
SpO2 socket (optional)
Connect any fetal sensor or patient module at the fetal sensor sockets, including an Avalon CL or an
Avalon CTS via interface cable (with red connector).
34
3 Basic Operation
Rear
Reserved for future use: protective
earth intended for use in system
installations
Equipotential grounding point
Power cord connector
Loudspeaker
Slot 01 for optional LAN/RS232
system interface (for connection to an
obstetrical information and
surveillance system)
Slot 03 reserved for future use
Video output (VGA)
Telemetry interface
Slot 02 for optional interfaces: Either
dual PS/2 system interface (A) for
mouse and keyboard connection) Or
MIB interface (B) for external
touchscreen connection, or the
optional interfaces for the flexible
nurse call or USB ports
Two Avalon CL base stations, or one Avalon CTS can be also connected to the Telemetry interface
sockets using the interface cable (with black connector).
Additional Optional Interfaces
Optional Interfaces
Description
Flexible nurse call interface card
Quad. USB ports
Dual MIB/RS232 interface
35
3 Basic Operation
Connecting the Monitor to AC Mains
WARNING
•
Always use the supplied power cord with the earthed mains plug to connect to an earthed AC
mains socket. Never adapt the mains plug from the fetal monitor to fit an unearthed AC mains
socket.
•
Check that the line frequency is correctly configured in the Global Settings menu.
•
FM20/FM30 only: The protective earth conductor is required for EMC purposes. It has no
protective function against electric shock. Double and/or reinforced insulation protects this
device against electric shock.
•
Do not use AC mains extension cords or multiple portable socket-outlets.
Always ensure that the monitor is positioned so that the AC mains plug is easily accessible, to allow
disconnection of the monitor from the AC mains.
Wired Transducers
Toco (M2734A) and Toco MP Transducer (M2734B)
36
Transducer finder LED - lights up
on the transducer supporting to
identify the measurement source
"MP" for M2734B "Toco MP"
transducers (additionally capable
of providing the maternal pulse
measurement)
Belt button
3 Basic Operation
Cable - connects to any of the
four fetal sensor sockets on the
monitor
The M2736AA US transducer is
identical to the M2736A US
transducer, including all specifications
Ultrasound Transducer (M2736A)
Connector - for connecting
ECG/IUP adapter cables
(M2735A Toco+ transducer only)
Butterfly belt clip (shown fitted;
for use with belts without button
holes)
Close-up of MECG adapter cable
connected to Toco+ transducer
Close-up of active finder LED
Connector - for connecting ECG/
IUP adapter cables (same as for
Toco+ transducer)
Cable - connects to any of the four
fetal sensor sockets on the monitor
Toco+ Transducer with ECG/IUP capability
(M2735A)
Patient Module for ECG/IUP (M2738A)
37
3 Basic Operation
Operating and Navigating
Your monitor has a touchscreen. Everything you need to operate the monitor, except the on and off
switch, is contained on its screen. Most screen elements are interactive. Screen elements include
measurement numerics, screen keys, information fields, status indicators, alarms fields, and menus.
Operator Position
The typical operator's position is in front of the monitor.
FM40/50
If an optional external touch display is connected to the monitor, you can operate the monitor using
the external touch display.
Monitor
information line
Measurement area
Key area
CAUTION
The screen contains sensitive personal data. For information how to protect personal information, see
“Protecting Personal Information” on page 17.
38
3 Basic Operation
Screen Elements
Monitor Information Line
LAN connection status indicator only. RS232 system connection is not indicated. The
locomotive icon indicates if the fetal monitor is connected to OB TraceVue/IntelliSpace
Perinatal, via a LAN cable or not.
Patient identification
Date and time
Bed label (when connected to a Philips OB TraceVue/IntelliSpace Perinatal system)
Fetal heart sound volume adjust/indicator
Alarm volume adjust/indicator
INOP and alarm status area - shows active alarm messages
39
3 Basic Operation
Measurement Area
Antenna symbol (indicates a cableless measurement from a connected Avalon CL or Avalon CTS
system)
Configurable alarm limits
NST test
Audio source symbol
Measurement numeric
Alarms off symbol
Fetal trace recorder - status indicator
Avalon CL or Avalon CTS system - status indicator
Battery status indicator
10 Status line - shows status and prompt messages
11 Signal quality indicator: good, acceptable, poor
12 Fetal heart rate measurement label
13 Measurement unit (configurable)
14 Coincidence symbol (see “Cross-Channel Verification (CCV)” on page 159)
15 NST timer, if configured (default is Off)
40
3 Basic Operation
Screen Details
Icon
Description
The antenna symbol indicates a cableless measurement
(Avalon CL or Avalon CTS).
Indicates a short range radio measurement (CL Pods).
Signal quality indicator:
Good
Acceptable
Poor
Fetal trace recorder - status indicator
Fetal recorder is on
Fetal recorder is off (when Paper Save Mode is off)
Fetal recorder is off (when Paper Save Mode is on)
There is a user-solvable recorder error (paper out, paper jam,
wrong paper scale set)
Fetal recorder is defective: call service
When an Avalon CL or Avalon CTS system is connected to the
monitor, a CL symbol is shown. It changes with the states of the
connected cableless device see “Cableless Status Indication” on
page 95.
Key Area
SmartKeys - these can vary according to your monitor's configuration
Main Screen
Scroll to display more SmartKeys
Silence
- closes all open menus and windows and returns to main screen
- acknowledges all active alarms by switching off audible alarm indicators
41
3 Basic Operation
Keys
The monitor has three different types of keys.
Permanent Keys
A permanent key is a graphical key that remains permanently on the screen, giving you fast access to
functions.
Key
Name
Function
Silence
Acknowledges all active alarms by switching off audible
alarm indicators.
Main Screen
Closes all open menus and windows and returns to the
main screen.
SmartKeys
SmartKeys are configurable graphical keys, located at the bottom of the main screen. They give you
fast access to functions. The selection of SmartKeys available on your monitor depends on your
monitor configuration, and on the options purchased.
SmartKey
42
Name
Function
FRStart/Stop
Turns the trace recorder on or off
Start Rec
Turns the trace recorder on
Stop Rec
Turns the trace recorder off
Paper Advance
Advances the paper automatically to the next fold
Set Marker
Marks an event
Enter Notes
Enters notes
Record ECG
Starts printing the MECG, DECG, or both waves, when
both are available
Stored Rec
Prints trace data from the monitor's memory
NST Report
Initiates an NST trace interpretation and obtains a Nonstress test (NST) report
Sound Vol. Up
Increases the fetal heart rate volume
Sound Vol. Down
Decreases the fetal heart rate volume
Toco/IUP Bsl
Resets Toco baseline
Tele Info
Calls up the Tele Info window
3 Basic Operation
SmartKey
Name
Function
Call Patient
Pages the patient. Only enabled if at least one
CL transducer is currently active
cl F&M Status
Calls up the cl F&M Electrode Status window
Pause Alarms
Pauses alarm indicators. Pause duration depends on
monitor configuration. If the pause duration is infinite, this
key is labeled Alarms Off
Select again to immediately re-enable alarm indicators
Defaults
Loads User Default
Main Setup
Enters main setup menu
Strt/Stp NBP
Starts/stops manual noninvasive blood pressure
measurement
Starts auto series
Stops current automatic measurement within series
Start NBP
Starts manual noninvasive blood pressure measurement
Starts auto series
Stop NBP
Stops manual noninvasive blood pressure measurement
Stops current automatic measurement within series
Stop All NBP
Stops all noninvasive blood pressure measurements
Repeat NBP
Sets the time interval between two noninvasive blood
pressure measurements
NBP Modes
Access NBP mode selection and setup, with direct start/
stop function
Enter Temp
Allows the manual input of the patient's temperature
Zero IUP
Resets the display and trace to 0. If you do not zero the IUP
measurement properly, the pressure trace may exceed the
paper scaling.
Timer
Enters NST timer window
Standby
Switches to standby screen, suspends monitoring. All
numerics and waves disappear from the display. All settings
and patient data information are retained
Patient Demogr.
Enters the patient identification menu to admit/discharge
QuickAdmit
Quick admits the patient for monitoring
Blank Key
Blank key, can be used as divider between a group of keys
43
3 Basic Operation
Pop-Up Keys
Pop-up keys are context-sensitive graphical keys that appear automatically on the monitor screen when
required. For example, the Confirm pop-up key appears when you need to confirm a change.
Using the Touchscreen
Select screen elements by pressing them directly on the monitor's screen.
Disabling Touchscreen Operation
To temporarily disable the touchscreen operation of the monitor, press and hold the Main Screen
permanent key for about three seconds. A red padlock will blink on the Main Screen permanent
key.
Press and hold the Main Screen permanent key again for about three seconds to re-enable the
touchscreen operation.
Operating Modes
When you switch on the monitor, it starts up in Monitoring Mode. To change to a different mode:
Select the Main Setup menu.
Select Operating Modes and select a mode.
Your monitor has four operating modes. Some are passcode protected.
Mode
Description
Monitoring Mode
The Monitoring Mode is the normal operating mode to
monitor patients. You can change elements such as alarm
limits. When you discharge the patient, these elements
return to their default values.
Password
Protected
no
You cannot select or change grayed out items. These items
are for your information only. To change these items,
switch to the Configuration Mode.
Demo Mode
44
The Demo Mode is used for demonstration and training
purposes. Do not change into Demo Mode during
monitoring. When transducers are connected to the
monitor and the recorder is on, a demo trace is recorded.
But the demo trace is not transmitted when the fetal
monitor is connected via RS232 to an information and
surveillance system such as OB TraceVue/IntelliSpace
Perinatal.
yes
3 Basic Operation
Mode
Description
Password
Protected
Configuration Mode
The Configuration Mode is for personnel trained in
configuration tasks. You can change and store the default
values and patient profiles permanently in the
Configuration Mode. These tasks are described in the
Configuration Guide. During installation, the fetal
monitor is configured for use in your environment. This
configuration defines the default settings you work with
when you switch on the fetal monitor.
yes
Service Mode
The Service Mode is for trained and authorized service
personnel only.
yes
A field displayed at the fetal monitor screen indicates if the monitor is in Demonstration Mode,
Configuration Mode, or Service Mode. To change to a different mode, select this field.
Automatic Screen Layouts
Your monitor's preconfigured screen layouts define how measurement information is arranged on the
screen. The monitor automatically applies the correct screen layout for the measurements you are
monitoring. No user action is required.
Connecting or disconnecting transducers, or activating or deactivating a cableless measurement, results
in an automatic adjustment of the screen layout. When a measurement is off, its numerics are removed
from the monitor's screen. The monitor stops acquiring data and generating alarms for this
measurement. If you disconnect a transducer while it is performing a measurement, the monitor issues
a disconnect INOP (and in the case of SpO2, replaces the measurement numeric with a question
mark).
Settings
This section describes the various settings available on the monitor.
Active Settings
What the monitor displays, and the way it operates, is controlled by its settings. They determine sound
volume settings, recorder settings, high and low alarm limits and so forth.
The "active settings" are the current settings the monitor uses, including any adjustments made by the
last user. Active settings are not permanent, but are retained after a loss of mains power.
There are also two preconfigured default settings:
•
User Default
•
Factory Default
45
3 Basic Operation
User Default
The User Defaults are a complete configuration stored in the monitor's long-term memory. You can
store the active settings, modified to your preference, in the User Defaults (in Configuration Mode).
In Monitoring Mode, you can load the User Defaults settings to return to your preferred settings:
Select the Defaults SmartKey.
Select Confirm in the dialog box to load the User Defaults.
Factory Default
The Factory Defaults is a complete configuration predefined at the factory. You cannot modify it. In
Configuration Mode, you can load the Factory Defaults as the active settings.
CAUTION
This resets all settings to factory defined values, but be aware that some values will differ from those
with which the fetal monitor was originally shipped from the factory (recorder speed and paper scale
type will need to be corrected, for instance). After loading the Factory Defaults, check the settings, and
if necessary, change them to the settings you normally use.
You can use the Factory Defaults as the basis for producing your User Defaults. See the Configuration
Guide for details.
Global Settings
General monitor configuration settings are stored in the Global Settings. These include settings for line
frequency, QRS type, and whether the monitor is automatically reset to the User Defaults after a power
interruption of more than one minute. You can change the Global Settings in Configuration Mode.
Changing Measurement Settings
Each measurement has a setup menu in which you can adjust all of its settings. You can enter a setup
menu:
with the measurement numeric - select the measurement numeric on the screen to enter its setup
menu. For example, to enter the Setup FHR1 menu, select the FHR1 (fetal heart rate 1) numeric.
with the Main Setup SmartKey - if you want to set up a measurement when the measurement is
switched off, use the Main Setup SmartKey and select Measurements. Then select the measurement
name from the pop-up list. With this SmartKey you can access any setup menu in the monitor.
This guide always describes the entry method using the measurement's setup menu. You can use the
method you prefer.
46
3 Basic Operation
Changing Monitor Settings
To change monitor settings such as brightness, or touch tone volume:
Enter the Main Setup menu.
Select the setting you want to change, or select User Interface to enter a sub menu where you can
change user interface settings.
Adjusting the Screen Brightness
Enter the Main Setup menu.
Select User Interface.
Select Brightness.
Select the appropriate setting for the screen brightness. 10 is the brightest, 1 is the least bright.
Optimum is suitable for most situations.
Adjusting Audio Volume
Here you can adjust the audio volume for Alarm Volume, QRS Volume, and Timer Volume. To adjust an
audio volume:
Enter the Main Setup menu.
Select User Interface.
Select Audio Volumes, then select one of the volume types, and select an audio level. 10 is the
loudest and 1 is the quietest. Selecting zero switches the volume off.
Setting the Date and Time
The current date and time is displayed in its own element in the information line of the monitor screen.
Select the date and time screen element from the monitor's information line to enter the Date,
Time menu.
Select, in turn, the Year, Month, Day, Hour (in 24 hour format), and Minute, as necessary.
Select Store Date, Time to change the date and time.
WARNING
Do not change the date and time setting, if the fetal monitor is connected to a Philips OB TraceVue/
IntelliSpace Perinatal system. The monitor uses the OB TraceVue/IntelliSpace Perinatal system date
and time, including daylight saving time changes. As long as the fetal monitor is connected to the OB
TraceVue/IntelliSpace Perinatal system via the LAN-setup (locomotive symbol displayed on the
monitor's screen), the option to change the date and time settings at the fetal monitor are disabled, this
is not valid for RS232 connections, or the connection to other systems.
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3 Basic Operation
When disconnected from AC power, the monitor retains the date and time setting for at least two
months. If the monitor is off longer than two months, and the operating system detects that the date
and time settings are invalid, the monitor initiates a "cold" start and sets the date to 1 Jan 1997 and the
time to 00:00.
Checking Your Monitor Revision
Select Main Setup, Revisions to open the Monitor Revision menu.
From the Monitor Revision menu, select the monitor component for which you need revision
information.
Preparing to Monitor
Confirm fetal life before you begin fetal monitoring. Familiarize yourself with the basic operation
principles before you start to monitor.
CAUTION
Check the fetal monitors housing for damage before you start to monitor as part of your safety
precautions.
After you switch on the monitor:
Check that you have the correct patient cables and transducers plugged in for the measurement
you want to monitor.
If you use an Avalon CL or Avalon CTS system, check if the cableless transducers are ready and
charged (apparent by either a lit up green or yellow LED indicator).
Admit your patient to the monitor (see “Admitting a Patient” on page 147).
Check that the alarm limits, alarm and fetal heart rate volumes, patient category, and so forth, are
appropriate for your patient. Change the settings if necessary.
Refer to the appropriate measurement section for details of how to perform the measurements
you require.
Start recording.
There is no special emergency access for the Avalon Fetal monitors. For all clinical use cases according
the Intended Use, the monitors are taken into operation by connecting them to AC mains and by
switching them on.
Switching On: FM20/FM30
Battery
Option
48
Connect the monitor to AC mains and switch the monitor on.
– The green power-on LED lights up.
– The monitor performs a self-test as it starts up. Selftest: OK, the serial number, and revisions
for the software and firmware are printed on the fetal trace paper (if recorder Auto Start is
configured to On).
– The monitor display comes on.
– There is a start-up tone from the loudspeaker.
•
If this option has been chosen, the green power-on LED on both the external power supply and
the battery LED indicator will light up.
3 Basic Operation
Switching On: FM40/FM50
Connect the monitor to AC mains.
– The green LED lights up.
Press the On/Standby switch.
– The monitor performs a self-test as it starts up. Selftest: OK, the serial number, and revisions
for the software and firmware are printed on the fetal trace paper (if recorder Auto Start is
configured to On).
– The monitor display comes on.
– There is a start-up tone from the loudspeaker.
Adjusting the Display Angle (FM20/FM30)
You can tilt the display on the FM20 and FM30 to one of five different positions, or you can fold it
completely down. The tilt/fold mechanism works on a one-way ratchet system. You hear a click as
each of the five positions is reached. The screen can be folded back down only after tilting the display
forwards as far as it will go.
To tilt the display from the folded position:
Unlock the display by releasing the catch.
Lift the display forward. You will hear a click as the first position engages. If you want to tilt the
display further, lift the display further forward until you reach the desired angle.
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3 Basic Operation
To fold the display, pull the display forwards as far as it will go.
Then push the display all the way back until it clicks shut.
If your monitor is wall-mounted, the display should be folded flat.
Fastening Belts and Transducers
You can use more than one belt if, for example, you are monitoring uterine activity and FHR
simultaneously. There are two basic ways to fasten belts and transducers:
•
Belts with button fixings.
•
Velcro belts together with the butterfly belt clip.
What You Need
50
•
Ultrasound transducer
•
Toco MP or CL Toco+ MP transducer
•
Ultrasound gel
•
Transducer belt (and optional butterfly belt clip, if applicable)
3 Basic Operation
Using Belts with Button Fixings
Place the transducer belt across the bed, so that the fixing button will face away from the mother
when it is fastened.
Lie the patient on the bed and arrange the belt around her until it is tight but still comfortable.
Fasten the belt by pushing the fixing button through the overlapping section of the belt. Ensure
that the fixing button and the loose ends of the belt are at the patient's side.
When you have positioned a transducer satisfactorily, you can attach it to the belt by pushing the
belt button on the transducer through one of the holes in the belt.
51
3 Basic Operation
Alternatively, attach the butterfly belt clip to the transducer belt button and use this to attach the
transducer to the belt. The clip allows you to slide the transducer for easy repositioning.
Using Belt with Velcro Fixings
Insert one end of the belt between the belt guides on one side of the butterfly belt clip, and secure with
the velcro fixing. Insert the other end of the belt between the belt guides on the other side of the
butterfly belt clip, adjust for the correct tension, then secure with the velcro fixing.
Velcro fixing
Belt guides
Velcro fixing
WARNING
When connecting devices for acquiring measurements, always position cables and NBP tubing
carefully to avoid entanglement or potential strangulation.
52
3 Basic Operation
Repositioning Transducers
A patient possibly wears transducers for long periods without interruption. In rare cases, skin
irritations may occur if a transducer is attached to one location for a longer period. To ensure there are
no adverse effects on the patient's skin, inspect the transducer application site at least every three
hours. If the skin quality changes, move the transducer to another site.
The ultrasound transducer is often repositioned to follow the fetal heart as part of the normal
monitoring process, but this is not so for the Toco transducer. Therefore, remember to check its
application site (between contractions) at least every three hours.
To reduce the risk of skin irritations, do not allow a cleaning or disinfecting agent to remain on the
transducer. Follow all instructions that accompany the specific cleaning and disinfecting agents you are
using. Remove agent residues with a cloth dampened in water before applying a transducer to a patient.
See “Care and Cleaning” on page 261 for further information, and a list of approved agents.
Connecting a Transducer to the Monitor
SpO2 socket
Noninvasive blood pressure socket
Fetal sensor sockets
You can plug a fetal transducer, an ECG/IUP patient module, an Avalon CL or
Avalon CTS Cableless Fetal Transducer System interface cable (red connector), or
an external event marker into any of the four fetal sensor sockets marked by the
fetal symbol, or "Fetal Sensors" (depending on geography).
For measuring maternal SpO2, connect the sensor to the socket marked with the
SpO2 symbol or "SpO2" (depending on geography).
For maternal noninvasive blood pressure, connect the cuff to the socket marked
with the NBP symbol or "NBP" (depending on geography).
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3 Basic Operation
For the FM20 and FM30, you can connect an Avalon CL or Avalon CTS Cableless Fetal Transducer
system interface cable (red connector) to one of the fetal sensor sockets at the left side of the monitor.
For the FM40 and FM50, you can connect an Avalon CL or Avalon CTS Cableless Fetal Transducer
System interface cable (black connector) to one of the two dedicated black sockets marked "Tele" at
the rear of the monitor, as an alternative to using one of the fetal sensor sockets (red connector) at the
front.
Interface cable to Avalon CL and
Avalon CTS Cableless Fetal
Transducer System.
Connect the black connector to one
of the two black sockets (marked
"Tele") on the rear of the monitor.
What You See on the Monitor
When you connect a transducer or sensor, the measurement numeric appears on the screen.
FM20/FM30
FM40/FM50
Fetal heart rate measurements are labeled in the order in which you plug in the transducers for those
measurements. It does not matter which fetal sensor socket you use, as the monitor allocates a channel
automatically. For instance, when monitoring triplets, the first transducer you connect is automatically
allocated a channel, and the measurement is labeled FHR1, the second FHR2, and the third FHR3. See
also chapters “Monitoring Twin FHRs” on page 183 and “Monitoring Triple FHRs” on page 191.
When you touch a measurement numeric on the screen, the setup menu for that measurement opens.
The fetal sensor socket to which the transducer for this measurement is connected is identified by the
transducer position indicator in the setup menu header.
54
3 Basic Operation
The blue finder LED on a wired fetal transducer lights up when you touch the measurement on the
screen, allowing you to identify the corresponding transducer.
finder LED
The white finder LED on a cableless fetal transducer lights up when you touch the measurement on
the screen, allowing you to identify the corresponding transducer.
finder LED cableless transducer
The recorder prints an annotation showing the date, time, recorder speed, and Monitoring Mode. It
repeats this every 10 minutes.
Start Recording
Checking/Setting Paper Scale
You can check the paper Scale Type (US for USA, or Internat'l for other geographies) in the Fetal
Recorder menu. In Monitoring Mode, you can see these settings (grayed out), but you cannot change
them. They can be changed in Configuration Mode, see the Configuration Guide.
NOTE
Check if the scale type of the paper and the settings in the fetal monitor match.
55
3 Basic Operation
Paper Guide FM40/FM50
The recorder in the FM40 and FM50 features a transparent paper guide which:
•
facilitates correct alignment of the paper, both during loading and while the recorder is running.
See “Loading Paper FM40/FM50” on page 65.
•
incorporates a tear-off edge, which not only allows you to tear off the trace paper where you like
(not necessarily at a fold), but also helps to avoid paper misalignment while doing so (see “Tearing
Off the Paper” on page 61).
•
is removable (see “Removing the Paper Guide: FM40/FM50” on page 269).
Switching the Recorder On and Off
In addition to the normal recording of real-time traces, you will sometimes see a trace recovery
printout from the monitor's internal backup memory at high speed when the recorder is started. For
details, see “Recovering Traces on Paper” on page 257.
For an explanation of the various symbols that can appear on the trace recording, see “Recorder
Specifications” on page 308.
To switch the recorder on, select in Main Setup the menu item Fetal Recorder, or press one of the
SmartKeys: Start/ Stop or Start Recordng.
The "recorder on" status indicator is displayed in the bottom right-hand corner of the screen when you
switch on the recorder.
The paper advances quickly for 2 cm and then returns to the set speed. Whenever the recorder is
switched on, a trace header is printed vertically on the trace paper, containing the following:
•
Selftest: OK:
confirmation that the monitor's self-test completed successfully, and that it is ready to
use
56
•
the software revision and firmware revision
•
the serial number
•
the time
•
the date
•
patient name and medical record number (if entered)
•
the recorder speed
3 Basic Operation
Fetal heart rate label
Uterine activity label
The current monitoring modes (if any transducers are connected to the monitor) are printed.
Whenever a transducer's mode is changed, the following are printed:
•
the time
•
the date
•
trace identification symbols
•
the recorder speed
The monitor prints the time, date, recorder speed, and monitoring modes in the trace header when
first switched on, in a periodic time stamp every ten minutes after, and if the monitoring modes
change. The time stamp begins with the symbol shown below. The data is reprinted in the header if the
time and date are locally adjusted, or if an obstetrical information and surveillance system is connected
that readjusts the time and date automatically.
57
3 Basic Operation
Time stamp printed every ten
minutes
The trace records maternal parameters also. When measuring noninvasive blood pressure, the
annotation is made at the end of the measurement. If the noninvasive blood pressure measurement
repetition time is short, the noninvasive blood pressure numeric may not always be printed.
The recording of notes (see “Entering Notes” on page 69) or time/date information may be
interrupted by connecting, or unplugging a transducer, or by a change in measurement-related setting
(for example, artifact suppression, Toco sensitivity, or alarm settings).
A new patient admission or a change to the paper scale setting stops all annotations, and prompts a
new vertical trace header to be printed.
To switch off the recorder:
Either select Start/Stop from the Fetal Recorder menu.
Or press one of the SmartKeys (depending on configuration): fetal recorder Start/ Stop or Stop
Recordng.
If your recorder is configured with Confirmed Stop on (a Configuration Mode setting), you will
need to confirm that you want to stop the recorder, before it will stop.
When the recorder is off, the "recorder off" status indicator is displayed in the bottom right-hand
corner of the screen: When the Paper Save Mode is set to Off the paper symbol shows an x mark,
and when Paper Save Mode is On the icon shows a paper trace icon.
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3 Basic Operation
Recording Elements
A variety of information can appear on the recorder trace. Here is a sample trace with some of the
most common elements and their meaning. Each trace header contains the last name and first name,
the patient ID, patient date of birth, the current date and time, patient's bed label, and the gestational
age of the pregnancy.
Name, patient ID, date of birth, current date and time
Recorder speed
Gestational age and patient bed label
FMP - Fetal Movement Profile
Other measurements for the patient such as temperature, arterial oxygen saturation, and pulse
Entered notes such as patient repositioned, or MD notified, or others
Time stamp
Trace separation
Recorder speed
10 Maternal ECG
11 Direct ECG
12 Coincidence of heart rate detected
13 HR with Alarms Off symbol
14 Alarm Limits
15 dFHR2 (second fetal heart rate from DECG)
16 FHR1 (first fetal heart rate)
59
3 Basic Operation
Caution
The trace contains sensitive personal data. For information how to protect personal information, see
“Protecting Personal Information” on page 17.
Choosing Recorder Speed
You can choose a recorder speed of 1, 2, or 3 centimeters per minute (cm/min). The default setting is
3 cm/min.
The ACOG technical bulletin on FHR monitoring states that "accurate pattern recognition is difficult if not
impossible at 1 cm/min and that 1 cm/min is only recommended for more economic screening. When FHR
abnormalities arise, the faster recorder speeds will enhance FHR pattern recognition".
Additionally, because a change in recorder speed results in a change in the appearance of an FHR trace,
you are advised to ensure ALL monitors in your institution are set to the same speed.
To set the recorder speed (in Configuration Mode), see the Configuration Guide.
Advancing the Paper
You can advance the paper automatically to the next fold by pressing the Paper Advance SmartKey at
any time except during a stored data recording. This is also possible using the Fetal Recorder menu.
Marking an Event
You can record significant events on the trace paper (for example, when pain medication is
administered or when the mother changes position). The mother can use the remote event marker to
mark events herself. You connect the remote event marker to any free fetal sensor socket.
To mark an event on the trace paper, you can:
60
Either select the Set Marker SmartKey.
Or press the button on the optional remote event marker (989803143411). The remote event
marker is connected to the monitor via any fetal transducer socket.
3 Basic Operation
A small arrow is printed on the heart rate scale on the trace paper.
This reflects exactly when the marker button was first pressed; keeping the button pressed has no
influence on the annotation.
Tearing Off the Paper
CAUTION
Never pull on the paper to advance it, as this can cause misalignment of the paper. Always tear off the
paper along the perforation.
FM40/FM50
The recorder's paper guide incorporates a tear-off edge, allowing you to tear off the trace paper cleanly
where you like (not necessarily at a fold). When you are not using the paper guide, always tear off the
paper along the perforation.
To tear off the trace paper after monitoring using the paper guide:
If the recorder is running (the "recorder on" status indicator is displayed), turn off the recorder by
selecting the fetal recorder Start/ Stop SmartKey or the Stop Recordng SmartKey.
Tear off the paper as shown in the picture. To ensure a clean tear, always tear in an upwards
motion, as indicated by the arrows. You can start tearing from the left or right (right-handed user
61
3 Basic Operation
shown). You may want to use both hands to guarantee that the paper is not misaligned during the
tear off.
FM20/FM30
If you wish to tear off the paper at a fold, select the Paper Advance SmartKey, wait for the paper to
stop, then tear it off.
The FM20/FM30 does not have a paper guide. The procedure is the same as described for the FM40/
FM50 with the exception that you should advance the paper to a perforation.
If you wish to tear off the paper at a perforation, select the Paper Advance SmartKey, wait for the paper
to stop, then tear it off.
Paper-Out Indication
Each pack of paper has 150 pages. The monitor issues a paper-out warning in the status line at the
bottom of the screen, when there are five pages to go. If you switch on the recorder or press the Paper
Advance key when there are fewer than five pages remaining, it may take two pages before the alarm is
activated. Load a new pack in time.
If the recorder runs out of paper, an audible paper-out alarm is sounded, if so configured. See
“Loading Paper FM40/FM50” on page 65, and “Loading Paper FM20/FM30” on page 62 to learn
how to reload paper.
Fetal traces continue to be recorded into the monitor's backup memory, and can be retrieved and
printed completely if new paper is loaded within one hour, when the Bridge Paperout setting is enabled
in Configuration Mode. See “Recovering Traces on Paper” on page 257 for further information.
Loading Paper FM20/FM30
CAUTION
Using recorder paper that is not approved by Philips can result in accelerated paper fading and can
damage the thermal line printhead. This type of damage is not covered by warranty.
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3 Basic Operation
FM20/FM30
To load a pack of paper:
If the recorder is on, press the recorder Start/ Stop SmartKey or the Stop Recordng SmartKey to
turn it off before loading a new pack of paper.
Press the paper table release to unlock the paper drawer and then pull the table forward to open it
fully.
Lift out any remaining paper from the tray.
Prepare to place the new pack of paper in the tray with the bottom side down. The bottom side is
indicated by the word STOP printed on the final page of the new pack.
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3 Basic Operation
64
Unfold the top page of the pack and position the uterine activity scale on the right.
Slide the pack into the tray.
3 Basic Operation
Push the paper drawer back until it "clicks" closed.
Press the recorder Start/ Stop SmartKey or the Start Recordng SmartKey to switch on the recorder.
Annotations of trace information are printed on the trace paper (see “Switching the Recorder On and
Off” on page 56 for details).
Loading Paper FM40/FM50
CAUTION
Using recorder paper that is not approved by Philips can result in accelerated paper fading and can
damage the thermal line printhead. This type of damage is not covered by warranty.
FM40/FM50
To load a pack of paper:
If the recorder is on, press the Start/ Stop Rec SmartKey or the Stop Recordng SmartKey to turn it
off before loading a new pack of paper.
Press the paper eject button to open the paper drawer.
65
3 Basic Operation
Lift out any remaining paper from the tray.
Press and hold the paper eject button to partially eject the paper, thus making it easier to remove.
Hinge the transparent paper guide forward. It is held in the closed position by a small protrusion
on each side of the holder.
A - Protrusion holds paper guide in closed position.
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3 Basic Operation
Prepare to place the new pack of paper in the tray with the bottom side down. The bottom side is
indicated by the word STOP printed on the final page of the new pack.
Unfold the top page of the pack and position the uterine activity scale on the right.
Slide the pack into the tray.
Feed the paper evenly through the paper guide. Do not close the paper guide yet.
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3 Basic Operation
10 Close the paper drawer.
11 Now close the paper guide.
12 Press the recorder Start/ Stop SmartKey or the Start Recordng SmartKey to switch on the recorder.
Annotations of trace information are printed on the trace paper (see “Switching the Recorder On
and Off” on page 56 for details).
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3 Basic Operation
Entering Notes
Your monitor has a set of 15 factory pre-configured notes (see below). It is possible to edit these notes
in Configuration Mode (see the Configuration Guide). The maximum length of one single note is
30 characters.
To enter a note:
Select the Enter Notes SmartKey to open the Enter Note menu.
Scroll if necessary, then select the note you wish to enter. A confirmation dialog box opens:
Select Confirm to enter the note. The note is then shown in the status line of the display, and is
annotated on the fetal trace if the fetal recorder is on.
By default, notes are printed lengthwise in the direction of the trace, in the space between the FHR
grid and the uterine activity grid. If you prefer, you can configure the recorder to print across the
trace. You can change this in Configuration Mode.
The following are the pre-configured notes from which to choose:
Patient Repositioned
Vaginal Examination
MD Notified
Sitting
On Back
Left Lateral
Ambulating
Tocolytic Given
Membranes Ruptured
10 Amniotomy
11 Amniotic Fluid Clear
12 Amniotic Fluid Not Clear
13 Oxytocin
14 Urinary Catheter
15 Micro Blood Analysis
Up to two notes can be printed directly, and the monitor can temporarily store up to a further two
notes, and these are printed after the first two have been printed. Any further notes are discarded. For
example, if you enter six notes in quick succession, the first two notes you entered are printed right
away, the next two are stored in memory and then printed when the first two have been printed, and
the last two are discarded.
If the printing of two notes happens to coincide with the regular printing of the time stamp that takes
place once every ten minutes, the time stamp is delayed until the notes have finished printing.
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3 Basic Operation
Typing Notes
Other than the pre-configured notes selectable in the Enter Note menu, a note can be typed in
manually.
To type a note:
Select the Enter Notes SmartKey to open the Enter Note menu.
Select Type a note and a window with a touch keypad opens.
Type the note and select Enter. The typed note can be up to 30 characters long. The note is shown
in the status line of the display, and is annotated on the fetal trace if the fetal recorder is on.
NOTE
The typed note remains in the window until it is deleted by using the backspace button of the
keyboard.
Signal Quality
During monitoring, if the fetal heart rate signal quality fluctuates, and becomes poor, it does not
necessarily mean that the transducer needs repositioning. The fluctuation may be caused by fetal
movement. Allow time for the signal to stabilize before deciding whether to reposition the transducer
(ultrasound), or apply a new electrode (ECG). For the best trace quality, the signal quality indicator
should be full, indicating good signal quality, even though it may be possible to make traces at a lower
signal quality level.
After Monitoring
Wired and cableless transducers
Discharge the patient.
Remove the transducer from the patient and, using a soft tissue, remove any gel from it. Then
clean the transducers.
Dock CL transducers to the base station so they can recharge.
Tear off the paper at the fold. To avoid misalignment of the recorder mechanism, NEVER pull on
the paper to advance it, or try to tear it other than at a fold (unless using the paper guide with the
FM40/FM50).
Switch off the monitor.
NOTE
If an Avalon CL base station is connected to your FM20/30 monitor, do not turn off the monitor if
you need to recharge the batteries of the CL transducers. They can only be recharged if the FM20/30
monitor is on. If an Avalon CL base station is connected to an FM40/50 at the Telemetry ports in the
rear, the batteries of the CL transducers can be recharged while the monitor is not switched on. If you
disconnect a base station from a fetal monitor when the CL transducers are not fully charged, the base
station starts beeping. If you want to still disconnect it, confirm your choice by pressing the Standby
key of the base station, and the beeping stops.
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Switching the Monitor to the Standby Screen
To switch the monitor to the Standby screen:
Either
Select the Monitor Standby SmartKey.
Or
Enter the Main Setup menu using the SmartKey.
Select Monitor Standby.
Pressing any key or selecting any field on the screen will resume monitoring.
Disconnecting from Power
FM20/30
To disconnect the monitor from AC power, switch the monitor off using the On/Off switch located
on the right side of the device, or unplug the power cord from the AC mains socket.
FM20/FM30 with Battery Option and FM40/FM50
The On/Standby button does not disconnect the monitor from the AC power source. To disconnect,
unplug the power cord from the AC mains socket. Note that if the power cord is unplugged from the
AC mains socket before the monitor is put into Standby, a beeper is activated. The beeper warns you if
the monitor is accidentally disconnected from AC mains.
External Power Supply for the Avalon CL Base Station
To disconnect, unplug the power supply from the AC mains socket. Note that if the power supply is
unplugged from the AC mains socket before all CL devices are fully charged, a beep is issued. To
confirm the disconnection from power, and to silence the beep, press the On/Standby button of the
CL base station.
Power On/Power Off Behavior
The general rules determining the behavior of the fetal monitors when connected to, or disconnected
from power are as follows:
•
A fetal monitor that was switched on prior to a temporary power loss, switches on again when
power is restored.
•
A fetal monitor that was switched off prior to a temporary power loss, remains off when power is
restored.
•
When AC mains power is lost, a battery powered monitor (FM20/30) continues to run without
interruption on battery power.
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3 Basic Operation
Monitoring After a Power Failure
•
A fetal monitor that was switched on prior to a temporary power loss, switches on again when
power is restored.
•
A fetal monitor that was switched off prior to a temporary power loss, remains off when power is
restored.
•
If the fetal monitor is without power for less than one minute, monitoring will resume with all
active settings unchanged.
•
If the fetal monitor is without power for more than one minute, the behavior depends on your
configuration.
– If Automat. Default is set to Yes, the default profile will be loaded when power is restored.
– If Automat. Default is set to No, all active settings are retained, if power is restored within
48 hours. The Automat. Default setting is made in Configuration Mode.
Troubleshooting
Problem
Possible Causes
Solutions
Light or no trace
Wrong paper
Use recommended paper
Dirty printhead
Clean printhead, see “Cleaning the
Print Head” on page 273
FM20/30 only: Paper misaligned due
to drawer not being correctly shut
Shut the drawer fully, pushing evenly
with both hands
End of paper noted when pack not Bad paper feed or wrong paper
finished
INOP messages always indicate
equipment
problems
FetRec Equip Malf INOP is displayed
Check Paper
Paper End
INOP is displayed
INOP is displayed
Wrong Paper Scale
72
INOP is displayed
Check paper feed and use
recommended paper
See “Patient Alarms and INOPs” on
page 129
4
Cableless Monitoring
Avalon CL Transducer System
The Avalon CL Fetal Transducer System lets you monitor the patient continuously with cableless
transducers during the antepartum period, labor, and delivery.
You can monitor the fetal heart rate (FHR):
•
Using noninvasive CL Ultrasound transducers
•
Invasively, using the CL ECG/IUP transducer or CL Toco+ MP transducer with a fetal scalp
electrode
•
Noninvasively, with the CL F&M Pod
The uterine activity can be monitored using:
•
Externally, using the CL Toco+MP transducer
•
Externally, using the CL F&M Pod
•
Invasively, using the CL ECG/IUP transducer or CL Toco+MP with an IUP catheter
The fetal and maternal parameters are measured and transmitted via radio frequency from the
CL transducers and CL Pods to the CL base station, eliminating the need for patient cables. With the
Avalon CL Transducer System, you can monitor a single fetus, twins, and triplets.
The Avalon fetal monitor (FM20-FM50) connected to the CL base station displays and records the
parameters. All the CL transducers and the CL F&M Pod are watertight. The IntelliVue CL Pods
should not be immersed in water. You can continuously monitor patients in a bath or shower using the
CL Toco+MP and the CL Ultrasound transducers, the CL F&M Pod should not be used during a bath.
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4 Cableless Monitoring
Basics of Cableless Systems
Avalon CL Transducer System
Avalon CTS Transducer System
Assigning Cableless Devices
The cableless devices of the Avalon CL are assigned by simply docking them at the base station
connected to the patient’s fetal monitor. See the Avalon CTS Instructions for Use for the assignment
of the CTS transducers.
Activating Cableless Devices
The CL devices of the Avalon CL are activated by picking them up from the base station. If the
CL devices are activated, a corresponding symbol is displayed on the fetal monitor screen next to the
numeric of the measurement. See the Avalon CTS Instructions for Use for the activation of the
CTS transducers.
Deactivating Cableless Devices
The CL devices of the Avalon CL are deactivated by redocking them at a base station. To deactivate all
cableless devices at once, press the Standby key of the Avalon CL base station. See the Avalon CTS
Instructions for Use for the deactivation of the CTS transducers.
Unassigning Cableless Devices
The CL devices of the Avalon CL are unassigned by manually removing them in the corresponding
setup menu from the group of assigned cableless devices, or by unassigning them directly in the Tele
Info window. See the Avalon CTS Instructions for Use for the unassignment of the CTS transducers.
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4 Cableless Monitoring
Twins and Triplets Support
Twins and Triplets
Singletons only
Avalon CL Transducer System and
CL transducers
Avalon CTS System
Avalon CL Transducer System with
CL Fetal & Maternal Pod
Configuration of Cableless Systems
You have to configure the radio channels of the Avalon CL and Avalon CTS transducer system for
communication to work, and not to interfere with any other telemetry devices.
The configuration of a connected Avalon CL system is done in Configuration Mode or Service Mode
of the fetal monitor. Service Mode functions can be used to identify channel assignment conflicts in
the hospital environment. The configuration should be carried out by authorized and qualified service
personnel, either by the hospital's biomedical department, or by Philips Support.
For a detailed description of the configuration see the Avalon CL Service Guide and the Fetal Monitor
Configuration Guide. For details regarding the configuration of a connected Avalon CTS system see
the Avalon CTS Service Guide.
Fetal Movement Profile
When using an Avalon CL or Avalon CTS you should be aware that monitoring FMP is not
recommended when the mother is likely to move, and you should disable Fetal Movement Profile
(FMP) on the fetal monitor (Fetal Movement Off) if the mother is walking. Maternal movements are
likely to create artifact in the FMP output. See also “Switching FMP On and Off” on page 171, the
sections “Cableless Monitoring - Important Considerations” on page 167, and “Fetal Movement
Profile” on page 170.
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4 Cableless Monitoring
Getting to Know Your Avalon CL
Front
Transducer docking slots
On/Standby button with LED
Device label
LED for optional cableless Pods
Docking slot for cableless Pods
WARNING
76
•
To avoid magnetic interference affecting the mode of the pacemaker, ensure that the Avalon
CL base station does not come into close contact with implanted pacemakers.
•
This equipment generates, uses, and radiates radio-frequency energy, and if it is not installed and
used in accordance with its accompanying documentation, may cause interference to radio
communications. Operation of this equipment in a residential area may cause interference, in
which case you must take whatever measures may be required to correct the interference.
4 Cableless Monitoring
Docking Slots for Cableless Transducers
The Avalon CL base station has three docking slots to hold the CL transducers. The transducers are
charged while docked. The base station has a built-in radio interface with an integrated antenna to
communicate with the transducers.
On/Standby Button
Pressing the On/Standby button switches the Avalon CL base station between the two modes On and
Standby.
On/Standby button
If you switch the base station to On, the LED button lights up green. The base station is ready for use.
When the transducers are picked up from their docking slot, the base station sets up the radio
communication to the CL transducer automatically. Wired transducers connected to the fetal monitor
are disabled, and the antenna symbol for the CL transducer is displayed on the screen of the fetal
monitor.
If you switch the base station to Standby, the LED button turns off. The base station is now in
Standby mode. No radio communication occurs, any existing radio communication is stopped.
If the LED of the On/Standby button turns red, it indicates a technical problem has occurred that
needs your attention. Check your monitor for a possible related INOP message.
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4 Cableless Monitoring
Docking Slot for Cableless Measurement Pods
The Avalon CL base station has one docking slot to hold a CL F&M Pod or an IntelliVue CL Pod.
The CL Pod is charged while docked. The LED under the docking slot indicates the battery status of
the CL Pod. The base station has a built-in short range radio interface with an integrated antenna to
communicate with the CL Pod.
Docking slot for CL Pods
WARNING
Short range radio connections are subject to interruption due to interference from other radio sources
in the vicinity, including microwaves, bluetooth devices, WLAN devices (802.11b,g,n), and cordless
phones. Depending on the strength and duration of the interference, the interruption may occur for an
extended period. A loss of connection, due to moving out-of-range, interference, or for other reasons,
is indicated with a No Host Monitoring INOP (here the host is the fetal monitor) on the NBP or
SpO2 Pods, or a cl NBP Disconnect or cl SpO₂ Disconnect INOP at the fetal monitor. Correct channel
configuration is important, see the Configuration Guide for details.
Audio Signal CL Base Station
The Avalon CL base station has two audio signals:
•
If the base station issues a descending tone sequence, the attempt to set up radio communication
to a CL transducer or CL Pod has failed.
•
The base station issues a permanent beeping tone if it is disconnected from a fetal monitor, or if
the FM20 or FM30 monitor is switched off, and the base station has transducers or a Pod
currently docked that need to be recharged.
Alarming is only available at the Avalon Fetal Monitor, not at the Cableless Measurement Devices, see
the Instructions of Use for the IntelliVue Cableless Measurements.
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4 Cableless Monitoring
Rear and Bottom
Name plate
Manufacturer label
Cable reel
79
4 Cableless Monitoring
Connection Options
The fetal monitors FM20/FM30 and FM40/FM50 are compatible with the Avalon CL and Avalon
CTS Transducer Systems. Regard the following points for cableless monitoring:
80
•
You can connect one Avalon CL base station with a red connector to an FM20/FM30 or an
FM40/FM50 (fetal socket), or one Avalon CL base station with a black connector to an FM40/
FM50 (telemetry socket).
•
You can connect two Avalon CL base stations with black connectors to an FM40/FM50
(telemetry sockets)
4 Cableless Monitoring
•
You cannot connect two Avalon CL base stations to an FM40/FM50, if one Avalon CL base
station has a red connector, and the other Avalon CL base station has a black connector.
•
You can connect one Avalon CTS system to an FM20/FM30 or FM40/FM50 at a time (either
fetal or telemetry socket).
81
4 Cableless Monitoring
82
•
You cannot connect an Avalon CTS and an Avalon CL at the same time to the same fetal monitor.
•
Monitoring a multiple pregnancy using cableless transducers is supported by the Avalon CL system
only.
•
Using a mixture of wired and cableless fetal transducers is not supported. You can use either wired
or cableless fetal transducers.
•
If you cannot get sufficient signal quality using Avalon CTS transducers, switch to wired
transducers.
4 Cableless Monitoring
Connecting Two CL Base Stations to an FM40/50 Monitor
Two base stations can be connected to an FM 40/50 fetal monitor at the rear black telemetry ports. At
both base stations CL transducers and CL Pods can be assigned, activated, and redocked for charging.
The base stations work as one extended system together. Pressing the Standby key of either base
station, puts both base stations in Standby mode. The Tele Info window shows both base stations in
operation.
External Power Supply (Option K60)
In combination with the optional external AC power supply an Avalon CL base station serves only as
a charging station for Avalon CL transducers and IntelliVue CL Pods, and all radio communications
are disabled. The On/Standby button of the base station lights up white in this operation mode. The
charging indication of the LEDs of the docked CL transducers and the IntelliVue CL Pods remain the
same as described in the sections “Cableless Transducer LED Indication” on page 86 and “Battery
Status LED for CL Pods” on page 93.
When a transducer is picked up from the base station after charging, it needs to be activated for
monitoring by docking it on a CL base station connected to the patient's fetal monitor.
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4 Cableless Monitoring
Cableless Transducers
The cableless Avalon CL transducers have a built-in radio interface with an on-board, integrated
antenna. The fetal monitor connected to the Avalon CL base station can control the transducer using
radio communication. The CL transducer transmits measured values, alarms, and status information to
the fetal monitor.
The CL transducers are assigned by simply docking them at the Avalon CL base station. If they are
picked up from their docking slot at the base station, they are automatically activated.
CAUTION
To ensure the correct assignment of CL transducers to the fetal monitor in use, always dock them at
the base station connected to that fetal monitor before use. This is particularly important when you
add an additional CL transducer that was previously docked at another base station.
NOTE
Avoid dropping the transducers.
Transducer finder LED - lights
up on the transducer providing
the measurement source.
CL Toco+ MP transducers
(capable of providing the
maternal pulse measurement)
Belt button
CL Ultrasound transducer
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4 Cableless Monitoring
CL ECG/IUP transducer
Connector Cap for the CL Toco+ MP Transducer
The CL Toco+ MP transducer is delivered with a connector cap covering the MECG/DECG/IUP
connector. The connector cap is designed to cover the connector, not to protect it from water. (The
connector itself is water-proof and may be immersed in water).
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4 Cableless Monitoring
Cableless Transducer LED Indication
The cableless transducers have a multi-color LED that indicates the status of the transducer with
specific colors. This LED remains visible when the transducer is correctly attached to the transducer
belt (Philips standard belt).
LED
LED Status
Meaning
White
The LED lights up to identify the transducer among other transducers,
and to easily verify the correct transducer assignment (transducer finder).
The transducer finder LED is controlled by the fetal monitor. Press the
numerics to identify the corresponding transducer.
The LED also lights up when the mother is paged with the Call Patient
SmartKey.
White one short blink
The LED shortly lights up to indicate that the transducer successfully
opened a radio communication with the base station and that it is ready to
use.
Green
The LED lights up green when the transducer is fully charged and docked
at the base station.
Yellow
The LED lights up yellow when the transducer is charging and docked at
the base station.
Red
The LED flashes red when the transducer is out of battery and has to be
recharged.
When a docked transducer performs an update, the LED will blink fast
red for about 1 minute. In this case, do not remove the transducer until
the LED lights up green or yellow again.
Cyan
86
The LED lights up cyan to indicate a technical problem that needs your
attention. Check your fetal monitor for a related INOP.
4 Cableless Monitoring
Audio Signal CL Transducers
The Avalon CL transducers have three audio signals:
•
If an ascending tone sequence is played three times, the transducer was triggered by the fetal
monitor to page the patient wearing it, or to locate a not docked transducer.
•
If the CL transducer's battery is empty, the transducer issues three beeps in intervals.
•
An INOP tone indicates that the transducer has detected a technical problem (INOP). Check your
fetal monitor for a related INOP message.
Standard Radio Range of CL Transducers
The CL transducers have an operating range around the base station of at least 100 m/300 ft in the
line of sight. Obstructions such as walls, metal doors, elevators, and other environment structures can
lead to signal loss. The CL symbol indicator and the Tele Info window on the monitor's display (see
“Screen Elements” on page 39 and “Tele Info Window” on page 94) provide information on the
status of the signal strength.
When a patient is approaching the end of range, the US sound is replaced by an artificial QRS sound
(like DECG), and the DECG and MECG waves are no longer displayed on the monitor.
Out of Range
If the patient walks out-of-range, the CL transducer LED lights up cyan and every 16 seconds a twotone audio signal is emitted. At the monitor the INOP e.g. cl US Disconnect is issued. Inform the
patient to return to the CL base station, when a CL transducer starts beeping.
Radiated Transmission Power
The Avalon CL transducers provide all the benefits and flexibility of cableless operation, but do so
with an effective radiated transmission power significantly less than that of a typical remote controlled
child’s toy or mobile phone.
Extended Range Radio
Using the optional CL Wide Range Pod extends the radio range of the CL transducers and the
CL Pods to the local WLAN infrastructure. If the CL Wide Range Pod is active, the US sound is
replaced by an artificial QRS sound (like DECG), and the DECG and MECG waves are no longer
displayed on the fetal monitor. Numerics, alarms, and traces are shown at the fetal monitor as usual.
See also “CL Wide Range Pod” on page 91.
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4 Cableless Monitoring
Using CL Transducers with a Belt Clip
The Avalon CL transducers can also be used with an optional belt clip to be ordered separately
(989803184851).
88
Avalon CL belt clip
4 Cableless Monitoring
CL Pods
CL Fetal & Maternal Pod
The CL F&M Pod provides measurement values for FHR, Toco, and HR. It communicates them to
the fetal monitor using short range radio (SRR). It is controlled via SRR from the Avalon CL base
station and the connected fetal monitor.
The CL F&M Pod is assigned by docking it at the Avalon CL base station. Before monitoring, the
CL F&M Pod is mounted on a single-use electrode patch, and held in place by integrated magnets.
When the CL F&M Pod is active, the wired transducers connected to the fetal monitor are disabled.
CL F&M Pod
CL F&M Patch
WARNING
The CL Fetal & Maternal Pod has been validated with a gestational age of >36 weeks with patients in
labor. It is only intended for singleton pregnancies. If the measurement signals are not good or in any
way suspicious, use other means of monitoring (CL transducers or wired transducers).
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4 Cableless Monitoring
CL Fetal & Maternal Pod LED Indication
The CL F&M Pod has a multi-color LED that indicates the status of the CL F&M Pod with specific
colors.
LED
LED Status
Meaning
White
The LED lights up to identify the CL Pod, and to easily verify the correct
assignment (finder). The finder LED is controlled by the fetal monitor.
Select the numerics to identify the corresponding CL Pod.
The LED also lights up when the mother is paged with the Call Patient
SmartKey.
White, one short blink
The LED briefly lights up to indicate that the CL Pod successfully
opened a radio communication with the base station and that it is ready to
use.
Green
The LED lights up green when the CL Pod is fully charged and docked at
the base station.
Yellow
The LED lights up yellow when the CL Pod is charging and docked at the
base station.
Red
The LED flashes red when the CL Pod's battery is empty, and has to be
recharged.
Cyan
The LED lights up cyan to indicate a technical problem that needs your
attention. Check your fetal monitor for a related INOP.
Audio Signal CL Fetal & Maternal Pod
The Avalon CL F&M Pod has three audio signals:
90
•
If an ascending tone sequence is played three times, the CL F&M Pod was triggered by the fetal
monitor to page the patient wearing it, or to locate a not docked CL F&M Pod.
•
If three beeps are issued at intervals, the CL F&M Pod's battery is empty.
•
An INOP tone indicates that the CL F&M Pod has detected a technical problem (INOP). Check
your fetal monitor for a related INOP message.
4 Cableless Monitoring
CL Fetal & Maternal Electrode Patch
The single-use disposable adhesive electrode patch holds the CL F&M Pod at the intended application
site on the abdomen of the patient. The electrode patch has five adhesive electrodes. The CL F&M
Pod is held in place during monitoring with magnetic contacts, and a connector. The electrode patch
and the CL F&M Pod can only be used together and within the Avalon Cableless Transducer System
solution for monitoring.
CAUTION
The electrode patch is single-patient use only, do not reuse the electrode patch on another patient to
avoid possible cross-infection.
CL Wide Range Pod
The Avalon CL Wide Range Pod is a battery-powered auxiliary network device that converts the SRR
and OB radio technology of Avalon CL transducers and the CL Pods into WLAN technology. This
allows data from the measurement devices to be transmitted to a fetal monitor while the patient is
ambulating.
The Avalon CL Wide Range Pod is a mobile device which can be worn by the patient or by an
attending caregiver. The display on the CL Wide Range Pod shows only technical data that may be
useful for troubleshooting system problems.
CL Wide Range Pod
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4 Cableless Monitoring
IntelliVue CL Pods
The two IntelliVue CL Pods provide measurement values for SpO2 and NBP on the built-in display,
and communicate them to the fetal monitor using short range radio (SRR). They are controlled with
SRR from the Avalon CL base station and the connected fetal monitor.
The maternal measurement pods are assigned by docking them at the Avalon CL base station.
CL NBP Pod
CL SpO2 Pod
The CL SpO2 Pod and the CL NBP Pod have an LCD display and three keys for basic operation e.g.
to assign the device to a patient:
Integrated LCD display
Hardkeys
Measurement identifier
For further details, see the IntelliVue Cableless Measurements Instructions for Use.
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4 Cableless Monitoring
Battery Status LED for CL Pods
The CL Pods do not have their own battery status LED, but a small battery gauge on their display. On
the Avalon CL base station, the battery status LED for the CL Pods is located directly under the
docking slot.
Battery status LED for CL Pods
The battery status LED shows five different states:
Status
Meaning
Green
The docked CL Pod is fully charged.
Yellow
The docked CL Pod is charging.
Yellow blinking
The communication is established with the docked CL Pod.
Cyan
Indicates that the docked CL Pod or the charging slot has a technical
problem that needs your attention. Check your fetal monitor for a related
INOP message.
Off
The battery status LED is off, when no CL Pod is docked.
Audio Signal CL Pods
The CL Pods have audio signals to let you know when a battery has to be recharged. If a CL Pod's
battery is empty, the CL Pod issues three beeps at intervals.
Calling Patients
To call a patient currently not near the fetal monitor and base station, select the SmartKey Call Patient
at the fetal monitor. The base station will then select one transducer, or the CL F&M Pod if it is
assigned and active, to emit the tone sequence to notify the patient. Inform the ambulating patient, if
the cableless device is issuing any beeping sounds, to return to the room with the fetal monitor.
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4 Cableless Monitoring
Telemetry
Tele Info Window
The Tele Info window of the fetal monitors allows you to manage the Avalon CL or CTS system.
Below is an exemplary view of the Tele Info window. Your window may differ depending on the status
of the connected system.
To open the Tele Info window, you can:
Configure a Tele Info SmartKey to open the window,
select the CL symbol on the main screen, or
select the Main Setup and then Tele Info.
CL transducer symbol assigned with the parameter labels
Cableless measurement symbol and equipment ID
Base station symbol with docking indication (the white slot indicates a charging transducer)
Key Remove
Key Find
Key Battery Report (in Service Mode)
CL symbol
Remaining battery time
Out of battery symbol
10 Indication of radio signal quality
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4 Cableless Monitoring
Cableless Status Indication
When the monitor recognizes a connected Avalon CL or Avalon CTS interface cable (red or black
connector), it confirms the recognition with the following status indicators displayed in the lower
right-hand corner of the screen:
Avalon CTS
Indicator
Description
Avalon CTS interface cable is connected to the monitor, but the Avalon CTS base station is not
connected to the interface cable, or it is disconnected from AC mains, or is in Standby mode.
Avalon CTS interface cable is connected to the monitor, Avalon CTS base station is connected,
powered on, and cableless transducers are ready to use, but no cableless transducers are currently
active (all are still docked at the base station).
Avalon CTS interface cable is connected to the monitor, Avalon CTS base station is connected,
powered on, and at least one cableless transducer is active and assigned.
Avalon CL
Indicator
Avalon CL
A base station is connected to the monitor, but the base station is in Standby mode.
A base station is connected to the monitor, but the base station is in Standby mode. The CL Wide
Range Pod is activated and trying to connect to the monitor.
A base station is connected to the monitor, but the base station is in Standby mode. The CL Wide
Range Pod is activated and connected to the monitor.
A base station is connected to the monitor but no cableless transducers and no cableless Pods are
currently active. All are still docked at the base station, or the base station holds no transducers.
A base station is connected to the monitor but no cableless transducers and no cableless Pods
(except the CL Wide Range Pod) are currently active. All are still docked at the base station, or the
base station holds no transducers. The CL Wide Range Pod is activated and trying to connect to
the monitor.
A base station is connected to the monitor but no cableless transducers and no cableless Pods
(except the CL Wide Range Pod) are currently active. All are still docked at the base station, or the
base station holds no transducers. The CL Wide Range Pod is activated and connected to the
monitor.
A base station is connected to the monitor, it is on, and minimum one assigned cableless
transducer or cableless Pod is active.
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4 Cableless Monitoring
Indicator
Avalon CL
A base station is connected to the monitor, it is on, and minimum one assigned cableless
transducer or cableless Pod is active. The CL Wide Range Pod is activated and trying to connect
to the monitor.
A base station is connected to the monitor, it is on, and minimum one assigned cableless
transducer or cableless Pod is active. The CL Wide Range Pod is activated and connected to the
monitor.
A CL transducer has moved away from the base station and is approaching the limit of the area of
reach (min. 100 m/300 ft in line of sight). The US sound is replaced by an artificial QRS sound
(like DECG). The DECG and MECG waves are no longer displayed.
A CL transducer has moved away from the base station and is approaching the limit of the area of
reach (ca. min. 100 m/300 ft in line of sight). The US sound is replaced by an artificial QRS sound
(like DECG). The DECG and MECG waves are no longer displayed. The CL Wide Range Pod is
activated and trying to connect to the monitor.
NOTE
A CL transducer is considered still active, even if it has an INOP condition (e.g. cl US Disconnect), until
it is either deactivated by docking it at the base station, or until it is manually removed from the Tele
Info window.
Pop-up Keys
Pop-Up key
Function
Remove
Selecting the Remove key deactivates and unassigns the selected active
transducer or CL Pod and removes it from the list. This key is disabled if no
active device is selected.
Find
Selecting the Find key pages the selected active CL transducer. This key is
disabled if no active device is selected.
Messages
The fetal monitor issues messages to certain user interactions. For example, if the CL SpO2 Pod is
picked up from the base station to activate it, the monitor displays the message cl SpO₂ Added and the
equipment label of the CL Pod.
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4 Cableless Monitoring
Use Priority When Combining Cableless and Wired Measurements
CL Transducers versus wired transducers
CL transducers have priority over wired transducers. If an Avalon CL or Avalon CTS base station is
connected to the fetal monitor, and both wired and CL transducers are connected to the monitor, all
the wired transducers are disabled whenever one CL transducer is active. To switch back to using
wired transducers, switch the base station to Standby mode, or redock all CL transducers at the base
station, and continue monitoring with the wired transducers.
CL NBP and CL SpO2 versus fetal monitor built-in NBP and SpO2 measurements
CL NBP and CL SpO2 have priority over the built-in NBP and SpO2 measurements. If a CL NBP or
CL SpO2 Pod is activated, the corresponding built-in measurement of the fetal monitor is deactivated.
To switch back to the built-in measurements, switch the base station to Standby mode, or redock the
CL Pods at the base station.
CL F&M Pod versus wired transducers
The CL F&M Pod has priority over wired transducers. If a CL F&M Pod is active, all the wired
transducers are disabled. To switch back to using wired transducers, switch the base station to Standby
mode, or redock the CL F&M Pod at the base station.
About RF Signal Quality
If you cannot get sufficient ultrasound signal quality using the Avalon CTS base station, try
repositioning the transducers, or switch to wired transducers.
Using an Avalon CL base station you should get a better signal by reducing the distance between the
CL transducer and the base station.
Signal transmission can be disturbed if:
•
the patient is out of range of the receiving area.
•
there is interference from another, possibly stronger, RF signal (a broadcasting station, for
instance).
•
the patient is near material that absorbs electromagnetic waves (for example, metal-reinforced
concrete, elevator doors) or the base station is in an enclosed metal rack.
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4 Cableless Monitoring
CL Transducer Assignment
The CL transducers are assigned by simply docking them at the Avalon CL base station connected to
the patient’s fetal monitor.
Since twins and triplets can be monitored with the Avalon CL base station, it can be delivered with up
to six CL transducers: one CL Toco+ MP, three CL US, and two CL ECG/IUP transducers. Up to
four CL transducer can be assigned at one time to the Avalon CL base station. Four assigned
CL transducers enable monitoring combinations such as 1 CL Toco+ MP transducer + 3 CL US
transducers for monitoring triplets externally, or 1 CL Toco+ MP transducer + 2 CL US transducer +
1 CL ECG/IUP transducer for monitoring twins.
Three CL transducers can be docked and charged at the Avalon CL base station at a time. If a fourth
transducer should be assigned to the Avalon CL base station:
Remove first the three docked CL transducers from the base station and place them on the patient.
Then dock the remaining fourth transducer at the base station and wait until the LED of the
fourth transducer signals that it has communication with the base station.
Place the fourth CL transducer on the patient and check on the fetal monitor in the Tele Info
window if the base station and the monitor have communication with all four transducers, and if
their numerics are displayed on the screen of the fetal monitor.
CL Transducer Unassignment
The cableless transducer needs to be unassigned:
•
before being used with another base station on another patient
•
to allow cleaning before docking it back onto the base station (e.g. to replace it with a fully charged
transducer of the same type)
There are three methods to do this:
Open the setup menu of the measurement e.g. FHR1 by selecting the numeric on the screen.
Select Remove from the open setup menu.
A confirmation window opens with the prompt Please Confirm and Device will be removed.
Select the Confirm pop-up key. A message confirms cl US has been removed.
or
Open the Tele Info window.
Select the symbol of the cableless transducer you want to unassign, and select Remove from the
pop-up menu.
A confirmation window opens with the prompt Please Confirm and Device will be removed.
Select Confirm the pop-up key. A message confirms cl US has been removed.
or
98
Redock the CL transducer at the base station.
Switch the base station to stand-by.
Remove the CL transducer; it is now unassigned.
4 Cableless Monitoring
NOTE
When a CL transducer is unassigned, all the measurements from this transducer are no longer
monitored; e.g. if you unassign a CL Toco+MP transducer, the Toco measurement, maternal Pulse, or
possibly also MECG or DECG are no longer monitored.
CL Pod Assignment
The CL Pods are assigned by simply docking them at the Avalon CL base station connected to the
patient’s fetal monitor.
CL Pod Unassignment
The CL Pods have to be unassigned:
•
before assigning them to another base station or to another patient
•
to allow cleaning, before docking them back onto the base station
There are three methods to do this:
Open the setup menu of the measurement e.g. by selecting the numeric on the screen.
Select Remove from the open setup menu.
A confirmation window opens with the prompt Confirm and Device will be removed.
Select the Confirm pop-up key. A message confirms  has been removed.
or
Open the Tele Info window.
Select the symbol of the CL Pod, and select Remove from the pop-up menu.
A confirmation window opens with the prompt Confirm and Device will be removed.
Select the Confirm pop-up key. A message confirms  has been removed.
or
Redock the CL Pod at the base station.
Switch the base station to stand-by.
Remove the CL Pod; it is now unassigned.
To unassign a IntelliVue CL Pod using its user interface, see the Cableless Measurement
Instructions for Use.
NOTE
If you unassign a CL Pod, all the measurements from it are no longer monitored, or are monitored by
a connected lesser prioritized sensor.
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4 Cableless Monitoring
Preparing to Monitor Cablelessly
When monitoring cablelessly with the FM20/30/40/40 monitors, most of the same procedures apply
as described in “Preparing to Monitor” on page 48. Additions and deviations applying to cableless
devices and existing procedures are described here.
CL Transducers
To monitor cablelessly with the CL transducers, assign them at the base station as described in
“CL Transducer Assignment” on page 98.
Place the CL transducers and the belt on the patient described in “Fastening Belts and
Transducers” on page 50.
Check the measurements on the monitor, and if necessary, move the CL transducers until you have
a good signal for all measurements.
IntelliVue CL Pods
To monitor cablelessly with the IntelliVue CL Pods, assign them at the base station as described in
“CL Pod Assignment” on page 99.
Put the CL Pods in their cradles and place them on the patient as described in the IntelliVue
Cableless Measurements Instructions for Use.
Applying the CL Fetal & Maternal Patch and Pod
WARNING
Do not use the CL Fetal & Maternal Pod and electrode patch for monitoring if:
•
The skin on the abdomen of the patient has established erythema, lesions, infection, inflammation,
or any kind of injuries at the applications site
•
The patient has a history of skin irritation, allergies, or hypersensitivity to adhesives
•
The patient carries multiple fetuses
•
The gestational age is less than 36 completed weeks. The measurement method is also only
validated with patients in labor.
CAUTION
During handling, avoid close contact of the CL Fetal & Maternal Pod or the electrode patch to an
implanted pacemaker or defibrillator.
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4 Cableless Monitoring
At the Mother's Side
Have a new single-use electrode patch ready, and make sure that the pouch is still intact. Check the
expiration date that is printed on the pouch.
Clean the application area on the abdomen of the patient. Use mild soap to wash any cream, oil, or
gel from the abdomen. Make sure to thoroughly wipe the area dry afterwards, ideally using paper
towels.
Take the electrode patch from its pouch.
Study the electrode patch Instructions for Use showing the correct placement of the electrode
patch on the abdomen of the patient.
Remove the cover from the adhesive area under the central area of the patch. (Do not remove the
cover from any of the five surrounding electrodes yet).
Verify the correct orientation of the patch. The “Philips/Monica” printed top electrode must point
to the patient’s chest.
Place the central adhesive area of the patch over the patient’s umbilicus as shown in the patch
Instructions for Use. Then press it down.
For patients with a displaced umbilicus:
Where the umbilicus has been displaced downwards, position the center of the patch along the
midline, where it intersects the horizontal line passing over the iliac crests. Alternatively, estimate
the mid-point between the fundus and symphysis pubis.
For very obese patients or patients with a large panniculus:
An alternative strategy is to position the patch along the midline such that the edge of the top
electrode is placed 10-12 cm (4-5 in) below the fundus.
Lift up one of the four electrodes. Identify the small area of the skin where you will place the
center of the electrode.
Use one piece of abrasive ECG skin preparation paper to prepare the patient's skin. Make three
horizontal and three vertical strokes with the skin preparation paper. Focus the strokes on the
small area of the skin where the conductive center of the electrode will be placed. Make deliberate
but gentle strokes, lifting the finger after each stroke.
CAUTION
Do not use too much pressure with the abrasive skin preparation paper to avoid skin injury.
incorrect
correct
10 Remove the protective cover from the electrode. Place the electrode on the prepared skin. Press it
down firmly, but avoid pressing the central gel area of electrode.
11 Repeat the steps for the skin preparation and electrode placement for the other three electrodes.
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4 Cableless Monitoring
12 For the last remaining electrode attached to the long flexible cable, identify the small area of skin
to prepare, so that the center of this reference electrode will be positioned on the midline,
approximately 6 cm (2.4 in) above the rim of the symphysis pubis.
For patients with a displaced umbilicus, very obese patients, or patients with a large
panniculus:
Place the electrode on top of the panniculus approximating to the point 6 cm (2.4 in) vertically
from the symphysis pubis. If during monitoring the aFHR signal quality is poor, reposition the
electrode lower down on the abdomen to maximize the FHR signal, and consider placing the
electrode under the panniculus just below the turn.
13 Prepare the skin like for the first four electrodes.
14 Remove the protective cover from the electrode. Then place the electrode on the prepared skin
and press it down firmly, but avoid pressing the central gel area of electrode.
15 Assign a CL F&M Pod at the base station as described in “CL Pod Assignment” on page 99.
16 Place the CL F&M Pod on the electrode patch.
102
CL F&M Pod and
electrode patch
centered on the
umbilicus
Placement of electrode
6 cm (2.4 in) above the
rim of the symphysis
pubis
4 Cableless Monitoring
At the Monitor
After you have placed the CL F&M Pod on the electrode patch, the cl F&M Electrode Status window
opens at the monitor.
In the cl F&M Electrode Status window, the electrodes and their skin contact status are shown. The skin
contact status indicates, whether the skin preparation at each electrode site was successful.
Electrode
Status
There are three methods to reopen a closed cl F&M Electrode Status window. Select:
– The clF&M Status SmartKey (configurable)
– cl F&M Status in the setup menu of one of the CL F&M parameters (for example, Setup aFHR1)
– cl F&M Status from the Main Setup menu
Description
What to Do
The skin contact status is good.
When a good skin contact status is indicated for all five
electrodes, the cl F&M Electrode Status window closes, and the
measurement starts automatically.
Further skin preparation may be
required.
Carefully remove the electrode from the skin.
Dry the skin.
Repeat the skin preparation procedure.
If the contact status cannot be improved, you can choose
to skip the electrode status check by selecting the Skip
Check, Start Measurement button in the cl F&M Electrode
Status window. Measurement accuracy should not be
affected, but fetal heart rate detection may be less
sensitive.
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4 Cableless Monitoring
Electrode
Status
Description
What to Do
Further skin preparation is required. 1
Electrode status is unknown.
Carefully remove the electrode from the skin.
Dry the skin.
Repeat the skin preparation procedure.
It is not recommended to skip the electrode status check,
if bad skin contact quality is persistently indicated for one
or more electrodes.
This status may be shown temporarily, or in case of a patch
malfunction, combined with an INOP message.
NOTE
If you have to repeat the skin preparation, or fix a loose electrode, ensure that enough wet gel remains
in the conductive middle of the electrode during the reapplication of the electrode. Add additional
fixation (any type of medical grade tape) to the pad in case the adhesive is compromised.
•
If you cannot get a good measurement signal quality, use an alternative monitoring method.
•
The electrode patch can remain applied for up to 48 hours. Remove the electrode patch, if there
are signs of skin irritation.
•
If you have to replace an electrode patch:
– Gently remove the electrode patch from the abdomen of the patient.
– Wipe the abdomen dry thoroughly.
– Apply a new patch over exactly the same location. In this case, no further skin preparation is
required.
•
Monitoring with the CL F&M Pod and electrode patch can continue when the patient takes a
shower. However, ensure that the CL F&M Pod remains on the electrode patch all the time, to
keep the contacts of the electrode patch dry. The achievable maximum wireless operating range
may be compromised when monitoring under a shower.
•
The CL Fetal & Maternal Pod is not intended for underwater monitoring, for example in a
bathtub.
CAUTION
Do not reuse a patch on another patient due to the risk of cross contamination.
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4 Cableless Monitoring
After Monitoring
After monitoring is done, remove the CL F&M Pod from the electrode patch.
Clean and disinfect the CL F&M Pod, see “Care and Cleaning” on page 261.
Dock the CL F&M Pod back at the base station.
Gently remove the electrode patch and the electrodes from the abdomen of the patient.
Dispose of the electrode patch.
Remove the residuals of the adhesive from the patient's skin.
CL Wide Range Pod
The CL Wide Range Pod extends the signal range for the cableless measurement devices worn by the
ambulating patient.
Assign the CL Wide Range Pod at the base station as described in “CL Pod Assignment” on
page 99.
Activate the CL Wide Range Pod by taking it off the base station.
The CL Wide Range Pod connects itself over WLAN and LAN with the fetal monitor. As soon as
the connection to the monitor is established, the CL Wide Range Pod takes over from the base
station, and sends the signals from the cableless devices to the monitor. The connection status of
the CL Wide Range Pod is shown on the monitor, see “Cableless Status Indication” on page 95.
Hand the CL Wide Range Pod to the patient to carry with her, or optionally wearing it using the
Mobile CL Transmitter Cradle (989803168881). The CL Wide Range Pod should be worn with its
rear side facing the body.
CL Wide Range Pod carried in hand, or CL Wide Range Pod worn with the belt clip (supporting
loop and belt clip part of the optional Mobile CL Transmitter Cradle).
While the CL Wide Range Pod is active, cableless devices can still be assigned or unassigned at the
base station dynamically to the patient. To hand the signal transfer back from the CL Wide Range
Pod to the base station, redock the CL Wide Range Pod at the base station.
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4 Cableless Monitoring
Battery Lifetime Management
The lifetime of a Lithium Ion battery depends on the frequency and duration of use.
CL Transducers
Battery replacement is recommended after 500 charge-discharge cycles, or if the battery is older than
4 years whatever is reached first. If the battery of a cableless transducer has aged and an exchange of
the battery is highly recommended, a prompt message is displayed at the fetal monitor for ca.
60 seconds. The prompt is repeated whenever the Tele Info window is opened until the battery is
replaced. The CL transducer battery allows for 10 hours of continuous operation.
Depending on the transducer type the following messages are displayed:
cl US battery has aged. Replacement strongly recommended
cl Toco battery has aged. Replacement strongly recommended
cl ECG/IUP batt has aged. Replacement strongly recommended
If you are getting this message, contact your service personnel so they can replace the CL transducer's
battery.
CL F&M Pod
Pod replacement is recommended after 500 charge-discharge cycles, or if the battery is older than
4 years whatever is reached first. If the battery of a CL F&M Pod has aged and an exchange of the Pod
is highly recommended, a prompt message is displayed at the fetal monitor for ca. 60 seconds. The
prompt is repeated whenever the Tele Info window is opened. The CL F&M battery allows for 16
hours of continuous operation.
The following message is displayed:
cl F&M battery has aged. Replacement strongly recommended
If you are getting this message, contact your service personnel so they can replace the CL F&M Pod.
CL Wide Range Pod
Battery replacement is recommended after 500 charge-discharge cycles, or if the battery is older than
4 years whatever is reached first. If the battery of a CL Wide Range Pod has aged and an exchange of
the battery is highly recommended, a prompt message is displayed at the fetal monitor for ca.
60 seconds. The prompt is repeated whenever the Tele Info window is opened until the battery is
replaced. The CL Wide Range Pod battery allows for 4 hours of continuous operation
The following message is displayed:
cl WRP battery has aged. Replacement strongly recommended
CL NBP and CL SpO2 Pods
For battery charge-discharge cycles specification of the IntelliVue CL Pods (NBP and SpO2), refer to
the Service Guide of the Cableless Measurements.
Charge Cycle
The age of a lithium ion battery begins at the date of manufacture. The lithium batteries are designed
for frequent recharging. A complete charging cycle is only reached and counted, when all recharging
periods equal a 100% charge.
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4 Cableless Monitoring
The date of manufacture and number of charge-discharge cycles can be printed out in a battery report.
Patient Transport Within the Hospital
During transport, the patient wearing the CL transducers can be transferred from one fetal monitor to
another fetal monitor.
To stop monitoring, discharge the patient at the fetal monitor. Do not switch the CL base station
to Standby.
Note: If you switch the CL base station to Standby after the discharge, the CL transducers only
hold the assignment to the CL base station for 1 minute.
Disconnect the CL base station from the fetal monitor.
The CL transducers hold the assignment to the CL base station for 30 minutes. Transport the
patient wearing the CL transducers with the disconnected CL base station to another fetal
monitor.
Connect the CL base station to the other fetal monitor. The fetal monitors need to have the same
software revisions, and the correct time and date settings.
Manually admit the patient to the fetal monitor, unless the patient is transferred to the new fetal
monitor with the OB TraceVue/IntelliSpace Perinatal system.
Resume monitoring. Once the base station and the transducer are connected and assigned to the
new monitor, the previous monitor can be switched off or to Standby.
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4 Cableless Monitoring
Underwater Monitoring
Only the battery-operated CL transducers of the Avalon CL and Avalon CTS systems can be used to
monitor under water. You can use them to monitor patients in a bathtub or shower. This does not
apply to the IntelliVue CL SpO2, CL NBP, and the CL Wide Range Pod, do not immerse the CL Pods
into water.
The CL F&M Pod can be worn within the shower, if the Pod is securely placed on the electrode patch,
so that the contacts cannot get wet. Radio transmission range of the CL F&M Pod may be reduced
under a shower.
Cableless transmission distances are shorter when monitoring under water. A metal bathtub is likely to
further reduce the operating range.
WARNING
Never immerse the base station in liquid. You must protect it against water sprays or splashes. Place
the base station where there is no chance of contact with water, or falling into water or other liquids.
CAUTION
Avoid the use of pulsating water jets in the bath or shower while monitoring, as these can be
misinterpreted as an incorrect (or totally artificial) heart rate.
Toco Baseline drift: When using transducers under warm water, the temperature increase causes a
significant baseline change due to internal pressure increase. The depth under water at which the Toco
transducer is used also has an effect on the Toco baseline, as the water pressure increases with depth.
After immersion, allow one to two minutes for the pressure to stabilize, then adjust the Toco baseline
(between contractions), and check it frequently.
When using the transducers underwater, the radio transmission range is reduced, and signal loss may
occur.
Water-proof belts like M1562B are recommended for the cableless transducers when monitoring in
water.
108
5
FM20/30 Battery Option
You can switch between battery-powered and mains-powered (AC) operation without interrupting
monitoring.
The monitor is connected to the AC mains power via the external power supply.
NOTE
The battery option is not available for the FM40/FM50.
External Power Supply M8023A
The external power supply M8023A (option #E25) allows you to operate the fetal monitor from an
AC (alternating current) power source of 100 V to 240 V (±10%) and 50/60 Hz (±5%). If this option
is used, then the M8023A (option #E25) power supply is included for FM20/30.
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5 FM20/30 Battery Option
AC power cord, connected to AC mains socket
Measurement Link (MSL) cable, supplies the power to the monitor for operation and for battery
charging
Power-on LED, the green light is on when the external power supply is connected to the AC
mains
WARNING
•
Always use the supplied power cord with the earthed mains plug to connect the external power
supply M8023A (option #E25) to an earthed AC mains socket. Never adapt the mains plug from
the power supply to fit an unearthed AC mains socket.
•
Do not use AC mains extension cords or multiple portable socket-outlets. If a multiple portable
socket-outlet without an approved isolation transformer is used, the interruption of its protective
earthing may result in enclosure leakage currents equal to the sum of the individual earth leakage
currents, so exceeding allowable limits.
•
Do not connect any devices that are not supported as part of a system.
•
Any non-medical device placed and operated in the patient’s vicinity must be powered with an
approved isolation transformer that ensures mechanical fixing of the power cords and covering of
any unused power outlets.
Using Batteries
The Lithium Ion batteries used in your monitor store a large amount of energy in a small package. This
allows reliable battery-operated monitoring, but also requires care in use and handling of the batteries.
Follow the instructions in this chapter and see the Service Guide for further details.
Battery Power Indicators
The battery LED and battery status information on the main screen, in combination with INOP
messages and prompts, help you keep track of the battery power status. The indicators always show
the remaining capacity in relation to the battery's actual maximum capacity, which may lessen as the
battery ages. You can see the actual capacity in the Battery Status window.
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5 FM20/30 Battery Option
Battery LED
The possible battery LED status on the right side of the monitor is described in the table below.
Battery LED Colors
If the monitor is connected to
mains power, this means
Green
Battery power is >90%
Yellow
Battery charging (battery power
< 90%)
Less than 10 minutes power
remaining
Red, flashing
Red, flashes intermittently
If the monitor is running on
battery power, this means
Battery or charger malfunction
Battery malfunction
Battery Status on the Main Screen
Battery status information is permanently displayed on all screens. It shows the status of the battery,
with the battery power remaining, with an estimate of the monitoring time this represents.
Battery power gauge: This shows the remaining battery power. It is divided into sections, each
representing 20% of the total power. If three sections are filled, as in this example, this indicates that
60% battery power remains. If no data is available from the battery, a question mark is shown in the
gauge.
Monitoring Time Available: Below the battery power gauge a time is displayed. This is the estimated
monitoring time available with the current battery power. Note that this time fluctuates depending on
the system load (the display brightness, the recorder configuration, and how many measurements you
carry out).
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5 FM20/30 Battery Option
Battery malfunction symbols: Normal battery function is indicated by the battery power gauge,
together with the remaining operating time, on the main screen. You are informed of problems or
changes in the status of the battery by the battery status/malfunction indicator. This consists of a blank
battery gauge containing a "!" symbol. If the symbol is red, this indicates a critical situation. You can
check the specific cause of the problem by looking at the symbol(s) displayed in the Battery Status
window.
Battery Status Indicator
Alternates with the battery gauge
on the main screen.
Check in the Battery Status
window to see which status
symbol is displayed to identify
the cause.
Battery Malfunction Indicator
The red exclamation mark
flashes. Critical battery situation
or malfunction. Check in the
Battery Status window to see
which malfunction indicator is
displayed, or refer to the INOP,
to identify the cause.
Battery Status Window
To access the Battery Status window and its associated pop-up keys, select the battery status
information on the screen, or select Main Setup, Battery.
– Capacity, remaining tells you how much power is left in the battery.
– Capacity, fullCharge tells you how much power the battery can hold when fully charged.
– TimeToEmpty tells you approximately how long you can continue to use the monitor without
an AC connection. The time span fluctuates depending on the system load (the display
brightness and how many measurements you carry out), and the remaining capacity of the
battery.
– TimeToFull is shown in place of TimeToEmpty if the monitor is connected to a power supply,
and tells you how much time is left until the battery is charged to 90%. If >10 hr is shown
here, the battery may not charge completely when the monitor is in use.
Battery status/malfunction symbols: If a problem is detected with the battery, an INOP may be
issued, and the following symbols are displayed in the Battery Status window, where they may be
accompanied by a status message providing more details.
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5 FM20/30 Battery Option
Symbols indicating critical situations are colored red.
Battery Status Symbols
Battery Malfunction Symbols
Battery is empty
(Red) incompatible battery
Battery not charging as the
temperature is above or below
the specified range
(Red) battery malfunction
Battery requires maintenance
(Red) battery has no power left
Charging stopped to protect the
battery
(Red) battery temperature too
high
(Red) battery is missing, insert
battery
Checking Battery Charge
To check the charge status of a battery, refer to the battery power gauge on the screen, or open the
Battery Status window.
When Battery Lifetime is Expired
When the battery is aged, either after 3 years from manufacturing date or after 500 charge-discharge
cycles, it is recommended to replace the battery. To remind you of this, a message will appear in the
Battery Status window. This message will only be displayed at the appropriate time when the date and
time on the monitor is correct.
Optimizing Battery Performance
The performance of rechargeable batteries may deteriorate over time. Battery maintenance as
recommended here can help to slow down this process.
Display Brightness Setting
In the Main Setup menu, select User Interface, Brightness, then Optimum. This selects a level of
brightness suitable for most monitoring locations that uses less battery power than brighter
settings.
Ensure that the current level of brightness is suitable for your monitoring location.
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5 FM20/30 Battery Option
Charging the Battery
To charge the battery:
Connect the monitor to the external power supply (M8023A).
Charge the battery until it is full, the battery LED is green, and the battery power gauge is filled.
During high load of the monitor (usage of multiple measurements) the battery may not charge. To
remedy this:
•
reduce the load by removing measurements
•
reduce the screen brightness or stop the recorder
Internal temperature conditions can also cause the battery to not charge. This is necessary to protect
the battery from damage and does not indicate a malfunction. Keep the monitor at room temperature
and move it away from heat sources or out of direct sunlight. The battery will resume charging when
the temperature is within range again. The battery will charge more quickly if the monitor is switched
off.
Conditioning the Battery
You must condition the battery when the "battery requires maintenance" symbol shows on the screen.
Do not interrupt the charge or discharge cycle during conditioning.
CAUTION
Condition the battery with a monitor not currently in use. The monitor switches off automatically
when there is no battery power left.
To condition the battery:
114
Charge the battery until it is completely full. Open the Battery Status window and check that the
Batt fully charged message is displayed.
Disconnect the monitor from mains power, and let the monitor run until there is no battery power
left and the monitor switches itself off.
Reconnect the monitor to mains power and charge the battery until it is full for use or charge to
50% for storage.
5 FM20/30 Battery Option
Battery Safety Information
WARNING
Use only Philips batteries part number M4605A. Use of a different battery may present a risk of fire
or explosion.
Do not open batteries, or dispose of them in fire, or cause them to short circuit. They may ignite,
explode, leak, or heat up, causing personal injury.
If battery leakage should occur, avoid contact with skin. Refer to qualified and authorized service
personnel.
Dispose of used batteries promptly and in an environmentally responsible manner. Do not dispose
of the battery in normal waste containers. Consult your hospital administrator to find out about local
arrangements. Do not expose batteries to liquids.
Do not crush, drop, or puncture batteries - mechanical abuse can lead to internal damage and internal
short circuits which may not be visible externally.
If a battery has been dropped or banged against a hard surface, whether damage is visible externally or
not:
•
discontinue use
•
dispose of the battery in accordance with the disposal instructions above.
Keep batteries out of the reach of children.
CAUTION
Do not disassemble, heat above 100°C (212°F) or incinerate the batteries, to avoid the risk of fire and
burns. Keep batteries out of the reach of children and in their original package until you are ready to
use them.
If battery leakage should occur, use caution in removing the battery. Avoid contact with skin. Refer to
qualified and authorized service personnel.
Do not install or use pre-damaged batteries.
Storing the Battery
WARNING
Remove the battery from the monitor when it is not used for a longer period of time, to avoid
potential damage caused by battery leakage.
Batteries should be charged to a maximum of 50% for storage.
The battery will discharge over time if it is stored inside the monitor without AC power connection.
The reported values for "remaining capacity" and "runtime" will become less accurate when the battery
is stored in this way for a longer period of time (that is, several weeks).
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5 FM20/30 Battery Option
Cableless Monitoring with FM20/30 Battery Option
The CL Pods can be used with the FM20/30 with battery option #E25. The CL Pods can be assigned
and activated, but will not be charged. The only exception to this is the CL F&M Pod, which can also
be charged.
The charging time of the CL transducers can take up to 6 hours if they are charged from an FM20/30
with battery option.
If you charge the CL transducers at an FM20/30 with battery option, be sure to remove all wired
transducers from the fetal monitor. Leaving them connected to the fetal monitor can cause the
CL transducers not to charge at all.
Patient Transport Within the Hospital
The FM20 and FM30 fetal monitor with battery option offer the possibility of continuous monitoring
of a patient, while she is transported within the hospital.
116
Unplug the MSL connector at the fetal monitor. Or, in case an external power supply is mounted
on a rollstand, unplug it from the AC Mains.
The fetal monitor is now operating on battery power.
Move the patient with the fetal monitor (on a cart) to the new location.
Reconnect the MSL connector at the fetal monitor or the external power supply to the AC Mains.
6
Alarms
The alarm information here applies to all measurements. Measurement-specific alarm information is
contained in the sections on individual measurements.
The fetal monitor has two different types of alarm: patient alarms and INOPs.
Patient Alarms
Patient alarms are red and yellow alarms. A red alarm indicates high priority, such as a potentially life
threatening situation (for example, SpO2 below the desaturation alarm limit). A yellow alarm indicates
a lower priority alarm (for example, a fetal heart rate alarm limit violation).
INOPs
INOPs are technical alarms. They indicate that the monitor cannot measure and therefore not detect
critical conditions reliably. If an INOP interrupts monitoring and alarm detection (for example, MECG
Leads Off), the monitor places a question mark in place of the measurement numeric and sounds an
audible tone. INOPs without this tone indicate that there may be a problem with the reliability of the
data, but that monitoring is not interrupted.
INOPs are cyan by default. The following INOPs can also be configured as red or yellow INOPs to
provide a severity indication:
•
ECG Leads Off
•
Battery Empty
•
Cuff Overpress
•
Cuff NotDeflated
•
No Pulse
(FM20/30, CL devices)
Alarm Delays
There is a delay between a physiological event at the measurement site and the corresponding alarm
indication at the monitor. This delay has two components:
•
The general measurement delay time is the time between the occurrence of the
physiological event and when this event is represented by the displayed numerical values.
This delay depends on the algorithmic processing and on the measurement dependent averaging
time.
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•
The time between the displayed numerical values exceeding an alarm limit and the alarm
indication on the monitor. This delay is the sum of the alarm delay configured for the specific
measurement plus the system alarm delay. The system alarm delay is the processing time the
system needs for any alarm on the monitor to be indicated after the measurement has triggered the
alarm. See the performance specifications in “Specifications and Standards Compliance” on
page 287 for the system alarm delay specification.
Multiple Alarms
If more than one alarm is active, the alarm messages are shown in the alarm status area in succession.
An arrow symbol next to the alarm message informs you that more than one message is active.
The monitor sounds an audible indicator for the highest priority alarm. If more than one alarm
condition is active in the same measurement, the monitor announces the most severe alarm condition
first.
WARNING
Alarm systems of the monitor and those of the connected obstetrical information and surveillance
system are independent and not synchronized.
Alarming is only available at the Avalon fetal monitor, not at the Cableless Measurement Devices, see
the Instructions for Use for the IntelliVue Cableless Measurements.
If configured so, SpO₂ No Pulse will only be displayed in yellow or red (instead of cyan), when no other
Pulse source is valid and is displayed instead of the Pulse from SpO2.
Alarm Mode
You can configure the alarm mode for your fetal monitor. There are two possible modes:
•
All:
alarms and INOPs are enabled, with all audible and visual indicators active.
•
INOP only:
only INOPs are enabled, with audible and visual indication active.
WARNING
In INOP only mode, no fetal/maternal patient alarms are enabled or indicated.
The alarm status area for yellow and red alarms shows the INOP only indication in conjunction with the
"Alarms Off" symbol. No individual measurement alarm limits or alarm off symbols are displayed. No
fetal/maternal patient alarm settings are available in the setup menus.
Nurse Call Systems
If configured to do so, red, yellow, and cyan alarms are indicated on a nurse call system which is
connected to the optional nurse call relay.
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Visual Alarm Indicators
Alarm message: An alarm message appears in the alarm status area on the second line at the top of
the screen indicating the source of the alarm. If more than one measurement is in an alarm condition,
the message changes every two seconds, and has an arrow at the side. The background color of the
alarm message matches the alarm priority: red for red alarms and red INOPs, yellow for yellow alarms
and yellow INOPs, and cyan for INOPs. The asterisk symbols (*) beside the alarm message match the
alarm priority: *** for red alarms, and ** for yellow alarms. INOPs are displayed without asterisks, but
a red INOP has !!! three exclamation marks, and a yellow INOP has !! two exclamation marks before it.
Depending on how your monitor is configured, it may display alarm limit violation messages:
•
in text form, for example ** FHR1 Low or
•
in numeric form, for example **FHR1 94<110, where the second number shows the currently set
alarm limit, and the first number shows the value at which that alarm limit was violated by the
widest margin.
Flashing numeric: The numeric of the measurement in alarm flashes.
Bright alarm limits: If the alarm was triggered by an alarm limit violation, the corresponding alarm
limit on the monitor screen is shown more brightly.
Audible Alarm Indicators
The audible alarm indicators configured for your fetal monitor depend on which alarm standard
applies in your hospital. Audible alarm indicator patterns are repeated until you acknowledge the alarm
by switching it off or pausing it, or until the alarm condition ceases (if audible alarm indication is set to
non-latching).
WARNING
Do not rely exclusively on the audible alarm system for fetal monitoring. Adjustment of alarm volume
to a low level or off during monitoring may result in a dangerous situation. Remember that the most
reliable method of fetal monitoring combines close personal surveillance with correct operation of
monitoring equipment.
Alarm Tone Configuration
The audible alarm indicators of your monitor are configurable. In the monitor's Configuration Mode,
you can:
•
increase the alarm volume of unacknowledged alarms at regular intervals
•
change the interval between alarm sounds (ISO/IEC Standard alarms only)
•
change the base volume of the red and yellow alarm tones and the INOP tones
•
change the alarm sound to suit the different alarm standards valid in different countries
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Standard Philips Alarms
•
Red alarms and red INOPs: a high pitched sound is repeated once a second.
•
Two-star yellow alarms and yellow INOPs: a lower pitched sound is repeated every two seconds.
•
One-star yellow alarms (short yellow alarms): the audible indicator is the same as for yellow
alarms, but of shorter duration.
•
Standard INOPs: an INOP tone is repeated every two seconds.
ISO/IEC Standard Audible Alarms
•
Red alarms and red INOPs: a high pitched tone is repeated five times, followed by a configurable
pause.
•
Two-star yellow alarms and yellow INOPs: a lower pitched tone is repeated three times, followed
by a configurable pause.
•
One-star yellow alarms (short yellow alarms): the audible indicator is the same as for yellow
alarms, but of shorter duration.
•
Standard INOPs: a lower pitched tone is repeated twice, followed by a pause.
Changing the Alarm Tone Volume
The alarm volume symbol at the top right of the monitor screen gives you an indication of the current
volume. To change the volume:
Select the volume symbol.
The volume scale pops up.
1 Alarm Volume
Select the required volume from the volume scale.
When the alarm volume is set to zero (Off), the alarm volume symbol shows this symbol:
If you switch the alarm volume off, you will not get any audible indication of alarm conditions.
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Minimum Volume for Severe Yellow or Red INOPs
Severe yellow or red INOPs require action to ensure the well-being of the patient. Therefore the
minimum volume for the INOP tone is set to at least alarm volume 8, irrespective of the current alarm
volume setting. The INOP tone will sound even if the monitor alarm volume is set to zero.
The severe INOPs for which this applies are:
INOP
Factory Default
INOP tone
Battery Empty
cyan
severe (fetal monitor with battery
option)
Battery Empty
cyan
severe (CL transducers and Pods)
Cuff Overpress
cyan
severe
Cuff NotDeflated
cyan
severe
Power Loss Tone
FM20/30 with
Battery
Option,
FM40/50
When power is lost - no power is available from the AC power source or from the battery - a beeper
will sound. The tone can be silenced by pressing the On/Standby button.
Acknowledging Alarms
To acknowledge all active alarms and INOPs, select the Silence key. This switches off the audible alarm
indicators.
•
A checkmark beside the alarm message indicates that the alarm has been acknowledged.
•
If the condition that triggered the alarm is still present after the alarm has been acknowledged, the
alarm message stays on the screen with a checkmark symbol beside it.
•
If the alarm condition is no longer present, all alarm indicators stop and the alarm is reset.
•
Switching off the alarms for the measurement in alarm, or switching off the measurement itself,
also stops alarm indication.
Acknowledging Disconnect INOPs
Acknowledging an INOP that results from a disconnected transducer, switches off the associated
measurement.
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Alarm Reminder
If Alarm Reminder is configured on for your monitor, you will get an audible reminder of alarm
conditions that remain active after you have acknowledged the alarm. This reminder may take the form
of a repetition of the alarm tone for a limited time, or an unlimited repetition of the alarm tone (this is
the same as a new alarm). Alarm Reminder is available only for yellow and red alarms and INOPs and
not for standard cyan INOPs.
In Configuration Mode, you can set the interval between silencing the alarm and sounding the
reminder tone to one, two, or three minutes.
Pausing or Switching Off Alarms
If you want to temporarily prevent alarms from sounding, for example while you are moving a patient,
you can pause alarms. Depending on your fetal monitor configuration, alarms are paused for one, two,
or three minutes, or infinitely.
To view the alarm pause setting chosen for your unit:
Select Main Setup, Alarms, Alarm Settings.
Check the Alarms Off setting.
This setting can be changed in Configuration Mode.
There are some settings made in Configuration Mode that can affect the availability of the pause
alarms functionality.
•
The Pause Alarms/Alarms Off SmartKey can be removed from the screen to avoid unintentional
switching off of alarms. In this case you can only pause alarms or switch alarms off permanently in
the Alarms menu, under Main Setup.
•
The Pause Alarms/Alarms Off SmartKey can be configured to pause or switch off red and yellow
alarms, yellow alarms only, or not to function at all. If it is configured not to function, you cannot
pause alarms or switch alarms off permanently at all.
When the alarms off priority is set to Yellow Only, the Pause Alarms/Alarms Off key becomes the Pause
Yellow/Yellow Al. Off.
To Pause All Alarms
If you have configured alarms to be paused for one, two, or three minutes, the SmartKey is labeled
Pause Alarms.
Select the Pause Alarms SmartKey to pause all alarms.
Or
122
Select Main Setup.
Select Alarms.
Select Pause Alarms.
6 Alarms
To Switch All Alarms Off
You can switch alarms off permanently if your monitor is configured to allow infinite alarms pause,
and the SmartKey is labeled Alarms Off.
Select the Alarms Off SmartKey.
Or
Select Main Setup.
Select Alarms.
Select Alarms Off.
While Alarms are Paused or Off
When red alarms are paused or off:
In the alarm field, the monitor displays the message Al. Paused x:yy or Alarms Off, together with the
alarms paused symbol or the alarms off symbol.
When yellow alarms are paused or off:
In the alarm field, the monitor displays the message YellowPaused x:yy or Yellow Alarms Off, together
with the alarms paused symbol or the alarms off symbol.
For red and yellow alarms:
Alarms Paused
Alarms Off
•
No alarms are sounded and no alarm messages are shown.
•
INOP messages are shown but no INOP tones are sounded.
The only exceptions are the INOPs Cuff NotDeflated, Cuff Overpress, and Battery Empty from the
FM20/30 monitor with battery option.
These INOPs switch all alarms back on again, so that an INOP tone can be sounded. You must
remove the INOP condition first, before you can switch off or pause the alarms again.
Restarting Paused Alarms
To manually switch on alarm indication again after a pause, select the SmartKey Pause Alarms (or
Alarms Off) again.
Alarm indication starts again automatically after the pause period expires. If the monitor is configured
to stay paused infinitely, you must select Alarms Off again to restart alarm indication.
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Extending the Alarm Pause Time
If your monitor has the function extended alarm pause enabled, you can extend the alarm pause time.
Use this to prevent alarms being indicated, for example, while you are washing a patient or carrying out
a procedure. Only extend the alarm pause time when you are sure that clinical personnel are available
to monitor the patient's condition closely.
To extend the alarm pause time to five or 10 minutes:
Select one of the alarm fields. This calls up the Alarm Messages window.
Select either the pop-up key PauseAl. 5 min or the pop-up key PauseAl. 10 min. Each time you
select one of these pop-up keys, the Alarm Pause Time is reset to five or 10 minutes.
To Switch Individual Measurement Alarms On or Off
This applies to alarm mode All.
Select the measurement numeric to enter its setup menu.
Select Alarms to switch between On and Off.
The alarms off symbol is shown beside the measurement numeric.
Alarm Limits
The alarm limits you set determine the conditions that trigger yellow and red limit alarms.
WARNING
Be aware that the monitors in your care area may each have different alarm settings, to suit different
scenarios. Always check that the alarm settings are appropriate before you start monitoring.
Viewing Individual Alarm Limits (Alarm Mode "All" Only)
Alarm Limits
You can usually see the alarm limits set for each measurement next to the measurement numeric on
the main screen.
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If your monitor is not configured to show the alarm limits next to the numeric, you can see them in the
related measurement setup menu. Select the measurement numeric to enter the menu and check the
limits.
Changing Alarm Limits
To change individual measurement alarm limits using the measurement's setup menu:
In the measurement's setup menu, select the alarm limit you want to change. This calls up a list of
available values for the alarm limit.
Select a value from the list to adjust the alarm limit.
CAUTION
Set the alarm limits to a meaningful value for the individual patient. Setting the alarm limits to a too
high or too low value may render the alarm function useless.
Extreme Alarm Limits for Heart Rate and Maternal Pulse
The extreme rate alarms, Extreme Tachy and Extreme Brady, generated by the active alarm source,
either HR or Pulse, are set in Configuration Mode by adding a set value (the Δ value) to the high and
low alarm limits.
Extreme Brady Limit
Low Limit
High Limit
Extreme Tachy Limit
Δ Extreme Brady
Δ Extreme Tachy
You need to know which value has been configured for your monitor. Changing the high and low
alarm limits automatically changes the extreme alarm limits within the allowed range.
To see the extreme rate alarms set for your monitor, in the Setup ECG menu, see the menu items Δ
ExtrTachy and Δ ExtrBrady.
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Reviewing Alarms
To review the currently active alarms and INOPs, select any of the alarm status areas on the fetal
monitor screen. The Alarm Messages window pops up. All alarms and INOPs are erased from the
monitor's alarm history when you discharge a patient, or if you leave the Demonstration Mode.
Alarm Messages Window
The Alarm Messages window shows all the currently active alarms and INOPs in chronological order,
beginning at the top with the most recent. INOPs are shown on the left hand side, and alarms are
shown on the right hand side. Any active red alarms are shown first, followed by yellow alarms.
Acknowledged alarms or INOPs are shown with the checkmark symbol.
The Alarm Messages window pop-up keys appear when the window is opened. Selecting the Review
pop-up key opens the Review Alarms window.
Alarms
Review Alarms Window
Alarms On
SpO₂ No Pulse
Alarms Silenced
** FHR1 High
** SpO₂ Low
The Review Alarms window contains a list of up to 300 of the most recent alarms and INOPs with date
and time information. If configured to do so, each alarm is shown with the alarm limit active when the
alarm was triggered and the maximum value measured beyond this limit. The Review Alarms window
also shows any changes made to the Alarms On/Off or Alarms Silenced status. Only the main alarms
On/Off transitions are logged in the alarm history, and On/Off alarm transitions for individual
measurements are not logged.
The information in the Review Alarms window is deleted when a patient is discharged.
The Review Alarms window pop-up keys appear when the window is opened. Selecting the Active
Alarms pop-up key opens the Alarm Messages window.
Latching Alarms
The alarm latching setting for your monitor defines how the alarm indicators behave when you do not
acknowledge them. When alarms are set to non-latching, their indicators end when the alarm condition
ends. Switching alarm latching on means that visual and/or audible alarm indications are still displayed
or announced by the monitor after the alarm condition ends. The indication lasts until you
acknowledge the alarm.
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Viewing the Alarm Latching Settings
To see the alarm latching setting for your monitor:
In the monitor's Main Setup menu, select Alarms.
Select Alarm Settings, and see the Visual Latching and Audible Latching settings.
This setting can be changed in Configuration Mode. You should be aware of the settings chosen for
your unit. There are three possible choices each for visual and audible latching: Red & Yellow, Red Only,
and Off. The audible latching configuration can never be configured to a higher level than that
configured for the visual latching. In other words, the audible latching setting is always the same level,
or lower, than the visual latching setting. For example, if visual latching is configured to Red Only, then
audible latching can only be set to Red Only or Off. The following table shows the possible
combinations for latching settings:
Possible Combinations for Alarm Latching Settings
Visual Latching Setting
Audible Latching Setting
Red & Yellow
Red & Yellow
Red & Yellow
Red Only
Red & Yellow
Off
Red Only
Red Only
Red Only
Off
Off
Off
Alarm Latching Behavior
Alarm Condition
Red and Yellow Measurement Alarms
Acknowledgment
Presence
Non-latching alarms Visual and audible
latching
Visual latching,
audible non-latching
Alarm has not been
acknowledged
Alarm
condition still
present
Alarm tone on
Alarm message
Flashing numerics
Alarm tone on
Alarm message
Flashing numerics
Alarm tone on
Alarm message
Flashing numerics
Alarm
condition no
longer present
All audible and visual
alarm indicators
automatically stop
Alarm tone on
Alarm message
Flashing numerics
Audible alarm
indicators automatically
stop
Alarm message
Flashing numerics
Alarm
condition still
present
Alarm tone off
Audible alarm
reminder (if
configured)
Alarm message
Flashing numerics
Alarm tone off
Audible alarm reminder
(if configured)
Alarm message
Flashing numerics
Alarm tone off
Audible alarm reminder
(if configured)
Alarm message
Flashing numerics
Alarm
condition no
longer present
Audible and visual
alarm indicators
automatically stop
Audible and visual
alarm indicators
automatically stop
Audible and visual
alarm indicators
automatically stop
Alarm has been
acknowledged
All INOPs except the "unplugged" INOPs are non-latching.
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Testing Alarms
When you switch the fetal monitor on, a self test is started. You should hear a single tone. This
indicates that the audible alarm indicators are functioning correctly. For further testing of individual
measurement alarms, perform the measurement on yourself (for example SpO2 or NBP) or use a
simulator. Adjust alarm limits and check that appropriate alarm behavior is observed.
To test the functioning of visible and audible alarms, do the following:
Enable the alarm (Alarm Mode needs to be set to All, see the Configuration Guide).
Set the alarm limits.
Measure or simulate the parameter that is out of range, or signal loss.
Verify that the visible and audible alarms are working.
As an example, to test the FHR alarms:
Connect the US transducer to a fetal sensor socket.
Enable the FHR alarming (see “Turning Alarms On or Off” on page 197).
Set the high alarm limit and delay to 150 bpm and 60 seconds respectively, and the low alarm limit and
delay to 110 bpm and 60 seconds respectively (see “Changing Alarm Limits” on page 197).
Generate a fetal heart rate of approximately 180 bpm (3 beats per second) for more than one
minute.
Verify the functioning of the visible and audible alarms.
Alarm Behavior at Power On
If the monitor is switched off for longer than one minute and then switched on again, or after a loss of
power lasting longer than one minute, the monitor can be configured to restore either the alarm
settings from the monitor's User Defaults, or the most recently used alarm settings. When a patient is
discharged, the User Defaults of the monitor are always restored independent of the setting. After any
of these situations, ensure that the alarm settings are appropriate for your patient. If power is lost for
less than one minute, the alarm settings prior to the power loss are restored.
•
128
If AlarmsOffAtStart is enabled in Configuration Mode alarms will be initially paused or off the next
time the monitor is switched on, depending on a set of related configuration settings, see the
Configuration Guide.
7
Patient Alarms and INOPs
This chapter lists alarms and technical alarms (INOPs) for the fetal monitors irrespective of their
priority.
Alarm Messages
Fetal alarms are identified by either "FHR", "dFHR", or aFHR. All other alarms without these
identifiers refer to maternal parameters. Alarm messages can be configured with the Enhanced setting
to give more information. These messages are shown additionally in the table below, with xxx for the
measured value and yyy for the alarm limit concerned.
Alarm Message
From
** aFHR1 High
FHR
The fetal heart rate obtained from the
(CL F&M Pod) CL F&M Pod has risen above the high
alarm limit.
** aFHR2 High
** aFHR3 High
** aFHR1 xxx>yyy
** aFHR2 xxx>yyy
Condition
Indication
Numeric flashes and high
limit is highlighted, yellow
alarm message, alarm tone.
xxx denotes the highest measured value, and
yyy is the high alarm limit.
** aFHR3 xxx>yyy
** aFHR1 Low
** aFHR2 Low
** aFHR3 Low
** aFHR1 xxxyyy
HR
The maternal heart rate obtained from the
(CL F&M Pod) CL F&M Pod fallen below the low alarm
limit.
Numeric flashes and low limit
is highlighted, yellow alarm
message, alarm tone.
xxx denotes the lowest measured value, and
yyy is the low alarm limit.
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7 Patient Alarms and INOPs
Alarm Message
From
Condition
Indication
*** Brady (Pulse)
SpO2
The heart rate from the Pulse signal has
fallen below the bradycardia limit.
Numeric flashes, red alarm
message, alarm tone.
***Brady/P xxxyyy
Numeric flashes, red alarm
message, alarm tone.
Numeric flashes and high
limit is highlighted, yellow
xxx denotes the highest measured value, and alarm message, alarm tone.
yyy is the high alarm limit.
**dFHR2 xxx>yyy
**dFHR3 xxx>yyy
** dFHR1 Low
** dFHR2 Low
** dFHR3 Low
**dFHR1 xxxyyy
The maternal heart rate obtained from the Numeric flashes, red alarm
maternal ECG has risen above the extreme message, alarm tone.
tachycardia limit.
xxx denotes the highest measured value, and
yy is the extreme tachycardia limit.
** FHR1 High
** FHR2 High
FHR
(ultrasound)
** FHR3 High
The fetal heart rate obtained from
ultrasound has risen above the high alarm
limit.
Numeric flashes and high
limit is highlighted, yellow
alarm message, alarm tone.
xxx denotes the highest measured value, and
yyy is the high alarm limit.
**FHR1 xxx>yyy
**FHR2 xxx>yyy
**FHR3 xxx>yyy
** FHR1 Low
** FHR2 Low
** FHR3 Low
**FHR1 xxxyyy
xxx denotes the highest measured value, and
yyy is the high alarm limit.
** HR Low
MECG
**HR xxx High
iTemp
The temperature value has exceeded the
high alarm limit.
Numeric flashes and high
limit is highlighted, alarm
tone.
**  Low
iTemp
The temperature value has dropped below
the alarm limit.
Numeric flashes and low limit
is highlighted, alarm tone.
** NBPs High
Noninvasive
blood pressure
The measured noninvasive blood pressure
value is above the high alarm limits s, d, or
m after the label indicates whether the
systolic, diastolic, or mean pressure has
crossed the limit.
Numeric flashes and high
limit is highlighted, yellow
alarm message, alarm tone.
Noninvasive
blood pressure
The measured noninvasive blood pressure Numeric flashes and low limit
value is below the low alarm limits s, d, or m is highlighted, yellow alarm
after the label indicates whether the systolic, message, alarm tone.
diastolic, or mean pressure has crossed the
limit.
** Pulse High
SpO2
The pulse rate has exceeded the high alarm Numeric flashes and high
limit.
limit is highlighted, yellow
alarm message, alarm tone.
** Pulse Low
SpO2
The pulse rate has dropped below the low
alarm limit.
** SpO₂ High
SpO2
The arterial oxygen saturation has exceeded Numeric flashes and high
the high alarm limit.
limit is highlighted, yellow
alarm message, alarm tone.
** SpO₂ Low
SpO2
The arterial oxygen saturation has fallen
below the low alarm limit.
Numeric flashes and low limit
is highlighted, yellow alarm
message, alarm tone.
*** Tachy (Pulse)
SpO2
The heart rate from the Pulse signal has
exceeded the tachycardia limit.
Numeric flashes, red alarm
message, alarm tone.
** NBPd High
** NBPm High
** NBPs Low
** NBPd Low
** NBPm Low
***Tachy/P xxx>yyy
Numeric flashes and low limit
is highlighted, yellow alarm
message, alarm tone.
xxx denotes the highest measured value, and
yyy is the tachycardia limit.
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7 Patient Alarms and INOPs
Technical Alarm Messages (INOPs)
Monitor INOPs
INOP Message
Indication
What to do
2nd Tele Incompatible
Monitor: INOP tone
One of the connected base stations is not supported by
the monitor. Check software revisions.
Bus Master Incomp
Monitor: INOP tone
The Bus Master board or firmware is incompatible and
cannot be used with this monitor software revision.
Contact your service personnel.
Bus Master Malfunc
Monitor: INOP tone
There is a problem with the monitor's hardware. Contact
your service personnel.
Check Flex Texts
Monitor: INOP tone
If this INOP appears, check the monitor and patient
settings before you resume monitoring. If the settings are
unexpected, there may be a problem with the monitor
software. Contact your service personnel.
Check Keyboard
Monitor: INOP tone
Perform a visual and functional check of the keyboard.
Contact your service personnel.
Check Monitor Func
Monitor: INOP tone
A potential internal problem with the monitor has been
detected. Contact your service personnel.
Check Mouse
Monitor: INOP tone
Perform a visual and functional check of the mouse input
device. Contact your service personnel.
Check OBR Config
Monitor: INOP tone
OBR (OB Radio) channel configuration is invalid or
settings are not present. Check channel configuration and
hardware option.
Check Settings
Monitor: INOP tone
If this INOP appears, check the monitor and patient
settings before you resume monitoring. If the settings are
unexpected, there may be a problem with the monitor
software. Contact your service personnel.
Check TI Config
Monitor: INOP tone
If this INOP appears, the monitor can be used normally,
except for the Trace Interpretation feature. Contact your
service personnel.
Check Touch Input
Monitor: Display only
Perform a visual and functional check of the touch input
device. Contact your service personnel.
Coincidence
Monitor: INOP tone
The fetal heart rate(s) and maternal heart rate/pulse
persistently coincide with another. (see “Cross-Channel
Verification (CCV)” on page 159). The INOP tone has a
configurable delay. The default setting is an instant INOP
tone.
Internal.Comm.Malf
Monitor: INOP tone
There is a problem with I2C Bus communication in the
monitor. Contact your service personnel.
NST Elapsed
Monitor: INOP tone
The time has expired for the NST timer. Clearing the
timer clears the INOP.
!! Coincidence
(Message and tone only if
Setup NST Timer, Notification
is set to Alarm in
Configuration Mode).
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7 Patient Alarms and INOPs
INOP Message
Indication
What to do
OBR Interference
Monitor: INOP tone
OBR (OB Radio) communication is disturbed by other
devices (not necessarily other wireless measurements).
Contact service personnel.
Paper End
Monitor: INOP tone
The end of the paper pack is detected. Insert a new pack
of paper.
Settings Malfunct
Monitor: INOP tone
The monitor cannot use the predefined settings for
monitoring. Contact your service personnel.
Speaker Malfunct
Monitor: INOP tone
Contact your service personnel to check the speaker and
the connection to the speaker.
SRR Incompatible
Monitor: INOP tone
The connected SRR (Short Range Radio) board or
firmware cannot be used with this base station's software
revision. Contact your service personnel.
SRR Interference
Monitor: INOP tone
The short range radio connection has interference from
another device. Try using another channel.
SRR Invalid Chan
Monitor: INOP tone
The channel configuration of the Short Range Radio is
invalid. Check channel and channel mask configuration.
SRR Malfunction
Monitor: INOP tone
Malfunction in the SRR (Short Range Radio) module(s).
If the INOP persists, contact your service personnel.
Tele Incompatible
Monitor: INOP tone
The base station is not supported by the monitor. Check
software revisions.
Tele Malfunction
Monitor: INOP tone
Malfunction of the connected base station. If the INOP
persists contact your service personnel.
Tele Unplugged
Monitor: INOP tone
The base station has been disconnected from the
monitor, while one or more CL devices were active. This
INOP is only issued, if the setting Sensor Disconnct is No
Auto Off, or the Alarm Mode is set to All.
Unsupported LAN
Monitor: INOP tone
There is a problem with the communication to the
network and central monitoring is currently not possible.
Check the connection. If the INOP persists, switch off
the monitor and contact your service personnel.
User I/F Malfunct
Monitor: INOP tone
Perform a visual and functional check of all the monitor
input devices. Contact your service personnel.
FM20/FM30 Battery INOPs
INOP Message
Indication
What to do
Batt Empty
Monitor: INOP tone
The estimated remaining battery-powered operating time
is less than 10 minutes. Connect the monitor to AC
immediately.
Battery LED at the monitor
flashes. During this INOP,
alarms cannot be paused or
switched off.
Batt Incompat
Monitor: INOP tone
If the condition persists and the monitor is not connected
to mains power, this INOP is re-issued two minutes after
you acknowledge it.
The battery cannot be used with this monitor. Replace it
with the correct battery.
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7 Patient Alarms and INOPs
INOP Message
Indication
What to do
Batt Low
Monitor: INOP tone
The estimated battery-powered operating time remaining
is less than 20 minutes.
Batt Malfunction
Monitor: INOP tone
The monitor cannot determine the battery status. If the
INOP persists, replace the faulty battery. If the condition
persists and the monitor is not connected to mains power,
this INOP is reissued two minutes after you acknowledge
it.
Battery at the monitor
flashes. During this INOP,
alarms cannot be paused or
switched off unless the
monitor is connected to
mains power.
Batt Missing
Monitor: INOP tone
No battery found in FM20/30. Contact your service
personnel.
Charger Malfunct
Monitor: INOP tone
There is a problem with the battery charger in the
monitor. Connect the monitor to mains power and
contact your service personnel.
Battery at the monitor may
flash.
Monitor: INOP tone
The temperature of the battery is too high. Check that the
monitor is not exposed to heat.
INOP Message
Indication
What to do
Check Paper
Monitor: display only
Check that there is no paper jam, that the print drawer is
properly shut, that the paper is loaded with the grid facing
upwards, and that the correct Philips paper is being used.
Check Batt Temp
Recorder INOPs
Recorder: printout
FetRec Chk Config
Monitor: INOP tone
and/or Scale Type settings are set to
and need to be set to the correct values in
Configuration Mode before the recorder can be operated.
Recorder Speed
Unknown
FetRec Equip Malf
Monitor: INOP tone
There is a problem with the fetal recorder hardware.
Contact your service personnel.
Printhead Overheat
Monitor: INOP tone
The printhead is too hot. The recorder stops, the recorder
Start/ Stop key is disabled, and remains so until the
printhead cools down sufficiently. Wait for the printhead
to cool down, then press the recorder Start/ Stop key or
the Silence key to clear the INOP.
Wrong Paper Scale
Monitor: INOP tone
The grid scale of the paper in the monitor does not match
the grid scale configured in the monitor. Make sure that
you use the correct paper and scale for your institution:
pre-printed: 30-240 in US and Canada, 50-210 in other
geographies.
Recorder: printout
134
7 Patient Alarms and INOPs
Wired Transducer INOPs
FHR (Ultrasound)
INOP Message
Indication
What to do
FHR1 Equip Malf
Monitor: INOP tone
There is a problem with the FHR hardware. Contact your
service personnel.
FHR2 Equip Malf
FHR3 Equip Malf
FHR3 Signal Loss
The input signal quality is not sufficient to process the
INOP tone if Alarm Mode is measurement. Adjust the position of the transducer to
set to All. No tone if Alarm obtain a better signal.
Mode is set to INOP only.
FHR1 Unplugged
Monitor: INOP tone
Reconnect the FHR transducer to the monitor. Check if
all connections are sound.
INOP Message
Indication
What to do
IUP Equip Malf
Monitor: INOP tone
There is a problem with the IUP hardware. Contact your
service personnel.
IUP Unplugged
Monitor: INOP tone
Reconnect the IUP transducer to the monitor. Check if all
connections are sound.
INOP Message
Indication
What to do
Pulse(Toco) Malf
Monitor: INOP tone
There is a problem with the Toco MP transducer
hardware. Contact your service personnel.
FHR1 Signal Loss
FHR2 Signal Loss
Monitor: INOP tone
FHR2 Unplugged
FHR3 Unplugged
IUP
Toco
Toco MP Maternal Pulse
Measurement
Toco Equip Malf
Monitor: INOP tone
There is a problem with the Toco hardware. Contact your
service personnel.
Toco Unplugged
Monitor: INOP tone
Reconnect the Toco transducer to the monitor. Check if
all connections are sound.
135
7 Patient Alarms and INOPs
Cableless Transducer INOPs
INOP Message
Indication
What to do
cl US Batt Empty
Monitor: INOP tone
(configurable cyan, yellow,
red)
The remaining monitoring time with this transducer is
below 15 minutes. Charge battery.
!!cl US Batt Empty
!!!cl US BattEmpty
cl Toco Batt Empty
!!clToco BattEmpty
CL transducer: yellow tone
and LED flashes red
!!!clTocoBattEmpty
cl ECG/IUP Empty
!!cl ECG/IUP Empty
!!!clECG/IUP Empty
cl US Batt Low
cl Toco Batt Low
Monitor: Display only
cl ECG/IUP BattLow
CL transducer: LED flashes
red
cl US Batt Malf
Monitor: INOP tone
cl Toco Batt Malf
clECG/IUP BattMalf
cl US Check Temp
cl Toco Chk Temp
clECG/IUP Chk Temp
cl US Disconnect
cl Toco Disconnect
cl ECG/IUP Disconn
cl US Malfunction
cl Toco Malf
cl ECG/IUP Malf
136
The remaining monitoring time with this transducer is
below 30 minutes. Charge battery.
Malfunction of the battery system (charger circuit or
CL transducer: tone and cyan battery) detected (e.g. persistent communication error,
overvoltage, overcurrent, battery incompatible). Contact
LED
your service personnel.
Monitor: INOP tone
The temperature of the transducer or its battery is
CL transducer: tone and cyan critically high. If the transducer is docked on the base
station, charging is interrupted. Check that the transducer
LED
is not covered and do not expose it to a heat source. Do
not place the base station in a sunny window in a room
without active air conditioning. The environment
temperature to charge a transducer battery should not
exceed 40°C/104°F. If the INOP persists, remove the
transducer from patient and contact your service
personnel.
Monitor: INOP tone
The cableless transducer has lost the connection to the
CL transducer: tone and cyan monitor.
LED
Monitor: INOP tone
Numeric is replaced by a -?CL transducer: tone and cyan
LED
Malfunction of the transducer. Contact your service
personnel.
7 Patient Alarms and INOPs
CL Fetal & Maternal Pod INOPs
INOP Message
Indication
What to do
aFHR1 Signal Loss
Monitor: INOP tone
The input signal quality is not sufficient to process the
measurement. Reapply the electrodes of the electrode
patch.
aFHR2 Signal Loss
aFHR3 Signal Loss
cl F&M Batt Empty
!!cl F&M BattEmpty
!!!cl F&M BatEmpty
Numeric is replaced by a -?INOP tone if Alarm Mode is
set to All. No tone if Alarm
Mode is set to INOP only.
Monitor: INOP tone
(configurable cyan, yellow,
red)
The remaining monitoring time with the CL F&M Pod is
below 15 minutes. Charge the battery.
CL F&M Pod: LED flashes
red and yellow tone
cl F&M Batt Incmp
Monitor: INOP tone
cl F&M Batt Low
Monitor: Display only
The battery cannot be used with the CL F&M Pod.
CL F&M Pod: cyan LED and Contact your service personnel.
INOP tone
CL F&M Pod: LED flashes
red
cl F&M Batt Malf
Monitor: INOP tone
CL F&M Pod: cyan LED
cl F&M Batt Temp
Monitor: INOP tone
CL F&M Pod: cyan LED
The remaining monitoring time with the CL F&M Pod is
below 30 minutes. Charge the battery.
Malfunction of the battery system (charger circuit or
battery) detected (for example: persistent communication
error, overvoltage, overcurrent, battery incompatible).
Contact your service personnel.
The temperature of the CL F&M Pod or its battery is
critically high. If the Pod is docked on the base station,
charging is interrupted.
Check that device is not covered. Do not expose device
to heat sources. If INOP persists, remove the CL F&M
Pod from patient. Contact your service personnel.
cl F&M Check Batt
Monitor: INOP tone
CL F&M Pod: cyan LED
During charging, the battery's temperature is below 0°C
(32°F), or above 45°C (113°F).
During discharge, the battery's temperature is below -5°C
(23°F), or above 55°C (131°F).
cl F&M Chk Chrg IF
Monitor: INOP tone
CL F&M Pod: cyan LED
There is an over-, or undervoltage at the charger interface.
Contact your service personnel.
137
7 Patient Alarms and INOPs
INOP Message
Indication
What to do
cl F&M Chk Electr.
Monitor: INOP tone
•
without tone, if no CL F&M
Pod parameter shows -?-
Not all electrodes have sufficient skin contact:
Prepare the skin at the application site further with
the abrasive pad.
CL F&M Pod: cyan LED
•
One or more leads between the measurement Pod
and the electrode(s) is broken: Replace the electrode
patch.
•
Contact problem between the CL F&M Pod and the
electrode patch: Reconnect the CL F&M Pod.
This INOP can only occur in monitoring mode after the
initial electrode impedance check has occurred.
cl F&M ChkSettings
Monitor: INOP tone
CL F&M Pod: cyan LED
cl F&M Disconnect
Monitor: INOP tone
CL F&M Pod: cyan LED
cl F&M License Req
Monitor: INOP tone
CL F&M Pod: cyan LED
cl F&M Malfunction
Monitor: INOP tone
CL F&M Pod: cyan LED
cl F&M Patch Disc
Monitor: INOP tone
CL F&M Pod: cyan LED
cl F&M Patch Malf
Monitor: INOP tone
cl F&M Remove
Monitor: INOP tone
138
The CL F&M Pod settings are incompatible or corrupted.
Check the settings. Contact your service personnel.
The CL F&M Pod has lost the connection to the monitor.
Call the patient back to the monitor. If the CL F&M Pod
has still no connection, remove it from the monitor, and
reassign it. If it still does not have a connection, contact
your service personnel.
There is no valid license registered. Contact your service
personnel.
The CL F&M Pod malfunctions. Contact your service
personnel.
The CL F&M Pod has been disconnected from the
electrode patch during monitoring mode. Reconnect the
CL F&M Pod.
The connected electrode patch cannot be identified.
CL F&M Pod: cyan LED and Either the electrode patch is malfunctioning, or the
connection between the CL F&M Pod and the patch is
INOP tone
defective.
The battery temperature is too high 60°C (140°F).
CL F&M Pod: cyan LED and Remove the CL F&M Pod immediately from the patient.
Contact your service personnel.
INOP tone
7 Patient Alarms and INOPs
CL Wide Range Pod INOPs
INOP Message
Indication
What to do
cl WRP Batt Empty
Monitor: INOP tone
(configurable cyan, yellow,
red)
The remaining time with the CL Wide Range Pod is
below 15 minutes. Charge the battery.
!!cl WRP BattEmpty
!!!cl WRP BatEmpty
CL Wide Range Pod: Display
only, yellow tone
cl WRP Batt Incmp
Monitor: INOP tone
cl WRP Batt Low
Monitor: Display only
cl WRP Batt Malf
Monitor: INOP tone
cl WRP Batt Temp
Monitor: INOP tone
The battery cannot be used with the CL Wide Range Pod.
CL Wide Range Pod: Display Contact your service personnel.
and INOP tone
The remaining monitoring time with the CL Wide Range
CL Wide Range Pod: Display Pod is below 30 minutes. Charge the battery.
only
Malfunction of the battery system (charger circuit or
CL Wide Range Pod: Display battery) detected (for example: persistent communication
error, overvoltage, overcurrent, battery incompatible).
only
Contact your service personnel.
The temperature of the CL Wide Range Pod or its battery
CL Wide Range Pod: Display is critically high. If the Pod is docked on the base station,
charging is interrupted.
only
Check that device is not covered. Do not expose device
to heat sources. If INOP persists, remove the CL Wide
Range Pod from patient. Contact your service personnel.
cl WRP Chk Chrg IF
Monitor: INOP tone
cl WRP ChkSettings
Monitor: INOP tone
cl WRP Disconnect
Monitor: INOP tone
cl WRP License Req
Monitor: INOP tone
cl WRP Malfunction
Monitor: INOP tone
cl WRP Remove
Monitor: INOP tone
There is an over-, or undervoltage at the charger interface.
CL Wide Range Pod: Display Contact your service personnel.
and INOP tone
The CL Wide Range Pod settings are incompatible or
CL Wide Range Pod: Display corrupted. Check the settings. Contact your service
personnel.
and INOP tone
The CL Wide Range Pod has lost the WLAN/LAN
CL Wide Range Pod: Display connection for more than 10 seconds to the monitor.
and INOP tone
There is no valid license registered. Contact your service
CL Wide Range Pod: Display personnel.
and INOP tone
The CL Wide Range Pod is malfunctioning. Contact your
CL Wide Range Pod: Display service personnel.
and INOP tone
The battery temperature is too high 60°C (140°F).
CL Wide Range Pod: Display Remove the CL Wide Range Pod immediately from the
patient. Contact your service personnel.
and INOP tone
139
7 Patient Alarms and INOPs
DECG and MECG INOPs
INOP Message
Indication
What to do
dFHR1 Equip Malf
Monitor: INOP tone
There is a problem with the DECG hardware. Contact
your service personnel.
Monitor: INOP tone
One or more DECG lead is not attached. Make sure that
all required leads are attached, and no electrodes have
been displaced. Check all connections are sound, and that
the leg plate attachment electrode is properly attached. If
the INOP persists, try using another adapter cable, or leg
plate attachment electrode. If the INOP persists, contact
your service personnel.
dFHR2 Equip Malf
dFHR3 Equip Malf
dFHR1 Leads Off
!! dFHR1 Leads Off
!!!dFHR1 Leads Off
Numeric is replaced by a -?-
dFHR2 Leads Off
!! dFHR2 Leads Off
!!!dFHR2 Leads Off
dFHR3 Leads Off
!! dFHR3 Leads Off
!!!dFHR3 Leads Off
dFHR1 Signal Loss
dFHR2 Signal Loss
dFHR3 Signal Loss
dFHR1 Unplugged
dFHR2 Unplugged
dFHR3 Unplugged
Monitor: INOP tone
Numeric is replaced by a -?-
The input signal quality is not sufficient to process the
measurement. Reapply the fetal scalp electrode.
INOP tone if Alarm Mode is
set to All. No tone if Alarm
Mode is set to INOP only.
Monitor: INOP tone
Numeric is replaced by a -?-
Reconnect the DECG transducer to the monitor. Check
if all connections are sound.
MECG Equip Malf
Monitor: INOP tone
There is a problem with the MECG hardware. Contact
your service personnel.
MECG Leads Off
Monitor: INOP tone
One or more MECG lead is not attached. Ensure that all
required leads are attached, and no electrodes have been
displaced. Check if all connections are sound. If the
INOP persists, try using another adapter cable. If the
INOP still persists, contact your service personnel.
!! MECG Leads Off
!!! MECG Leads Off
MECG Unplugged
Numeric is replaced by a -?-
Monitor: INOP tone
Numeric is replaced by a -?-
140
Reconnect the MECG transducer to the monitor. Check
if all connections are sound.
7 Patient Alarms and INOPs
NBP INOPs
INOP Message
Indication
Cuff Not Deflated
Monitor: INOP tone (severe Remove the cuff from the patient. Make sure that the
yellow/red INOP tone)
tubing is not kinked or twisted. Try restarting the
Numeric is replaced by a -?- measurement. You can silence the INOP, but the INOP
message remains visible until the next measurement is
During this INOP, alarms
started, or the Stop All SmartKey is selected.
cannot be paused or switched
off.
!! Cuff Not Deflat
!!!Cuff Not Deflat
NBP Check Cuff
Monitor: INOP tone
Numeric is replaced by a -?-
What to do
Check if cuff is connected to the NBP Pod and cuff is
applied to the patient; check tubing and cuff for leakage.
Try restarting the measurement. If the INOP occurs
repeatedly, contact your service personnel. You can
silence this INOP, but the INOP message remains visible
until the next measurement is started or the Stop All
SmartKey is selected.
This INOP is issued, when the maximum time for
inflation is exceeded, or when there is a significant change
in inflation time between two successive measurements in
auto and sequence mode.
NBP Cuff Overpress
!! Cuff Overpress
!!!Cuff Overpress
NBP Equip Malf
Monitor: INOP tone (severe The cuff pressure exceeds the overpressure safety limits.
yellow/red INOP tone)
Remove the cuff from the patient. Ensure that the tubing
Numeric is replaced by a -?- is not kinked or twisted, and that the correct patient
category is selected.
During this INOP, alarms
cannot be paused or switched Try restarting the measurement. You can silence this
INOP, but the INOP message remains visible until the
off.
next measurement is started, or the Stop All SmartKey is
selected.
Monitor: INOP tone
Numeric is replaced by a -?-
Remove the cuff from the patient. The noninvasive blood
pressure hardware is faulty. Contact your service
personnel.
You can silence this INOP, but the INOP message
remains visible until the next measurement is started, or
the Stop All SmartKey is selected.
141
7 Patient Alarms and INOPs
INOP Message
Indication
What to do
NBP Interrupted
Monitor: INOP tone
Check the tubing and cuff for leakages or kinks. Check
that you are using the correct cuff size and placement,
and that the correct patient category is selected. Try
restarting the measurement. If the INOP occurs
repeatedly, contact your service personnel.
Numeric is replaced by a -?-
You can silence this INOP, but the INOP message
remains visible until the next measurement is started, or
the Stop All SmartKey is selected. This INOP arises when
the measurement needed longer than the maximum time
allowed for inflation, deflation, or the total measurement.
NBP Measure Failed
Monitor: INOP tone
Numeric is replaced by a -?-
Check that you are using the correct cuff size and
placement, and that the correct patient category is
selected. Try restarting the measurement.
You can silence this INOP, but the INOP message
remains visible until the next measurement is started, or
the Stop All SmartKey is selected.
Check the condition and suitability of the patient for
noninvasive blood pressure monitoring. Use another cuff
to continue measuring.
CL NBP Pod INOPs
INOP Message
Indication
What to do
Check Charger I/F
Monitor: INOP tone
Overvoltage or undervoltage detected at the charger
interface. Clean contacts of charger interface at Cableless
Measurement Device and charging station. If the INOP
persists, contact your service personnel.
CL NBP Pod: display
message
cl NBP Batt Empty
!!cl NBP BattEmpty
!!!cl NBP BatEmpty
Monitor: INOP tone
(configurable cyan, yellow,
red)
The remaining battery time of the CL NBP Pod is below
30 minutes. Charge the battery.
CL NBP Pod: display
message, yellow tone
cl NBP Batt Incomp
Monitor: INOP tone
CL NBP Pod: display
message
cl NBP Batt Low
Monitor: INOP tone
CL NBP Pod: display
message
cl NBP Batt Malf
Monitor: INOP tone
CL NBP Pod: display
message
142
The battery in use with the CL NBP Pod is incompatible.
Replace it with one approved for use with the CL NBP
Pod.
The remaining battery time of the CL NBP Pod is below
2 hours.
There is a malfunction in the CL NBP Pod's battery
system. Contact your service personnel.
7 Patient Alarms and INOPs
INOP Message
Indication
What to do
cl NBP Batt Temp
Monitor: INOP tone
The temperature of the battery in the CL NBP Pod is
critically high. Check that the Pod is not covered or
exposed to a heat source. If the INOP persists, remove
the Pod from the patient, and contact your service
personnel.
CL NBP Pod: display
message
cl NBP Check Batt
Monitor: INOP tone
CL NBP Pod: display
message
cl NBP ChkSettings
Monitor: INOP tone
CL NBP Pod: display
message
The battery in the CL NBP Pod is nearing the end of its
useful life. Only 50 charge-discharge cycles remain.
Contact your service personnel to replace the battery.
If this INOP appears and an INOP tone sounds, check
the Cableless Measurement Device and patient settings
before you resume making measurements. If the settings
are unexpected, there may be a problem with the
Cableless Measurement Device software. Contact your
service personnel.
If this INOP is acknowledged at the Cableless
Measurement Device, it is cleared. If it is silenced
remotely, only the tone is cleared.
cl NBP Disconnect
Monitor: INOP tone and
display
The CL NBP Pod has lost the SRR connection to the
monitor.
CL NBP Pod: display
message
cl NBP No Cradle
Monitor: INOP tone
CL NBP Pod: display
message
cl NBP Remove
Monitor: INOP tone
CL NBP Pod: display
message
cl NBP Serv Batt
Monitor: INOP tone
CL NBP Pod: display
message
NBP Check Cuff
Monitor: INOP tone
CL NBP Pod: display
message
The CL NBP Pod is not in the cradle. You can silence this
INOP, but the INOP message remains visible until the
CL NBP Pod is inserted into the cradle, and the next
measurement is started, or the Stop All SmartKey is
selected.
The temperature of the battery in the CL NBP Pod is too
high. Remove the Cableless Measurement Device from
the patient and contact service personnel.
The battery in the CL NBP Pod has reached the end of its
useful life. It can no longer be charged. Contact your
service personnel to replace the battery.
Check if cuff is connected to the NBP Pod and cuff is
applied to the patient; check tubing and cuff for leakage.
Try restarting the measurement. If the INOP occurs
repeatedly, contact your service personnel. You can
silence this INOP, but the INOP message remains visible
until the next measurement is started or the Stop All
SmartKey is selected.
This INOP arises when the maximum time for inflation is
exceeded or when there is a significant change in inflation
time between two successive measurements in auto and
sequence mode.
143
7 Patient Alarms and INOPs
SpO2 INOPs
INOP Message
Indication
What to do
SpO₂ Equip Malf
Monitor: INOP tone
There is a problem with the SpO2 hardware. Contact your
service personnel.
SpO₂ Erratic
Monitor: INOP tone
Check the sensor placement. Try another adapter cable
and sensor. If the INOP persists, contact your service
personnel.
Numeric is replaced by a -?SpO₂ Extd.Update
Monitor: display only
Numeric is replaced by a -?-
SpO₂ Low Perf
Monitor: display only
Numeric is replaced by a -?-
SpO₂ No Pulse
!!  No Pulse
!!! No Pulse
SpO₂ No Sensor
Monitor: INOP tone
Numeric is replaced by a -?Monitor: INOP tone
Numeric is replaced by a -?-
SpO₂ NoisySignal
Monitor: INOP tone
Numeric is replaced by a -?-
SpO₂ Poor Signal
Monitor: display only
Numeric is replaced by a -?-
SpO₂ Pulse?
Monitor: INOP tone
Numeric is replaced by a -?-
SpO₂ Searching
Monitor: display only
Numeric unavailable
SpO₂ Sensor Malf
Monitor: INOP tone
Numeric unavailable
SpO₂ Sensor Off
Monitor: INOP tone
Numeric unavailable
SpO₂ Unkn.Sensor
Monitor: display only
Numeric is replaced by a -?-
144
The update period of displayed values is extended due to
a noninvasive blood pressure measurement on the same
limb, or an excessively noisy signal.
Accuracy may be compromised due to very low
perfusion. Stimulate circulation at sensor site. If INOP
persists, change the measurement site.
Check the perfusion at measurement site. If necessary,
stimulate circulation or change measurement site. If the
INOP is due to noninvasive blood pressure measurement
on the same limb, wait until the measurement is finished.
Ensure the SpO2 sensor is connected. If the INOP
persists, try another adapter cable and sensor. If you
silence this INOP, the measurement will be switched off.
Excessive patient movement or electrical interference is
causing irregular pulse patterns. Try to reduce patient
movement, or to relieve the cable strain on the sensor.
The signal condition of the SpO2 measurement is poor
and measurement accuracy may be compromised.
The detectable pulsations of the SpO2 signal are outside
the specified pulse rate range.
SpO2 is analyzing the patient signal to derive Pulse, and
SpO2 values. Please wait until the search analysis is
complete.
The SpO2 sensor or adapter cable is faulty. Try another
adapter cable and sensor. If the INOP persists, contact
your service personnel.
The SpO2 sensor is not properly applied to the patient.
Apply the sensor following the instructions supplied by
the manufacturer.
The connected sensor or adapter cable is not supported
by the SpO2 measurement. Use only specified sensors
and cables.
7 Patient Alarms and INOPs
INOP Message
Indication
What to do
SpO₂ Upgrade
Monitor: display only
The SpO2 measurement is currently in upgrade mode.
Monitoring is not possible in this mode.
Numeric unavailable
SpO₂Interference
Monitor: INOP tone
Numeric is replaced by a -?-
There is too much interference caused by a high level of
ambient light, and/or electrical interference. Cover the
sensor to minimize ambient light. If the INOP persists,
ensure that the sensor cable is not damaged, or positioned
too close to power cables.
CL SpO2 Pod INOPs
INOP Message
Indication
What to do
Check Charger I/F
Monitor: INOP tone
Overvoltage or undervoltage detected at the charger
interface. Clean contacts of charger interface at Cableless
Measurement Device and charging station. If the INOP
persists, contact your service personnel.
CL SpO2 Pod: display
message
cl SpO₂ Batt Empty
!!cl SpO₂ BatEmpty
!!!cl SpO₂ BtEmpty
Monitor: INOP tone
(configurable cyan, yellow,
red)
The remaining battery time of the CL SpO2 Pod is
below 30 minutes. Charge the battery.
CL SpO2 Pod: display
message, yellow tone
cl SpO₂ Batt Incmp
Monitor: INOP tone
CL SpO2 Pod: display
message
cl SpO₂ Batt Low
Monitor: INOP tone
CL SpO2 Pod: display
message
cl SpO₂ Batt Malf
Monitor: INOP tone
CL SpO2 Pod: display
message
cl SpO₂ Batt Temp
Monitor: INOP tone
CL SpO2 Pod: display
message
cl SpO₂ Check Batt
Monitor: INOP tone
CL SpO2 Pod: display
message
The battery in use with the CL SpO2 Pod is incompatible.
Replace it with one approved for use with the CL SpO2
Pod.
The remaining battery time of the CL SpO2 Pod is below
2 hours.
There is a malfunction in the CL SpO2 Pod's battery
system. Contact your service personnel.
The temperature of the battery in the CL SpO2 Pod is
critically high. Check that the Pod is not covered or
exposed to a heat source. If the INOP persists, remove
the CL Pod from the patient, and contact your service
personnel.
The battery in the CL SpO2 Pod is nearing the end of its
useful life. Only 50 charge-discharge cycles remain.
Contact your service personnel to replace the battery.
145
7 Patient Alarms and INOPs
INOP Message
Indication
What to do
cl SpO₂ Chk Sett
Monitor: INOP tone
If this INOP appears and an INOP tone sounds, check
the Cableless Measurement Device and patient settings
before you resume making measurements. If the settings
are unexpected, there may be a problem with the
Cableless Measurement Device software. Contact your
service personnel.
CL SpO2 Pod: display
message
If this INOP is acknowledged at the Cableless
Measurement Device, it is cleared. If it is silenced
remotely, only the tone is cleared.
cl SpO₂ Disconnect
Monitor: INOP tone
CL SpO2 Pod: INOP tone
and display message
cl SpO₂ No Cradle
Monitor: INOP tone
The CL SpO2 Pod has lost the SRR connection to the
monitor.
The CL SpO2 Pod is not in its cradle.
CL SpO2 Pod: display
message
cl SpO₂ Remove
Monitor: INOP tone
CL SpO2 Pod: display
message
cl SpO₂ Serv Batt
Monitor: INOP tone
CL SpO2 Pod: display
message
The temperature of the battery in the CL SpO2 Pod is too
high. Remove the CL SpO2 Pod from the patient and
contact service personnel.
The battery in the CL SpO2 Pod has reached the end of
its useful life. It can no longer be charged. Contact your
service personnel to replace the battery.
Tympanic Temperature INOPs
INOP Message
Indication
What to do
 CalRequired
Monitor: INOP tone
The thermometer requires calibration. Contact your
service personnel.
 Incompat.
Monitor: INOP tone
The thermometer firmware is not supported by the
monitor software.
Numeric is replaced by a -? Malfunction
Monitor: INOP tone
Numeric is replaced by a -?-
 Meas Failed
Monitor: INOP tone
Numeric is replaced by a -?-
 Overrange
Monitor: INOP tone
Numeric is replaced by a -?-
146
The thermometer or the interface board is defective.
Check the thermometer on another monitor - if the same
INOP occurs, replace the thermometer. If not, connect
another thermometer to this monitor. If the problem
persists, the interface board has a problem. Contact your
service personnel.
The ambient temperature is out of range. If the ambient
temperature is within the valid range, check the
thermometer. Try picking up a new probe cover. If the
problem persists replace the thermometer and contact
your service personnel.
The measured temperature is out of range. If the
temperature is within the valid range, check with another
thermometer.
8
Admitting and Discharging
The fetal monitor can store basic patient demographic information used to identify patients.
Admit/Discharge on the Monitor
This section describes how you admit and discharge patients when using the monitor as a stand-alone
device (that is, when not used with an obstetrical information and surveillance system such as
OB TraceVue/IntelliSpace Perinatal).
Admitting a Patient
The fetal monitor displays physiological data as soon as a patient is connected. This lets you monitor a
patient who is not yet admitted. It is however important to admit patients properly so that you can
identify your patient on recordings.
Use the Patient Demographics window and its associated pop-up keys to admit and discharge patients.
To admit a patient:
Select the patient name field or select the Patient Demogr. SmartKey to open the Patient
Demographics window.
Clear any previous patient data by selecting Dischrge Patient and then Confirm.
If you do not discharge the previous patient, you will not be able to distinguish data from the
previous and current patients on the recording.
Select Admit Patient.
Enter the patient information: select each field and use the on-screen keyboard.
If a conventional keyboard is connected to the monitor, you can use this to enter patient
information:
– Last Name: Enter the patient's last name (family name), for example Doe.
– First Name: Enter the patient's first name, for example Jane.
– MRN: Enter the patient's medical record number (MRN), for example 12345678. Depending
on your configuration this field may be labeled differently e.g. Record ID, Lifetime ID, Account
Number, Serial Number, or SSN.
– Gestational Age: Enter the gestational age of the pregnancy. Enter one numeric for the week
(0-50) and one numeric for the day (0-6).
– Date of Birth: Enter the patient's date of birth.
Select Confirm. The patient status changes to admitted. If the recorder is running, the recorder
stops and immediately restarts to annotate the new patient data.
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8 Admitting and Discharging
Quick Admitting a Patient
Use Quick Admit to quickly admit a patient using only a limited set of demographic data.
Select the Quick Admit SmartKey.
Enter the required data (ID fields or last name depending on configuration) with the keyboard or a
barcode scanner.
Select Enter.
In the confirmation window, select Confirm to stop monitoring for the previous patient.
Complete the rest of the demographic details as soon as possible to fully identify the patient on the
network, on the monitor, and on printed reports. To complete the details, open the Patient
Demographics window and complete all required fields.
Editing Patient Information
To edit the patient information after a patient has been admitted, select the patient name field on the
main screen of the fetal monitor to open the Patient Demographics window, and enter the required
changes.
Discharging a Patient
You should always perform a discharge even if your previous patient was not admitted. A discharge:
–
–
–
–
clears the information in the Patient Demographics window.
resets all monitor settings to the settings defined in the User Defaults.
advances the paper automatically if the recorder is running.
stops the fetal recorder.
When a patient is discharged from the monitor, all patient demographic data is deleted (trace data is
not affected).
Depending on your configuration, monitoring for a patient may end automatically when the fetal
monitor has been powered off, or is in Standby mode for a set time.
To discharge a patient:
Select the patient name field to display the Patient Demographics window and associated pop-up
keys.
Select the pop-up key for Dischrge Patient.
Select Confirm to discharge the patient.
CAUTION
In order to ensure that the settings are reset to User Defaults for a new patient, always discharge the
previous patient from the fetal monitor.
NOTE
In order to ensure a continuous record, it is recommended to discharge the patient at the monitor
before performing a new patient admission in OB TraceVue/IntelliSpace Perinatal.
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8 Admitting and Discharging
New Patient Check
The fetal monitor can be configured to ask you in certain situations:
•
after a specified power-off period
•
after a specified standby period
whether a new patient is now being monitored. The pop-up window is entitled Is this a New Patient?.
The monitor offers a Yes key, to discharge the previous patient and begin monitoring a new patient,
and a No key, to continue monitoring with the current patient data and settings.
The time periods for the two conditions can be configured independently.
OB TraceVue/IntelliSpace Perinatal
When the monitor is connected to an OB TraceVue/IntelliSpace Perinatal system over a LAN
connection, it has the control over patient demographic data. All patient and location-related data
visible on the monitor is set, overwritten, or updated by the OB TraceVue/IntelliSpace Perinatal
system. In the Patient Demographics window, a padlock symbol before the patient identification fields
indicates the locked state. The locked state prevents the reuse of the monitor for another patient, until
the current patient is discharged, and the monitor is freed through the OB TraceVue/IntelliSpace
Perinatal system. Locked fields remain locked when system connectivity is lost, until the monitor is
freed by discharging the patient. See the OB TraceVue/IntelliSpace Perinatal Instructions for Use for
details.
Transferring a Patient
When you are transferring a patient from one bed to another, both the monitor from which you are
transferring her and the monitor to which you are transferring her must be switched on and connected
to the OB TraceVue/IntelliSpace Perinatal network during the patient transfer.
149
8 Admitting and Discharging
OB TraceVue/IntelliSpace Perinatal via RS232
In contrast to a LAN connection, when the monitor is connected to an OB TraceVue/IntelliSpace
Perinatal system over an RS232 connection, the OB TraceVue/IntelliSpace Perinatal system does not
have full control over the monitor's patient admission and discharge functions.
Depending on how OB TraceVue/IntelliSpace Perinatal is configured, either the Last Name, First Name,
and the bed label, or just the bed label alone, are taken from the OB TraceVue/IntelliSpace Perinatal
system. See the OB TraceVue/IntelliSpace Perinatal Instructions for Use for details.
150

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