Philips Medical Systems North America SRRBV1 Dual Short Range Radio Module User Manual

Philips Medical Systems North America Co. Dual Short Range Radio Module

User Manual Olympus

Instructions for UseIntelliVue Patient MonitorMX800Release H.0 with Software Revision H.0x.xxPatient MonitoringDraft
Part Number 453564208131Printed in Germany 07/10*453564208131*
31Table of Contents1Introduction 13Introducing the Monitor 13Devices for Acquiring Measurements 14Operating and Navigating 22Operating Modes 29Understanding Screens 31Connecting Additional Displays to the Monitor 32Using the XDS Remote Display 32Using the Visitor Screen 33Understanding Profiles 33Understanding Settings 34Changing Wave Speeds 36Freezing Waves 36Entering Measurements Manually 40Changing Monitor Settings 41Checking Your Monitor Revision 42Getting Started 42Disconnecting from Power 43Networked Monitoring 44Using the Integrated PC 44Using the X2 or MP5 with a Host Monitor 462Alarms 47Visual Alarm Indicators 48Audible Alarm Indicators 49Acknowledging Alarms 51Pausing or Switching Off Alarms 52Alarm Limits 54Reviewing Alarms 58Latching Alarms 59Testing Alarms 60Alarm Behavior at Power On 60Alarm Recordings 613Patient Alarms and INOPs 63Patient Alarm Messages 63Technical Alarm Messages (INOPs) 684Managing Patients 93Admitting a Patient 93
4Quick Admitting a Patient 94Editing Patient Information 95Discharging a Patient 95Transferring Patients 96Data Upload from an MMS 100Care Groups 1035ECG, Arrhythmia, ST and QT Monitoring 109Skin Preparation for Electrode Placement 109Connecting ECG Cables 109Selecting the Primary and Secondary ECG Leads 110Checking Paced Status 110Understanding the ECG Display 110Monitoring Paced Patients 111Changing the Size of the ECG Wave 112Changing the Volume of the QRS Tone 113Changing the ECG Filter Settings 113Selecting Positions of Va and Vb Chest Leads (for 6-lead placement) 114Choosing EASI or Standard Lead Placement 114About ECG Leads 114ECG Lead Fallback 115ECG Lead Placements 115Capture 12-Lead 121EASI ECG Lead Placement 123ECG and Arrhythmia Alarm Overview 124Using ECG Alarms 125ECG Safety Information 126About Arrhythmia Monitoring 127Switching Arrhythmia Analysis On and Off 128Choosing an ECG Lead for Arrhythmia Monitoring 128Understanding the Arrhythmia Display 130Arrhythmia Relearning 132Arrhythmia Alarms 133About ST Monitoring 137Switching ST On and Off 138Understanding the ST Display 139Updating ST Baseline Snippets 140Recording ST Segments 140About the ST Measurement Points 141ST Alarms 143Viewing ST Maps 144About QT/QTc Interval Monitoring 147QT Alarms 150Switching QT Monitoring On and Off 151
56Monitoring Pulse Rate 153Entering the Setup Pulse Menu 153System Pulse Source 153Switching Pulse On and Off 154Using Pulse Alarms 1547Monitoring Respiration Rate (Resp) 157Lead Placement for Monitoring Resp 157Understanding the Resp Display 158Changing Resp Detection Modes 158Changing the Size of the Respiration Wave 159Changing the Speed of the Respiration Wave 160Using Resp Alarms 160Changing the Apnea Alarm Delay 160Resp Safety Information 1608Monitoring SpO2 163SpO2 Sensors 163Applying the Sensor 163Connecting SpO2 Cables 164Measuring SpO2 165SpO2 Signal Quality Indicator (Fast SpO2 only) 165Assessing a Suspicious SpO2 Reading 166Changing the Averaging Time 166Understanding SpO2 Alarms 166Pleth Wave 169Perfusion Numeric 169Perfusion Change Indicator 169Setting SpO2/Pleth as Pulse Source 170Setting Up Tone Modulation 170Setting the QRS Volume 170Calculating SpO2 Difference 1709Monitoring NBP 171Introducing the Oscillometric NBP Measurement 171Preparing to Measure NBP 173Starting and Stopping Measurements 174Enabling Automatic Mode and Setting Repetition Time 176Enabling Sequence Mode and Setting Up The Sequence 176Choosing the NBP Alarm Source 176Switching Pulse from NBP On/Off 177Assisting Venous Puncture 177Calibrating NBP 17710 Monitoring Temperature 179Making a Temp Measurement 179
6Calculating Temp Difference 18011 Monitoring Invasive Pressure 181Setting up the Pressure Measurement 181Zeroing the Pressure Transducer 183Adjusting the Calibration Factor 185Displaying a Mean Pressure Value Only 185Changing the Pressure Wave Scale 185Optimizing the Waveform 185Using the Wave Cursor 186Non-Physiological Artifact Suppression 186Choosing the Pressure Alarm Source 186Calibrating Reusable Transducer CPJ840J6 187Calculating Cerebral Perfusion 189Calculating Pulse Pressure Variation 189Measuring Pulmonary Artery Wedge Pressure 190Editing the Wedge 191Identifying the Pressure Analog Output Connector 19212 Monitoring Cardiac Output 193Hemodynamic Parameters 193Using the C.O.Procedure Window 194Accessing the Setup C.O. and Setup CCO Menus 195Entering the HemoCalc Window 196Measuring C. O. Using the PiCCO Method 196Measuring C.O. Using the Right Heart Thermodilution Method 201Documenting C.O. Measurements 204C.O. Injectate Guidelines 204C.O./CCO Curve Alert Messages 205C.O./CCO Prompt Messages 207C.O./CCO Warning Messages 207C.O./CCO Safety Information 20813 Monitoring Carbon Dioxide 211Measurement Principles 212Measuring CO2 using M3014A or X2 212Measuring Mainstream CO2 using M3016A 216Measuring Microstream CO2 using M3015A/B 218Setting up all CO2 Measurements 22014 Monitoring Airway Flow, Volume and Pressure 223Attaching the Flow Sensor 224Zero Calibration 226Automatic Purging 227Manual Purging 227Gas Compensation 227
7Setting up Spirometry 22815 Monitoring tcGas 231Identifying tcGas Module Components 231Setting the tcGas Sensor Temperature 231Using the tcGas Site Timer 232Setting the tcGas Barometric Pressure 233Remembraning the tcGas Transducer 233Calibrating the tcGas Transducer 233Applying the tcGas Transducer 235Finishing tcGas Monitoring 236TcGas Corrections 23616 Monitoring Intravascular Oxygen Saturation 239Selecting a Measurement Label 240Preparing to Monitor with the M1021A Wide Module 240Preparing to Monitor with the M1011A Narrow Module 244Further Information for Both Modules 24517 Monitoring EEG 247EEG Monitoring Setup 247Using the EEG Impedance/Montage Window 248About Compressed Spectral Arrays (CSA) 250Changing EEG Settings 251EEG Reports 252EEG Safety Information 253EEG and Electrical Interference 25318 Monitoring BIS 255BIS Monitoring Setup 255BIS Continuous Impedance Check 258BIS Cyclic Impedance Check 258BIS Window 259Changing the BIS Smoothing Rate 260Switching BIS and Individual Numerics On and Off 260Changing the Scale of the EEG Wave 260Switching BIS Filters On or Off 260BIS Safety Information 26119 Assigning a Telemetry Device and a Monitor to One Patient 263How Can You Combine Devices? 263Functions Available When the Telemetry Data Window is Displayed 265General Telemetry-related Functions 266Use Models With Telemetry 268
820 Trends 269Viewing Trends 269Setting Up Trends 272Documenting Trends 276Trends Databases 276Screen Trends 27721 Calculations 281Viewing Calculations 282Reviewing Calculations 283Performing Calculations 283Entering Values for Calculations 284Documenting Calculations 28522 High Resolution Trend Waves 287Changing the Hi-Res Trend Waves Displayed 287Hi-Res Trend Wave Scales 287Hi-Res Trend Waves and OxyCRG 287Printing Hi-Res Trend Wave Reports 288Hi-Res Trend Wave Recordings 28823 Event Surveillance 289Levels of Event Surveillance 289Event Groups 290Event Episodes 291Events Pop-Up Keys 292Event Triggers 292The Events Database 296Viewing Events 296Annotating Events 299Documenting Events 29924 ProtocolWatch 307SSC Sepsis Protocol 30725 Recording 315Central Recording 315Starting and Stopping Recordings 315Overview of Recording Types 317All ECG Waves Recordings 318Creating and Changing Recordings Templates 318Changing ECG Wave Gain 319Recording Priorities 319Recording Strip 319Reloading Paper 321Recorder Status Messages 321
926 Printing Patient Reports 323Starting Report Printouts 323Stopping Reports Printouts 324Setting Up Reports 325Setting Up Individual Print Jobs 326Checking Printer Settings 327Printing a Test Report 327Switching Printers On Or Off for Reports 328Dashed Lines on Reports 328Unavailable Printer: Re-routing Reports 328Checking Report Status and Printing Manually 329Printer Status Messages 330Sample Report Printouts 33127 Using the Drug Calculator 337Accessing the Drug Calculator 338Performing Drug Calculations 338Charting Infusion Progress 340Using the Titration Table 341Documenting Drug Calculations 34128 IntelliBridge EC10 Module 343Connecting an External Device 343Changing Waves and Numerics Displayed 344Viewing the IntelliBridge Device Data Window 344Using Screens with External Device Data 344Alarms/INOPs from External Devices 345Language Conflict with External Device Drivers 34529 VueLink Modules 347Connecting an External Device 348Changing VueLink Waves and Numerics Displayed 348Viewing the VueLink Device Data Window 349Using VueLink Screens 349Switching VueLink On and Off 349Alarms/INOPs From External Devices 349Language Conflict with External Device Drivers 35030 Using Timers 351Viewing Timers 351Timer Setup Pop-up Keys 352Setting Up Timers 352Displaying a Timer On The Main Screen 353Displaying A Clock On The Main Screen 354
1031 Respiratory Loops 355Viewing Loops 355Capturing and Deleting Loops 356Showing/Hiding Loops 356Changing Loops Display Size 356Using the Loops Cursor 356Changing Loops Type 357Setting Up Source Device 357Documenting Loops 35732 Laboratory Data 359Viewing Received Data 35933 Care and Cleaning 361General Points 361Cleaning the Monitor 362Disinfecting the Monitor 362Sterilizing the Monitor 363Cleaning, Sterilizing and Disinfecting Monitoring Accessories 363Cleaning the SO2 Optical Module 363Cleaning the Recorder Printhead (M1116B only) 36334 Maintenance and Troubleshooting 365Inspecting the Equipment and Accessories 365Inspecting the Cables and Cords 366Maintenance Task and Test Schedule 366Troubleshooting 367Disposing of the Monitor 367Disposing of Empty Calibration Gas Cylinders 36735 Accessories 369ECG/Resp Accessories 369NBP Accessories 373Invasive Pressure Accessories 375SpO2 Accessories 376Temperature Accessories 380Cardiac Output (C.O.) Accessories 381Mainstream CO2 Accessories 382Sidestream CO2 Accessories 382Mainstream CO2 Accessories (for M3016A) 383Microstream CO2 Accessories 383Spirometry Accessories 384tcGas Accessories 385EEG Accessories 385BIS Accessories 386SO2 Accessories for M1021A 386
11SO2 Accessories for M1011A 387Recorder Accessories 387Battery Accessories 38736 Specifications 389Intended Use 389Manufacturer's Information 389Symbols 391Installation Safety Information 392Monitor Mounting Precautions 395Altitude Setting 395Monitor Safety Specifications 395EMC And Radio Regulatory Compliance 395Physical Specifications 397Environmental Specifications 399Performance Specifications 401Interface Specifications 404Measurement Specifications 408Safety and Performance Tests 42737 Default Settings Appendix 433Country-Specific Default Settings 433Alarm and Measurement Default Settings 440Alarm Default Settings 440ECG, Arrhythmia, ST and QT Default Settings 441Pulse Default Settings 442Respiration Default Settings 443SpO2 Default Settings 443NBP Default Settings 444Temperature Default Settings 445Invasive Pressure Default Settings 445Cardiac Output Default Settings 447CO2 Default Settings 448Spirometry Default Settings 449tcGas Default Settings 449SO2 Default Settings 450SvO2 Default Settings 450ScvO2 Default Settings 450EEG Default Settings 451BIS Default Settings 451VueLink Default Settings 452Index 453
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1131IntroductionThese Instructions for Use are for clinical professionals using the IntelliVue MX800 patient monitor.This basic operation section 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 a measurement on and off, setting up and adjusting wave speeds, working with profiles). 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.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 care and cleaning that is not repeated here.This guide describes all features and options. Your monitor may not have all of them; they are not all available in all geographies. Your monitor is highly configurable. What you see on the screen, how the menus appear and so forth, depends on the way it has been tailored for your hospital and may not be exactly as shown here.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.Introducing the MonitorThe IntelliVue MX800 patient monitor offers a monitoring solution optimized for the high-end surgical, cardiac, medical and neonatal care environments. Combining patient surveillance and data management, it allows multi-measurement monitoring by linking separate modules. The MX800 uses the touch screen as primary input device and has a remote control for convenient access to the five main keys and numeric data input.The monitor stores data in trend, event, and calculation databases. You can see tabular trends (vital signs) and document them on a printer. You can view measurement trend graphs, with up to three measurements combined in each graph, to help you identify changes in the patient's physiological condition. You can view fast-changing measurement trends with beat to beat resolution and see up to four high resolution trend segments. Event surveillance enhances documentation and review of physiologically significant events by automatically detecting and storing up to 50 user-defined clinical events over a 24 hour period.
1 Introduction14With the optional Integrated PC, you have computer functionality directly in the monitor. You can use standard applications (e.g. Web browsers), connect to the hospital network or intranet, and run a second independent display with content from the patient monitor.An IntelliVue X2 or MP5 can be connected to your monitor, where it acts as a multi-measurement module, acquiring measurements for the host monitor. When the X2 or MP5 is disconnected from the the original host monitor, it continues to monitor the patient as a fully independent, battery powered patient monitor, eliminating the need for a separate transport monitor. On connection to a new host monitor, the X2 or MP5 resumes its role as multi-measurement module, ensuring fully continuous monitoring.Major Parts and KeysDevices for Acquiring MeasurementsThe patient monitor acquires patient measurements using the devices described in this section. You can also extend the measurement capabilities of your monitor with such devices. Of these measurement devices, only the X2 has its own power on/standby switch, and can be powered from an external power supply or a rechargeable battery when not directly connected to the monitor (refer to the IntelliVue X2 Instructions for Use for details). All the rest take their power exclusively from the monitor, and switch on automatically when you turn on the monitor. A green power-on LED indicates when they are drawing power from the monitor. A permanently illuminated, or flashing, red LED indicates a problem with the unit that requires the attention of qualified service personnel.All symbols used on the front panels are explained in “Symbols” on page 391.WARNINGWhen connecting devices for acquiring measurements, always position cables and tubing carefully to avoid entanglement or potential strangulation.1Color coded alarm lamps2Alarms Off lamp3Power on/Standby switch with integrated LED: Green - On/Standby, Red - Error4AC power LED5Mounting quick-release lever (when this is pressed the monitor is not fixed on the mounting)6Part number and serial number
1 Introduction15Flexible Module Rack (M8048A)The flexible module rack (FMS) lets you use up to eight plug-in physiological measurement modules.The maximum number of specific module types that can be used simultaneously in an FMS is: five pressure modules, four temperature modules, four VueLink or IntelliBridge modules (any combination).Connect the FMS to the monitor via the measurement link cable (MSL). Use the MSL connector on the left-hand side to connect an additional MMS. Use the connector on the right to connect to the monitor.Measurement ModulesYou can use up to eight measurement modules with the Flexible Module Rack (M8048A). Available modules are:• Invasive blood pressure (M1006B)• Temperature (M1029A)• Oxygen saturation of arterial blood (SpO2) (M1020B)• Cardiac output (M1012A), and Continuous cardiac output with M1012A Option #C10• Transcutaneous gas (M1018A)• Mixed venous oxygen saturation - SvO2 (M1021A)• Intravascular Oxygen Saturation - ScvO2 or SvO2 (M1011A)• Recorder (M1116B)• VueLink device interface (M1032A)• IntelliBridge EC10• EEG (M1027A)• Bispectral Index - BIS (M1034A)• Spirometry (M1014A)You can plug in and unplug modules during monitoring. Insert the module until the lever on the module clicks into place. Remove a module by pressing the lever upwards and pulling the module out. A measurement automatically switches on when you plug the module in, and switches off when you unplug it. Reconnecting a module to the same monitor restores its label and measurement settings, such as alarms limits. If you connect it to a different monitor, the module remembers only its label.1X1 Multi-Measurement Module2Multi-Measurement Module mount3Flexible Module Rack4Power on LED5Interruption indicator
1 Introduction16The connector socket on the front of each module is the same color as the corresponding connector plug on the transducer or patient cable.Press the Setup key on the module's front to display the measurement's setup menu on the monitor screen. When the setup menu is open, a light appears above the key. Some modules have a second key. On the pressure module, for example, it initiates a zeroing procedure.Example Module (SpO2)X1 Multi-Measurement Module (M3001A)The X1 Multi-Measurement Module (MMS) can simultaneously monitor 3-, 5-, 6- or 10-lead ECG (including arrhythmia and ST monitoring), respiration, SpO2, NBP and either invasive pressure or temperature. You can connect it to the monitor via a cable or mount it on the left side of the FMS.1Module name2Setup key LED3Setup key to enter setup menu of measurement modules or external device data window. Some modules have a second module-specific key next to this one, for example Zero.4Connector socket for patient cable/transducer
1 Introduction17X1 Connectors and SymbolsX2 Multi-Measurement Module (M3002A)The X2 Multi-Measurement Module (MMS) can simultaneously monitor 3-, 5-, 6- or 10-lead ECG (including arrhythmia and ST monitoring), respiration, SpO2, NBP and either invasive pressure and temperature, or CO2. It has a color touchscreen display.The X2 has the added capability to operate as a stand-alone monitor, and can be powered by a rechargeable battery. This makes it particularly suited to transport situations. When the X2 is disconnected from the original host monitor, it continues to monitor the patient as a stand-alone monitor running on battery power, eliminating the need for a separate transport monitor. When the X2 is connected to a new host monitor, it resumes its role as MMS, ensuring fully continuous monitoring. For details of using the X2 as a stand-alone monitor, refer to the IntelliVue X2 Instructions for Use.When connected to a host monitor (Companion Mode is indicated), the X2 takes power from the host, including that required for battery charging. The X2 can also be powered by AC mains when not connected to a host monitor using the optionally available external power supply (M8023A). See the IntelliVue X2 Instructions for Use for details.1White ECG/Resp connector2Blue SpO2 connector3Red NBP connector4Combined pressure (red) and temperature (brown) connector - connect either invasive pressure transducer or temperature probe. You might have a version of the MMS that does not have this connector.5NBP STAT key - starts NBP STAT series of measurementsORZero key - initiates a zero procedure for the connected pressure transducer when pressed and held for a second6NBP Start/Stop key - starts or stops NBP measurements7Silence: acknowledges all active alarms by switching off audible alarm indicators and lamps
1 Introduction18X2 OverviewX2 Controls and Indicators1External power LED. Green when monitor is powered from an external power source.2Battery status LED. Yellow when charging. Flashing red when battery is empty.3On/Standby LED. Green when monitor is on. Red indicates an error.4On/Standby switch. Disabled when X2 is connected to a host monitor1On/Standby switch2Power and battery indicators (see “X2 Controls and Indicators” on page 18)33.5-inch TFT LCD touchscreen QVGA display4Alarm lamps (see “X2 Controls and Indicators” on page 18)5Battery eject button6Hard keys (see “X2 Controls and Indicators” on page 18)7Measurement connectors (see “X2 Patient Connectors, Right Side” on page 19)8Battery compartment
1 Introduction195Main Screen key: closes all open menus/windows and returns to the main screen.6SmartKeys key: brings up SmartKeys on the screen.7Alarms key: turns alarms On/Off, or pauses them.8Silence key9Active alarm lamp. Red or yellow, depending on alarm level. Blinks until active alarm is acknowledged.10 Active INOP alarm lamp in light blue. Blinks until active INOP is acknowledged.11 Alarms off indicator. When alarms are suspended, the lamp is red, and the alarms off symbol is shown.X2 Patient Connectors, Right SideShowing symbols version (international) - English version has text labels X2 Left Side1Pressure (option)2Temperature (option)3Noninvasive blood pressure4SpO25ECG sync pulse output6ECG/Respiration7CO2 (option in place of Pressure and Temperature)1Loudspeaker2MSL Connector. Connects to the external power supply or a host monitor via the MSL cable for AC mains operation, battery charging, and communication with a network.
1 Introduction20MMS ExtensionsThe MMS extensions connect to the X1 and X2 MMS and use the MMS settings and power. Trend data and measurement settings from the measurements in the extensions are stored in the MMS.WARNING• The MMS extensions can only function when they are connected to an MMS. If the MMS is removed during monitoring, the measurements from both the MMS and the extension are lost.• Measurements from an MMS extension connected to an X2 are not available when the X2 is running on its own battery power. They are only available when the X2 is powered from AC mains, when connected to a host monitor or the external power supply (M8023A), or from the Battery Extension.To separate an extension from the MMS, press the release lever down, and push the MMS forward.M3014A, M3015A, M3015B and M3016A Capnography MMS ExtensionsThe optional M3014A Capnography extension adds mainstream capnography or sidestream capnography, and optionally one pressure plus either a pressure or a temperature, Cardiac Output and Continuous Cardiac Output to the MMS.M3014A1Pressure connectors (red)2Temperature connector (brown)3Mainstream/sidestream connector CO24Cardiac Output connector
1 Introduction21The optional M3015A Microstream CO2 extension adds microstream capnography and optionally either pressure or temperature to the MMS. The optional M3015B Microstream CO2 extension adds microstream capnography, two pressures and a temperature to the MMS.The optional M3016A Mainstream CO2 extension adds mainstream capnography and optionally either pressure or temperature to the MMS. When a capnography extension is connected to an X2 MMS with CO2, the CO2 from the extension will be automatically deactivated in favor of the one in the X2. If you prefer to use the CO2 measurement on the extension, you can activate it via the measurement selection key (see “Resolving Label Conflicts” on page 38).M3015A M3015B1Pressure connectors (red) - M3015A optional2Temperature connector (brown) - M3015A optional3Inlet4Microstream connector CO25Gas sample outletM3016A1Pressure connectors (red)2Temperature connector (brown)3Mainstream/sidestream connector CO2 (optional)
1 Introduction22The cardiac output measurement in the M3014A is deactivated when the extension is used with an X2 MMS, even if the X2 is connected to an external power supply. The cardiac output measurement is only available when the X2 is connected to a host monitor.M3012A Hemodynamic MMS ExtensionThe M3012A Hemodynamic extension can be connected to the M3001A Multi-Measurement Module to provide the following additional measurements: Temperature, Pressure, an additional Pressure or Temperature, and C.O. and CCO measurements.The cardiac output measurement is deactivated when the extension is used with an X2 MMS unless the X2 is connected to a host monitor.Operating and NavigatingEverything you need to operate the monitor is contained on its screen. Almost every element on the screen is interactive. Screen elements include measurement numerics, waveforms, screen keys, information fields, alarms fields and menus.The configurability of the monitor means that often you can access the same element in different ways. For example, you might be able to access an item through its on-screen setup menu, via a hard key, or via a SmartKey.1Cardiac Output (orange; optional)2Connection to MMS3Pressure connectors (red)4Temperature connectors (brown)
1 Introduction23Selecting Screen ElementsSelect a screen element to tell the monitor to carry out the actions linked to the element. For example, select the Patient Identification element to call up the Patient Demographics window, or select the HR numeric to call up the Setup ECG menu. Select the ECG wave segment to call up the ECG Lead menu.Note that the space between each line of a menu may be configured to wide or narrow to facilitate your most common method of operation, either touch, remote control or a pointing device such as a mouse.Monitor information line Other screen elements1network connection indicator (documented in Information Center Instructions for Use)10 alarm status area - shows active alarm messages2bed label 11 status line - shows information messages and prompting you for action3patient identification 12 close all open menus and windows and return to main screen4patient category 13 enter Main Setup menu5paced status 14 scroll right to display more SmartKeys6date and time 15 SmartKeys - these change according to your monitor's configuration7access the Profiles menu 16 scroll left to display more SmartKeys8current screen name/enter Change Screen menu 17 Pause Alarms - pauses alarm indicators. Pause duration depends on monitor configuration. If pause duration is infinite, this key is labeled Alarms Off. Select again to immediately re-enable alarm indicators.9adjust alarm volume/level indicator 18 Silence - acknowledges all active alarms by switching off audible alarm indicators and lamps permanently or temporarily, if alarm reminder (ReAlarm) is configured on.
1 Introduction24Using the TouchscreenSelect screen elements by pressing them directly on the monitor's screen.Disabling Touchscreen OperationTo temporarily disable touchscreen operation of the monitor, press and hold the Main Screen permanent key. A padlock will appear on the Main Screen permanent key.Press and hold the Main Screen permanent key again to re-enable the touchscreen operation.Using a Mouse or TrackballIf you are using a mouse or trackball, select screen elements by clicking on them (press and release the left mouse button). While you are moving the mouse, a cursor appears and a highlight shows your current position.Moving WindowsYou can move windows and menus using the Touchscreen or a mouse. To move a window,1Select the title of the window and keep your finger on the title, or the mouse button pressed.2Move your finger on the Touchscreen, or move the mouse, to move the window.3Take your finger off the screen, or release the mouse button, to place the window in the final position.The new position is only active until the window or menu is closed. Not all locations on the screen can be a target position, a window cannot overlap the monitor info line, the alarms and INOPs or the status line.Using KeysThe monitor has four different types of keys:Permanent KeysA permanent key is a graphical key that remains on the screen all the time to give you fast access to functions.Pause Alarms - pauses alarm indicators. Pause duration depends on monitor configuration. If pause duration is infinite, this key is labeled Alarms Off.Select again to immediately re-enable alarm indicators.Silence - acknowledges all active alarms by switching off audible alarm indicators and lamps.Main Screen - close all open menus and windows and return to the main screen.Main Setup - enter main setup menu.
1 Introduction25SmartKeysA SmartKey is a configurable graphical key, located at the bottom of the main screen. It gives you fast access to functions. The selection of SmartKeys available on your monitor depends on your monitor configuration and on the options purchased. If you have an integrated PC (iPC) you may also see Smartkeys generated by applications on the iPC.enter profile menu, or revert to default profilechange Screen, or revert to default screenshow BIS Sensor previous Screenfreeze waves quick admit a patientset alarm limits enter patient identification menu to admit/discharge/transferchange alarm volume end case to discharge a patientchange QRS volume view information for patients in other bedsenter standby mode - suspends patient monitoring. All waves and numerics disappear from the display. All settings and patient data information are retained.change screen brightness (not for independent displays)review beat labels (annotate arrhythmia wave)re-learn arrhythmiachange amplitude (size) of ECG waveenter cardiac output procedure- start/stop manual NBP measurement- start auto series- stop current automatic measurement within seriesstart NBP STAT measurementstop automatic or STAT NBP measurement and measurement seriesstart NBP measurement and measurement seriesstop current NBP measurementstart veni puncture (inflate cuff to subdiastolic pressure)set the NBP repeat time
1 Introduction26access patient reports zero invasive pressure transducerstart a delayed recording access pop-up recording keysaccess Vital Signs recording functionaccess Select Waves recording functionset wide automatic alarm limits set narrow automatic alarm limitsaccess wedge procedure window access the Loops windowreview vital signs trend review graph trendaccess event surveillance access calculationsaccess the calculator access the Drug Calculatorgas analyzer - exit standby mode suppress zero for all gas measurementsunpair equipment and continue central monitoring with the monitorunpair equipment and continue central monitoring with the telemetry deviceaccess the spirometry data windowaccess ST Map applicationstart 12-Lead Capture (only available if Information Center is connected)access remote applications (if Application Server is connected)access EEG CSA access the EEG montage
1 Introduction27HardkeysA hardkey is a physical key on a monitoring device, such as the zero pressure key on the MMS or a setup key on a module.Pop-Up KeysPop-up keys are task-related graphical keys that appear automatically on the monitor screen when required. For example, the Confirm pop-up key appears only when you need to confirm a change.display external device informationaccess timersaccess ProtocolWatch set standard or EASI lead placementswitch CO2 pump off new lead setupenter data manually start/stop car seat assessment recordopen the Histogram window open Unit Conversion window
1 Introduction28Using the Remote ControlThe remote control provides you with direct access to five hard keys, a navigation knob and a numeric keypad:The remote control can be used with a USB cable connection to the monitor or without a cable using short range radio. When used without a cable, the remote control must be assigned to the monitor. The assignment is made in Configuration mode.When using a remote control without a cable, it is important that the user knows which remote control is assigned to which monitor. Use the tethering cable delivered with the remote control to attach it to a bed rail or IV pole, or label the remote control with the bed or monitor ID.Hardkeys1Silence - acknowledges all active alarms by switching off audible alarm indicators and lamps. Behavior follows the Silence permanent key configuration.2Alarms Off/Pause Alarms- pauses alarm indicators. Behavior follows the Pause Alarms permanent key configuration.3Main Screen - close all open menus and windows and return to the main screen.4SmartKeys - display a block of SmartKeys specially configured for remote tasks (see below)5Back - go back one step to the previous menu.Keypad6 Type numeric data on the keypad and press the Enter key to enter the data on the monitor.Navigation knob7 Rotate the knob to highlight screen elements, then press to select the highlighted element.
1 Introduction29Using the SmartKeys KeyThe SmartKeys hard key on the remote control displays a block of SmartKeys on the monitor screen.Nine SmartKeys appear in a 3 by 3 matrix which corresponds to the layout of the numeric pad on the remote control.Pressing the 1 key on the remote control selects the top left SmartKey, pressing the 8 key selects the bottom center SmartKey. The .and the   key can be used to select the arrow keys to page up and down in the available SmartKeys.The SmartKeys which appear can be configured so that you have the functions available which you most often need when using the remote control. If no list of SmartKeys has been configured, the standard SmartKeys will be displayed and you can page through to the key you want.Using the On-Screen KeyboardUse this as you would a conventional keyboard. Enter the information by selecting one character after another. Use the Shift and capital Lock keys to access uppercase letters. Use the Back key to delete single characters, or use the Clr key to delete entire entries. Select Enter to confirm what you have entered and close the on-screen keyboard.If a conventional keyboard is connected to the monitor, you can use this instead of or in combination with the on-screen keyboard.Using the On-Screen CalculatorYou can use the on-screen calculator to perform any of the standard operations for which you would normally use a handheld calculator.• To access the on-screen calculator, select the Calculator SmartKey, or select Main Setup then Calculations followed by Calculator.Operating ModesWhen you switch the monitor on, it starts up in monitoring mode. To change to a different mode:1Select the Main Setup menu.2Select Operating Modes and choose the mode you require.Your monitor has four operating modes. Some are passcode protected.
1 Introduction30•Monitoring Mode: This is the normal, every day working mode that you use for monitoring patients. You can change elements such as alarm limits, patient category and so forth. When you discharge the patient, these elements return to their default values. Changes can be stored permanently only in Configuration Mode. You may see items, such as some menu options or the altitude setting, that are visible but ‘grayed out’ so that you can neither select nor change them. These are for your information and can be changed only in Configuration Mode.•Demonstration Mode: Passcode protected, this is for demonstration purposes only. You must not change into Demonstration Mode during monitoring. In Demonstration Mode, all stored trend information is deleted from the monitor’s memory.•Configuration Mode: Passcode protected, this mode is for personnel trained in configuration tasks. These tasks are described in the Configuration Guide. During installation the monitor is configured for use in your environment. This configuration defines the default settings you work with when you switch on, the number of waves you see and so forth.• Service Mode: Passcode protected, this is for trained service personnel.When the monitor is in Demonstration Mode, Configuration Mode, or Service Mode, this is indicated by a box with the mode name in the center of the Screen and a symbol in the bottom right-hand corner. Select the mode box in the center of the screen to change to a different mode.When an X2 or MP5 is connected to a host monitor (Companion Mode is indicated):• The monitor in companion mode will adopt the operating mode of the host monitor.• You cannot change the operating mode at the monitor in companion mode.Standby ModeStandby mode can be used when you want to temporarily interrupt monitoring.To enter Standby mode,• select the Monitor Standby SmartKey or•select Main Setup, followed by Monitor Standby.The monitor enters Standby mode automatically after the End Case function is used to discharge a patient.Standby suspends patient monitoring. All waves and numerics disappear from the display but all settings and patient data information are retained. A special Standby screen is displayed. This can be configured to a moving image or a blank screen. If a patient location is entered at the Information Center, this will also be displayed on the Standby screen (availability depends on Information Center revision).To resume monitoring,• Select anything on the screen or press any key.If you connect an X2 or MP5 that is powered on (and not in Standby) to a host monitor in Standby mode, the host will leave Standby mode. When connected to a host monitor, with both the host and the monitor in companion mode in Standby mode, leaving Standby on the monitor in companion mode will also make the host leave Standby.
1 Introduction31Understanding ScreensYour monitor comes with a set of pre-configured Screens, optimized for common monitoring scenarios such as OR adult, or ICU neonatal. A Screen defines the overall selection, size and position of waves, numerics and other elements on the monitor screen when you switch on. You can easily switch between different Screens during monitoring. Screens do NOT affect alarm settings, patient category and so forth.When you switch from a complex to a less complex Screen layout, some measurements may not be visible but are still monitored in the background. If you switch to a more complex Screen with, for example, four invasive pressure waves but you have only two pressures connected to the monitor, the "missing" two pressures are either left blank or the available space is filled by another measurement.Switching to a Different Screen1To switch to a different Screen, select the current Screen name in the monitor info line, or select the Change Screen SmartKey.2Choose the new Screen from the pop-up list.Changing a Screen's ContentIf you do not want to change the entire Screen content, but only some parts of it, you can substitute individual waves, numerics, high-res waves, or trends. Be aware that these changes cannot be stored permanently in Monitoring Mode.To change the selection of elements on a Screen,1Select the element you want to change.2From the menu that appears, select Change Wave, Change Numeric, or ChangeHiResTrend, and then select the wave or numeric you want, or select the high-resolution trend wave you want from the list of available waves.If you do not see Change Numeric in the menu, this Screen may be configured to always display the numeric beside its wave. Changing the wave will automatically change the numeric.The changed Screen is shown with an asterisk in the monitor info line.In the Change Screen menu, the changed Screen is shown linked to the original Screen and marked with an asterisk.Up to three modified Screens can be accessed via the Change Screen menu.To recall Screens, either• select the name of the Screen in the Change Screen menuor• use the previous/next arrows at the top of the Change Screen menu to move back and forth in the Screen history. The ten most recently-used Screens including up to three modified Screens can be accessed.After a patient discharge, the monitor's default Screen is shown. Modified Screens are still available in the Change Screen menu.
1 Introduction32If the monitor is switched off and then on again, modified Screens are erased from the monitor's memory and cannot be recalled. If a modified Screen was the last active Screen when the monitor was switched off, it is retained (unless Automat. Default is configured to Yes).Connecting Additional Displays to the MonitorYou can connect a second display, showing the same Screen as the main display, to your monitor, for viewing only.If you have the optional independent display interface, you can connect a second display which can be configured and operated individually using standard input devices.For monitors with multiple displays and multiple input devices, the usage and behavior can be configured according to specific requirements at installation (for example, use for two independent operators or tracking of mouse input across two displays). For details refer to the Service Guide.When two operators are using two displays, the scope of an action depends on the type of operation:• Patient monitoring operations such as Silence or Pause alarms take effect for the monitor as a whole, the results will be seen on both displays.• Display operations such as the Main Screen key and Back hardkey will take effect only on the display being operated. If you are operating two displays with one remote control, to navigate from one display to another:1Move the highlight to the Main Screen key and then turn one click further.The highlighting moves to a special "jump" field at the edge of the Screen.2Press the navigation knob on the remote control to confirm; the highlighting will automatically move to the other display.The content of each Screen can be changed individually as described in the previous section. If you are operating two displays, you can choose Screens for both displays from one location:1Select Profiles in the monitor info line of the first display,2Select Display 1, or Display 2, then select the Screen you want to appear on that display from the list of available Screens.When two displays are mounted next to each other or one above the other, a special Screen can be assigned which spans across both displays. The Screen content for these Tall and Wide Screens can then use the increased area available with two displays. These Screens appear in the Screen list with a special Tall Screen or Wide Screen symbol.Certain windows (for example: cardiac output procedure) can only be shown on one display at a time. If you try to open one of these windows when it is already shown on another display, you will see a blank gray window with a cross through it.Using the XDS Remote DisplayUsing the IntelliVue XDS solution it is possible to view an independent monitor screen on an external display. The XDS solution consists of a medical grade PC-based hardware platform, XDS application software and the XDS connectivity option on the monitor. Depending on the configuration you can also operate the monitor from the external display. The XDS must be connected to the same Local Area Network (LAN) as the monitor.It is also possible to use an existing PC, connected to the same LAN, to host the XDS Application software.
1 Introduction33For more details, including limitations and restrictions, refer to the Instructions for Use for the XDS Application.Using the Visitor ScreenIf a visitor Screen is configured for your monitor, you can use it to clear the screen of all waves and numerics but continue to monitor the patient with active alarms and trend storage at the bedside and Information Center. You can change the name of the visitor Screen in Configuration Mode.• To activate this Screen, select the Screen name in the monitor info line to open the Change Screen menu, then select the name of the visitor Screen configured for your monitor from the list of available Screens.To select a Screen with waves and numerics again,• Touch the gray box in the center of the screen, showing the visitor Screen's name, to open the Change Screen menu and select a different Screen to show waves and numerics again.Understanding ProfilesProfiles are predefined monitor configurations. They let you change the configuration of the whole monitor so you can adapt it to different monitoring situations. The changes that occur when you change a complete profile are more far reaching than those made when you change a Screen. Screens affect only what is shown on the display. Profiles affect all monitor and measurement settings.The settings that are defined by Profiles are grouped into three categories. Each category offers a choice of 'settings blocks' customized for specific monitoring situations. These categories are:•Display (screens)Each profile can have a choice of many different predefined screens. If you are using a second display, each display can have its own individual screen selection. When you change the profile, the screen selection configured for the new profile becomes active.•Measurement SettingsEach profile can have a choice of different predefined measurement settings. These relate directly to individual measurements, for example, measurement on/off, measurement color, alarms limits, NBP alarm source, NBP repeat time, temperature unit (°F or °C), pressure unit (mmHg or kPa).•Monitor SettingsEach profile can have a choice of different predefined monitor settings. These relate to the monitor as a whole; for example, display brightness, alarms off/paused, alarm volume, QRS tone volume, tone modulation, prompt tone volume, wave speed, resp wave speed, pulse source.You can change from one complete profile to another or swap individual settings blocks (display/monitor settings/measurement settings) to change a subset of a profile. Changes you make to any element within the settings blocks are not saved when you discharge the patient, unless you save them in Configuration Mode.Depending on your monitor configuration, when you switch on or discharge a patient the monitor either continues with the previous profile, or resets to the default profile configured for that monitor.
1 Introduction34WARNINGIf you switch to a different profile, the patient category and paced status normally change to the setting specified in the new profile. However some profiles may be set up to leave the patient category and paced status unchanged. Always check the patient category, paced status, and all alarms and settings, when you change profiles.When you leave Demonstration Mode, the monitor uses the default profile.Swapping a Complete Profile1Select Profiles in the monitor info line, or select the Profiles SmartKey.2In the Profiles menu, select Profile.3Chose a profile from the pop-up list.4Confirm your selection.Swapping a Settings Block1Select Profiles in the monitor info line, or select the Profiles SmartKey.2In the Profiles menu, select Display or Measmnt.Settings or Monitor Settings to call up a list of the settings blocks in each category.3Choose a settings block from the pop-up list.4Confirm your selection.Default ProfileYour monitor has a default profile that it uses when you leave Demonstration, or Service modes, or when you discharge a patient. This profile is indicated by a diamond shaped symbol.Locked ProfilesUnderstanding SettingsEach aspect of how the monitor works and looks is defined by a setting. There are a number of different categories of settings, including,Some profiles are locked, so that you cannot change them, even in Configuration Mode. These are indicated by this lock symbol.
1 Introduction35Screen Settings, to define the selection and appearance of elements on each individual ScreenMeasurement settings, to define settings unique to each measurement, for example, high and low alarm limitsMonitor settings, including settings that affect more than one measurement or Screen and define general aspects of how the monitor works, for example, alarm volume, reports and recordings, and display brightness.You must be aware that, although many settings can be changed in Monitoring Mode, permanent changes to settings can only be done in the monitor's Configuration Mode. All settings are reset to the stored defaults:• when you discharge a patient• when you load a Profile• when the monitor is switched off for more than one minute (if Automat. Default is set to Yes).Changing Measurement SettingsEach measurement has a setup menu in which you can adjust all of its settings. You can enter a setup menu:• via the measurement numeric - select the measurement numeric to enter its setup menu. For example, to enter the Setup ECG menu, select the HR (heart rate) numeric.• via the Setup hardkey (on plug-in modules) - press the Setup hardkey on the module front.•via the Main Setup permanent key - if you want to setup a measurement when the measurement is switched off, use the Main Setup permanent key and select Measurements. Then select the measurement name from the pop-up list. With this permanent key you can access any setup menu in the monitor.• via the Measurement Selection key.This guide always describes the entry method using the setup menu. But you can use any method you prefer.Switching a Measurement On and OffWhen a measurement is off, its waves and numerics are removed from the monitor's screen. The monitor stops data acquisition and alarming for this measurement. A measurement automatically switches off if you disconnect its module or MMS. If you disconnect a transducer, the monitor replaces the measurement numeric with question marks. If in this situation alarms are paused or switched off, the measurement in question may be switched off completely, depending on monitor configuration.1Enter the measurement's setup menu and select the measurement.2Select the measurement name to switch between on and off. The screen display indicates the active setting.Switching Numerics On and OffFor some measurements, such as EEG, you can choose which numerics to view on the screen.In the measurement's setup menu, select the numeric name to toggle between on and off.For example in the Setup EEG menu, select the EEG numeric name to toggle between on and off.
1 Introduction36Adjusting a Measurement WaveTo quickly adjust wave-related measurement settings (such as speed or size), select the measurement wave itself. This displays the measurement wave menu, which has only wave-related measurement settings.Changing Wave SpeedsLowering the wave speed compresses the wave and lets you view a longer time period. Increasing the speed expands the waveform, giving you a more detailed view.The monitor distinguishes three groups of wave speed settings,•RespiratorySpeed, for all respiratory waves: CO2, anesthetic agents and O2•EEG Speed, for all EEG and BIS waves•Global Speed, for all waves not included in the other two groups.Changing the Wave Group SpeedThe wave speed group setting defines the speed of all the waves in the group.To change the wave speed of a wave speed group,1Select Main Setup, then select User Interface2Select Global Speed, RespiratorySpeed, or EEG Speed as required3Select a value from the list of available speeds.Changing Wave Speed for a ChannelTo change the wave speed of an individual wave channel,1Enter the Wave menu for a measurement by selecting its wave.2Select Change Speed.3To set the speed to the wave group speed, select RespiratorySpeed, EEG Speed, or Global Speed.To set an individual channel speed, select a numeric value from the list of available speeds. This overrides the wave group speed setting and set the speed for the individual wave channel on the monitor Screen. The wave channel speed is independent of the wave (label) depicted in the channel, if you change the wave, the new wave will retain the set channel speed.Freezing WavesYou can freeze waves on the screen and measure parts of the wave using cursors. The waves are frozen with a history of 20 seconds so that you can go back and measure what you have seen.Freezing An Individual WaveTo freeze a wave,1Enter the Wave menu for the measurement by selecting the wave on the screen.2Select Freeze Wave.The realtime wave is replaced with the frozen wave.
1 Introduction37Freezing All WavesTo freeze all waves on the screen,1Select the Freeze Waves SmartKey.All realtime waves are replaced with frozen waves.Measuring Frozen WavesTo measure a frozen wave,1Select the frozen wave.If you are using touch, this automatically positions the vertical cursor. The cursor can be repositioned by touching the required point on the wave, or2Using the SpeedPoint or another pointing device or touch: use the right/left arrow keys to move the vertical cursor.The vertical cursor moves through the time axis and the current value is displayed next to the cursor.3Use the up/down arrow keys to activate and move the horizontal cursor.The horizontal cursor measures the wave value, which is displayed above the cursor line. If the wave is a pressure wave, the cursor value can be stored as a systolic, diastolic or mean pressure value; if the pressure wave is a PAP wave it can also be stored as a PAWP value; for pressure waves P, P1 to P8 it can also be stored as an IAP value. The stored value appears in the trend database as a manually entered value.Changing The Wave SpeedLowering the wave speed compresses the wave and lets you view a longer time period. Increasing the speed expands the waveform, giving you a more detailed view.To change the wave speed:1Select the frozen wave.2Select Change Speed.3Select a speed from the list.Using LabelsYou may have more than one instance of some measurements, for example pressure, being used simultaneously. The monitor uses labels to distinguish between them. The default settings defined in the profile (such as measurement color, wave scale, and alarm settings) are stored within each label. When you assign a label to a measurement, the monitor automatically applies these default settings to the measurement. The labels assigned are used throughout the monitor, in reports, recordings, and in trends.Changing Measurement Labels (e.g. Pressure)To change a measurement label of a measurement with multiple labels (e.g. invasive pressure or temperature),1Enter the wave menu of the measurement.
1 Introduction382Select Label.3Choose a label from the list.The monitor automatically applies the scale, color, etc. settings stored in the Profile for the label you select. You can change scale settings in Monitoring Mode, but color can only be changed in the monitor's Configuration Mode.Any labels already being used in the monitor are shown "grayed-out" in the list and cannot be selected.About Label SetsYour monitor may be configured to use a Restricted or Full label set. The Full label set provides extra labels for Pressure and Temp. See the sections in this Instructions for Use on Pressure and Temp for more information.If you connect an MMS from a monitor using a Full label set to an IntelliVue monitor using a Restricted label set or an M3/M4 monitor, any additional labels switch to labels available in the target monitor. This may cause a label conflict with other monitored measurements.Be aware that connecting a monitor using the Full label set to an Information Center with certain software revisions may affect the availability of measurement information from the additional labels on the Information Center. See the Information Center documentation and your monitor's Configuration Guide for information on label set compatibility.Resolving Label ConflictsEach label must be unique, that is, it can only be assigned once. You cannot monitor two pressures labeled "ICP" at the same time. If you need to use two identical pressures, you must assign different labels to them, for example, P and ICP.Measurement labels are stored in the measurement device (module or MMS). If you try to use two measurement devices that have identical labels, this causes a label conflict in the monitor.Measurement selection key with question marks indicating a label conflict.Depending on your configuration, the monitor will either• resolve the conflict automatically, by assigning a new, generic label to the most recently connected conflicting label (e.g. a second FAP label could be changed to ABP)•display the Measurement Selection window automatically for you to resolve the conflict• take no action, you must enter the Measurement Selection window and resolve the conflict.
1 Introduction39All the currently available measurement devices, for example MMSs, MMS extensions, measurement modules, Gas analyzers, devices connected to a host monitor and manually entered measurements (marked  ), are depicted in the Measurement Selection window.Any measurement labels causing a label conflict are shown in red. If a measurement device is connected but currently unavailable, for example, because it was deactivated due to a label conflict, the device is shown "grayed-out".When an X2 or MP5 is connected to a host monitor, the measurement selection window looks like this:WARNINGWhen an X2 or MP5 with an active measurement, say SpO2, is connected to a host monitor with the same measurement already active, the SpO2 measurement on the X2 or MP5 is deactivated and the Meas. DEACTIVATED INOP is displayed. The measurement can only be reactivated if the X2 or MP5 is disconnected from the host monitor. The label conflict can be resolved on the host monitor like any other label conflict.To resolve a label conflict:1Select the measurement selection key or select Main Setup, then Meas. Selection to display the Measurement Selection window.2Select the device whose label you want to correct.3Use the measurement selection pop-up keys to resolve the conflict. Select either:–Change Label: to assign a different label to the conflicting labelDe-activated devices are grayed-out (here the Temp measurement on the left)X2 connected to host monitor MP5 connected to host monitor
1 Introduction40–De- Activate: to disable the conflicting device. It retains its label for future use but becomes invisible to the monitor, as though it had been unplugged. When the device has been deactivated the question marks under the measurement selection key will be replaced by XXX.–Setup <Measurement Label>: to enter the Setup menu for the measurement and change the conflicting device's label to a different label.–Modify Driver (VueLink/IntelliBridge only): - to modify the device driver setup to disable the conflicting device's label.Label CompatibilityWhen a new measurement is introduced, or new labels for an existing measurement, these labels will not be shown on older Information Centers, and consequently not on the Overview screen sourced from the Information Center.When a patient is transferred from a monitor with these new labels to one with an older software revision, the labels will be replaced with a generic label for that measurement. The settings for that generic label will then be used.If it is critical that the measurement labels are available at the Information Center and after transfers, the older monitors and the Information Center must be upgraded to the appropriate software revision.Updating The Frozen WaveTo update the wave, that is freeze the current wave:1Select the frozen wave.2Select Freeze Again.Releasing Frozen WavesTo release frozen waves,1Select a frozen wave.2Select Unfreeze Waves.All frozen waves are released.Entering Measurements ManuallyYou can enter values into the monitor that have been measured with other equipment or manually (for example, manual temperatures, lab values). These values are then stored in the database, included in trends and reports, and passed on to the Information Center and central charting systems. There is no alarm functionality for manually entered measurements.To enter values,1Select the Enter Values SmartKey or select Main Setup then select Enter MeasValues.2Select the measurement you want to enter values for. The Edit window will open.3If the measurement is switched off, switch it on by selecting the label.4Select Value and enter the value.5Select Date/Time to enter the date and time for the value. The default is always the current date and time.
1 Introduction416For compound labels, for example ABPs, ABPd and ABPm, select the Format field to select whether all values are required or a single value.7Select Save.When a manually entered value has been configured to display as a numeric on the screen, you can also enter a new value for this measurement by selecting the numeric, then selecting Enter MeasValues.Manually entered measurement values are marked with a * on the display, in trends, and so forth. Each measurement has a defined measurement interval after which a value becomes invalid (no value is then displayed). Values can be entered up to two hours after they have been measured or up to the measurement interval, if this is shorter.The list of measurement labels which appears in the Enter Measurement Values window is set in Configuration Mode.No values can be entered manually on a monitor in companion mode when it is connected to a host monitor.Switching Manually Entered Measurements On and OffTo switch a manually entered measurement on or off,1Select the Enter Values SmartKey or select Main Setup then select Enter MeasValues.2Select the measurement you want to switch on or off.3Select the measurement label field to switch between On and Off.Changing Monitor SettingsTo change monitor settings such as brightness, or QRS tone volume, select the Main Setup permanent key and then select User Interface to enter a submenu where you can change these settings.Adjusting the Screen Brightness1Select the Brightness SmartKey.2Select the appropriate setting for the screen brightness. 10 is the brightest, 1 is the least bright. Optimum is suitable for most monitoring locations and optimizes power usage for battery powered monitors.Your monitor may be configured with a lower brightness for Standby mode and also (for battery powered monitors) for transport to conserve battery power. These settings can only be changed in the monitor's Configuration Mode.If you are using a monitor with an external display, the Brightness SmartKey does not adjust the brightness of this display. See the instructions supplied with the external display for instructions.Setting the Date and Time1Select the Date, Time screen element from the monitor's info line to enter the Date, Time menu.2Select, in turn, the Year, Month, Day, Hour (in 24 hour format, only) and Minute as necessary. Select the correct values from the pop-up list.
1 Introduction423Select Store Date, Time to change the date and time.If your monitor is connected to an Information Center, the date and time are automatically taken from this. Once it is set, the internal clock retains the setting even when you switch off the monitor.WARNINGChanging the date or time will affect the storage of trends and events.Checking Your Monitor Revision1Select Main Setup then select Revisions to open the Monitor Revision menu.2Select the correct device from the device pop-up keys.3From the Monitor Revision menu, select the monitor component for which you need revision information.Getting StartedOnce you understand the basic operation principles, you can get ready for monitoring. We also recommend working through the CBT for self-training before using the monitor (not available in all languages). Inspecting the MonitorWARNINGIf the monitor is mechanically damaged, or if it is not working properly, do not use it for any monitoring procedure on a patient. Contact your service personnel.1Before you start to make measurements, carry out the following checks on the monitor including all connected MMSs, modules, or MMS extensions.– Check for any mechanical damage.– Check all the external cables, plug-ins and accessories.2Plug the power cord into the AC power source. 3Check all the functions of the instrument that you need to monitor the patient, and ensure that the instrument is in good working order.Switching OnPress the power on/standby switch on the monitor for one second. The monitor performs a self test and is then ready to use. If you see a message such as CO₂ SENS.WARMUP wait until it disappears before starting to monitor that measurement. Connected devices usually take their power from the monitor. External devices such as gas monitors and those connected via VueLink/IntelliBridge have their own power switches.
1 Introduction43Power On/Power Off BehaviorThe general rules determining the behavior of the monitor when connected to, or disconnected from power are as follows:• A monitor that was switched on prior to a temporary power loss switches on again when power is restored.• A monitor that was switched off prior to a temporary power loss remains off when power is restored.• An X2 or MP5 switches on automatically when connected to a running host monitor.• When an X2 or MP5 is disconnected from a running host monitor, the X2 or MP5 continues to run without interruption on battery power.Setting up the Modules1Decide which measurements you want to make.2Connect the required modules, MMSs, or MMS extensions.3Check that you have the correct patient cables and transducers plugged in. The connectors are color-coded to the patient cables and transducers for easy identification.Starting MonitoringAfter you switch on the monitor,1Admit your patient to the monitor.2Check that the profile, alarm limits, alarm and QRS volumes, patient category and paced status and so forth are appropriate for your patient. Change them if necessary.3Refer to the appropriate measurement chapter for further details of how to perform the measurements you require.WARNINGDuring MR imaging, remove all transducers, sensors and cables from the patient. Induced currents could cause burns.Disconnecting from PowerThe On/Standby switch does not disconnect the monitor from the ac power source. To disconnect, unplug the power cable.Monitoring After a Power FailureIf the monitor is without power for less than one minute, monitoring will resume with all active settings unchanged. If the 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.
1 Introduction44Networked MonitoringYou can connect your monitor to an Information Center on a network, using one of the optional interfaces:• Standard wired LAN• Wireless LAN• IntelliVue Instrument Telemetry System (IIT).WARNINGDo not connect patient monitors to the standard hospital network.Additionally, when an IntelliVue X2 or MP5 is equipped with IIT and declared at the Information Center as a telemetry device, it allows data continuity when paired to a host monitor. After disconnection from the host monitor, it continues to monitor the patient during transport and provides continuous data to the same sector on the Information Center. (See “Assigning a Telemetry Device and a Monitor to One Patient” on page 263.)If your monitor is connected to a network, a network symbol is displayed in the upper left corner next to the bed label. To see details about the Care Group, the monitoring equipment, and technical information about the network,• in the monitor info line, select the bed label.Be aware that some network-based functions may be limited for monitors on wireless networks in comparison to those on wired networks.Printout functionality and data export are not guaranteed when using a standard hospital network.Using the Integrated PCIf your monitor has the optional integrated PC (iPC), you can run applications on the iPC. The applications display data on the monitor's display (or on a second independent display) that is generated on and retrieved from the iPC or externally.For details about applications, refer to the XDS/iPC Instructions for Use.The monitor runs independently of the iPC, and vice versa. WARNING• Some clinical applications may show data from another patient. Be aware that some of the data on your patient monitor display may not always be from your patient.• Applications running on the iPC cannot act as a primary alarming device and cannot be relied upon for alarm notification. There may be no audible or visible indications apart from what is shown on the screen and any data shown may be delayed.Starting the iPCYour monitor may be configured to have the iPC start up automatically when the monitor is switched on. If not:
1 Introduction451Select Main Setup then Internal PC.2In the Internal PC menu, select Switch PC On to start the iPC.Viewing the iPC Desktop on the Monitor DisplayIf the Desktop is not displayed on the monitor display:1Select the iPC icon, or2Select Main Setup ÎInternal PC ÎShow PC Window.To hide the Desktop again, select Main Screen.Adjusting the iPC Audio VolumeThe Audio from the iPC is normally configured to be off. However, your monitor may have the iPC audio configured on for use with specific PC applications.WARNINGAlways minimize the iPC audio volume or mute it completely when it is not needed for an iPC application. This will avoid iPC tones distracting from or masking tones from the monitor.Using Input Devices with the iPC and MonitorYou can connect input devices such as a mouse, trackball and keyboard to the rear of the patient monitor (using the left hand row of USB connectors) and use them for input to the monitor. Correspondingly you can connect input devices to the rear of the patient monitor (using the right hand row of USB connectors) or to the front USB connector and use them for the iPC. Sharing input devices and touchscreen input requires a specific software application; refer to the XDS/iPC Instructions for Use for details. If the iPC is switched off when input devices are shared, any input devices connected to it will not be available for use with the monitor.Shutting the iPC DownThe iPC will be shut down automatically when the monitor is switched off.If you want to shut down the iPC when the monitor is on, 1Select Main Setup then Internal PC.2In the Internal PC menu, select Switch PC Off. If there is a problem with the shutdown, and you need to switch off the iPC manually, 1Select Main Setup then Internal PC.2In the Internal PC menu, select Force PC Off to force the iPC to power down.Special Situations at Shutdown• If you switch the monitor off and then on again immediately, the iPC will continue running and will not be shut down.
1 Introduction46• In some situations, shutting down the iPC can take a little time. The monitor will go into Standby mode until the shutdown is complete. By touching the touchscreen, you can bring the monitor back into operating mode. If you do this, the iPC will restart when the shutdown is complete.• If the shutdown cannot be completed within a certain time, a window will open giving the reason: for example, that a file has not been saved, or that updates are being installed. You can then decide whether to wait (for example, in the case of the updates) or to take action (for example by saving the unsaved file). You will also have the option to force shutdown, if necessary. Using the X2 or MP5 with a Host MonitorWhen you connect an X2 or MP5 in companion mode to a host monitor, an integrated system is formed for monitoring a single patient. The following general observations and considerations apply to such a system:• The host monitor is the "master" of the system, and you have full control over all the system's operation only via the host monitor.• Functions you can operate on a monitor in companion mode are restricted to measurements originating in that device. If you try to operate controls that are disabled, you are prompted by the message Not available in Companion Mode.• Depending on how it is configured, your host monitor can determine whether the user interface of a connected monitor in companion mode is completely disabled or not, and what is displayed on the screen (a standard main screen, or a blank screen indicating Companion Mode).This is controlled by two monitor settings that are applied to the monitor in companion mode on connection. You can change the settings in Configuration Mode.• Global settings such as line frequency, QRS sound and ECG lead colors from the host monitor, are applied to the monitor in companion mode on connection. When disconnected from the host, the monitor in companion mode re-applies its own global settings.• No audible alarms are available on a monitor in companion mode when connected to a host monitor. The only visual alarm indication is provided by the alarm lamps which are controlled by the host monitor. Alarms become active again as soon as the monitor in companion mode is disconnected from the host monitor.• The host monitor is the master of all ADT information. ADT operations on the monitor in companion mode are disabled, and any pending actions on the monitor in companion mode (for example, admit or end case) are canceled.• The date and time of the monitor in companion mode is synchronized with that of the host monitor.• Event surveillance in the monitor in companion mode is disabled. Main Setup menu operations and SmartKeys are disabled. While connected to a host monitor, no new events are detected in the monitor in companion mode, and no events are deleted. There is no transfer of stored events from the monitor in companion mode to the host monitor. After disconnection from the host monitor, event surveillance is enabled again in the monitor in companion mode, and new events are detected.
2472AlarmsThe alarm information here applies to all measurements. Measurement-specific alarm information is discussed in the sections on individual measurements.The monitor has two different types of alarm: patient alarms and INOPs.Patient AlarmsPatient Alarms are red and yellow alarms. A red alarm indicates a high priority patient alarm such as a potentially life threatening situation (for example, asystole). A yellow alarm indicates a lower priority patient alarm (for example, a respiration alarm limit violation). Additionally there are short yellow alarms, most of which are specific to arrhythmia-related patient conditions (for example, ventricular bigeminy).INOPsINOPs are technical alarms, they indicate that the monitor cannot measure or detect alarm conditions reliably. If an INOP interrupts monitoring and alarm detection (for example, LEADS OFF), the monitor places a question mark in place of the measurement numeric and an audible indicator tone will be sounded. INOPs without this audible indicator indicate that there may be a problem with the reliability of the data, but that monitoring is not interrupted.Most INOPs are light blue, however there are a small number of INOPs which are always yellow or red to indicate a severity corresponding to red and yellow alarms. The following INOPs can also be configured as red or yellow INOPs to provide a severity indication:•ECG LEADS OFF•NBP CUFF OVERPRESS•CUFF NOT DEFLATED•OCCLUSION•TELE DISCONNECTED•Replace TeleBattAll monitors in a unit should have the same severity configured for these INOPs.Alarms are indicated after the alarm delay time. This is made up of the system delay time plus the trigger delay time for the individual measurement. See the specifications section for details.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.
2Alarms48The 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. Your monitor may be configured to increase alarm indicator volume automatically during the time when the alarm is not acknowledged.Visual Alarm IndicatorsWARNING• No alarms are available on an X2 or MP5 when connected to a host monitor (Companion Mode is indicated). Alarms become active again as soon as the X2 or MP5 is disconnected from the host monitor.• Alarm fields and other visual alarm indicators are disabled on an X2 or MP5 when connected to a host monitor. The only visual alarm indication is provided by the alarm lamps, which are controlled by the host monitor.Alarm MessageAn alarm message text appears in the alarm status area 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, yellow for yellow alarms, light blue for standard INOPs, red for red INOPs and yellow for yellow INOPs. The asterisk symbols (*) beside the alarm message match the alarm priority: *** for red alarms, ** for yellow alarms, * for short yellow alarms. Standard INOPs do not have a symbol, red and yellow INOPs have exclamation marks beside the alarm message: !!! for red INOPs and !! for yellow INOPs.Depending on how your monitor is configured, it may display alarm limit violation messages:• in text form, for example ** SpO₂ LOW or• in numeric form, for example **Pulse xxx>yyy where the first number shows the maximum deviation from the alarm limit, and the second number shows the currently set limit.Flashing NumericThe numeric of the measurement in alarm flashes.Bright Alarm LimitsIf the alarm was triggered by an alarm limit violation, the corresponding alarm limit on the monitor screen is shown more brightly if Show ALarmLimits is enabled and there is sufficient room on the screen.Alarm LampA lamp on the monitor's front panel flashes. The alarm lamp is divided into two sections. The right one flashes for a patient alarm, except for short yellow alarms where the lamp will light for approximately six seconds. The color is yellow or red corresponding to the highest priority patient alarm currently present. The left one lights continuously for a light blue INOP and flashes for yellow or red INOPs as follows:
2Alarms49If only patient alarms are present, and no INOPs, the patient alarms will use both left and right sections to flash (for red and yellow alarms) or light for approximately six seconds (for short yellow alarms). If only INOPs are present, and no patient alarms, red and yellow INOPs will use both left and right sections to flash but light blue INOPs will always light continuously in the left section only.Nurse Call SystemsIf configured to do so, red, yellow and light blue alarms are indicated on any device connected to the nurse call relay.Audible Alarm IndicatorsThe audible alarm indicators configured for your 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 patient monitoring. Adjustment of alarm volume to a low level or off during patient monitoring may result in patient danger. Remember that the most reliable method of patient monitoring combines close personal surveillance with correct operation of monitoring equipment.• No audible alarm indicators are available on an X2 or MP5 when connected to a host monitor (Companion Mode is indicated). Alarms become active again as soon as the X2 or MP5 is disconnected from the host monitor.Alarm Tone ConfigurationThe 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.Traditional Audible Alarms (HP/Agilent/Philips/Carenet)• 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.INOP Lamp Color On OffYellow 1.0 seconds 1.0 secondsRed 0.25 seconds 0.25 seconds
2Alarms50• 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 and then select the required volume from the pop-up selection.• If you want to see a numerical indication of the current alarm volume on a scale from zero to 10, or change the setting, select the Alarm Volume SmartKey.The volume scale pops up. The current setting is indented. To change the setting, select the required number on the scale. Any settings that are inactive ("grayed out") have been disabled in the monitor's Configuration Mode.• When the alarm volume is set to zero (off), the alarm volume symbol reflects this.If you switch the alarm volume off, you will not get any audible indication of alarm conditions.There is no alarm volume indication on the screen of an X2 or MP5 when connected to a host monitor (Companion Mode is indicated).Minimum Volume for No Central Monitoring INOPIf your monitor is connected to an Information Center, and the connection is interrupted, the INOP message No Central Monit. will appear within 30 seconds, accompanied by an INOP tone. To help ensure that this INOP, and any other active alarm, is not overlooked, the INOP and alarm tones may be configured to have a minimum volume. In this case, INOP and alarm tones will sound even if the monitor alarm volume is set to zero.Minimum Volume for Severe Yellow or Red INOPsSevere 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.
2Alarms51The severe INOPs for which this applies are:CUFF NOT DEFLATED (configurable to yellow or red)NBP CUFF OVERPRESS (configurable to yellow or red)!!INSERT BATTERY - X2 (yellow)Power Loss ToneWhen power is lost - no power is available via the power cable - a buzzer will sound, if so configured. The tone can be silenced by pressing the On/Off power switch.Acknowledging AlarmsTo acknowledge all active alarms and INOPs, select the Silence permanent key. This switches off the audible alarm indicators and alarm lamps.Alternatively, you can acknowledge alarms by pressing the Silence hardkey on the MMS or on the SpeedPoint. The hardkeys follow the behavior configured for the permanent key.A check mark beside the alarm message indicates that the alarm has been acknowledged  . If the monitor is configured to re-alarm, a dashed check mark will be shown .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 check mark symbol beside it, except for NBP alarms and alarms from other intermittent measurements. When such an alarm is acknowledged the alarm message disappears.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 INOPsAcknowledging an INOP that results from a disconnected transducer switches off the associated measurement, unless the monitor is configured to not allow this. The only exception is ECG/Resp: acknowledging a disconnect INOP for ECG leads does not switch off the ECG and Resp measurements. Acknowledging a disconnect INOP at the Information Center switches off the audible INOP indicator but does not switch off the measurement.Unplugging an MMS or a plug-in module automatically switches off its measurements.
2Alarms52Alarm ReminderIf 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 not available for standard, light blue INOPs but for yellow and red INOPs.In Configuration Mode, you can set the interval between silencing the alarm and sounding the reminder tone to one, two, or three minutes.The alarm reminder behavior at the Information Center is different to that at the monitor. Refer to the Information Center Instructions for Use for further information.Pausing or Switching Off AlarmsIf you want to temporarily prevent alarms from sounding, for example while you are moving a patient, you can pause alarms. Depending on your monitor configuration, alarms are paused for one, two, or three minutes, or infinitely.To view the alarm pause setting chosen for your unit,1Select Main Setup, Alarms, then Alarm Settings2Check the Alarms Off setting.This setting can only be changed in Configuration Mode.To Pause All Alarms• Select the Pause Alarms permanent key. If your monitor is configured to infinite pause time, the permanent key is labeled Alarms Off, and selecting it switches alarms off.• Or press the Alarms hardkey on the SpeedPoint or Navigation Point. The hardkey follows the behavior configured for the permanent key.Depending on the configuration, you may need to select Confirm to complete the change.To Switch All Alarms OffYou can only switch alarms off permanently if your monitor is configured to allow infinite alarms pause and the permanent key is labeled Alarms Off.• Select the Alarms Off permanent key.• Or press the Alarms hardkey on the SpeedPoint or Navigation Point. The hardkey follows the behavior configured for the permanent key.Depending on the configuration, you may need to select Confirm to complete the change.Pausing alarms infinitely is the same as switching them off.
2Alarms53To Switch Individual Measurement Alarms On or Off1Select the measurement numeric to enter its setup menu.2Select Alarms to switch between on and off.The alarms off symbol is shown beside the measurement numeric.While Alarms are Paused or Off• The red Alarms Paused lamp on the monitor front panel is lit.In the alarm field, the monitor displays the message ALARMS PAUSED 1:28 or ALARMS OFF, together with the alarms paused symbol or the alarms off symbol.• 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 NOT DEFLATED, NBP CUFF OVERPRESS and INOPs relating to empty, missing and malfunctioning batteries.These INOPs switch the alarms on, and the INOP tones are sounded, even if alarms are paused or off. You need to remove the INOP condition first before you can switch the alarm tones off again.• The nurse call relay is not active.If a disconnect INOP is present and alarms are paused or switched off, the measurement in question may be switched off, depending on monitor configuration.Restarting Paused AlarmsTo manually switch on alarm indication again after a pause, select the permanent key 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.Resetting Arrhythmia Alarm TimeoutsTo reset the arrhythmia alarm timeout period, select the Alarms Off or Pause Alarms permanent key and then reselect it. Alarms Paused Alarms Off
2Alarms54Extending the Alarm Pause TimeIf your monitor has 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,1Select one of the alarm fields. This calls up the Alarm Messages window.2Select 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.Alarm LimitsThe alarm limits you set determine the conditions that trigger yellow and red limit alarms. For some measurements (for example, BIS and SpO2), where the value ranges from 100 to 0, setting the high alarm limit to 100 switches the high alarm off, or setting the low alarm limit to 0 switches it off. In these cases, the alarms off symbol is not displayed.WARNINGBe aware that the monitors in your care area may each have different alarm settings, to suit different patients. Always check that the alarm settings are appropriate for your patient before you start monitoring.Viewing Individual Alarm LimitsYou can usually see the alarm limits set for each measurement next to the measurement numeric on the main screen. If your monitor is not configured to show the alarm limits next to the numeric, you can see them in the appropriate measurement setup menu. Select the measurement numeric to enter the menu and check the limits.Viewing All Alarm LimitsThe Alarm Limits overview window lists the currently set alarm limits for all measurements. If an Apnea alarm delay time is set, this is also shown. The alarms off symbol is shown beside the measurement label of any measurement whose alarm switched off.To open the Alarm Limits window, either select any alarm field to open the Alarm Messages window, then select the Alarm Limits pop-up key, or select the Alarm Limits SmartKey, if configured.
2Alarms551Measurement labels, with alarms off symbol where appropriate2Current alarm limits3Graphic view of current yellow and red alarm limits and currently monitored measurement value.Off indicates the measurement is switched off•Select Show ST Limits to expand the list of ST leads and view the currently set alarm limits. Selecting Hide ST Limits hides the list again.You can use the pop-up keys that open with the Alarm Limits window to perform common tasks:–All Al. On/All Al. Off–All Lim. Narrow/All Lim. Wide to set narrow or wide alarm AutoLimits for all measurements.–Print Limits/Record Limits to print a list of all current alarm limit settings on a connected printer or recorder.These pop-up keys are not available in the window for changing individual alarm limits which you access by selecting the measurement label in the Alarm Limits window.Changing Alarm LimitsTo change individual measurement alarm limits using the measurement's Setup Menu,1In 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.2Select a value from the list to adjust the alarm limit.Alternatively, you can use the keys in the measurement alarm limits window, which you access by selecting the measurement label in the Alarm Limits window.
2Alarms56TTo change alarm limits,1Enter the Alarm Limits window.2Using touch: to set the high alarm limit, select the high yellow alarm field to open a pop-up list of high alarm limits. Select a limit from the list. Repeat to set the low yellow alarm field.Using a SpeedPoint or Navigation Point: position the cursor in the high yellow alarm field, then press the knob inwards. Rotate the knob to the left or right to adjust the limit. Press the knob again to set the displayed limit. Repeat to set the low yellow alarm limit.If you set the yellow alarm limit outside the red alarm limit, the monitor will automatically adapt the red alarm limit.When an ST measurement is in the alarm limits window there are also two pop-up keys available labeled All ST Narrow/All ST Wide. With these keys you can set Auto Limits for all ST Leads.1Parameter label2High red alarm (view only)3High yellow alarm field. Select to open a pop-up list of high alarm limits4Alarms On/Off key - select to switch between alarms on or off5Preview Alarm AutoLimits for a measurement before applying6Select to apply wide AutoLimits7Select to apply narrow AutoLimits8Low yellow alarm field. Select to open a pop-up list of low alarm limits9Low red alarm (view only)10 Graphic view of alarm limits with currently measured value11 15-min trend, showing alarm limits and monitored measurement values
2Alarms57About Automatic Alarm LimitsThe monitor can automatically set alarm limits suited to your individual patient, using the Automatic Alarm Limits function (AutoLimits). This tells the monitor to adapt the alarm limits of selected measurements to the measured vital signs within a defined safe limit. The monitor calculates safe AutoLimits for each patient based on the measured values from the last 12 seconds.The wide and narrow limits have a fixed relationship to the measured value within the non-pathological range. Outside of this range, no auto limits are calculated. To set values outside of the non-pathological range, limits must be changed manually, based on the clinician's judgment about the specific patient.Limits Narrow sets limits close to the currently measured values for situations where it is critical for you to be informed about small changes in your patient's vital signs.Limits Wide sets limits further away from the currently measured values for situations where small changes are not so critical.Use the keys in the measurement alarm limits window to apply AutoLimits for individual measurements. These keys are not available if AutoLimits have been disabled for the measurement in the monitor's Configuration Mode.AutoLimits are not available for all measurements. The list of measurements for which AutoLimits can be used is defined in the monitor's Configuration mode.Use the measurement alarm limits window to check AutoLimits before you apply them to ensure that they are appropriate for your individual patient and their clinical condition. Once applied, AutoLimits are shown on the monitor screen just like manually-set alarm limits. If the AutoLimits are not appropriate for your patient, you must set alarm limits manually. The limits remain unchanged until you set them again or change them manually.About Smart Alarm DelaysThe monitor can be configured to apply a delay before announcing limit alarms. The delay is calculated using an intelligent algorithm. This capability can be used to suppress alarms which occur because a limit is exceeded for a short time or by a small amount. Currently, Smart Alarm Delays are available only for SpO2 limit alarms and are not available in the U.S.A. or in clinical environments under FDA control. See the Monitoring SpO2 chapter for details.1Wide alarm limits2Narrow alarm limits3Alarm Limits4Measurement value
2Alarms58WARNINGBefore using Smart Alarm Delays, make sure that you fully understand how the delay is applied and what the consequences are.Documenting Alarm LimitsThe alarm limits pop-up keys appear with the Alarm Limits and measurement alarm limits windows.• Select the Print Limits pop-up key to print an overview of all alarm limits on a connected printer.• Select the Record Limits pop-up key to send a recording of the alarm limits to a recorder.Reviewing AlarmsYou can see which alarms and INOPs are currently active in the respective alarms and INOPs fields at the top of the screen.To see the currently active alarms and INOPs listed in one place, select any of the alarm status areas on the monitor screen. The Alarm Messages window pops up.All alarms and INOPs are erased from the Alarm Messages window when you discharge a patient, or if you change to Demonstration Mode.Alarm Messages WindowThe Alarm Messages window shows all the currently active alarms and INOPs sorted by priority, beginning at the top with the most recent. INOPs are shown on the left hand side and patient 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 check mark symbol.The Alarm Messages window pop-up keys appear when the window is opened. If alarm pause extension is disabled, the pause pop-up keys are inactive ("grayed-out"). Selecting the Review Alarms pop-up key opens the Review Alarms window.If you do not immediately understand an INOP or alarm message, refer to its help text.•In the Alarm Messages window, select the INOP message. This calls up a help window with an explanation of the INOP message and, where appropriate, a suggested solution for the problem.• If the alarm or INOP was generated in a device other than the monitor (for instance, in an MMS or FMS), this source is specified at the end of the help text.Review Alarms WindowThe Review Alarms window contains a list 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 when the monitor was switched on (after being switched off for longer than 1 minute) and any actions related to switching alarms on and off, entering or leaving Standby mode, silencing alarms or changing the ECG source.
2Alarms59When you select an item from the list, you can get additional information about that item. If you select a high or low limit alarm in the list, the Graphical Trends window will open to provide further data. If you select an alarm resulting from an event alarm notification, the Event Episode window for that event will open. If you select an alert other than a high or low alarm, a help text window opens with more information. This is the same as the help text window that opens in the Alarm Messages window. Some items in the list are simply log items not related to a patient alert as such (for example, Alarms On or Alarms Off). You cannot see any further information if you select one of these items. When you close these windows you will return to the Review Alarms window.The information in the Review Alarms window is deleted when a patient is discharged, and when you leave Demonstration Mode.The Review Alarms window pop-up keys appear when the window is opened. If alarm pause extension is disabled, the pause pop-up keys are inactive. Selecting the Active Alarms pop-up key opens the Alarm Messages window.Latching AlarmsThe 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.Viewing the Alarm Latching SettingsTo see the alarm latching setting for your monitor1In the monitor's Main Setup menu, select Alarms.2Select Alarm Settings, and see the Visual Latching and Audible Latching settings.This setting can only 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, red and yellow, and off. These choices can be combined to give the following settings:Visual Latching Audible LatchingRed&Yellow Red&YellowRed&Yellow Red OnlyRed&Yellow OffRed Only Red OnlyRed Only OffOff Off
2Alarms60Alarm Latching BehaviorAll INOPs are non-latching. See “Yellow Arrhythmia Alarms” on page 134 for information on one-star yellow alarms latching behavior.Testing AlarmsWhen you switch the monitor on, a selftest is started. You must check that the alarms lamps light, one after the other, and that you hear a single tone. This indicates that the visible and audible alarm indicators are functioning correctly. For further testing of individual measurement alarms, perform the measurement on yourself (for example SpO2 or CO2) or use a simulator. Adjust alarm limits and check that appropriate alarm behavior is observed.Alarm Behavior at Power OnIf 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, or when a patient is discharged), the monitor can be configured to:• restore the alarm settings from the monitor's configured default Profile,• restore the most recently used alarm settings, or • switch the alarms off. After any of these situations, you should check that the alarm settings are appropriate for your patient and monitoring situation, and if necessary, select the correct Profile and patient category.If power is lost for less than one minute, the alarm on/off condition prior to the power loss is restored.Red & Yellow Measurement AlarmsNon-latching alarms Visual and audible latchingVisual latching, audible non-latchingAlarm has not been acknowledged.Alarm condition still present.Alarm tone on. Alarm lamp on. Alarm message. Flashing numerics.Alarm tone on. Alarm lamp on. Alarm message. Flashing numerics.Alarm tone on. Alarm lamp on. Alarm message. Flashing numerics.Alarm condition no longer present.All audible and visual alarm indicators automatically stop.Alarm tone on.Alarm lamp on. Alarm message. Flashing numerics.Alarm message. Flashing numerics.Audible alarm indicators automatically stop.Alarm has been acknowledged.Alarm condition still present.Alarm tone off. Alarm lamp off. Alarm message. Flashing numerics. Audible alarm reminder (if configured).Alarm tone off. Alarm lamp off. Alarm message. Flashing numerics. Audible alarm reminder (if configured).Alarm tone off. Alarm lamp off. Alarm message. Flashing numerics. Audible alarm reminder (if configured).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.
2Alarms61Alarm RecordingsYou can set up your monitor so that it automatically triggers alarm recordings at the Information Center, or if configured, to a printer as a realtime report.1Press the Main Setup SmartKey.2Select Alarms from the Main Setup menu.3Select Alarm Recording from the Alarms menu to open the Alarm Recordings menu.4Select a measurement from those listed for which you want to change the alarm condition that triggers an alarm recording. This opens a pop-up list.5For the desired measurement(s), choose the alarm condition to trigger an alarm recording:Red Only: an alarm recording will automatically be triggered when the measurement enters a red alarm condition.Red&Yellow: both yellow and red alarms will trigger an alarm recording.Off: disables automatic alarm recording.Refer to the Recording chapter for details of how to set up a recording.
2Alarms62
3633Patient Alarms and INOPsThis chapter lists patient alarms alphabetically, and technical alarms (INOPs) arranged by the source of the INOP and then alphabetically, irrespective of their priority. All alarms and INOPs are listed here; the ones which can appear on your monitor will depend on the model and the individual options.For information on alarms and INOPs from the gas modules refer to your Gas Module Instructions for Use.Patient Alarm MessagesThe measurement labels and abbreviations for pressure, temperature, SpO2, and anesthetic agent alarms are explained in the individual chapters. Some alarms may be shown at the Information Center in shortened form, when transferred through IntelliVue Instrument Telemetry. These shortened alarm texts are included in the list and identified with the note "at Information Center".Note that yellow arrhythmia alarms may be shown with one or with two stars, depending on your monitor configuration and the Information Center revision you are using.Refer to your IntelliBridge Device Driver Instructions for Use for patient alarms from connected external devices.Refer to your Gas Module Instructions for Use for patient alarms and INOPs from the gas modules.Alarm Message From Condition Indication* AFIB** AFIBECG/Arrhythmia Atrial fibrillation waveform detected yellow alarm lamp, short yellow audible alarm*** APNEA*** APNEA x:yy*** APNEA >10minCO2, Resp, SpirometryRespiration has stopped for longer than the preset apnea time. "x:yy" denotes the Apnea duration in minutes and secondsnumeric flashes, red alarm lamp, alarm tone*** ASYSTOLE ECG No QRS detected for a period greater than the asystole threshold (in the absence of Vfib or chaotic ECG)numeric flashes, red alarm lamp, alarm tone** awRR HIGH CO2, Resp, AGM The airway respiration rate has exceeded the high alarm limit.numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone
3 Patient Alarms and INOPs64** awRR LOW CO2, Resp, AGM The airway respiration rate has dropped below the low alarm limit.numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone** BIS HIGH BIS The Bispectral Index value has exceeded the high alarm limit.numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone** BIS LOW BIS The Bispectral Index value has dropped below the low alarm limit.numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone** CCO HIGH** CCI HIGHCCO Continuous Cardiac Output or CC Index is above the high alarm limit.numeric flashes and high alarm limit is highlighted, yellow alarm lamp, alarm tone** CCO LOW** CCI LOWCCO Continuous Cardiac Output or CC Index is below the low alarm limit.numeric flashes and low alarm limit is highlighted, yellow alarm lamp, alarm tone** CPP HIGH CPP The CPP value has exceeded the high alarm limit.numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone** CPP LOW CPP The CPP value has fallen below the low alarm limit.numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone*** DESAT*** DESAT xx < yySpO2The SpO2 value has fallen below the desaturation alarm limit. xx denotes the lowest measured value, and yy is the desaturation limit.numeric flashes, red alarm lamp, alarm tone** EC10 ALARM*** EC10 ALARMat Information CenterEC10 Intellibridge A yellow (**) or red (***) patient alarm is present on the IntelliBridge module. Check the monitor display for more detailed alarm information.(on monitor) yellow or red alarm lamp; the alarm text is defined by the Intellibridge device driver** etCO₂ HIGH CO2, Resp, AGM The end tidal CO2 high alarm limit has been exceeded.numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone** etCO₂ LOW CO2, Resp, AGM The end tidal CO2 value has fallen below the low alarm limit.numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone** etO₂ HIGH O2, AGM The end tidal O2 high alarm limit has been exceeded.numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone** etO₂ LOW O2, AGM The end tidal O2 value has fallen below the low alarm limit.numeric flashes, and low limit is highlighted, yellow alarm lamp, alarm tone* EVENT** EVENT*** EVENTat Information centerEvent surveillance An event has occurred and the event notification is configured to alarm. Check on the monitor for more details on event group.(on monitor) event group name flashes, yellow or red alarm lamp and alarm tone* EVENT:<Event Group>** EVENT:<Event Group>*** EVENT:<Event Group>Event surveillance An event has occurred and the event notification is configured to alarm.event group name flashes, yellow or red alarm lamp and alarm toneAlarm Message From Condition Indication
3 Patient Alarms and INOPs65*** EXTREME BRADY ECG The bradycardia limit has been exceeded. numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone** HR LOW ECG The heart rate has fallen below the low alarm limit.numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone. If configured to short yellow, the sound switches off after 5 seconds if Arrhythmia is switched on.* IRREGULAR HR** IRREGULAR HRECG/Arrhythmia Consistently irregular heart rhythm. numeric flashes, yellow alarm lamp, short yellow audible alarm* MISSED BEAT** MISSED BEATECG/Arrhythmia No beat detected for 1.75*R-R interval, or if HR>120bpm no beat detected for one second (non-paced patients only).numeric flashes, yellow alarm lamp, short yellow audible alarm* MULTIFORM PVCs** MULTIFORM PVCsECG/Arrhythmia Two differently shaped Vs detected, each occurring at least twice within the last 300 beats and at least once within the last 60 beats.numeric flashes, yellow alarm lamp, short yellow audible alarm** NBP HIGH NBP The measured NBP value is above the high alarm limit.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 lamp, alarm tone** NBP LOW NBP The measured NBP value is below the low alarm limit.s, d, or m after the label indicates whether the systolic, diastolic or mean pressure has crossed the limit.numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone* NON-SUSTAIN VT** NON-SUSTAIN VTECG/Arrhythmia A run of Vs having a ventricular HR>V-Tach HR limit, but lasting for less than the V-Tach Run limit has been detected.numeric flashes, yellow alarm lamp, short yellow audible alarm* PACER NOT CAPT** PACER NOT CAPTECG/Arrhythmia(paced patients only)A missed beat with a pace pulse was detected. numeric flashes, yellow alarm lamp, short yellow audible alarm* PACER NT PACING** PACER NT PACINGECG/Arrhythmia(paced patients only)A missed beat without a pace pulse was detected.numeric flashes, yellow alarm lamp, short yellow audible alarm* PAIR PVCs** PAIR PVCsECG/Arrhythmia A non-ventricular contraction, followed by two ventricular contractions, followed by a non-ventricular contraction has been detected.numeric flashes, yellow alarm lamp, short yellow audible alarm* PAUSE** PAUSEECG/Arrhythmia No beat detected for a period greater than the pause threshold.numeric flashes, yellow alarm lamp, short yellow audible alarm*** <Press Label> HIGH PRESS The measured pressure value is above the extreme high alarm limit.s, d, or m after the label indicates whether the systolic, diastolic or mean pressure has crossed the limit.numeric flashes, high limit is highlighted, red alarm lamp, alarm tone** <Press Label> HIGH PRESS The measured pressure value is above the high alarm limit.s, d, or m after the label indicates whether the systolic, diastolic or mean pressure has crossed the limit.numeric flashes, high limit is highlighted, yellow alarm lamp, alarm toneAlarm Message From Condition Indication
3 Patient Alarms and INOPs66*** <Press Label> LOW PRESS The measured pressure value is below the extreme low alarm limit.s, d, or m after the label indicates whether the systolic, diastolic or mean pressure has crossed the limit.numeric flashes and low limit is highlighted, red alarm lamp, alarm tone** <Press Label> LOW PRESS The measured pressure value is below the low alarm limit.s, d, or m after the label indicates whether the systolic, diastolic or mean pressure has crossed the limit.numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone** Pulse HIGH PRESS, SpO2The pulse rate has exceeded the high alarm limit.numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone** Pulse LOW PRESS, SpO2The pulse rate has dropped below the low alarm limit.numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone* PVCs/min HIGH** PVCs/min HIGHECG/Arrhythmia More premature ventricular contractions have been detected in a minute than the limit.numeric flashes, yellow alarm lamp, short yellow audible alarm** QTc HIGH ECG/QT QTc value has exceeded the QTc high limit for more than 5 minutesnumeric flashes, yellow alarm lamp, alarm tone* R-ON-T PVCs** R-ON-T PVCsECG/Arrhythmia For HR <100, a PVC with R-R interval < 1/3 the average interval followed by a compensatory pause of 1.25 x average R-R interval or two such Vs without compensatory pause occurring within 5 minutes of each other. (When HR >100, 1/3 R-R interval is too short for detection.).numeric flashes, yellow alarm lamp, short yellow audible alarm** RR HIGH RESP The respiration rate has exceeded the high alarm limit.numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone** RR LOW RESP The respiration rate has dropped below the low alarm limit.numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone* RUN PVCs HIGH** RUN PVCs HIGHECG/Arrhythmia A run of PVCs greater than 2 was detected. numeric flashes, yellow alarm lamp, short yellow audible alarm** <SO₂ Label> HIGH SvO2/SO2The the measured intravascular oxygen saturation has exceeded the high limit.numeric flashes and high alarm limit is highlighted, yellow alarm lamp, alarm tone** <SO₂ Label> LOW SvO2/SO2The measured intravascular oxygen saturation has fallen below the low limit.numeric flashes and low alarm limit is highlighted, yellow alarm lamp, alarm tone** <SpO₂ Label> HIGH SpO2The arterial oxygen saturation has exceeded the high alarm limit.numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone** <SpO₂ Label> LOW SpO2The arterial oxygen saturation has fallen below the low alarm limit.numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone** ST-<n> HIGH ECG/ST The ST elevation in lead <n> is higher than the limit.numeric flashes and high alarm limit is highlighted, yellow alarm lamp, alarm toneAlarm Message From Condition Indication
3 Patient Alarms and INOPs67** ST-<n> LOW ECG/ST The ST depression in lead <n> is lower than the limit.numeric flashes and low alarm limit is highlighted, yellow alarm lamp, alarm tone* SVT** SVTECG/Arrhythmia A run of supraventricular beats greater than the SVT run limit has been detected and the HR has exceeded the SVT HR limit.numeric flashes, yellow alarm lamp, alarm tone** Tblood HIGH C.O. The blood temperature value has exceeded the high alarm limit.numeric flashes, high alarm limit is highlighted, yellow alarm lamp, alarm tone** Tblood LOW C.O. The blood temperature value has fallen below the low alarm limit.numeric flashes, low alarm limit is highlighted, yellow alarm lamp, alarm tone** tcpO₂ HIGH** tcpCO₂ HIGHtcGas The tcpO2 or tcpCO2 value has exceeded the high alarm limit.numeric flashes, high alarm limit is highlighted, yellow alarm lamp, alarm tone** tcpO₂ LOW** tcpCO₂ LOWtcGas The tcpO2 or tcpCO2 value has fallen below the low alarm limit.numeric flashes, low alarm limit is highlighted, yellow alarm lamp, alarm tone* TELE ALARM** TELE ALARM*** TELE ALARMTelemetry This is a generic alarm from the telemetry system. The specific alarm cause is indicated in the alarm message in the Telemetry Data Window.yellow or red alarm lamp and alarm tone** <Temp Label> HIGH TEMP The temperature has exceeded the high alarm limit.numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone** <Temp Label> LOW TEMP The temperature has fallen below the low alarm limit.numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone* VENT BIGEMINY** VENT BIGEMINYECG/Arrhythmia A dominant rhythm of N, V, N, V (N = supraventricular beat, V = ventricular beat) was detected.numeric flashes, yellow alarm lamp, short yellow audible alarm*** VENT FIB/TACH ECG A fibrillatory waveform for 4 consecutive seconds was detected.numeric flashes, red alarm lamp, alarm tone* VENT RHYTHM** VENT RHYTHMECG/Arrhythmia A dominant rhythm of adjacent Vs > vent rhythm limit and ventricular HR < VTach HR limit was detected.numeric flashes, yellow alarm lamp, short yellow audible alarm* VENT TRIGEMINY** VENT TRIGEMINYECG/Arrhythmia A dominant rhythm of N, N, V, N, N, V (N = supraventricular beat, V = ventricular beat) was detected.numeric flashes, yellow alarm lamp, short yellow audible alarm*** VTACH ECG, Arrhythmia Ventricular tachycardia has been detected (Consecutive PVCs exceed V-Tach Run limit and HR exceeds V-Tach HR limit).numeric flashes, red alarm lamp, alarm tone** VueLink ALARM*** VueLink ALARMat Information CenterVueLink A yellow (**) or red (***) patient alarm is present on the VueLink module. Check the monitor display for more detailed alarm information.(on monitor) yellow or red alarm lamp; the alarm text is defined by the VueLink device driver** ΔQTc HIGH ECG/QT ΔQTc value has exceeded the ΔQTc high limit for more than 5 minutesnumeric flashes, yellow alarm lamp, alarm toneAlarm Message From Condition Indication
3 Patient Alarms and INOPs68Technical Alarm Messages (INOPs)If an INOP interrupts monitoring and alarm detection, the measurement numeric will be replaced by -?-. If an INOP may lead to unreliable measurement values, a ?appears next to the numeric.The measurement labels and abbreviations for pressure, temperature, SpO2, and VueLink INOP messages are explained in the individual measurement chapters.Monitor INOPs***BRADY/P xxx<yyy***BRADY xxx < yyyPress, SpO2The heart rate from the Pulse signal has fallen below the bradycardia limit. xxx denotes the lowest measured value; yyy is the bradycardia limit.numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone***<Pressure> DISCONNECTPRESS The pressure is non-pulsatile and the mean pressure is continuously less than 10mmHg (1.3kPa). This alarm occurs only with arterial pressures (P, ABP, ART, Ao, BAP, FAP, PAP, UAP, P1, P2, P3, P4).numeric flashes, red alarm lamp, alarm tone**ST MULTI <n>,<n> ECG/ST The ST depression or elevation is outside of the limit in two or more leads <n> and <n>numeric flashes, yellow alarm lamp, alarm tone**ST MULTIat Information CenterECG/ST The ST depression or elevation is outside of the limit in two or more leads. Check on the monitor (on monitor) numeric flashes, yellow alarm lamp, alarm tone***TACHY xxx > yy ECG The tachycardia limit has been exceeded numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone***TACHY/P xxx>yyor***TACHY xxx > yyPress, SpO2, ECG The tachycardia limit has been exceeded. xxx denotes the highest measured value; yy is the tachycardia limit.numeric flashes, alarm limit is highlighted, red alarm lamp, alarm toneAlarm Message From Condition IndicationINOP Message, Indication What to do !! CHECK PAIRINGINOP toneThere is a problem with device pairing. Check that the monitor and telemetry device are correctly paired.Bad Server LinkINOP tone1) An MMS with an incompatible software revision is connected to the monitor. This combination does not allow monitoring, OR 2) You cannot use this combination of monitor, MMS and cable. Switch off the monitor and contact your service personnel.CENTRAL: TELE ONLYINOP toneSystem connectivity via telemetry device is limited (No alarms, only local numerics) when in companion mode and host monitor does not have system connectivity. Only telemetry device parameters can be displayed at central station.Check Alarm LampsINOP tonePerform a visual check of the alarm lamp to establish whether there is a problem. Contact your service personnel to check the internal connections to the alarm lamps.Check DrugSettingsINOP toneThere was a problem loading the drug settings. Check that the settings are complete and correct.!!CHECK ECG SOURCEINOP toneThe telemetry device and the monitor both have valid ECG signals. Unpair the telemetry device and the monitor if they are no longer used for the same patient.
3 Patient Alarms and INOPs69Check Flex TextsINOP toneCheck the names of the monitor menus, for example the labels for screens, profiles, event or trend group names, before you resume monitoring. If they are unexpected, there may be a problem with the monitor software. Contact your service personnel.Check KeyboardINOP tonePerform a visual and functional check of the keyboard. Contact your service personnel.Check Main Board 2INOP toneThere is a problem with the second main board in the monitor. Contact your service personnel.Check Monitor FuncINOP tonePotential problem with alarm lamps, display or interfaces detected. Contact your service personnel.Check Monitor TempINOP toneThe temperature inside the monitor is too high. Check that the monitor ventilation is not obstructed. If the situation continues, contact your service personnel.Check Mouse DeviceINOP tonePerform a visual and functional check of the mouse input device. Contact your service personnel.Check MSL VoltageINOP toneThere is a problem with the voltage of the Measurement Link (MSL). Contact your service personnel.Check Network ConfINOP toneThe monitor is receiving network topology information from more than one source, e.g. the Database Server and an Application Server. Contact your service personnel.Check Screen Res.INOP toneThe Screen you have selected uses a resolution which is not supported by the display. The monitor will show a generic Screen instead until you select a different Screen.Contact your service personnel if you want the Screen deleted from the Profile(s) to avoid this in future.Check SettingsINOP toneIf 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 SpeedPointINOP tonePerform a visual and functional check of the SpeedPoint input device. Contact your service personnel.Check Touch InputINOP tonePerform a visual and functional check of the touch input device. Contact your service personnel.Check WavesINOP toneThe options purchased with this monitor may not support the number of waves required to show the selected Screen, so some waves or high resolution trends are missing from the Screen. Select a different Screen with fewer waves.Contact your service personnel if you want the Screen deleted from the Profile(s) to avoid this in future.CHK ECG Sync CableINOP toneThe ECG Sync is detecting an invalid signal, or the ECG Sync cable is disconnected.Chk IndepDsp Cable The monitor cannot communicate with the D80 Intelligent Display. Check the MSL coupling cable. The end with the gray connector must be connected to the Intelligent Display.Chk MSL ConnectionINOP toneCheck that the MSL cable is properly connected. If this is the case, try using another MSL cable, to check if your cable is defective. If this does not help, the device connected via the MSL cable may be defective, contact your service personnel.ECG EQUIP MALF TNumeric is displayed with a -?-INOP toneContact your service personnel.The ECG in the Telemetry device is faulty.Internal.Comm.MalfINOP toneThere is a problem with I2C Bus communication in the monitor. Contact your service personnel.MCC ReversedINOP toneThe MSL coupling cable is reversed. Connect the end with the grey connector to the Intelligent Display.MCC UnsupportedINOP toneAn MSL coupling cable has been connected to a device which does not support MSL coupling.INOP Message, Indication What to do
3 Patient Alarms and INOPs70Meas. DEACTIVATED An X2 or MP5 has been connected to a host monitor (companion mode) and all derived measurements have been deactivated and/or measurements with a label conflict. The measurements can only be reactivated by disconnecting the measurement device from the host monitor.!!MORE BED ALARMS!!!MORE BED ALARMSat Information CenterThe monitor is associated with a telemetry device and is sending data to the Information Center via the telemetry device. There are currently more alarms at the bedside than can be transmitted to the Information Center.MSL Power High The power consumption of the devices connected to the Measurement Link (MSL) cable is too high. If this situation continues, the MSL will be switched off. Contact your service personnel.MSL Power OffINOP toneThe power consumption of the devices connected to the Measurement Link (MSL) cable was too high for too long and the MSL has been switched off. Contact your service personnel.MSL Power OverloadINOP toneThe power consumption of the devices connected to the Measurement Link (MSL) cable is much too high or there has been a short circuit. The MSL has been switched off. Contact your service personnel.No Central Monit.INOP toneThere is a problem with the communication to the network. Central monitoring is currently not possible (no patient alarms or information). Check the connection. In case the connection is via a telemetry device, the current telemetry use model does not support central monitoring. Contact your service personnel.NO ECG AT CENTRAL The ECG measured with the monitor ECG is not being sent to the Information Center via the telemetry device.Rem.AlarmDev.Malf.INOP toneThere is a problem with the connection to the remote alert device. Contact your service personnel to check the remote alert device and its connections.Settings Malfunc.INOP toneThe monitor cannot use the predefined settings for monitoring. Contact your service personnel.Speaker Malfunct. Contact your service personnel to check the speaker and the connection to the speaker.SRR INTERFERENCEINOP toneThe short range radio connection has interference from another device. Try using another channel.SRR INVALID CHANINOP toneThe channel configuration of the Short Range Radio is invalid. Check channel and channel mask configuration.SRR MALFUNCTION Malfunction in the short range radio device. If the INOP persists contact your service personnel.TAAP DISABLEDINOP toneThe currently selected telemetry configuration on the monitor does not allow connection of telemetry devices to the monitor.TELE CONFIG UNSUPPINOP toneTelemetry device not supported (companion mode)TELE EQUIP MALFINOP toneThe telemetry device has a malfunction. Disconnect and reconnect the telemetry device. If the INOP reappears, replace the telemetry device.TELE INCOMPATIBLE SRR-enabled telemetry device is not supported by this central software revision. Please check configuration.TELE UNSUPPORTEDINOP toneThis telemetry device is not supported for direct connection to the monitor.TimeExpired:<Timer Label>INOP toneThe time has expired for the timer indicated in the INOP text. Clearing the timer clears the INOP.Unsupported LANINOP toneThere 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.INOP tonePerform a visual and functional check of all the monitor input devices. Contact your service personnel.INOP Message, Indication What to do
3 Patient Alarms and INOPs71Battery INOPsINOP Message, Indication What to do Batt 1 MISSINGBatt 2 MISSINGINOP toneDuring this INOP, alarms cannot be paused or switched off.The monitor requires two batteries but can detect only one battery. Insert the missing battery immediately.Batt EMPTYINOP tone, battery LED flashesDuring this INOP, alarms cannot be paused or switched off.The estimated remaining battery-powered operating time is less than 10 minutes. Replace the battery immediately.If the condition persists and the monitor is not connected to mains power, this INOP is re-issued two minutes after you acknowledge it.BATT EXTENSN MALFINOP toneThere is a hardware error in the Battery Extension. Contact your service personnel.Batt INCOMPAT.INOP toneThe battery cannot be used with this monitor. Replace with the correct battery (M4607A).Batt LOWINOP toneThe estimated battery-powered operating time remaining is less than 20 minutes.Batt MALFUNCTIONINOP tone, battery LED flashesDuring this INOP, alarms cannot be paused or switched off unless the monitor is connected to mains power.The monitor cannot determine the battery status. If this INOP persists, replace the faulty battery. If the condition persists and the monitor is not connected to mains power, this INOP is re-issued two minutes after you acknowledge it.Place the battery in a different monitor or in a battery charger. If the same INOP is shown, contact your service personnel.BATTERIES EMPTYBatt 1 EMPTYBatt 2 EMPTYINOP tone, battery LED flashesDuring this INOP, alarms cannot be paused or switched off.The estimated remaining battery-powered operating time of the indicated battery or batteries is less than 10 minutes. Replace the batteries immediately.If the condition persists and the monitor is not connected to mains power, this INOP is re-issued two minutes after you acknowledge it.BATTERIES INCOMPATBatt 1 INCOMPAT.Batt 2 INCOMPAT.INOP toneThe indicated battery or batteries cannot be used with this monitor. Replace with the correct battery or batteries as specified in this book.BATTERIES LOWBatt 1 LOWBatt 2 LOWINOP toneThe estimated battery-powered operating time remaining is less than 20 minutes.BATTERIES MALFUNC.Batt 1 MALFUNCTIONBatt 2 MALFUNCTIONINOP tone, battery LED flashesDuring this INOP, alarms cannot be paused or switched off unless the monitor is connected to mains power.The monitor cannot determine the battery status. If this INOP persists, replace the faulty battery or batteries. If the condition persists and the monitor is not connected to mains power, this INOP is re-issued two minutes after you acknowledge it.Place the batteries in a different monitor or in a battery charger. If the same INOP is shown, contact your service personnel.Charge Batt 1 NowCharge Batt 2 NowINOP toneBattery must be charged. Connect the monitor to mains power or exchange the battery.CHARGER MALFUNC.INOP tone, battery LED may flashThere is a problem with the battery charger in the monitor. Connect the monitor to mains power and contact your service personnel.
3 Patient Alarms and INOPs72MMS, MMS Extensions and FMS INOPsCHECK BATT TEMPINOP toneThe temperature of one or both batteries is too high. Check that ventilation openings (if applicable) are not blocked and monitor is not exposed to heat.Chk MSL Connection Check the MSL connection between X2/MP2 and the battery extension for damage or loose connections. Check also if a second X1 or X2 has been connected accidentally (e.g. in companion mode). ExtBat EMPTY The estimated battery-powered operating remaining time is less than 10 minutes. Replace the battery in the battery extension immediately.ExtBat INCOMPAT. The battery in the battery extension cannot be used.ExtBat LOW The estimated battery-powered operating time remaining is less than 20 minutes.ExtBat MALFUNCTION The monitor cannot determine the status of the battery in the battery extension. If this INOP persists, replace the faulty battery in the battery extension. If the condition persists and the monitor is not connected to mains power or a host monitor, this INOP is re-issued two minutes after you acknowledge it.ExtBat MISSING There is no battery in the Battery Extension!!INSERT BATTERYSevere yellow INOP toneDuring this INOP, alarms cannot be paused or switched off.X2/MP2 only: There is no battery in the battery compartment. You cannot operate the monitor on AC mains while the battery compartment is open (not sealed with a battery). Load a battery immediately.MSL Power High The power consumption of the devices connected to the Battery Extension is too high. If this situation continues, the Battery Extension will be switched off. Contact your service personnel. MSL Power Off The power consumption of the devices connected to the Battery Extension was too high for too long. The Battery Extension has been switched off. Contact your service personnelINOP Message, Indication What to do INOP Message, Indication What to do FMS UNPLUGGEDINOP toneMake sure that the Flexible Module Rack is connected to the monitor. All FMS measurements are off while the FMS is unplugged.FMS UNSUPPORTEDINOP toneThe Flexible Module Rack is not supported by your monitor. Contact your service personnel.MEASSRV UNSUPPORTDINOP toneThe Multi-Measurement module is not supported by the monitor. Contact your service personnel.MMS Ext. UNPLUGGEDINOP toneThe MMS extension has been disconnected from the Multi-Measurement Module.MMS Ext. UnpoweredINOP toneThe MMS extension cannot operate while the Multi-Measurement Module is running on battery power.MMS Ext.EQUIP MALFINOP toneLoss of communication between the Multi-Measurement Module and the MMS extension. Contact your service personnel.MMS UNPLUGGEDINOP toneMake sure that the Multi-Measurement Module is connected to the monitor. All MMS measurements are off while the MMS is unplugged.
3 Patient Alarms and INOPs73Display INOPsECG, Arrhythmia, QT and ST INOPsMMS UNSUPPORTEDINOP toneThe Multi-measurement Module is not supported by your monitor. Contact your service personnel.MMSExt.UnsupportedINOP toneThe MMS extensions not supported by your monitor. Contact your service personnel.NO PPV FROM FMS The measurement device does not supply a beat-to-beat arterial pressure value. Contact your service personnel.NO PPV FROM MMS The measurement device does not supply a beat-to-beat arterial pressure value. Contact your service personnel.INOP Message, Indication What to do INOP Message, Indication What to do Indep.Dsp Malfunc. There is a problem with the Independent Display. Check the MSL coupling cable then contact your service personnel.Indep.Dsp NotSupp. The monitor does not support a second main display. The monitor software is incompatible. Contact your service personnel.Intell.Dsp Malf. There is a problem with the Intelligent Display. Check the MSL coupling cable then contact your service personnel.Intell.Dsp Missing The monitor has lost contact with the connected Intelligent Display. Contact your service personnel.Intell.Dsp Unsupp. The monitor does not support the connected Intelligent Display. The monitor software is incompatible.INOP Message, Indication What to do C LEAD OFFHR Numeric is replaced by -?-for 10 seconds.INOP toneThe C electrode (AAMI: V electrode) has become detached from the patient or the lead set has been changed. Reattach the electrode or select New Lead Setup in the Setup ECG menu to confirm the new lead set.CANNOT ANALYZE ECG The arrhythmia algorithm cannot reliably analyze the ECG data. Check the ECG signal quality of the selected primary and secondary leads. If necessary, improve lead position or reduce patient motion.If you have arrhythmia analysis on, and you are not getting a reliable HR because the signal is below a minimum amplitude, unstable, or contains artifact, and you have tried to improve the system performance by choosing another lead and changing electrodes, you should consider turning arrhythmia analysis off.CANNOT ANALYZE ECG The arrhythmia algorithm cannot reliably analyze the ECG data. Check the ECG signal quality of the selected primary and secondary leads. If necessary, improve lead position or reduce patient motion.If you have arrhythmia analysis on, and you are not getting a reliable HR because the signal is below a minimum amplitude, unstable, or contains artifact, and you have tried to improve the system performance by choosing another lead and changing electrodes, you should consider turning arrhythmia analysis off.CANNOT ANALYZE QT The QT algorithm cannot generate a valid QT value for more than 10 minutes, or 1 minute in the initial phase.
3 Patient Alarms and INOPs74CANNOT ANALYZE ST The ST algorithm cannot generate a valid ST value. Possible causes are large variations in the measured ST values for consecutive beats, or ventricular paced beats. Review the ECG signal quality and the ST measurement points. If the patient has a ventricular pacemaker, ST analysis is not possible.ECG EL. NOISY <ECG Lead>The ECG signal from the named ECG electrodes [RA, LA, LL, RL, V (or C)] is noisy. Check the ECG connections and make sure that the electrode indicated is attached.ECG EQUIP MALFNumeric is replaced by -?-INOP toneContact your service personnel.The ECG hardware is faulty.<ECG Lead> LEAD OFF!! <ECG Lead> LEAD OFF!!! <ECG Lead> LEAD OFFNumeric is replaced by -?-INOP toneNot all the required leads for ECG monitoring are connected. Check the ECG connections and make sure that the electrode indicated by <ECG lead> [RA, LA, LL, RL, V or C] electrodes is attached. In EASI mode, all 5 electrodes must be connected.ECG LEADS OFF!! ECG LEADS OFF!!!ECG LEADS OFFCheck that all of the required ECG leads are attached, and that none of the electrodes have been displaced.ECG NOISY SIGNALINOP toneThe ECG signal is too noisy. Check that the electrodes are properly placed and have not dried out. Remove any possible sources of signal noise (such as power cords) from the area around the cable and the patient.The ECG signal may be saturated or overloaded.!!ECG/AR ALARM OFF All ECG alarms have been switched off, or the HR alarm source is not ECG. To resume ECG alarm generation, switch ECG alarms on or select ECG as the alarm source.ECG/ARRH ALARM OFF!!ECG/AR ALARM OFFAll ECG alarms have been switched off, or the HR alarm source is not ECG. To resume ECG alarm generation, switch ECG alarms on or select ECG as the alarm source.EcgOut EQUIP MALFINOP toneThere is a problem with the device connected to the ECG Out connector. Contact your service personnel.LA LEAD OFFNumeric is replaced by -?- for 10 seconds.INOP toneThe LA electrode has become detached from the patient or the lead set has been changed. Reattach the electrode or select New Lead Setup in the Setup ECG menu to confirm the new lead set.LL LEAD OFFNumeric is replaced by -?- for 10 seconds.INOP toneThe LL electrode has become detached from the patient or the lead set has been changed. Reattach the electrode or select New Lead Setup in the Setup ECG menu to confirm the new lead set.RA LEAD OFFNumeric is replaced by -?-INOP toneThe RA electrode has become detached from the patient or the lead set has been changed. Reattach the electrode or select New Lead Setup in the Setup ECG menu to confirm the new lead set.RL LEAD OFFNumeric is replaced by -?- for 10 seconds.INOP toneThe RL electrode has become detached from the patient or the lead set has been changed. Reattach the electrode or select New Lead Setup in the Setup ECG menu to confirm the new lead set.SOME ECG ALRMS OFF This message appears (if configured to do so) when the on/off settings of the yellow arrhythmia alarms differ from the current Profile.V LEAD OFFNumeric is replaced by -?- for 10 seconds.INOP toneThe V electrode (IEC: C electrode) has become detached from the patient or the lead set has been changed. Reattach the electrode or select New Lead Setup in the Setup ECG menu to confirm the new lead set.INOP Message, Indication What to do
3 Patient Alarms and INOPs75Pulse INOPsResp INOPsNBP INOPsINOP Message, Indication What to do PULSE NO ALARMINGNumeric is replaced by -?-INOP tonePulse has no alarming because the system pulse is measured by an external device. Select another pulse source to enable pulse alarming.INOP Message, Indication What to do Resp EQUIP MALFNumeric is replaced by -?-INOP toneContact your service personnel. The RESP hardware is faulty.Resp ERRATICNumeric is replaced by -?-The monitor has detected too many artifacts in the measured Resp signal. Check that the RA and LL electrodes are correctly attached and have not dried out.Resp LEADS OFFNumeric is replaced by -?-INOP toneNot all the required leads for Resp monitoring are attached. Make sure that the RA and LL leads are attached.INOP Message, Indication What to do !! CUFF NOT DEFLAT!!!CUFF NOT DEFLATNumeric is displayed with a -?-Severe yellow/red INOP toneDuring this INOP, alarms cannot be paused or switched off.Remove the cuff from the patient. Make sure that the tubing is not kinked or twisted and that the correct patient category is selected. Try repeating the measurement. You can silence the INOP, but the INOP message remains visible until the next NBP measurement is started or the Stop All SmartKey is selected.[Adult or pediatric patients: The NBP cuff pressure has exceeded 15 mmHg (2kPa) for more than 3 minutes. Neonatal patients: The NBP cuff pressure has exceeded 5mmHg (0.7kPa) for more than 90 seconds.]!! CUFF OVERPRESS!!!CUFF OVERPRESSNumeric displayed with -?-Severe yellow/red INOP toneDuring this INOP, alarms cannot be paused or switched off.The NBP cuff pressure exceeds the overpressure safety limits. Remove the cuff from the patient. Make sure that the tubing is not kinked or twisted 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.
3 Patient Alarms and INOPs76Temperature INOPsNBP DEACTIVATEDINOP toneThe NBP measurement label in the measurement device has been deactivated by deactivating the label in the Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, reactivate the measurement label in the Measurement Selection window.NBP EQUIP MALFNumeric is replaced by -?- INOP toneRemove the cuff from the patient. The NBP 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.NBP INTERRUPTEDNumeric is replaced by -?- INOP toneCheck 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.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 for inflation, deflation or the total measurement.NBP MEASURE FAILEDNumeric may be displayed with a -?- INOP toneCheck 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 NBP monitoring. Use another cuff to continue measuring.INOP Message, Indication What to do INOP Message, Indication What to do T1, T2, T3, T4 INOPs See <Temp Label> INOPsTamb INOPs See <Temp Label> INOPsTart INOPs See <Temp Label> INOPsTcereb INOPs See <Temp Label> INOPsTcore INOPs See <Temp Label> INOPs<Temp Label> DEACTIVATEDINOP toneA Temp measurement label in the measurement device has been deactivated, either by connecting a Pressure transducer in the shared Press/Temp socket, or by deactivating the label in the Measurement Selection window.The measurement automatically disappears from the display.To switch the measurement on again, either reconnect a Temp transducer or reactivate the measurement label in the Measurement Selection window.<Temp Label> EQUIP MALFNumeric is replaced by -?-INOP toneContact your service personnel.The temperature hardware is faulty.<Temp Label> NO TRANSDUCNumeric is replaced by -?-INOP toneMake sure the TEMP probe is connected to the MMS or module.If you silence this INOP, the measurement will be switched off.<Temp Label> OVERRANGENumeric is replaced by -?-INOP toneTry changing the application site of the transducer.[The temperature is less than -1°C, or greater than 45°C.]
3 Patient Alarms and INOPs77SpO2 INOPs<Temp Label> UNPLUGGEDINOP toneA Temp measurement label has been deactivated, either by unplugging a module, or by deactivating the label in the Measurement Selection window.The measurement automatically disappears from the display.To switch the measurement on again, either replug the module or reactivate the measurement label in the Measurement Selection window.Tesoph INOPs See <Temp Label> INOPsTnaso INOPs See <Temp Label> INOPsTrect INOPs See <Temp Label> INOPsTskin INOPs See <Temp Label> INOPsTtymp INOPs See <Temp Label> INOPsTven INOPs See <Temp Label> INOPsTvesic INOPs See <Temp Label> INOPsINOP Message, Indication What to do INOP Message, Indication What to do <SpO₂ Label> DEACTIVATEDINOP toneThe SpO2 measurement label in the measurement device has been deactivated by deactivating the label in the Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, reactivate the measurement label in the Measurement Selection window.<SpO₂ Label> EQUIP MALFNumeric is replaced by -?-INOP toneThe MMS or module is faulty. Unplug and replug the MMS or module. If the INOP persists, contact your service personnel.<SpO₂ Label> ERRATICNumeric is replaced by -?-INOP toneCheck the sensor placement. Try another adapter cable and sensor. If the INOP persists, contact your service personnel.<SpO₂ Label> EXTD.UPDATENumeric is replaced by -?-(questionable numeric)The update period of displayed values is extended due to an NBP measurement on the same limb or an excessively noisy signal.<SpO₂ Label> INTERFERNCENumeric is replaced by -?-INOP toneThere 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, make sure that the sensor cable is not damaged or positioned too close to power cables.<SpO₂ Label> LOW PERFNumeric is replaced by -?-(questionable numeric)Accuracy may be compromised due to very low perfusion. Stimulate circulation at sensor site. If INOP persists, change the measurement site.<SpO₂ Label> NO SENSORNumeric is replaced by -?-INOP toneMake sure 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.<SpO₂ Label> NOISY SIGN.Numeric is replaced by -?-INOP toneExcessive patient movement or electrical interference is causing irregular pulse patterns. Try to reduce patient movement or to relieve the cable strain on the sensor.
3 Patient Alarms and INOPs78Pressure INOPs<SpO₂ Label> NON-PULSAT.Numeric is replaced by -?-INOP toneCheck the perfusion at measurement site. If necessary, stimulate circulation or change measurement site. If the INOP is due to NBP measurement on the same limb, wait until the NBP measurement is finished.<SpO₂ Label> POOR SIGNALNumeric is replaced by -?-(questionable numeric)The signal condition of the SpO2 measurement is poor and measurement accuracy may be compromised.<SpO₂ Label> PULSE?Numeric is replaced by -?-INOP toneThe detectable pulsations of the SpO2 signal are outside the specified pulse rate range.<SpO₂ Label> SEARCHINGNumeric unavailableSpO2 is analyzing the patient signal to derive Pulse, SpO2 and Perf values. Please wait until the search analysis is complete.<SpO₂ Label> SENSOR MALFNumeric is replaced by -?-INOP toneThe SpO2 sensor or adapter cable is faulty. Try another adapter cable and sensor. If the INOP persists, contact your service personnel.<SpO₂ Label> SENSOR OFFNumeric is replaced by -?-INOP toneThe SpO2 sensor is not properly applied to the patient. Apply the sensor following the instructions supplied by the manufacturer.<SpO₂ Label> UNKN.SENSORNumeric is replaced by -?-The connected sensor or adapter cable is not supported by the SpO2 measurement. Use only specified sensors and cables.<SpO₂ Label> UNPLUGGEDNumeric is replaced by -?-INOP toneAn SpO2 measurement label has been deactivated, either by unplugging a module, or by deactivating the label in the Measurement Selection window.The measurement automatically disappears from the display.To switch the measurement on again, either replug the module or reactivate the measurement label in the Measurement Selection window.<SpO₂ Label> UPGRADENumeric is replaced by -?-Numeric is unavailableThe SpO2 measurement is currently in upgrade mode. Monitoring is not possible in this mode.INOP Message, Indication What to do INOP Message, Indication What to do ABP INOPs See <Press Label> INOPsAo INOPs See <Press Label> INOPsART INOPs See <Press Label> INOPsBAP INOPs See <Press Label> INOPsCPP CHK SOURCESNumeric is replaced by -?-INOP toneNot all measurements or values required to perform the calculation are available. Check the measurement sources.CPP CHK UNITSNumeric is replaced by -?-The monitor has detected a conflict in the units used for this calculation. Check the unit settings.CVP INOPs See <Press Label> INOPs
3 Patient Alarms and INOPs79FAP INOPs See <Press Label> INOPsIC1 / IC2 INOPs See <Press Label> INOPsICP INOPs See <Press Label> INOPsLAP INOPs See <Press Label> INOPsP / P1 / P2 / P3 / P4 INOPs See <Press Label> INOPsPAP INOPs See <Press Label> INOPsPPV BAD <Press Label> SIGNALThe arterial pressure source selected for PPV is not providing a pulsatile signal.PPV BAD SIGNALat Information CenterThe arterial pressure source selected for PPV is not providing a pulsatile signal.PPV CHK SOURCES The arterial pressure source selected for PPV is unplugged or switched off. When this INOP has displayed for 1 minute PPV will be switched off.<Press Label> ARTIFACTNumeric questionableA non-physiological event (flush or blood sample) is detected. A resulting limit alarm or non-pulsatile INOP will be suppressed.<Press Label> DEACTIVATEDINOP toneA Pressure measurement label in the measurement device or extension has been deactivated, either by connecting a Temp transducer in the shared Press/Temp socket, or by deactivating the label in the Measurement Selection window.The measurement automatically disappears from the display.To switch the measurement on again, either reconnect a Pressure transducer or reactivate the measurement label in the Measurement Selection window.<Press Label> EQUIP MALFNumeric is replaced by -?- INOP toneContact your service personnel.The pressure hardware is faulty.<Press Label> NO TRANSDUCERNumeric is replaced by -?-INOP toneMake sure that the pressure transducer is connected to the measurement device or module.If you silence this INOP, the measurement will be switched off.<Press Label> NOISY SIGNALPulse numeric is replaced by -?-INOP toneThis INOP can only arise when a pressure is selected as the pulse source. It occurs when the pulse detector finds a pulse rate above 350bpm. This is usually caused by movement artifact or electrical interference.<Press Label> NON-PULSATILEPulse numeric is replaced by -?-INOP toneThis INOP can only arise when a pressure is selected as the pulse source. It occurs when the pulse rate being measured is less than 25 beats per minute or the amplitude is less than three mmHg.Check the catheter and connections to the patient.<Press Label> OVERRANGENumeric is replaced by -?-INOP toneMake sure that the measurement has been properly prepared and zeroed, and that the transducer is level with the heart. If this INOP persists, try another transducer.Possible causes are a measured pressure outside the allowed pressure range, or a broken wire to the transducer.<Press Label> REDUCE SIZEIncrease the scale for the pressure wave.<Press Label> UNPLUGGEDINOP toneA Pressure measurement label has been deactivated, either by unplugging a module, or by deactivating the label in the Measurement Selection window.The measurement automatically disappears from the display.To switch the measurement on again, either replug the module or reactivate the measurement label in the Measurement Selection window.INOP Message, Indication What to do
3 Patient Alarms and INOPs80CO2 INOPs<Press Label> ZERO+CHECK CALNumeric is replaced by -?-Perform a zero and check the calibration of the transducer.RAP INOPs See <Press Label> INOPsUAP INOPs See <Press Label> INOPsUVP INOPs See <Press Label> INOPsINOP Message, Indication What to do INOP Message, Indication What to do !! CO₂ OCCLUSION!!! CO₂ OCCLUSIONNumeric is replaced by -?-INOP toneThe sample line or exhaust tube is blocked. Check the tubing, then disconnect and reconnect the sample line. If the INOP persists, connect a new sample line.CO₂ AUTO ZERONumeric is replaced by -?-if the Autozero lasts >15 sec, INOP tone sounds.The automatic zero calibration is in progress. This typically takes 10 seconds. During this time the CO2 values may not be updated, or they may be replaced by -?-. Wait until the zero calibration is complete to resume monitoring.CO₂ CAL MODECO2 numeric displays current CO2 value for accuracy checkCurrently no calibration is running. Accuracy can be checked by placing the transducer on the two cells of the calstick and starting calibration. To start monitoring, leave Cal. Mode.CO2 CAL RUNNINGNumeric is replaced by -?-Wait until calibration is finished.CO₂ CHECK CALNumeric is replaced by -?-INOP toneThe CO2 value is outside the measurement range. Perform an accuracy check for both calstick cells and, if necessary, recalibrate the transducer.CO₂ CHK ADAPTERNumeric is replaced by -?-INOP toneCheck that the sensor is connected to the airway adapter, clean the airway adapter, if necessary. Perform a zero calibration. If the INOP persists, contact your service personnel.CO₂ DEACTIVATEDINOP toneThe CO2 measurement label in the measurement device has been deactivated by deactivating the label in the Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, reactivate the measurement label in the Measurement Selection window.CO₂ EQUIP MALFNumeric is replaced by -?-INOP toneThe Measurement Extension is faulty. Unplug and replug the Multi-Measurement Module with Extension. If you are using the mainstream method, unplug and replug the transducer or try another transducer. If the INOP persists, contact your service personnel.CO₂ FAILED CALNumeric is replaced by -?-INOP toneMake sure that the Cal cell was changed between CAL1 and CAL2. Repeat the calibration. If the INOP reappears, try another transducer. If the INOP persists, contact your service personnel.CO₂ NO SENSORfrom M3014ANumeric is replaced by -?-INOP toneThere is no CO2 sensor connected. If you silence this INOP the CO2 measurement will be switched off.CO₂ NO TRANSDUCfrom mainstream CO2 (except M3014A)Numeric is replaced by -?-INOP toneThere is no CO2 transducer connected. If you replace the transducer, the new transducer must be calibrated. If you silence this INOP the CO2 measurement will be switched off.
3 Patient Alarms and INOPs81SO2 INOPsCO₂ NO TUBINGNumeric is replaced by -?-INOP toneEither the sample line is disconnected, or an incorrect line is attached. Check the connection. If necessary, connect another sample line (Use only the approved accessories).If you silence this INOP, the measurement will be switched off.CO₂ OVERRANGENumeric is replaced by -?-INOP toneThe CO2 value is higher than the measurement range. If you suspect a false high value, contact your service personnel.CO₂ PUMP OFFNumeric is replaced by -?-.The pump has been switched off for fifteen minutes. To switch it on again, select Pump On in the Setup CO₂ menu.CO₂ PURGINGNumeric is replaced by -?-INOP toneThe Filterline is being purged to remove an occlusion in the line or airway adapter. If the occlusion is removed, the INOP will disappear. If not, the INOP CO₂ OCCLUSION is displayed.CO₂ SENS.WARMUPNumeric is replaced by -?-Microstream CO2: INOP toneMainstream CO2: no INOP toneWait until the sensor reaches operating temperature and the INOP disappears.CO₂ UPDATE FWNumeric is replaced by -?-INOP toneThe software in the Measurement Extension does not match the software in the MMS. Contact your service personnel.CO₂ WAIT CAL2Numeric is replaced by -?-Calibration on the first calstick cell is complete. Place the transducer on the other calstick cell and start the CAL2 calibration cycle.CO₂ ZERO FAILEDNumeric is replaced by -?-INOP toneAn error occurred during the last zero calibration. Check the airway adapter and clean, if necessary. Perform another zero calibration. If the INOP persists, contact your service personnel.CO₂ ZERO REQU'DNumeric is replaced by -?-INOP tonePerform zero calibration for the CO2 sensor. If the INOP persists, contact your service personnel.CO₂CHANGE SCALE The CO2 wave is clipped. Select a more appropriate wave scale to display the whole wave.CO₂ZERO RUNNING Wait until zero calibration is finished.INOP Message, Indication What to do INOP Message, Indication What to do <SO₂ Label> CAL FAILEDNumeric is replaced by -?-INOP toneThe calibration failed. Check the catheter-to-Optical-Module connection. Manually restart the calibration. Try another catheter and Optical Module. If the catheter is already inserted, perform an in-vivo calibration.<SO₂ Label> CAL MODENumeric is replaced by -?-INOP tonePre-insertion calibration is complete, but the catheter tip is still inside the optical reference. The catheter is now ready for insertion.<SO₂ Label> CANNOT MEASNumeric is replaced by -?-INOP toneThe signal is out of the normal range, and no oxygen saturation can be derived. Perform an in-vivo calibration. If the INOP persists, try another Optical Module and catheter.<SO₂ Label> CONN OPTMODNumeric is replaced by -?-INOP toneThe Optical Module was disconnected during data storage. Reconnect the Optical Module for at least 20 seconds.
3 Patient Alarms and INOPs82<SO₂ Label> EQUIP MALFNumeric is replaced by -?-INOP toneThe SO2/SvO2 Module or Optical Module is faulty. Unplug and replug the Optical Module and SO2/SvO2 module. Exchange the modules. If the INOP persists, contact your service personnel.<SO₂ Label> INCOMPAT.INOP toneThe SO2 Module or Optical Module is not supported. Contact your service personnel.<SO₂ Label> IN-VIVO CAL The in-vivo calibration is not yet complete. Lab values must be stored to the Optical Module to complete the calibration. Either continue with the next steps of the current calibration or recall the previous calibration.<SO₂ Label> LOW LIGHTNumeric is replaced by -?-INOP toneThe optical signal levels are too low. Check that the catheter is either in the optical reference or inserted into the patient. Check the catheter-to-Optical Module connection. If INOP persists, try another catheter and Optical Module.<SO₂ Label> NO OPTMODNumeric is replaced by -?-INOP toneConnect the Optical Module. If the INOP persists, try another Optical Module. Silencing this INOP switches the measurement off.<SO₂ Label> OPTMOD MALFThe Optical Module memory is faulty, and calibration data cannot be stored for transport or during power failure. If this capability is needed, use another Optical Module.<SO₂ Label> PRE-INS CALNumeric is replaced by -?-INOP toneThe pre-insertion calibration is running. This typically takes one minute. During this time alarms are switched off. Wait until the calibration is complete.<SO₂ Label> UNPLUGGEDNumeric is replaced by -?-INOP toneMeasurement switched on and SO2/SvO2 module unplugged from the rack.<SO₂ Label> UPGRADEINOP toneThe SO2 module is currently in upgrade mode.Monitoring is not possible in this mode.<SO₂ Label> WARMUPNumeric is replaced by -?-The Optical Module has not yet reached the operating temperature. Wait a few minutes until warm-up is finished.<SO₂ Label>CAL REQUIREDNumeric is replaced by -?-INOP toneThere is no valid calibration data in the Optical Module. Perform either a pre-insertion or an in-vivo calibration.<SO₂ Label>CONFIG ERRORNumeric is replaced by -?-INOP toneThe Optical Module has been configured to SaO2 Mode. Use Change to Venous in the setup menu to reconfigure to venous saturation mode.<SO₂ Label>LIGHT INTENSNumeric is replaced by -?-INOP toneThe intensity changed considerably since the last light intensity calibration. This may indicate that the catheter tip is positioned against a blood vessel wall or that there is low blood flow. Reposition the catheter (and perform a Light Intensity Calibration).INOP Message, Indication What to do
3 Patient Alarms and INOPs83C.O. INOPsINOP Message, Indication What to do C.O. DEACTIVATEDINOP toneThe Cardiac Output measurement label in the measurement device has been deactivated by deactivating the label in the Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, reactivate the measurement label in the Measurement Selection window.C.O. EQUIP MALFNumeric is replaced by -?-INOP toneThere is a problem with the C.O. hardware. Contact your service personnel.C.O. UNPLUGGEDNumeric is replaced by -?-INOP tonePlug in the C.O. module. Silencing this INOP switches off the measurement.CCI NO BSACCI numeric unavailableINOP toneCCI cannot be calculated because the patient's body surface area is unknown. Enter the patient weight and height to provide the BSA for CCI calculation.CCO BAD PRESS SIGNNumeric is replaced by -?-INOP toneThe arterial pressure wave can currently not be used for pulse contour calculation for CCO or CCI measurement. Possible causes are air bubbles in the tubing or a physiological condition, for example severe arrhythmia.CCO NO CALIBRATIONNumeric is replaced by -?-The CCO measurement is currently not calibrated.CCO NO <Press Label>Numeric is replaced by -?-INOP tone may soundCCO/CCI cannot be calculated. Make sure that the pressure chosen in the Setup CCO menu under CCO From matches the pressure measured with the arterial catheter for CCO measurement. A pressure from an external device cannot be used. Select another pressure label, either ABP, Ao, ART, BA P,  FA P, o r  UA P.CCO NO PRESSat Information CenterCCO/CCI cannot be calculated. Make sure that the pressure chosen in the Setup CCO menu under CCO From matches the pressure measured with the arterial catheter for CCO measurement. A pressure from an external device cannot be used. Select another pressure label, either ABP, Ao, ART, BA P,  FA P, o r  UA P.CCO NOT SUPPORTEDNumeric is replaced by -?-INOP toneA catheter for transpulmonary C.O. measurements has been unplugged and replaced with a Right Heart C.O. catheter, or the measurement mode has been changed manually. Silencing this INOP switches the measurement off.CCO OVERRANGECCI OVERRANGENumeric is replaced by -?-INOP toneThe measured CCO or CCI value is not within the specified range for CCO/CCI measurement.CCO PRESS INVALIDat Information CenterThe arterial pressure selected for pulse contour calculation for CCO is available but currently invalid. Make sure the pressure transducer is connected and the zero calibration is valid.CCO <Press Label> INVALIDNumeric is replaced by -?-INOP tone may soundThe arterial pressure selected for pulse contour calculation for CCO is available but currently invalid. Make sure the pressure transducer is connected and the zero calibration is valid.CCO PRESS OVERRANGNumeric is replaced by -?-INOP toneThe mean value of the arterial pressure values used for pulse contour calculation for CCO is below 0 mmHg or above 300 mmHg.CCO PULSE OVERRANGNumeric is replaced by -?-INOP toneThe pulse rate of the pressure used for pulse contour calculation for CCO is below 30 bpm or above 240 bpm.
3 Patient Alarms and INOPs84tcGas INOPsCCO RECALIBRATENumeric is replaced by -?-The most recent CCO or CCI calibration was made over 8 hours ago or the arterial pressure measurement used for CCO calculation has been zeroed after the CCO calibration was performed. You should recalibrate CCO or CCI with transpulmonary C.O. measurements at least every 8 hours or when the hemodynamic condition of the patient has changed. The pressure measurement must be zeroed before a CCO calibration.CCO/Tbl NO TRANSD.Numeric is replaced by -?-INOP toneNo transducer attached to the module or catheter disconnected.Tblood NO TRANSDUCNumeric is replaced by -?-INOP toneNo transducer attached to the module or catheter disconnected.Tblood OVERRANGENumeric is replaced by -?-Tblood out of range 17°C - 43°C.INOP Message, Indication What to do INOP Message, Indication What to do <tcGas Label> CAL FAILEDNumeric is replaced by -?-INOP toneA calibration failed. Check the calibration unit, gas pressure, and tubing connections, then restart the calibration. If the calibration has failed more than once, remembrane the transducer and restart the calibration. If this INOP persists, contact your service personnel.<tcGas Label> CAL REQUIRDNumeric is replaced by -?-INOP toneCalibration is required before applying the transducer to the patient. Insert a membraned transducer into the calibration chamber on the module, connect the calibration unit to the calibration chamber, open the gas valve and start the calibration. If this INOP occurs during a calibration, there may be a module or transducer malfunction: contact your service personnel.<tcGas Label> CAL RUNNINGNumeric displays first -?-, then numeric is displayed with a ?Wait until the tcpO2/tcpCO2 calibration is finished.<tcGas Label> CHANGE SITEIf Heat Switch Off is configured to Yes, numeric is replaced by -?-INOP toneSite Timer has timed out. Change the application site to avoid skin burns. To reset the Site Timer, either calibrate and change the measurement site, or change the measurement site and reset the Site Timer manually by selecting the appropriate site time from the Setup tcGas menu.<tcGas Label> CHECK TIMESite Timer due to time out in 15 minutes or less.
3 Patient Alarms and INOPs85EEG INOPs<tcGas Label> EQUIP MALFNumeric is replaced by -?-INOP toneThere is a malfunction in the transducer or module. Connect another transducer. If this INOP persists, contact your service personnel.<tcGas Label> NO TRANSDUCNumeric is replaced by -?-INOP toneNo transducer is connected to the tcpO2/tcpCO2 module. Silencing the alarm switches off the measurement.<tcGas Label> STABILIZINGNumeric is replaced by ?The transducer has not yet reached the selected temperature and/or skin hyperemization is not yet finished. This INOP will disappear within three minutes.<tcGas Label> UNPLUGGEDNumeric is replaced by -?-INOP toneThe measurement is switched on but the module is unplugged.The measurement automatically disappears from the display. Silencing this INOP switches off the measurement.INOP Message, Indication What to do INOP Message, Indication What to do EEG EQUIP MALFINOP toneThe EEG hardware is faulty. Contact your service personnel.EEG IMPEDANCE HIGHEEG1 IMPED. HIGHEEG2 IMPED. HIGHThe signal electrode in one or both channels exceeds the user-selected impedance limit, or the impedance of a single electrode exceeds the limit. Check the impedance. If the impedance is too high, reconnect the electrodes according to the EEG monitoring setup guidelines. If the INOP persists, contact your service personnel.EEG LINE NOISEEEG1 LINE NOISEEEG2 LINE NOISEExcessive line noise has been detected in either channel EEG1 or EEG2, or in both EEG channels. Keep all cables together and away from metallic bodies, other cables & radiated fields.EEG MUSCLE NOISEEEG1MUSCLE NOISEEEG2MUSCLE NOISEToo much power above 30 Hz has been detected in channel EEG1 or EEG2, or both. Check the Electrode-to-Skin Impedance and reposition the electrode away from possible muscle activity, if necessary.EEG NO TRANSDUCINOP toneThe trunk cable is disconnected from the EEG plug-in module. Reconnect the trunk cable. Silencing this INOP switches the measurement off.EEG UNPLUGGEDINOP tonePlug in module. Silencing this INOP switches off the measurement.EEG1 LEAD OFF <n>EEG2 LEAD OFF <n>[n = electrode]Reconnect specified electrode.EEG1 LEAD OFFEEG2 LEAD OFFat Information CenterOne or more electrodes are not connected. Check in the EEG Impedance / Montage window on the monitor which electrode(s) are affected and reconnect the electrodes.EEG1 LEADS OFFEEG2 LEADS OFFTwo or more electrodes are not connected. Check in the EEG Impedance / Montage window which electrodes are affected and reconnect the electrodes.EEG1 OVERRANGEEEG2 OVERRANGEInput signal is too high in one or both channels. This is usually caused by interfering signals such as line noise or electrosurgery.
3 Patient Alarms and INOPs86BIS INOPsINOP Message, Indication What to do BIS CABLE INCOMPATINOP toneThe semi-reusable sensor cable connected is unknown or not supported by your software revision. Replace it with a Philips-supported sensor cable.BIS CABLE USAGEINOP toneThe semi-reusable sensor cable has exceeded the maximum number of uses. Replace the cable.BIS DSC DISCONNINOP toneDSC is not properly connected OR either DSC or BIS engine may be faulty.Make sure that the DSC is properly connected to the BIS Engine. If INOP persists, replace DSC with a known good one of the same type. If INOP persists replace BIS engine.Silencing this INOP switches the measurement off.BIS DSC INCOMPTINOP toneDSC is not supported by the BIS engine or new DSC connected to an old BIS engine. A software upgrade may be required. Contact your service personnel.BIS DSC MALFUNC Electrocautery used during self-test OR malfunction in the DSC hardware.Make sure not to use electrocautery during the self-test procedure. Disconnect and reconnect the DSC to the BIS engine. If the INOP persists, replace the DSC or contact your service personnel.BIS DSC UPDATEINOP toneDSC update currently being carried out. This INOP will disappear when the DSC update is finished. Do not disconnect the DSC during the update. No action is needed.BIS ELECTR. DISC.INOP toneOne or more electrodes are not connected to the semi-reusable sensor cable. Check all electrode connections.BIS ENGINE DISCONNINOP toneBIS engine not connected OR Module Cable defective.Make sure that the Module Cable is properly connected. If INOP persists, replace the Module Cable. Silencing this INOP switches the measurement off.BIS ENGINE INCOMPTINOP toneBIS engine software is not supported. A software upgrade may be required. Contact your service personnel. MP20/30 - BIS engine not supported.BIS ENGINE MALFUNCINOP toneMalfunction in the BIS engine hardware. Disconnect and reconnect the BIS engine. If the INOP persists, replace BIS engine.BIS EQUIP MALFINOP toneThere is a malfunction in the BIS hardware. Unplug and replug the BIS module. If the INOP persists, contact your service personnel.BIS HIGH IMPEDANCEINOP tone may soundImpedance of one or more electrode(s) is above the valid range, most often caused by bad skin preparation. Check the sensor montage and press the electrode pads firmly. If this INOP persists, replace the sensor(s) in question using correct skin preparation.If INOP persists, contact your service personnel.BIS IMPEDANCE CHCKINOP tone may soundThe Cyclic Impedance check is running. It will stop automatically if all impedances are within the valid range. If any electrodes do not pass the impedance test, check the sensor montage and press the electrode pads firmly. To manually stop the Cyclic Impedance Check, select Cyclic Check off in the Setup BIS menu.BIS ISOELECTRC EEG No discernible EEG activity is detected for longer than one minute.Check the patient. Check that the electrodes are properly connected.BIS LEAD OFFINOP tone may soundOne or more electrodes have no skin contact and therefore impedances cannot be measured. Check the sensor montage and press the electrode pads firmly. If this INOP persists, replace the sensor(s) in question, using correct skin preparation.BIS OVERCURRENTINOP toneUnplug and replug the BIS module or, f or the MP20/MP30, disconnect and reconnect the BISx from the Interface board. If the INOP persists, contact your service personnel.
3 Patient Alarms and INOPs87Spirometry INOPsBIS SENSOR DISCONNINOP toneThe sensor is not properly connected to the patient interface cable (PIC) and/or the PIC is not properly connected to the DSC or BISx, or the sensor or PIC or DSC or BISx may be faulty. Check all the connections. Disconnect and reconnect the sensor, PIC, DSC, BISx. If the INOP persists, replace the sensor.If the INOP persists, replace PIC. If INOP persists, contact your service personnel. Silencing this INOP switches the measurement off.BIS SENSOR INCOMPTINOP toneUnsupported sensor connected or sensor type unknown or not supported by your software revision. Replace the sensor, using only Philips supported sensors.BIS SENSOR MALFUNCINOP toneMalfunction in the sensor hardware, most often caused by liquids permeating into the connectors OR patient interface cable (PIC) or DSC or BISx may be faulty. Replace the sensor. Manually initiate a Cyclic Impedance Check. Make sure all electrodes pass the test. Make sure that the both sides of the PIC connector (between PIC and sensor) are dry. If you are not sure that the connector is dry, replace the PIC until it has dried. If this INOP persists, contact your service personnel.BIS SENSOR USAGEINOP toneExcessive sensor usage. Replace sensor. A Cyclic Impedance Check will start automatically.BIS SQI < 15% (INOP tone)ORBIS SQI < 50% (no INOP tone)If the signal quality is below 50%, BIS numerics cannot be reliably derived. If the signal quality is below 15%, no BIS numerics can be derived. This may occur as a result of artifacts such as those generated from motion or the presence of electrocautery devices. Make sure the sensor is properly attached to the patient. Manually initiate a Cyclic Impedance Check. Make sure all electrodes pass the test. Make sure the patient is completely relaxed (even small motions of the facial muscles affect the signal quality).BIS UNPLUGGEDINOP tonePlug in the BIS module. Silencing this INOP switches off the measurement.BISx DISCONNECTEDINOP toneThe BISx is not connected to the BIS module or the BIS interface board. Silencing this INOP switches the measurement off.BISx INCOMPATIBLEINOP toneThe BISx software is not compatible with the BIS module or with the MP20/MP30 monitor software. A software upgrade may be required. Contact your service personnel.BISx MALFUNCTIONINOP toneThe BISx is faulty. Disconnect and reconnect it to the module or BIS interface board. If the INOP persists, replace the BISx.MP20/MP30 - Malfunction on interface board. If the INOP persists, contact your service personnel.INOP Message, Indication What to do INOP Message, Indication What to do AWFCHANGE SCALE Airway flow signal exceeds range of selected scale. Adjust scale to display complete wave.AWPCHANGE SCALE Airway pressure signal exceeds range of selected scale. Adjust scale to display complete wave.AWVCHANGE SCALE Airway volume signal exceeds range of selected scale. Adjust scale to display complete wave.SPIRO ALARMS SUPPR Alarming is suppressed for the spirometry module.SPIRO CANNOT MEAS Measurement is at its limit, e.g. ambient pressure out of range.SPIRO GAS COMPENS? Gas compensation is set to Gas Analyzer but not all gases necessary for compensation are measured by a gas monitor. Some of the fall-back values provided by the user are used. Measurement accuracy might be reduced.SPIRO INCOMPATIBLE Module revision not compatible with the host monitor software revision. Contact your service personnel.SPIRO MALFUNCTION Module failure detected. Contact your service personnel.
3 Patient Alarms and INOPs88VueLink INOPsSPIRO NO BREATH No breath was detected for more than 25 seconds. Breath derived numerics are not available.SPIRO NO SENSOR No sensor detected. Make sure the correct sensor is attached to the breathing circuit.SPIRO PATIENT CAT. Mismatch of patient size configured in the host monitor and sensor type plugged into the module. Check the instructions on selecting the correct sensor in the chapter on “Spirometry” on page 422.SPIRO PURGE FAILED The purge operation could not be completed successfully. Check for kinked sensor tubings, hard occlusions and make sure that the pump is running and all valves are switching.SPIRO PURGING A purge operation is in progress - no data update on the screen. Wait until purge is complete.SPIRO UNKN. SENSOR An unknown sensor ID code was detected. Use only the sensors listed in the “Accessories” on page 369 chapter.SPIRO UPGRADE The module is running a firmware upgrade. Wait until upgrade is completed before resuming monitoring.INOP Message, Indication What to do INOP Message, Indication What to do VueLink ALARMat Information CenterA technical alarm is present on the VueLink module. The INOP text on the monitor is defined by the VueLink device driver. <VueLink Option> CHECK SETUPINOP toneNo information was received from the external device. The device may be switched off or disconnected.VueLink INOP abbreviations may differ slightly depending on the device category.<VueLink Option> CHK CABLEINOP toneNo cable or the wrong cable connected to the VueLink module, or incorrect device selected. Silencing this INOP switches the measurement off. VueLink INOP abbreviations may differ slightly depending on the device category.<VueLink Option> CHK CONF.INOP toneThe wrong external device has been selected on the VueLink module, or the external device has not been correctly setup, or the wrong cable has been used to connect the device to the VueLink module.VueLink INOP abbreviations may differ slightly depending on the device category.<VueLink Option> EQUIP MALFINOP toneMalfunction in the VueLink module. If this message appears repeatedly, the module must be replaced. Contact your service personnel.VueLink INOP abbreviations may differ slightly depending on the device category.<VueLink Option> NO CONFIGINOP toneThe VueLink module has not been configured during installation. The installation process should be completed by either your biomedical engineering department or the Philips service engineer.VueLink INOP abbreviations may differ slightly depending on the device category.<VueLink Option> UNPLUGGEDINOP toneThe VueLink module has been unplugged from the rack, or the whole rack has been disconnected. The measurement automatically disappears from the display. Silencing this INOP switches off the measurement.VueLink INOP abbreviations may differ slightly depending on the device category.
3 Patient Alarms and INOPs89IntelliBridge INOPsTelemetry INOPsINOP Message, Indication What to do DEVICE CHECK CONF.INOP toneDevice identification completed, but communication could not be established due to error.IntelliBridge INOP abbreviations may differ slightly depending on the device category.DEVICE CHECK SETUPINOP toneDevice identification completed, but communication could not be established due to timeout.IntelliBridge INOP abbreviations may differ slightly depending on the device category.DEVICE DEMO DATAINOP toneThe device connected to the IntelliBridge module reports demo data but the monitor is not in DEMO mode.DEVICE REAL DATAINOP toneThe monitor is in DEMO mode but the device connected to the IntelliBridge module reports data that are not flagged as demo data.DEVICE UNSUPPORTEDINOP toneDevice identification completed, but no appropriate device driver installed.IntelliBridge INOP abbreviations may differ slightly depending on the device category.<EC10 / EC40> EQUIP MALFINOP toneMalfunction in the IntelliBridge module. If this message appears repeatedly, the module must be replaced. Contact your service personnel.EC10 INOP!! EC10 INOP!!! EC10 INOPat Information CenterA technical alarm is present on the IntelliBridge EC10 module.On the monitor the indication is a red (!!!), yellow (!!) or cyan alarm lamp (as appropriate) and an INOP text that is defined by the IntelliBridge EC10 device driver.<External Device> UNPLUGGEDINOP toneThe IntelliBridge module has been unplugged from the rack, or the whole rack has been disconnected. Silencing this INOP switches off the measurement.IntelliBridge INOP abbreviations may differ slightly depending on the device category.NO DEVICE DATA Communication with connected device has been lost.TEXT UPLOAD FAILEDINOP toneIncoming text from the IntelliBridge modules exceeds the maximum limit. Try unplugging one of the IntelliBridge modules. If the INOP occurs repeatedly contact your service personnel; a software upgrade may be necessary.INOP Message, Indication What to do !! REPLACE BATT. T!!!REPLACE BATT. TSevere yellow/red INOP toneDuring this INOP, alarms cannot be paused or switched off.The battery in the telemetry device is almost empty and must be replaced.!! TELE INOP!!! TELE INOPSevere yellow/red INOP toneCheck for further details at the Information Center or in the Telemetry Data window on the monitor.BATTERY LOW T The battery in the Telemetry device is low and must be replaced soon.Check ECG SettingsINOP toneSynchronization of ECG settings between the monitor and Information Center has failed. Check that the ECG settings in use are appropriate.!!CHECK ECG SOURCE Both the telemetry device and the monitor have valid ECG signalsChk SpO₂T SettingsINOP toneSynchronization of SpO2T settings between the monitor and Information Center has failed. Check that the SpO2T settings in use are appropriate.
3 Patient Alarms and INOPs90ProtocolWatch INOPsCalculated Values INOPsINVALID LEADSETLEADSET UNPLUGGED The leadset has been unplugged from the telemetry device.NO ECG SOURCE A telemetry device is paired with the monitor but the Information Center is not detecting a valid ECG signal from either of them.!!TELE DISCONNECT!!!TELE DISCONNECTINOP toneTelemetry transceiver was disconnected or short range radio link was lost. For cable connections; check Telemetry interface, cable connection and setup.For short range radio connections: if the telemetry transceiver has not moved out-of-range, check for interference sources close to the monitor (bluetooth devices, DECT phones, cellular phones, microwaves, etc.). If this INOP persists, ask your service personnel to survey the interference sources.Tele Sync Unsupp.INOP toneThe MMS in use does not support synchronization of ECG and SpO2 settings between the monitor and central station after a telemetry device has been paired. Use an MMS with revision E.0 or above.INOP Message, Indication What to do INOP Message, Indication What to do PW In Conflict There is a patient information mismatch which has not yet been resolved (>15 minutes).PW: Check Settings Contact your service personnel. Settings could not be loaded or interpreted correctlyPW:Action Required The protocol currently running requires a user response. Check which pop-up window is displayed and provide the appropriate response.INOP Message, Indication What to do Sp-vO₂ CHK SOURCESNumeric is replaced by -?-Not all measurements or values required to perform the calculation are available. Check measurement sources.Sp-vO₂ CHK UNITSNumeric is replaced by -?-The monitor has detected a conflict in the units used for this calculation. Check the unit settings.SVR CHK SOURCESSVRI CHK SOURCESNumeric is replaced by -?-Not all measurements or values required to perform the calculation are available. Check measurement sources.SVR CHK UNITSSVRI CHK UNITSNumeric is replaced by -?-The monitor has detected a conflict in the units used for this calculation. Check the unit settings.SVR SET CVP USEDSVRISET CVP USEDA CVP value is required for this calculation, but is not currently being measured. The monitor is using the CVP value preset in the Setup SVR menu.ΔSpO₂ CHK SOURCESNumeric is replaced by -?-Not all measurements or values required to perform the calculation are available. Check measurement sources.ΔSpO₂ CHK UNITSNumeric is replaced by -?-The monitor has detected a conflict in the units used for this calculation. Check the unit settings.ΔTemp CHK SOURCESNumeric is replaced by -?-Not all measurements or values required to perform the calculation are available. Check measurement sources.ΔTemp CHK UNITSNumeric is replaced by -?-The monitor has detected a conflict in the units used for this calculation. Check the unit settings.
3 Patient Alarms and INOPs91Cableless Measurement Device INOPsINOP Message, Indication What to do cl NBP Batt Empty The remaining battery time of the NBP Pod is below 30 minutes. Change the battery. cl NBP Batt Incomp The battery in use with the NBP Pod is incompatible. Replace it with one approved for use with the NBP Pod.cl NBP Batt Low The remaining battery time of the NBP Pod is below 2 hours.cl NBP Batt Malf There is a malfunction in the NBP Pod's battery system. Contact your service personnel.cl NBP Batt Temp The temperature of the battery in the 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 Check Batt The battery in the NBP Pod is nearing the end of its useful life. Only 50 charge/discharge cycles remain. Contact your service personnel to replace the battery.cl NBP Disconnect The NBP Pod has lost the connection to the monitor.cl NBP No Cradle The NBP Pod is not in its cradle.cl NBP Remove The temperature of the battery in the NBP Pod is too high. Remove the Cableless Measurement Device from the patient and contact service personnel.cl NBP Serv Batt The battery in the NBP Pod has reached the end of its useful life. It can no longer be charged. Contact your service personnel to replace the batterycl SpO₂ Batt Empty The remaining battery time of the SpO2 Pod is below 30 minutes. Change the battery.cl SpO₂ Batt Incmp The battery in use with the SpO2 Pod is incompatible. Replace it with one approved for use with the SpO2 Pod.cl SpO₂ Batt Low The remaining battery time of the SpO2 Pod is below 2 hours.cl SpO₂ Batt Malf There is a malfunction in the SpO2 Pod's battery system. Contact your service personnel.cl SpO₂ Batt Temp The temperature of the battery in the SpO2 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 SpO₂ Check Batt The battery in the SpO2 Pod is nearing the end of its useful life. Only 50 charge/discharge cycles remain. Contact your service personnel to replace the battery.cl SpO₂ Disconnect The SpO2 Pod has lost the connection to the monitor.cl SpO₂ No Cradle The SpO2 Pod is not in its cradle.cl SpO₂ Remove The temperature of the battery in the SpO2 Pod is too high. Remove the SpO2 Pod from the patient and contact service personnel.cl SpO₂ Serv Batt The battery in the SpO2 Pod has reached the end of its useful life. It can no longer be charged. Contact your service personnel to replace the battery
3 Patient Alarms and INOPs92
4934Managing PatientsUse the Patient Demographics window and its associated pop-up keys to admit, discharge, and transfer (ADT) patients.All patient demographic and ADT information is shared between the patient monitor and the Information Center, for example, patients admitted to the monitor are automatically admitted to a connected Information Center.Note that when an X2 or MP5 monitor is connected to a host monitor, its ability to admit or discharge a patient is disabled, and the host monitor controls patient demographic and ADT information.Admitting a PatientThe monitor displays physiological data and stores it in the trends 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, reports, and networked devices.During admission you enter data that the monitor needs for safe and accurate operation. For example, the patient category setting determines the algorithm the monitor uses to process and calculate some measurements, the safety limits that apply for some measurements, and the alarm limit ranges.NOTEIt is strongly recommended that the same patient data fields be configured to be mandatory at the monitor and the Information Center.To admit a patient,1Select the patient name field or select the Admit/Dischrg SmartKey to open the Patient Demographics window.2Clear any previous patient data by selecting the Dischrge Patient or End Case pop-up key 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, for example, in the trend database.3Select Admit Patient.4Enter the patient information: select each field and use the on-screen keyboard or choose from the pop-up list of alternatives to input information.If a conventional keyboard or a barcode scanner 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 Doe, John.
4 Managing Patients94–Middle Name (if configured to appear): Enter the patient's middle name.–Lifetime Id, Encounter Id: Whether these fields appear and how they are labeled can be configured for your hospital. One or both fields may be displayed and the labels may read: MRN, Case Id, Visit Id, etc. Enter the appropriate data for the fields displayed.–Patient Cat.: Choose the patient category, either Adult, Pedi, or Neo.–Paced: Choose Yes or No (You must use Yes if your patient has a pacemaker).–Height: Enter the patient's height.–Weight: Enter the patient's weight.–BSA: The monitor calculates the body surface area automatically.–Date Of Birth: Enter the patient's date of birth. Enter this in the form dd/mm/yyyy.–Age: The monitor calculates the patient age automatically.–Gender: Choose Male or Female.–Notes (1) / Notes (2): Enter any extra information about the patient or treatment.Select Confirm. The patient's name appears on the monitor info line at the top of the screen.Patient Category and Paced StatusThe patient category setting determines the algorithm the monitor uses to process and calculate some measurements, the safety limits that apply for some measurements, and the alarm limit ranges.The paced setting determines whether the monitor shows pacemaker pulses or not. When Paced is set to No, pace pulses are filtered and therefore do not show in the ECG wave.WARNINGPatient Cat. and Paced status will always contain a value, regardless of whether the patient is fully admitted or not. If you do not specify settings for these fields, the monitor uses the default settings from the current profile, which might not be correct for your patient.Patient categoryChanging the patient category may change the arrhythmia and NBP alarm limits. Always check alarm limits to make sure that they are appropriate for your patient.Paced statusFor paced patients, you must set Paced to Yes. If it is incorrectly set to No, the monitor could mistake a pace pulse for a QRS and fail to alarm during asystole.Admitting a Centrally-Monitored PatientYou can admit a patient at either the bedside or the Information Center. When you admit a patient, the patient's name appears on the bedside monitor and the Information Center.If you do not fill in all patient information required by the Information Center, the Information Center may reject the admission. Complete all the required fields and try again to admit the patient.Quick Admitting a PatientUse Quick Admit only if you do not have the time or information to fully admit a patient. Complete the rest of the patient demographic details later.1Select the Quick Admit SmartKey.
4 Managing Patients952Enter the required data (ID fields or last name depending on configuration) with the keyboard or a barcode scanner.3Select Enter.4In the confirmation window, select Confirm to discharge the previous patient (if confirmation is configured).5Check that patient category and paced status are correct for the new patient.If the monitor is connected to an Information Center and only the ID field is entered, the patient name is set to - - - at the Information Center. 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, select Admit Patient again and complete all required fields.Editing Patient InformationTo edit the patient information after a patient has been admitted, select the patient name field on the Main Screen to open the Patient Demographics window, and make the required changes.Discharging a PatientWARNINGAlways perform a discharge before starting monitoring for a new patient, even if your previous patient was not admitted. Failure to do so can lead to data being attributed to the wrong patient.A discharge:– clears the information in the Patient Demographics window– erases all patient data (such as trend, event, and calculation data) from the monitor, measurement modules and Information Center. This ensures that data from a previous patient are not mixed with data from the new patient.– resets patient category and paced settings to the settings defined in the default Profile– resets all monitor and measurement settings as well as the active Screen to the settings defined in the default Profile– discharges the patient from the Information Center.When a patient is discharged from the monitor or from an Information Center, all patient data is deleted. Make sure that you have printed out any required reports before discharging. Check that a functioning local or central printer is available before you use End Case.To Discharge a Patient1Select the patient name field or select the Admit/Dischrg SmartKey to open the Patient Demographics window and associated pop-up keys.2Select the pop-up key for either:–End Case - to print any configured end case reports or vital signs recording, discharge the patient and clear the patient database, then enter standby mode. If an End Case SmartKey is configured for your monitor, you can also select this instead and then confirm.To see which end case reports are set up for your monitor, select Main Setup, Reports, then Auto Reports. For each auto report, if End Case Report is set to On, this report will be
4 Managing Patients96printed when you select End Case. See the section on AutoReports for information on setting up end case reports.–Dischrge Patient - to discharge the patient without printing any reports.New Patient CheckThe monitor can be configured to ask you in certain situations:• after a specified power-off period• after a specified standby period• when no basic vitals (HR, RR, Pulse, SpO2, NBP) have been measured for a specified periodwhether 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 three conditions can be configured independently.Transferring PatientsTo save you from having to enter the same patient data multiple times and enable patient transfer without loss of data, information can be shared between Multi-Measurement Modules (MMS), patient monitors, and Information Centers.– patient demographic information is shared between connected MMSs, patient monitors, and Information Centers– measurement settings and calibration data can be uploaded from an MMS to a patient monitor, if configured– trend information can be uploaded from an MMS to a patient monitor, if configured.Different sets of patient and measurement-related data are stored in the monitor and the Multi-Measurement Module. Understanding this will help you to understand what happens to patient data when you transfer patients.Patient Information Stored in Monitor Stored in MMS and extensionsPatient demographics (name, DOB, patient IDs)yes yesMonitor settings (alarm pause time, alarm volume)yes no
4 Managing Patients97WARNINGIf the monitor is not battery-powered, you cannot monitor during transport.Transferring a Centrally-Monitored PatientScenario: A centrally-monitored patient is moved to another monitoring location on the same Information Center database server without interrupting the collection of patient trend information.1Before you disconnect the MMS from the monitor, select the patient name field or select the Admit/ Dischrge SmartKey to open the Patient Demographics window, then select the Transfer pop-up key. If the patient is not admitted or not monitored by an Information Center, the Transfer key is inactive ("grayed-out").This step preserves the patient's demographic data during the transfer.2Remove the MMS and any connected extensions from the monitor.3Connect the MMS to the transfer monitor and monitor your patient during the move.4At the new location, connect the MMS to the monitor. If the monitor detects a patient mismatch, a window will open showing your patient's data and asking whether to Complete Transfer Of This Patient?.5Select Yes to complete the transfer. This re-admits the patient from the transfer list to the new monitor. This will upload the patient demographics, and, if configured, the measurement settings and trend data stored in the MMS to the receiving monitor.6Verify that the settings for patient category and paced mode are correct.Measurement settings for all measurements (alarm limits, measurement on/off, etc.)yes yes, for all MMS and extensions measurementsTrend data yes, for all MMS and extensions measurements (up to a maximum of 16 or 32, depending on your database configuration)most recent 8 hours of information, for all MMS and extensions measurementsCalculation data (HemoCalc data)yes noEvents data yes noPatient Information Stored in Monitor Stored in MMS and extensions
4 Managing Patients98Transferring a Centrally-Monitored Patient with X2 or MP5WARNINGMeasurements from a MMS extension connected to an X2 are not available when the X2 is running on battery power. They are only available when the X2 is running on external power, either when connected to a host monitor or the external power supply (M8023A).Scenario: A centrally-monitored patient is moved to another monitoring location on the same Information Center database server without interrupting the collection of patient trend information.1Before you disconnect the X2/MP5 from the host monitor, select the patient name field or select the Admit/ Dischrge SmartKey to open the Patient Demographics window, then select the Transfer pop-up key. If the patient is not admitted or not monitored by an Information Center, the Transfer key is inactive ("grayed-out").This step preserves the patient's demographic data during the transfer.2Remove the X2/MP5 and any connected extensions from the monitor.3Move the patient using the X2/MP5 as the transport monitor.4At the new location, connect the X2/MP5 to the new host monitor. If the monitor detects a patient mismatch, a window will open showing your patient's data and asking Complete Transfer Of This Patient?.5Select Yes to complete the transfer. This re-admits the patient from the transfer list to the new monitor. This will upload the patient demographics, and, if configured, the measurement settings and trend data stored in the X2/MP5 to the receiving monitor.6Verify that the settings for patient category and paced mode are correct.Transferring a Centrally-Monitored Patient with X2 or MP5 using IITWARNINGMeasurements from a MMS extension connected to an X2 are not available when the X2 is running on battery power. They are only available when the X2 is running on external power, either when connected to a host monitor or the external power supply (M8023A).Scenario: A centrally-monitored patient is moved with an X2 or MP5 to another monitoring location on the same Information Center database server without interrupting the collection of patient trend information. The X2/MP5 has an IntelliVue Instrument Telemetry interface (IIT), is connected to a host monitor, and is declared as a telemetry device at the Information Center.NOTEThe Transfer key is not available while the X2/MP5 is connected to a host monitor (Companion Mode is indicated).1Remove the X2/MP5 and any connected extensions from the host monitor.2Move the patient using the X2/MP5 as the transport monitor.3At the new location, just before connecting the X2/MP5 to the new host monitor:– open the Patient Demographics window.– select the Transfer pop-up key.
4 Managing Patients99–wait until the transfer has completed.4Connect the X2/MP5 to the new host monitor. The monitor detects a patient mismatch and a window will open showing your patient's data and asking Complete Transfer Of This Patient?.5Select Yes to complete the transfer. This re-admits the patient from the transfer list to the new monitor. This will upload the patient demographics, and, if configured, the measurement settings and trend data stored in the X2/MP5 to the receiving monitor.6Verify that the settings for patient category and paced mode are correct.If you accidentally transfer a patient, use Re-Admit to restore this patient's data to the Information Center. If you are not connected to the network, select Clear Transfer to leave transfer mode. The patient data remains in the monitor.Transferring a Patient with an X1 (no Information Center)Scenario: A patient is moved to another monitoring location using a transport monitor and re-admitted at the new monitor.1Disconnect the X1 from the original monitor and silence the resulting UNPLUGGED INOP.If you are sure that the patient will not be returning to this monitor, you should perform a discharge or end-case. This prevents data from the next patient accidentally being mixed up with your current patient's data.2Connect the X1 to the transport monitor and move the patient.3At the new monitoring location, remove the X1 from the transport monitor and connect it to the new monitor.4If prompted, re-admit the patient to the new monitor: in the Select Patient window, select the patient in the X1 to retain the data in the X1. This will upload the patient demographics, and, if configured, the measurement settings and trend data stored in the X1 to the monitor. Verify that the settings for patient category and paced mode are correct.Transferring a Patient with an X2 or MP5 (no Information Center)WARNINGMeasurements from a MMS extension connected to an X2 are not available when the X2 is running on battery power. They are only available when the X2 is powered from AC mains, either when connected to a host monitor or the external power supply (M8023A).Scenario: A patient is moved to another monitoring location using the X2 or MP5 and re-admitted at the new monitor.1Disconnect the X2/MP5 from the original host monitor and silence the resulting UNPLUGGED INOP.If you are sure that the patient will not be returning to this monitor, you should perform a discharge or end-case. This prevents data from the next patient accidentally being mixed up with your current patient's data.2Move the patient using the X2/MP5 as the transport monitor.3At the new monitoring location, connect the X2/MP5 to the new host monitor.4If prompted, re-admit the patient to the new monitor: in the Select Patient window of the new monitor, select the patient in the X2/MP5 to retain the data in the X2/MP5. This will upload the
4 Managing Patients100patient demographics, and, if configured, the measurement settings and trend data stored in the X2/MP5 to the monitor. Verify that the settings for patient category and paced mode are correct.Data Upload from an MMSThe Multi-Measurement Module stores eight hours of patient trend data at one-minute resolution. It also stores patient demographic information and the measurement settings (including the ST baseline) and calibration data for the measurements carried out by the MMS and any connected extensions. This data can be uploaded to an IntelliVue patient monitor, if your monitor is configured to do so and if at least five minutes of trend information is stored in the MMS.Your monitor's data upload settings are defined in Configuration Mode to suit your patient transfer use model.How data is uploaded to the host monitor depends on the configuration mode settings MMS Trend Upload and MMS Sett. Upload.If there is a patient mismatch and you select Continue Monitor, no data will be uploaded from the MMS.Data Exchange Between Information CentersYou can transfer demographic data and trend data from one IIC to another by selecting Transfer on the patient monitor. Trend data is not shared between Information Centers and monitors.Resolving Patient Information MismatchWhen you connect together devices which store patient demographic data, for example:• an MMS and a monitor,• an X2 or MP5 and a host monitor,• a monitor and an Information Center,the system compares patient category, paced status, and unique patient identification in order to synchronize this information. If configured to do so, the monitor indicates a mismatch if the information is not identical.Depending on your monitor's configuration, this mismatch may be automatically resolved or you may have to resolve it manually. If your monitor is configured to resolve mismatches automatically, depending on the configuration, either the monitor or the Multi-Measurement Module data is automatically retained.WARNING1When a monitor is connected to an Information Center by the wireless IntelliVue Instrument Telemetry interface, the patient data will automatically be merged in the case of a transfer. This means there is no patient discharge at the monitor and settings and trend data will be retained. You will see a message on the monitor and the Patient Demographics window will automatically appear so that you can check the data and change it if necessary.2It is important to resolve the mismatches as soon as they are identified. Failure to do so could result in using incorrect/confusing data to make clinical decisions. Certain settings, for example Paced and Patient Cat., may not match between the Information Center and the monitor. If the Paced status is set incorrectly, the system could mistake a pace pulse for a QRS and fail to alarm in
4 Managing Patients101the case of asystole. It is important that the patient category is set correctly so the ECG can be analyzed correctly and initial arrhythmia alarm limits set.In the case where an MP5 or X2 with an IntelliVue Instrument Telemetry interface is declared as a "telemetry device" at the Information Center and is connected to a host monitor, it is important to resolve an existing mismatch between the monitor and the Information Center before disconnecting the MP5/X2. Failure to do so discharges the MP5/X2 and synchronizes the demographics and settings to the Information Center.Manually Resolving Patient MismatchThe patient mismatch is indicated by question marks (???) beside the questionable fields in the Monitor Info Line and in the Select Patient window. The monitor displays a message such as Different patients in Central and Monitor.The Select Patient window automatically opens so you can decide which patient data to use. You do not have to resolve the mismatch immediately, but the indicators remain until you do.For some common mismatch situations, the monitor will simplify the resolution by suggesting a solution for the mismatch. For example, when a patient arrives after transport and the Transfer key has been selected, the monitor will show this patient's data and ask Complete Transfer Of This Patient?. You can then select Yes to complete the transfer. If you select No you will go to the Select Patient window.There can be up to three sets of demographic data in the Select Patient window if the patient is different in the Information Center, monitor, and MMS.After you resolve the mismatch, the monitor displays a confirmation window that shows the patient that has been selected and where data will be erased, if applicable. Confirm your choice. The monitor automatically displays the Patient Demographics window after confirmation. Verify that the settings shown are correct for the patient.Gender, date of birth, height, weight, and nursing notes do not generate a mismatch. If these fields are different on different devices, the monitor resolves them itself. For example, it may take date of birth from the Information Center, whilst taking gender from the MMS. Always check the Patient Demographics after combining patients, to ensure that you are satisfied with the results. Change them if necessary.WARNINGAfter resolving a patient mismatch, check that the monitor settings (especially patient category, paced status and alarm limits) are correct for the patient.Patient Mismatch - If One Set of Patient Data is CorrectIf there is a mismatch between an Information Center and a monitor, or a monitor and an MMS, choose the data set you want to continue using for this patient by selecting one of the sectors in the Select Patient window.
4 Managing Patients1021Patient demographics2Patient category and paced status3Same Patient - see “Patient Mismatch - If Both Patient Data Sets Are Correct” on page 102 below.4New Patient - see “Patient Mismatch - If Neither Patient Data Set is Correct” on page 102 below.After you resolve the mismatch, the monitor displays a confirmation window that shows the patient that has been selected and where data will be erased, if applicable. Confirm your choice. The monitor automatically displays the Patient Demographics window after confirmation. Verify that the settings shown are correct for the patient.Patient Mismatch - If Neither Patient Data Set is CorrectA patient mismatch where neither set of patient data is correct might occur if you connect a new MMS to a monitor in order to prepare for a new patient, before you actually start measuring.Select New Patient if you are sure that none of the information is correct. This discharges all patients, erases all data in both the monitor and MMS, resets all settings to the default Profile, and lets you admit a new patient.Patient Mismatch - If Both Patient Data Sets Are CorrectA patient mismatch where both sets of patient data are correct might occur if you admit a new patient at the monitor (or Information Center) before the patient arrives at your unit and then connect the MMS that was used during the patient transport to the monitor.Select Same Patient if the patient information is different, but you are sure it is the same patient. This merges the demographics and updates them in the Information Center, monitor, and MMS, according to this table. Be aware that your monitor may be configured to merge trend data from the MMS and the monitor, and to upload measurement settings from the MMS to the monitor.Patient Information This information is taken from...Patient name the monitor, if the patient was admitted there. For centrally-admitted patients, this information is taken from the Information Center.Patient IDsScreen Notes
4 Managing Patients103Automatically Resolving Patient MismatchYour monitor can be configured to automatically resolve mismatches in one of two ways.• continue using the patient in the MMS, and delete the old data in the monitor. This is suitable for transport monitors.• continue with the patient in the monitor, and delete the data in the MMS.Care GroupsIf your monitor is connected to an Information Center, you can group bedside monitors into Care Groups. This lets you:• view information on the monitor screen from another bed in the same or in a different Care Group.• be notified of yellow or red alarm conditions at the other beds in the Care Group.• see the alarm status of all the beds in the Care Group on each monitor screen.There are two main types of Care Groups:• standard care group (Bed-based Care Group) - up to 12 patients monitored by up to 4 Information Centers• unit group (Unit-based Care Group) - for a complete unit with up to 64 patients monitored by up to 4 Information CentersMonitors must be assigned to these Care Groups at the Information Center. There is a third care group which can be assigned locally at the bedside. This is the My Central care group which includes all beds (up to 16) from the Information Center your bed is connected to. This care group setting is typically used in facilities with only one Information center. The selection of beds is automatic and cannot be changed.The functions available with Care Groups depend on the Information Center revision your monitors are connected to. See your Information Center Instructions for Use for further details.Patient Category the Multi-Measurement Module, if connected, otherwise the data is taken from the monitor.Date of BirthHeightWeightGenderPaced Status Paced status is always set to Yes where there is a mismatch in patient information.Trend data if there is newer trend data stored in the MMS, it is uploaded to the monitor.Patient Information This information is taken from...
4 Managing Patients104Understanding the Care Group Overview BarThe Care Group monitors' status is shown in symbol form in the Care Group overview bar. Flashing symbols indicate active alarms, symbols that are not flashing indicate alarms that have been acknowledged. Selecting a bed symbol calls up the window for that bed or a setup window to select this.The Care Group overview bar must be configured to display on the monitor Screen. If it is not visible on your monitor, select a Screen which has been configured to show the bar.Care Group Symbols (four alternative display possibilities depending on space available)No data from this bedThe alarms are on but there are no currently active alarms at this monitorThe highest priority alarm at this monitor is a standard INOPThe highest priority alarm at this monitor is a short yellow alarmThe highest priority alarm at this monitor is a yellow alarmThe highest priority alarm at this monitor is a red alarmThe highest priority alarm at this bed is a yellow INOPThe highest priority alarm at this bed is a red INOP
4 Managing Patients105Viewing the My Care Group WindowThis window shows the alarm status, bed name, and patient name for every bed in the Care Group.The window for the Unit group shows first the beds of the Information Center this bed is connected to. By selecting the Information Center name at the top of the list, you can display a list of all Information Centers associated with the Unit group, and select another Information Center to view.To enter the My Care Group window,• select the Other Patients SmartKey, if configured, or•in the Main Setup menu, select My Care Group.The alarms at this monitor are suspendedThe monitor is in standby modeThe monitor is in Demonstration modeThe current monitorCare Group Symbols (used in the Care Group overview bar and the My Care Group window)This is a telemetry bed This bed is on a wireless network.This bed is on a wired network.This is a "paired" bed, with a bedside monitor and a telemetry transmitter assigned.Care Group Symbols (four alternative display possibilities depending on space available)
4 Managing Patients106Use the My Care Group pop-up keys to navigate through the Care Groups:My Unit lets you view a list of all the Information Centers in your Care Unit. Select an Information Center to see a list of the monitors connected to it. Select any monitor to see the Other Patient window for that bed.Other Units lets you view a list of all the Care Units in your Care Domain. Select any Care Unit to view a list of the Information Centers connected to it. Select an Information Center to see a list of the monitors connected to it. Select any monitor to see the Other Bed window for that bed.Alarming Beds lets you view a list of all beds in your care group with an unacknowledged alarm. The beds are listed in order of alarm severity.Viewing the Other Bed WindowThe Other Bed window lets you view a subset of the waveform and numeric information from another bed on the same network. Waves and numeric information from another bed are delayed. If configured, Other Bed information is displayed in color, using the colors defined by the Information Center.The Other Bed window can be configured to pop-up automatically when an alarm occurs at another bed. To avoid too many windows appearing (for example, in large care groups) and covering the monitor's own bed data on the screen, you can temporarily disable this automatic pop-up:1Select Main Setup then Network followed by Auto Window2Select DisabledWhen automatic pop-up is disabled in this way, an icon will appear as a reminder in the Care Group Overview Bar next to the monitor's own bed label  . Depending on the configuration, the automatic pop-up is disabled for five minutes or until you set it to Enabled again. • To open the Other Bed window, select the required bed label or patient name in the Care Group Overview Bar. If you are in a Unit Group with many beds, the My Care Group window may open for you to select the bed.The Other Bed window may be configured to display embedded in a specially designed Screen.• To display the embedded Other Bed screen element, in the Change Screen menu, select a Screen designed to show the Other Bed information permanently.
4 Managing Patients107Note that a Screen with an embedded Other Bed screen element cannot be displayed on the D80 Intelligent Display.Changing the Screen may automatically change the bed shown in the other bed window. If you switch to a different Screen, you should check that the correct other bed is displayed.Other Bed Pop-Up KeysSelect the Other Patients SmartKey or the Other Bed window or embedded screen element to access the associated pop-up keys:Next Wave lets you view waveforms not currently shown in the other bed window.More Vitals lets you view more numerics not currently shown in the other bed window.Next Bed lets you view waveforms and numerics from the next available bed in the Care Group.My Care Group lets you call up the Care Group window to select another bed.Alarming Beds lets you view a list of all beds in your care group with an unacknowledged alarm. The beds are listed in order of alarm severity.Silence Bed lets you silence active alarms at the other bed. (Whether you see this key depends on the revision and configuration of the Information Center your monitors are connected to.)WARNINGThe Silence Bed pop-up key in the Other Bed window silences alarms at a remote bed. Be aware that accidental use of this key could silence alarms for the wrong patient.To silence own bed alarms use the Silence permanent key on screen.Visual Alarm Status Information in the Other Bed Window• If individual alarms are switched off at the other bed, this is indicated by the crossed alarm symbol beside the measurement numeric.• If alarms are switched off at the other bed, the message Alarms Off is shown in the other bed window.• In the embedded Other Bed window, the crossed speaker symbol in the upper right hand indicates that the volume of the audible alarm status change notification for the other beds in the care group is set to zero at the overview monitor.
4 Managing Patients108Care Group AlarmsChanges in the alarm status of beds in a Care Group are announced visually and audibly at all other beds in the same Care Group. The visual and audible indicators used depend on the monitor and Information Center configuration.When an alarm is detected at another bed in the Care Group,• the alarm status is shown in the Care Group overview bar as an icon.• a message informing you about the care group alarm is shown in the monitor status line.• if configured, the Other Bed window, the Alarming Beds window or the My Care Group window may pop up on the Screen (if automatic alarm notification is enabled at the bedside monitor and at the Information Center). The automatic alarm notification is suppressed when a window, menu or pop-up keys are active.• if configured, an audible status change notification is issued. The tone type and volume can be configured.Automatic alarm notification can be switched off permanently in the monitor's Configuration Mode or at the Information Center. To temporarily disable and re-enable automatic alarm notification at the bedside monitor, for example if you want to carry out a procedure, in Monitoring Mode:1Select the network symbol on the monitor screen to call up the Network menu.2Select Auto Window to toggle between the settings Enabled and Disabled.This setting resets to the default at discharge and when the monitor is switched on. Always re-enable the Auto Window as soon as possible.
51095ECG, Arrhythmia, ST and QTMonitoringThe electrocardiogram (ECG) measures the electrical activity of the heart and displays it on the monitor as a waveform and a numeric. This section also tells you about arrhythmia monitoring (see “About Arrhythmia Monitoring” on page 127), ST monitoring (see “About ST Monitoring” on page 137) and QT monitoring (see “About QT/QTc Interval Monitoring” on page 147).Skin Preparation for Electrode PlacementGood electrode-to-skin contact is important for a good, noise-free ECG signal, as the skin is a poor conductor of electricity.1Select sites with intact skin, without impairment of any kind.2Clip or shave hair from sites as necessary.3Wash sites thoroughly with soap and water, leaving no soap residue.We do not recommend using ether or pure alcohol, because this dries the skin and increases the resistance.4Dry skin thoroughly.5Gently abrade the skin using ECG skin preparation paper to remove dead skin cells to improve the conductivity of the electrode site.Connecting ECG Cables1Attach the clips or snaps to the electrodes before placing them. If you are not using pre-gelled electrodes, apply electrode gel to the electrodes before placement.2Place the electrodes on the patient according to the lead placement you have chosen.3Attach the electrode cable to the patient cable.4Plug the patient cable into the white ECG connector. An ECG waveform and numeric appears on the monitor display.
5 ECG, Arrhythmia, ST and QT Monitoring110CAUTIONTo protect the monitor from damage during defibrillation, for accurate ECG information and to protect against noise and other interference, use only ECG electrodes and cables specified by Philips.Selecting the Primary and Secondary ECG LeadsThe monitor uses the primary and secondary lead to compute HR and to analyze and detect cardiac arrhythmias. They are also available for recordings and for display on the Information Center.The secondary lead is only used if your monitor is configured for multi-lead (instead of single-lead) arrhythmia analysis.You should choose a lead as primary or secondary lead that has the following characteristics:To select a lead as primary or secondary lead:•In the Setup ECG menu, select Primary or Secondary, then select the appropriate lead. You can assign any available lead whether it is currently displayed or not.Checking Paced StatusIt is important to set the paced status correctly when you start monitoring ECG.♦To change the paced status in the Setup ECG menu, select Paced to toggle between Yes or No.WARNINGPace pulse rejection must be switched on for paced patients by setting Paced to Yes. Switching pace pulse rejection off for paced patients may result in pace pulses being counted as regular QRS complexes, which could prevent an asystole event from being detected. When changing profiles, and at admission/discharge, always check that paced status is correct for the patient.Some pace pulses can be difficult to reject. When this happens, the pulses are counted as a QRS complex, and could result in an incorrect HR and failure to detect cardiac arrest or some arrhythmias. Make sure that pace pulses are detected correctly by checking the pace pulse markers on the display. Keep pacemaker patients under close observation.Understanding the ECG DisplayYour display may be configured to look slightly different.• the QRS complex should be either completely above or below the baseline and it should not be biphasic• the QRS complex should be tall and narrow• the P-waves and T-waves should be less than 0.2 mV
5 ECG, Arrhythmia, ST and QT Monitoring1111Lead label of the displayed wave21 mV calibration bar3Pacer spikes4Pace pulse markers5Current heart rate6Current heart rate alarm limits7EASI lead placement label8ECG Filter labelECG HR numeric: This is the heart rate derived from the monitored ECG.Pace pulse markers: These are shown if the Paced status has been set to Yes, the pacer spikes are not configured to have a fixed size, and the patient has a paced signal.Pacer Spikes: The pacer spikes are shown in white, unless the ECG wave is white, then they will be green. If the pacer spikes have been configured to have a fixed size, they will be displayed in the background as a dotted line.Defibrillator synchronization marks: If an HP/Agilent/Philips defibrillator is connected, or the 2nd Sync Out channel is configured to ECG SyncPuls and a sync cable is plugged in, the synchronization marks (vertical lines on the ECG wave) are shown on the ECG wave. The synchronization marks will be shown in yellow, unless the ECG wave is yellow, then they will be green.ST numerics in ECG wave: ST numerics can be configured to show underneath the ECG wave on the left side.Monitoring Paced PatientsAn ECG optimized for monitoring a paced patient should look like this:You should choose a lead as primary or secondary lead that has these characteristics:1Pacer spikes configured to have a fixed size1Normal Beats2Pace Pulses/Beats
5 ECG, Arrhythmia, ST and QT Monitoring112• the normal QRS complex should be either completely above or below the baseline and it should not be biphasic. For paced patients, the QRS complexes should be at least twice the height of pace pulses.• the QRS complex should be tall and narrow• the P-waves and the T-waves should be less than 0.2 mV.For ease of identification on the screen, the pacer spikes can be configured to have a fixed size. They are then shown in the background as a dotted lines. The length of the dotted line is fixed to the wave channel height and is independent of the actual pacer amplitude.Setting the Paced Status (Pace Pulse Rejection)Avoiding Pace Pulse Repolarization TailsSome unipolar pacemakers display pace pulses with repolarization tails. These tails may be counted as QRSs in the event of cardiac arrest or other arrhythmias.If you note a visible repolarization tail, choose a lead that decreases the size of the repolarization tail.Changing the Size of the ECG WaveIf any of the displayed ECG waves is too small or clipped, you can change the size of one or all of the ECG waves on the screen.In the Setup ECG menu, select Paced to toggle between Yes and No.You can also change the paced status in the Patient Demographics window.When Paced is set to Yes:– Pace Pulse Rejection is switched on. This means that pacemaker pulses are not counted as extra QRS complexes.– pace pulse marks are shown on the ECG wave as a small dash (only when the pacer spikes are not configured to have a fixed size).– The paced symbol is displayed on the main screen.When Paced is set to No, pacer spikes are not shown in the ECG wave. Be aware that switching pace pulse rejection off for paced patients may result in pace pulses being counted as regular QRS complexes, which could prevent an asystole event from being detected.PacedNon-Paced1Repolarization tail (note width)
5 ECG, Arrhythmia, ST and QT Monitoring113Changing the adjustment factor only changes the visual appearance of the ECG wave on the screen. It does not affect the ECG signal analyzed by the monitor.Comparing the wave size to the 1 mV calibration bar on the ECG wave segment can help you to get an idea of the true ECG signal strength. If you choose a fixed adjustment factor, the 1 mV calibration bar will be the same size for all the displayed ECG waves. If you choose Auto Size, or an individual size using the Size Up/Size Down keys, the calibration bar may be a different size for each wave.To Change the Size of an Individual ECG Wave1Select the wave segment you want to change. This calls up the lead menu for this segment.2In the lead menu, select Size Up to increase wave size or Size Down to decrease the size.Selecting Auto Size lets the monitor choose the optimal adjustment factor for all available ECG waves.To Change the Size of all the ECG WavesTo change the size of all the ECG waves on the screen by a fixed adjustment factor,1In the Setup ECG menu, select Adjust Size.2Select the required adjustment factor from the line of pop-up keys.–Size X0.5 to halve the wave size–Size X1 to display the wave without zoom–Size X2 to double the wave size–Size X4 to multiply the wave size by four–Previous Size: to return one step to the previous size–Auto Size: to let the monitor choose the optimal adjustment factor for all the ECG waves.Changing the Volume of the QRS ToneThe QRS tone is derived from either the HR or Pulse, depending on which is currently selected as the alarm source. The QRS volume can be set from 0 to 10 (0 means off).To change the QRS volume, in the Setup ECG menu select QRS Volume and then select the appropriate volume from the pop-up list.Changing the ECG Filter SettingsThe ECG filter setting defines how ECG waves are smoothed. An abbreviation indicating the filter type is shown underneath the lead label on the monitor display. Filter settings do not affect ST measurement.To change the filter setting, in the Setup ECG menu, select Filter and then select the appropriate setting.–Monitor: Use under normal measurement conditions.–Ext. Monitor: Use when diagnostic quality is required but low frequency interference or a wandering baseline may be expected. The upper edge frequency is the same as the Diag setting and the lower edge frequency is the same as the Monitor setting.–Filter: The filter reduces interference to the signal. It should be used if the signal is distorted by high frequency or low frequency interference. High frequency interference usually results in large amplitude spikes making the ECG signal look irregular. Low frequency interference
5 ECG, Arrhythmia, ST and QT Monitoring114usually leads to a wandering or rough baseline. In the operating room, the Filter reduces artifacts and interference from electrosurgical units. Under normal measurement conditions, selecting Filter may suppress the QRS complexes too much and thus interfere with the clinical evaluation of the ECG displayed on the monitor. This does not affect the ECG analysis performed by the monitor.If AutoFilter is set to On in Configuration Mode, the filter setting will automatically be set to Filter if electromagnetic interference is detected.–Diag: Use when diagnostic quality is required. The unfiltered ECG wave is displayed so that changes such as R-wave notching or discrete elevation or depression of the ST segments are visible.The setting Diag selects the highest available ECG bandwidth which is 0.05 to 150 Hz for the Adult, Pedi and Neo patient category. The term "diagnostic" relates only to the ECG bandwidth requirements for diagnostic electrocardiographic devices as outlined in the ANSI/AAMI standard EC11-1991.Selecting Positions of Va and Vb Chest Leads (for 6-lead placement)The two chest leads for the 6-lead placement can be positioned at any two of the V1 to V6 positions. Select the positions you have used in the Setup ECG menu, so that the chest leads will be correctly labeled.1In the Setup ECG menu, select Va Lead.2Select the position used from the list.3Select Vb Lead and select the position used from the list.Choosing EASI or Standard Lead PlacementYou must enable either standard lead placement or EASI lead placement.•In the Setup ECG menu, select Lead Placement and then Standard or EASI.EASI is shown beside the 1 mV calibration bar on the ECG wave on the display, and EASI is marked on any recorder strips and printouts.See the section on “EASI ECG Lead Placement” on page 123 for electrode placement diagrams.About ECG LeadsTo make it possible to compare measured ECG signals, the electrodes (or lead sets) are placed in standardized positions, forming so-called "leads". To obtain ECG signals optimized for use in diagnosis and patient management in different care environments, different lead sets in varying lead placements can be used. You can use either standard lead placements or EASI lead placements with this monitor.When placing electrodes, choose a flat, non-muscular site where the signal will not be interfered with by either movement or bones. Correct lead placement is always important for accurate diagnosis. Especially in the precordial leads, which are close to the heart, QRS morphology can be greatly altered if an electrode is moved away from its correct location.
5 ECG, Arrhythmia, ST and QT Monitoring115ECG Leads MonitoredChanging Lead SetsTo change the ECG lead set,•When adding leads: place the additional electrodes as required - the monitor automatically recognizes the new lead placement.•When removing leads: there are two possibilities - removing the complete chest leads block or removing individual leads. If you unplug the chest lead block from the trunk cable connector, the monitor will automatically recognize the new lead placement. Remove individual leads by removing the electrodes. The monitor will issue a LEAD OFF INOP message; select New Lead Setup in the Setup ECG menu and the INOP message will disappear.ECG Lead FallbackIf fallback is configured on and there is a leads off INOP in the primary lead (and in the secondary lead, if you are using multi-lead monitoring) for longer than 10 seconds, and if another lead is available, this available lead automatically becomes the primary lead. This is known as lead fallback. When the Leads Off condition is corrected, the leads are automatically switched back.This setting can only be changed in Configuration Mode.ECG Lead PlacementsThe labels and colors of the ECG electrodes differ according to the standards that apply for your hospital. The electrode placement illustrations in this chapter use the AAMI labels and colors.If you are using these leads are available: Resp is measured between electrodes:a 3-electrode set I, II, III RA and LLa 5-electrode set I, II, III, aVR, aVL, aVF, V and MCL RA and LLa 6-electrode set I, II, III, aVR, aVL, aVF, Va, Vb RA and LLa 10-electrode set I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6 RA and LLan EASI 5-electrode set I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6 I and AElectrode labels Electrode colorsAAMI EASI IEC AAMI IECRA I R White RedLA S L Black YellowLL A F Red GreenRL N N Green BlackVECBrown WhiteV1 C1 Brown/Red White/Red
5 ECG, Arrhythmia, ST and QT Monitoring116Standard 3-Lead PlacementV2 C2 Brown/Yellow White/YellowV3 C3 Brown/Green White/GreenV4 C4 Brown/Blue White/BrownV5 C5 Brown/Orange White/BlackV6 C6 Brown/Violet White/VioletElectrode labels Electrode colorsAAMI EASI IEC AAMI IEC1RA placement: directly below the clavicle and near the right shoulder2LA placement: directly below the clavicle and near the left shoulder3LL placement: on the left lower abdomen
5 ECG, Arrhythmia, ST and QT Monitoring117Standard 5-Lead Placement6-Lead PlacementFor a 6-lead placement use the positions from the 5-lead diagram above but with two chest leads. The two chest leads, Va and Vb, can be positioned at any two of the V1 to V6 positions shown in the chest electrode diagram below. The Va and Vb lead positions chosen must be selected in the Setup ECG Menu to ensure correct labeling.1RA placement: directly below the clavicle and near the right shoulder2LA placement: directly below the clavicle and near the left shoulder3RL placement: on the right lower abdomen4LL placement: on the left lower abdomen5V placement: on the chest, the position depends on your required lead selection
5 ECG, Arrhythmia, ST and QT Monitoring118Chest Electrode PlacementFor accurate chest electrode placement and measurement, it is important to locate the fourth intercostal space. 1Locate the second intercostal space by first palpating the Angle of Lewis (the little bony protuberance where the body of the sternum joins the manubrium). This rise in the sternum is where the second rib is attached, and the space just below this is the second intercostal space.2Palpate and count down the chest until you locate the fourth intercostal space.10-Lead PlacementWhen monitoring 12-leads of ECG, using a 10-Electrode Lead Placement, it is important to correctly place electrodes and to label all 12-lead ECG reports with the correct lead placement.V1 on the fourth intercostal space at the right sternal borderV2 on the fourth intercostal space at the left sternal borderV3 midway between the V2 and V4 electrode positionsV4 on the fifth intercostal space at the left midclavicular lineV5 on the left anterior axillary line, horizontal with the V4 electrode positionV6 on the left midaxillary line, horizontal with the V4 electrode positionV3R -V6R on the right side of the chest in positions corresponding to those on the leftVE over the xiphoid processV7 on posterior chest at the left posterior axillary line in the fifth intercostal spaceV7R on posterior chest at the right posterior axillary line in the fifth intercostal spaceA - Angle of Lewis
5 ECG, Arrhythmia, ST and QT Monitoring119Conventional 12-Lead ECGIn conventional 12-Lead ECG using 10 electrodes, an electrode is placed on the right arm, left arm, right leg, and left leg. Six V- electrodes are placed on the chest. The right leg electrode is the reference electrode.Limb electrodes:– Place arm electrodes on the inside of each arm, between the wrist and the elbow.– Place leg electrodes inside of each calf, between the knee and the ankle.Chest electrodes:V1 - on the 4th intercostal space at the right sternal borderV2 - on the 4th intercostal space at the left sternal borderV3 - midway between the V2 and V4 electrode positionsV4 - on the 5th intercostal space at the left midclavicular lineV5 - on the left anterior axillary line, horizontal with the V4 electrode positionV6 - on the left midaxillary line, horizontal with the V4 electrode position1V1 - V62LA3RA4RL5LL
5 ECG, Arrhythmia, ST and QT Monitoring120Modified 12-Lead ECGIf your institution uses modified 10 Lead ECG electrode placement (the Mason-Likar Lead System), place the four limb electrodes close to the shoulders and lower abdomen.The six V electrodes are placed on the chest in the same position as the conventional 12-lead placement.Choosing Standard or Modified Electrode PlacementIf your institution uses modified 10 Lead ECG electrode placement (the Mason-Likar Lead System), you must switch Mod.LeadPlacment to On in the monitor. To do this,•in the Setup ECG menu, select Mod.LeadPlacment to toggle between On and Off.– When Mod.LeadPlacment is set to On, 12 Lead ECG Reports will be labeled 12 Lead ECG Report (Mason-Likar), and captured 12-lead ECGs will be labeled Mason-Likar to the right of the bandwidth annotation at the Information Center.– When Mod.LeadPlacment is set to Off, 12 Lead ECG Reports will be labeled 12 Lead ECG Report (Standard), and captured 12-lead ECGs will not be annotated at the Information Center.WARNINGDo not use ECG analysis interpretation statements and measurements for 12-lead ECGs obtained using the modified (Mason-Likar) limb electrode placement. This may lead to misdiagnosis since the modified (Mason-Likar) limb electrode placement does not look the same as the conventional 12-lead ECG and may mask inferior infarction due to calculated axis, R, P and T wave magnitudes shifts and ST slope.Do not export 12-lead ECGs obtained using the modified (Mason-Likar) limb electrode placement. Captured 12-Lead ECGs using the modified (Mason-Likar) limb electrode placement exported from the Information Center are not annotated with the Mason-Likar label.1LA2V1-V63LL4RL5RA6Angle of Lewis
5 ECG, Arrhythmia, ST and QT Monitoring121Capture 12-LeadYou can view a 12-Lead ECG on the screen, capture a 12-Lead ECG episode, preview the captured ECG data and then store it and send it to a connected Information Center for analysis. You can also print a 12-Lead report.The monitor can store one 12-Lead ECG episode at any time.Viewing the Realtime 12-Lead ECGTo open the 12-Lead ECG window and view the realtime ECG waves, • Select the Capture 12 Lead SmartKey, or •Select Main Screen, then Capture 12 Lead.If a previously viewed 12-Lead ECG was not stored, a window will pop up asking whether you want to keep it or not. The title bar of the window shows the date and time when this 12-Lead ECG was captured. If you do not need the ECG, select No to discard it, otherwise, select Yes and then select Store & Send to store that 12-Lead ECG and send it to an Information Center (if one is connected).If your patient is not admitted, you will be prompted to enter at least the age and gender of the patient. This information is needed for analysis of the 12-Lead ECG at the Information Center but is not essential if you only want to capture the 12-Lead ECG without sending it for analysis. To enter this information:1Select the Admit Patient pop-up key, then 2Enter the information in the Patient Demographics window.3Open the 12-Lead ECG window again as described above.The age and gender will now be displayed in the title bar of the pop-up keys.To change the way the realtime waves are displayed, select the Change View pop-up key or select the wave area. You can switch between a one or two column display. The two column display lets you see a larger representation of the waves.While the realtime 12-Lead waves are being viewed in the window, the ECG filter mode (see “Viewing the Realtime 12-Lead ECG” on page 121) is changed to the 12-Lead filter setting (see “Setting Up the 12-Lead ECG” on page 122).Capturing the 12-Lead ECGTo capture the last 10 seconds of ECG data, select the Capture Waves pop-up key. The pop-up key is active as soon as enough wave data is available; until then a progress bar is displayed in the title bar of the pop-up keys. A preview of the captured data appears on the screen (unless your monitor is connected to an Information Center with software release earlier than Revision M — then the captured data is automatically stored and sent to the Information Center).The title bar of the pop-up keys will now show the current filter setting and, if you are using EASI lead placement, an EASI indicator (see “EASI ECG Lead Placement” on page 123).You can at any time return to the realtime 12-Lead ECG view by selecting the Show Waves pop-up key. From there, you return to the preview window by selecting the Show Preview pop-up key.
5 ECG, Arrhythmia, ST and QT Monitoring122Setting Up the 12-Lead ECGIn the Preview window, select the Setup 12 Lead pop-up key to choose settings for filter, gain, etc., if changes are needed. All changes apply to both the display and the printed 12-Lead report.Storing and Sending the 12-Lead ECGYou can enter an order number that will then be associated with the 12-Lead ECG. To enter an order number, select the Enter OrderNo. pop-up key. The order number will be displayed in the title bar of the pop-up keys.To store the previewed data on the monitor and send it to a connected Information Center for storage and analysis, select the Store & Send pop-up key. If the monitor is connected to an Information Center, use the Store & Send function before patient transport to store the 12-Lead ECG centrally, as the 12-Lead ECG data will not be uploaded from the MMS to another monitor after transport.If the connection to the Information Center is not active while storing, the 12-Lead ECG will be automatically sent as soon as the connection is established or restored. If a previously stored 12-Lead ECG is waiting to be sent to the Information Center, it will be overwritten when a new 12-Lead ECG is stored and can then not be sent to the Information Center.Printing the 12-Lead ECGPrint a dedicated 12-Lead ECG report by selecting the Print Report pop-up key.Filter Applies a filter to the waveforms.Choices are 0.05-150Hz D, 0.5-150Hz eM, 0.5-40Hz M (or 0.5-55Hz M for pediatric and neonatal patient categories), 0.5-20Hz F. The selected filter will be displayed in the title bar of the pop-up keys.Gain Defines the gain used for the waveforms.Choices are 2.5 mm/mV, 5 mm/mV, 10 mm/mV and 20 mm/mV.Chest Gain Defines the gain for the chest leads relative to the standard gain setting.Choices are Full and Half.Paper Speed Defines the waveform speed.Choices are 25 mm/sec and 50 mm/sec.Format Defines the page layout.Choices are 12X1, 6X2, 3X4, 3X4 1R and 3X4 3R. 1R and 3R refer to 1 or 3 rhythm leads.Time Defines whether all leads show simultaneous or sequential intervals of time, when displaying or printing 2 or more columns.Choices are Sequential and Simultaneous.Rhythm Lead 1Rhythm Lead 2Rhythm Lead 3Defines which lead will be used as rhythm lead 1, 2 or 3.Choices are Primary, Secondary, I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6, V, MCL.This setting is only relevant when 3X4 1R or 3X4 3R is selected as Format.Lead Sequence Defines the sequence in which the leads are presented.Choices are Cabrera and Internat.
5 ECG, Arrhythmia, ST and QT Monitoring123Capture 12-Lead Pop-up KeysHere is a summary of all the pop-up keys available during 12-Lead ECG procedure:EASI ECG Lead PlacementUsing a standard 5-electrode set in EASI lead placement you can monitor up to 12 standard ECG leads simultaneously and continuously at the bedside. EASI provides a monitoring method for trending ST segment changes that can provide an early indication of ischemia.WARNINGEASI-derived 12-lead ECGs and their measurements are approximations to conventional 12-lead ECGs. As the 12-lead ECG derived with EASI is not exactly identical to the 12-lead conventional ECG obtained from an electrocardiograph, it should not be used for diagnostic interpretations.Respiratory monitoring is also possible with the EASI placement; respiration is measured between the I and A electrodes.Place the electrodes as accurately as possible to obtain the best quality EASI measurements.When EASI lead placement is selected, EASI is shown beside the 1mV calibration bar on the ECG wave on the display, and EASI is marked on any recorder strips and printouts.EASI Monitoring During INOP ConditionsIf one of the derived EASI leads has an INOP condition (for example, LEAD OFF), a flat line is displayed. After 10 seconds, the directly acquired EASI AI, AS, or ES lead (depending on which is available) is displayed with the corresponding lead label. This causes an arrhythmia relearn.Pop-up Keys Selecting this pop-up key lets youAdmit Patient enter the age and gender for the patient in the Patient Demographics window, to allow analysis of the 12-Lead ECG.Change View switch between the single column and two-column display of the realtime wave data.Capture Waves capture the current ECG waves and open the preview window.Show Waves return to the realtime 12-Lead ECG view.Show Preview show the preview of the captured 12-Lead wave data.Setup 12 Lead choose settings for filter, gain, display layout, etc.Enter OrderNo. enter an order number that is stored with the capture and displayed in the title bar of the pop-up keys.Print Report print a 12-Lead report.Store & Send store the captured 12-Lead ECG in the monitor and send it to the Information Center.Show Stored view a previously stored 12-Lead ECG, allowing a visual comparison between the current and the stored data.
5 ECG, Arrhythmia, ST and QT Monitoring124EASI Electrode PlacementECG and Arrhythmia Alarm OverviewThe ECG and arrhythmia alarms available depend on which measurements are switched on, and the arrhythmia option enabled for your monitor.• Cardiotach alarms are available when HR is on and the active alarm source is ECG, but arrhythmia is switched off• Basic arrhythmia alarms are available when Arrhythmia is switched on• Advanced arrhythmia alarms are available when Arrhythmia is switched on and the Advanced Arrhythmia option has been enabled for your monitor1E (V) - on the lower sternum at the level of the fifth intercostal space2A (LL) - on the left midaxillary line at the same level as the E electrode3S (LA) - on the upper sternum4I (RA) - on the right midaxillary line at the same level as the E electrode5N - reference electrode - can be anywhere, usually below the sixth rib on the right hip
5 ECG, Arrhythmia, ST and QT Monitoring125Using ECG AlarmsECG alarms can be switched on and off and the high and low alarm limits changed just like other measurement alarms, as described in the Alarms chapter. Special alarm features which apply only to ECG are described here.Extreme Alarm LimitsThe 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.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.Cardiotach Alarms Additional Alarms with Basic Arrhythmia OptionAdditional Alarms with Enhanced Arrhythmia Option***Asystole***Ventricular Fibrillation/Tachycardia***Extreme Bradycardia***Extreme Tachycardia**High heart rate**Low heart rate***Ventricular Tachycardia**Pacer Not Capture**Pacer Not Pacing**PVCs/min HIGH (PVC > limit/min)**Afib**Supraventricular Tach**Missed Beat**Pause**Irregular HR**Ventricular Rhythm**Run PVCs High**Pair PVCs**R-on-T PVCs**Ventricular bigeminy**Ventricular trigeminy**Non-sustain VT**Multiform PVCs1Extreme Brady Limit2Low Limit3High Limit4Extreme Tachy Limit5Δ Extreme Brady6Δ Extreme Tachy
5 ECG, Arrhythmia, ST and QT Monitoring126ECG Alarms Off DisabledBe aware that your hospital department may have decided to disable the Alarms Off setting for ECG in the monitor's Configuration Mode. In this case, HR alarms cannot be switched off in Monitoring Mode. If you try to switch off the HR alarms, you will see the message To activate enter Config and enable Alarms Off.HR Alarms When Arrhythmia Analysis is Switched OffWhen arrhythmia analysis is switched off, only these HR-related alarms will be detected:• the asystole alarm• the ventricular fibrillation/tachycardia alarm• the extreme tachycardia and extreme bradycardia alarms• the high heart rate and low heart rate alarms.Enhanced Asystole DetectionIn order to improve alarming on asystole under certain conditions, you can set Asystole Detect. in Configuration Mode to Enhanced. In enhanced mode an asystole alarm will be suppressed for up to five seconds if a valid beat-to-beat Pulse is detected from a Pressure.ECG Safety InformationCAUTIONInterference from instruments near the patient and ESU interference can cause problems with the ECG wave. See the monitor specifications for more information.WARNINGDefibrillation and Electrosurgery:Do not touch the patient, or table, or instruments, during defibrillation.After defibrillation, the screen display recovers within 10 seconds if the correct electrodes are used and applied in accordance with the manufacturers instructions.ECG cables can be damaged when connected to a patient during defibrillation. Check cables for functionality before using them again.According to AAMI specifications the peak of the synchronized defibrillator discharge should be delivered within 60 ms of the peak of the R wave. The signal at the ECG output on the IntelliVue patient monitors is delayed by a maximum of 30 ms. Your biomedical engineer should verify that your ECG/Defibrillator combination does not exceed the recommended maximum delay of 60 ms.When using electrosurgical (ES) equipment, never place ECG electrodes near to the grounding plate of the ES device, as this can cause a lot of interference on the ECG signal.General:When you are connecting the electrodes or the patient cable, make sure that the connectors never come into contact with other conductive parts, or with earth. In particular, make sure that all of the ECG electrodes are attached to the patient, to prevent them from contacting conductive parts or earth.
5 ECG, Arrhythmia, ST and QT Monitoring127During surgery:Use the appropriate orange electrode ECG safety cable, or lead cable with an orange connector, for measuring ECG in the operating room. These cables have extra circuitry to protect the patient from burns during cautery, and they decrease electrical interference. This also reduces the hazard of burns in case of a defective neutral electrode at the HF device. These cables cannot be used for measuring respiration.Pacemaker failure:During complete heart block or pacemaker failure to pace/capture, tall P-waves (greater than 1/5 of the average R-wave height) may be erroneously counted by the monitor, resulting in missed detection of cardiac arrest.Patients exhibiting intrinsic rhythm:When monitoring paced patients who exhibit only intrinsic rhythm, the monitor may erroneously count pace pulses as QRS complexes when the algorithm first encounters them, resulting in missed detection of cardiac arrest.The risk of missing cardiac arrest may be reduced by monitoring these patients with low heart rate limit at or slightly above the basic/demand pacemaker rate. A low heart rate alarm alerts you when the patient's heart rate drops to a level where pacing is needed. Proper detection and classification of the paced rhythm can then be determined.Filtered ECG signal from external instruments:Instruments such as defibrillators or telemetry units produce a filtered ECG signal. When this signal is used as an input to the bedside monitor, it is filtered again. If this twice-filtered signal is passed to the arrhythmia algorithm, it may cause the algorithm to fail to detect pace pulses, pacemaker non-capture, or asystole, thus compromising paced patient monitoring performance.External pacing electrodes:When a pacemaker with external pacing electrodes is being used on a patient, arrhythmia monitoring is severely compromised due to the high energy level in the pacer pulse. This may result in the arrhythmia algorithm's failure to detect pacemaker noncapture or asystole.Fusion beat pacemakers:Pacemakers that create fusion beats (pace pulse on top of the QRS complex) cannot be detected by the monitor's QRS detector.Rate adaptive pacemakers:Implanted pacemakers which can adapt to the Minute Ventilation rate may occasionally react on the Impedance measurement used by patient monitors for the determination of the Resp value and execute pacing with the maximum programmed rate. Switching off the Resp measurement can prevent this.About Arrhythmia MonitoringArrhythmia analysis provides information on your patient's condition, including heart rate, PVC rate, rhythm, and ectopics. The monitor uses the user-selected primary and secondary ECG leads for single-lead or multi-lead arrhythmia analysis. During arrhythmia analysis, the monitor continuously
5 ECG, Arrhythmia, ST and QT Monitoring128• optimizes ECG signal quality. This is important for arrhythmia analysis. The monitor continuously filters the ECG signal to remove baseline wander, muscle artifact, and signal irregularities. Also, if the Patient Paced status is set to Yes, pace pulses are filtered out to avoid processing them as QRS beats.• detects beats, for example, QRS complexes, identifying them for further analysis.• measures signal features such as R-wave height, width, and timing.• creates beat templates, and classifies and labels beats to aid in rhythm analysis and alarm detection.• examines the ECG signal for ventricular fibrillation, asystole, and noise.Arrhythmia OptionsYour monitor has either the basic or the enhanced arrhythmia option. Both options provide rhythm and ectopic status messages and beat labeling. The number of rhythms being classified, events being detected, and alarms generated differs according to the option. The alarms available with the different options are listed in the section “ECG and Arrhythmia Alarm Overview” on page 124, the rhythm and ectopic messages detected are listed in “Arrhythmia Status Messages” on page 130.Where Can I Find More Information?See the Application Notes on ST and Arrhythmia supplied on your documentation DVD for detailed information on the arrhythmia algorithm and its clinical application.Switching Arrhythmia Analysis On and Off1In the Setup Arrhythmia menu, select Arrhythmia to toggle between On and Off.2Select the Confirm pop-up key which appears at the bottom of the screen.Be aware that when arrhythmia analysis is switched off,– the message Arrhythmia Off appears beside the ECG wave, if configured to do so– only the HR-related alarms are detected (the asystole alarm, the ventricular fibrillation/tachycardia alarm, the extreme tachycardia and extreme bradycardia alarms, the high heart rate and low heart rate alarms)– HR High and HR Low alarms behave like normal yellow alarms, no timeout periods are active.Choosing an ECG Lead for Arrhythmia MonitoringIt is important to select a suitable lead for arrhythmia monitoring.Guidelines for non-paced patients are:– QRS complex should be tall and narrow (recommended amplitude > 0.5 mV)– R-Wave should be above or below the baseline (but not bi-phasic)– T-wave should be smaller than 1/3 R-wave height– the P-wave should be smaller than 1/5 R-wave height.For paced patients, in addition to the above, the pace pulse should be:– not wider than the normal QRS– the QRS complexes should be at least twice the height of pace pulses– large enough to be detected, with no re-polarization.
5 ECG, Arrhythmia, ST and QT Monitoring129To prevent detection of P-waves or baseline noises as QRS complexes, the minimum detection level for QRS complexes is set at 0.15 mV, according to AAMI-EC 13 specifications. Adjusting the ECG wave size on the monitor display (gain adjustment) does not affect the ECG signal which is used for arrhythmia analysis. If the ECG signal is too small, you may get false alarms for pause or asystole.Aberrantly-Conducted BeatsAs P-waves are not analyzed, it is difficult and sometimes impossible for the monitor to distinguish between an aberrantly-conducted supraventricular beat and a ventricular beat. If the aberrant beat resembles a ventricular beat, it is classified as ventricular. You should always select a lead where the aberrantly-conducted beats have an R-wave that is as narrow as possible to minimize incorrect calls. Ventricular beats should look different from these 'normal beats'. Instead of trying to select two leads with a narrow R-wave, it may be easier to just select one lead and use single lead arrhythmia monitoring. Extra vigilance is required by the clinician for this type of patient.Atrial Fibrillation AlarmThe monitor performs atrial fibrillation analysis using information about the RR irregularity, PR interval variability and P wave variability.In order to generate an Afib alarm the following criteria must be detected for 1 minute:• normal beat RR intervals must be irregular• PR interval deviation must be large• P-wave region must not match wellAtrial fibrillation analysis is only available for adult patients and atrial fibrillation detection cannot be performed on PVCs or Paced beats.Since most atrial flutters have regular RR intervals, they cannot be detected by the atrial fibrillation algorithm.An Afib alarm can be falsely detected in the presence of:• sinus arrhythmia,• muscle noise, or• electrode motion artifact.If you also have monitors with earlier software revisions, the Afib alarm will not be generated after a transfer to one of these monitors. Always leave the Irregular HR alarm switched on, so that this alarm can be generated in such situations.See the Application Note on Arrhythmia/ST supplied on your documentation DVD for detailed information on the arrhythmia algorithm and ECG analysis.Intermittent Bundle Branch BlockBundle branch and the other fascicular blocks create a challenge for the arrhythmia algorithm. If the QRS during the block changes considerably from the learned normal, the blocked beat may be incorrectly classified as ventricular, causing false PVC alarms. You should always select a lead where the bundle branch block beats have an R-wave that is as narrow as possible to minimize incorrect calls. Ventricular beats should look different from these 'normal beats'. Instead of trying to select two leads with a narrow R-wave, it may be easier to just select one lead and use single lead arrhythmia monitoring. Extra vigilance is required by the clinician for this type of patient.
5 ECG, Arrhythmia, ST and QT Monitoring130Understanding the Arrhythmia DisplayYour monitor screen may look slightly different from the illustration.1Beat label2Pace pulse marks3Rhythm status message4PVC Numeric5HR Numeric6Ectopic status message7Delayed arrhythmia waveViewing Arrhythmia WavesTo review arrhythmia beat labels, in the Setup Arrhythmia menu, select Annotate Arrhy.The wave showing the primary ECG lead will be delayed by six seconds and shown on a gray background. Beat labels will be annotated above the ECG wave and Delayed will be written beside it.To return to the normal ECG primary lead display, select Annotate Arrhy again.Arrhythmia Beat LabelsArrhythmia beat labels tell you how the monitor is classifying beats.N = NormalV = Ventricular EctopicS = Supra-ventricular PrematureP = Paced' = Pacer spike" = Biventricular Pacer SpikeL = Learning patient's ECGA = Artifact (noisy episode)? = Insufficient information to classify beatsI = Inoperative condition (e.g., LEADS OFF)M = Pause or missed beatArrhythmia Status MessagesThe monitor displays two types of status messages:
5 ECG, Arrhythmia, ST and QT Monitoring131• Rhythm Status Messages -- to indicate the patient's rhythm.• Ectopic Status Messages -- to indicate the presence of ectopic beats.These status messages are shown on the right hand side of the primary ECG wave. They are updated every second, with the exception of the Sinus and Supraventricular (SV) rhythm messages.The Sinus and SV rhythm messages are updated based on the current heart rate, taking into account the patient category (adult, pediatric, or neonatal). For the message to change from one rhythm status to another, the HR must be in the new range for five beats.If you have basic arrhythmia capability, you will get only messages for the alarms provided with this level.Rhythm Status MessagesThe label B or E indicates basic (B) or enhanced (E) arrhythmia capability.Ectopic Status MessagesThe label B or E indicates basic (B) or enhanced (E) arrhythmia capability.Rhythm Status Message Description B or EAsystole No QRS for 4 consecutive seconds in absence of vent fib or chaotic signalB, EVent Fib/Tach A fibrillatory wave for 4 consecutive seconds B, EVtach A dominant rhythm of adjacent Vs and a HR > the V-Tach Heart Rate LimitB, ESustained VT Ventricular tachycardia rhythm for more than 15 seconds EVent Rhythm A dominant rhythm of adjacent PVCs and a HR ≤ the V-Tach HR LimitEVent Bigeminy A dominant rhythm of N, V, N, V EVent Trigeminy A dominant rhythm of N, N, V, N, N, V EPaced Rhythm A dominant rhythm of paced beats B, EIrregular HR Consistently irregular rhythm ESinus BradySinus RhythmSinus TachA dominant rhythm of SV beats preceded by P-waves B, ESV BradySV RhythmSV TachA dominant rhythm of SV beats not preceded by P-waves B, EUnknown ECG Rhythm Rhythm cannot be determined B, ELearning ECG Algorithm is learning the ECG beat morphology B, ELearning Rhythm Algorithm is learning the rhythm of the classified beats B, ECANNOT ANALYZE ECG ECG signal is predominantly invalid and therefore cannot be analyzedB, E
5 ECG, Arrhythmia, ST and QT Monitoring132Arrhythmia RelearningDuring a learning phase:• Alarm timeout periods are cleared• Stored arrhythmia templates are cleared• Asystole, Vfib, and HR alarms (when there are enough beats to compute the HR) are active. No other alarms are active.Initiating Arrhythmia Relearning ManuallyTo initiate relearning manually, in the Setup Arrhythmia menu, select Relearn Arrhy.– While the monitor is learning, the delayed arrhythmia wave displays the beat label L and the rhythm status message Learning ECG.– Next, the monitor determines the dominant rhythm. The beats are labeled N, and the rhythm status message changes to Learning Rhythm.After relearning is complete, you should check the delayed arrhythmia wave to ensure that the algorithm is labeling the beats correctly.If beats are still not classified correctly, check that the ECG is optimized for arrhythmia monitoring. You may need to select a different lead or change the electrodes or electrode positions if there is excessive noise, unstable voltage, low amplitude, or large P- or T-waves.Ectopic Status Message Explanation B or E(No message displayed) No ectopic activity within the last minuteRun PVCs More than 2 consecutive PVCs within the last minute EPair PVCs Pair PVCs within the last minute EPacer Not Capt Pause with pace pulse (paced patient only) within the last minuteB, EPacer Nt Pacing Pause without pace pulse (paced patient only) within the last minuteB, EPause No beat detected for 1.75 x average R-R interval for HR <120, or No beat for 1 second with HR >120 (non-paced patient only), or No beat detected for more than the set pause threshold.ER-On-T PVCs R-ON-T detected within the last minute EMultiform PVCs Multiform PVCs detected within the last minute EFrequent SVPBs SVPB count within last minute is greater than 5 ESVPBs 1-5 SVPBs in the last minute with a sinus rhythm and no Vs ESV Beats SV count within last minute and rhythm status is paced B, EPaced Beats Paced beat count within last minute and rhythm status is not pacedB, E
5 ECG, Arrhythmia, ST and QT Monitoring133Automatic Arrhythmia RelearnArrhythmia relearning is initiated automatically whenever:• ECG monitoring is switched on• The ECG Lead or Lead Label of the primary/secondary lead is changed manually, or when fallback occurs• A Leads Off INOP condition (that has been active for > 60 seconds) ends.If you are monitoring multi-lead arrhythmia and there is a change in one lead only, relearning happens only in the affected lead. During this learning phase, the system will continue monitoring using the other lead. Therefore, the delayed arrhythmia wave is not labeled L and there is no Learning ECG rhythm status message. In addition, alarm timeout periods are maintained, stored arrhythmia templates are maintained for the operative lead, and all alarms switched on are active.Arrhythmia Relearn and Lead FallbackLead fallback triggers an automatic arrhythmia relearn.WARNINGIf arrhythmia learning takes place during ventricular rhythm, the ectopics may be incorrectly learned as the normal QRS complex. This may result in missed detection of subsequent events of V-Tach and V-Fib.For this reason you should:• take care to initiate arrhythmia relearning only during periods of predominantly normal rhythm and when the ECG signal is relatively noise-free• be aware that arrhythmia relearning can happen automatically• respond to any INOP messages (for example, if you are prompted to reconnect electrodes)• be aware that a disconnected EASI electrode triggers an arrhythmia relearn on all leads• always ensure that the arrhythmia algorithm is labeling beats correctly.Arrhythmia AlarmsArrhythmia alarms can be switched on and off and the alarm settings changed just like other measurement alarms, as described in the Alarms section. Special alarm features which apply only to arrhythmia are described here.The different alarms detected and generated by the monitor depend on the level of arrhythmia analysis that is enabled. For a complete list of arrhythmia alarms and INOPs, see the Alarms chapter.The monitor detects arrhythmia alarm conditions by comparing ECG data to a set of pre-defined criteria. An alarm can be triggered by a rate exceeding a threshold (for example, HR >xx), an abnormal rhythm (for example, Ventricular Bigeminy), or an ectopic event (for example, Pair PVCs).
5 ECG, Arrhythmia, ST and QT Monitoring134Yellow Arrhythmia AlarmsYellow arrhythmia alarms are short yellow alarms specific to arrhythmia-related patient conditions. Depending on your monitor and Information Center configuration, they may be shown with one or two stars. The heart rate alarms (High HR and Low HR) can be configured as short yellow or standard yellow alarms. When they are standard yellow alarms they exist independently of the other arrhythmia alarms and no timeout periods apply.WARNINGWhen arrhythmia analysis is on, all yellow ECG and arrhythmia alarms are short yellow alarms (one-star). This means that the yellow alarm lamp and the tones are active for six seconds only, after which the blinking numeric and the alarm message remain for up to three minutes. The only exception to this are the HR High and Low alarms which can be configured as standard yellow alarms. Red alarms behave as usual.Arrhythmia Alarms and LatchingWhen using arrhythmia analysis, Visual Latching and Audible Latching should be on for red alarms, or at least Visual Latching should be on. Because of the transient nature of arrhythmia alarms, many arrhythmia conditions may go unnoticed if alarm latching is off. This setting can only be changed in Configuration Mode.Switching Individual Arrhythmia Alarms On and OffSome arrhythmia alarms can be individually switched on or off. They are:Non-Sustain, Vent Rhythm, Run PVCs, Pair PVCs, R-On-T PVCs, V.Bigeminy, V.Trigeminy, Multif.PVCs, Pause, SVT, IrregularHR, Missed Beat, PVCs/min and Afib.To switch individual alarms on or off, in the Setup Arrhythmia menu, select the alarm from the list to toggle between On and Off. The monitor displays the INOP message SOME ECG ALRMS OFF, if configured, when more alarms are switched off than configured in your active profile.Switching All Yellow Arrhythmia Alarms On or OffAll yellow arrhythmia alarms can be switched on and off together. To do this,•In the Setup Arrhythmia menu, select All Yellow Off or All Yellow On.Adjusting the Arrhythmia Alarm LimitsSome arrhythmia alarms have limits which can be individually adjusted. They are:VTach HR, VTach Run, PVCs/min, Vent Rhythm, SVT HR, SVT Run, Asystole Thresh., Pause Threshold1To adjust alarm limits, in the Setup Arrhythmia menu, select the alarm to be adjusted.2Select the appropriate setting from the pop-up list.Arrhythmia Alarm Timeout PeriodsNormally, an arrhythmia alarm is announced when an alarm condition is detected. However, there are certain situations that can inhibit the audible and visible indications of the alarm even though the alarm condition was detected. These include:
5 ECG, Arrhythmia, ST and QT Monitoring135• if a more serious alarm condition is active in the same chain• if a timeout period is in effect for a particular alarm• if a timeout period is in effect for a higher alarm in that chain.See “Arrhythmia Alarm Chaining” on page 136 for more details on alarm chains.What is a Timeout Period?Timeout periods are automatically started when a yellow arrhythmia alarm is detected. During this period, the same alarm condition will not generate another alarm. Alarm conditions further down the same arrhythmia alarm chain will also not generate an alarm, but alarms further up the chain will: see “Arrhythmia Alarm Chaining” on page 136.To view the timeout period configured for your monitor, in the Setup Arrhythmia menu, see the menu items TimeOut 1st and TimeOut 2nd.This setting can only be changed in Configuration Mode.Resetting the Timeout PeriodTo reset the timeout period, select the Alarms Off or Pause Alarms permanent key and then reselect it.How are Yellow Arrhythmia Alarms Indicated?When a yellow arrhythmia alarm is generated, it triggers visual and audible indicators. Yellow arrhythmia alarms are always set to latch visually for three minutes except HR High/Low alarms, if configured to standard yellow. Depending on the alarm condition, audible and visual alarm indicators will appear as follows:If you silence a yellow arrhythmia alarm and the alarm condition still exists, the visual indicators continue until the condition stops. You will get an alarm reminder every time the configured timeout period has expired.If you silence a yellow arrhythmia alarm and the alarm condition has stopped, the visual indicators are immediately cleared. Silencing an alarm does not reset its timeout period, so you will not get a realarm for the same condition or lower on the chain until the timeout expires.Alarm Condition Example Short yellow alarm tone sounds  Alarm message displayed Single alarm instanceNon-sustained V-tachwhen alarm condition is initially detectedfor 3 minutes (latching time)Continuous alarm conditionPVCs/min HIGH when alarm condition is initially detected and - as an alarm reminder - every time the configured timeout period has expireduntil the alarm condition stops, plus a maximum of three minutes latching timeSame intermittent alarm conditionPair of PVCs each time the alarm condition is detected, provided that the configured timeout period has expired
5 ECG, Arrhythmia, ST and QT Monitoring136Arrhythmia Alarm ChainingWhen arrhythmia analysis is switched on, multiple alarm conditions may be present. Announcing all of the detected alarm conditions would be confusing, and might hide a more serious condition. For this reason, arrhythmia alarms are prioritized in three alarm "chains": PVC Alarms; Beat Detection Alarms, and Rate Alarms.Only the highest priority alarm condition in each chain is announced. Lower priority alarms in the same chain will not be announced while an alarm is active or during the configured timeout period. If alarm conditions of equal severity from different chains are detected, the alarm condition that occurred most recently is announced. The exception is Irregular HR, which only occurs if no other alarms are occurring.See “ECG and Arrhythmia Alarm Overview” on page 124 for information on which alarms are included in the different arrhythmia options. See “Arrhythmia Alarm Timeout Periods” on page 134 for an explanation of how alarm timeouts work.
5 ECG, Arrhythmia, ST and QT Monitoring137– If there is an active Vent Bigeminy alarm, a PVCs > xx/min will not be triggered because it is lower on the same chain. However, a high HR alarm will become active because it is on a different chain.– Higher priority alarms supersede previous alarms. For example, if a Vent Trigeminy alarm is active and a Pair PVCs occurs, the Pair alarm will be activated.Understanding PVC-Related AlarmsPVC-related alarms are detected on the basis of the current ventricular heart rate and the number of consecutive PVCs counted (referred to as PVC Runs).Example:This diagram illustrates the conditions under which PVC alarms would be generated if the Vent Rhythm Run limit is set to 12, the V-Tach Run Limit is set to 8, and the V-Tach HR Limit is set to 100.You will see that• if both the V-Tach Heart Rate Limit and the V-Tach Run Limit are exceeded, a red V-Tach alarm is generated• if the ventricular heart rate exceeds the V-Tach Heart Rate Limit but not the V-Tach Run Limit, a yellow Non-Sustain VT alarm is generated.About ST MonitoringThe monitor performs ST segment analysis on normal and atrially paced beats and calculates ST segment elevations and depressions. This information can be displayed in the form of ST numerics and snippets on the monitor.All available leads can be monitored continuously. The ECG waveform does not need to be displayed on the monitor for ST Segment analysis.ST analysis is always performed using a dedicated filter which ensures diagnostic quality. If you are monitoring ECG using an ECG filter mode other than Diagnostic, the ST segment of the ECG wave may look different from the ST segment of the ST snippet for the same wave. For diagnostic evaluation of the ST segment, always switch to Diagnostic filter mode or use the ST snippet.
5 ECG, Arrhythmia, ST and QT Monitoring138WARNINGSome clinical conditions may make it difficult to achieve reliable ST monitoring, for example:• if you are unable to get a lead that is not noisy• if arrhythmias such as atrial fib/flutter are present, which may cause an irregular baseline• if the patient is continuously ventricularly paced• if the patient has left bundle branch block.You should consider switching ST monitoring off if these conditions are present.This monitor provides ST level change information; the clinical significance of the ST level change information should be determined by a physician.ST segment monitoring is intended for use with adult patients only and is not clinically validated for use with neonatal and pediatric patients. For this reason, the recommended - and default - setting for ST monitoring in neonatal and pediatric modes is ST Analysis: Off.Switching ST On and OffTo switch all ST monitoring on or off, in the Setup ST Analysis menu, select ST Analysis to toggle between On and Off.Selecting Leads for ST AnalysisYou select which leads to use for ST analysis in the Setup ST Analysis menu.To see the current list of leads selected for ST analysis:1Enter the Setup ST Analysis menu.2Select Setup ST Leads. This opens the Setup ST Leads pop-up window. Leads chosen for ST monitoring are listed here. There are two pop-up keys at the bottom of the screen, Add and Delete. If all leads are already selected, the Add pop-up key is disabled.To choose a lead for ST monitoring:1Select the Add key at the bottom of the Setup ST Leads window. This opens the Choices pop-up window.2Choose a lead from the list for ST monitoring. This closes the Choices window and adds the selected lead to the list of chosen leads.To disable ST monitoring for a lead:1Choose a lead from the list in the Setup ST Leads window.2Select the Delete key. This removes this lead from the list.NOTEThe order in which ST leads are listed in the Setup ST Leads menu determines the order in which ST leads are displayed on the monitor screen.To change the order in which ST leads are displayed,1In the Setup ST Leads menu, choose a lead from the list.2Select the Sort Up or Sort Down key to move the lead up or down in the list.
5 ECG, Arrhythmia, ST and QT Monitoring139Understanding the ST DisplayYour monitor screen may be configured to look slightly different from the illustrations.ST NumericsUp to 12 ST numerics plus the ST index can be displayed on the monitor screen. They can be configured to show beside the measurement numerics, beside the ECG wave, or beside the ST snippet.A positive ST value indicates ST segment elevation; a negative value indicates depression.ST numerics are displayed in the order in which you select ST leads for analysis. If there is additional space in the field assigned to ST numerics, the monitor will display extra numerics in the order in which they appear in the list in Setup ST Leads, in the Setup ST Analysis menu. Any ST leads switched on for analysis that do not fit in the assigned numerics field are shown in succession in place of the last ST numeric.ST IndexThe ST index numeric (STindx) is the sum of the absolute values for the ST leads V2, V5, aVF. Because it is based on absolute values, it is always a positive number. If you haven't selected one of the leads V2, V5, and aVF for ST analysis, the ST index numeric will display a question mark "?".To switch the ST index numeric on or off for display, in the Setup ST Analysis menu, select ST-Index to toggle between On and Off.ST SnippetsST snippets show a one second wave segment for each measured ST lead. The most recent snippet is drawn in the same color as the ECG wave, usually green, superimposed over the stored baseline snippet, drawn in a different color. The comparison shows any deviation in the measurement since the baseline snippet was stored, for example as a result of a procedure carried out on the patient.The information is updated once per minute.If you do not see ST snippets on the Screen, select the Screen name in the Monitor Info Line and select a Screen configured to show snippets from the pop-up list of available Screens.ST Baseline WindowThe ST Baseline Window shows an ST snippet drawn on a grid. The current ST numeric and the ST numeric stored with the baseline are shown, as well as the difference between these two numerics.A "?" in front of the difference numeric indicates that the ST measurement points were adjusted since the baseline snippet was stored.The Baseline Window opens with the ST pop-up keys Update Baseline, Record ST, Change ST Lead, Adjust ST Points, ST Map and arrow keys for scrolling through the available leads.To view the ST Baseline window, select any snippet on the Screen.1ST numerics2Current HR alarm limits3Current heart rate
5 ECG, Arrhythmia, ST and QT Monitoring1401ST label and numeric2Baseline ST numeric3Difference between current values and baseline values41 mV calibration bar5Current snippet6ST baseline7Timestamp of most recently stored baseline snippetUpdating ST Baseline SnippetsST analysis requires valid samples to measure and store a snippet. ST Snippets and ST values are updated every minute. If there is artifact in the signal, it may take longer for an ST snippet and an ST value to appear.The first baseline is stored automatically after ST monitoring is started, or when a new patient is admitted. To update ST baselines,1Select an ST snippet to open the ST Baseline window.2In the ST Baseline window, select Update Baseline to store all current snippets as baselines. This deletes all previously-stored baselines.An ST baseline copy is also stored in the MMS, for transport purposes.Recording ST SegmentsTo record all currently available ST snippets and baselines, in the ST Baseline window, select the pop-up key Record ST.
5 ECG, Arrhythmia, ST and QT Monitoring141About the ST Measurement PointsThe ST value for each beat complex is the vertical difference between the ISO point and the ST point, as shown in the diagram below. The isoelectric (ISO) point provides the baseline, the ST point is at the midpoint of the ST segment. The J point is where the QRS complex changes its slope; as it is a fixed distance away from the ST point, it can be useful to help you position the ST point correctly. CAUTIONThe ST measurement points need to be adjusted when you start monitoring, and if the patient's heart rate or ECG morphology changes significantly, as this may affect the size of the QT interval and thus the placement of the ST point. Artifactual ST segment depression or elevation may occur if the isoelectric point or the ST point is incorrectly set.Always ensure that ST measurement points are appropriate for your patient.Adjusting ST Measurement PointsDepending on your monitor's configuration, the ST point can be positioned either• relative to the J-point.In the Adjust ST Points window, the pop-up keys ISO Point, J Point and ST Point are visible and can be adjusted.or• directly by selecting a numeric value for the ST point.In the Adjust ST Points window, you can adjust the ISO and ST point.The ST Uses setting can only be changed in Configuration Mode.To adjust the ST measurement points,1In the Setup ST Analysis menu, select Adjust ST Points to open the Adjust ST Points window. Alternatively, you can use the Adjust ST Points pop-up key in the ST Baseline window.2Select a suitable ECG lead for ST measurement, with a visible J-point and a visible P wave. Use the up and down arrow keys to scroll through the ST snippets for the other ECG leads.1R-wave peak at 0 msec2J point, for example, 48 msec3Difference = ST value4ST measurement point, for example, J + 60 msec5Isoelectric point set to -80 msec6P7Q8S9T
5 ECG, Arrhythmia, ST and QT Monitoring1423Use the Select Point pop-up key to scroll through the points and activate the point you need to adjust, then use the left and right arrow keys to move the measurement point. Each point is highlighted while active.1  ST label and the ST numeric that would apply using the current points2  1mV calibration bar3  Cursors for adjusting ST points4  Timestamp of most recent ST point adjustment5  Highlighted ST pointThe ISO-point cursor (1) positions the isoelectric point relative to the R-wave peak. The relation is shown beside the ISO-point in milliseconds. Position the ISO-point in the middle of the flattest part of the baseline (between the P and Q waves or in front of the P wave).The J-point cursor (2) positions the J-point relative to the R-wave peak. It helps you to correctly position the ST-point. Position the J-point at the end of the QRS complex and the beginning of the ST segment.The J-point cursor is not available if your monitor is configured to let you set the ST point directly.
5 ECG, Arrhythmia, ST and QT Monitoring143To position the ST-point (3) relative to the J-point:select either J+60 or J+80. Select J Point and use the arrow keys to move the J-Point and position the ST-point at the midpoint of the ST segment.To position the ST-point directly:select ST Point and use the left and right arrow keys to position the ST point at the midpoint of the ST segment.4Select the Apply Changes pop-up key to activate the new ST measurement points and recalculate all ST values.The most recent ST Points adjustment time is displayed in the Adjust ST Points window. This information is cleared when a patient is discharged or when a new Profile is loaded into the monitor.5To update the ST snippet shown in the Adjust ST Points window, select the Update pop-up key.ST AlarmsST alarms are yellow alarms. Each ST lead has its own alarm limit. ST alarms are triggered when an ST value exceeds its alarm limit for more than one minute. Switching ST alarms off switches off alarms for all ST leads.If more than one ST measurement is in alarm, the monitor only displays the alarm message of the ST lead which is currently furthest from its set alarm limits.Single- or Multi-lead ST AlarmingBe aware that if multi-lead ST alarming is switched on, only alarms involving more than one ST lead will be announced.To choose individual or multi-lead ST alarming,•In the Setup ST Analysis menu, select ST Alarm Mode and select either Single ST or Multi ST.Changing ST Alarm LimitsThe monitor can detect alarms on each ST lead separately, so you can set high and low ST alarm limits individually for each ST lead. You can also set separate alarm limits for single-lead and multi-lead ST monitoring. Set the high and low alarm limits based on your assessment of the patient's clinical condition, unit protocols, physician orders or medication specified limits. A good guideline is + 1.0 mm or - 1.0 mm from the patients's ST, or follow your hospital protocol.1In the Setup ST Analysis menu, select ST Alarm Mode and select Single ST or Multi ST.2Select the alarm to be adjusted.3Select the appropriate setting.
5 ECG, Arrhythmia, ST and QT Monitoring144Viewing ST MapsThe monitor can derive a multi-axis portrait (map) from the ST analysis to help you detect changes in ST values. It displays two planes obtained from a multilead ECG in a multi-axis diagram, where each axis represents a lead. The ST value at the J point is given. The position of the axes within the diagram correspond to the placement of the ECG leads. Each ST value is assigned to either a limb lead, or to a chest lead. Every axis shows the polarity of the lead it represents. By joining adjacent ST values, the monitor obtains the ST map. The contour line, and the map shading, is shown in the same color as the ECG parameter.Current ViewIn current view, the monitor displays an ST map that corresponds to the current ST values. Three or more leads per plane are necessary to display a map.The left of the following diagram shows leads I, II, III, aVR, aVL, and aVF on the limb leads. On the right, the V-leads (V1, V2, V3, V4, V5, and V6) are on the chest leads.1Alarm status indicator2EASI Limb Leads3EASI Chest Leads4ST index (for EASI)5ST label, value and polarity of corresponding lead6ST map If an ST lead is switched off, its axis is not shown in the map.
5 ECG, Arrhythmia, ST and QT Monitoring145If a lead is in INOP (the value is being measured but is invalid or unavailable because, for example, the corresponding ECG electrode is off), the area formed by the remaining ST leads is left open.If there is insufficient information (for example, there are less than three chest leads) for a second ST map to be displayed, the currently available ST values are displayed in place of the second ST map.Trend ViewIn trend view, you can see up to four trended ST maps, and the current ST map, simultaneously. You can configure the time interval between trended samples. The most recent map is shown in the same color as the parameter itself. Past values change from white through dark gray. In the diagram below, the time interval between trends is 12 seconds. The first trended sample is white and is 12 seconds old. The second trended sample corresponds to the ST values 24 seconds ago and so forth. The ST values on the diagrams show the current ST values.If a lead is turned off, its axis is no longer shown. This has no impact on the presentation of trended values that were recorded while the lead was still on. In the diagram below, lead V4 was switched off 20 seconds ago. The current ST values and the first trended value reflect this change in the lead setup. All other maps are displayed the way in which they were recorded.1Limb Leads2Chest Leads3current ST values4trending interval
5 ECG, Arrhythmia, ST and QT Monitoring146Viewing an ST MapTo display an ST map,•In the Main Setup menu, select ST Map.Working in the ST Map Task WindowYou may need to activate the ST map task window to see all the data, and to access the pop-up keys. Select the map view on screen to activate its task window. Once you activate it, you can perform the tasks detailed here.Switching Between ST Map ViewsTo switch between views,•Select Current View or Trend View to toggle between views.If your trend view is empty, you need to adjust the priority of this measurement in the trending priority list. See “Trend Priority” on page 274.Displaying an ST Reference BaselineYou can display an ST reference baseline for the current view, or for the trended view. The baseline is shown in yellow. However, if the ECG color is yellow, the baseline is shown in green. Use this baseline to detect ST changes. The baseline is derived automatically whenever the monitor relearns arrhythmia and also on user request.Select Show Baseline/Hide Baseline to toggle between baseline display on and off.Updating an ST Map Reference BaselineTo update the baseline,•In the Setup ST Analysis menu, select ST Baseline then select Update Baseline.Changing the Scale of the ST MapTo change scale,•Select Size Up or Size Down to alter the size at which monitor displays the map.In this diagram, V4 was either temporarily switched off, or in INOP, for around 30 seconds. No data was recorded. Consequently, the affected maps are not closed.
5 ECG, Arrhythmia, ST and QT Monitoring147Changing the Trending IntervalTo determine how frequently the monitor displays a trended sample,1In Trend view, select Select Interval.2Select the required interval from the menu. The interval ranges between 12 seconds to 30 minutes.Printing an ST Map ReportTo print the most recently viewed (current or trend) window,1Select Main Setup then select Reports.2Select ST Map.3Press Print.About QT/QTc Interval MonitoringThe QT interval is defined as the time between the beginning of the Q-wave and the end of the T-wave. It measures the total duration of the depolarization (QRS duration) and repolarization (ST-T) phases of the ventricular action potential. QT interval monitoring can assist in the detection of prolonged QT interval syndrome.The QT interval (1) has an inverse relationship to heart rate. Faster heart rates shorten the QT interval and slower heart rates prolong the QT interval. Therefore there are several formulas used to correct the QT interval for heart rate. The heart rate corrected QT interval is abbreviated as QTc. The monitor uses as a default the Bazett correction formula and the alternative Fridericia formula can be selected in Configuration Mode.For QT interval monitoring to be effective, basic or enhanced arrhythmia monitoring should be turned on.QT Measurement AlgorithmThe QT values are updated every five minutes except in the initial phase (first five minutes) where they are updated once per minute. Normal or atrial paced beats and beats with a similar morphology are averaged to form a representative waveform for further processing. Normal beats followed by a premature QRS will be excluded from the measurements to prevent the premature beat from obscuring the end of the T-wave. If the algorithm cannot form a representative waveform, for example because the morphology of the beats is too varied, a CANNOT ANALYZE QT INOP will be generated after 10 minutes. This is also the case if normal beats have been falsely labeled so that the algorithm does not have enough valid beats to make QT measurements. No QT value is calculated if the QT-HR is >150 bpm (Adult) or >180 bpm (Pedi/Neo).
5 ECG, Arrhythmia, ST and QT Monitoring148Because of the different algorithm approaches, a QT/QTc measurement from a diagnostic 12-lead program may differ from the realtime measurement on the monitor.Where Can I Find More Information?See the Application Note on QT/QTc Interval Monitoring and the QT Interval Monitoring Quick Guide supplied on your documentation DVD for detailed information on the QT algorithm and performance.Indications For Use Of QT Interval MonitoringOf special concern for QT monitoring is the administration of QT prolonging drugs to patients identified with risk factors for Torsade de Pointe. Females, older patients and patients with bradycardia, impaired left ventricular function (ischemia, left ventricular hypertrophy), hypokalemia and hypomagnesemia are in this increased risk category.Limitations For Use Of QT Interval MonitoringSome conditions may make it difficult to achieve reliable QT monitoring, for example:• the T-wave is very flat• T-waves are not well defined due to atrial flutter or atrial fibrillation• the end of the T-wave is difficult to define because of the presence of U-waves• a high heart rate causes the P-wave to encroach on the end of the previous T-wave• noise or high QRS morphology variationFor these cases you should select a lead with a good T-wave amplitude and no visible flutter activity, and without a predominant U-wave or P-wave.Some conditions such as left or right bundle branch block or hypertrophy can lead to a widened QRS complex. If a long QTc is observed you should verify it to ensure that it is not caused by QRS widening.Because normal beats followed by ventricular beats are not included in the analysis, no QT measurement will be generated in the presence of a bigeminy rhythm.If the heart rate is extremely high (over 150 bpm for adults and over 180 bpm for pediatrics and neonates) QT will not be measured.When the heart rate changes, it can take several minutes for the QT interval to stabilize. For reliable QTc calculation it is important to avoid a region where the heart rate is changing.WARNINGQT/QTc measurements should always be verified by a qualified clinician.Selecting The QT LeadsFor QT Monitoring you can select one of the following three modes:• All Leads mode - all available leads (I, II, III, V, MCL, V1 - V6) are used to produce a global QT measurement. For EASI lead placement, directly acquired AI, AS and ES leads are used.• Primary-Lead mode - the primary lead will be used for QT measurement. If the original primary lead becomes unavailable or is changed, QT measurement will continue with the new primary lead.
5 ECG, Arrhythmia, ST and QT Monitoring149• Single-Lead mode - a single lead selected from all available leads (except the augmented leads) will be used for QT measurement. QT measurement will stop if the selected lead becomes unavailable.To select the mode,1Select the QT numeric to enter the Setup QT Analysis window.2Select QT Lead and select All, Primary Lead or one of the available single leads.When using the All Leads mode, make sure when you compare QT values that they are based on the same set of leads.Changing the lead(s) used for QT measurements will not cause the baseline to be reset.QT ViewIn the QT View window you can verify that the QT algorithm detects correct Q and T points.The current waves are shown in the upper half of the window and the baseline waves in a different color below. The Q and T points are marked with a vertical line. By selecting one of the lead labels at the top of the window you can highlight the corresponding wave; the other waves are shown in gray. The underlined lead labels are the leads used for the QT calculation. By selecting the numeric area you can highlight all underlined leads.Changing The View To A Single Wave SetTo view one set of waves in a larger scale, you can cycle through the different views,1Select Current view to see the set of current waves.2Select Baseline view to see the set of baseline waves.3Select Split view to return to the combined view with current and baseline waves.Setting The QT BaselineIn order to quantify changes in the QTc value, you can set a QTc baseline. For example to assess the effect of medication on the QT interval you can set the current value as the baseline before you begin medication. This baseline will then be used to calculate the ΔQTc value.
5 ECG, Arrhythmia, ST and QT Monitoring150To set the baseline,•Select Set Baseline and set the value.If no baseline has been set for this patient, the first five minute value after the start of monitoring is automatically set as baseline. If you set a new baseline the previous baseline is discarded. As the ΔQTc alarm is based on the difference between the baseline and the current value, setting an inappropriate new baseline may prevent a ΔQTc alarm from being generated. Discharging a patient clears the baseline.Printing The QT WavesTo start a printout,•Select Print QT.Recording The QT WavesTo start a recording,•Select Record QT.QT AlarmsThere are two QT alarms, QTc high limit alarm and ΔQTc high alarm. The QTc high limit alarm is generated when the QTc value exceeds the set limit for more than 5 minutes. The ΔQTc alarm is generated when the difference between the current value and the baseline value exceeds the set limit for more than 5 minutes.The CANNOT ANALYZE QT INOP and the -?- will be displayed when no QT measurement could be calculated for 10 minutes. Up to this time the previous valid value will be displayed. The following additional messages on the cause of the invalid measurements may also be displayed.Additional Message Cause of Invalid QT MeasurementQT Startup QT monitoring was just turned on or has been resetAsystole or Leads Off 1Not all specified leads needed to perform QT analysis are available, or2Asystole condition is detectedInsufficient Valid Leads Not enough valid QRS complexes to generate a QT measurementInvalid Rhythm for QTc Not enough valid RR intervals to generate QT-HR, the averaged HR used for QTc calculationHigh QT-HR QT-HR exceeds the specified upper limit of 150 bpm (for adults) or 180 bpm (for neonates and pediatrics)Small R Wave R-wave of the signal is too smallSmall T Wave T-wave of the signal is too small
5 ECG, Arrhythmia, ST and QT Monitoring151Switching Individual QTc Alarms On and OffEach QTc alarm can be switched off individually.To switch an alarm on or off, in the Setup QT Analysis menu, select QTc High Alarm or ΔQTc High Alarm to toggle between On and Off.Changing QTc Alarm LimitsSet the high alarm limits based on your assessment of the patient's clinical condition, unit protocols, physician orders or medication specified limits.1In the Setup QT Analysis menu, select QTc High Limit.2Select the appropriate setting.3Select ΔQTc High Limit.4Select the appropriate setting.Switching QT Monitoring On and OffTo switch all QT monitoring on or off, in the Setup QT Analysis menu, select QT Analysis to switch between On and Off.End of T not Detected End of the T-Wave cannot be accurately detectedQT out of Range QT measurement is outside the specified range of valid QT values (200-800 msec)QTc out of Range QTc measurement is outside the specified range of valid QTc values (200-800 msec)QTc Erratic QTc measurements are not stableAdditional Message Cause of Invalid QT Measurement
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61536Monitoring Pulse RateThe pulse numeric counts the arterial pulsations that result from the mechanical activity of the heart in beats per minute (bpm). You can display a pulse from any measured SpO2 signal (pleth wave), or any arterial pressure (P, ABP, ART, Ao, PAP, UAP, FAP, BAP: see the pressure section for an explanation of the pressure labels). The displayed pulse numeric is labeled and color-coded to match its source wave. If the pulse numeric is not displayed, see the Setup Pulse menu to check whether it is switched on.Entering the Setup Pulse MenuIf a pulse numeric is displayed on the screen, select it to enter the setup menu for that pulse source. If no pulse numeric is visible, in the Setup SpO₂ menu or the setup menu from an arterial pressure, select pulse with the correct source, e.g. Pulse (HR).System Pulse SourceThe currently selected system pulse source is shown in the setup menus of the pulse source measurements. The pulse rate chosen as system pulse:• is monitored as system pulse and generates alarms when you select pulse as the active alarm source• is sent via the network to the Information Center, if available• is trended in the HighRes Trends and stored in the monitor's databases.To define which pulse rate is used as system pulse,1In the Setup Pulse menu, select System Pulse.2Select one of the SpO2 or arterial pressure labels from the pop-up list, or select Auto. If you select Auto, the monitor automatically chooses a pulse rate to be used as system pulse. It looks through the list from top to bottom and activates the first pulse rate that is switched on and available.If your selected pulse source measurement becomes unavailable or is switched off, the monitor will use the next measurement from the list as system pulse until the selected pulse source measurement becomes available again.
6 Monitoring Pulse Rate154Switching Pulse On and OffTo switch a particular pulse numeric on or off, enter the Setup Pulse menu via the measurement setup menu or wave menu of the pulse source. For example, to switch an SpO2 pulse numeric on or off,1Enter the Setup Pulse menu by selecting the Pulse numeric or by selecting Pulse in the Setup SpO₂ menu.2In the Setup Pulse menu, select the correct pulse label, e.g. Pulse (SpO₂), to toggle between On and Off.Using Pulse AlarmsYou can change pulse rate alarm limits in the ECG/Pulse Alarms menu which can be accessed from the Setup Pulse menu or the Setup ECG menu by selecting Alarm Source. Changing the alarm limits for a specific Pulse numeric changes the alarm limits for all pulse rate alarms and heart rate alarms.Pulse alarms are only generated when the active alarm source is set to Pulse, a pulse source is set as system pulse and pulse alarms are switched on.Selecting the Active Alarm Source: ECG or Pulse?In most cases the HR and Pulse numerics are identical. In order to avoid simultaneous alarms on HR and Pulse, the monitor uses either ECG or Pulse as its active alarm source. To change the alarm source, select Alarm Source in the ECG/Pulse Alarms menu, then select•ECG/Arrhythm: if you want the HR to be the alarm source for HR/Pulse.•Pulse: If you select Pulse as the active alarm source, the monitor will prompt you to confirm your choice. Be aware that if you select Pulse as the alarm source, all arrhythmia and ECG HR alarms are switched off.•Auto: If the alarm source is set to Auto, the monitor will use the heart rate from the ECG measurement as the alarm source whenever the ECG measurement is switched on and at least one ECG lead can be measured without an INOP condition.The monitor will automatically switch to Pulse as the alarm source if:– a valid ECG lead can no longer be measuredand– a Pulse source is switched on and available,The monitor then uses the pulse rate from the measurement currently active as system pulse. While Pulse is the alarm source, all arrhythmia and ECG HR alarms are switched off. If an ECG lead becomes available again, the monitor automatically uses HR as alarm source.Note:If ECG is switched off, the monitor will always change to Pulse as alarm source, if a Pulse is available. One exception to this rule can arise when you have a telemetry device paired with your monitor. The monitor ECG is then deactivated but the monitor may be configured to allow only ECG as the active alarm source. In this case the monitor will not switch to Pulse as alarm source and Pulse will not be available as a selection in the ECG/Pulse Alarms menu.
6 Monitoring Pulse Rate155WARNINGSelecting Pulse as the active alarm source for HR/Pulse switches off the arrhythmia alarms listed in the section “ECG and Arrhythmia Alarm Overview” on page 124, including Asystole, Vfib and Vtach alarms, and the heart rate alarms. This is indicated by the message ECG/ARRH ALARM OFF (unless this has been configured off for your monitor), and the crossed-out alarm symbol beside the ECG heart rate numeric. The message ECG/ARRH ALARM OFF can be configured off, or to switch to a yellow (medium severity) INOP after a fixed number of hours.High and low pulse rate and extreme bradycardia and extreme tachycardia alarms from pulse are active.Alarm Source Selection DisabledIf you cannot change the alarm source, selection of the alarm source may be disabled. If you try to change the source, the monitor displays the message To activate enter Config and enable Alarm Source Selection. This setting can only be changed in Configuration Mode.Changing HR/Pulse Alarm LimitsAs Pulse and HR share the same high and low alarm limits, if you change the alarm limit in the Setup Pulse menu, the high or low alarm limits for HR in the Setup ECG menu change automatically, and vice versa. The only exceptions are caused by a low limit clamp for each measurement: the lowest value for Pulse when derived from SpO2 is 30 bpm; from HR 15 bpm, and from Pressure 25 bpm.Extreme Alarm LimitsThe 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 to the high and low alarm limits. You need to know what 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 values added to the high and low limit alarms to create the extreme rate alarms for your monitor, in the Setup ECG menu, see the menu items Δ ExtrTachy and Δ ExtrBrady.QRS ToneThe active alarm source is also used as a source for the QRS tone. You can change the tone volume in the Setup SpO₂ and Setup ECG menus and the QRS tone modulation in the Setup SpO₂ menu.WARNINGThe audible QRS tone might be influenced by external interference and is not intended to be used as a substitute for ECG based arrhythmia analysis.If arrhythmia detection is needed, do not rely on the audible QRS tone.
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71577Monitoring Respiration Rate(Resp)For the respiratory measurement (Resp), the monitor measures the thoracic impedance between two ECG electrodes on the patient's chest. Changes in the impedance due to thoracic movement produce the Resp waveform on the monitor screen. The monitor counts the waveform cycles to calculate the respiration rate (RR).Lead Placement for Monitoring RespCorrect patient skin preparation techniques for electrode placement are important for Resp measurement: you will find this information in the chapter on ECG.The Resp measurement uses the standard ECG cable sets and lead placements. You can use any of the different types of ECG cable sets - 3-lead, 5-lead, 6-lead or 10-lead, using either standard or EASI™ placement - to measure Resp, as long as you use ICU ECG cables.The Resp signal is always measured between two of the ECG electrodes. If you are using standard ECG electrode placement, Resp is measured between the RA and LL electrodes. If you are using EASI™ ECG electrode placement, Resp is measured between the I and A electrodes.Optimizing Lead Placement for RespIf you want to measure Resp and you are already measuring ECG, you may need to optimize placement of the two electrodes between which Resp will be measured for some patients. Repositioning ECG electrodes from standard positions, especially when you are using EASI™ ECG electrode placement, results in changes in the ECG waveform and may influence ST and arrhythmia interpretation.Cardiac OverlayCardiac activity that affects the Resp waveform is called cardiac overlay. It happens when the Resp electrodes pick up impedance changes caused by the rhythmic blood flow. Correct electrode placement can help to reduce cardiac overlay: avoid the liver area and the ventricles of the heart in the line between the respiratory electrodes. This is particularly important for neonates.
7 Monitoring Respiration Rate (Resp)158Lateral Chest ExpansionSome patients, especially neonates, expand their chests laterally. In these cases it is best to place the two respiratory electrodes in the right midaxillary and left lateral chest areas at the patient's maximum point of breathing movement to optimize the respiratory wave.Abdominal BreathingSome patients with restricted chest movement breathe mainly abdominally. In these cases, you may need to place the left leg electrode on the left abdomen at the point of maximum abdominal expansion to optimize the respiratory wave.Understanding the Resp DisplayThe Resp measurement is displayed on the monitor as a continuous wave and a numeric respiration rate. If the detected respiration rate is close to the heart rate, this is indicated by the text HR = RR next to the respiration wave if you are in manual monitoring mode. Your monitor screen may look slightly different from the illustration.1Resp wave label2One Ohm calibration bar3Manually-set Resp detection level4Resp numeric and labelChanging Resp Detection ModesThe Resp detection level can be set either automatically or manually.• To change the resp detection mode, in the Setup Resp menu, select Detection to toggle between the settings.Auto Detection ModeIn Auto Detection Mode, the monitor adjusts the detection level automatically, depending on the wave height and the presence of cardiac artifact. Note that in Auto Detection Mode,
7 Monitoring Respiration Rate (Resp)159• the detection level (a dotted line) is not displayed on the waveform,• the algorithm expects a heart rate and therefore needs at least 3 electrodes attached to the patient. If you are monitoring respiration with only two electrodes, the detection algorithm becomes less sensitive which may result in reduced breath detection performance.Use Auto Detection Mode for situations where:• the respiration rate is not close to the heart rate• breathing is spontaneous, with or without continuous positive airway pressure (CPAP)• patients are ventilated, except patients with Intermittent Mandatory Ventilation (IMV).Manual Detection ModeIn Manual Detection Mode you must set the Resp detection level.•In the Setup Resp menu, select Manual Up or Manual Down. Use the dotted detection level line in the Resp waveform to determine when the desired level is reached.Once set, the detection level will not adapt automatically to different respiration depths. It is important to remember that if the depth of breathing changes, you may need to change the detection level.Use Manual Detection Mode for situations where:• the respiration rate and the heart rate are close.• patients have Intermittent Mandatory Ventilation.• respiration is weak. Try repositioning the electrodes to improve the signal.Resp Detection Modes and Cardiac OverlayIn Auto Detection Mode:If you are monitoring Resp and the ECG is switched off, the monitor cannot compare the ECG and Resp rates to detect cardiac overlay. The respiration detection level is automatically set higher to prevent the detection of cardiac overlay as respiration.In Manual Detection Mode:Cardiac overlay can in certain situations trigger the respiration counter. This may lead to a false indication of a high respiration rate or an undetected apnea condition. If you suspect that cardiac overlay is being registered as breathing activity, raise the detection level above the zone of cardiac overlay. If the Resp wave is so small that raising the detection level is not possible, you may need to optimize the electrode placement as described in the section “Lateral Chest Expansion” on page 158.Changing the Size of the Respiration WaveWARNINGWhen monitoring in Manual Detection Mode, make sure to check the respiration detection level after you have increased or decreased the size of the respiration wave.•In the Setup Resp menu, select Size Up to increase the size of the wave or Size Down to decrease it.
7 Monitoring Respiration Rate (Resp)160Changing the Speed of the Respiration WaveResp waveforms are usually viewed at a slower speed than other waveforms. For this reason, the Resp measurement has its own speed control and is not affected by the wave speed settings of the other measurements.• Select the Resp wave to enter the Resp Wave menu, then select Change Speed. Choose the required speed from the pop-up list. This defines the speed at which the wave is drawn across the screen in millimeters per second (mm/s).Using Resp AlarmsResp alarms can be switched on and off and the high and low alarm limits can be changed just like other measurement alarms, as described in the Alarms chapter.Changing the Apnea Alarm DelayThe apnea alarm is a high priority red alarm used to detect apneas. The apnea alarm delay time defines the time period between the point where the monitor cannot detect any respiration activity and the indication of the apnea alarm.1In the Setup Resp menu, select Apnea Time.2Select the appropriate setting.Resp Safety InformationWARNINGRespiration detection levelIf you do not set the detection level for the respiration correctly in manual detection mode, it may not be possible for the monitor to detect apnea. If you set the detection level too low, the monitor is more likely to detect cardiac activity, and to falsely interpret cardiac activity as respiratory activity in the case of apnea.ApneaThe respiration measurement does not recognize obstructive and mixed apneas - it only indicates an alarm when a pre-adjusted time has elapsed since the last detected breath.The safety and effectiveness of the respiration measurement method in the detection of apnea, particularly the apnea of prematurity and apnea of infancy, has not been established.InterferenceIf operating under conditions according to the EMC Standard EN 60601-1-2 (Radiated Immunity 3V/m), field strengths above 1V/m may cause erroneous measurements at various frequencies. Therefore it is recommended to avoid the use of electrically radiating equipment in close proximity to the respiration measurement unit.Resp Accessories
7 Monitoring Respiration Rate (Resp)161To monitor respiration, use only the non-OR ECG accessories listed in the Resp section of the accessories chapter. You cannot measure respiration if you are using an orange OR ECG cable set. This is because of the higher internal impedance of the OR cable set, required for use if electrosurgery is being performed.Rate adaptive pacemakersImplanted pacemakers which can adapt to the Minute Ventilation rate may occasionally react on the Impedance measurement used by patient monitors for the determination of the Resp value and execute pacing with the maximum programmed rate. Switching off the Resp measurement can prevent this.
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81638Monitoring SpO2Philips pulse oximetry uses a motion-tolerant signal processing algorithm, based on Fourier artifact suppression technology (FAST). It provides four measurements:• Oxygen saturation of arterial blood (SpO2) - percentage of oxygenated hemoglobin in relation to the sum of oxyhemoglobin and deoxyhemoglobin (functional arterial oxygen saturation).• Pleth waveform - visual indication of patient's pulse.• Pulse rate (derived from pleth wave) - detected pulsations per minute.• Perfusion indicator - numerical value for the pulsatile portion of the measured signal caused by arterial pulsation.The monitors are also compatible with SpO2 technologies from other manufacturers. Please refer to the instructions for use provided with these devices for further information.SpO2 SensorsDepending on the purchased SpO2 option, different sensors and adapter cables can be used. The sensors for the different options are color-coded to match the connectors. See the section on Accessories for a compatibility table.Familiarize yourself with the instructions for use supplied with your sensor before using it. In particular, check that the sensor being used is appropriate for your patient category and application site.CAUTIONDo not use OxiCliq disposable sensors in a high humidity environment, such as in neonatal incubators or in the presence of fluids, which may contaminate sensor and electrical connections causing unreliable or intermittent measurements. Do not use disposable sensors when there is a known allergic reaction to the adhesive.Always use the MAX-FAST forehead sensor with the foam headband provided by Nellcor.Applying the Sensor1Follow the SpO2 sensor's instructions for use, adhering to all warnings and cautions.2Remove colored nail polish from the application site.
8 Monitoring SpO21643Apply the sensor to the patient. The application site should match the sensor size so that the sensor can neither fall off, nor apply excessive pressure.When using the M1195A Infant Finger Sensor, select a finger or toe with a diameter of between 7 and 8 mm (0.27" and 0.31"). When applying a M1193A neonatal sensor do not overtighten the strap.4Check that the light emitter and the photodetector are directly opposite each other. All light from the emitter must pass through the patient's tissue.WARNINGLoose Sensor: If a sensor is too loose, it might compromise the optical alignment or fall off. If it is too tight, for example because the application site is too large or becomes too large due to edema, excessive pressure may be applied. This can result in venous congestion distal from the application site, leading to interstitial edema, hypoxemia and tissue malnutrition. Skin irritations or lacerations may occur as a result of the sensor being attached to one location for too long. To avoid skin irritations and lacerations, periodically inspect the sensor application site and change the application site at least every four hours.Venous Pulsation: Do not apply sensor too tightly as this results in venous pulsation which may severely obstruct circulation and lead to inaccurate measurements.Ambient Temperature: At elevated ambient temperatures be careful with measurement sites that are not well perfused, because this can cause severe burns after prolonged application. All listed sensors operate without risk of exceeding 41°C on the skin if the initial skin temperature does not exceed 35°C.Extremities to Avoid: Avoid placing the sensor on extremities with an arterial catheter, an NBP cuff or an intravascular venous infusion line.Connecting SpO2 CablesConnect the sensor cable to the color-coded socket on the measurement device (MMS or module). You can connect some Philips sensors directly to the measurement device. For other sensors, use the corresponding adapter cable.CAUTIONExtension cables: Do not use more than one extension cable (M1941A). Do not use an extension cable with Philips reusable sensors or adapter cables with part numbers ending in -L (indicates "long" cable version).Electrical Interference: Position the sensor cable and connector away from power cables, to avoid electrical interference.Humidity: For neonatal patients, make sure that all sensor connectors and adapter cable connectors are outside the incubator. The humid atmosphere inside can cause inaccurate measurements.
8 Monitoring SpO2165Measuring SpO21Select the correct patient category setting (adult/pediatric and neonatal), as this is used to optimize the calculation of the SpO2 and pulse numerics.2During measurement, ensure that the application site:– has a pulsatile flow, ideally with a perfusion indicator value above 1.0.– has not changed in its thickness (for example, due to edema), causing an improper fit of the sensor.WARNING• Inspect the application site every two to three hours to ensure skin quality and correct optical alignment. If the skin quality changes, move the sensor to another site. Change the application site at least every four hours.• Injected dyes such as methylene blue, or intravascular dyshemoglobins such as methemoglobin and carboxyhemoglobin may lead to inaccurate measurements.• Inaccurate measurements may result when the application site for the sensor is deeply pigmented or deeply colored, for example, with nail polish, artificial nails, dye or pigmented cream.• Interference can be caused by:– High levels of ambient light (including IR warmers) or strobe lights or flashing lights (such as fire alarm lamps). (Hint: cover application site with opaque material.)–Another SpO2 sensor in close proximity (e.g. when more than one SpO2 measurement is performed on the same patient). Always cover both sensors with opaque material to reduce cross-interference.– Electromagnetic interference, especially at perfusion indicator values below 1.0 and signal quality indicator below medium.– Excessive patient movement and vibration.SpO2 Signal Quality Indicator (Fast SpO2 only)The SpO2 numeric is displayed together with a signal quality indicator (if configured and enough space is available) which gives an indication of the reliability of the displayed values.The level to which the triangle is filled shows the quality of the signal; the indicator below shows a medium signal quality, the signal quality is at a maximum when the triangle is completely filled.
8 Monitoring SpO2166Assessing a Suspicious SpO2 ReadingTraditionally, pulse rate from SpO2 was compared with heart rate from ECG to confirm the validity of the SpO2 reading. With newer algorithms, such as FAST-SpO2, this is no longer a valid criteria because the correct calculation of SpO2 is not directly linked to the correct detection of each pulse.When pulse rate is very low, or strong arrhythmia is present, the SpO2 pulse rate may differ from the heart rate calculated from ECG but this does not indicate an inaccurate SpO2 value.If you doubt the measured SpO2, use the signal quality indicator (if available) or the pleth wave and perfusion indicator instead to assess the signal quality.WARNINGWith pulse oximetry, sensor movement, ambient light (especially strobe lights or flashing lights) or electromagnetic interference can give unexpected intermittent readings when the sensor is not attached. Especially bandage-type sensor designs are sensitive to minimal sensor movement that might occur when the sensor is dangling.Changing the Averaging TimeDepending on the monitor configuration, you may be able to change the averaging time for the SpO2 values. The averaging time represents the approximate time period used for the calculation. The exact averaging algorithm depends on the SpO2 technology (option) used and on the signal conditions. The longer the averaging time, the longer the time needed until the SpO2 value reflects the physiological event. Fast averaging is useful for situations where an extremely fast measurement is required or few artifacts are expected. Use slow averaging where you expect the number of artifacts to be relatively high.1In the Setup SpO₂ menu, select Average.2Select the required averaging time from the list.Understanding SpO2 AlarmsThis refers to SpO2 specific alarms. See the chapter on “Alarms” on page 47 for general alarm information. SpO2 offers high and low limit alarms, and a high priority desat alarm. You cannot set the low alarm limit below the desat alarm limit.
8 Monitoring SpO2167CAUTIONIf you measure SpO2 on a limb that has an inflated noninvasive blood pressure cuff, a non-pulsatile SpO2 INOP can occur. If the monitor is configured to suppress this alarm there may be a delay of up to 60 seconds in indicating a critical status, such as sudden pulse loss or hypoxia.Alarm DelaysThere is a delay between a physiological event at the measurement site and the corresponding alarm at the monitor. This delay has two components:• The general system 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 the configured averaging time. The longer the averaging time configured, the longer the time needed until the numerical values reflect the physiological event.• The time between the displayed numerical values crossing an alarm limit and the alarm indication on the monitor. This delay is the combination of the configured alarm delay time plus the general system alarm signal delay time.The alarm delay time can be configured to a fixed value (between 0 and 30 seconds) or the monitor can be configured to apply a delay based on an intelligent algorithm. See “About Smart Alarm Delays” on page 167 for details on how this works. See “Performance Specifications” on page 401 for delay specifications. About Smart Alarm DelaysThe Smart Alarm Delay functionality is currently not available in the U.S.A. or in clinical environments under FDA control.The monitor can be configured to apply a delay before announcing SpO2 limit alarms. The delay is calculated using an intelligent algorithm. This capability can be used to suppress alarms which occur because a limit is exceeded for a short time or by a small amount.WARNINGBefore using Smart Alarm Delays, make sure that you fully understand how the delay is applied and what the consequences are.The following factors are considered when calculating the delay:• the amount by which a limit is exceeded• the time it is exceeded for, and hence•the speed with which the values change when a limit is exceededIf the measured value rises, or falls, very quickly, an alarm will be announced with only a short delay. If the value changes slowly, the delay will be longer before an alarm is announced. And if the value changes slowly and only for a short time, an alarm may not be announced at all. Here are some specific examples to illustrate this.
8 Monitoring SpO2168ExamplesIn the examples, the SpO2 low alarm limit is set to 90%, and the Smart Alarm Delay is configured on. The measured SpO2 signal is represented by the dotted curve. The vertical axis (V) shows the change in the SpO2 value and the horizontal axis (T) shows the time.In example 1, the SpO2 value is dropping quickly and goes below the low alarm limit at the point marked a. At the point marked b it also crosses into the shaded area which represents the Smart Alarm Delay criteria - the low limit alarm is announced. The delay between the limit being crossed and the alarm being announced, the distance between a and b, is short.In example 2, the SpO2 value is dropping more slowly and goes below the low alarm limit at the point marked c. At the point marked d it also crosses into the shaded area which represents the Smart Alarm Delay criteria - the low limit alarm is announced. The delay between the limit being crossed and the alarm being announced, the distance between c and d, is this time longer.In example 3, the SpO2 value drops slowly below the low alarm limit and after a short time increases again above the limit. As the value never crosses into the shaded area which represents the Smart Alarm Delay criteria, no alarm is announced.However, if a limit is exceeded by a small amount for a very long time, an alarm will be announced. For this case there is a maximum delay time after which an alarm will always be announced.ConfigurationTo accommodate different levels of patient stability, there are three different Smart Alarm Delay settings: Short, Medium and Long, which correspond to three different sets of criteria (three different shaded areas). The appropriate setting for the treatment area where the monitor is to be used is decided during monitor configuration. The Short setting ensures a quick response to changing conditions for less stable patients. The Medium and Long settings extend the delay to avoid unnecessary alarms for more stable patients. For detailed numeric information about the different settings, see the SpO2 section in the Specifications chapter. For background information as a basis for the decision for a specific setting, see the Configuration Guide.
8 Monitoring SpO2169Adjusting the Alarm LimitsIn the Setup SpO₂ menu:•Select High Limit then choose the high alarm limit.•Select Low Limit then choose the low alarm limit.WARNINGHigh oxygen levels may predispose a premature infant to retrolental fibroplasia. If this is a consideration do NOT set the high alarm limit to 100%, which is equivalent to switching the alarm off.Adjusting the Desat Limit AlarmThe Desat alarm is a high priority (red) alarm notifying you of potentially life threatening drops in oxygen saturation.1In the Setup SpO₂ menu, select Desat Limit.2Adjust the limit.Pleth WaveThe Pleth wave is autoscaled to maximum display size. It decreases only when the signal quality becomes marginal. It is NOT directly proportional to the pulse volume. If you need an indication of change in pulse volume, use the perfusion indicator.1 Minimum size for reliable SpO2 valuePerfusion NumericThe perfusion numeric (Perf) gives a value for the pulsatile portion of the measured signal caused by the pulsating arterial blood flow.As pulse oximetry is based on the pulsatile nature of the signal, you can also use the perfusion numeric as a quality indicator for the SpO2 measurement. Above 1 is optimal, between 0.3-1 is acceptable. Below 0.3 is marginal; reposition the sensor or find a better site.Perfusion Change IndicatorThe perfusion change indicator is a graphic symbol which shows the change in the perfusion value, relative to a reference value which you can set.To set the current perfusion value as the reference value:•In the Setup SpO₂ menu, select Set Perf Ref..
8 Monitoring SpO2170When a reference value has been set, the perfusion change indicator is displayed next to the perfusion numeric.Setting SpO2/Pleth as Pulse Source1In the Setup SpO₂ menu, select Pulse (SpO₂) to enter the Setup Pulse menu.2In the Setup Pulse menu, select System Pulseand select the correct SpO2 label from the pop-up list.Setting Up Tone ModulationIf tone modulation is on, the QRS tone pitch lowers when the SpO2 level drops. Remember, the QRS tone is derived from either heart rate or pulse depending on which is currently selected as the active alarm source.In the Setup SpO₂ menu, select Tone Modulation to switch between Yes (for on) and No (for off).Tone modulation is licensed under US patent US 4.653.498 from Nellcor Puritan Bennett Incorporated.Setting the QRS VolumeIn the Setup SpO₂ menu, select QRS Volume and set the appropriate QRS tone volume.Calculating SpO2 DifferenceWhen a second SpO2 measurement is present (either through the SpO2 module or through an external device), the monitor displays both SpO2 values, and calculates the difference between them. The second value is subtracted from the first.1From the Main Setup menu, select Measurements.2From the Setup ΔSpO₂menu, select First SpO₂.3Choose the first measurement source.4Select Second SpO₂.5Choose the second measurement source.
91719Monitoring NBPThis monitor uses the oscillometric method for measuring NBP. In adult and pediatric mode, the blood pressure measurements determined with this device comply with the American National Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP10-1992) in relation to mean error and standard deviation, when compared to intra-arterial or auscultatory measurements (depending on the configuration) in a representative patient population. For the auscultatory reference, the fifth Korotkoff sound was used to determine the diastolic pressure.In neonatal mode, the blood pressure measurements determined with this device comply with the American National Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP10-1992) in relation to mean error and standard deviation, when compared to intra-arterial measurements in a representative patient population.The NBP measurement is suitable for use in the presence of electrosurgery and during the discharge of a cardiac defibrillator according to IEC 601-2-30:1999/EN 60601-2-30:2000.A physician must determine the clinical significance of the NBP information.Introducing the Oscillometric NBP MeasurementOscillometric devices measure the amplitude of pressure changes in the occluding cuff as the cuff deflates from above systolic pressure. The amplitude suddenly increases as the pulse breaks through the occlusion in the artery. As the cuff pressure decreases further, the pulsations increase in amplitude, reach a maximum (which approximates to the mean pressure), and then diminish.Studies show that, especially in critical cases (arrhythmia, vasoconstriction, hypertension, shock), oscillometric devices are more accurate and consistent than devices using other noninvasive measuring techniques.WARNINGPatient Category: Select the correct patient category setting for your patient. Do not apply the higher adult inflation, overpressure limits and measurement duration to neonatal patients.Intravenous infusion: Do not use the NBP cuff on a limb with an intravenous infusion or arterial catheter in place. This could cause tissue damage around the catheter when the infusion is slowed or blocked during cuff inflation.Skin Damage: Do not measure NBP in cases of sickle-cell disease or any condition where skin damage has occurred or is expected.
9 Monitoring NBP172Unattended measurement: Use clinical judgement to decide whether to perform frequent unattended blood pressure measurements in cases of severe blood clotting disorders because of the risk of hematoma in the limb fitted with the cuff.CAUTIONIf you spill liquid onto the equipment or accessories, particularly if there is a chance that it can get inside the tubing or the measurement device, contact your service personnel.Measurement LimitationsMeasurements are impossible with heart rate extremes of less than 40 bpm or greater than 300 bpm, or if the patient is on a heart-lung machine.The measurement may be inaccurate or impossible:• with excessive and continuous patient movement such as shivering or convulsions• if a regular arterial pressure pulse is hard to detect• with cardiac arrhythmias• with rapid blood pressure changes• with severe shock or hypothermia that reduces blood flow to the peripheries• with obesity, where a thick layer of fat surrounding a limb dampens the oscillations coming from the artery• on an edematous extremity.The effectiveness of this sphygmomanometer has not been established in pregnant, including pre-eclamptic patients.Measurement ModesThere are four modes for measuring NBP:•Manual - measurement on demand.•Auto - continually repeated measurements (between one minute and 24 hours adjustable interval).•Sequence - up to four measurement cycles which will run consecutively, with number of measurements and interval between them configurable for each cycle.•STAT - rapid series of measurements over a five minute period, then the monitor returns to the previous mode. Use only on supervised patients.Reference MethodThe measurement reference method can be Auscultatory (manual cuff) or Invasive (intra-arterial). For further information, see the Application Note supplied on the monitor documentation DVD.In Neonatal mode, to comply with safety standards, invasive is always used as the reference method. This setting cannot be changed and is not visible in any operating mode.
9 Monitoring NBP173In Adult and Pediatric mode, to check the current setting, select Main Setup then Measurements followed by NBP, and check whether the Reference setting is set to Auscultatory or Invasive. This setting can only be changed in Configuration Mode.Preparing to Measure NBP1Connect the cuff to the air tubing.2Plug the air tubing into the red NBP connector. Avoid compression or restriction of pressure tubes. Air must pass unrestricted through the tubing.3Make sure that you are using a Philips-approved correct sized cuff and that the bladder inside the cover is not folded or twisted.A wrong cuff size, and a folded or twisted bladder, can cause inaccurate measurements. The width of the cuff should be in the range from 37% to 47% of the limb circumference. The inflatable part of the cuff should be long enough to encircle at least 80% of the limb.4Apply the cuff to a limb at the same level as the heart. If it is not, you must use the measurement correction formula to correct the measurement.The marking on the cuff must match the artery location. Do not wrap the cuff too tightly around the limb. It may cause discoloration, and ischemia of the extremities. Inspect the application site regularly to ensure skin quality and inspect the extremity of the cuffed limb for normal color, warmth and sensitivity. If the skin quality changes, or if the extremity circulation is being affected, move the cuff to another site or stop the blood pressure measurements immediately. Check more frequently when making automatic or stat measurements.Correcting the Measurement if Limb is not at Heart LevelTo correct the measurement if the limb is not at heart level, to the displayed valueadd 0.75 mmHg (0.10 kPa) for each centimeter higher ordeduct 0.75 mmHg (0.10 kPa) for each centimeter lower oradd 1.9mmHg (0.25kPa) for each inch higher. deduct 1.9mmHg (0.25kPa) for each inch lower.
9 Monitoring NBP174Understanding the NBP NumericsDepending on the NBP numeric size, not all elements may be visible. Your monitor may be configured to display only the systolic and diastolic values.The measured NBP value, together with the corresponding pulse rate if this is switched on, will be displayed for one hour. After that the values are regarded as invalid and are no longer displayed. In Auto mode the measurement values may disappear more quickly (to be replaced by new measurement values), if the repeat time is set to less than one hour. Alarm SourcesIf you have parallel alarm sources, the sources are displayed instead of the alarm limits.NBP TimestampDepending on your configuration, the time shown beside the NBP numeric can be:– the time of the most recent NBP measurement, also known as the "timestamp", or– the time until the next measurement in an automatic series, displayed with a graphic representation of the remaining time, as shown here.The NBP timestamp will normally show the completion time of the NBP measurement. Only under the following conditions the timestamp shows the beginning of the measurement:• when in Auto or Sequence mode, and• the monitor is configured to synchronize the measurements in a measurement series to an "easy-to-document" time. For example, if you start the first measurement at 08:23, and the Repeat Time is set to 10 minutes, the monitor automatically performs the next measurement at 8:30, then 8:40 and so on. During MeasurementsThe cuff pressure is displayed instead of the units and the repeat time. An early systolic value gives you a preliminary indication of the systolic blood pressure during measurement.Starting and Stopping MeasurementsUse the Setup menu, SmartKeys or the MMS hardkey to start and stop measurements.1Alarm source2Measurement Mode3Timestamp/Timer4Mean pressure5Diastolic6Systolic7Alarm limits
9 Monitoring NBP175Action to be performed NBP Setup menu SmartKeys MMS hardkeyStart manual measurementStart Auto seriesStart/StopStart/ StopStart/StopStart NBP---Start STAT measurement NBP STATNBP STATSTAT (for MMS without Pressure/Temp measurement)Start STATStop Manual measurements Start/StopStart/ StopStart/StopStop NBPStop current Auto measurement Start/StopStart/ StopStart/StopStop NBPStop current STAT measurement and end seriesStart/StopStart/ StopStart/StopNBP STATNBP STATSTAT (for MMS without Pressure/Temp measurement)Stop NBPStop Auto, Manual or STAT measurement AND seriesStop AllStop All
9 Monitoring NBP176CAUTIONUse clinical judgment to decide whether to perform repeated series of STAT measurements because of the risk of purpura, ischemia and neuropathy in the limb with the cuff.Enabling Automatic Mode and Setting Repetition Time1In the Setup NBP menu, select Mode and select Auto from the pop-up menu.2For an automatic measurement, select Repeat Time and set the time interval between two measurements.Enabling Sequence Mode and Setting Up The Sequence1In the Setup NBP menu, select Mode and select Sequence from the pop-up menu.2Select Setup Sequence to open the Setup Sequence window.Up to four measurement cycles can be setup which will run consecutively. For each cycle you can set the number of measurements and the interval between them. If you want to run less than four cycles in a sequence, you can set the number of measurements for one or more cycles to Off.3Select each sequence in turn and select the number of measurements and the time interval between the measurements.4To have measurements continue after the sequence, set the number of measurements for your last cycle to Continuous and this cycle will run indefinitely.CAUTIONBe aware that, if none of the cycles are set to Continuous, NBP monitoring will end after the last measurement of the cycle.When the NBP measurement mode is set to Sequence, the repetition time for Auto mode cannot be changed.Choosing the NBP Alarm SourceYou can monitor for alarm conditions in systolic, diastolic and mean pressure, either singly or in parallel. Only one alarm is given, with the priority of mean, systolic, diastolic.In the Setup NBP menu, select Alarms from and choose from:
9 Monitoring NBP177If Mean is not selected as alarm source (Sys., Dia., or Sys & Dia selected), but the monitor can only derive a mean value, mean alarms will nevertheless be announced using the most recent mean alarm limits. Check that the mean alarm limits are appropriate for the patient, even when not using mean as the alarm source. When no value can be derived an NBP MEASURE FAILED INOP will be displayed.Switching Pulse from NBP On/OffIn the process of making the NBP measurement, a pulse value can be derived and displayed. The pulse value is displayed together with the time the measurement was made. After one hour the value becomes invalid. There are no alarms associated with pulse from NBP.To switch the display of the pulse value on or off:•In the Setup NBP menu select Pulse (NBP).Assisting Venous PunctureYou can use the NBP cuff to cause sub-diastolic pressure. The cuff deflates automatically after a set time (adult/pediatric 170 seconds, neonatal 85 seconds) if you do not deflate it.1In the Setup NBP menu select VeniPuncture.2Puncture vein and draw blood sample.3Reselect VeniPuncture to deflate the cuff.During measurement, the NBP display shows the inflation pressure of the cuff and the remaining time in venous puncture mode.NOTEPerforming a venous puncture while automatic or sequence NBP measurements are being made suspends the measurement series for the duration of the venous puncture inflation and for three minutes afterwards.Calibrating NBPNBP is not user-calibrated. Cuff-pressure transducers must be verified at least once every two years by a qualified service professional, and calibrated, if necessary. See the Service Guide for details.Menu option Pressure value monitoredSys. systolicDia. diastolicMean meanSys & Dia systolic and diastolic in parallelDia & Mean diastolic and mean in parallelSys & Mean systolic and mean in parallelSys&Dia&Mean all three pressures in parallel
9 Monitoring NBP178
1017910Monitoring TemperatureWARNINGMeasurements from an MMS extension connected to an X2 are not available when the X2 is running on its own battery power. They are only available when the X2 is powered by external power: when connected to a host monitor, to the external power supply (M8023A) or to the Battery Extension (865297).You can measure temperature using an X1 or X2 Multi-Measurement Module (MMS), one of the MMS extensions, or the temperature plug-in module.Temp measurement automatically switches on when you connect a probe. You can switch the measurement off manually.Making a Temp Measurement1Select the correct type and size of probe for your patient.2If you are using a disposable probe, connect the probe to the temperature cable.3Plug the probe or temperature cable into the temperature connector socket.4Apply the probe to the patient. You are advised to use a protective rubber cover on rectal probes.5Select an appropriate temperature label.6Check that the alarm settings (on or off, high and low limits) are appropriate for this patient and this type of temperature measurement.WARNINGMake sure you set alarm limits for the correct label. The alarm limits you set are stored for that particular label only. Changing the label may change the alarm limits.Selecting a Temperature for MonitoringTell the monitor which temperature you want to monitor by selecting its temperature label. The label is a unique identifier for each type of temperature. When you choose a label, the monitor uses that label's stored color and alarm settings.1In the Setup <Temp Label> menu, select Label.
10 Monitoring Temperature1802Select the appropriate label from the list.Extended Temperature Label SetThe following additional labels are available if Label Set is set to Full. This setting can only be changed in Configuration Mode.Note that if your monitor is connected to an Information Center, the additional labels in the extended label set may not be correctly displayed. See the Configuration Guide for your monitor for more information.Calculating Temp DifferenceThe monitor can calculate and display the difference between two temperature values by subtracting the second value from the first. The difference is labeled ΔTEMP.1In the Main Setup menu, select Measurements.2In the Setup ΔTemp menu, select First Temp.3Label the measurement source as appropriate.4Select Second Temp.5Label the measurement source as appropriate.Temp non-specific temperature label Trect rectal temperatureTart arterial temperature Tskin skin temperatureTcore core temperature Tven venous temperatureTesoph esophageal temperature Tnaso nasopharyngeal temperatureT1, T2, T3, T4 Non-specific temperature labelsTamb ambient temperatureTcereb cerebral temperatureTtymp tympanic temperatureTvesic vesical temperature
1118111Monitoring Invasive PressureWARNINGMeasurements from an MMS extension connected to an X2 are not available when the X2 is running on its own battery power. They are only available when the X2 is powered by external power: when connected to a host monitor, to the external power supply (M8023A) or to the Battery Extension (865297).CAUTIONDo not use the X2 in combination with monitors using an M1006A pressure module and the HP1290A pressure transducer. This may cause interference on the respiration or invasive pressure signals.You can measure pressure using an X1 or X2 Multi-Measurement Module (MMS), one of the MMS extensions or the pressure plug-in module. With the plug-in module you may see a wave channel before the pressure cable is plugged in - with the MMS this will not be the case.Setting up the Pressure Measurement1Plug in the pressure cable.2Prepare the flush solution.3Flush the system to exhaust all air from the tubing. Ensure that the transducer and stopcocks are free of air bubbles.WARNINGIf air bubbles appear in the tubing system, flush the system with the infusion solution again. Air bubbles may lead to a wrong pressure reading.1Connect the pressure line to the patient catheter.2If you are using an infusion pressure cuff with the pressure line, attach the pressure cuff to the fluid to be infused. Inflate it according to your standard hospital procedure, then start the infusion.
11 Monitoring Invasive Pressure1823Position the transducer so that it is level with the heart, approximately at the level of the midaxillary line.WARNINGIf measuring intracranial pressure (ICP, IC1 or IC2) with a sitting patient, level the transducer with the top of the patient's ear. Incorrect leveling may give incorrect values.Selecting a Pressure for MonitoringTell the monitor which pressure you want to monitor by selecting its pressure label. The label is a unique identifier for each type of pressure. When you choose a label, the monitor uses that label's stored settings, for example color, wave scale and alarm settings. The label also determines which algorithm is used to process the pressure signal, so an incorrect label can lead to incorrect pressure values.1In the Setup <Press Label> menu, select Label.2Select the appropriate label from the list.Extended Pressure Label SetThe following additional labels are available if Label Set is set to Full. This setting can only be changed in Configuration Mode.Note that if your monitor is connected to an Information Center, the additional labels in the extended label set may not be correctly displayed. See the Configuration Guide for your monitor for more information.Label Description Label DescriptionABP Arterial blood pressure PNon-specific pressure labelART Arterial blood pressure (alternative) PAP Pulmonary artery pressureAo Aortic pressure RAP Right atrial pressureCVP Central venous pressure UAP Umbilical arterial pressureICP Intracranial pressure UVP Umbilical venous pressureLAP Left atrial pressureLabel DescriptionBAP Brachial arterial pressureFAP Femoral arterial pressureIC1, IC2 Alternative intracranial pressuresP1, P2, P3, P4 Alternative non-specific pressure labels
11 Monitoring Invasive Pressure183Zeroing the Pressure TransducerTo avoid inaccurate pressure readings, the monitor requires a valid zero. Zero the transducer in accordance with your hospital policy. You must perform a zero:• when you use a new transducer or tubing• every time you reconnect the transducer cable to the monitor• if you think the monitor's pressure readings are not correct.When using a pressure module, the zero information is stored in the module. When a pressure module, with the transducer connected, is plugged into the monitor, the monitor will use the Zero stored in the module.Zeroing ICP (or IC1/IC2)Your hospital guidelines may require you to zero the ICP transducer less frequently than other transducers, due to the need for aseptic conditions. When you zero an ICP transducer, the zero values are automatically stored and you will not be prompted to repeat the zero procedure.If you want to simultaneously zero all pressures except ICP, disconnect the ICP transducer from the Multi-Measurement module or pressure module while zeroing. Reconnecting the transducer recalls the stored values.WARNINGIf you select the label ICP (or IC1/IC2), the measurement device uses the most recently stored zero. Therefore, make sure you zeroed the transducer correctly in accordance with the transducer manufacturer's instructions and your hospital policy. When you use a transducer that you cannot rezero after placement, ensure that you keep the measuring device with the patient so that you are certain you have the correct zero data for this patient.Determining a Pressure's Most Recent ZeroThe monitor displays the most recent zero on the status line. If this has "timed-out" after you have performed a zero, redisplay the information in the status line by entering the pressure's setup menu.Zeroing a Pressure MeasurementWARNINGInvasive pressure alarms (and pulse alarms, if derived from invasive pressure) are temporarily suppressed until 30 seconds after the transducer finishes zeroing.1Turn off the stopcock to the patient.2Vent the transducer to atmospheric pressure, to compensate for the static and atmospheric pressure exerted on the transducer.3In the setup menu for the pressure, select Zero <Press Label>.
11 Monitoring Invasive Pressure1844When you see the message <Press Label> zero done at <date and time> on the status line, close the stopcock to atmospheric pressure, and open the stopcock to the patient.CAUTIONWhen using high frequency ventilation, ensure that the tubing from the ventilator does not touch the arterial line, or connect with it indirectly, while zeroing the pressure. This could cause small pressure variations which can interfere with the zero procedure.Using the Zero HardkeyPressing the Zero hardkey for two seconds on the M1006B Pressure module starts a zero for the pressure currently measured with the module.Pressing the Zero hardkey for two seconds on the M3001A Multi-Measurement module zeros the pressure being measured by the Multi-Measurement module and the pressures from any connected MMS extensions.Zeroing All Pressures SimultaneouslyWARNINGBefore zeroing all pressures, make sure that all pressure transducers are vented to atmospheric pressure.If you are measuring pressures with more than one measuring device, using the Zero Press SmartKey to initiate the zeroing calls up a list of all active pressures. Select the pressure you want to zero or select All Press to zero all pressures simultaneously.Troubleshooting the ZeroThe status line lists the probable cause of an unsuccessful zero:Message Corrective Actionunable to zero - equipment malfunctionThe hardware is faulty. Contact your service personnel.unable to zero - excessive offsetMake sure the transducer is vented to air and try again. If this fails, the hardware may be faulty. Replace the adapter cable and try again. If it fails, replace the transducer and try again. If it still fails, contact your service personnel.unable to zero - unstable signal
11 Monitoring Invasive Pressure185Adjusting the Calibration FactorEach time you use a reusable transducer, compare the calibration factor written on your transducer with the calibration factor shown on the monitor. To ensure accurate measurement, they must be the same.1In the Setup <Press Label> menu, select Cal. Factor.If the value here does not match that on the transducer, select the corresponding value from the list now in accordance with your hospital's procedure.2To confirm you want to use the new calibration factor, select the Confirm pop-up key.Displaying a Mean Pressure Value OnlyUse this when you want to see only the mean pressure.In the pressure's setup menu, select Mean only. Toggle between On to display mean pressure value only, and Off to display all pressure values (systolic, diastolic and mean).Changing the Pressure Wave Scale1Select the label of the pressure wave whose scale you want to set to enter the Setup <Press Label> menu.2In the Setup <Press Label> menu, (for example ABP) select Scale.3Select a value from the pop-up list:– a positive value sets the top gridline. The bottom gridline is set at zero.– a negative value sets the bottom gridline. The middle gridline is set at zero.Optimizing the WaveformIn the Setup <Press Label> menu, select Optimum Scale to let the monitor select the best minimum and maximum scales for the current wave.unable to zero - no transducerMake sure that the transducer is connected and try again. If this fails, exchange the adapter cable and try again. If this fails, exchange the transducer.unable to zero - pulsatile pressureMake sure that the transducer is vented to air, not to the patient, and try again.unable to zero - timed outTry pressing the Zero hardkey or Zero <Press Label> key again. If this fails, replace the transducer and adapter cable and contact your service personnel.Switch on first Pressure measurement is switched off. To switch it on, in the Setup <Press Label> menu, select the pressure's label.Message Corrective Action
11 Monitoring Invasive Pressure186Using the Wave CursorWhen the pressure wave is selected, you can display a cursor in the wave. It appears as a white horizontal line in the wave. Using the pop-up keys you can move the cursor up or down to the required position and store the corresponding value. The cursor value can be stored • as a systolic, diastolic or mean pressure value, • as an IAP (intra-abdominal pressure) value - for the waves P, P1 to P8, if IAP is configured as a measurement which can be manually entered • as a PAWP value - if the pressure wave is a PAP wave The stored value appears in the trend database as a manually entered value.To display and position the cursor1Select the pressure wave.2Select Activate Cursor.3Use the pop-up arrow keys to position the cursor.Using the pop-up keys you can also change the scale or the speed for the wave, freeze the wave or start a printout or recording.Non-Physiological Artifact SuppressionSome clinical procedures may affect blood pressure, for example, a flush procedure or a blood sample. Your monitor may be configured to suppress these non-physiological artifacts for a specified duration (Artifact Suppr. is configured to 30 sec, 60 sec, or 90 sec). During artifact suppression, the monitor shows the INOP message <Press Label> ARTIFACT, and a question mark is shown beside the pressure numerics. Pressure alarms and the <Press Label> NON-PULSATILE INOP are suppressed during the configured period. The CPP alarms are not suppressed.Choosing the Pressure Alarm SourceWARNINGMake sure you set alarm limits for the correct label. The alarm limits you set are stored for that particular label only. Changing the label may change the alarm limits.You can monitor for alarm conditions in systolic, diastolic and mean pressure, either singly or in parallel. Only one alarm is given at a time, in this order of priority: mean, systolic, diastolic.In the Setup <Press Label> menu, select Alarms from and choose the source.Menu option Pressure value monitoredSys. systolicDia. diastolicMean mean
11 Monitoring Invasive Pressure187Select and set the High Limit and Low Limit for the pressure(s) you have selected.Extreme Alarm LimitsThe extreme pressure alarms, Extreme High and Extreme Low, can be made available for your monitor in Configuration Mode and are additional to the standard High and Low limit alarms. They are generated by the active pressure alarm source, and are setup in Configuration Mode by adding a set value (the Δ value) to the high and low alarm limits. This value can be set for each pressure label individually.1Extreme Low Limit2Low Limit3High Limit4Extreme High Limit5Δ Extreme Low6Δ Extreme HighYou need to know which values have 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 pressure alarms set for your monitor, in the Setup <Press Label> menu, see the menu items Δ Extreme High and Δ Extreme Low.The extreme pressure alarms are high priority, red alarms, marked *** in the alarm message.Calibrating Reusable Transducer CPJ840J6Depending on your monitor's configuration, you may be able to perform a calibration in monitoring mode. Perform a mercury calibration when you use a new transducer, and at regular intervals according to your hospital policy. You require:• standard sphygmomanometer.• sterile 10cc syringe with heparinised solution.•3-way stopcock.Sys & Dia systolic and diastolic in parallelDia & Mean diastolic and mean in parallelSys & Mean systolic and mean in parallelSys&Dia&Mean all three pressures in parallelMenu option Pressure value monitored
11 Monitoring Invasive Pressure188• approximately 25cm of tubing.Making the Pressure CalibrationWARNINGNever perform the invasive pressure calibration while a patient is being monitored.1Zero the transducer.2Connect the syringe and manometer.a. Attach the tubing to the manometer.b. Connect the 3-way stopcock to the stopcock that is not connected to the patient catheter when you measure a patient.c. Attach the syringe to one port and the manometer tubing to the other port.d. Open the port to the manometer.1 Tubing to manometer2 Syringe with heparinised solution3 To pressure connector on monitor4 Patient connection stoppered5 Off3Move the syringe barrel in and raise the mercury to 200 mmHg (30 kPa). 200 mmHg is the recommended calibration pressure.4In the Setup <Press Label> menu, select Cal. Press.5Select the calibration pressure from the list, for example 200 mmHg.6Select Confirm to recalculate the calibration factor using the applied pressure.7When the monitor displays <Press Label> mercury calibr. done at <date and time>, remove the manometer tubing, syringe and extra stopcock. We recommend you replace the transducer dome and tubing with sterile ones.8Label the transducer with the calibration factor shown in the Cal. Factor field in the pressure's setup menu.
11 Monitoring Invasive Pressure1899Reconnect the patient and start measuring again.Troubleshooting the Pressure CalibrationThe status line lists the probable cause of an unsuccessful calibration.Calculating Cerebral PerfusionThe monitor can calculate the difference between mean arterial pressure and the intracranial pressure. The difference is labeled CPP.1In the Main Setup menu, select Measurements.2In the Setup CPP menu, select one of the listed pressures as the arterial pressure source.Calculating Pulse Pressure VariationNote: Pulse Pressure Variation can be calculated in two different ways on this monitor - directly from the pressure measurement or in conjunction with the CCO measurement. Refer to the Cardiac Output chapter for information on PPV from CCO. Only one PPV can be active at a time.Pulse Pressure Variation (PPV) is calculated from beat-to-beat arterial pressure values. Pulse pressure is the difference between the systolic and the diastolic pressure values for a single beat. Pulse pressure variation is defined as the maximal pressure less the minimum pressure divided by the average of these two pressures. The average variation in pulse pressure is calculated over periods of 32 seconds.WARNING• This monitor can calculate PPV from beat-to-beat values of any arterial pulsatile pressure. The circumstances under which the calculation of a PPV value is clinically meaningful, appropriate and reliable must be determined by a physician.• The clinical value of the derived PPV information must be determined by a physician. According to recent scientific literature, the clinical relevance of PPV information is restricted to sedated patients receiving controlled mechanical ventilation and mainly free from cardiac arrhythmia.• PPV calculation may lead to inaccurate values in the following situations:– at respiration rates below 8 rpmMessage Corrective Actionunable to calibrate - equipment malfunctionContact your service department. The pressure hardware is faulty.unable to calibrate - out of range Make sure that you have selected the value for Cal. Press that you are applying to the transducer, and repeat the calibration.unable to calibrate - no transducerMake sure that the transducer is connected and try again.unable to calibrate - unstable signalMake sure there are no disturbances to the transducer, and repeat the calibration.unable to calibrate - perform zero firstNo valid zero. Zero the transducer.
11 Monitoring Invasive Pressure190– during ventilation with tidal volumes lower than 8 ml/kg– for patients with acute right ventricular dysfunction ("cor pulmonale").• The PPV measurement has been validated only for adult patientsTo select an arterial pressure as PPV source:1In the Main Setup menu, select Measurements.2In the Setup PPV menu, select ABP, ART, Ao, BAP, P or FAP as the arterial pressure source.CAUTIONOlder Multi-Measurement modules cannot supply a beat-to-beat arterial pressure value. In this case the monitor shows a NO PPV FROM<Server> INOP.Measuring Pulmonary Artery Wedge PressurePulmonary Artery Wedge Pressure (PAWP) values, used to assess cardiac function, are affected by:• Fluid status• Myocardial contractility• Valve and pulmonary circulation integrityObtain the measurement by introducing a balloon-tipped pulmonary artery flotation catheter into the pulmonary artery. When the catheter is in one of the smaller pulmonary arteries, the inflated balloon occludes the artery allowing the monitor to record changes in the intrathoracic pressures that occur throughout the respiration cycle. The pulmonary wedge pressure is the left ventricular end diastolic pressure (preload).The most accurate PAWP values are obtained at the end of the respiration cycle when the intrathoracic pressure is fairly constant. You can use the respiration waveform as a reference when assessing the PAWP waveform, to ensure constant measurement timing relative to the respiratory cycle. The monitor displays the PAWP value for up to 24 hours or until you admit a new patient.WARNINGThe pressure receptor in the catheter records pressure changes that occur only in front of the occlusion. Even though the catheter tip is in the pulmonary artery, the receptor records pressure changes transmitted back through the pulmonary circulation from the left side of the heart.While performing the wedge procedure, the monitor switches off the pressure alarms for pulmonary artery pressure (PAP).Due to a slight measurement delay, you should not use sidestream CO2 as a direct reference for determining the end expiratory point in the pressure curve.To start the Wedge procedure,1In the Main Setup menu, select Wedge to display the wedge procedure window.2Prepare and check the pressure line according to your hospital policy.
11 Monitoring Invasive Pressure1913Use the Refernce Wave 1 and Refernce Wave 2 pop-up keys to select any ECG or respiratory wave as reference waves.4Select Change Speed if you want to change the speed of the displayed wave. The speed can also be changed in the screen for editing the wedge.5Select Change Scale to change the wave scale of the PAP. The same scale will be used in the screen for editing the wedge. If the setting Optimum Scale is used, the wave scale will be optimized when a wedging waveform is recognized and will revert to the previous scale when the wedge procedure window is closed.6Inflate the balloon when the monitor prompts you: Ready for balloon inflation. The waveform changes from the PAP to the PAWP wave. The measurement takes approximately 12 seconds. On completion, the monitor stores the PAWP waveform display and prompts you to deflate the balloon. If the monitor cannot detect a wedging waveform you must use Store Trace to store the wedge and two reference waves manually.7Deflate the balloon when the monitor prompts you: Ready for balloon deflation and verify that the waveform returns to pulmonary artery shape.8If you need to start a new measurement, select Restart Wedge.Editing the Wedge1Select the Edit Wedge pop-up key to see the stored waveforms.2The monitor displays a cursor in the waveform at the PAWP mean value. It also displays any previously stored value and the time it was stored.3Select Change Speed if you want to change the speed (resolution) of the displayed wave.4Move the cursors up, down, right and left to set them on the correct wedge position.5Select Store Wedge to store the PAWP value.6Select Print Wedge to print the PAWP waveform and any reference waves or Record Wedge to record them. While recording or printing, you cannot perform any more Wedge tasks.WARNINGProlonged inflation can cause pulmonary hemorrhage, infarction or both. Inflate the balloon for the minimum time necessary to get an accurate measurement.If the pulmonary artery flotation catheter drifts into the wedge position without inflation of the balloon, the pulmonary artery pressure waveform assumes a wedged appearance. Take appropriate action, in accordance with standard procedures, to correct the situation.If the PAWP (mean) is greater than the PAP (systolic), deflate the balloon and report the incident in accordance with hospital policy, because the pulmonary artery could be accidentally ruptured, and the wedge value derived will not reflect the patient's hemodynamic state, but will merely reflect the pressure in the catheter or balloon.
11 Monitoring Invasive Pressure192Identifying the Pressure Analog Output Connector1Analog output (module M1006B, option C01 only)
1219312Monitoring Cardiac OutputThe Cardiac Output (C.O.) measurement invasively measures cardiac output and other hemodynamic parameters using a technique called thermodilution. This can be used to determine the flow rate of a system by introducing a cold solution into the system and measuring the resulting drop in temperature at a downstream site. The temperature change is displayed as a curve in the C.O. procedure window, and the monitor calculates the C.O. value from this curve. The C.O. value is inversely proportional to the area under the curve. As cardiac output varies continuously, a series of measurements must be carried out to achieve a reliable C.O. average value. Always use the average of multiple thermodilution measurements for therapy decisions.The measurements can be carried out using the right heart thermodilution method or the PiCCO method (transpulmonary thermodilution).• The right heart method is available with– C.O. module M1012A, standard and option #C10– M3012A Hemodynamic Measurement Extension Module, options #C05 and #C10– M3014A Capnography Measurement Extension Module, option #C05 and #C10• The PiCCO method is available with– C.O. module M1012A, option #C10– M3012A Hemodynamic Measurement Extension Module, option #C10– M3014A Capnography Measurement Extension Module, option #C10The PiCCO method additionally lets you measure Continuous Cardiac Output (CCO) by performing pulse contour analysis on the blood pressure waveform.Hemodynamic ParametersThis table illustrates the hemodynamic parameters available with each method, whether they are measured continuously, and whether they can be shown on the monitor's main screen or in the Hemodynamic Calculations window.
12 Monitoring Cardiac Output194* currently not available in the U.S.A. or in clinical environments under FDA control.Using the C.O.Procedure WindowThe procedure window displays up to six trials (measurement curves) with the trial number and the C.O. value under the thermodilution curve. When you open the window, a line of pop-up keys automatically appears to let you carry out C.O.-related tasks. This example shows the procedure window for the transpulmonary (PiCCO) Method. The window may be configured to look slightly different on your monitor.To open the procedure window,•Select Cardiac Output in the Setup C.O. or Setup CCO menu, or• Select the Cardiac Output SmartKey on the Screen, if configured, or• Press the START hardkey on the front of the C.O. plug-in module, if available, or• Press a remote start switch, if you are using one.Measured and Calculated Hemodynamic Parameters and IndexesPiCCO Method (Transpulmonary Thermodilution)Right Heart ThermodilutionContinuous? Main ScreenHemoCalc Window Continuous? Main ScreenHemoCalc WindowBlood Temperature (Tblood) Y Y N Y Y NC.O./C.I.: Cardiac Output N Y Y N Y YCCO/CCI: Continuous Cardiac Output Y Y Y (in the C.O. field)Not availableSVR/SVRI: Systemic Vascular Resistance N and Y Y Y N N YSV/SI: Stroke Volume/SV Index N and Y Y Y N N YSVV: Stroke Volume Variation Y Y Y Not available*dPmax: Left Ventricular Contractility Index Y Y Y Not availableCFI: Cardiac Function Index N Y Y Not availablePPV: Pulse Pressure Variation Y Y Y Not availableITBV/ITBVI: Intrathoracic Blood Volume N Y Y Not availableEVLW/EVLWI: Extravascular Lung Water N Y Y Not availableGEDV/GEDVI: Global End-Diastolic Volume N Y Y Not available*PVPI: Pulmonary Vascular Permeability Index N Y Y Not available*GEF: Global Ejection Fraction N Y Y Not available*RLShnt: Right-Left-Shunt Fraction N N N Not availablePVR/PVRI: Pulmonary Vascular Resistance Not available N N YLCW/LCWI: Left Cardiac Work N N Y N N YRCW/RCWI: Right Cardiac Work Not available N N YRVSW/RVSWI: Right Ventricular Stroke Work Not available N N Y
12 Monitoring Cardiac Output1951Average - column of averaged values2Unit column3Continuously measured numeric4Prompt message field5Thermodilution curve of current trial6Curve alert message field7Current trial number8Setup information9Trial numbers for the trial curves10 Trial curves11 Results table of current trial12 Trial curve scale• To change the measurement parameters shown in the results table of the procedure window, select the Table Contents pop-up key and choose from the list of available parameters.• To view the currently-used temperature unit, see the "grayed-out" setting Temperature Unit in the Setup C.O. menu. This setting can only be changed in Configuration Mode.• The Cardiac Output screen element may be configured to display permanently on a specially designed Screen. Selecting the screen element opens the cardiac output pop-up keys.Accessing the Setup C.O. and Setup CCO MenusC.O. settings can be changed in the Setup C.O. menu. To access this menu,• press the C.O. hard key on the C.O. module, or• select any of the discontinuous C.O. numerics (for example, C.O., C.I.) on the screen.
12 Monitoring Cardiac Output196CCO/CCI settings can be changed in the Setup CCO menu. To access this menu,• select any of the continuously measured hemodynamic numerics (CCO, CCI.) on the screen.Entering the HemoCalc WindowFrom the procedure window, select the pop-up key Hemo Calc to open the Hemo Calculations window.Measuring C. O. Using the PiCCO MethodThe PiCCO method combines transpulmonary thermodilution and pulse contour analysis on the blood pressure waveform. A fluid with a known volume and temperature is injected into the right atrium through a CVP catheter. The injectate bolus mixes with the blood in the heart and the change in blood temperature is measured with a thermistor at the distal end of an arterial catheter placed in one of the bigger systemic arteries, for example, the femoral or the axillary artery.The PiCCO Method requires a pressure measurement made using either the M1006B Pressure module, or a M3001A/M3002A MMS, or a measurement extension module M3015A, M3014A, or M3012A. (A pressure from an external device may not be used.) You will also need a conventional central venous (CVP) line and an arterial catheter from PULSION Medical Systems. You must use the approved catheters and puncture locations.Measuring Continuous Cardiac OutputEvery time C.O. is measured with the PiCCO method, the monitor uses this C.O. value and the result of the pulse contour analysis to calculate a patient-specific calibration factor. The monitor uses this value to compute CCO and the other continuous hemodynamic parameters. CCO values are calculated on a beat-to-beat basis and then averaged over a 12-second time frame. The calculated values are displayed as numerics on the monitor screen.Measuring Systemic Vascular ResistanceThe monitor uses CCO, an arterial pressure, and CVP to calculate a continuous SVR value. If a continuously measured CVP value is not available, the monitor uses a preset, static CVP value to calculate the SVR (you will see the INOP message SVR SET CVP USED). If the BSA is available, the monitor uses the CCI to calculate the SVRI. A CCO or CCI from an external device can also be used for the SVR/SVRI calculation.SVR/SVRI settings can be changed in the corresponding setup menu. To enter the menu, select Main Setup then Measurements followed by SVR or SVRI.To display a SVR/SVRI numeric on the Screen, select any numeric, then select Change Numeric and select SVR or SVRI from the list of available numerics.Measuring Pulse Pressure VariationNote: Pulse Pressure Variation can be calculated in two different ways on this monitor - in conjunction with CCO or directly from the pressure measurement. Refer to the Invasive Pressure chapter for information on PPV from pressure. Only one PPV can be active at a time.
12 Monitoring Cardiac Output197Pulse Pressure Variation (PPV) is calculated from beat-to-beat arterial pressure values. Pulse pressure is the difference between the systolic and the diastolic pressure values for a single beat. Pulse pressure variation is defined as the maximal pressure less the minimum pressure divided by the average of these two pressures.WARNING• The monitor calculates PPV from beat-to-beat values of the arterial pressure selected for CCO. The circumstances under which the calculation of a PPV value is clinically meaningful, appropriate and reliable must be determined by a physician.• The clinical value of the derived PPV information must be determined by a physician. According to recent scientific literature, the clinical relevance of PPV information is restricted to sedated patients receiving controlled mechanical ventilation and mainly free from cardiac arrhythmia.• PPV calculation may lead to inaccurate values in the following situations:– at respiration rates below 8 rpm– during ventilation with tidal volumes lower than 8 ml/kg– for patients with acute right ventricular dysfunction ("cor pulmonale").• The PPV measurement has been validated only for adult patients
12 Monitoring Cardiac Output198Setting Up the PiCCO C.O. Measurement1Set up the arterial line using the arterial catheter (transpulmonary catheter) and the transducer kit from PULSION Medical Systems. It must be placed in one of the bigger systemic arteries, for example, the femoral or the axillary artery. You must use the approved catheters and puncture locations.2Set up the central venous line.3Connect the injectate temperature probe housing to the venous line.4Plug the C.O. interface cable into the C.O. module or measurement extension module and connect the following devices to the C.O. interface cable:– Injectate temperature probe– Thermistor connector– Remote start switch (if used).Follow your hospital standards to avoid unintentional extraction of the C.O. catheter. Secure the cable using the mounting clip shipped with each C.O. interface cable. You may also find it helpful to loop the C.O. interface cable, tape the loop, and attach it to the undersheet of the patient's bed using a safety pin.1C.O.Module2C.O.Interface Cable3 PULSION Pressure Transducer4 Press Module5 Pressure Adapter Cable6 Thermistor Connection Cable7 Thermistor Connection8 PULSION Arterial Catheter9CVP Line10 Injectate Temperature Probe Housing11 Injectate Syringe12 Injectate Temperature Probe13 Remote Switch
12 Monitoring Cardiac Output1995If you are measuring CCO, set up the pressure measurement now. The CCO measurement requires a minimally dampened invasive pressure setup. You must ensure that there are no air bubbles in the pressure line or dome and use only specified accessories.6Check that the correct measurement method is selected.If a catheter is already connected to the Cardiac Output Interface Cable, the monitor automatically recognizes the method used. If not, in the Setup C.O. menu, select Method and then select Transpulmnry.7Check that you are using the correct probe - the M1646. This is the only probe supported for use; it can be used with room temperature injectate or with cold injectate.8Check that the correct arterial catheter constant is selected.If the catheter is recognized by the monitor, the catheter constant is automatically displayed and cannot be changed manually. If it is not recognized, in the procedure window, select CathCt and use the pop-up keypad to enter the correct value. The catheter constant is usually written either on the catheter or on the catheter packaging.9Make sure that the injectate volume setting matches the injectate volume you will use. To change the volume, in the procedure window, select InjVol and select the correct injectate volume from the pop-up list.If there is a problem with the volume or temperature you have chosen, the monitor will issue a curve alert message to inform you of this.10 If you are measuring CCO or CCI, check that the correct pressure source is selected in the Setup CCO menu. The pressure label under CCO From must match the pressure measured with the arterial catheter. To change the pressure source, select CCO From to call up a list of available pressure labels and select the correct label.11 If you are measuring CCO or CCI, verify that the correct alarm source is selected in the menu item Alarms From. To change the alarm source, select Alarms From and choose either CCO or CCI.Performing PiCCO C.O. MeasurementsAlways wait for the monitor to indicate readiness for the next step before proceeding.If you are measuring CCO, all measurements should be conducted within 15 minutes. Older measurements "expire" for CCO calibration.1Enter the procedure window.2When you see the message Ready for new measurement, start the measurement by selecting the pop-up key Start C.O. or pressing the Start hardkey on the C.O. module, or pressing the remote start switch. If the measuring mode is set to Auto the Start C.O. key will also enable the automatic start of consecutive measurements.3When you hear the ready tone and see the message Stable baseline, inject now!, inject the solution into the CVP catheter.At the end of the measurement the thermodilution curve, cardiac output, index values, ITBV and EVLW values and any curve alerts are displayed and a message will appear Wait before starting new measurement or in Auto mode Prepare for next injection or press Stop.4When you see the Stable baseline, inject now! message, repeat the procedure until you have completed the measurements you want to perform. You can perform a maximum of 6 measurements before editing. If you perform more than 6 measurements without rejecting any, the oldest will automatically be deleted when a 7th curve is stored.
12 Monitoring Cardiac Output200Editing PiCCO C.O. MeasurementsIt is important to identify and reject erroneous trials, as the monitor uses all the measurement trial values you do not reject to calculate the averaged cardiac output.1Review the trials. Irregular trials or trials marked with a "?" should be reviewed carefully. Consider the similarity of the values and the shape of the C.O. curve. A normal C.O. curve has one smooth peak and returns to the temperature baseline level after the peak.2Reject unsatisfactory trials: use the Select Trial pop-up key to move between trials, then select the Accept Reject pop-up key to accept or reject trials. If you are using a touch screen you can accept or reject trials directly by tipping on the trial curve. Discard conspicuously different values. The background of rejected trials is red and the background of accepted trials is green. The monitor recalculates the average values after you reject or accept trials.If all values are different from each other, there may be true hemodynamic instability caused, for example, by severe cardiac arrhythmia.Saving and Calibrating PiCCO C.O. MeasurementsWhen you have finished editing the trials, you must save the results. This closes the measurement series, sends the average C.O. numeric to be displayed on the main screen, and stores the averaged values in the trends and calculations databases.Before the monitor can calculate CCO, you must calibrate the measurement. You should also calibrate CCO every eight hours, or if the hemodynamic condition of the patient changes consistently in the same direction over 15 minutes, or if there are large or sudden changes in the patient's condition.The monitor only uses C.O. measurements from within the last 15 minutes for calibrating CCO.To save and calibrate,• In the procedure window, select the pop-up key SaveC.O. &Cal CCO to use the averaged C.O. value to calibrate Continuous Cardiac Output (CCO).Your monitor may be configured to have two separate pop-up keys, Save C.O. and Cal CCO, instead of the combined SaveC.O. &Cal CCO.WARNINGCCO calibration is patient-specific. When the C.O. module or measurement extension module is plugged in after the patient has changed, make sure that the correct CCO calibration is used. When in doubt perform a new CCO calibration first.CCO Calibration Status IndicatorsEach measurement trial is tagged with a calibration status indicator next to its trial number. Reflecting the quality of the pressure signal during the thermodilution measurement, this tag indicates each trial's validity to be used in a CCO calibration.
12 Monitoring Cardiac Output201For a trial to be eligible for calibration, the pressure signal must be continuously available and undisturbed starting 30 seconds before the first C.O. measurement of the series. Do not zero the pressure measurement, change the pressure label, or disturb the pressure signal in any other way during this time.Measuring C.O. Using the Right Heart Thermodilution MethodIn the right heart thermodilution method, a fluid of known volume and temperature is injected into the right atrium through the proximal port of a pulmonary artery (PA) (Swan-Ganz) catheter. The injectate bolus mixes with the blood in the right ventricle and the change in blood temperature is measured with a thermistor at the distal end of the catheter in the pulmonary artery.Cal A pressure signal for CCO was available during the measurement (valid for calibration)?Cal A disturbed pressure signal for CCO was available during the measurement (valid for calibration)N/A No adequate pressure signal for CCO was available during the measurement (no valid calibration data)Exp This trial is more than 15 minutes older than the most recent trial and has expired for CCO calibration (no valid calibration data)
12 Monitoring Cardiac Output202Setting up RH C.O. Measurements1Set up the PA line using a PA catheter.2Attach the injectate temperature probe housing to the PA line.3Plug the C.O. interface cable into the C.O. module or measurement extension module and connect the following devices into the C.O. interface cable:– injectate temperature probe– remote start switch (if used).Follow your hospital standards to avoid unintentional extraction of the C.O. catheter. Secure the cable using the mounting clip shipped with each C.O. interface cable. You may also find it helpful to loop the C.O. interface cable, tape the loop, and attach it to the undersheet of the patient's bed using a safety pin.4Plug the thermistor connection cable of the PA catheter into the thermistor connector.5Connect the injectate temperature probe to the injectate temperature probe housing.6Check that the correct measurement method is selected.If a catheter is already connected to the Cardiac Output Interface Cable, the monitor automatically recognizes the method used. If not, in the Setup C.O. menu, select Method and then select Right Heart.1C.O.Module2C.O.Interface Cable3 Remote Start Switch4 Thermistor Connector5 Thermistor Connection Cable6 PA Catheter7 Injectate Temperature Probe Housing8 Injectate Syringe9 Injectate Temperature Probe
12 Monitoring Cardiac Output203Ice-Bath Setup for RH Thermodilution C.O. MeasurementsIf you are using the flow-through method illustrated above, the injectate temperature is measured at the time of injection by the temperature probe in the injectate temperature probe housing.If you are using the ice-bath setup, the injectate temperature probe and the injectate are both placed in an ice-bath and the probe measures the temperature of the contents of the ice bucket.Setting the Computation ConstantCheck that the correct Computation Constant is entered in the procedure window. This can be found in the documentation supplied with the catheter and is based on the injectate volume, injectate temperature and catheter type. To change the value, in the procedure window, select Computation Constant and use the pop-up keypad to enter the correct value.Performing RH C.O. Measurements1Enter the procedure window.2When you see the message Ready for new measurement, select the pop-up key Start C.O.. If the measuring mode is set to Auto the Start C.O. key will also enable the automatic start of consecutive measurements.3When you hear a ready tone and see the message Inject now!, inject the solution into the right atrial port of the Swan-Ganz catheter. The optimal injection rate is 2.5 ml/second.At the end of the measurement the thermodilution curve, cardiac output, index values and curve alerts (if necessary) are displayed and a message will appear Wait before starting new measurement or in Auto mode Prepare for next injection or press Stop.4When you see the Inject now! message, repeat the procedure until you have completed the measurements you want to perform. You can perform a maximum of six measurements before editing. If you perform more than six measurements without rejecting any, the oldest will automatically be deleted when a seventh curve is stored.Editing and Saving RH C.O. MeasurementsIt is important to identify and reject erroneous measurements (called "trials"), as the monitor uses all the measurement trial values you do not reject to calculate the averaged cardiac output.1Review the trials. Irregular trials or trials marked with a "?" should be reviewed carefully. Consider the similarity of the values and the shape of the C.O. curve. A normal C.O. curve has one smooth peak and returns to the temperature baseline level after the peak.2Reject unsatisfactory trials: use the Select Trial pop-up key to move between trials, then select the Accept Reject pop-up key to accept or reject trials. If you are using a touch screen you can accept or reject trials directly by tipping on the trial curve. Discard conspicuously different values. The background of rejected trials is red and the background of accepted trials is green. The monitor recalculates the average values after you reject or accept trials.If all values are different from each other, there may be true hemodynamic instability caused, for example, by severe cardiac arrhythmia.3Save average C.O. values. To close a measurement series, you must save the average values by selecting the pop-up key Save C.O.. This sends the average C.O. numeric to be displayed on the main screen, and stores the averaged values in the trends and calculations databases.
12 Monitoring Cardiac Output204Documenting C.O. MeasurementsYou can document C.O. measurements on the default printer or recorder.1In the procedure window, select the pop-up key Print/ Record.2From the pop-up list, choose:–Print Results to print the contents of the procedure window–Record Results to record the contents of the procedure window–Record Trial to send an individual trial curve to the recorder.C.O. Injectate GuidelinesThe greater the injectate volume and the colder the temperature, the more accurate the measurement. Reduced injectate volume or higher injectate temperature may reduce the specified accuracy.For adult patients, to ensure the greatest measurement accuracy, use a cold injectate (< 8°C) of 10 ml volume, if not contra-indicated by the patient's condition. Your choice of injectate volume should be based on the injectate temperature and the patient's cardiac output.Guidelines for Right Heart Thermodilution C.O. InjectateIf you are using the right heart thermodilution method, the use of injectate with a temperature less than 8°C lower than the blood temperature may cause incorrect values for the thermodilution.Guidelines for PiCCO C.O. InjectateIf you are using the PiCCO method, the use of injectate with a temperature that is not at least 12°C lower than the blood temperature may cause incorrect values for the thermodilution and CCO calibration.Injectate Volume, Patient Weight and ETVI Values (PiCCO Only)When deciding on an injectate volume and temperature, you must consider your patient's weight and extra-vascular thermal volume index (ETVI).High ETVIThe dilution of injectate is influenced by extravascular tissue and fluid. The accuracy of the PiCCO method may be reduced in patients with high extra-vascular thermal volume index (ETVI) values. Use the table below as a guide in selecting the correct injectate temperature. As shown in the table, if your patient has an ETVI > 10, you must use cold injectate.WeightUse the table below as a guide in choosing an injectate volume appropriate for the patient weight.
12 Monitoring Cardiac Output205C.O./CCO Curve Alert MessagesAfter each measurement trial, the monitor analyzes the thermodilution curve. If the curve appears abnormal, a curve alert message appears in the procedure window. A question mark symbol ("?") may appear next to the cardiac output numeric if any of these messages appear. The curve alert messages are not error messages and do not necessarily mean that the measured values are invalid.Patient WeightCold Injectate Room Temperature InjectateETVI < 10 ETVI ≥ 10 ETVI < 10 ETVI ≥ 10< 3 kg 2 ml 2 ml 3 ml Use cold injectate< 10 kg 2 ml 3 ml 3 ml< 25 kg 3 ml 5 ml 5 ml< 50 kg 5 ml 10 ml 10 ml< 100 kg 10 ml 15 ml 15 ml≥ 100 kg 15 ml 20 ml 20 ml
12 Monitoring Cardiac Output206C.O./CCO Curve Alert MessagesPossible CausesTinj off scale The Tinjectate is out of the range -1°C and 30°C. Cool down or heat up the injectate or change the injectate solution and repeat the measurement.Noisy baseline A blood temperature baseline drift that could not be compensated was detected during the C.O. measurement. Possible causes are:- Interference may be caused by a ventilator.- Interference may be caused by an infusion pump: infusions of significant volume through the central line should be paused at least 30 seconds before the first thermodilution measurement in a series and should not recommence until the measurement series is completed.- Do not administer injections through the central line during a measurement series.- Electrical devices in the vicinity can cause interference: check for infusion pumps connected to the central catheter, cables parallel to the thermodilution cable, electrocautery. Make sure all devices are properly grounded.- Wait until measurement results are displayed before moving the patient or catheter.- Close the stopcock to the injectate syringe after the injection.- Do not rinse the catheter during measurement, to avoid temperature fluctuations.Temperature baseline drift May occur if patient is recovering from open heart surgery, or if patient was cooled down for surgery and is in the process of regaining normal body temperature when the measurement is made.Small signal, more indicator requiredThe peak of the transpulmonary thermodilution curve was below 0.1ºC. Increase injectate volume and/or lower injectate temperature.Injectate temperature too high The difference between the blood and injectate temperatures is too small. The calculated value for C.O. may not be accurate.High ETVI, use cold injectate or greater inj. volumeThe ETVI value is too high. The accuracy of the transpulmonary thermodilution measurement may be reduced. Increase injectate volume and/or lower injectate temperature following the guidelines given in the section “Guidelines for PiCCO C.O. Injectate” on page 204.Disturbed injection The injection should be performed quickly and with a steady pressure. Shaking, unsteady pressure, or injections that take longer than six seconds may cause this message to appear; you should bear this in mind if you are using a large injectate volume (> 10 ml).
12 Monitoring Cardiac Output207If you have followed all of these guidelines, your measurement values should be valid, even if you still see a curve alert message. Ensure that at least three subsequent measurements within the current series do no differ by more than 15%. If the difference exceeds 15%, use your clinical judgment to determine the appropriate intervention.C.O./CCO Prompt MessagesPrompt messages appear in the procedure window if a C.O. measurement trial must be terminated.C.O./CCO Warning MessagesWarning messages contain important information about the C.O. measurement.Check Injectate Temperature Probe TypeThe recorded Tinj signal is uncharacteristic for the M1646 injectate temperature probe. An incorrect probe type may have been used.Unsteady baseline There is a noisy baseline, and thermal baseline drift.Multiple peaks Caused by faulty injection technique.Abnormal decay time May be caused by low cardiac output. Calculated value for C.O. may not be accurate.Very long curve The decay time of the curve is longer than 15 seconds.Very short curve Decay time of the curve is less than 0.5 seconds. If there is a noisy baseline, part of the baseline may have been mistaken for a thermodilution curve. Calculated value for C.O. may not be accurate.Irregular curve Any combination of curve alert messages.Delayed injection Injection is given more than 15 seconds after Start C.O. is selected. Calculated value for C.O. may not be accurate.C.O./CCO Curve Alert MessagesPossible CausesC.O./CCO Prompt Messages Possible CausesCurve below baseline, measurement terminatedMay be caused by thermal baseline drift. No C.O. value calculated.Excessive curve height, measurement terminatedThe curve exceeds the upper limit. This may be caused by an injectate that was too cold. No C.O. value calculated.Unstable baseline, injection not recommended!The baseline is unstable. Wait until the baseline is stable before injecting. If this does not occur within a reasonable time, injection is possible but the accuracy of the measured values may be reduced.Excessive baseline drift, don't inject now!No measurement is possible. Measured values are incorrect.
12 Monitoring Cardiac Output208C.O./CCO Safety InformationWARNINGCatheter constant - Make sure that the arterial catheter constant for the measurement is appropriate to the catheter used.Computation Constant - Make sure that the computation constant for the measurement is appropriate to the injectate volume, injectate temperature and catheter type used.IABP - Do not perform transpulmonary thermodilution measurements on patients undergoing IABP treatment.CCO accuracy - Accuracy of the CCO measurement and all the derived values may be influenced by patients with valve diseases or artificial valves.C.O. and MRI - Do not use the Cardiac Output Interface Cable in Magnetic Resonance Imaging (MRI) Applications.Aortic graft patients - Do not use an arterial catheter in the arteria femoralis when it is contra indicated, for example, with patients who have an aortic graft.C.O./CCO Warning Messages Possible CausesNext measurement erases older curveSix curves are stored, this is the maximum possible. If another measurement is stored, the oldest thermodilution curve will be erased.Previous C.O. setup data replaced A C.O. module or measurement extension module has been plugged in with different C.O. setup data from the previous data. The new C.O. setup data is read from the new C.O. device, and replaces the current data. The message disappears when the Start C.O. pop-up key is pressed.Verify C.O. setup data A new transpulmonary thermodilution catheter has been connected to the C.O. Interface Cable.Check arterial pressure, CCO cal currently not possiblePoor or invalid pressure signal, for example if pressure was not zeroed.Verify the Computation Constant A new catheter has been plugged in, or the computation constant has been changed and Start C.O. has not been selected.Previous Comp. Constant replacedA new C.O. module or measurement extension module with a different computation constant from the current one has been connected. The new computation constant is read from the new C.O. device, and replaces the current one. The message disappears when Start C.O. is selected.
12 Monitoring Cardiac Output209CAUTIONDuring the cardiac output measurement procedure the blood temperature alarms are inactive. This is indicated by a crossed-out alarm symbol next to the temperature numeric. Making alarms inactive during this procedure prevents false alarms. The alarms are automatically reactivated when you have completed the measurement procedure.
12 Monitoring Cardiac Output210
1321113Monitoring Carbon DioxideWARNINGMeasurements from an MMS extension connected to an X2 are not available when the X2 is running on its own battery power. They are only available when the X2 is powered by external power: when connected to a host monitor, to the external power supply (M8023A) or to the Battery Extension (865297).Only one CO2 measurement at a time is supported.Use the CO2 measurement to monitor the patient's respiratory status and to control patient ventilation.There are two methods for measuring carbon dioxide in the patient's airway:• Mainstream measurement uses a CO2 sensor attached to an airway adapter directly inserted into the patient's breathing system. This method is available using the M3014A Capnography Extension and the M3016A Mainstream CO2 Extension, or the X2 with the optional CO2 measurement.• Sidestream measurement takes a sample of the respiratory gas with a constant sample flow from the patient's airway and analyzes it with a remote CO2 sensor built into the measurement system. Philips offers the sidestream CO2 measurement in the M3014A Capnography Extension or the X2 with the optional CO2 measurement, and the Microstream method of sidestream CO2 measurement in the M3015A/B Microstream CO2 Extension.Refer to your Gas Module Instructions for Use, if you are using a Gas Module to monitor CO2.WARNINGCorrelation: The etCO2 readings do not always correlate closely with paCO2, especially in neonatal patients and patients with pulmonary disease, pulmonary embolism or inappropriate ventilation.Pharmaceuticals in aerosols: Do not measure CO2 in the presence of pharmaceuticals in aerosols.Explosion Hazard: Do not use in the presence of flammable anesthetics or gases, such as a flammable anesthetic mixture with air, oxygen or nitrous oxide. Use of the devices in such an environment may present an explosion hazard.Failure of operation: if the measurement or a sensor fails to respond as described, do not use it until the situation has been corrected by qualified personnel.
13 Monitoring Carbon Dioxide212Low etCO2 values: Leakages in the breathing system or sampling system may cause the displayed etCO2 values to be significantly too low. Always connect all components securely and check for leaks according to standard clinical procedures. Displacement of the nasal or combined nasal oral cannulas can cause lower than actual etCO2 readings. Even with combined nasal oral cannulas, the etCO2 readings may be slightly lower than actual in patients breathing through the mouth only.Measurement PrinciplesFor both mainstream and sidestream measurements, the measurement principle is infrared transmission, where the intensity of infrared light passing the respiratory gas is measured with a photo detector. As some of the infrared light is absorbed by the CO2 molecules, the amount of light passing the gas probe depends on the concentration of the measured CO2.When using a wet ventilator circuit, monitor mainstream CO2 if available, in preference to sidestream CO2.The partial pressure is calculated from the gas concentration by multiplying the concentration value with the ambient pressure.The measurement provides:•a CO2 waveform.•an end tidal CO2 (etCO2) value: the CO2 value measured at the end of the expiration phase.• an inspired minimum CO2 (imCO2): the smallest value measured during inspiration.• an airway respiration rate (awRR): the number of breaths per minute, calculated from the CO2 waveform.Depending on the Max Hold setting configured for your monitor, the etCO2 numeric shows either the highest CO2 value measured within the configured time period (Max Hold set to 10 sec or 20 sec) or the etCO2 numeric shows breath-to-breath value (Max Hold set to Off).Measuring CO2 using M3014A or X2The M3014A Capnography Extension or the X2 with the CO2 option measures partial pressure of carbon dioxide in a patient's expired gas using the mainstream method or the sidestream method.The mainstream CO2 measurement can be used, with appropriate accessories, with intubated adult, pediatric and neonatal patients. The sidestream CO2 measurement can be used, with appropriate accessories, with intubated and non-intubated adult, pediatric, infant and neonatal patients. With intubated patients, a sample of the respiratory gas is drawn from the patient's breathing circuit through an airway adapter and a gas sampling tube. With non-intubated patients, the gas sample is drawn through a nasal or oral-nasal cannula.
13 Monitoring Carbon Dioxide213WARNINGAltitude Setting: The monitor is not equipped with automatic barometric pressure compensation. Before the CO2 measurement is used for the first time, the altitude must be set to the correct value. An incorrect altitude setting will result in incorrect CO2 readings. The CO2 readings will typically deviate 5% for every 1000m difference.CAUTIONUse the CO2 measurement with Philips approved accessories only. Refer to the instructions for use provided with the accessory.Preparing to Measure Mainstream CO2You must perform a zero as described in this procedure each time you use a new airway adapter.1Attach the sensor connector to the CO2 connector on the MMS extension, or on the X2 (when the optional CO2 measurement is integrated).2Wait 2 minutes, allowing the sensor to reach its operating temperature and a stable thermal condition.3Choose the appropriate airway adapter and connect it to the sensor head. The airway adapter clicks into place when seated correctly. To zero the sensor:– expose the sensor to room air and keep it away from all sources of CO2 including the ventilator, the patient's breath and your own.– in the setup menu for the CO2, select Start Zero Cal.
13 Monitoring Carbon Dioxide214– When you see the message CO₂ calibration done at <date and time> on the status line, the zero calibration is finished and you can begin monitoring.4Install the airway adapter at the proximal end of the circuit between the elbow and the ventilator Y-section.WARNINGTo prevent stress on the endotracheal tube, support the sensor and airway adapter.Position sensor cables and tubing carefully to avoid entanglement or potential strangulation. Do not apply excessive tension to any cable.Replace the airway adapter, if excessive moisture or secretions are observed in the tubing or if the CO2 waveform changes unexpectedly without a change in patient status.To avoid infection, use only sterilized, disinfected or disposable airway adapters.Inspect the airway adapters prior to use. Do not use if airway adapter appears to have been damaged or broken. Observe airway adapter color coding for patient population.Preparing to Measure Sidestream CO21Plug the sensor cable into the monitor's CO2 input connector. Allow the sensor two minutes warm up time 2Connect the cannula, airway adapter, or sample line as appropriate, to the sensor. It will click into place when seated correctly.3To zero the sensor:
13 Monitoring Carbon Dioxide215– expose the sensor to room air and keep it away from all sources of CO2 including the ventilator, the patient's breath and your own.– in the setup menu for the CO2, select Start Zero Cal.– when you see the message zero done at <date and time> on the status line, the zero calibration is finished and you can begin monitoring.4For intubated patients requiring an airway adapter: Install the airway adapter at the proximal end of the circuit between the elbow and the ventilator Y-section. For intubated patients with an integrated airway adapter in the breathing circuit.: Connect the male luer connector on the straight sample line to the female port on the airway adapter.For non-intubated patients: Place the nasal cannula onto the patient.For patients prone to mouth breathing use an oral-nasal cannula.For nasal or oral-nasal cannulas with oxygen delivery, place the cannula on the patient as shown then attach the oxygen supply tubing to the oxygen delivery system and set the prescribed oxygen flow.WARNINGAlways connect the airway adapter to the sensor before inserting the airway adapter into the breathing circuit. In reverse, always remove the airway adapter from the breathing circuit before removing the sensor.Make sure that you do not accidentally connect the luer connector of the gas sample line to an infusion link or any other links in the patient vicinity.
13 Monitoring Carbon Dioxide216CAUTIONAlways disconnect the cannula, airway adapter or sample line from the sensor when not in use.Using the Sidestream Sensor HolderThe holder delivered with the sensor can be used to clamp the sensor onto an IV pole or a shelf.1Push the sensor into the holder until it clicks into position.2Clamp the holder onto an IV pole, a shelf or another appropriate location.To remove the sensor from the holder, release the clip and pull the sensor out of the holder.Removing Exhaust Gases from the SystemWARNINGAnesthetics: When using the sidestream CO2 measurement on patients who are receiving or have recently received anesthetics, connect the outlet to a scavenging system, to avoid exposing medical staff to anesthetics.Use an exhaust tube to remove the sample gas to a scavenging system. Attach it to the sidestream sensor at the outlet connector.Measuring Mainstream CO2 using M3016AThe M3016A Mainstream CO2 Extension measures partial pressure of carbon dioxide in a patient's expired gas using the mainstream method. When using the appropriate accessories you can use the mainstream CO2 measurement with ventilated adults, pediatric and neonatal patients.WARNINGInfra-red radiation: Do not expose the airway adapter or M1460A transducer to infra-red radiation during use. This may cause incorrect readings.
13 Monitoring Carbon Dioxide217Preparing to Measure Mainstream CO21Attach the transducer connector to the CO2 connector on the M3016A extension.2Wait 20 minutes, allowing the transducer to reach its operating temperature and a stable thermal condition.3Perform an accuracy check and then, if necessary, calibrate the transducer.Checking Transducer AccuracyWARNINGCheck transducer accuracy at least once a week or if you doubt the CO2 readings.1In Setup CO₂ menu, select Cal. Mode to switch on calibration mode.2Look at the calibration value displayed in the Setup CO₂ menu next to Start CAL1. Is it the same as the value on the calstick? If not, calibrate the transducer now.3Place the transducer on the low cell of the calstick (labeled 0.0 mmHg or "ZERO"). The reading on the screen should be zero within ±1 mmHg within one minute.4Place the transducer on the high cell of the calstick. The reading on the screen should be within ±1 mmHg of the value on the calstick within one minute.5If both readings are in range, you can leave calibration mode and begin monitoring. If either of the readings is out of range, calibrate the transducer.Calibrating the Transducer1Check that the windows on the calstick are clean and clear.2Place the transducer on one of the calstick cells and select Start CAL1.3Enter the calibration value printed on the calstick then press Confirm to start calibration.4When the message CO₂ CAL1 calibration done -- Start CAL2 calibration appears, put the transducer on the other cell and select Start CAL2 then press Confirm.5When you see the message CO₂ calibration completed - leave Cal. Mode, calibration is complete.6Select Cal. Mode to switch calibration mode off. You cannot monitor in calibration mode.Attaching and Removing the CO2 Transducer1Open the latch and place the transducer (B) onto the airway adapter (A). Place the airway adapter in the patient's breathing circuit between the endotracheal tube and the Y-piece. You may see the
13 Monitoring Carbon Dioxide218CO₂ SENS.WARMUP message until the transducer reaches operating temperature. Wait until this disappears before starting the measurement.2To remove the transducer from the airway adapter, open the latch and pull out the airway adapter.WARNINGTo prevent stress on the endotracheal tube, support the transducer and airway adapter.To avoid infection, use only sterilized airway adapters.Measuring Microstream CO2 using M3015A/BThe M3015A/B Microstream CO2 Extension measures the partial pressure of carbon dioxide in a patient's expired gas using Microstream technology.The measurement is equipped with an automatic barometric pressure compensation.
13 Monitoring Carbon Dioxide219Preparing to Measure Microstream CO2Use appropriate accessories for:• the patient type (adult, pediatric or neonatal),• the ventilation situation (including humidification)• the duration - short term use, up to 24 hours (typically OR), or long term use (typically ICU).All accessories are for single patient use only.Using Microstream AccessoriesThe Microstream measurement can be operated with the special Microstream accessories only. Refer to the instructions for use provided with the accessory.For intubated patient with non-humidified ventilation, you can use a Microstream FilterLine set. For humidified ventilation, use a FilterLine H Set.For non-intubated patients, the gas sample is taken through a Nasal FilterLine, or a Smart CapnoLine (which is a combined oral-nasal FilterLine). In parallel to the measurement of the CO2, oxygen (O2) may be delivered to the patient to support gas exchange. This is done by using an O2/CO2 FilterLine, or a Smart CapnoLine O2 (a combined oral-nasal O2/CO2 FilterLine).Using the FilterLine and Airway AdapterWARNINGMake sure that you do not accidentally connect the luer connector of the gas sample line to an infusion link or any other links in the patient vicinity.1Attach the female Luer connector to the CO2 inlet connector by pushing the socket cover aside and screwing the connector into place.2Check that the FilterLine is not kinked.3Change the FilterLine if a CO₂ OCCLUSION INOP appears on the monitor or if the readings become extremely erratic.Disconnect the FilterLine during suctioning and nebulizing therapies or suppress sampling by turning off the pump as described in “Suppressing Sampling (not Mainstream CO2)” on page 221.Check the table in the Microstream CO2 Accessories section of the Accessories chapter for typical usage times for the different Microstream accessories.CO2 values for non-intubated patients using Microstream accessories will always tend to be lower than for intubated patients. If values appear extremely low, check whether the patient is breathing through the mouth or whether one nostril is blocked.
13 Monitoring Carbon Dioxide220Removing Exhaust Gases from the SystemWARNINGAnesthetics: When using the Microstream CO2 measurement on patients who are receiving or have recently received anesthetics, connect the outlet to a scavenging system, or to the anesthesia machine/ventilator, to avoid exposing medical staff to anesthetics.Use an exhaust tube to remove the sample gas to a scavenging system. Attach it to the MMS Extension at the outlet connector.Suppressing Zero CalibrationTo prevent an automatic zero calibration from being started in the next five minutes,•in the Setup CO₂ menu, select No Zero For 5Min, or select the Suppress CO₂ Zero SmartKey, if configured.Selecting No Zero For 5Min or selecting the Suppress CO₂ Zero SmartKey again before the timer has timed out resets the timer to five minutes, unless an AutoZero became due during the previous suppression.Setting up all CO2 MeasurementsThese tasks are common to all CO2 measurements except where otherwise noted.Adjusting the CO2 Wave Scale1In the CO₂ Wave menu or the Setup CO₂ menu, select Scale.2Choose a suitable scale range from the pop-up list.Setting up CO2 CorrectionsTemperature, water vapor in the patient's breath, barometric pressure, and the proportions of O2, N2O and Helium in the mixture all influence CO2 absorption. If values seem inaccurately high or low, check that the monitor is using the appropriate corrections.
13 Monitoring Carbon Dioxide221Suppressing Sampling (not Mainstream CO2)To temporarily stop sampling, in the Setup CO₂ menu, select Pump 15Min Off or use the CO₂ Pump Off SmartKey if available.Selecting Pump 15Min Off again before fifteen minutes have passed resets the timer to fifteen minutes.To re-start the pump, in the Setup CO₂ menu, select Pump On.Changing CO2 AlarmsThis refers to CO2 specific alarms. See the Alarms section for general alarm information.1In the Setup CO₂ menu, select etCO₂ High or imCO₂ High and choose the high alarm limit.2Select etCO₂ Low and choose the low alarm limit.Changing the Apnea Alarm DelayThis determines the time limit after which the monitor alarms if the patient stops breathing.1In the Setup CO₂ menu, select awRR.CorrectionAltitude(M3014A only)Altitude is set during installation. The monitor automatically applies an appropriate correction.O2(M3014A only)In the Setup CO₂ menu, select Oxy. Corr and select a value between 20% and 100%, the default value is 20%. If you are not measuring the expired O2, estimate it by subtracting 5% from the inspired O2 then select the nearest value from the list.Humidity At installation, the monitor is configured to automatically apply either Body Temperature Pressure Saturated (BTPS) or Ambient Temperature Pressure Dry (ATPD). To see which, go to the Setup CO₂ menu, and scroll down to look at Hum. Corr or Humidity Corr..N2O(M3016A mainstream and M3015A/B microstream only)In the Setup CO₂ menu, select N₂O Corr. and turn on or off. If N2O is present in the ventilation gas mixture, you must turn this on.If the N2O correction is not available in the Setup CO₂ menu, the CO2 measurement in your MMS Extension does not require N2O correction or it is setup with Gas Corr. (see below).Gas(M3014A only)In the Setup CO₂ menu, select Gas Corr. and select Helium, N₂O or turn off. If Helium or N2O is present in the ventilation gas mixture, you must make the appropriate selection.If the Gas correction is not available in the Setup CO₂ menu, the CO2 measurement in your MMS Extension does not require N2O or Helium correction or the N2O correction is setup with N₂O Corr. (see above).Agent(M3014A only)In the Setup CO₂ menu, select Agt. Corr and select the concentration of the anesthetic agent (between 0.0% and 20.0%). If an anesthetic agent is present in the ventilation gas mixture, you must select the appropriate concentration.
13 Monitoring Carbon Dioxide2222In Setup awRR menu, select Apnea Time.3Choose the apnea alarm delay time.WARNINGSafety and effectiveness of the respiration measurement method in the detection of apnea, particularly the apnea of prematurity and apnea of infancy, has not been established.Prolonged delay: The selected apnea alarm delay may be prolonged by up to 17 seconds, if an apnea occurs during the automatic zero process. This applies to the Microstream (M3015A/B) measurement only.Deriving Alarms From awRR1In the Setup CO₂ menu, select awRR.2In the Setup awRR menu, select Alarms.3Choose On to derive alarms from the airway respiration signal or Off to disable them.Changing awRR Alarm Limits1In the Setup CO₂ menu, select awRR.2Select High Limit to set the upper alarm limit.Select Low Limit to set the lower alarm limit.3Select the appropriate setting.
1422314Monitoring Airway Flow,Volume and PressureThe M1014A Spirometry Module is designed to be used in combination with Philips-branded airway flow sensors and combined CO2/airway flow sensors. It produces a real time wave for flow, volume and pressure of respiratory gases together with numerics for analysis of ventilatory mechanics.The measurement provides:• Airway flow, airway volume and airway pressure waveform.•Numerics for:– respiratory rate–tidal volume– minute volume– PEEP (positive end-expiratory pressure)– PIP (peak inspiration pressure)– dynamic compliance– airway resistance• Numerics for: (only visible in SpirometryValues Window, no alarming, no trending)–peak inspiratory flow–peak expiratory flow– negative inspiratory pressure– mean airway pressure– plateau pressure numeric–I:E ratioThe measurement also provides pressure-volume loops, flow-volume loops and pressure-flow loops. Please see the “Respiratory Loops” on page 355 chapter for details on loops.When using combined CO2/Flow sensors you can also perform mainstream capnography with intubated adult, pediatric and neonatal patients. See the Measuring CO2 chapter for details on the CO2 measurement and the Accessories chapter for a list of compatible accessories.
14 Monitoring Airway Flow, Volume and Pressure224WARNINGElectrical Shock Hazard: Do not open the module. Contact with exposed electrical components may cause electrical shock. Always turn off and remove power before cleaning the module. Refer servicing to qualified service personnel.Attaching the Flow SensorCAUTIONUse the M1014A Spirometry Module with Philips approved accessories only. Refer to the instructions for use provided with the accessory.1Select the appropriate flow sensor. Make sure that you are using the correct sensor for the respective patient category. Otherwise accuracy may be reduced.You can also use combined CO2/flow sensors. Note that the M3014A Capnography Extension is required to measure CO2.Pediatric/Adult Flow Sensor (M2785A). Color: clearFor intubated patients with endotracheal tube diameters >4 mm. Adds approximately 6.5 cc of deadspace.Infant/Neonatal Flow Sensor (M2786A) Color: violetFor intubated patients with endotracheal tube diameters ≤ 4 mm. Adds less than 1 cc of deadspace.Pediatric/Adult Combined CO2/Flow Sensor (M2781A). Color: clearFor intubated patients with endotracheal tube diameters >5.5 mm. Adds 8 cc of deadspace.Pediatric Combined CO2/Flow Sensor (M2783A): Color: greenFor intubated patients with endotracheal tube diameters of 3.5 - 6 mm. Adds less than 4 cc of deadspace.Infant/Neonatal Combined CO2/Flow Sensor (M2782A). Color: violetFor intubated patients with endotracheal tube diameters of 2.5 -4 mm. Adds less than 1 cc of deadspace.
14 Monitoring Airway Flow, Volume and Pressure2251If you are using a combined CO2/Flow sensor, connect it to the CO2 sensor head first. The airway adapter clicks into place when seated correctly.2Click the connector into place in the flow sensor receptacle on the monitor before connecting to the breathing circuit.3Install the flow sensor or the combined CO2/Flow sensor at the proximal end of the breathing circuit between the elbow and the ventilator Y-piece. Make sure that the spirometry sensor is in a horizontal position with its tubing pointing upwards. The correct position is also indicated by an arrow on some of the sensors. (Graphic shows combined CO2/Flow Sensors).1 Pediatric/adult sensor2 Pediatric sensor3 Infant/Neonatal sensorWARNINGTo prevent stress on the endotracheal tube, support the sensor and airway adapter.Position sensor cables and tubing carefully to avoid entanglement or potential strangulation. Do not apply excessive tension to any cable or tubing.Replace the sensor, if excessive moisture or secretions are observed in the tubing and cannot be removed by a purge cycle.Reuse poses a patient hazard. Do not disassemble, clean, disinfect or sterilize the sensor.A system leak may significantly affect readings of flow, volume, pressure and other respiratory mechanics parameters.Do not leave the sensor in the patient circuit when not connected to the monitor.NOTE• Do NOT place the airway adapter between the endotracheal tube and the elbow (pediatric/adult circuit), as this may allow patient secretions to block adapter windows.• The striped tubing of the flow sensor should always be proximal to the patient.• Position the airway adapter with the spirometry tubing pointing upwards.• To prevent "rain-out" and moisture from draining into the airway adapter, do NOT place the airway adapter in a gravity dependent position.
14 Monitoring Airway Flow, Volume and Pressure226• Periodically check the flow sensor and tubing for excessive moisture or secretion build up. Perform a purge cycle if droplets are visible within the sensor or tubing. Repeat if necessary. If purging does not remove the droplets, replace the sensor.• For routine performance of airway care, separate the system between the endotracheal tube and the airway adapter (neonatal circuit), or between the endotracheal tube and elbow (pediatric/adult circuit). Lavage and suctioning of the airway can then be performed without fluids and mucous accumulating on the airway adapter windows.• Measurement values provided by a ventilator may differ significantly from the values provided by the spirometry module, due to different locations of the flow sensor.• Incorrect entry of gas compensation parameters (i.e. temperature, gas composition) may reduce the accuracy of the measured values.• An abnormal volume waveform as displayed below may be an indicator of an air leak:In general, if MVexp or TVexp are significantly smaller than MVin or TVin, the tubing should be checked for leaks.Zero CalibrationThe zero calibration maintains the accuracy of the spirometry waves and numerics by regularly compensating for drifts within the measurement section. It is performed automatically without user interaction and takes about 2 seconds to complete. The automatic zero calibration is normally carried out every ten minutes. During warm-up or when the ambient pressure changes, this interval may be reduced to two minutes.During the zero calibration the waveform is flat but the numerics remain on the screen. Typically, a zero calibration is started at the beginning of a respiration cycle, therefore a waveform may begin normally and then immediately become flat for the time of the zero calibration.1 Zero Calibration
14 Monitoring Airway Flow, Volume and Pressure227Automatic PurgingA double lumen connecting line (tubing) connects the flow sensors to the patient monitor. The M1014A Spirometry Module includes an automatic and manual purge feature which provides a flush of room air to keep the sensor tubing free from water condensation and patient secretions. This feature is available for the adult, pediatric, and neonatal modes. The purge will begin with the exhalation portion of the ventilator cycle.NOTE• During the purge cycle the pump will be heard• If the purge does not sufficiently clear the flow tubing lines, the flow sensor should be replaced• With each purge cycle, a zero calibration is automatically performedAdult ModeThe system automatically purges the sensor tubing every ten minutes or less, depending on system conditions. In adult mode, the system will purge both sides of the line, one at a time, during each purge cycle. The higher the pressure, the more frequent the purging. This action anticipates increased moisture migration into the sensor tubing due to the increase in circuit pressure.Neonatal and Pediatric ModesThe automatic purge cycles used in the neonatal or pediatric mode is fixed at every three minutes regardless of circuit pressure. Only one side of the sensor tubing will be purged during each purge cycle.Unlike the adult purge mode, the neonatal or pediatric purge mode does not use the full force of the internal pump, but rather pressurizes an internal reservoir which is used for the purge. This minimizes the pressure delivered to the ventilator circuit, but does deliver a sufficient pressure to purge the sensor tubing.Manual PurgingOccasionally, purging may be required in between the automatic purge cycles. The manual purge may be used as often as needed. Check the orientation of the flow sensor if repeated manual purge cycles become necessary.To manually purge, press the Purge button on the module (marked by   on international versions of the module) or select Purge in the Setup Spirometry window to initiate a combined purge and zero cycle.Gas CompensationTemperature and the proportions of individual gases influence the flow measurement. If values seem inaccurately high or low, check that the monitor is using the appropriate gas compensation. Gas compensation can be done using either manually entered gas concentrations or gas concentrations from the gas analyzer.
14 Monitoring Airway Flow, Volume and Pressure228NOTEIf you unintentionally switch the gas compensation to the incorrect setting, the accuracy of the measured flow and volume values may be significantly reduced. The tables below show examples of incorrect gas compensation settings and the resulting inaccuracies:Incorrect Balance Gas Setting (N2O instead of N2)Incorrect Agent Percentage SettingSetting up SpirometryThe following settings can be accessed through the Setup Spirometry menu.Optimizing Scale SettingsIn the Setup Spirometry menu, select Optimize Scales. The scale settings for all three spirometry waves (AWF, AWP, AWV) will be optimized.Spirometry Values WindowYou can view all spirometry measurement data in the spirometry data window. In the Setup Spirometry menu, select Show All Values.Alarms and Alarm LimitsAlarms can be derived from PEEP, PIP, MV and RRspir. In the Setup Spirometry menu you can set the alarm limits. Please refer to the Alarms chapter of this manual for details on alarm settings.Changing the Apnea Alarm DelayThis determines the time limit after which the monitor alarms if the patient stops breathing.1In the Setup Spirometry menu, select RRspir.2In Setup RRspir menu, select Apnea Time.3Choose the apnea alarm delay time.N2O2N2OAgent Difference between measured and actual valuesActual Gas Composition 60 40Gas Compensation Setting 40 60 15%N2O2N2OAgent Difference between measured and actual valuesActual Gas Composition 55 40 5Gas Compensation Setting 60 40 0 15%
14 Monitoring Airway Flow, Volume and Pressure229WARNINGSafety and effectiveness of the respiration measurement method in the detection of apnea, particularly the apnea of prematurity and apnea of infancy, has not been established.WARNINGIf an apnea occurs during a zero calibration or purge, the time delay between the start of apnea and the activation of the apnea alarm could be up to 10 seconds plus the configured apnea delay time.Automatic Alarm SuppressionIf the automatic alarm suppression is switched on, all spirometry alarms are suppressed until breathing activity has been detected. This setting must be made in configuration mode.Choosing Measured AWV Components1In the Setup Spirometry menu, select AWV.2Select MV to choose the measured components for Minute Volume (inspiratory and/or expiratory or off).Select TV to choose the measured components for Tidal Volume (inspiratory and/or expiratory or off).NOTEIf MV and TV are set to off, there will be no alarming for these parameters.Setting the Gas Compensation Mode1In the Setup Spirometry menu, select Gas Compensation.2Select Mode to choose the Gas Compensation mode:–select Manual for manually entered gas concentrations or–select Gas Analyzer for gas concentrations from the gas analyzer.NOTE• Gas concentrations from the gas analyzer are only available for Philips gas analyzers, not for devices connected via a Vuelink/IntelliBridge module.• If gas concentrations from the gas analyzer are selected but not all data is available, the missing data is taken from manually entered values. In case of invalid data or no data at all, the INOP message SPIRO GAS COMPENS? is displayed.Changing the Type of Balance Gas1In the Setup Spirometry menu, select Gas Compensation.2Select Balance Gas to change the type of balance gas.3Select the appropriate setting (N2 or N2O).
14 Monitoring Airway Flow, Volume and Pressure230Changing the Concentration of Inspired O2 and the Inspired Agents1In the Setup Spirometry menu, select Gas Compensation.2Select Inspired O₂ to change the concentration of inspired O2.Select Inspired Agent to change the concentration of the inspired agent(s).3Select the appropriate setting.Changing the Temperature of the Inspired GasDepending on the type of ventilator environment (e.g. if you are using a Heat Moisture Exchanger) you may want to change the temperature setting of the inspired gas:1In the Setup Spirometry menu, select Gas Compensation.2Select Inspired Temp to change the temperature of the inspired gas.3Select the appropriate temperature setting.NOTEChanging the temperature setting unintentionally will result in approximately 3% reduced accuracy per 10°C (18°F) temperature setting change.
1523115Monitoring tcGasThe tcGas module measures the partial pressure of the oxygen and carbon dioxide that diffuses through the skin, thereby providing a measure of these gases in the capillary blood.The monitor's settings for altitude and barometric pressure influence the measurement. The tcpO2/tcpCO2 measurement is valid for an infant patient not under gas anesthesia. Anesthetic agents, such as halothane, can cause incorrect or drifting readings.Transcutaneous measurements cannot replace arterial blood gas monitoring. However, you can use transcutaneous monitoring to reduce the frequency of arterial sampling. The values at tissue level will not be the same as those measured arterially because the measurement is transcutaneous. They correlate with (track closely) the arterial values. For example, a drop in transcutaneous values usually indicates a corresponding drop in arterial values.Transcutaneous values will not always correlate with blood samples taken from the capillary blood of the heel (heelsticks or astrups).Identifying tcGas Module ComponentsSetting the tcGas Sensor Temperature1In the Setup tcGas menu, select Transducer Temp..1Press to enter Setup tcGas menu2Press to start calibration3Calibration chamber4Transducer connector
15 Monitoring tcGas2322Choose a temperature value appropriate for your patient's age, weight and physical condition in accordance with your hospital policy.Usually, a higher transducer temperature gives a better correlation and a quicker response time. However, higher temperatures also increase the risk of skin burns. Most physicians prefer a temperature between 42°C (107°F) and 44°C (111°F), and a site time of four hours or less. Usually, the higher the transducer temperature, the less the site time should be. Whenever you change the temperature setting, the monitor forces you to make a new calibration.Using the tcGas Site TimerAvailability and behavior of the site timer depend on your monitor's configuration.WARNINGProlonged continuous monitoring may increase the risk of undesirable changes in skin characteristics, such as irritation, reddening, blistering or burns. If the site timer is disabled, the transducer will heat indefinitely while on a patient. Change the site regularly, in accordance with medical procedures in your hospital.Setting the tcGas Site TimerThe site timer helps reduce the risk of skin burn by ensuring that the transducer is used at one site for no longer than a predefined period. It reminds you when this period expires.1In the Setup tcGas menu, select Site Time.2Choose the time you want the transducer to remain on the measurement site. The optimum time depends on the transducer temperature and your patient's skin sensitivity.The site timer starts automatically when you remove the calibrated transducer from the calibration chamber. If you return the transducer to the chamber and then remove it again, the site time continues to count down the remaining time; it does not start a new time period. The time remaining before the site timer expires appears in the status line which is visible as long as the Setup tcGas menu is open. When the time expires, the monitor sounds a tone and a displays a change site INOP. The monitor either switches off the transducer heating or continues monitoring, depending on its configuration. Although you can reuse the transducer for up to two hours after the heating is switched off, without making a new calibration, you are recommended to recalibrate before applying it to a patient. After two hours without heat, you must recalibrate.During the initial few minutes of use, the monitor eliminates false alarms by temporarily suppressing tcGas alarms. It displays the <tcGas Label> STABILIZING INOP. After you apply the transducer to the skin, the instrument reading slowly assumes a steady value. The reading stabilizes when the measurement site is warm and local hyperemization is complete. This takes 10 to 20 minutes for the tcpO2 reading and three to seven minutes for tcpCO2.Restarting the tcGas SiteTimerTo restart the site timer without recalibration (for example, after the site time has elapsed):1In the Setup tcGas menu, select Site Time.2Enter and confirm your desired time.
15 Monitoring tcGas233Disabling the tcGas Site TimerDepending on your monitor's configuration, you might be able to disable the site timer. Remember, this means that the transducer heats indefinitely while on a patient.1In Setup tcGas menu, select Site Timer and switch this to Disabled.2Select the Confirm pop-up key.Setting the tcGas Barometric PressureAltitude and barometric pressure affect tcGas values. The monitor derives barometric pressure from its altitude setting. If you want to set the true barometric pressure you must do this before starting a calibration - changes after calibration do not influence tcGas values. The monitor remembers this pressure setting until you enter a new one.1In the Setup tcGas menu, select Ambient Pressure.2Enter the current barometric pressure reading indicated by your barometer.3Select the Confirm pop-up key.Remembraning the tcGas TransducerFollow the instructions supplied with the transducer.New/Dried Out TransducersRemembrane all new or dried out transducers twice before using. After the first remembraning, unplug the transducer from the module and leave it for 24 hours with the cap on. Remembrane again before calibrating.Storing tcGas TransducersIf you need to store a sensor for more than 24 hours, protect it for up to 28 days by putting two drops of electrolyte solution into the cap. Screw the cap on the sensor. Remembrane if it dries out or after 28 days.Calibrating the tcGas TransducerYou can use either a Philips (15210B) or a Radiometer TCC3 calibration unit and a gas cylinder whose pressure indicator is above the 'out-of-gas' zone (black on 15210B, red on TCC3). To maintain accuracy, it is recommended to calibrate the transducer every four hours, even if the monitor does not prompt you to do so. You MUST calibrate when:• you remembrane the transducer• you change the transducer heat setting• you doubt the measurement accuracy• you start a new monitoring period or use a new site• the monitor displays the Calibration required INOP message.
15 Monitoring tcGas2341Connect the calibration unit to the inlet on the side of the module's calibration chamber using the recommended gas tubing. Different tubing will cause inaccurate measurements.2Plug the transducer cable into the module. Swing the calibration chamber cover open and insert the transducer into the chamber. Close the cover to secure the transducer. Set the transducer temperature at the monitor now.3On the 15210B calibration unit, turn the timer control clockwise as far as you can. On the Radiometer calibration unit, press the button with the green arrow once.4Press CAL on the module until the light above the key comes on and wait (three - 20 minutes) for the completion message to appear on the monitor. Alternatively, in the Setup tcGas menu, select StartCalibration. To save gas on 15210B, if the timer control dial is not in the start position when the monitor displays the completion message, turn the dial counter-clockwise to the start position. For TCC3, if the green light is still flashing when INOP <tcGas Label> CAL RUNNING disappears, press the green arrow button again.Calibration FailureIf calibration fails, the monitor displays <tcGas Label> transducer or cal. unit malfunction and the <tcGas Label> CAL FAILED INOP for the measurement.
15 Monitoring tcGas235Troubleshooting tcGas CalibrationPerform each of the following steps, in order, until calibration is successful.1Check the calibration unit, then recalibrate, remembering to turn on the gas supply on the calibration unit. If the pressure indicator reading is in the out of gas zone, there is insufficient gas in the cylinder. Connect the gas tubing firmly to the calibration unit and to the module's calibration chamber.2If Step 1 fails, check whether you need to activate the transducer (necessary if the electrolyte has dried out or if you have a new transducer). Remembrane the transducer, removing the old membranes, and cleaning the transducer head thoroughly.3Calibrate a second time.4If Step 2 is unsuccessful, calibrate again. This calibration may be required to stabilize the electrochemical system in the transducer.5Only if the above steps are unsuccessful (you have activated and remembraned the transducer and calibration has still failed twice), replace the transducer.Applying the tcGas Transducer1Peel protection film from fixation ring. Using a finger, press the sticky side of the ring on to clean, dry skin. Press around the outside to ensure a good seal. Apply three to five drops of contact fluid in the ring's center. Remove transducer from chamber.2Align the arrow on the transducer with the tab on the ring and fasten by turning a quarter-turn clockwise. Wait 10-20 minutes for readings to stabilize.3Apply the transducer as soon as possible after you see the message indicating that calibration is complete. If you wait longer than 30 minutes, the heat supply to the transducer switches off to prevent the electrolyte from drying out and a new calibration is necessary.Optimize the measurement by selecting a site with high capillary density and blood flow, thin epidermis and no cardiovascular disorders. Most physicians use the abdomen, chest and back.
15 Monitoring tcGas236WARNINGYou must either remove the transducer before defibrillating, or remembrane and calibrate the transducer after defibrillating.CAUTIONTo avoid transducer damage, remove it from the patient during high frequency surgical procedures.Selecting the tcGas HeatPowerDisplay ModeThe heat power display gives an indication of the skin's perfusion below the transducer and of the transducer's contact with the skin. If the transducer loses contact, the heat power value drops significantly. When perfusion is poor you need less heat power to maintain the transducer temperature.•In the Setup tcGas menu, select HeatPowerDisplay and then Relative or Absolute. Choose Relative when the skin temperature is stable (the <tcGas Label> STABILIZING INOP disappears). This indicates subsequent changes in the relative heat power (and therefore changes in perfusion or transducer contact) since the last zeroing.Zeroing the tcGas Relative Heat PowerWhen you start a calibration, the HeatPowerDisplay is set to Absolute. When you switch to Relative, it automatically zeros. Zero again if you change application site.Finishing tcGas MonitoringReplace the transducer in the calibration chamber.When changing the application site after a measuring period, some users leave the fixation rings in position to allow them to quickly move the transducer from site to site. Always unscrew the transducer from the fixation ring before removing the fixation ring from the skin.TcGas CorrectionsTranscutaneous pCO2 values tend to be higher than arterial values due to the metabolic processes of the skin and the effect of heating on the blood under the transducer. Depending on your monitor's configuration, one or both of these corrections may automatically apply.Temperature Correction for tcpCO2The transducer temperature causes an increase in partial CO2 pressure. Your monitor may be configured to correct this.•In the Setup tcGas menu, look at the menu item CO₂ Correction. If correction is enabled, it is set to On.
15 Monitoring tcGas237Metabolism Correction for tcpCO2CO2 production in the epidermis increases the CO2 value. Your monitor may be configured to automatically deduct a metabolism factor (only applies when CO₂ Correction is on).In the Setup tcGas menu, look at the value shown for the menu item MetabolismFactor. This is deducted from the CO2 value.
15 Monitoring tcGas238
1623916Monitoring IntravascularOxygen SaturationDepending on the probe or catheter used and the measurement location, the two modules, M1011A and M1021A, measure the central venous oxygen saturation or mixed venous oxygen saturation continuously and invasively.The two modules can be differentiated by their size and their labeling. The M1011A is a single-width module (narrow) and is labeled SO2. The M1021A is a double-width module (wide) and is labeled SvO2.WARNINGInjected dyes, such as methylene blue, or intravascular dyshemoglobin may lead to inaccurate measurements.Do not monitor oxygen saturation during infusion of I.V. fat emulsion or other turbid substances through the distal lumen of the OptiCath catheter. These liquids might temporarily modify the blood scattering and absorption characteristics at the catheter tip. This interferes with the optical measurement of oxygen saturation. After infusion is complete, you can again monitor oxygen saturation accurately.During injection of the bolus for thermodilution cardiac output measurements, the SvO2 measurement might be disturbed.Explosion Hazard: Do not use in the presence of flammable anesthetics or gases, such as a flammable anesthetic mixture with air, oxygen or nitrous oxide. Use of the devices in such an environment may present an explosion hazard.1 M1011A2 M1021A
16 Monitoring Intravascular Oxygen Saturation240Do not use probes/catheters when they, or the packaging, are damaged.Always select the correct label for the measurement location and the catheter/probe in use. This is especially important when Protocol Watch is in use, to ensure that the correct limits are used for the criteria applied.CAUTIONUse the modules with Philips approved accessories only. Refer to the instructions for use provided with the accessory.Selecting a Measurement LabelAlways select a measurement label before inserting a catheter/probe.Use the SvO2 label when the catheter/probe will be located in the pulmonary artery (measuring mixed venous oxygen saturation). This is the only label which allows the measurement value to be used to calculate oxygen extraction (see “Calculating Oxygen Extraction” on page 245) and in the standard oxygen calculations.Use the ScvO2 label when the catheter/probe will be located in a central vein (measuring central venous oxygen saturation.Use the SO2 label in all other cases.To select a measurement label:1Select Main Setup then Measurements followed by <SO₂ Label>2Select Label.3Select the appropriate label for the catheter/probe location.Preparing to Monitor with the M1021A Wide ModuleIn addition to the measurement module, you need a Hospira OptiCath catheter, and 50131 Optical Module. Use only the Hospira accessories listed in the Accessories section.
16 Monitoring Intravascular Oxygen Saturation241Connect the optical module (Hospira 50131) to the measurement module. Allow the optical module to warm up before you perform a calibration. Although the warm up message disappears from the screen after one minute, Hospira recommends letting the optical module warm up for 15 minutes for best accuracy. Please refer to the instructions for the optical module.To avoid false alarms during the pre-insertion calibration and insertion of the catheter into the patient, the monitor automatically suspends alarms during the pre-insertion calibration, for up to three minutes after you remove the catheter tip from the optical reference. After light intensity calibration, or after three minutes (whichever comes first), the monitor returns to the alarm state it was in prior to pre-insertion calibration.Carrying out a Pre-insertion CalibrationWARNINGIt is strongly recommended to carry out a pre-insertion calibration prior to all insertions. If this is not possible, you must perform an in-vivo calibration after insertion.Refer to the instructions for use that accompany the catheter. Do not use the catheter if the packaging is damaged. If you have to disconnect the monitor from the patient (for example, when transferring the patient from one location to another), you must disconnect at the SvO2 module. The catheter should remain in the optical module, otherwise you need to recalibrate.1Remove outer wrapping from catheter tray to uncover optical connector.2Place the optical module on the catheter tray in the space provided and open the lid.3Place the optical connector into the optical module (with the label "TOP" facing upwards) and close the lid.4In the Setup <SO₂ Label> menu, select Start Pre-InsCal. Ensure that the tip of the catheter is still in the optical reference.5Insert the catheter when you see the message <SO₂ Label> calibration completed - catheter ready for insertion. If the calibration fails, repeat the calibration before inserting the catheter. If it fails a second time, replace the optical module.1Optical module2Balloon inflation stopcock3Hospira fiber optic catheter4Optical reference5Enter setup/calibration
16 Monitoring Intravascular Oxygen Saturation242Inserting the Catheter1Remove the inner cover of the catheter tray.2Remove the catheter tip from the optical reference. Check the catheter's proper operation (for example: the balloon tip).3Prepare and insert the catheter in accordance with standard hospital practice.The SvO2 catheter is thin and flexible, treat it carefully. Avoid kinking, bending or grasping the catheter with forceps or a hemostat. Damage to the fiber results in low intensity light and sudden decrease in intensity readings. Refer to the documentation provided with the fiber-optic catheter, paying special attention to any precautions, warnings or contraindications.Secure the optical module directly or in close proximity to the patient, to avoid placing excessive tension on the catheter, which would result in movement of the catheter tip from the optimal position in the patient. Position the optical module to avoid contact with liquids, because fluid entering the catheter-optical module connection may impair light transmission.If you place the catheter in the patient without performing the pre-insertion calibration, you must perform an in-vivo calibration once the catheter is in place.Performing a Light Intensity CalibrationPerform a light intensity calibration after the catheter is in its proper position. When the catheter is positioned properly, the light intensity indicator must cover at least two small divisions above the midpoint.•In the Setup <SO₂ Label> menu, select Start Light Cal.Calibration is complete after a few seconds. If you doubt existing light intensity readings, recalibrate.Performing In-Vivo CalibrationPerform an in-vivo calibration:• if you place the catheter in a patient without performing a pre-insertion calibration.• if the catheter was disconnected from the optical module.• when the catheter has been in the patient for 24 hours.• if any significant change in light intensity occurs that the monitor cannot correct automatically.Setting Up the In-Vivo CalibrationCheck for:• proper positioning of the catheter in the patient.• relatively stable oxygen saturation in patient.•that the SvO2 light intensity indicator covers at least two divisions above the midpoint.
16 Monitoring Intravascular Oxygen Saturation243Making the In-Vivo Calibration1Be prepared to draw a blood sample from the patient.2In the Setup <SO₂ Label> menu, select Start In-VivoCal.3To clear the distal lumen, draw off and discard at least 2 ml of blood before taking the sample.4Draw a blood sample from the distal port of the catheter and flush the line according to standard hospital practice.5Obtain laboratory analysis of the sample using direct measurements.6Select CalibrationValue and select from the list the value received from the lab.7Complete the calibration by selecting Store In-VivoCal (even if the stored calibration value did not change) and select Confirm. This updates the data stored in the optical module.Selecting Recall Last Cal recalls the previously stored calibration value.If the calibration fails, check that the light intensity indicator is indicating a stable medium to high level. Repeat the calibration.Setting Up the In-Vivo CalibrationCheck for:• proper positioning of the probe/catheter in the patient.• relatively stable oxygen saturation in patient.• that the light intensity indicator is indicating a stable medium to high level.Depending on the probe/catheter in use you may need to enter a catheter correction factor. This will be indicated in the table in the Accessories chapter or in the catheter documentation.1In the Setup <SO₂ Label> menu, select Catheter Factor.2Enter the correction factor.Making the In-Vivo Calibration1Be prepared to draw a blood sample from the patient.2In the Setup <SO₂ Label> menu, select Start In-VivoCal.3To clear the distal lumen, draw off and discard at least 2 ml of blood before taking the sample.4Draw a blood sample from the distal port of the catheter and flush the line according to standard hospital practice.5Obtain laboratory analysis of the sample using direct measurements.6Select CalibrationValue and select from the list the value received from the lab.7Select Hct [%] (or Hb [mmol/l] or Hb [g/dl] depending on the set up) and enter the corresponding value from the laboratory analysis.To change the setup for entering the Hb/Hct, see “Changing the Lab Value Required for Entry” on page 244 below.8Complete the calibration by selecting Store In-VivoCal (even if the stored calibration value did not change) and select Confirm. This updates the data stored in the optical module.Selecting Recall Last Cal recalls the previously stored calibration value.If the calibration fails, check that the light intensity indicator is indicating a stable medium to high level. Repeat the calibration.
16 Monitoring Intravascular Oxygen Saturation244Changing the Lab Value Required for EntryYou can change the lab value required to be entered: Hb [g/dl], Hb [mmol/l] or Hct [%].1In the Setup <SO₂ Label> menu, select Hb/Hct Entry.2Select your preferred lab value and unit.Preparing to Monitor with the M1011A Narrow ModuleIn addition to the module, you need a Philips SO2 Optical Module and a compatible fiber optic probe or catheter. Use only the accessories listed as applicable for the intended measurement location in the Accessories section.Connecting the Optical Module1Connect the optical module to the SO2 module. Allow the optical module to warm up before you insert the probe/catheter and perform a calibration.Although the warmup message disappears from the screen after one minute, it is preferable to let the optical module warm up for 10 minutes for best accuracy.2Position the optical module to avoid contact with liquids. Fluid entering the catheter-optical module connection will impair measurement performance.3Place the optical module on the catheter tray in the space provided and open the lid.4For instructions on the placement of fiber optic catheters/probes, refer to the documentation provided with the accessory.After InsertionThe SO2 probe/catheter is thin and flexible, treat it carefully. Avoid kinking, bending or grasping the probe/catheter with forceps or a hemostat. Damage to the fiber results in low intensity light and a sudden decrease in intensity readings. Refer to the documentation provided with the fibre-optic probe/catheter, paying special attention to any precautions, warnings or contraindications.Secure the optical module directly attached or in close proximity to the patient, to avoid placing excessive tension on the catheter, which would result in movement of the catheter tip from the optimal position in the patient.You must perform an in-vivo calibration once the probe/catheter is in place.
16 Monitoring Intravascular Oxygen Saturation245The probe/catheter should be replaced after it has been in place for 72 hours.CAUTIONDo not apply excessive tension to any sensor cable or part of the catheter.Performing In-Vivo CalibrationPerform an in-vivo calibration:• when you place the catheter in a patient.• if the catheter was disconnected from the optical module.• when the catheter has been in the patient for 24 hours.• if any significant change in light intensity occurs that the monitor cannot correct automatically.Further Information for Both ModulesChecking Suspicious ValuesIf you have any doubts about the correctness of the measurement value, take a blood sample and have it analyzed using standard laboratory procedures.Calculating Oxygen ExtractionOxygen extraction is the difference between the measured SpO2 and SvO2 values. If you are monitoring SpO2 and SvO2, the monitor can calculate this value and display it as a numeric.• To switch oxygen extraction calculation on or off, in the Setup Sp-vO₂ menu, select Sp-vO₂ and toggle between On and Off.•If more than one SpO2 value is available, you must choose which value is used in the calculation. In the Setup Sp-vO₂ menu, select SpO₂ Source and select the required source.If one of the calculation sources becomes unavailable, the monitor displays the INOP Sp-vO₂ CHK SOURCES for one minute. After this time, the calculation automatically switches off. If the missing source becomes available again, the calculation automatically switches on again.
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1724717Monitoring EEGThe Electroencephalograph (EEG) module monitors the patient's cerebral function by measuring the electrical activity of the brain. It provides the monitor with two channels of realtime EEG waves, EEG trend information in the form of Compressed Spectral Arrays (CSA), and up to eight of the following numerics:Spectral Edge Frequency - The SEF is the frequency below which a defined percentage of the Total Power lies. The percentage is set in Configuration Mode.Mean Dominant Frequency (MDF) - The MDF is the mean value of the frequency which dominates the measured EEG.Peak Power Frequency (PPF) - The PPF is the frequency with the highest measured amplitude.Total Power (TP) - The TP numeric indicates the power in the measured frequency band.Percentage of total power in each frequency band:–Alpha waves (8 to 13 Hz)–Beta waves (13 to 30 Hz)–Theta waves (4 to 8 Hz)–Delta waves (0.5 to 4 Hz).EEG Monitoring Setup1Plug the trunk cable into the EEG module.2Prepare the patient's skin prior to placing the electrodes. Good electrode-to-skin contact is important for a good EEG signal, as the skin is a poor conductor of electricity.– Shave hair from sites, if necessary.– Wash sites thoroughly with soap and water. We do not recommend using ether or pure alcohol, because this dries the skin and increases the resistance.– Use a skin preparation paste to remove skin cells and oil before placing the electrodes.3Select the desired electrode montage in the Setup EEG menu or in the EEG Impedance / Montage window.4Attach the reference electrode first.5Place the electrodes on the patient's head according to the selected montage. Use electrode gel if you are not using pre-gelled electrodes. Remember to select a site where the signal will not be interfered with by muscle artifacts.6Connect the electrode connector end to the trunk cable.
17 Monitoring EEG2487Check the electrode-to-skin impedance in the EEG Impedance / Montage window.8For good signal quality, keep all lead wires together and away from other electric devices and metallic bodies.Using the EEG Impedance/Montage WindowTo open the window, in the Setup EEG menu, select Show Montage, or select the EEG Montage SmartKey.The window may be configured to look slightly different on your monitor.1Electrode locations on the patient's head. The symbols represent the electrode-to-skin impedance.2Wiring and impedance values for the selected montageChoosing an EEG Electrode Montage1To activate one of the five pre-configured electrode montages, select the arrow beside the label in the EEG Impedance / Montage window and choose a montage from the list.2Attach the electrodes as illustrated in the EEG Impedance / Montage window.The five default electrode montage configurations can be modified and renamed in Configuration Mode.The electrode locations are labeled according to the international 10-20 electrode placement system.Montage Name EEG1+ EEG1- Label1 EEG2+ EEG2- Label2Montage A Fp1 T3 Fp1-T3 Fp2 T4 Fp2-T4Montage B O1 T3 O1-T3 O2 T4 O2-T4Montage C F3 C3 F3-C3 F4 C4 F4-C4Montage D C3 P3 C3-P3 C4 P4 C4-P4Montage E Fp1 T5 Fp1-T5 Fp2 T6 Fp2-T6
17 Monitoring EEG249Changing the Impedance LimitThe impedance limit can be set for all electrodes simultaneously in the Setup EEG menu, or in the EEG Impedance / Montage window using the pop-up keys. If the limit is exceeded during monitoring, an INOP will appear and the graphic impedance indicator will change.To change the impedance limit, either• use the pop-up keys that appear with the EEG Impedance / Montage window, or•in the Setup EEG menu, select Impedance Limit to call up a list of selections between 1 and 30 kOhm, then select the required limit from this list.About Electrode-to-Skin ImpedanceElectrode-to-skin impedance is the main quality indicator for the measured EEG signal. During normal EEG monitoring, electrode-to-skin impedance is measured continuously and disconnected electrodes are detected. The impedance value for each single, independent signal electrode is displayed in the EEG Impedance / Montage window. If the measured electrode-to skin impedance of one or more electrodes is above the limit, an INOP will be issued.For impedance measurement at least two electrodes, plus the reference electrode, must be connected.
17 Monitoring EEG250Impedance IndicatorsAbout Compressed Spectral Arrays (CSA)The continuous EEG signal is sampled periodically and this value is stored in a frame. Each frame is processed using Fast Fourier Transformation (FFT) to provide a frequency spectrum displayed as a compressed spectral array (CSA).The CSA window provides an overview of the patient's EEG values over time. It may be configured to look slightly different on your monitor.• To view the CSA window permanently embedded on a Screen, select a Screen configured to display the CSA window.• To view the CSA window over the current Screen, select the EEG CSA SmartKey, if configured, or select Setup EEG or Main Setup then Show CSA.Electrode/Skin ImpedanceSymbol Color Displayed Impedance ValueActionElectrode not connected red no value connect electrodeNoisy signal gray 60 kΩ (fixed) check electrode-to-skin connectionsElectrode connected, impedance above limityellow measured value (e.g. 15 kΩ)check limit, check electrode-to-skin contactElectrode connected, impedance at or below limitgreen measured value (e.g. 3 kΩ)no action necessary
17 Monitoring EEG251Changing CSA SettingsWhen CSAs are shown embedded on the Main Screen, select the CSA to show the pop-up keys. When the CSA is shown in a window over the current screen, the pop-up keys are always displayed.Changing EEG SettingsBe aware that any changes made to EEG settings apply to both EEG channels.Switching EEG Numerics On and OffEach EEG numeric can be individually switched on or off in the Setup EEG menu.1In the Setup EEG menu, select the numeric label.2Select On or Off to switch between the settings.Changing the Scale of the EEG Waves for DisplayThis only changes the visual appearance of the wave. It does not affect the signal analyzed by the monitor or printed in reports or recordings.The CSA contains the following informationStatus lineLead label for example, Fp1-T3, Fp2-T4CSA label CSA1 or CSA2 according to EEG channelMontage label for example, Montage AFilter settings for example, 1-30 HzBuffer label and time the buffer and interval between spectral lines on the CSACurrent SEF Threshold can only be changed in Configuration ModeSpectral lines The energy at each frequency is computed and displayed as a spectral lineTrendlines EEG values are sampled at configured time intervals and displayed as color-coded trendlines. Trendlines are available for the three frequency numerics (SEF, PPF, MDF)Annotations:INOP markerFilter change markerMontage change markerSetup CSA Window This menu entry lets youBuffer choose one of the three pre-configured buffers. A buffer defines the interval between the spectral lines displayed in the CSA. On/Off SEFOn/Off MDFOn/Off PPFswitch the trendline of the specific numeric on or off
17 Monitoring EEG2521In the Setup EEG menu, select Wave Scale to call up a list of wave scales.2Select the required scale from this list.Scaling information is displayed with each EEG wave.•If Show Gridlines is set to On in Configuration Mode, gridlines and the current wave scale values are shown with the EEG wave.•If Show Gridlines is set to Off in Configuration Mode, the current wave scale is indicated by a size bar beside the EEG wave.Changing Filter FrequenciesThe low and high pass filters screen out undesirable interference from the raw EEG wave display. The current EEG filter frequency settings are shown in the header of the CSA. Changing filter settings affects the EEG wave and all the EEG numerics. Whenever the filter setting is changed, a filter change marker appears next to the spectral lines.To change the filter settings:1In the Setup EEG menu, select Low Filter or High Filter to call up a list of available frequencies.2Select the required frequency from this list.Changing the Speed of the EEG WaveThe EEG measurement has its own speed control and is not affected by the wave speed settings of the other measurements.In the Setup EEG menu, select EEG Speed. Choose the required speed from the pop-up list. This defines the speed at which the wave is drawn across the screen in millimeters per second (mm/s).EEG ReportsThe content of EEG Reports is always the same and does not need to be configured.To print an EEG Report, in the Setup EEG menu, select Print Report.Alternatively, you can select the CSA and use the Print Report pop-up key to start the report.To modify the buffer and trendline settings on the CSA Report, in the Reports menu, select CSA On EEG Rep.. If you do not change these settings, the monitor will use the default settings with the trendlines for the SEF numeric on and the buffer time from Buffer C.CSA On EEG Rep. This menu entry lets youBuffer choose one of the three pre-configured buffer timesTrend SEFTrend MDFTrend PPFswitch the trendline of the specific numeric on or off
17 Monitoring EEG253EEG Safety InformationWARNINGDo not touch the patient, or table, or instruments during defibrillation.When connecting electrodes and/or patient cables, ensure that the EEG leads and connectors do not come into contact with other conductive parts or earth.High-frequency Surgery - To reduce the hazard of burns in the high-frequency surgical neutral electrode connection, the EEG electrodes should not be located between the surgical site and the electrosurgical unit return electrode.EEG and Electrical InterferenceCAUTIONInterference from a non-grounded instrument near the patient and electrosurgery interference can cause problems with the waveform and the CSA.Radiated field strengths above 1 V/m and patient signals ≤ 50 µV may cause noise on the EEG waves at various frequencies. Therefore, it is recommended to avoid the use of electrical radiating equipment in close proximity to the patient monitor. The noise does not influence the measurement accuracy.Interference from ECG can be eliminated by adjusting the low filter settings.
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1825518Monitoring BISBispectral Index monitoring helps to monitor the level of consciousness of a patient under general anesthesia or sedation in the OR and ICU. The BIS sensor is placed on the patient's forehead to capture electroencephalographic (EEG) signals from which several numerics are derived, including a single BIS value representing the level of consciousness. See the chapter on Specifications for the BIS intended use statement.The BIS Module provides the monitor with an EEG wave and the following numerics:Bispectral Index (BIS). The BIS numeric reflects the patient’s level of consciousness. It ranges from 100 (fully awake) to 0 (suppression; no electrical brain activity).Signal Quality Index (SQI). The SQI numeric reflects signal quality and provides information about the reliability of the BIS, SEF, TP, SR, and Bursts numerics during the last minute. It ranges from 0 to 100%:SQI < 15%: the numerics cannot be derivedSQI 15% to 50%: the numerics cannot be reliably derivedSQI 50% to 100%: the numerics are reliable.Electromyographic Activity (EMG). The EMG numeric reflects the electrical power of muscle activity and high frequency artifacts.EMG < 55 dB: this is an acceptable EMG EMG ≤ 30 dB: this is an optimal EMG (note that the minimum possible EMG is approximately 25 dB).Suppression Ratio (SR). The SR is the percentage of time over the last 63-second period during which the EEG is considered to be in a suppressed state.Spectral Edge Frequency (SEF). The SEF is the frequency below which 95% of the Total Power is measured.Total Power (TP). The TP numeric indicates the power in the frequency band 0.5 to 30 Hz. The useful range is 30 - 100 dB. Bursts (BISx module used with the Extend sensor only). The Bursts numeric helps you quantify suppression by measuring the number of EEG bursts per minute, where an EEG burst is defined as a period of activity followed and preceded by inactivity (at least 0.5 second).BIS Monitoring SetupThere are two BIS solutions available for use with the M1034A BIS module: using the DSC and BIS engine or using the BISx.
18 Monitoring BIS256Monitoring BIS Using the DSC and BIS Engine1If you are monitoring BIS with the DSC and BIS engine,a. Connect the BIS engine to the BIS module using the BIS Engine Cable.b. Connect the digital signal converter (DSC) to the digital signal converter port on the front of the BIS Engine. Use the attachment clip to secure the digital signal converter near, but not above the patient's head.c. Attach the patient interface cable (PIC) to the digital signal converter (DSC).2Attach the BIS sensor to the patient following the instructions supplied with the sensor.Make sure that the patient's skin is dry. Be aware that a wet sensor or a salt bridge may cause erroneous BIS and impedance values.A variety of sensors are available for use in the OR and ICU environments: see the chapter on accessories for information.3Connect the BIS sensor to the patient interface cable.As soon as a valid sensor is detected, the impedances of all electrodes are measured automatically and the results are shown in the BIS window.1BIS Engine Cable2BIS Module3Aspect BIS Engine 185-01114Aspect Digital Signal Converter 185-01245Aspect Patient Interface Cable 186-01316Aspect BIS Sensor
18 Monitoring BIS257Monitoring BIS using the BISx1If you are monitoring BIS using the BISx,a. Connect the BISx device to the BIS moduleb. Use the clip on the rear of the BISx device to affix it in a position convenient for your patient, not above the patient's head.2Attach the BIS sensor/BIS electrodes to the patient following the instructions supplied with the sensor.Make sure that the patient's skin is dry. Be aware that a wet sensor or a salt bridge may cause erroneous BIS and impedance values.A variety of sensors are available for use in the OR and ICU environments: see the chapter on accessories for information.CAUTIONEnsure that the BISx does not come into prolonged contact with your patient's skin, as it may generate heat and cause discomfort.The BISx may remain connected to a patient during defibrillation as long as the sensor is not located between the defibrillator pads.3With sensors for single-patient use:a. Attach the patient interface cable (PIC) to the BISx device.b. Connect the BIS sensor to the PIC.With Semi Re-usable Sensors:c. Attach the sensor cable to the BISx device.d. Snap the sensor cable onto the electrodes.As soon as a valid sensor is detected, the impedances of all electrodes are measured automatically and the results are shown in the BIS window. The number of uses remaining for the semi re-usable sensor is shown in the status line when the BIS window is open.Manufacturer's InformationBISx, the Patient Interface Cable and the BIS Sensors are manufactured by Aspect Medical Systems.1BIS Module2Aspect BISx 185-0145-PH3Aspect Patient Interface Cable 186-01314Aspect BIS Sensor
18 Monitoring BIS258BIS Continuous Impedance CheckThis checks:• the combined impedance of the signal electrodes plus the reference electrode.This is done continuously and does not affect the EEG wave. As long as the impedances are within the valid range, there is no notification of this check or its results.• the impedance of the ground electrode.This is done every ten minutes and takes approximately 4 seconds. It causes an artifact in the EEG wave, and the message Ground Check is shown on the monitor screen during the check. If the ground electrode does not pass this check, another check is started. This continues until the ground electrode passes the check.If the Continuous Impedance Check interferes with other measurements, it can be switched off. To do this:1In the Setup BIS menu, select Cont. Imp. Check.2Select On or Off as required.CAUTIONSwitching the continuous impedance check off will disable automatic notification to the user of impedance value changes, which may lead to incorrect BIS values. Therefore, this should only be done if the check interferes with or disturbs other measurements.When a Semi-reusable Sensor is in use the continuous impedance check cannot be switched off. If it is switched off when the sensor is connected, it will automatically be switched on again.BIS Cyclic Impedance CheckThis measures the exact impedance of each individual electrode. It causes a disturbed EEG wave, and the INOP BIS IMPEDANCE CHCK is shown on the monitor screen during the check.Starting a Cyclic Impedance CheckThe Cyclic Impedance Check is automatically started when a sensor is connected. To manually start a Cyclic Impedance Check:•select Cyclic Check in the Setup BIS menu to toggle between On and Off, or•select StartCyclicCheck in the BIS window.Stopping a Cyclic Impedance CheckThe Cyclic Impedance Check stops automatically if the impedances of all electrodes are within the valid range. To manually stop a Cyclic Impedance Check:•select Cyclic Check in the Setup BIS menu to toggle between On and Off, or•select Stop CyclicCheck in the window.If you stop a Cyclic Impedance Check before the ground electrode has passed, a ground electrode impedance check will be started automatically. This cannot be switched off.
18 Monitoring BIS259BIS WindowTo open the BIS window, in the Setup BIS menu, select Show Sensor.The window may look slightly different on your monitor. The graphic in the BIS Window automatically adapts to show the type of sensor you are using, showing three or four electrodes as required. Each symbol in the graphic represents an electrode and illustrates the most recently-measured impedance status of the electrodes. Although BIS may still be measured when the electrode status is red or yellow, for best performance, all electrodes should be green.In addition, if the measured electrode-to skin impedance of any electrode or electrode combination is above the limit, or if disconnected electrodes are detected, an INOP will be issued, either BIS HIGH IMPEDANCE or BIS LEAD OFF.1Reference Electrode2Ground Electrode3Signal Electrode(s)4Time of the most recent cyclic checkBIS Impedance IndicatorsElectrode-to-Skin ImpedanceSymbol Color ActionElectrode has no skin contact red Reconnect electrode, or check the sensor-to-skin contact. If necessary, clean and dry skin.Too much signal noise, impedance cannot be measuredgray Check sensor-to-skin contact. Press sensor more firmly to skin. If necessary, clean and dry skin.Impedance above limit yellow Check sensor-to-skin contact. Press sensor more firmly to skin. If necessary, clean and dry skin.Impedance within valid range green No action necessary
18 Monitoring BIS260In addition to the symbols, the impedance value in kOhm is also displayed. Changing the BIS Smoothing RateThe smoothing rate defines how the monitor averages the BIS value.To change the smoothing rate, in the Setup BIS menu, select Smoothing Rate then choose either:–15 sec: this provides increased responsiveness to changes in the patient's state.–30 sec: this provides a smoother BIS trend with decreased variability and sensitivity to artifacts.Switching BIS and Individual Numerics On and OffTo switch the BIS measurement on or off:•In the Setup BIS menu, select BIS and then On or Off as required.To switch individual numerics provided by the BIS Module on or off:•In the Setup BIS menu, select SQI, TP, SEF, SR, EMG, or Bursts and then On or Off as required. Changing the Scale of the EEG WaveChanging the scale only changes the visual appearance of the wave. It does not affect the signal analyzed by the monitor or printed in reports or recordings.The scale information shown depends on whether gridlines are switched on or off for display. This setting can only be changed in Configuration Mode.1In the Setup BIS menu, select Scale to call up a list of wave scales.2Select the required scale from this list.– When gridlines are switched off, you can choose from the available scale values: 50 mV, 100 mV, 200 mV, and 500 mV. Scaling information is displayed as a vertical bar on the EEG wave together with its height equivalent in mV.– When gridlines are switched on, scales are defined as a range, either ± 25 mV, ± 50 mV, ± 100 mV, or ± 250 mV. Scaling information is shown in the form of gridlines.Switching BIS Filters On or OffThe low and high pass filters screen out undesirable interference from the raw EEG wave display. The notch filter removes line frequency interference. Filter settings affect the EEG wave and the SEF and TP values, but they do not affect the BIS, EMG, SR, and SQI values.The filter settings are set in Configuration Mode. You can switch all the filters on or off together in Monitoring Mode.1In the Setup BIS menu, select Filters.2Select On or Off as required.
18 Monitoring BIS261BIS Safety InformationFor information on the use of BIS in specific monitoring situations and on pharmacological responses to the anesthetic agents Nitrous Oxide (when used as the sole anesthetic agent), Ketamine, and Etomidate, please contact Aspect Medical Systems to request a copy of their publication "A Clinician's Guide to the Bispectral Index®".Considerations for UseDue to limited clinical experience in the following applications, BIS values should be interpreted cautiously in patients with known neurological disorders, those taking psychoactive medications, and in children below the age of 1.WARNINGConductive Parts: The conductive parts of sensors and connectors should not contact other conductive parts, including earth.High-frequency Surgery: To reduce the hazard of burns in the high-frequency surgical neutral electrode connection, the BIS sensor should not be located between the surgical site and the electro-surgical unit return electrode.Defibrillation: The BIS sensor must not be located between defibrillator pads when a defibrillator is used on a patient connected to the patient monitor.Securing Cables: To minimize the risk of patient strangulation, the patient interface cable (PIC) must be carefully placed and secured.CAUTIONRevisions: The system will only function if all component revisions are compatible. Otherwise, an incompatibility INOP is displayed.If the DSC has an older software revision than the BIS Engine, the DSC will automatically be upgraded by the BIS Engine. Do not disconnect the DSC from the BIS Engine, or disconnect the BIS module from the monitor, or switch the monitor power off within the first ten seconds after connection, as this will disrupt a possible software upgrade and cause damage to the DSC.Impedance Checks: Impedance checks may influence data acquisition of other electroencephalographic devices.
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1926319Assigning a TelemetryDevice and a Monitor to OnePatientIt is possible to assign a monitor and a telemetry device to the same patient, resulting in the information from both devices being combined in one sector at the Information Center. This is called "pairing" and when a telemetry device and a monitor are paired, the measurement data from the telemetry device will be displayed on the monitor screen.A telemetry device can be:• any Philips telemetry device (only for indirect connections, see below).• a TRx/TRx+ Intellivue Telemetry system transceiver.• an MP5 monitor or X2 Multi measurement module with a telemetry interface, declared as a telemetry device and with a telemetry equipment label.For complete user information, including accessory listings and specifications, for the M4841A/M4851A TRx/TRx+ IntelliVue Telemetry Transceiver, refer to the Instructions for Use provided with the device.How Can You Combine Devices?•With an indirect connection, using standard telemetry transmission - the data are sent to the monitor via the Information Center and arrive with a delay of several seconds at the monitor.•With a direct connection to the monitor– an MP5 or X2 is connected via MSL cable to the monitor, or– a telemetry transceiver with a short range radio adapter is assigned to an MP5 or X2 which is connected (Companion Mode) to a an MX800 host monitorthe data arrive with a minimal delay on the monitor screen.Indirect Connection - Manual PairingThe telemetry device can be paired with the monitor at the Information Center or at the monitor. For detailed information regarding pairing and configuration at the Information Center, see the Information Center Instructions for Use.To pair the monitor with a telemetry device at the monitor:
19 Assigning a Telemetry Device and a Monitor to One Patient2641Select Main Setup then Measurements2Select TelemetryThe Setup Telemetry menu will appear with only one entry Paired Equipment.3Enter here the equipment label of the telemetry device to be paired.Pairing at the monitor is only possible when the monitor already has a connection to the Information Center and the Information Center software version allows pairing at the monitor.Telemetry Data WindowThe measurements from the telemetry device are shown in the telemetry data window on the monitor.1A current alarm generated by the telemetry device.2Delayed - indication that data in the window is delayed3Telemetry data windowWARNINGAll data presented in the telemetry data window are delayed for several seconds.If you need realtime data, for example for defibrillation, always use the monitor ECG instead of telemetry. As long as the ECG is being measured with the telemetry device there will be no ECG signal available at the ECG analog output.Direct Connection - Automatic PairingThe following direct connections are possible:• an MP5 or X2, declared as a telemetry device, and connected with an MSL cable to a monitor.WARNING• When ECG is being measured with a telemetry device directly connected to the monitor, there will be no ECG signal available at the ECG analog output or ECG Sync Pulse output and no synchronization marks on the ECG wave. A No ECG Out message will appear in the ECG wave channel.
19 Assigning a Telemetry Device and a Monitor to One Patient265• When a telemetry device is connected to the monitor, arrhythmia relearning is initiated, and again when the telemetry device is disconnected.• Controls on the Telemetry Device (e.g. nurse call) will be inactive when the device is directly connected to the monitor except in the case when the monitor has no network connection and data are transferred via the telemetry device.Pairing an X2 or MP5 With a Telemetry Interface to a Host MonitorAn X2 Multi-measurement module or an MP5 using an IntelliVue Instrument Telemetry interface will be automatically paired when it is connected to a host monitor and it has been declared as a "telemetry device" at the Information Center.When the X2 or MP5 is disconnected from the host monitor it will remain paired and the measurement data will appear at the host monitor in the Telemetry Data window. After the X2 or MP5 is disconnected from the monitor it may take over 15 seconds until their data is displayed at the Information Center.Pairing of a host monitor and a telemetry device, with all the related functionality, is only possible when the host monitor is using a wired LAN connection or a wireless LAN interface (but not using the IntelliVue Instrument Telemetry interface).The X2 or MP5 can also be manually paired to a host monitor without a direct connection, as described in “Indirect Connection - Manual Pairing” on page 263.Refer also to “Use Models With Telemetry” on page 268 for further related use modes.Functions Available When the Telemetry Data Window is DisplayedControlling the Telemetry Device from the BedsideYou can change settings for a paired telemetry device at the monitor:1Select the telemetry data screen element2Select the Setup Tele pop-up keyThe Setup Telemetry menu will appear with the settings available for the telemetry device. These will normally include: adjusting heart rate alarms, ECG size control, selecting primary/secondary lead, relearning arrhythmia, and selecting the arrhythmia analysis mode. The Equipment label of the paired device is also shown here.Viewing and Silencing Telemetry Alarms at the BedsideWhen a telemetry device is paired with the monitor, telemetry alarms will also be indicated on the monitor, in addition to the main indication at the Information Center.If configured, a generic * TELE ALARM message will appear in the alarm status area with standard alarm tones. The * TELE ALARM message will have the color and * or ! coding corresponding to the severity of the alarm. The specific alarm message (for example ** HR LOW) will appear in the telemetry data window.
19 Assigning a Telemetry Device and a Monitor to One Patient266If configured, alarms generated from a paired telemetry device can be silenced at the bedside. Either the monitor Silence key is configured to silence both monitor and telemetry alarms (must be configured at the Information Center) or the Silence Bed pop-up key will be available:1Select the telemetry screen element.2Select the Silence Bed pop-up key.Depending on your Information Center configuration, the Silence Bed key may silence both telemetry alarms and bedside alarms.WARNINGEven when the telemetry data is not visible on the screen, you may be silencing telemetry and monitor alarms, if the Information Center and monitor are so configured.Suspending Telemetry AlarmsWhen you select Pause Alarms or Alarms Off at the monitor, the alarms are off or paused for the bedside measurements. When you switch alarms off or pause alarms at the Information Center, both telemetry and monitor alarms are affected.Refer to the Information Center Instructions for Use for more details on the Suspend/Pause alarms behavior of the Information Center and telemetry device.Using StandbyWhen you select Standby mode at the monitor, the bedside goes into Standby mode but the telemetry device will continue monitoring.Refer to the Information Center Instructions for Use for details on the Standby behavior of the Information Center and telemetry device.General Telemetry-related FunctionsThe following functions are valid for directly and indirectly connected telemetry devices.ECG Source Tracking at the Information CenterThe Information Center continuously checks whether a valid ECG signal is coming from the monitor or the telemetry device. If you unplug the ECG patient cable from the monitor and plug it into the telemetry device, the Information Center will automatically switch to monitoring the ECG from the telemetry device. At the monitor, its own ECG measurement will be deactivated - the ECG Setup menu will no longer be accessible.When you unplug the patient cable from the telemetry device and plug it back into the monitor again, the Information Center will switch back to monitoring the ECG from the monitor. The ECG measurement will be activated again at the monitor. Note that in this case, as the screen switches back to the monitor's own measurements, the SpO2T measurement (if present) will no longer be displayed.In the same way the source is tracked when a telemetry device is directly connected to a monitor, then disconnected and vice versa.
19 Assigning a Telemetry Device and a Monitor to One Patient267In case of ambiguity, a yellow INOP message !!CHECK ECG SOURCE indicates that more than one valid ECG source is active.Synchronized SettingsIf ECG is measured at the monitor, and then the patient is connected to a telemetry device for monitoring, the Information Center will use the monitor settings for the telemetry device. In general, the following settings will be synchronized:WARNING• Not all settings are synchronized; after changing the ECG source, always check that the settings are appropriate.• Va and Vb leads are reset to default (V2, V5) if the configured Va or Vb lead for the telemetry device is not one of V1 through V6If later the patient is disconnected from the telemetry device, and reconnected to the monitor again, any changes in the settings made in the meantime will be passed on to the monitor. In this way, settings continuity is preserved when the ECG source changes.Settings synchronization can only take place when there is no patient information mismatch between the monitor and the Information Center. If a Check ECG Settings or !! CHECK PAIRING INOP appears always check that the ECG settings, especially the paced setting, are appropriate for your patient.Heart Rate HR/Pulse Alarm On/Off, Heart Rate High/Low Limit,ECG Primary Lead, Secondary Lead, Va Lead1, Vb Lead1, Lead PlacementArrhythmia Analysis Mode, Asystole Threshold, Pause Threshold, VTach HR, VTach Run, PVCs/min, Vent. Rhythm, SVT HR, SVT Run, PVCs/min On/Off, Pacer not capture On/Off, Pacer not pace On/Off, Non-Sustain On/Off, Vent. Rhythm On/Off, Run PVCs On/Off, Pair PVCs On/Off, Missed Beat On/Off, Pause On/Off, R-on-T PVCs On/Off, Vent. Bigeminy On/Off, Vent. Trigeminy On/Off, Multiform PVCs On/Off, Irregular HR On/Off, SVT On/Off, Afib On/OffST ST Analysis On/Off, ST Alarm On/Off, ISO Point, J point, ST point, ST Priority List, Single ST Alarm Limit, Multi ST Alarm LimitQT QT analysis On/Off, QT Lead, QTc High Alarm On/Off, ΔQTc Alarm On/Off, QTc High Limit, ΔQTc High Limit, QTc Formula2, QT BaselineSpO2TSpO2 Alarms on/off, SpO2 Alarm limitsNBP Alarm Suppression On/Off, Pulse(SpO2) On/Off1Va and Vb leads are reset to default (V2, V5) if the configured Va or Vb lead for the telemetry device is not one of V1 through V6.2This setting will only be synchronized when the Information Center supports QT Analysis for Telemetry
19 Assigning a Telemetry Device and a Monitor to One Patient268Use Models With TelemetryThe standard use model combining a monitor and a telemetry device involves pairing the two devices so that the data measured by the telemetry device appears on the monitor screen - and at the Information Center in the same patient sector as the monitor data. The following variations are possible:1The monitor is paired with a telemetry transceiver - indirect connection– telemetry data appear on the monitor2An MP5 or X2 is declared as a telemetry device and paired with an MX800 monitor - direct or indirect connection– MP5/X2 measurement data appear on the monitor it is paired with– a telemetry transceiver cannot be used with the MP5/X23A telemetry transceiver directly connected (SRR or for MP5 cable) to an MP5 or X2, that is connected (Companion Mode) to an MX800 monitor - direct connection.– telemetry data appear on the host monitor– telemetry transceiver is paired with the host monitor but is assigned to the MP5 or X2–the MP5 or X2 must have no equipment labelThe different variations require different configuration settings; refer to the Configuration Guide for details.
2026920TrendsTrends are patient data collected over time and displayed in graphic, tabular or histogram form to give you a picture of how your patient's condition is developing. Trend information is stored in the trends database for continuously-monitored measurements, such as ECG, as well as for aperiodically-measured parameters, such as Cardiac Output.Viewing TrendsTrend information can be viewed embedded as a screen element on specially-designed Screens, or you can open a trend window over the current Screen.• To view trends embedded as a screen element, enter the Change Screen window, then select a Screen designed to show an embedded trend window.• To open the tabular trends window over the current Screen, select Main Setup, Trends, then Vitals Trend, or select the Vitals Trend SmartKey  .• To open the graphic trends window over the current Screen, select the Graph Trend SmartKey .• To open the histogram trend window over the current screen, select Main Setup, Trends, then Histogram, or select the Histo- gram SmartKey.The trend windows open displaying the most recent data and are updated as new data is stored. A timescale along the bottom or the top of the screen shows you where you are in the trends database. The preview column on the right-hand side shows the latest available measurement value. The preview column is updated every five minutes or whenever an NBP or other aperiodic measurement is completed.A question mark (?) beside a value means that the data may not be reliable, due perhaps to an INOP condition in the measurement.Your monitor screen may look slightly different to the examples shown in this chapter.
20 Trends270Trends Pop-Up KeysWhen you open the graphic or tabular trends window, a selection of pop-up keys appears to let you navigate through the stored trend data and carry out trends-related tasks.Viewing Graphic TrendsA cursor spanning all measurements in the trend group helps you to navigate through the trends database and shows you your current position in the database. When the cursor is moved across the time line, the values measured at the cursor time are shown in the right hand column.In graphical trends, aperiodic measurement trends are shown as an asterisk, NBP has a special symbol.Pop-Up Keys Selecting this pop-up key lets you....Select Group see a pop-up list of trend groups and select a group for viewing.Select Interval see a pop-up list of available data resolution settings and select the level of detail shown in the trend view.Print/ Record print a tabular trends report or make a tabular trend recording of the data in the current window. The report will use the current trend interval settings.Print print a graphic trends report of the data in the current window. The report will use the current trend interval settings.move the cursor one step to the left or right to navigate through the trends database timeline.move the cursor one page to the left or right to navigate through the trends database timeline.jump to the beginning or the end of the trends database to see the most recent or oldest trend information stored.scroll up and down the screen to see measurement trends that do not fit in the current view.Vital Signs open the current trend view in tabular form. The displayed time period and resolution stay the same.Graph Trend open the current trend view in graphic form. The displayed time period and resolution stay the same.
20 Trends271To use the trend cursor to navigate in time through the trends database,1Select the graphical trend or the arrow pop-up keys to activate the cursor.2Use the arrow pop-up keys to move the trend cursor backwards and forwards in time, or3Place the cursor at a specific time by touching the graph.Viewing Vital Signs Trends1Aperiodic values are shown with a timestampThe currently-selected column is highlighted. The values can be configured to display in the same colors as the waves and numerics on the realtime display.Any values available for display before the next scheduled update are shown in the right hand column, with a timestamp in brackets.If more than one value is available for an aperiodic trend for a certain trend period, all measured values are stored in the database and the value closest to the timestamp is shown in the Vital Signs display marked with an arrow.To view the Vital Signs trend with one column for each NBP measurement (see “Defining the Column Interval Using the NBP Measurement” on page 275):1With the Vital Signs trend open, select Interval.2Select NBP from the pop-up list.
20 Trends272Viewing Histogram TrendsThe title line of the window shows the label of the trended measurement and the resolution of the data; in the RR histogram above, 1 minute trend samples.The horizontal axis shows the range and unit of the displayed measurement. The vertical axis shows the percentage of time.The columns in the foreground show how much of the time the measured values fell into this range on the scale. For example, in the histogram above, the RR value was between 15 and 20 rpm during 70% of the last four hours. The arrow mark over that column shows that the currently measured value is also in this range. These columns are displayed in the same color as the measurement data.The columns in the background show the cumulative percentage value: each of the foreground columns is added to the sum of those columns to the left of it.A question mark is displayed if less than two-thirds of the data are valid samples.The pop-up keys in the window can be used to change the measurement, the time period and the range. You can also print out a histogram report.The SpO2 histograms can be trend histograms or realtime histograms with 1 second samples. For SpO2 realtime histograms, the range cannot be changed.Setting Up TrendsTrends are set up in Configuration Mode. You can make temporary changes to trends settings such as trend groups, priorities, or scales in Monitoring Mode. The general settings for all Trends are under Main Setup, Trends.Settings for a single segment in graphical trends or for the corresponding trend group can be made more easily in that segment menu.Making Segment SettingsThe Graphical Trends window is divided into measurement segments, each of which has its own settings.To enter the segment menu,• select the left hand column of the segment, where the measurement label is displayed.
20 Trends273Expanded ViewTo expand the segment to fill the Graphical Trends window,•in the Segment menu, select Expand to have that segment enlarged to fill the window.In the expanded view, you can also highlight a measurement to make it more easily visible (for example when multiple ST trends are in one segment). To highlight a measurement,•in the Segment menu, select Highlight repeatedly until the highlight is on the required measurement.To return the segment to its original size,•in the Segment menu, select Expand again.Trend Scales for Segment MeasurementsTo change the trend scales for a measurement in the current segment:1In the Segment menu, select the measurement label2Select Upper to change the upper limit of the scale or Lower to change the lower limit of the scale.Optimum ScaleTo have the monitor automatically select an optimum scale for viewing, based on current values,•in the Segment menu, select Optimum Scale.This scale change is temporary. When the graphical trend window is closed the scale reverts back to the setting in Parameter Scales.To switch off automatic optimum scaling,•in the Segment menu, select Optimum Scale again.Trend GroupTo add or remove measurements for this trend group or change the order of the existing measurements:1In the Segment menu, select Change Group.2Use the Add, Change, Sort Up and Sort Down pop-up keys to change or re-order the group as required.No. of SegmentsIn an embedded graphical trend window, you can select the number of segments to be displayed in the Segment menu:•In the Segment menu, select No. Of Segments.Trend GroupsThe measurements grouped in trend groups define the trends displayed together in the Vital Signs or Graphical Trends windows and printed in trends reports and recordings. The sequence of the measurements in the group defines the order in which they are displayed. Measurements listed between dotted line separators are displayed overlapping. The trend group All contains all available measurements, you cannot change the order or selection of this group.
20 Trends274To change the selection of measurements in a trend group, either use the Change Group setting in the Segment menu or:1Select Main Setup, Trends, then Trend Groups.2Select the Trend Group you want to change and use the pop-up keys to Add, Change, or Delete the selection of measurements trended.To temporarily change the order in which the measurements are displayed in a group,1Select Main Setup, Trends, then Trend Groups.2Select the Trend Group and then the measurement you want to move and use the Sort Up/Sort Down pop-up keys.Trend IntervalThe trend interval defines the resolution of trend data shown on the Screen. High-resolution data is especially suited for neonatal applications, where the clinical situation may change very quickly. In adult monitoring, where the patient's status typically changes more gradually, a longer trend may be more informative.To set the trend resolution, in the Vital Signs or Graphical Trends window,• Select the Select Interval pop-up key and then select the required interval from the list.Trend PriorityThe monitor stores trend information for all monitored measurements, if configured to do so. (Data from VueLink or IntelliBridge modules cannot be included in trends when the label is a free-text label.) If your configuration restricts the number of measurements trended, you must choose which measurements will be included. A priority list is used to select the trended measurements.To see the measurement priority list for trending,1In the Main Setup menu, select Trends.2Select Trend Priority.To add measurements to the priority list,1Select the pop-up key Add and choose from the pop-up list of available measurements.2Use the Sort Up and Sort Down pop-up keys to change the priority order.Trend Parameter ScalesParameter scales define how the trend waveform will appear on the screen and in trend reports. Separate scales can be set for adult, pediatric, and neonatal patient trends. To change the trend parameter scales settings, either use the Scale setting in the Segment menu or:1In the Main Setup menu, select Trends.2Select Parameter Scales.3Select the measurement or parameter you want to change from the list.4Select the pop-up key Change to call up the Scale menu.5In the Scale menu, select the parameter label you want to define settings for. Select Adult, Pedi, and Neo and use the pop-up keypad to enter new upper and lower scale definitions.
20 Trends275Graphical Trend PresentationGraphical trends and screen trends for measurements with compound values (for example ABP or CO2) can be viewed in line or band form.To change the presentation style,1Select Main Setup then select Trends.2Select Global Style and choose•Line to display the trends as a continuous line•Band to fill the area between the trend lines, for example, between the systolic and diastolic pressures, with color.This sample ABP trend shows the continuously-measured values for the systolic, diastolic and mean pressures displayed in band form.Defining the Column Interval Using the NBP MeasurementYou can have the NBP measurement determine the interval between the columns on the Vital Signs trend. Each NBP measurement will generate a column in the trend table. The values for the other measurements are added to the column to provide a complete vital signs set for the NBP measurement time. To use the NBP measurement to determine the column interval:1Select Main Setup then Trends.2In the Trends menu, select Setup VitalSigns.3In the Vital Signs menu, select Column and then NBP from the pop-up menu.Setting Measurement and Period for HistogramsTo set the default for the measurement data to be used in the histogram,1Select Main Setup then select Trends.2Select Setup Histogram.3Select Data Source.4Select either a realtime SpO2 or Trended Data. From the trended data list select the required measurement.To set the default period for the histogram,1Select Main Setup then select Trends.2Select Histogram.3Select Select Period and select the required time period from the list.When viewing a histogram, the data source, the period and the range can be changed using the pop-up keys.
20 Trends276Documenting TrendsTo print a Vital Signs or Graphical Trends report,•in the Vital Signs or Graph Trends window, select the pop-up key Print to print a report for the trend group currently on the monitor screen. Reports include the most recent information in the trends database and extend backwards in time according to the selected trend interval and your monitor's configuration. Trends reports can be printed on central or local printers.To make a Vital Signs recording,•in the Vital Signs window, select the Print/ Record pop-up key, then select the Record Vitals pop-up key.Vital Signs recordings print the trend data for the current group and trend period shown in the Vital Signs window.Trends DatabasesDepending on the purchased options and the monitor's configuration, the trends databases store information for up to 32 measurements for up to 72 hours.The values in the trends database are stored as measured by the monitor, they are not averaged values. The trend resolution defines how often a value is stored. In general, if more than one value is available for storage in the trends database, the most recent value is used. Some values in the trends are marked with arrows. This indicates that for this time period, more values were available and the most recent one is shown.Example database configurationIn this example, we see that the monitor stores the most recent data at the highest resolution, older data are stored at a lower resolution."4 hours @ 12 second resolution" means that the monitor stores trend data every 12 seconds, for the most recent four hours.Aperiodic Trends DatabaseAperiodic trends do not count toward the maximum number of trends allowed by the trend configuration. Trend data for aperiodic measurements is stored in a separate database and timestamped with the measurement time.
20 Trends277Trending Multiple-Value MeasurementsSome measurements generate multiple values, for example invasive pressure measurements can provide systolic, diastolic, and mean values. These values are trended as separate measurements.Screen TrendsTrends configured to display permanently on special monitor Screens are called screen trends. The selection and number of measurement waves in the Screen Trend segment depends on your monitor configuration. Screen trends are color-coded to match the measurement wave and numerics, and they can be viewed in graphical, tabular, histogram or horizon format.If you do not see screen trends on the monitor Screen, select a different Screen, one that is configured to show screen trends. Screen trends are only available on specially designed Screens.Screen Trend information is taken from the Trends database. If you do not see a Screen Trend for a particular measurement on the Screen, check the trend priority list to ensure that this measurement is being trended.Setting the Screen Trend TimeTo set the ScreenTrend Time for all graphical, histogram and horizon screen trends ("global" trend time),1Select a screen trend then select Setup Trend, or select Main Setup then select Trends.2Select ScreenTrend Time and select the required time: 30 minutes, one, two, four, eight, or twelve hours.This is now the Global screen trend time and defines the period of trend information shown for all screen trends.To set a different ScreenTrend Time for a screen trend or a group of aligned screen trends,1Select a screen trend.2Select Change TrendTime3Select the required trend time.Selecting Global leaves the trend time set to the global screen trend time.Changing the Selection of Screen Trends Displayed1Select the screen trend.2Select Change Trend and select the required trend from the list of available trends.Select Blank to remove the selected trend from the Screen.If you do not see Change Trend in the screen trend menu, the trend is aligned to display with the measurement wave. Changing the wave automatically changes the trend.To display two or more screen trends overlapping,1Select the screen trend to open the screen trend menu,2Select Change Trend followed by Add Trend and select a screen trend from the pop-up list.Activating the Cursor for Screen TrendsTo activate the cursor for Screen Trends:
20 Trends2781Select the screen trend.2Select Activate Cursor.You can now use the arrow keys to move the cursor across the time line. The values measured at the cursor time are shown next to the cursor.To de-activate the cursor,•Select Main Screen.Changing the Screen Trend ViewTo switch between tabular, graphic, histogram and horizon views, select the screen trend then select Change View and select the required view.Tabular ViewAperiodic measurements such as NBP, C.O., C.I., and Wedge can be viewed as a screen trend in tabular form. The measured values and their timestamps are shown, with the measurement label.The trend time for tabular screen trends depends on the space available on the Screen. Up to 30 measurements or 12 hours information can be shown.Histogram ViewThe histogram view presents a combination of graphical trend and histogram. The histogram is on the right hand side in a horizontal presentation with vertical gridlines representing 25%, 50%, 75% and 100%. Each column shows the percentage of time that the measurement values were in a specific range. This range is represented by the column's position in the graphical trend gridlines. The arrow mark next to a column shows that the currently measured value is in the range covered by that column.If less than two-thirds of the samples are valid, a question mark will be displayed with the histogram, except when the histogram consists of intermittently measured data.Horizon ViewThe horizon view presents trend information superimposed over a defined baseline or base range. This helps you visualize changes in your patient's condition since the baseline was set.The horizon view is made up of:
20 Trends279• a horizon, drawn in white, as a reference point or baseline to help you visualize changes in your patient's condition. The horizon can be set to represent your patient's current condition, or a target condition and can be a single value or a range.• a graphical trend, displaying patient data for the set TrendTime (1).• a trend indicator arrow, indicating how the patient trend has developed in the set time period (10minutes, 5minutes or 2minutes) (2).• a deviation bar, showing how the currently measured value deviates from the set horizon (3). The height of the deviation bar is an indication of the extent of the change in your patient's condition relative to the (horizon) baseline.Your monitor may not be configured to show all elements of the screen trend horizon view.Setting the HorizonThe horizon is the reference value to which deviations in the measurements are compared.1To set the horizon, select the horizon trend.2Select–Set High Horizon to select the upper horizon value. If the high and low horizon values are the same, the horizon is a baseline - if the values are different the horizon is a range.–Set Low Horizon to select the lower horizon value.–Auto Horizon to set the horizon for the selected horizon trend to the currently-measured value.–Auto All to reset the horizon for all horizon screen trends to the currently-measured values.–Set Horizon to set the horizon to a specific value from a pop-up list.Setting the Horizon Trend ScaleThe horizon trend scale is defined with respect to the horizon. If your horizon is set to 100 and you select 20 as the horizon scale delta, the upper limit of the horizon scale will be 120 and lower limit 80.To set the horizon trend scale delta,1Select the horizon trend.2Select Set Scale Delta and select a value to define the distance between the horizon and the upper and lower scale limits.Be aware that changing the horizon trend scale can change the angle of the trend indicator, without the patient's condition having changed.If a measurement exceeds the outer limits of the scale, the wave will be clipped and you must either reset the horizon or the horizon trend scale to display the values outside the scale limits.Setting the Time Period for the Trend Indicator ArrowThe time period for which the trend indicator arrow is displayed can be set in the Trends window.1Select Main Setup then select Trends.2Select HorizonArrowTime.3Select 10, 5 or 2 minutes.
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2128121CalculationsCalculations are patient data that is not directly measured but calculated by the monitor when you provide it with the appropriate information.Your monitor can perform the following hemodynamic, oxygenation, and ventilation calculations.The hemodynamic calculations available depend on the Cardiac Output measurement method being used and the regulatory standards that apply for your hospital: see the C.O. chapter for availability details.Hemodynamic Oxygenation VentilationCardiac Index (C.I.)Stroke Volume (SV)Stroke Index (SI)Systemic Vascular Resistance (SVR)Systemic Vascular Resistance Index (SVRI)Pulmonary Vascular Resistance (PVR)Pulmonary Vascular Resistance Index (PVRI)Left Cardiac Work (LCW)Left Cardiac Work Index (LCWI)Left Ventricular Stroke Work (LVSW)Left Ventricular Stroke Work Index (LVSWI)Right Cardiac Work (RCW)Right Cardiac Work Index (RCWI)Right Ventricular Stroke Work (RVSW)Right Ventricular Stroke Work Index (RVSWI)Extra Vascular Lung Water Index (EVLWI)Intrathoracic Blood Volume Index (ITBVI)Global End Diastolic Volume Index (GEDVI)Arterial Oxygen Content (CaO2)Venous Oxygen Content (CvO2)Arteriovenous Oxygen Content (CavO2)Oxygen Availability Index (DO2I)Oxygen Consumption (VO2)Oxygen Consumption Index (VO2I)Oxygen Extraction Ratio (O2ER)Alveolar-Arterial Oxygen Difference (AaDO2)Percent Arteriovenous Shunt (Qs/Qt)Minute Volume (MINVOL)Compliance (COMP)Dead Space (Vd)Dead Space/Tidal Volume Ratio (Vd/Vt)Alveolar Ventilation (ALVENT)
21 Calculations282Viewing Calculations• Select the Calcs SmartKey to open the Calculations window.• Select the Calc Type field and select the required calculation type for display.Calculations WindowsThis example calculations window shows the Hemodynamic Calculations window. The ventilation and oxygenation windows are similar.1Height used for the calculations2Weight used for the calculations3Calculation Time4Calculations input values5Output values6Indexed calculation valuesCalculations Pop-Up KeysDepending on the calculations group you choose, a selection of pop-up keys will appear to let you navigate through the stored events and carry out calculations-related tasks.
21 Calculations283Reviewing CalculationsTo enter the calculations review window, select the Oxygen Review, Vent Review, or Hemo Review pop-up key as required.The review window lists all the input and output values for each measurement in the calculations group. The timeline in the review window lists the times the calculations were performed.To review individual calculations, select the calculation in the review window and then select the Original Calc pop-up key.The storage time for calculations is the same as the trend database storage time configured for the monitor. So if trends are stored for 48 hours, the calculations will also be stored for 48 hours.Performing CalculationsYou must check that all input values are appropriate for your patient before performing calculations.1Select the Calcs SmartKey to open the Calculations window.2Check the calculation time in the Calc Time field.When you enter the calculation window, this field will show either the current time or the time of the most recent available C.O. measurement, depending on your monitor configuration.– To choose a different calculation time, select the Calc Time field. This calls up a list showing the timestamps of calculations performed earlier. Select a time from this list, or select Select Time to enter a time of your choice. The values from the Vital Signs database from the 30 minute period before the selected time will be used. – To enter the current time, select the Resample Vitals pop-up key. If you choose the current time, the monitor will resample all the required values that are monitored.Pop-Up Keys Selecting this pop-up key lets you....Resample Vitals use the most recent monitored values. Resampling sets the calculation time to the current time, and displays the corresponding values for the previous second.Perform Calc perform the displayed calculation using the currently-input values and store the calculation in the calculations databasePrint/Record print or record the displayed calculation.On/Off DateTime toggle between showing the date and time or the units for the calculation input values.On/Off Ranges toggle between showing the normal ranges or the units for the calculation output values.Cardiac Output access the C.O. procedure window.Hemo Review open the hemodynamic calculations review window.Vent Review open the ventilation calculations review window.Oxygen Review open the oxygenation calculations review window.
21 Calculations2843Enter any values that must be entered or edited manually. Select the value field and then use the pop-up keypad to enter the required values. Select Enter to confirm each entered value. Manually-entered values are marked with an asterisk (*).Entering Values for CalculationsThe monitor automatically enters any available values for calculations. For aperiodically-measured values such as C.O., the monitor will re-use the most recent value in the calculation database until a new value becomes available. If the calculation time is the last C.O. time, values will be used from up to and including 30 minutes before the C.O. time, except for height and weight where the last available value will be used.• To enter calculations values manually or edit automatically-entered values, select the value field to open the on-screen keyboard and use this to enter the correct value. Values edited manually are marked with an asterisk (*).If you enter a value that has more decimal places than allowed for a particular input, the value you enter will be rounded off after you select Enter. If you enter a value which cannot be stored, the message Value out of range will appear. Enter a new value.In hemodynamic calculations, if the systolic and diastolic pressures are manually entered, the mean pressure is calculated and marked with an asterisk (*). The formula used to estimate the mean pressure is [systolic + (diastolic x 2)] / 3.Automatic Value SubstitutionIf the monitor cannot find a value required for calculation, it automatically tries to find an equivalent source for this value. For example, if C.O. is required but unavailable, the monitor automatically looks for CCO as a alternative source of C.O. values, or an alternative Pressure label may be used instead of ABP. The label of the value in the Calculations window does not change. Substituted values are marked with an asterisk (*).Automatic Unit ConversionThe monitor needs consistent units for performing calculations. It automatically converts units where necessary before it performs the calculation, for example, pressures sourced in kPa, cmH2O, or mbar are automatically converted to mmHg, or to cmH2O for ventilation calculations.Manual Unit ConversionIf you need to convert units for other purposes you can use the Unit Conversion window:1Select Main Setup then select Calculations.2Select Unit Conversion.3Select the field under the unit you know and use the on-screen keypad to enter the known value. The converted value automatically appears in the adjacent field.BSA FormulaYour monitor provides both the Boyd and Dubois formulas for the calculation of body surface area (BSA). For calculations, the monitor uses the setting defined in the Patient Demographics menu. All calculation results that use BSA are indexed to the selected formula.
21 Calculations285• To check the current setting, select the patient name to enter the Patient Demographics menu. BSA(B) indicates that the Boyd formula is used; BSA(D) indicates that the Dubois formula is used.Comparing Dynamic Compliance ValuesIf you compare the dynamic compliance value (COMP) from the ventilation calculations with the value from the Spirometry measurement you may see a difference. This comes from the different sampling methods:• The algorithm in the ventilation calculations takes into account only two sets of paired AWP/AWV data: those from complete expiration and complete inspiration, when AWF is zero.• The algorithm in the Spirometry application takes into account all sets of paired AWP/AWV data (125Hz sampling rate), over one complete breath cycle, and calculates an "averaged" compliance using a least square method.Documenting CalculationsTo send a Calculations recording to a connected recorder, in the Calculations window, select the Print/ Record pop-up key, then select the Record Calc pop-up key.Calculations recordings print the patient demographic information and the content of the current Calculations window on the recorder strip.To print a report for the calculation group currently on the monitor screen, select the pop-up key Print Calc. To print the review window, select the pop-up key Print in the review window. All the calculations in the current group will be printed in the report.Calculation reports can be printed on central or local printers.This example report shows the oxygen calculation group. Ventilation and hemodynamic calculation reports are similar.1Patient information2Calculation group3Three columns of calculations input and output values, with times, units and ranges, where appropriate
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2228722High Resolution Trend WavesHigh resolution (hi-res) trend waves provide information for fast-changing parameters at a glance. They can help you to recognize trend patterns and to find interrelationships between measurements, by comparing changes in your patient's condition across different hi-res trend waves.This can aid in the early detection of cardiorespiratory and hemodynamic problems.The amount of data you can show on a screen depends on the display size and resolution: for example, on an eight inch (20 cm) wave trace on your monitor screen, you can view approximately six minutes of hi-res trend wave trace. The hi-res waves are drawn at a speed of 3 cm/minute.The availability of hi-res trend waves depends on your monitor configuration and on the options purchased for your monitor.Changing the Hi-Res Trend Waves DisplayedTo change the selection of hi-res trend waves on the Screen:1Select a displayed hi-res trend wave.2Select the required hi-res trend wave from the pop-up list.If there are no hi-res trend waves on the Screen, you must change to a Screen with hi-res trend waves.Hi-Res Trend Wave ScalesHi-res trend waves are either compressed realtime waves or fast numeric trends.• Hi-res trend waves from compressed realtime waves include: Resp, CO2, A BP,  PAP, CV P, ICP, AWP, anesthetic agents.• Hi-res trend waves from fast numeric trends include: btbHR, SpO2, tcpO2, tcpCO2, Pulse, Perf, CPP, BIS, CCO, inO2, Delta SpO2.Hi-res trend waves from realtime waves use the wave scale as their display scale. Changing the wave scale changes the hi-res trend wave scale.Hi-res trend waves from numerics use a pre-defined display scale dependent on the patient category.Hi-Res Trend Waves and OxyCRGOxyCRG is a combination of three hi-res trend waves, btbHR, SpO2, and Resp, mainly used in neonatal monitoring.
22 High Resolution Trend Waves288Printing Hi-Res Trend Wave ReportsTo print hi-res trend waves on reports, you can choose to print either• all VisibleWaves - prints all waves and hi-res trend waves currently displayed•All Waves - prints realtime waves and hi-res trend waves for all currently-monitored measurements•HiRes Waves - prints hi-res trend waves for the currently-monitored measurements•OxyCRG Waves - prints hi-res trend waves for btbHR, SpO2, and Resp.For each hi-res trend wave, a maximum of six minutes of measurement data will be printed.See the section on Reports for more information on setting up reports.Hi-Res Trend Wave RecordingsThe selection of waves in hi-res trend wave recordings and the recording speed are defined by the pre-configured HiResTrd recording template. See the section on Recordings for more information.To start a hi-res trend waves recording,1select the Recor- dings SmartKey, if configured, or select Main Setup then select Recordings.2select the HiRes Recordng pop-up key.
2328923Event SurveillanceEvents are electronic records of episodes in your patient's condition. You can trigger them manually, or set them to trigger automatically during pre-defined clinical situations.Depending on the level of event surveillance available on your monitor, the information stored for each event episode can include:• waveforms for up to four measurements of your choice (depending on episode type, see “Events Pop-Up Keys” on page 292 for more details)• numeric vital signs for all the measurements monitored• any alarm conditions active when the event episode was triggered• any annotations connected with the event.You can navigate through the event database to view events retrospectively, and you can document events on a recording or report marked with the patient name, bed label, and the data and time.When an MP5 is connected to a host monitor, event surveillance will be disabled. No new events will be detected and no existing events will be deleted. There is no data exchange between the host monitor and the MP5 for event surveillance. When the MP5 is disconnected from the host monitor event surveillance will resume and new events will be detected.Levels of Event SurveillanceThe appearance of the Events windows and menus and the settings you can select for events depends on the event surveillance option purchased for your monitor: basic event surveillance, advanced event surveillance, or neonatal event review (NER). This table lists the differences between the options.To determine which level of event surveillance your monitor has, select Main Setup then Event Surveill. followed by Setup Events and select the trigger group to see the available event groups.• if the only event group listed is NER, your monitor has the Neonatal Event Review option• if there is one event group and it is not NER, your monitor has the Basic Event Surveillance option• if you see six event groups, your monitor has the Advanced Event Surveillance option.
23 Event Surveillance290Event GroupsThe event group• monitors the patient's signals to detect event triggers• defines which waveforms are recorded in the event data.In basic event surveillance only one event group can be active at a time, with Advanced Event Surveillance all six groups can be active simultaneously. Active event groups monitor for event triggers.Event groups are defined in Configuration Mode. In monitoring mode the groups can be adapted to current conditions, for example episode types and threshold levels can be changed.Event FunctionalityBasic Event Surveillance Option C06Advanced Event SurveillanceOption C07Neonatal Event Review (NER)Option C04Event groups 1 6 (one group can be configured to NER)NERMeasurements per group 3 4 3 (plus 1 for episode recording)Triggers per measurement 12 1Trigger types Simple ("at least one") Combined ("at least two") Simple ("at least one")Annotation no yes yesTypes of event episodeAverage trendSnapshot eventsAverage trendHigh resolution trendSnapshot eventsHigh Resolution TrendEvent viewsGraphic Event Review window, Graphic Event Episode windowSummary view, graphic and tabular Event Review window, graphic and tabular Event Episode windowGraphic and tabular Event Review window, graphic and tabular Event Episode windowDatabase capability25 events for 24 hours 25 events for 24 hours25 events for 8 hours50 events for 8 hours 50 events for 24 hours25 events for 24 hours25 events for 8 hours50 events for 8 hours 50 events for 24 hoursEvent Notification no yes no
23 Event Surveillance291Event EpisodesWhen an event occurs, information for a predefined duration is stored. This is the event episode. It includes information from a defined period before the trigger, called the event pre-time. The episode time after the event is called the event post-time. If a further event occurs during the event post-time it changes a single event to a combined event (combi-event).Manually-triggered event episodes document patient information from the time leading up to the event trigger; they do not have a post-time.The episode type defines the level of detail captured in an event episode. The higher the data resolution, the shorter the period that the monitor can store in its memory. High-resolution data is suited for neonatal applications, where the clinical situation may change very quickly. In adult monitoring, where the patient's status typically changes more gradually, a longer trend may be more informative.Event Episode Types Pre-time Post-timeAverage trend20 minutes, five samples per minute2 minutes 18 minutes4 minutes 16 minutes6 minutes 14 minutes8 minutes 12 minutes10 minutes 10 minutes12 minutes 8 minutes14 minutes 6 minutes16 minutes 4 minutes18 minutes 2 minutesHiResTrendFour minutes, four samples per second.Neonatal Event Review (NER) is a type of HiResTrend1 minute 3 minutes2 minutes 2 minutes3 minutes 1 minuteRealtime Wave Snapshot15 seconds5 seconds 10 seconds10 seconds 5 seconds
23 Event Surveillance292Events Pop-Up KeysDepending on the events view you choose, a selection of the events pop-up keys let you navigate through the stored events and carry out events-related tasks.Event TriggersYou can trigger event capture manually, for example, if you want to record a patient's condition before a procedure. You can also set events to trigger automatically, when the patient's values cross a predefined threshold value, or when a particular measurement or procedure is carried out.Pop-Up Keys Selecting this pop-up key lets you....Event Setup open the Event Setup menu.Show Episode open the Event Episode window to review the selected event in detail.Show Review open the Event Review window.Review Group choose a different event group for reviewing in the Event Review window (Advanced Event Surveillance only).Show Summary open the Event Summary window.Manual Event start a manually-triggered event capture.Start CAR Stop CAR open the Start CAR window to start a Car seat Assessment Record (CAR) period or stop a currently running CAR.CAR Histogrm open the window showing the CAR SpO2 histogrammove the cursor left or right to the next event to navigate through the events database. Placing the cursor over an event highlights it and shows the event values for the selected event.jump to the first or last event in the event database.Vitals View Graphic Viewtoggle between a tabular and graphic version of the Event Episode window currently viewed.Table ReviewGraphic ReviewCAR Reviewtoggle between a tabular and graphic version of the Event Review window currently viewed.Delete Event delete the currently-selected event from the database. The monitor asks you to confirm this deletion. You cannot retrieve deleted events.Select Annotatn access the list of available annotations to add a nursing note for the current event episode (Advanced Event Surveillance only).Print/ Record access the printing and recording pop-up keys to document events.
23 Event Surveillance293If more than one trigger is available for the measurements in the active event group, the trigger condition may be At Least One Param., At Least Two Param., At Least Three Par., or All Four Parameter. If the trigger is At Least One Param. (this is short for 'at least one measurement parameter'), the monitor starts an event capture if a trigger occurs in any of this event group's measurements. If the trigger is At Least Three Par., the monitor captures events when three or more trigger thresholds from this event group's measurements are violated. With Enhanced Condition you can not only select a minimum number of triggers to trigger an event but define which specific measurement triggers these must be. For example, At Least Two Param. will cause an event to be captured if a trigger occurs in any two of this event group's measurements - with Enhanced Condition you can select that only when triggers are in HR and SpO2 an event will be captured.The trigger condition for event groups is set in the monitor's Configuration Mode.If You Use Alarm Limits As Event TriggersThe event capture is triggered automatically when your patient's values violate set alarm limits, or when a specified alarm condition, such as apnea, occurs. No events of this kind are triggered if alarms are switched off. Changing alarm limits changes the event trigger definitions.The asterisk symbols beside the trigger tell you about the alarm triggers:*** indicates a high priority (red) alarm** indicates a lower priority (yellow) alarm. This category includes short yellow arrhythmia alarms, which may be configured to be shown as one star alarms (*) on your monitor.Triggers without asterisk symbols are user-defined triggers.If You Set User-defined Threshold TriggersYou can define event triggers that are independent of alarm limits. You must set a threshold value and a threshold time for the trigger. If you set the trigger threshold time to 12 seconds, the monitor triggers an event if the threshold is violated for more than 12 seconds.If You Set "On Measurement" TriggersYou can set aperiodic measurements (such as NBP) or procedures (such as Cardiac Output) to trigger an event whenever they start.
23 Event Surveillance294If You Set Use-defined Deviation TriggersYou can define event triggers that are independent of specific limits and based instead on deviations from the current values. You must set a deviation and a period of time in which the deviation occurs. There are three types of deviation available: ANY Deviation, UP Deviation where only changes in a positive direction are detected and DOWN Deviation where only changes in a negative direction are detected. The deviation can be defined either in relative terms as a percentage, for example 10%, or as an absolute value, such as 10 bpm.Event RetriggeringIf a condition that triggered an event persists and the values remain beyond the trigger threshold, a new event will not be triggered.For a new event to be triggered by the same condition, the measured values for at least one of the triggers must cross back into the normal range and then recross the trigger threshold.Event Notification(Advanced Event Surveillance Only). You can be notified when an event is detected. For each event group you can define a type of notification depending on the severity of the event conditions. The notification can be a status message with a prompt tone or a standard *, **, or *** alarm notification. These event alarms are handled exactly like measurement alarms; they can be silenced and are also suspended when all alarms are suspended. You should only use alarm notification for events which are comparable in severity to standard measurement alarms to avoid potential confusion due to too many alarms. Notification in the form of an alarm is not available when the trigger condition is At Least One Param.. Selecting None switches event notification off.Setting the type of notification, or switching notification off, is done in Configuration Mode.Setting Triggers for NER and Basic Event Surveillance1Group Name2Episode Type3Measurements used as event triggers1Select Main Setup then Event Surveill. followed by Setup Events to enter the Event Setup window.2Select the name of the current episode type to set the episode pre/post time.
23 Event Surveillance2953Set the event trigger for each measurement. Select each trigger name and select, if available, either an alarm trigger, or a user-defined trigger from the pop-up trigger list. If you select a user-defined trigger, set the required threshold level and delay time.4Set the trigger status to Activated to start event triggering. If the status is Deactivated event surveillance is effectively switched off.5Select Confirm to confirm your changes.Setting Triggers and Notification for Advanced Event Surveillance1Group Name2Group Type3Notification Type4Episode Type5Trigger Condition6Measurements used as event triggers1Select the group name to enter the setup window for that group.2Set the trigger status to Activated, to have this event group trigger events, or Deactivated.3Set the episode type.Select the name of the current episode type and select an episode type from the pop-up list. The pre/post episode time for the selected episode type is displayed.4Set the trigger for each measurement. Select each trigger name and select either an alarm trigger or a user-defined trigger from the pop-up trigger list. If you select a user-defined trigger, set the required threshold level and delay time. If a deviation trigger is configured, set the deviation and duration.5Select Confirm to confirm your changes.Triggering Events ManuallyTo manually trigger an event, select the SmartKey Manual Event and (for Advanced Event Surveillance) select the group in which the event will be triggered.For manually-triggered events, patient information for the time leading up to the trigger moment is stored using the settings of the assigned event group.
23 Event Surveillance296Running a Car Seat Assessment RecordIn the NER group you can run a Car Seat Assessment Record (CAR). This is a special period of event surveillance using the current setup of the NER group.To start a CAR period:1Select the Start CAR pop-up key or SmartKey.2Select the required time period for the assessment.3Select Confirm to start the CAR.If the NER group was not active it will be activated automatically.During the CAR period an SpO2 histogram is also generated with 1 second samples. For general information about the presentation of data in a histogram, see “Viewing Histogram Trends” on page 272. The CAR SpO2 histogram is unique: it can only be accessed from the events function. It is generated from the beginning of the CAR period (contrary to the non-SpO2 histograms which are generated from trended data retrospectively at the end of a time period). Settings are fixed for this histogram and cannot be changed when viewing it.The Events DatabaseThe maximum number of events that can be stored in the event database depends on the database configuration and the level of event surveillance used. The event database is set up in the monitor's Configuration Mode. Events are stored in the monitor's event database for the configured lifetime, either 8 hours or 24 hours. Deleted events cannot be retrieved. Events are automatically deleted when:• their configured lifetime is over• the storage capacity of the database is exceeded (storing a further event deletes the oldest event in the memory)• a patient is discharged.As the event database is cleared when you discharge a patient, you should ensure that you have documented any events you require for the patient records before you confirm the discharge.Viewing Events• To see a summary of all the events in every group in the event database, use the Event Summary window.• To review all the events in a particular event group, use the Event Review window.• To review individual event episodes in detail, use the Event Episode window.To start viewing events, either:•in the Main Setup menu, select Event Surveill. and then select the event view you require from the list, or• select the Event Surveill SmartKeyand then select the event view you require from the list.
23 Event Surveillance297Event Summary and Event CounterVertical bars mark events in the Event Summary window. The timeline shows the position of the stored events in the event database. Selecting this view activates a cursor that lets you navigate across the timeline. Use the Show Episode pop-up key to select individual events for review in the Event Episode window. It also calls up the events pop-up keys.The event counter counts the total number of events in the database. If more than one event group was set to trigger events within the event history, the event counter also counts the event group totals.Counting Combi-EventsIf one or more events occur during the same Episode Time, the monitor combines them and displays them as distinct events in one event episode, called a combi-event. The first event is the trigger event, and the others are follow-up events. For example, if an apnea event is followed 40 seconds later by a brady event, the brady event is not counted as a single event but as part of the apnea event.Counting Neonatal Event Review (NER) EventsFor neonatal events (NER, formerly "OxyCRG"), apnea events (A), bradycardia events (B), and combinations of these events are counted and classified by the event counter in the Event Summary. If they are associated with a Desaturation (D), this is also marked. Manual events (M) are counted separately. For example, A(D):2(1) indicates that two apnea events occurred and one of them was associated with a desaturation.Event Summary Window(Advanced Event Surveillance only). The Event Summary window shows the number of stored events in each event group and the total number of events in the database. Vertical bars mark events on a timeline showing the position of the stored events in the event database. The symbol next to the group name indicates the activation and notification status:symbol meaninggroup activated, notification set to ***alarmgroup activated, notification set to **alarm
23 Event Surveillance298Selecting the Event Summary window calls up the events pop-up keys.Parts of the Event Summary window can also be embedded in Screens so that they are always visible, for example the Total row showing the total number of events with the bars on the timeline or the column showing all the groups with the activation and notification status.Event Review WindowTo enter the Event Review window, select the graphic event summary, if available, or select the events pop-up key Show Review.When you open the Event Review window, it automatically shows the event group with the most recent event.• To view other event groups, select the pop-up key Review Group and select the group from the list.Event Episode WindowTo enter the Event Episode window, select the pop-up key Show Episode.group activated, notification set to *alarmgroup activated, notification set to screen promptgroup is activated, notification is switched offno symbol group not activatedsymbol meaning
23 Event Surveillance299Depending on the event group settings, the Event Episode window shows either 20 minutes of average trend event information, four minutes of high-resolution event information, or 15 seconds of realtime wave information.The event values to the left of the measurement channels show the trigger threshold set and the maximum amount by which this limit was exceeded. In this example, Desat 71<85 tells you that 76 was the lowest SpO2 value measured during the event time and that the Desat trigger threshold was set to 85 when the event was triggered. If the event was manually triggered, the event value boxes display "manual".Annotating Events1To annotate an event, in the Event Episode window, select the pop-up key Select Annotatn.2Select the required annotation from the pop-up list of available annotations for the currently active event group.Up to 20 annotations can be configured to let you add commonly-used clinical notes to event episodes for documentation purposes. To see the complete list of available annotations, in the Event Setup menu, select Event Annotation.Documenting EventsYou can print a report or make a recording of the events history stored in the database or of individual event episodes or a Car Seat Assessment Record.Documenting Event Review1In the Event Review window, select the pop-up key Print/ Record. This calls up the event documentation pop-up keys.1Follow-on event values2Trigger event values, highlighted3Timeline, showing episode Pre/Post-time4Active event group
23 Event Surveillance3002For a graphic Event Review recording, select the Record Graphic pop-up key.For a tabular Event Review recording, select the Record Tabular pop-up key.For a CAR review report, select the Print CAR pop-up keyTo print an Event Report, select the Print Review pop-up key.Documenting an Event Episode1In the Event Episode window, select the pop-up key Print/ Record. This calls up the event documentation pop-up keys.2To make an Event Episode recording, select the Record pop-up key.To print an Event Episode, select the Print Episode pop-up key.Event RecordingsEvent recordings can be sent to a locally-connected M1116B recorder module.Event Review RecordingsEach event review recording strip begins with a summary of the events stored in the event database.Recording strip annotation is explained in the Recording chapter.1Event total per event group2Event types3Total events in database4Event groups5Recording strip code
23 Event Surveillance3016Patient information and medical record no.In tabular event review recordings, the events stored in the event database are shown in chronological order, with a number and time-stamp.The measurements in the event group are shown in the next columns, marked "Parameter 1, Parameter 2...", along with the event values measured at the time of the event. For each event, the trigger values are shown.This section of the recording is A4 or letter size, so that it fits in a patient file.Event Episode RecordingsEvent episode recordings are divided into four sections.The first section shows the patient information and the event group of the episode with the event values for the group measurements. The trigger symbol marks the event trigger.In graphic event review recordings, events are represented by bars, and each event group is printed on a separate channel.The timeline reflects the period stored in the database, either 24 hours (divided into 4 hour sections) or 8 hours (divided into one-hour sections).
23 Event Surveillance302The second section (2 below) shows the waveforms recorded during the episode. The trigger moment is marked with a triangle and divides the episode into the pre/post time. Any calibration marks and grid marks on the screen are automatically printed on the recording.If there are four measurements in the event group being recorded, two waveforms will be recorded in two separate waveforms segments.The third section (3 above) shows the most important vital signs information, including numerics, active alarms, and any annotations made on the event episode.The fourth section (4 above) shows the numerics for all the currently monitored vital signs and any alarm conditions or INOPs active at the time the event was triggered.Event ReportsEvent reports can be printed on A4 and letter size paper on a printer connected locally or centrally to your monitor.Event Review ReportsThe event review report documents all the events stored in the event database for a selected group.
23 Event Surveillance303Event Episode ReportsThe event episode report documents the patient information from the currently-selected event. See the section on event recordings for an explanation of the report elements.
23 Event Surveillance304Event Summary Reports(Advanced Event Surveillance only). The event summary report shows a graphical view and a tabular view of all events in the database for all groups.
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2430724ProtocolWatchProtocolWatch (PW) is a clinical decision support tool. It allows you to run a clinical protocol which can monitor developments in the patient's condition, taking into account:• measured values from the monitor• values manually entered by you (for example manual temperature measurements, lab values)• your assessment of patient statusProtocolWatch notifies you when certain conditions or combinations of conditions occur and it documents developments in a log which can be printed.SSC Sepsis ProtocolThe SSC (Surviving Sepsis Campaign) Sepsis Protocol is a protocol implemented for the ProtocolWatch application. The SSC Sepsis Protocol is for use in screening for severe sepsis and monitoring of its treatment. It is a computerized implementation of the January 2008 Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock. Philips does not make any claims about their effectiveness to reduce the morbidity or mortality associated with severe sepsis.The SSC Sepsis Protocol assists you in recognizing the early signs and symptoms of sepsis by comparing the state of your patient to the defined criteria and then guides you through the recommended treatment protocol. Use of the SSC Sepsis Protocol requires thorough knowledge of the complete SSC Guidelines for Management of Severe Sepsis and Septic Shock. Due to space limitations on the screen, the recommendations cannot always be reproduced in the full detail available in the printed and on-line guidelines. The SSC Sepsis Protocol is not a diagnostic or therapeutic tool and is not intended to replace the competent judgment of a clinician.The SSC Sepsis Protocol consists of three separate consecutive phases:Severe Sepsis Screening - measurement values and patient status are compared to the Severe Sepsis Screening criteria. When these criteria have been met, the clinician confirms the presence of infection and sepsis-related organ dysfunction and can authorize entering the Sepsis Resuscitation Bundle.Sepsis Resuscitation Bundle - the recommendations for sepsis resuscitation are listed and can be checked off as they are implemented. After achievement of all the sepsis resuscitation goals, or at the latest after 6 hours, the Sepsis Resuscitation Bundle is completed and the Sepsis Management Bundle begins.Sepsis Management Bundle - the recommendations to maintain patient status are listed and can be checked off as they are implemented. The Sepsis Management Bundle ends when 24 hours have passed since the Sepsis Resuscitation Bundle began.
24 ProtocolWatch308Depending on the option your monitor has, it may be that only the Severe Sepsis Screening phase is implemented. If, at the end of this phase sepsis has been confirmed, and the patient is transferred for treatment in the resuscitation and management phases, you can transfer the current state, the settings and the log from the SSC Sepsis Protocol in the MMS to another monitor with the full version of the SSC Sepsis Protocol. The transfer of data and settings must be enabled in Configuration mode.WARNINGAlways consider the specific clinical context for your patient, before following SSC Sepsis Protocol treatment recommendations.The SSC Sepsis Protocol and this description are based on the SSC Guidelines for Management of Severe Sepsis and Septic Shock from January 2008 and the SSC Bundle definitions from January 2005. To check the version of the Guidelines and Bundle definitions on the monitor,•Select Main Setup then Revision then ProtocolWatch followed by SSC SepsisOrientation On The ScreenAt the top of each window there is an orientation line showing the phases available on your monitor, with the currently active phase highlighted.You can also place the ProtocolWatch symbol, together with the currently active phase, on the main screen, in one of the numeric positions. This allows you to see at a glance which phase is currently active, even when no SSC Sepsis Protocol window is currently displayed.If you need to enter data or perform an action in an SSC Sepsis Protocol window, the symbol will turn into a SmartKey.Transferring Patients And Moving Manually Between PhasesIf a patient has already been diagnosed as having severe sepsis before connecting them to the monitor, you can select Main Setup then ProtocolWatch followed by Manual Transition to go directly to the Sepsis Resuscitation Bundle to monitor treatment. Direct entry to the Sepsis Management Bundle is also possible using the Manual Transition function and the time into the selected bundle can be set.If a patient has been screened on arrival, for example in the emergency department, then transferred to Intensive Care when Sepsis is confirmed, the current state, the settings and the log from the SSC Sepsis Protocol will be transferred with the MMS to the new monitor. Should it be necessary, you can select the phase at the new monitor manually with Main Setup then ProtocolWatch followed by Manual Transition. The transfer of data and settings must be enabled in Configuration mode.
24 ProtocolWatch309CAUTIONIt is not possible to transfer SSC Sepsis Protocol data from a monitor with release F.0 software to another monitor with release G.0 software or above, and vice versa.Suspending the Protocol for 24 HoursTo suspend the protocol for 24 hours:1Select Main Setup then ProtocolWatch followed by Suspend for 24 hours.2Select Confirm.The protocol will resume activity after 24 hours with Severe Sepsis Screening.Severe Sepsis ScreeningAs soon as an adult patient is connected to the monitor, and heart rate or pulse is being measured, the protocol begins to observe heart rate, temperature and respiration rate values in the background. If temperature or respiration rate is not being measured continuously, a pop-up window appears at 4-hour intervals to ask for manually measured values. These values are all compared to the screening criteria: HR above 90, Temp above 38.3°C (100.9°F) or below 36.0°C (96.8°F), RR above 20.If any one of the values fulfills the screening criteria, the first Severe Sepsis Screening window appears:The measured value which has fulfilled the criteria is shown highlighted (in the example shown above it is respiration). There is a check box for the infection signs and symptoms listed,• if the monitor has measured values which meet the screening criteria, and• for all signs and symptoms which cannot be measured by the monitor.Check the box if you can confirm that this sign or symptom is present and new. If the patient is mechanically ventilated, the Mechanically ventilated box must be checked. If you have manually measured temperature or respiration rate, you can enter the values using the Enter RR and Enter Temp keys.
24 ProtocolWatch310Select Confirm when the check boxes reflect the current patient status.Select Remind 15 min if you want to delay filling out this screen. (When you enter the screen manually this key will be a Cancel key, as no action is required in this case.)Changing ConditionsThe window reappears if:• a previously fulfilled criteria is again fulfilled• a new HR or RR criteria is fulfilled,• the HR or RR value which previously fulfilled the criteria now triggers a ** RR HIGH, ** HR HIGH alarm or a ***TACHY xxx > yy alarm,• after 8 hours (configurable to 12 hours) if at least one infection sign is still present.Two Or More Infection Signs Or Symptoms ConfirmedIf you have confirmed two or more infection signs in the first Severe Sepsis Screening window, a new pop-up window appears asking Is the patient history suggestive of a new infection?.If you select Yes, the next screen appears requesting a lactate measurement.If you select No, the screening phase continues and the first Severe Sepsis Screening window reappears in the situations described in Changing Conditions above.Lactate MeasurementTo enter the Lactate value, select the Enter Lact key. If the value entered is > 4 mmol/l the check box is automatically checked.Select Confirm when a value has been entered. What follows depends on the Lactate value:•If Lactate is > 4 mmol/l: the value meets the criteria for severe sepsis and a window appears recommending authorized clinician review before entering the Sepsis Resuscitation Bundle.•If Lactate is ≤ 4 mmol/l: a further window appears requiring your input to determine on the basis of blood pressure values whether the patient meets the criteria for severe sepsis.Hypotension EvaluationIf the Lactate value was not above 4 mmol/l, the next window asks whether the patient has persistent hypotension.The protocol defines Hypotension as:• SBP < 90mmHg (12.0kPa), or• MAP < 65mmHg (9.0kPa), or• SBP decrease > 40mmHg (5.0kPa) below baseline.You can see this definition in the window by selecting Show Details.If the patient has persistent hypotension as defined, select Yes. This acknowledges that the patient meets the criteria for severe sepsis and a final window appears recommending authorized clinician review before entering the Sepsis Resuscitation Bundle.If the patient does not have persistent hypotension, select No. After an hour a screen appears asking Is the previously acknowledged infection still present?.
24 ProtocolWatch311If you select Yes, the window for the Lactate measurement will reappear. If you select No, screening continues - comparing heart rate, temperature and respiration rate values against the screening criteria.Authorized Clinician ReviewTo review the protocol, select Protocol Log. You can also print out the log to document the screening phase.Select Confirm to complete the screening phase and, if you have the appropriate monitor option, continue to the Sepsis Resuscitation Bundle phase.Sepsis Resuscitation BundleThe treatment recommendations from the Sepsis Resuscitation Bundle are presented and the implementation of the recommendations is monitored.When the Sepsis Resuscitation Bundle phase begins, the ProtocolWatch Screen automatically appears on the monitor (if configured and available on the monitor).The lower area of the screen contains:• a reminder list of the treatment recommendations - recommendations which have been fulfilled are shown in gray, overdue recommendations are shown in orange• a timer showing the time already passed in this phase• three horizon trends for MAP, CVP and ScvO2 or SvO2, if these measured values are available• a list of the latest manually entered values - if you select this list you will open the Manual Entry Log window where the last 24 manually entered values are shown for referenceIf ScvO2 or SvO2 and CVP are not being continuously measured, a pop-up window appears at hourly intervals to ask for a manually measured value.Monitoring the Sepsis Resuscitation Bundle RecommendationsWhen you select the lower area of the ProtocolWatch Screen, the Sepsis Resuscitation Bundle window appears. If you do not have the ProtocolWatch Screen displayed, the Sepsis Resuscitation Bundle window appears automatically once an hour.
24 ProtocolWatch312Select the Enter Lact key to enter a lactate value. When you have entered a value, or if a lactate value had previously been entered, the box is checked.Check the Take Blood Cultures box when you have taken blood cultures.Check the Administer Intravenous Antibiotics box when you have started broad-spectrum antibiotic therapy.The remaining three recommendations are automatically compared to the Sepsis Resuscitation Bundle criteria, if the measurements are available on the monitor. A box is checked when the corresponding recommendation has been fulfilled.Depending on your configuration, continuously measured CVP values may be disregarded if they exceed a set limit. Whether this is so, and which limit is applied, is set in the monitor's Configuration mode.If you have manually measured ScvO2 or CVP, you can enter the values using the Enter ScvO2 and Enter CVP keys. The box is checked automatically if the value fulfils the recommendation.The boxes for MAP, ScvO2/SvO2 and CVP can also be checked manually (for cases where the monitor does not measure them) but only when the timer has reached 4 hours to ensure that these values are achieved and maintained mid-term. Check these boxes if the recommendation has been fulfilled.To see more details about the recommendations, select the Show Details key.Select Confirm when the check boxes reflect the current treatment status.Checking The Sepsis Resuscitation Bundle WindowDuring the Sepsis Resuscitation Bundle you can open the Sepsis Resuscitation Bundle window at any time to check the status or to make entries. The recommendations are shown as follows:• Recommendations which are not yet fulfilled are shown in black. They also appear in the list on the lower area of the ProtocolWatch Screen.• Recommendations which are overdue are shown in orange.• Recommendations which have been fulfilled and confirmed are shown in gray. They no longer appear in the list on the lower area of the ProtocolWatch Screen.Previewing the Sepsis Management BundleAt any time during the Sepsis Resuscitation Bundle you can preview the Management Bundle in order to see which recommendations will follow there.• Select the Preview Managmnt key.Ending The Sepsis Resuscitation BundleWhen all recommendations have been fulfilled and confirmed, or when 6 hours have passed since the bundle started, the Sepsis Resuscitation Bundle is ended.You are asked to confirm with the Yes key that the Sepsis Management Bundle should now be started. If you select No, the Sepsis Resuscitation Bundle is extended for 1 hour.Sepsis Management BundleThe stabilization recommendations from the Sepsis Management Bundle are presented and the implementation of the recommendations is monitored.
24 ProtocolWatch313When the Sepsis Management Bundle phase begins, the ProtocolWatch Screen is automatically updated (if configured and available on the monitor). In the lower area of the Screen, the list of recommendations for the Sepsis Management Bundle replaces the list for the Sepsis Resuscitation Bundle. The timer shows the combined time for both phases.Monitoring the Sepsis Management Bundle RecommendationsWhen you select the lower area of the ProtocolWatch Screen, the Sepsis Management Bundle window appears. If you do not have the ProtocolWatch Screen displayed, the Sepsis Management Bundle window appears automatically once every six hours.The Low Dose Steroids for septic shock per policy recommendation and/or the Drotrecogin Alfa per policy recommendation may not appear if they have been configured not to do so for your hospital.Check the Low Dose Steroids administered box when you have started steroid therapy or the Low Dose Steroids contra-indicated box if this treatment is contra-indicated for your patient.Check the Drotrecogin Alfa administered box when you have started recombinant human activated protein C therapy or the Drotrecogin Alfa contra-indicated box if this treatment is contra-indicated for your patient.The boxes for Maintain Glucose <8.3mmol/l (150 mg/dl) and Maintain Insp. Plateau Pressure <30cmH₂O can only be checked when the timer has reached 20 hours to ensure that the stabilization of these values is achieved long-term. Check these boxes if the recommendation has been fulfilled.Recommendations which have been fulfilled are shown in gray with the time fulfillment was entered.To see more details about the recommendations, select the Show Details key.Select Confirm when the check boxes reflect the current treatment status.Ending The Sepsis Management BundleThe Sepsis Management Bundle normally ends 24 hours after the Sepsis Resuscitation Bundle started, as documented by the bundle timer on the ProtocolWatch screen. You are asked to confirm with the Yes key that routine monitoring should now resume. By selecting No you can extend the Sepsis Management Bundle phase by an additional 6 hours.
24 ProtocolWatch314After completion of the Sepsis Management Bundle a sepsis standby phase begins which allows time for further patient stabilization and recovery. During this phase Severe Sepsis Screening is suspended. The standby phase is by default 7 days but the length can be adjusted in Configuration Mode.Viewing And Printing The Protocol LogThe Protocol Log stores all user interactions, alarms and phase transitions while the SSC Sepsis Protocol is running.To view the Log select Main Setup then ProtocolWatch followed by Protocol LogYou can choose between three different views of the Protocol Log:•Summary View - a short form which does not include when the windows were triggered•Full View - a complete log of all user interactions, alarms and phase transitions•Phase View - you can view log entries for one phase by selecting that phase on the orientation lineWhen the Log consists of several pages, you can move through the pages with the Previous Page and Next Page keys.To start a Protocol Log printout, select Print.The log is cleared whenever a patient is discharged.Always Discharge PatientsIt is essential that patients are discharged when monitoring ends. As a reminder, the monitor can be configured to display a pop-up window when the monitor has been switched off, in Standby mode, or not monitoring basic vitals for a certain time. The window asks whether a new patient is being monitored and offers a pop-up key to discharge the previous patient if this is the case. The window must be configured in Configuration Mode.When the previous patient is discharged, this clears the protocol log, resets the timers and deletes manually entered measurement values.
2531525RecordingThe M1116B plug-in recorder records numerics for all active measurements and up to three waveforms. You can use it for local recording mounted in the monitor's FMS.Central RecordingFor central recording from the bedside, your monitor must be connected via a network to an Information Center. You can use either the M1116B 2-Channel Recorder or the standalone M3160A 4-Channel Recorder. Recordings made on the M3160A may look slightly different to those described here. See the documentation supplied with the Information Center for information on the 4-Channel Recorder.Starting and Stopping RecordingsThe recordings pop-up keys let you start and stop recordings. Select the Recor- dings SmartKey to call up the line of pop-up keys. Scroll right or left to see any pop-up keys not displayed.1M1116B Plug-in Recorder2Continue LED - flashes if a continuous recording is ongoing3RUN/CONT key - starts a delayed recording or makes the current recording continuous4STOP key - stops the current recording
25 Recording316The selection of pop-up keys available depends on the monitor you are using.Quickstarting RecordingsTo quickstart any type of recording using a pre-configured recordings template,• Select the Recor- dings SmartKey and then select the pop-up key of the recording type you want to start.Alternatively, you can• Select the Main Setup SmartKey, select Recordings, then select the recording type.To quickstart a delayed recording,• Select the SmartKey Delayed Record to immediately start a delayed recording.M1116B only• You can also start a delayed recording by pressing the Run/Cont key on the recorder module.Extending RecordingsTimed (non-continuous) recordings stop when their runtime is over. Continuous recordings continue until stopped manually or by an INOP condition.• To extend an ongoing recording by its runtime, reselect its Start pop-up key once.• To make an ongoing recording continuous, reselect its Start pop-up key twice within 5 seconds.M1116Bonly• You can also make an ongoing recording continuous by pressing the Run/Cont key on the recorder module.Stopping RecordingsRecordings stop automatically when the preset runtime is over, when the recorder runs out of paper, when you open the recorder door or when the recorder has an INOP condition.• To manually stop a recording, select the Recor- dings SmartKey and then select the pop-up key Stop All Recordng.M1116Bonly• You can also stop a recording by pressing the Stop key on the recorder module.Recording Without a TemplateTo record without a pre-configured template, selecting the waves you require,Delayed Recordng Vital SignsRT A Recordng Alarm LimitsRT B Recordng ST SegmentsRT C Recordng ECG QTSelect Waves Setup RecordngHiRes Recordng Stop All RecordngAll ECG Waves
25 Recording3171Either: Select the Recor- dings SmartKey then select the pop-up key Select Waves.Or: Select the SmartKey Record Waves.2Use the pop-up keys to choose up to three measurement waves to be printed on the recording. If you want fewer than three waves on the recording, select the waves you want then select the Continue pop-up key.3Select one of the recording speed pop-up keys to set the required recording speed.4Select the Start pop-up key to start the recording.Select Waves recordings use default values for any recorder settings not defined: runtime is continuous, overlapping is set to non-overlapping.Overview of Recording TypesThis table details settings for local recordings. For details on recordings made on the central recorder, see your Information Center Instructions for Use.Delayed Alarm Realtime (RT) All ECG Waves HiRes Trend Procedure or ContextType of recordingmanual automatic, triggered by defined alarm conditionsmanual manual manual manual, use the context window's pop-up keys to startRecording Destinationlocal recorder and centrallocal recorder and centralprinter local recorder and centrallocal recorder onlylocal recorder onlylocal recorder onlyInformation recordedfrom the start trigger minus the delay timefrom the start trigger minus the delay timeN/A from the start triggerfrom the start trigger, in realtimefrom the start trigger minus delay timedefined by the contextNumber of wavesup to 3 up to 3 N/A up to 3 all ECG waves currently monitored and availableup to 3 high-resolution trends (beat-to-beat) wavesup to 3 waves, or specific to the context, e.g. a wedge procedureSpeed 50, 25, 12.5, 6.25, 2.5 mm/sec50, 25, 12.5, 6.25, 2.5 mm/secN/A 50, 25, 12.5, 6.25, 2.5 mm/sec25 mm/sec 1, 2, 2.5, 3, 6 cm/mindefined by the contextRuntime 15, 20, 25, or 30 seconds15, 20, 25, or 30 secondsN/A 6, 8, 10, 15 seconds or continuously4 seconds per wave10 minutes, or continuouslydefined by the contextStops automatically automatically N/A automatically if limited, manually if continuousautomatically automatically if limited, manually if continuousdefined by the contextDelay Time 10, 15 seconds 10, 15 seconds N/A none none 6, 5, 4, 3, 2, 1 minutesdefined by the contextOverlap up to 3 waves up to 3 waves N/A up to 3 waves none up to 3 waves defined by the contextN/A = not applicable
25 Recording318All ECG Waves RecordingsAn All ECG Waves recording shows a 4 second recording of each lead with a calibration bar preceding each ECG lead. All available leads are recorded sequentially in the standardized lead order. The recording is realtime, that is, the information recorded is not simultaneous.Creating and Changing Recordings TemplatesTo save you defining recording settings each time you start a recording, you can create templates for commonly-used types of recordings in the Setup Recording menu. You can create templates for one delayed recording, one alarm recording, three realtime recordings (two for MP20/30), and one high resolution recording. All ECG Waves recordings do not need to be configured, they always use the same format.Changing recordings templates changes the settings that will be used each time a recording of this name is triggered.1Select the Main Setup permanent key to call up the Main Setup menu.2Select Recordings to enter the Setup Recording menu.3Select the name of the template you want to create or change. Each recording name is linked to a recording type, delayed, alarm, realtime, and hi-res trends. Recording names can be changed in the monitor's Configuration Mode.4Design the template by selecting each menu item and entering the information for the template.•Recorder: choose which recorder the recording will print to (Local, Central 2-Ch, or Central 4-Ch recorder, or Printer (for realtime reports in alarm recording only)).•Channel 1, Channel 2, etc.: choose which waveform to record in each channel. If the wave assigned to a recording channel in a particular template is not available when a recording is triggered, the channel is left blank on the recording strip. The pop-up list of available (currently monitored) waves differs according to the recording type:– Realtime, delayed and alarm recordings: the list shows all the currently available waves.– High-resolution recordings: the list shows all the available high-resolution waves.In addition to the currently available waves, you can choose from several other settings which make an automatic allocation when the recording starts:–Alarm Par will always record the measurement in alarm in the chosen recorder channel–Primary Lead will always record the current primary lead in the chosen recorder channel–SecondryLead will always record the current secondary lead in the chosen recorder channel–Any Agent will always record the currently selected anesthetic agent.For high-resolution recordings only the Any Agent setting is available.•Overlap: define whether the recorded waveforms will be printed overlapping or beside each other.•Speed: choose the recording print speed.•Delay Time: Delayed recordings start documenting on the recorder strip from a pre-set time before the recording is started. This interval is called the "Delay Time" and can be set as specified in “Overview of Recording Types” on page 317. This setting can only be changed in Configuration Mode.•Run Time: see how long this type of recording is configured to run. This setting can only be changed in Configuration Mode. Continuous recordings run indefinitely.
25 Recording319Central Config: if available in the General menu, select this setting to use the recording settings made for the centrally-connected recorder.Changing ECG Wave GainThe ECG Gain setting in the General Recording Setup window defines how every recorded ECG wave, irrespective of template or recording type, will appear on the recorder strip. This does not affect the displayed ECG wave, or printed ECG reports. To change the ECG gain setting for recordings,1In the Setup Recording menu select General.2Select ECG Gain.3Select the required setting:–Auto: the wave recording will use the same scale as the ECG wave on the monitor screen–5 mm/mV, 10 mm/mV, 20 mm/mV: the wave recording will use a scale of 5, 10, or 20 millimeters per millivolt.Recording PrioritiesManually-started recordings have priority over automatically-started recordings. If an automatically-triggered alarm recording is running, and a realtime or delayed recording is manually started, the alarm recording is stopped and the manually-requested recording is started.More recent manually-started recordings have priority over older manually-started recordings. If a manually-started recording is running, and another manually-started recording is triggered, then the older recording is stopped and the more recent manually-started recording is started.Alarm recordings are prioritized according to alarm priority. If an alarm recording triggered by a yellow alarm is running and a new alarm recording is triggered by a red alarm, the yellow alarm recording is stopped and the red alarm recording is started.Recording StripThe information printed on the recording strip includes the patient name and MRN, bed number, date and time of recording, recording speed, and recording code. Active alarm and INOP messages as well as numerics for all currently monitored measurements are also printed.Recording strip annotations are printed at the beginning of the recording strip and updated at regular intervals, every 15 minutes for recordings made at speeds lower than 6.25 mm/s, and every 60 seconds for recordings made at speeds greater or equal to 6.25 mm/s.Recording Strip CodeThe recording strip code printed in the first line of the initial annotation has up to seven characters, specifying recording type, operating mode, application area, patient category, and delay time, if applicable.
25 Recording320Recorded WaveformsA selection of up to three waveforms is recorded, marked with wave labels and wave scale information. Wave scale information can be in the form of a calibration bar, like the 1 mV calibration bar for ECG, or calibration steps before the waveform starts.Maintaining Recording StripsRecording ink sometimes fades when covered with transparent tape. Avoid covering any part of a recording that is clinically relevant (annotation or waveforms) when taping a recording strip to a patient record or other patient documentation.Code MeaningRecording type 908A0B91RealtimeDelayedAlarmContext (Procedures)Operating mode MDCSMonitoringDemoConfigurationServiceApplication area IOCNICUORCCUNICUPatient category APNAdultPediatricNeonatal
25 Recording321Reloading PaperM1116BRecorder Status Messages1Use the latch on the right side of the recorder door to pull the door open.2Remove the empty core.3Insert a new roll so that it fits snugly into its housing and the paper end is feeding from the top. Recommended paper: 40477A and 40477B.4Pull out some paper and fold along the front edge at a 45° angle. This makes it easier to feed the paper under the roller as shown.5Feed the paper through and pull some paper out from the top of the roller.6Close the recorder door.7To test if paper is loaded correctly, start a recording. If no printing appears, paper may be loaded backwards. Try reloading the paper.Recorder Status Messages ExplanationFor example:Local alarm recording runningThe named recording is currently running.No Central alarm recording availableNo local alarm recording availableNo alarm recording can be made on the selected recorder. Try selecting another recorder. If a local recorder was selected, the monitor will try to reroute the recording to a central recorder. Recordings configured to a central recorder cannot be rerouted to a local recorder. Alarm recordings may be lost. Try configuring Printer as the alarm recording destination.No alarm recording available No recorder available. Alarm recordings will be lost.Try configuring Printer as the alarm recording destination.Central Recorder out of paperLocal Recorder out of paperThe named recorder is out of paper.Central Recorder door openLocal Recorder door openThe door of the specified recorder is open.<Recorder name> not supported The M1116A recorder is not supported. Connect a M1116B plug-in recorder.
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2632326Printing Patient ReportsStarting Report PrintoutsMost patient reports can be printed by selecting Main Setup then Reports (or the Print Reports SmartKey) and then selecting the report name in the top half of the Reports menu. Report names are shown only for reports that have been correctly set up.Data from the time of the print request is printed, even if the print job is delayed in the printer queue.Your monitor can also be set up to automatically print all reports when a matching printer is available. To set this up1Select Main Setup then select Reports2Select Auto Print Dbs.–Always will print all reports when a matching printer is available.–Host Only will print the reports stored on the host monitor when a matching printer is available. Reports stored in the companion database (shown in gray on the Reports Job List) must be manually sent to the printer. See “Checking Report Status and Printing Manually” on page 329.–Never will print no reports automatically; all reports stored in the host or companion database must be manually sent to the printer. See “Checking Report Status and Printing Manually” on page 329.Printout LocationDepending on availability, reports can be printed on locally connected printers, printers connected to the Information Center or the Application server, an external PC-based print server with Philips server software or into the print database. Print jobs stored in the database are automatically printed when a print device with a matching paper size becomes available.Print jobs in the print database are not deleted after a patient discharge. A new patient can be admitted and their reports are saved in addition to the previous reports. Always admit your patient so that reports can be clearly assigned to a patient.When an X2 or MP5 is connected to a host monitor, reports requested or stored on the X2 or MP5 can be printed via the host monitor. Reports requested on the X2 or MP5 when connected to a host monitor will not show any patient alarms or INOPs. In order to see alarms, reports should be requested on the host monitor.
26 Printing Patient Reports324Starting the Different Types of ReportStopping Reports Printouts• To stop Reports printing, in the Reports menu, selectReport types Report contents How to start printing reportsVital Signs Report depends on selected trend group, data resolution, and period.In the Vital Signs window, select Print/ Record, then select Print.Graphic Trends Report In the Graphical Trends window, select Print.Events Reports Event Episode In the Event Episode or Event Review window, select the pop-up key Print/ Record, then select Print Review or Print Episode.Graphic or tabular Event ReviewEEG Report EEG Waves, numerics, CSAs, montage information and impedance valuesIn the Setup EEG menu, select Print Report.ECG Reports Depends on format selected Select the ECG Report A or ECG Report B Smartkeys, if configured, or the Print Reports SmartKey followed by ECG Report A or ECG Report B.ST Map Report ST data in a transversal and/or horizontal multiaxis diagram,In the ST Map (Current) or ST Map (Trend) window, select Print.Cardiac Output Report Trial curves and numerics In the Cardiac Output (Right Heart) or Cardiac Output (Transpulmonary) window, select the pop-up key Print/ Record.Wedge Report Wedge numerics and reference wave In the Wedge window, select the Print Wedge pop-up key.Calculations Report Hemodynamic, Oxygenation, or Ventilation ReviewIn the Calculations windows, select the Print/ Record pop-up key.Drug Calculator ReportTitration Table In the Titration Table window, select the Print Titr.Tbl pop-up key.Drip Table In the Drip Table window, select the Print Drip Tbl pop-up key.Alarm Limits Report Graphic and numeric report of all current alarm limitsIn the Alarm Limits window, select Print Limits.Realtime Reports, including oxyCRG Reportspatient data and numerics, and either: all displayed waves OR all measured waves OR all measured RT waves Or all measured HiRes waves, OR oxyCRG waves (RT waves: ECG Primary lead, Pleth, Resp; HiRes waves: btbHR, HiRes SpO2, HiRes Resp)Select the Realtime Report SmartKey, if configured.Loops Report Individual Loops diagram with timestamp, currently measured numericsIn the Loops window, select Print Loop.Battery Report Battery serial numbers, information on the currently-measured and potential charge status of the battery or batteriesIn the Battery Status window, select Print Status.Central Report A/B/C These are reports configured at the Information Center. Monitors connected via the IntelliVue Instrument Telemetry wireless network can have these reports available.In the Main Setup select Reports then Central Report A, Central Report B or Central Report C.
26 Printing Patient Reports325–Delete Report to stop the current print job–Delete All Repts to cancel all queued report printouts–Scheduled Rep. to select Off and switch off scheduled reports.Setting Up ReportsAs the content of context-linked reports, such as Cardiac Output, Calculations, and Wedge, is defined by the content of the procedure window these reports do not need to be set up, however a target printer can be configured in the Setup Reports menu.The content you define in the individual Setup Reports menus will be used in all reports of this type: for example, if you set a print speed of 50 mm/sec in the ECG Reports menu, every ECG report will be printed at this speed, irrespective of format.ECG report layout and Auto Reports settings must be defined in Configuration Mode.Setting Up ECG ReportsThe settings you choose in the ECG Reports menu apply for all ECG reports printed. To set up ECG Reports,1Select Main Setup, Reports, then ECG Reports. Note the report layout configured for your monitor, either Internat or Cabrera. This setting is inactive ("grayed-out") in Monitoring Mode and can only be changed in Configuration Mode.2Select ECG Gain and set the required ECG gain to define how ECG waves will appear on the ECG report printouts.3Select Speed and select the report print speed.4Select Annotation and switch to On if the printed ECG wave should be annotated with beat labels. See the chapter on ECG for a list of beat labels. Pace pulse marks are automatically printed beside the wave for paced patients.Setting Up Vital Signs and Graphic Trend ReportsThe settings you choose in the Vital Signs Report and Graphical Trend Report menus apply for all Vital Signs and Graphic Trend reports printed.To set up Vital Signs and Graphic Trend reports,Select Main Setup, Reports, then Vital Signs Rep. or Graph Trend Rep..1Select Trend Group and select the group you want to print on the report. The groups available depend on your monitor's trend configuration.2Select Period and select the period of time for which trend data should be printed on the report. If Automatic Period is configured to On, all trend data for the current patient will be printed, irrespective which trend period is selected.3Select Interval (Vital Signs Reports only) and select the resolution of the trend data printed on the report,
26 Printing Patient Reports326Setting Up Auto ReportsAuto Reports print automatically when a specified trigger occurs. There are two types of Auto Reports: Scheduled Reports, which print at predefined intervals, and End Case Reports, which print when a patient is discharged using the End Case function. An Auto Report can be both a Scheduled Report and an End Case report.To set up Auto Reports,1Select Main Setup, Reports, then Auto Reports and select the Auto Report you want to set up (A, B, C, or D).2Select Report and assign a report type to the Auto Report.3Select End Case Report and switch to On if you want the selected report to print automatically when you select End Case to discharge a patient.Switch End Case Report to Off if the report is a Scheduled Report only.4Select Scheduled Rep. and toggle to On if you want the selected report to print at predefined intervals, starting at a predefined time of day. The start time you set applies for every following day. For example, if you set a start time of 07:00 and a repeat time of six hours, the first report will print at 07:00 every day, the next at 13:00 and so on.– To set the time of day at which you want the report to print every day: select Start Hour and Start Minute and select the required time from the pop-up list– To set the time interval in minutes between two scheduled reports: select Rep. Freq. (hrs) and Rep. Freq. (min) and select the time interval from the pop-up list.If you are setting up an end case report, these settings will be inactive ("grayed-out").Switch Scheduled Rep. to Off if the report is an End Case Report only.5Repeat the procedure for all Auto Reports you want to set up.All Auto Reports or Scheduled Reports set to On print automatically at the predefined trigger.Be aware that the monitor's memory for reports is limited. If the memory is full, Auto Reports cannot be printed and the information may be lost.Setting Up Individual Print JobsTo adjust the appearance of individual print jobs, in the Reports menu,Select Main Setup, Reports, then Setup Reports to enter the Setup Reports menu.1Select Report and then select the report you want to set up.
26 Printing Patient Reports3272Select Report Type and then select the reports template you want the report selected in Step 2 to use. The selection of templates listed depends on the report type selected.Each template includes patient demographic data, and each Realtime Report also includes alarm and INOP information. In addition, the templates include:VisibleWaves: all waves currently visible, in the order they appear on the screen.All Waves: all measured waves.RT Waves: all currently measured realtime waves, according to the monitor's priority list.HiRes Waves: all measured HiRes waves.OxyCRG Waves: the OxyCRG/Neonatal Event Review waves.Vital Signs: trend information in tabular form.Graph Trend: trend information in graphic form.ECG reports: ECG3X4, ECG6X2, ECG12X1, ECG4X2, ECG8X1,ECG12X1 (2P)EEG reports: EEG Report.Episode: a single patient event episode.Review: an overview of patient eventsAlarm Limits: a list of all currently set alarm limits.3Select Report Size to set the paper size to be used for the report: Unspecified to use the default size for the template chosen, Universal, A4, Letter, LrgUniversal, A3, or Ledger. The list of available sizes depends on the report type selected.4Select Orientation to set the orientation of the report printout: Unspecified to use the default size for the template chosen, Landscape or Portrait.5Select Target Device and choose which printer the print job will be sent to: Unspecified to use the default printer, or choose from the list of printer names defined at the Information Center or in the monitor's Configuration Mode (for example, Remote 1 or Database).Some settings may be inactive ("grayed-out") in this menu for reports that can only be started in a special window.Checking Printer SettingsThe printer settings for your monitor are defined in Configuration Mode. The printer settings Paper Size, Resolution, Color Support, and Duplex Option for the active printer are visible but inactive ("grayed-out") in the Setup Printers menu. When Print Database is selected as active printer only the Paper Size setting will be shown.To enter the Setup Printers menu, in the Reports menu, select Setup Printers.Printer names for locally-connected printers can be defined in Configuration Mode. You can see whether a specified printer is centrally or locally connected in the Setup Printers menu under Port. If "Local" is included in the port name, e.g. Local 2, that indicates locally-connected printers, and "Remote", e.g.Remote 1, indicates centrally-connected printers.Printing a Test ReportA test report can be printed in Configuration mode, refer to the Service Guide for details.
26 Printing Patient Reports328Switching Printers On Or Off for ReportsYou can enable or disable printer status to switch individual printers on or off for report printouts.1In the Setup Printers menu, select Printer and then select the name of the device you want to switch on or off for Reports printing from the pop-up list.2Select Printer Status to toggle between the settings Enabled and Disabled. If you set this to Disabled, no reports will be printed to the named printer.If the monitor detects that no printer of a particular type is available, the Printer Status setting will automatically be set to Disabled and "grayed out".Dashed Lines on ReportsIf a section of a wave on a report is drawn with dashed lines, this tells you that a setting that affects the appearance of the wave on the screen was changed while the report was printing.For example, if you change the wave scale while a report is printing, the wave scale and wave size are changed immediately on the monitor screen and on the report. To indicate that the scale information printed at the beginning of the report no longer matches the currently used scale, the wave will be printed using dashed lines, starting from the moment the change took place.Some examples of settings that cause dashed lines in reports if changed during printing are: Filter mode, ECG lead placement, wave scale, measurement unit, paced/non-paced setting, and measurement mode. Note that as ECG waves are drawn with a fixed gain on reports (either 10 mm/mV or 20 mm/mV), changing the ECG wave scale will not cause dashed-line reports.To avoid dashed lines on reports, wait 15 seconds after changing a setting before you trigger a report.Unavailable Printer: Re-routing ReportsIf you send a report to be printed on a printer that is not available, for example, because it has run out of paper, this print job is suspended and stored in the monitor's memory.If the target device of this print job was set to Unspecified, the monitor will periodically try to resend the print job to the first printer listed in the Setup Printers menu under Printer that is set to Enabled and that has paper of the correct size.To allow the report to print, you must either solve the problem with the target printer, or re-route the print job to another printer with paper of the correct size. To re-route a print job,• Enable the new target printer by selecting it in the Setup Printers menu and toggling to Enabled. As the monitor tries to send the report to the printers in the order they are listed, you must make sure that all the printers above the new target printer are disabled.If the target device of the print job was set to a specific printer, re-routing is not possible.
26 Printing Patient Reports329Checking Report Status and Printing ManuallyA list of all print requests which are waiting, printing or stored can be viewed in the Reports Job List. To view the list, in the Reports menu, select Reports Job List.The following information is displayed for each print request:• Report title• Patient name (except for system reports such as the battery status report)• Request date and time• Report paper format•Job status: Preparing, Printing, Waiting, In Database, In Companion, Retry, Cancelling, Error.Individual reports can be deleted from the list with the Delete Report key, and all reports with the Delete All Repts key.CAUTIONThe Reports Job List includes privacy information, in the form of the patient name with the related report title and date. It is advisable to provide controlled access to this data to ensure confidentiality.If an MP5 or an X2 is connected to a host monitor, all print requests which are stored in the print database are shown "grayed out" on the Reports Job List and will not be deleted with the Delete All Repts key.Printing ManuallyThose jobs shown in black will be printed automatically when a matching printer is available. If the Auto Print Dbs setting is Host Only or Never, some or all reports will not be printed automatically and will be shown in gray. Any jobs shown in gray must be printed manually; to do this,1In the Reports Job List, select the required report2Select Print Report.Selecting Print All Reps will send all reports to the printer.
26 Printing Patient Reports330Printer Status MessagesPrinter Status Message Possible causes and suggested actionPrint job queued for <Printer Name>The report has been placed in the queue for the named printer.Print job could not be queued (insufficient resources)Print job could not be queued (queue is full)Print job could not be queued (no matching printer found)The printer queue is full and the monitor cannot accept another report request. Wait until some more reports have been printed, then try again, ORA report has been triggered that uses a paper size unavailable with the target printer. Try another printer, if available, or change the paper size of the print request.Cancelling all print jobs Delete All Reps has been selected in the Reports menu, ORThe Operating Mode has been changed from Monitoring Mode to Demonstration or Service Mode.Cancelling the active print job The current report is being canceled as the result of a user request.Cancelling print jobs due to patient dischargeWhen a patient is discharged, all queued reports are canceled except those stored in the print database.Cancelling # print jobs due to hotstartThe monitor has restarted and all report requests have been canceled except those stored in the print database. "#" is the number of reports canceled.Printing failed: No report configured!A report has been triggered which has not been correctly set up. Enter the setup menu for the report type to set up the report.Printing on <Printer Name>... A report is in progress, or the monitor is waiting for the central printer to accept the print job.Printer <Printer Name> unavailable -> job suspendedThe chosen device is unavailable. Check that the printer is properly connected and that paper is available. The requested report will start printing when the printer becomes available.Print database full -> job suspendedThe requested report does not fit into the print database. You can select another printer to print the report (see “Unavailable Printer: Re-routing Reports” on page 328). Alternatively you can delete another report from the Reports Job List (using the Delete Report key) to create space for your report.Job on <Printer Name> failed (data unavailable)Job on <Printer Name> failed (printer unavailable)Job on <Printer Name> failed (data requisition error)A report cannot be started on the requested printer. One of three reasons is shown in the status message:• data unavailable - the connected X2 or MP5 has been removed before the data for the report was transferred.• printer unavailable - make sure the printer is plugged in, switched on, and has paper loaded.• data requisition error - an internal error has caused data required for the report to be unavailable, try starting the report again.Print job on <Printer Name> doneThe report has been printed.
26 Printing Patient Reports331Sample Report PrintoutsEach report header contains the patient's bed label, last name and first name, middle name (if there is enough space) the patient ID, the date and time, and the name of the report. The report footer contains the hospital label and page number, and the last page contains a note to mark the report end.The monitor may be configured to leave a space on the top left or right of the report printout to enable you to stick a patient address label on it. This setting is called the Addressograph and it can only be changed in the monitor's Configuration Mode.
26 Printing Patient Reports332Alarm Limits Report1Measurement labels, with alarms off symbol where alarms are switched off2Graphic view of current alarm limits in relation to currently monitored measurement value
26 Printing Patient Reports333Realtime Report1Patient demographic information, time stamp2Active Alarms and INOPs, followed by vital signs3Measurement waves section
26 Printing Patient Reports334Cardiac Output ReportECG Reports1Patient information2Numeric block3Wave areaBelow the header on ECG Reports, the numeric block shows the current HR, PVC, and ST values. The wave area shows the printed waves for all available ECG leads. A 1 mV calibration bar is printed at the beginning of each wave. With the 3X4, 6X2, and 2X4 formats, a rhythm stripe prints a longer section of the ECG wave from the primary ECG lead for ECG rhythm evaluation. The ECG signal bandwidth, the patient's paced status, the ECG gain, and the print speed are printed at the bottom of the wave area. Pace pulse marks are automatically printed beside the wave for paced patients. Beat labels can be set to print on the rhythm stripe. The 12X1 (2P) format prints the report over two pages.ECG Report type Available Formats Available Paper Sizes12-Lead ECG 3X4 landscape A4, letter, A3, ledger6X2 landscape A4, letter, A3, ledger12X1 portrait A4 and letter only12X1 landscape A4, letter, A3, ledger12X1 (2P) landscape A4, letter (2 pages)Multi-lead ECG 2X4 landscape A4, letter, A3, ledger8X1 portrait A4 and letter only8X1 landscape A4, letter, A3, ledger
26 Printing Patient Reports335Other ReportsSee the sections on Trends and Calculations and the chapter on Event Surveillance for other example reports.
26 Printing Patient Reports336
2733727Using the Drug CalculatorDrug mixtures for intravenous (IV) drug infusions combine information on drug dose, rate, amount, volume, concentration, and standardized rate. The Drug Calculator helps you to manage infusions by calculating one of these values at a time.*Be aware that your hospital may use either 'µg' or 'mcg' as an abbreviation for microgram. These abbreviations are equivalent.WARNINGBefore you administer any drug, always check that the correct calculation units and patient category are selected. Consult your pharmacy if you have questions.Decisions on the choice and dosage of drugs administered to patients must always be made by the physician in charge. The Drug Calculator performs calculations based on the values input during use, it does not check the plausibility of the calculations performed.Ter m Definition UnitsDose total quantity of drug to be delivered to the patient over timeamount units per time or per kg/time, if the drug is weight-dependentRate volume of the mixture to be delivered to the patient over timeml/hourAmount amount of drug to be added to diluent to make up a mixtureng, mcg*, mg, g, mUnit, Unit, where g stands for gramVolume quantity of mixture of diluent and drug mlConcentration ratio of the amount of drug to the solution volumeamount units per mlStandardized Rate 1ml volume of the mixture to be delivered to the patient per hourml/hr
27 Using the Drug Calculator338Accessing the Drug CalculatorTo access the Drug Calculator, select Main Setup then Calculations followed by Drug Calculator, or select the  Drug Calc SmartKey, if configured.Performing Drug CalculationsUsing the service Support Tool, a list of drugs can be configured for the monitor containing pre-defined dosage recommendations and unit settings. Selecting the arrow beside the drug name in the Drug Calculator window opens a list of configured drugs. Contact your pharmacist if you have any questions about the drugs in the list.If ANY DRUG is the only entry in the list of drugs, no drugs have been pre-configured for your monitor. Drug calculations can be performed for non-specific drugs.You must have a Support Tool to add additional drugs to the Drug Calculator.About the Rule of SixIf the Rule of Six has been enabled for use with individual drugs in your Drug Calculator, you can use the formula in crisis situations to quickly calculate the amount of a drug needed to yield a target dose for continuous infusion for neonatal or pediatric patients (the drug amount is given in "mg", the patient weight in "kg"). The Rule of Six can only be used with the dose unit mcg/kg/min.CAUTIONJCAHO recommends disabling the Rule of Six. The configuration is not JCAHO-compliant if Rule of Six is enabled.The Drug Calculator uses the following formula for Rule of Six calculations, based on the patient's weight:• For a target dose of 0.1 mcg/kg/min, the Drug Calculator multiplies 0.6 x patient weight to calculate the amount you need to add to the IV solution to equal a total of 100 ml.• For a target dose of 1.0 mcg/kg/min, the Drug Calculator multiplies 6.0 x patient weight to calculate the amount you need to add to the IV solution to equal a total of 100 ml.
27 Using the Drug Calculator339Performing Calculations for a Non-Specific DrugIf a list of drugs has not been configured for your monitor, you can use the Drug Calculator to calculate drug doses for a single, generic drug called ANY DRUG. Selecting the arrow beside the drug name in the Drug Calculator window shows that are no other drugs configured.1Enter three of these four values: dose, amount, volume, and rate of the infusion solution.To enter values, select the correct unit, then select each value field and use the pop-up keypad to enter the correct value.2If you have chosen a weight-dependent dose unit, you must enter the patient weight now or choose a different unit.If available, the patient weight from the Patient Demographics window is entered automatically in the Drug Calculator window when the Drug Calculator is accessed. To change the patient weight, select the Weight key then use the on-screen keypad to enter the correct value. This will not change the patient weight stored in the patient demographic information.3When you have entered three values, the Drug Calculator automatically calculates the unknown fourth value and shows it in the highlighted field. Standardized rate and concentration are also calculated.Performing Calculations for a Specific Drug1Select the arrow beside ANY DRUG, then select the required drug from the list of drugs.This opens the window for the selected drug.
27 Using the Drug Calculator3402Select the correct patient category for your patient.If you have a neonatal or pediatric patient, the Rule Of 6 choice may be available. Select if required.3Enter the patient weight, if necessary.If available, the patient weight from the Patient Demographics window is entered automatically in the Drug Calculator window. To change the patient weight, select the Weight key then use the on-screen keypad to enter the correct value. This will not change the patient weight stored in the patient demographic information. Select the weight unit shown to change between lb and kg.4When a specific drug is selected, the initial values for Dose, Amount and Volume are the configured Start values for this drug. The Rate is then calculated. If other values are required you can calculate any value by entering the remaining three values as described in “Performing Calculations for a Non-Specific Drug” on page 339.The column on the right of the window shows either drug dose or dosage rate, whichever is the calculated value. The current calculated value is shown on a scale with the recommended range in green. If the current calculated value lies outside the recommended range it is shown in red.If you have changed values in the Drug Calculator and you want to revert to the configured values, select Reset Values key at any time. Charting Infusion ProgressThe Drip Table shows you at a glance how much of the infusion has been administered to your patient and how much time is left.•To see the Drip Table, in the Drug Calculator window, select the Drip Table pop-up key.If the Drip Time exceeds 24 hours, the Drip Time timestamp shows - - :- - : - - .
27 Using the Drug Calculator341Using the Titration TableUse the Titration Table to see at a glance what dose your patient would receive of a drug at different infusion rates. By clicking on the title row of the table you can switch between the Dose increments and Rate increments view.Values outside of the recommended range are shown in red.To see the Titration Table,•in the Drug Calculator window, select the pop-up key Titr. Table.The Titration Table is configured with the service Support Tool.Documenting Drug Calculations•In the Drug Calculator window, select the pop-up key Record DrugCalc to immediately start a recording of the current drug calculation.•In the Titration Table window, select the pop-up key Print Titr.Tbl to print a report of the current Titration Table.•In the Drip Table window, select the pop-up key Print Drip Tbl to print a report of the current Drip Table.
27 Using the Drug Calculator342
2834328IntelliBridge EC10 ModuleAn IntelliBridge EC10 module transmits information from a connected external device to your monitor. The IntelliBridge EC5 ID module is used to provide identification information from the external device. Data imported from the external device, for example waveforms, measurement numerics, settings and alarms, can be displayed on the monitor, passed on to an Information Center and included in trends as appropriate. The external device may show more information than is available on the monitor. Data from IntelliBridge EC10 modules cannot be included in monitor trends when the label is a free-text label.See the documentation supplied with the IntelliBridge module for a list of supported devices and accessories, and for configuration information.Connecting an External Device1Insert the module into the FMS or integrated module slot.2Check that you have the correct EC5 ID module for the external device - indicated on the EC5 label.3Connect the EC5 ID module to the external device.4Connect the EC5 to the EC10 module using the supplied cable.5Switch the external device on.6The connection status LED (4) will flash green until it has correctly identified the external device and started communication. Check that the connection status LED then lights green continuously indicating that communication has been established.1module name2setup indicator LED3setup/data viewing key4connection status LED5external device cable connector
28 IntelliBridge EC10 Module344Changing Waves and Numerics DisplayedTo change the waves and numerics from the IntelliBridge module displayed on the Screen,1Select Main Setup, Measurements, then <External Device> to enter the setup menu for the connected device.2Select Setup Driver.3Select Setup Wavesor Setup Numerics and make the changes required.4Close the setup menu. The monitor takes a few seconds to activate the change.Viewing the IntelliBridge Device Data WindowTo view the IntelliBridge device data window, either• select the setup key on the IntelliBridge module, or• select the External Devices SmartKey and then select the pop-up key with the device name on it, or•in the Setup <External Device> menu, select Show Device Data.Check that the correct external device ID is shown in the window title.Select the device data window then Setup Device to open the setup menu for the connected device.With the More Data key you can page through additional data which does not fit on the first screen.When an infusion system is connected the data is presented differently. The data from each pump is displayed in a horizontal frame in the window. Data from several infusion pumps can be displayed.To see a detailed information window for one of the pumps, you can select data for that pump on the Screen or select the More Data pop-up key. Using Screens with External Device DataYour monitor may be configured to show external device data permanently on the Screens.Select the device data window to display the pop-up keys that let you access the setup menu and make changes.
28 IntelliBridge EC10 Module345Alarms/INOPs from External DevicesThe IntelliBridge module itself generates INOPs, but does not generate alarms. If the external device's alarms are on, the module transmits these to the monitor. A message in the External Device Data window tells you either Device Alarms Ignored or Device Alarms Accepted or No Alarms Available. External device alarms status symbols precede some, but not all, measurement labels.Alarms from external devices are transmitted to the monitor. For all numerics configured in the setup menu, an alarm condition is announced at the monitor. For one or more measurements not configured in the setup menu, an alarm is announced as a text message for the highest priority alarm. Priority is determined at the external device.Refer to the documentation supplied with the IntelliBridge module for details of how alarms are announced on the monitor and the Information Center.INOPs from the IntelliBridge ModuleLanguage Conflict with External Device DriversYou should avoid language conflicts between the IntelliBridge module device driver and the monitor. Be aware that if you connect an IntelliBridge module with a different operating language to the monitor, the monitor will show:• measurement labels in the monitor language• alarm and INOP texts in the IntelliBridge module device driver language.the monitor is configured to accept external device alarms, but the alarms are switched off at the external device.INOP Text INOP Condition!!NO DEVICE DATA!!!NO DEVICE DATACommunication has been lost to a connected device when– !! a medium priority INOP or patient alarm was present– !!! a high priority INOP or patient alarm was presentNO DEVICE DATA Communication has been lost to a connected device with no (or only low priority) INOPs/physical alarms.DEVICE UNSUPPORTED Device identification completed but no appropriate device driver installedDEVICE CHECK CONF. Device identification completed but communication could not be established due to errorsDEVICE CHECK SETUP Device identification completed but communication could not be established due to timeout
28 IntelliBridge EC10 Module346
2934729VueLink ModulesA VueLink module transmits information from a connected external device to your monitor. Each module can be connected to one of up to three preselected external devices, and supports alarms from the external device. Data from VueLink modules cannot be included in monitor trends when the label is a free-text label.The external device may show more information than is available on the monitor. The number of waves and numerics you can view simultaneously on your monitor's main screen depends on the module type. Type A modules support one wave and two numerics, type B modules support two waves and six numerics.Module Type Max. Wave Max. NumericExternal DevicesAuxiliary A 1 2 standalone measurement moduleVentilator B 2 6 ventilatorsGas Analyzer B 2 6 gas analyzersAnesthesia MachineB 2 6 anesthesia machinesAuxiliary Plus B 2 6 external multi-measurement devices1module name2device label3selection LED4setup key5external device cable connector6setup indicator LED7module type (A or B)
29 VueLink Modules348The device labels (2) on the module indicate for which external devices the module is configured. The selection LED (3) shows which device is currently active. The device label text may differ slightly from the labels on the external devices.See the documentation supplied with the VueLink module for a list of supported devices and accessories, and for configuration information.Connecting an External Device1Insert the module into the FMS or integrated module slot. 2Check that the device selection LED (3) lights to show that it has correctly identified the external device. If not, select Main Setup, Measurements and then the name of the external device to enter the setup menu for the connected device.3In the device setup menu, select Device, select the correct device from the list, and confirm the selection.4Connect the external device to the module and switch it on.Once the VueLink device has been correctly connected, you can select the External Devices SmartKey and then select the Setup Device pop-up key to access the setup menu for the connected device.CAUTIONSelecting the wrong device can cause unpredictable system behavior. Rectify this by switching off the external device when it is safe to do so, and selecting the correct device.Changing VueLink Waves and Numerics DisplayedTo change the waves and numerics from the VueLink module displayed on the Screen,1Select Main Setup, Measurements and then the name of the connected device to enter its setup menu.2Select the item you want to change, then select the new item from the pop-up list,orSelect Show Device Data to view the device data window.3Close the setup menu. The monitor takes a few seconds to activate the change.
29 VueLink Modules349Viewing the VueLink Device Data WindowTo view the VueLink device data window, either• select the setup hardkey on the VueLink module or the External Devices SmartKey, and then select the pop-up key for the device, or•in the Setup <External Device> menu, select Show Device Data.Select the device data window then the Setup Device key to open the setup menu for the connected device.Using VueLink ScreensYour monitor may be configured to show VueLink device data permanently on the Screens.Select the device data window to display the external device pop-up keys that let you access the setup menu and carry out external device tasks.Switching VueLink On and Off• To switch VueLink measurements on and off, in the setup menu for the external device, select Device Interface to toggle between the settings On and Off.Alarms/INOPs From External DevicesThe VueLink module itself generates INOPs, but does not generate alarms. If the external device's alarms are on, the module transmits these to the monitor. A message in the VueLink info window tells you either Device Alarms Ignored or Device Alarms Accepted or No Alarms Available. External device alarms status symbols precede some, but not all, measurement labels.the monitor is configured to accept external device alarms, but the alarms are switched off at the external device.!alarms status of this external measurement is unknown
29 VueLink Modules350Alarms from external devices are:• transmitted to the monitor. For all numerics configured in the setup menu, an alarm condition is announced at the monitor. For one or more measurements not configured in the setup menu, an alarm is announced as a text message for the highest priority alarm. Priority is determined at the external device.• always non-latching on the monitor.• announced as a flashing numeric while the alarm condition persists.• announced audibly and visibly at the Information Center.Language Conflict with External Device DriversYou should avoid language conflicts between the VueLink module device driver and the monitor. Be aware that if you connect a VueLink module with a different operating language to the monitor, the monitor will show:• measurement labels in the monitor language• alarm and INOP texts in the VueLink module device driver language.
3035130Using TimersWith the Timers function you can set timers to notify you when a specific time period has expired.CAUTIONDo not use the timers to schedule critical patient-related tasks.Viewing TimersYou can view currently active timers in the Timers window or directly on the Main Screen (if a timer has been substituted for a numeric).To open the Timers window:• Select the Timer SmartKeyor•Select Main Setup then select TimerThe maximum number of timers which can be active depends on your monitor model.For a timer with a defined run time a progress bar is shown with the run time for that timer. Next to the progress bar the elapsed time or the remaining time is shown, depending on whether the timer is counting up or down. On the left, the label of the timer and a symbol indicating the type of expiry notification is shown.Timer TypesThere are four types of timer: Basic, Enhanced, Cyclic and No Limit. A Basic timer has a single, defined run time and progress is shown in the progress bar. An Enhanced timer is like a Basic timer but the progress bar shows progress beyond the end of the run time. A Cyclic timer is like a Basic timer but restarts automatically when the run time is expired. A No Limit timer has no run time or progress bar and shows the time elapsed since the timer was started.The type of timer is set in the monitor's Configuration Mode and is associated with the timer label.
30 Using Timers352Timer Setup Pop-up KeysWhen you open the Timers window and select a timer, then select the setup key, the setup window opens and a selection of pop-up keys appear to let you activate and control the timers.Setting Up TimersThe timer type, display color of the timer and whether a window automatically pops up on expiry are settings made in Configuration Mode for each timer label.The remaining timer settings can be made in Monitoring Mode. If you change settings when a timer is running it will not be stopped. The timer will continue to count but the new settings will be applied.To display the setup window for a timer,•in the Timers window, select the required timer, then select the setup key or• select a timer on the Screen then select Setup Timers.Timer LabelYou can select from a variety of specific labels, for example Tourniquet, Infus, Docu or from four non-specific labels TimerA, TimerB, TimerC, and TimerD. When you assign a label to a timer, the monitor automatically applies the associated configuration settings to this timer, but the timer continues counting and is not reset.To select a label, in the Timers window:1Select the required timer and display the Setup window.2Select Label.3Select a specific or non-specific label from the list.Run TimeThe run time can be set between 1 minute and 96 hours. No Limit timers have no run time.To set the run time, in the Timers window:1Select the required timer and display the Setup window.2Select Run Time.3Select a run time from the list.Pop-Up Keys Selecting this pop-up key lets you....Start start the timer.Stop stop the timer, allowing either restarting after a pause (Start key) or clearing (Clear key).Clear clear the timer, ending this timer episode.Timers return to the timer window showing all active timers
30 Using Timers353Timer Counting DirectionTimers can count up or down, showing elapsed time or remaining time. No Limit timers automatically count up.To change the direction, in the Timers window:1Select the required timer and display the Setup window.2Select Direction to switch between Up and Down.NotificationWhen a timer expires (except a No Limit timer), the color changes to red and a message appears in the status line on the Main Screen. Be aware that if a timer has been configured to display in light red, the color will not visibly change when the timer expires.Additional notification is also available and can be set to:Alarm: An INOP alarm indicates the expiry of the timerSound: A single tone indicates the expiry of the timerNo Sound: No additional notificationTo set the additional notification, in the Timers window:1Select the required timer and display the Setup window.2Select Notification and select the notification level required from the list.If an MP5 is connected to a host monitor, and notification is set on the MP5 to Alarm, the INOP alarm will appear on the host monitor TimeExpired:MMS.Timer VolumeFor all Timers with the notification setting Sound, you can set the volume of the tone.To set the volume, in the Timers window:1Select the required timer and display the Setup window.2Select Timer Volume and select a volume setting from the list.Displaying a Timer On The Main ScreenIf you want to have a timer displayed on the Main Screen, you can substitute it for a numeric which is not directly associated with a wave. If limited space is available, some of the timer display elements may not be displayed. The minimum information displayed is the label and the elapsed or remaining time.
30 Using Timers354To display a timer on the Main Screen:1Select the numeric you want to substitute.2Select Change Numeric.3Select Any Timer.Main Screen Timer Pop-up KeysWhen you select a timer displayed on the Main Screen, additional pop-up keys become available:Displaying A Clock On The Main ScreenIn the same way that you can substitute a timer for a numeric, you can also substitute a larger clock display for a numeric.To display a clock on the Main Screen:1Select the numeric you want to substitute.2Select Change Numeric.3Select Clock.When you select the clock on the Main Screen you can select Date, Time in the menu to set the date and time.Pop-Up Keys Selecting this pop-up key lets you....Setup <Timer Label> enter the setup screen for the currently selected timer.Change Timer select a different timer for display.Timers enter the Timers window.
3135531Respiratory LoopsUsing a Spirometry module or a VueLink/IntelliBridge module connected to a ventilator, you can measure and store graphic representations of realtime respiratory loops. Respiratory loops can help you recognize changes in your patient's lung function, and they can also indicate a fault in the airway tubing (for example, if the respiratory loop does not close).You can measure:• Pressure-volume loops• Pressure-flow loops• Volume-flow loops.Note that you cannot store loops from different patients and different source devices in the same list as they are patient and device specific. This prevents you from inadvertently comparing information from different patients.Viewing LoopsIn the loops display, the current loop is drawn in white, and up to six stored loops are color-coded to match their timestamps. The currently-used source device is shown in the window title.To view respiratory loops permanently on your Screen,• select the current Screen name to open the Change Screen menu, then select a Screen configured to display the loops screen element.Select the loops screen element to access the loops pop-up keys.
31 Respiratory Loops356To open the Loops window, and its associated pop-up keys,•select Main Setup then Loops, or select the Loops SmartKey, if configured.In the Loops window, in addition to the stored loops, two realtime airway waves and up to nine available numerics from the source device can be shown.Capturing and Deleting LoopsUp to six loops of each kind can be stored for reference.To capture the current Loop and display it in the Loops window,• select the Capture Loop pop-up key.The monitor will prompt you to save the loop for reference, either in addition to or in place of previously stored loops.Status messages at the bottom of the window provide information on the loop capture process.To delete Loops from the reference list,• Select the Select Loop pop-up key to view the list of stored loops and delete the loops from the list.Showing/Hiding LoopsColored rectangles beside the loops timestamps and color-coded with the loops tell you whether each loop is currently displayed or not:– A filled-in rectangle marks loops currently shown in the Loops window– A rectangle outline marks loops not currently shown.Selecting the timestamp of the currently-displayed loop hides it and shows the next in the list; selecting the timestamp of a currently hidden loop displays it.Changing Loops Display SizeTo change the loops display size, in the Loops window, select the pop-up key Select Size then select•Size X0.5 to display loops at half the usual size•Size X1 to display loops at the usual size•Size X2 to display loops at twice the usual sizeThis does not affect the size of loops printed in reports.Using the Loops CursorTo view the coordinates for any point on a stored loop,1Select the pop-up key Select Loop.2Select the required loop from the list of available loops.3Use the arrow pop-up keys to move the cursor around the loop. The values for both loop axes are shown for every point on the loop.Select the X at the top of the loop list to exit the cursor.
31 Respiratory Loops357Changing Loops TypeTo change the loop type, in the Loops window, select the Loop Type pop-up key (only available if the source device delivers three waves), then select•Press/Volume to display Pressure/Volume loops•Flow/Volume to display Volume/Flow loops•Press/Flow to display Pressure/Flow loops.or, if the source device only delivers two waves,1In the Loops window, select the Setup Device pop-up key to enter the setup window for the external device.2Select Wave 1 and select pressure, flow, or volume waves as required. Repeat for Wave 2.Setting Up Source DeviceThe source device for the loops is indicated in the Loops window title.• Select the Setup Device pop-up key to view the settings of the current source device.If the source device is changed, all reference loops from a previous device are cleared from the reference list when the first loop from the new source device is captured. Reconnecting the previous device recalls its reference list.Documenting Loops1In the Loops window, select the pop-up key Print Loop2From the list of available loops, select an individual loop, or select Print All to print a report of allFor each loop, the report prints• the currently-displayed loop, with the loop capture timestamp• up to six realtime numerics provided by the loop source device•SpO2, etCO2, PO2, and PCO2 numerics from the patient monitor, if available.
31 Respiratory Loops358
3235932Laboratory DataLaboratory data can be entered manually at the Information Center or at the monitor. For details on manual entry at the monitor, see “Entering Measurements Manually” on page 40. Selected laboratory data can be integrated on the monitor - values are then stored in the database and included in trends and reports and can be displayed as a numeric on the main screen. Which data can be stored and used on the monitor in this way is selected in Configuration Mode.Viewing Received DataWhen new data has been received from the Information Center a New Lab Data received. Check Lab Results Window. message will appear with the arrival time. To view the data, select Main Setup then select Lab Results or the Lab Results SmartKey.The Lab Results window shows the most recent set of data received. The data is grouped into categories:•Blood Gases•Electrolytes•Hematology•Metabolites•Chemistry•Enzymes/Markers•Coagulation•Urine DiagnosticsIf no results are available for a particular category, that category will not be shown. Values which were entered manually at the Information Center will be marked with an asterisk (*).
32 Laboratory Data360
3336133Care and CleaningUse only the Philips-approved substances and methods listed in this chapter to clean or disinfect your equipment. Warranty does not cover damage caused by using unapproved substances or methods.Philips makes no claims regarding the efficacy of the listed chemicals or methods as a means for controlling infection. Consult your hospital's Infection Control Officer or Epidemiologist. For comprehensive details on cleaning agents and their efficacy refer to "Guidelines for Prevention of Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to Health Care and Public-Safety Workers" issued by the U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, Atlanta, Georgia, February 1989. See also any local policies that apply within your hospital, and country.General PointsKeep your monitor, modules, Multi-Measurement Module, MMS extensions, Flexible Module Rack, cables and accessories free of dust and dirt. After cleaning and disinfection, check the equipment carefully. Do not use if you see signs of deterioration or damage. If you need to return any equipment to Philips, decontaminate it first.Observe the following general precautions:• Always dilute according to the manufacturer's instructions or use lowest possible concentration.• Do not allow liquid to enter the case.• Do not immerse any part of the equipment or any accessories in liquid.• Do not pour liquid onto the system.• Never use abrasive material (such as steel wool or silver polish).• Never use bleach.WARNINGIf you spill liquid on the equipment, battery, or accessories, or they are accidentally immersed in liquid, contact your service personnel or Philips service engineer. Do not operate the equipment before it has been tested and approved for further use.The general care and cleaning information given here meets the requirements of Aspect Medical Systems for their BIS measurement devices.
33 Care and Cleaning362Cleaning the MonitorClean with a lint-free cloth, moistened with warm water (40°C/104°F maximum) and soap, a diluted non-caustic detergent, tenside, ammonia- or alcohol-based cleaning agent. Do not use strong solvents such as acetone or trichloroethylene.Take extra care when cleaning the screen of the monitor because it is more sensitive to rough cleaning methods than the housing. Do not permit any liquid to enter the monitor case and avoid pouring it on the monitor while cleaning. Do not allow water or cleaning solution to enter the measurement connectors. Wipe around, not over, connector sockets.CAUTIONTo clean the touch-enabled display, disable the touch operation by switching off the monitor during the cleaning procedure, or by selecting and holding the Main Screen key until the padlock symbol appears on it, indicating that touch operation is disabled. Select and hold again to re-enable touch operation.Unplug a mouse, keyboard or other connected device before cleaning it.Disinfecting the MonitorCAUTIONSolutions: Do not mix disinfecting solutions (such as bleach and ammonia) as hazardous gases may result.Hospital policy: Disinfect the product as determined by your hospital's policy, to avoid long term damage to the product.Clean equipment before disinfecting. Recommended types of disinfecting agents are:Product Name Product Type IngredientsIsopropanol liquid Isopropanol 80%Bacillol® AF liquid, spray 100 g concentrate contains:Propan-1-ol 45.0 g; Propan-2-ol 25.0 g; Ethanol 4.7 gBacillol®25 liquid Ethanol 100 mg/gPropan-2-ol (= 2-Propanol) 90 mg/g; Propan-1-ol (= 1-Propanol) 60 mg/gMeliseptol® spray 50% 1-PropanolAccel TB RTU liquid 0.5% accelerated hydrogen peroxideOxivir® Tb Cleaner Disinfectant spray 0.5% accelerated hydrogen peroxideOxivir® Tb Wipes wipes 0.5% accelerated hydrogen peroxide
33 Care and Cleaning363Sterilizing the MonitorSterilization is not recommended for this monitor, related products, accessories or supplies unless otherwise indicated in the Instructions for Use that accompany the accessories and supplies.Cleaning, Sterilizing and Disinfecting Monitoring AccessoriesTo clean, disinfect and sterilize reusable transducers, sensors, cables, leads, and so forth, refer to the instructions delivered with the accessory.Cleaning the SO2 Optical ModuleThe outside of the optical module can be cleaned as described under “Cleaning the Monitor” on page 362. The compartment with the fiber-optic connection can only be cleaned with a dry cloth. Do not introduce any moisture into this compartment.Cleaning the Recorder Printhead (M1116B only)If you run recordings at low speed (1 or 2cm/min) for extended periods, deposits of paper debris may collect on the print head making recordings unevenly fainter in horizontal stripes.1Remove the recorder.2Open the recorder door and un-thread the paper from behind the rubber roller.3Tear off or roll up the excess paper into the roll chamber to get it out of your way.Carpe DiemTM/MC TbReady-to-Use General Virucide, Bactericide, Tuberculocide, Fungicide, Sanitizerspray 0.5% accelerated hydrogen peroxideCarpe DiemTM/MC Tb Wipes wipes 0.5% accelerated hydrogen peroxideSuper Sani-ClothGermicidal Disposable Wipeswipes isopropanol 55%quaternary ammonium chlorides 0.5%SANI-CLOTH® PLUSGermicidal Disposable Wipeswipes isopropanol 15%quaternary ammonium chlorides 0.25%SANI-CLOTH® HB GermicidalGermicidal Disposable Wipeswipes isopropanol < 0.15%quaternary ammonium chlorides 0.14%Product Name Product Type Ingredients
33 Care and Cleaning3644Thread the cloth cleaning strip instead of paper around the rubber roller until approximately two inches of the strip come out from the top of the roller.5Close the recorder door, aligning both ends of the strip over the top of the door.6Holding the top end of the cleaning strip between your thumb and forefinger, pull the strip through and out of the recorder.7Open the door and ensure that the paper cavity is dust-free. Re-thread the paper and replace the recorder.
3436534Maintenance andTroubleshootingWARNINGSchedule: Failure on the part of the responsible individual hospital or institution employing the use of this equipment to implement a satisfactory maintenance schedule may cause undue equipment failure and possible health hazards.Contact: If you discover a problem with any of the equipment, contact your service personnel, Philips, or your authorized supplier.Inspecting the Equipment and AccessoriesYou should perform a visual inspection before every use, and in accordance with your hospital's policy. With the monitor switched off:1Examine unit exteriors for cleanliness and general physical condition. Make sure that the housings are not cracked or broken, that everything is present, that there are no spilled liquids and that there are no signs of abuse.2Inspect all accessories (cables, transducers, sensors and so forth). If any show signs of damage, do not use.3Switch the monitor on and make sure the backlight is bright enough. Check that screen is at its full brightness. If the brightness is not adequate, contact your service personnel or your supplier.4If the MMS and MMS Extensions are mounted on the monitor, make sure that they are locked into place and do not slide out without releasing the locking mechanism.WARNINGElectrical Shock Hazard: Do not open the monitor or measurement device. Contact with exposed electrical components may cause electrical shock. Always turn off and remove power before cleaning the sensor, monitor or measurement device. Do not use a damaged sensor or one with exposed electrical contacts. Refer servicing to qualified service personnel.
34 Maintenance and Troubleshooting366Inspecting the Cables and Cords1Examine all system cables, the power plug and cord for damage. Make sure that the prongs of the plug do not move in the casing. If damaged, replace it with an appropriate Philips power cord.2Inspect the Measurement Link cable and ensure that it makes good connection with the MMS and the FMS. Make sure that there are no breaks in the insulation.3Inspect the cable connecting the MMS to the monitor. Make sure the connectors are properly engaged.4Inspect the patient cables, leads and their strain reliefs for general condition. Make sure there are no breaks in the insulation. Make sure that the connectors are properly engaged at each end to prevent rotation or other strain.5Apply the transducer or electrodes to the patient, and with the monitor switched on, flex the patient cables near each end to make sure that there are no intermittent faults.Maintenance Task and Test ScheduleThe following tasks are for Philips-qualified service professionals only. All maintenance tasks and performance tests are documented in detail in the service documentation supplied on the monitor documentation DVD.Ensure that these tasks are carried out as indicated by the monitor's maintenance schedule, or as specified by local laws. Contact a Philips-qualified service provider if your monitor needs a safety or performance test. Clean and disinfect equipment to decontaminate it before testing or maintaining it.Maintenance and Test Schedule FrequencyMonitor TestsSafety checks. Selected tests on the basis of IEC 60601-1At least once every two years, or as needed, after any repairs where the power supply is removed or replaced, or if the monitor has been dropped.Monitor MaintenanceCheck ECG synchronization of the monitor and defibrillator (only if hospital protocol requires use of monitor during defibrillation)At least once every two years, or as needed.Replace backlight (integrated displays only)25,000 - 30,000 hours (about three years) of continuous usage, or as needed.Multi-measurement Module and Module TestsPerformance assurance for all measurements not listed below.At least once every two years, or if you suspect the measurement values are incorrect.Multi-measurement Module and Module MaintenanceNBP calibration  At least once every two years, or as specified by local laws.Microstream CO2 calibration and performance testAt least once a year or after 4000 operating hours.Mainstream and sidestream CO2 calibration check (M3014A)At least once a year, or if you suspect the measurement values are incorrect.
34 Maintenance and Troubleshooting367TroubleshootingIf you suspect a problem with an individual measurement, read the Instructions for Use and double-check that you have set up the measurement correctly.If you suspect an intermittent, system-wide problem call your service personnel. You may be asked for information from the status log. To view the status log,1In the Main Setup menu, select Revisions.2Select the pop-up key corresponding to the status log you want to consult, for example, for the MMS or the monitor.3View the status log by selecting Status Log from the Monitor Revision window.Disposing of the MonitorWARNINGTo avoid contaminating or infecting personnel, the environment or other equipment, make sure you disinfect and decontaminate the monitor appropriately before disposing of it in accordance with your country's laws for equipment containing electrical and electronic parts. For disposal of parts and accessories such as thermometers, where not otherwise specified, follow local regulations regarding disposal of hospital waste.You can disassemble the monitor, MMS, FMS and modules as described in the Service Guide.You will find detailed disposal information on the following web page:http://www.healthcare.philips.com/main/about/Sustainability/Recycling/pm.wpdThe Recycling Passports located there contain information on the material content of the equipment, including potentially dangerous materials which must be removed before recycling (for example, batteries and parts containing mercury or magnesium).Do not dispose of waste electrical and electronic equipment as unsorted municipal waste. Collect it separately, so that it can be safely and properly reused, treated, recycled, or recovered.Disposing of Empty Calibration Gas Cylinders1Empty the cylinder completely by pushing in the pin of the regulator valve or by pulling out the pin of the fill valve using a tire valve stem wrench or a pair of needle nose pliers.2When the cylinder is empty, either remove the valve stem from the fill (or regulator) hole, or drill a hole in the cylinder.3Write "Empty" on the cylinder and dispose of it appropriately for scrap metal.
34 Maintenance and Troubleshooting368WARNINGEnsure that the cylinder is completely empty before trying to remove the valve stem or drill a hole in the cylinder.
3536935AccessoriesYou can order parts and accessories from Philips supplies at www.medical.philips.com or consult your local Philips representative for details.WARNINGReuse: 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.Philips' approval: Use only Philips-approved accessories. Using non-Philips-approved accessories may compromise device functionality and system performance and cause a potential hazard.Packaging: Do not use a sterilized accessory if its packaging is damaged.ECG/Resp AccessoriesThis symbol indicates that the cables and accessories are designed to have special protection against electric shocks (particularly regarding allowable leakage currents), and are defibrillator proof.The following cables may not all be available in all countries. Please check availability with your local Philips supplier.Recommended CablesTrunk Cables3-Electrode Cable Set5-Electrode Cable Set6-Electrode Cable Set10-Electrode Cable set(5+5)10-Electrode Cable set(6+4)Part No. M1669A M1668A M1667A M1663A M1665ALength 2.7 m 2.7 m 2.7 m 2.0 m 2.7 m
35 Accessories3703-Electrode Cable Sets5-Electrode Cable Sets6-Electrode Cable Sets10-Electrode (5+5)Cable SetsDescription Length AAMI Part No. IEC Part No.OR Grabber shielded 1.0 m M1675A M1678AICU Grabber shielded 1.0 m M1671A M1672AICU snap shielded 1.0 m M1673A M1674AICU Clip non-shielded 0.45 m M1622A --ICU Clip non-shielded 0.7 m M1624A M1626ADescription Length AAMI Part No. IEC Part No.OR Grabber shielded 1.0 m/1.6 m M1973A M1974AICU Grabber shielded 1.0 m/1.6 m M1968A M1971AICU Snap shielded 1.0 m/1.6 m M1644A M1645AICU Miniclip non-shielded 0.7 m/1.3 m M1647A M1648ADescription Length AAMI Part No. IEC Part No.OR Grabber 1.0 m/1.6 m M1684A M1685AICU Grabber 1.0 m/1.6 m M1680A M1681AICU Snap 1.0 m/1.6 m M1682A M1683ADescription Length AAMI Part No. IEC Part No.ICU Grabber, chest, shielded 1.0 m M1976A M1978AICU Snap, chest, shielded 1.0 m M1602A M1604AOR Grabber, chest, shielded 1.0 m M1979A M1984AFor Limb Leads see 5-electrode cable sets
35 Accessories37110-Electrode (6+4)Cable SetsOne-piece CablesRadio-translucent CablesPack of five single wires, radio-translucent, 0.9 m, M1649ASet Combiners and OrganizersDescription Length AAMI Part No. IEC Part No.ICU Grabber, chest, shielded 1.0 m M1532A M1533AICU Snap, chest, shielded 1.0 m M1537A M1538AOR Grabber, chest, shielded 1.0 m M1557A M1558AFor Limb Leads see 6-electrode cable setsDescription Length AAMI Part No. IEC Part No.3-lead Grabber, ICU 1.0 m 989803143181 9898031431715-lead Grabber, ICU 1.0 m 989803143201 989803143191Set combiners and organizers Part No.Set combiner 3-electrode M1501A5-electrode M1502ASet organizer for shielded leadsets - grabber and snap 3-electrode M1503A4-electrode M1664A5-electrode M1504A6-electrode M1679ASet organizer for non-shielded lead sets - miniclip 3-electrode M1636A5-electrode M1638ABedsheet clip M1509AReplacement red cover for trunk cable (for 5-electrode cable sets) 989808148861
35 Accessories372Supported CablesTrunk Cables3-Electrode Cable Sets5-Electrode Cable Sets3-Electrode One Piece CablesLength 3-Electrode Cable Set 5-Electrode Cable SetAAMI Part No. IEC Part No. AAMI Part No. IEC Part No.0.9 m M1540C M1550C M1560C M1570C2.7 m M1500A M1510A M1520A M1530ADescription Length AAMI Part No. IEC Part No.OR 1.0 m M1601A M1611AICU Grabber shielded 1.0 m M1603A M1613AICU snap shielded 1.0 m M1605A M1615AICU Clip non-shielded 0.45 m M1608A M1618AICU Clip non-shielded 0.7 m M1609A M1619ADescription Length AAMI Part No. IEC Part No.OR Grabber shielded 1.0 m/1.6 m M1621A M1631AICU Grabber shielded 1.0 m/1.6 m M1623A M1633AICU Snap shielded 1.0 m/1.6 m M1625A M1635AICU Clip non-shielded 0.7 m/1.3 m M1629A M1639AAAMI 3-Electrode One Piece CablesLength AAMI Part No. IEC 3-electrode One Piece CablesIEC Part No.OR Grabber 1.9 m M1970A OR Grabber M1980AICU Snap 1.9 m M1972A ICU Grabber M1981A
35 Accessories3735-Electrode One Piece CablesSet Combiners and OrganizersNBP AccessoriesThese cuffs and tubings are designed to have special protection against electric shocks (particularly regarding allowable leakage currents), and are defibrillator proof. You can use them during electrosurgery.Adult/Pediatric Multi-Patient Comfort Cuffs and Disposable CuffsAAMI 5-electrode One Piece CablesLength AAMI Part No. IEC 5-electrode One Piece CablesIEC Part No.OR Grabber 2.5 m M1975A OR Grabber M1985AICU Snap 2.5 m M1977A ICU Grabber M1986ASet combiners and organizers Part No.Set combiner 3-electrode M1501A5-electrode M1502ASet organizer Shielded 3-electrode M1503AShielded 5-electrode M1504ABedsheet clip M1509APatient Category Limb CircumferenceBladder WidthDisposable cuff Part No.Reusable cuff Part No.TubingAdult (Thigh) 42 to 54 cm 20 cm M1879A M1576A M1598B (1.5 m) or M1599B (3 m)Large Adult 34 to 43 cm 16 cm M1878A M1575AAdult 27 to 35 cm 13 cm M1877A M1574ASmall Adult 20.5 to 28 cm 10.5 cm M1876A M1573APediatric 14 to 21.5 cm 8 cm M1875A M1572AInfant 10 to 15 cm 5.5 cm M1874A M1571A
35 Accessories374Reusable Cuff KitsAdult/Pediatric Antimicrobial Coated Reusable cuffsAdult/Pediatric Soft Single Patient Single-Hose Disposable CuffsCuff Kits Part No.Infant, pediatric, small adult, adult M1577ASmall adult, adult, large adult, thigh M1578AInfant, pediatric, small adult, adult, large adult, thigh M1579APatient Category (color) Limb CircumferenceBladder WidthPart No. TubingAdult Thigh (gray) 45 - 56.5 cm 21.0 cm M4559A M1598B (1.5 m) or M1599B (3 m)Large Adult X-Long (burgundy) 35.5 - 46.0 cm 17.0 cm M4558ALarge Adult (burgundy) 35.5 - 46.0 cm 17.0 cm M4557AAdult X-Long (navy blue) 27.5 - 36.5 cm 13.5 cm M4556AAdult (navy blue) 27.5 - 36.5 cm 13.5 cm M4555ASmall Adult (royal blue) 20.5 - 28.5 cm 10.6 cm M4554APediatric (green) 13.8 - 21.5 cm 8.0 cm M4553AInfant (orange) 9 - 14.8 cm 5.4 cm M4552APatient Category Limb CircumferenceBladder WidthPart No. TubingAdult (Thigh) 45 - 56.5 cm 20.4 cm M4579A M1598B (1.5 m) or M1599B (3 m)Large Adult X-Long 35.5 - 46 cm 16.4 cm M4578ALarge Adult 35.5 - 46 cm 16.4 cm M4577AAdult X-Long 27.5 - 36.5 cm 13.1 cm M4576AAdult 27.5 - 36.5 cm 13.1 cm M4575ASmall Adult 20.5 - 28.5 cm 10.4 cm M4574APediatric 15.0 - 21.5 cm 8.0 cm M4573AInfant 9 - 15 cm 5.6 cm M4572A
35 Accessories375Neonatal/Infant Cuffs (Disposable, non-sterile)Invasive Pressure AccessoriesThese transducers and accessories are designed to have special protection against electric shocks (particularly regarding allowable leakage currents), and are defibrillator proof.If you are using the M3012A Hemodynamic MMS Extension, and you want to measure temperature and invasive pressure at the same time, we recommend that you use the pressure transducer CPJ840J6, with a round module connector piece, and not a transducer with a square connector. Pressure transducers with square connectors may make it difficult to connect the adjacent Temperature connector at the same time.Cuffs Limb CircumferenceBladder WidthPart No. TubingSize 1 3.1 to 5.7 cm 2.2 cm M1866A M1596B (1.5 m) or M1597B (3 m)Size 2 4.3 to 8.0 cm 2.8 cm M1868ASize 3 5.8 to 10.9 cm 3.9 cm M1870ASize 4 7.1 to 13.1 cm 4.7 cm M1872ATransducer, accessories, sensor kits Part NoReusable pressure transducer 5 µV/V/mmHg sensitivity CPJ840J6Sterile disposable pressure domes for CPJ840J6 (pack of 50) CPJ84022Transducer holder for CPJ840J6 (pack of 4) CPJ84046IV pole mount for CPJ840J6 CPJ84447Monitoring Line Set for CPJ840J6 CPJ84026Single channel disposable sensor kit (20) - (EU/EFTA only) M1567ADual channel disposable sensor kit (20) (EU/EFTA only) M1568ATransducer holder for M1567/8A (EU/EFTA only) M2271AIV pole mount for M1567/8A (EU/EFTA only) M2272CAdapter cable for disposable sensor kit 3,0m for M1567/8A M1634APressure transducer kitsPiCCO monitoring kit, 30cm pressure line, includes PV4046 injectate temperature sensor housing for M1646APV8103PiCCO monitoring kit, 150cm pressure line, includes PV4046 injectate temperature sensor housing for M1646APV8115PiCCO monitoring kit, 150cm pressure line, includes PV4046 injectate temperature sensor housing for M1646A and central venous pressure linePV8115CVPPULSION Pressure Interface Cable for disposable pressure transducer PMK 206
35 Accessories376SpO2 AccessoriesThis section lists accessories for use with Philips SpO2 technology. For accessory lists for other SpO2 technologies, refer to the instructions for use provided with these devices.Some Nellcor sensors contain natural rubber latex which may cause allergic reactions. See the Instructions for Use supplied with the sensors for more information. M1901B, M1902B, M1903B and M1904B disposable sensors are not available in USA from Philips. Purchase Nellcor sensors and adapter cables directly from Tyco Healthcare.Do not use more than one extension cable with any sensors or adapter cables. Do not use an extension cable with:• Masimo adapter cables,• Philips reusable sensors or adapter cables with part numbers ending in -L (indicates "Long" version) or with a cable longer than 2 m.All listed sensors operate without risk of exceeding 41°C on the skin, if the initial skin temperature does not exceed 35°C.Make sure that you use only the accessories that are specified for use with this device, otherwise patient injury can result.Always use the MAX-FAST forehead sensor with the foam headband provided by Nellcor.Option A01 is the Philips FAST-SpO2 version; Option A02 is the Nellcor OxiMax-compatible version.The SpO2 Option A02 may not be available in all countries. Some sensors may not be available in all countries.Product NumberDescription Compatible with CommentsOpt. A01 Opt. A02Philips reusable sensors.M1191A/B Adult sensor (2 m cable), for patients over 50 kg. Any finger, except thumb.yes no No adapter cable required.M1191AL/BL M1191A/B with longer cable (3 m) yes noM1192A Small adult, pediatric sensor (1.5 m cable) for patients between 15 kg and 50 kg. Any finger except thumb.yes noM1193A Neonatal sensor (1.5 m cable) for patients between 1kg and 4 kg. Hand or foot.yes noM1194A Ear sensor (1.5 m cable) for patients more than 40 kg.yes noM1195A Infant sensor (1.5 m cable) for patients between 4kg and 15 kg. Any finger except thumb.yes noM1196A Adult clip sensor (3 m cable) for patients over 40 kg. Any finger except thumb.yes no
35 Accessories377M1191T Adult sensor (0.45 m cable), for patients over 50 kg. Any finger, except thumb.yes no Requires M1943 (1 m) or M1943AL (3 m) adapter cableM1192T Small adult, pediatric sensor (0.45 m cable) for patients between 15 kg and 50 kg. Any finger except thumb.yes noM1193T Neonatal sensor (0.9 m cable) for patients between 1 kg and 4 kg. Hand or foot.yes noM1196T Adult clip sensor (0.9 m cable) for patients over 40 kg. Any finger except thumb.yes noPhilips disposable sensors. Not available in the USA.M1904B Identical to OxiMax MAX-A yes yes Option A01: Use adapter cable M1943A or M1943AL.Option A02: Must use adapter cable M1943NL.M1903B Identical to OxiMax MAX-P yes yesM1902B Identical to OxiMax MAX-I yes yesM1901B Identical to OxiMax MAX-N yes yesPhilips disposable sensors. Available worldwide.M1131A Adult/Pediatric finger sensor, 0.45 m cable (patient size > 20 kg)yes no Use adapter cable M1943A or M1943AL.M1132A Infant finger or toe sensor, 0.9 m cable (patient size 3 - 10 kg)yes no Use adapter cable M1943A or M1943AL.M1133A Adult/Infant/Neonatal, 0.9 m cableFoot or hand for neonates < 3 kgBig toe or thumb for patients between 10 kg and 20 kgAny finger except thumb for patients > 40 kgyes no Use adapter cable M1943A or M1943AL.M1134A Adhesive-free, Adult/Infant/Neonatal, 0.9 m cableFoot or hand for neonates < 3 kgBig toe or thumb for patients between 10 kg and 20 kgAny finger except thumb for patients > 40 kgyes no Use adapter cable M1943A or M1943AL.NELLCOR disposable sensors (must be ordered from Nellcor)OxiMax MAX-AAdult finger sensor (patient size > 30 kg) yes yes Option A01: Use adapter cable M1943A or M1943AL.Option A02: Must use adapter cable M1943NL.OxiMaxMAX-ALOxiMax MAX-A with long cable yes yesOxiMax MAX-PPediatric foot/hand sensor (patient size 10-50 kg)yes yesOxiMax MAX-I Infant foot/hand sensor (patient size 3-20 kg) yes yesOxiMax MAX-NAdult finger or neonatal foot/hand sensor (patient size > 40 kg or < 3 kg)yes yesProduct NumberDescription Compatible with CommentsOpt. A01 Opt. A02
35 Accessories378MAX-FAST Forehead sensor no yes Must use M1943NL adapter cable.OxiMax MAX-RAdult nasal sensor no yesOxiMax SC-A Adult SoftCare sensor no yesOxiMax SC-NEONeonatal SoftCare sensor no yesOxiMax SC-PR Pre-term infant SoftCare sensor no yesOxisensor II D-25Adult sensor (patient size > 30 kg) yes no Must use M1943A or M1943 AL adapter cable.Oxisensor II D-20Pediatric sensor (patient size 10-50 kg) yes noOxisensor II I-20Infant sensor (patient size 3-20 kg) yes noOxisensor II N-25Neonatal sensor (patient size < 3 kg or > 40 kg)yes noOxiCliq A See OxiMax MAX-A yes yes Option A01: Use adapter cable M1943A or M1943AL together with OC-3 adapter cable.Option A02: Must use adapter cables M1943NL and OC-3 adapter cable.OxiCliq P See OxiMax MAX-P yes yesOxiCliq I See OxiMax MAX-I yes yesOxiCliq N See OxiMax MAX-N yes yesOxiband OXI-A/NAdult / neonatal sensor no yes Must use M1943NL adapter cable.Oxiband OXI-P/IPediatric / infant sensor no yesDurasensor DS100AAdult finger clip sensor no yesDura-Y D-YS Y-sensor no yesExtension / Adapter Cables for Philips and Nellcor SensorsM1941A Extension cable (2 m) yes yes For use with Philips reusable sensors and M1943A adapter cable.Product NumberDescription Compatible with CommentsOpt. A01 Opt. A02
35 Accessories379M1943A Adapter cable (1.1 m cable) yes no Adapter cable for Philips/Nellcor disposable sensors.M1943AL Adapter cable (3 m cable) yes noM1943NL OxiMax adapter cable (3 m cable) no yes Adapter cable for Philips disposable/Nellcor disposable and reusable sensors.OC-3 Adapter Cable for OxiCliq sensors yes yes Available from Nellcor only.Product NumberDescription Compatible with CommentsOpt. A01 Opt. A02Product NumberDescription Compatible with Philips Part NumberOpt. A01 Opt. A02MASIMO LNOP® reusable sensors.LNOP DCI Adult Finger Sensor (> 30 kg) yes no n/aLNOP DCIP Pediatric Finger Sensor (10 - 50 kg) yes no n/aLNOP YI Multi-Site Sensor (> 1kg) yes no n/aLNOP TC-I Ear Sensor (> 30 kg) yes no n/aMASIMO LNCS® reusable sensors.LNCS DCI Adult Finger Sensor (> 30 kg) yes no n/aLNCS DCIP Pediatric Finger Sensor (10 - 50 kg) yes no n/aLNCS YI Multi-Site Sensor (> 1kg) yes no n/aLNCS TC-I Ear Sensor (> 30 kg) yes no n/aMASIMO LNOP® disposable adhesive sensors.LNOP Adt Adult Sensor (> 30 kg) yes no n/aLNOP Adtx Adult Sensor (> 30 kg) yes no n/aLNOP Pdt Pediatric Sensor (10 - 50 kg) yes no n/aLNOP Pdtx Pediatric Sensor (10 - 50 kg) yes no n/aLNOP Inf-L Infant Toe Sensor (3 - 20 kg) yes no n/aLNOP Neo-L Neonatal Sensor (< 3 kg)or Adult adhesive Sensor (> 40 kg)yes no n/aLNOP NeoPt-LNeonatal Pre-Term Sensitive Skin Sensors (< 1 kg)yes no n/aMASIMO LNCS® disposable adhesive sensors.LNCS Adtx Adult Finger Sensor, 18 inch (> 30 kg) yes no n/aLNCS Adtx-3 Adult Finger Sensor, 3 feet (> 30 kg) yes no n/aLNCS Pdtx Pediatric Finger Sensor, 18 inch (10 - 50 kg) yes no n/aLNCS Pdtx-3 Pediatric Finger Sensor, 3 feet (10 - 50 kg) yes no n/aLNCS Inf Infant Toe Sensor, 18 inch (3 - 20 kg) yes no n/aLNCS Inf-3 Infant Toe Sensor, 3 feet (3 - 20 kg) yes no n/a
35 Accessories380The Philips M3001A/M3002A option A01 and the M1020B option A01 SpO2 Module use Masimo certified pulse oximetry for reduced noise and low perfusion performance with Masimo Sensors under the Masimo NR&LP protocol available from Masimo.Temperature AccessoriesLNCS Neo Neonatal Foot Sensor, 18 inch (< 3 kg)or Adult Finger Sensor 18 inch(> 40 kg)yes no n/aLNCS Neo-3 Neonatal Foot Sensor, 3 feet (< 3 kg)or Adult Finger Sensor, 3 feet(> 40 kg)yes no n/aLNCS NeoPt Neonatal pre-term sensitive skin Sensor 18 inch (< 1 kg)yes no n/aLNCS NeoPt-3 Neonatal pre-term sensitive skin Sensor 3 feet (< 1 kg)yes no n/aAdapter Cable for MASIMO sensors.LNOP MP12 LNOP MP Series Patient Cable (3.6 m) Adapter Cable for Masimo LNOP Sensorsyes no 451261000761LNC MP10 LNCS MP Series Patient Cable (3.0 m) Adapter Cable for Masimo LNCS Sensorsyes no 989803148221Product NumberDescription Compatible with Philips Part NumberOpt. A01 Opt. A02Temperature Probes Part No. Minimum measurement time for accurate readingsReusableGeneral purpose probe 21075A 90 secSmall flexible vinyl probe (Infant/Pediatric) 21076A 60 secAttachable surface probe 21078A 60 secDisposableGeneral purpose probe M1837A 90 secSkin probe 21091A 60 secEsophageal/Stethoscope Probe (French 12) 21093A 180 secEsophageal/Stethoscope Probe (French 18) 21094A 210 secEsophageal/Stethoscope Probe (French 24) 21095A 310 secEsophageal/Rectal Probe (French 12) 21090A 90 sec
35 Accessories381Cardiac Output (C.O.) AccessoriesSee Pressure accessories for PULSION continuous cardiac output accessories.Foley Catheter Probe (12 French) M2255A 180 secFoley Catheter Probe (16 French) 21096A 180 secFoley Catheter Probe (18 French) 21097A 180 secAdapter cable 1.5m 21082BAdapter cable 3.0m 21082ATemperature Probes Part No. Minimum measurement time for accurate readingsDescription Part NoAccessories common to both methodsAccessories Set of ice buckets 14455ARemote handswitch 15244APiCCO inline temperature probe Latex free M1646ARight Heart ThermodilutionC.O. Interface Cables 2.7 meter cable M1642A2.4 m + 2.4 m cable M1643ARight heart catheter for thermodilution (from Edwards Lifesciences) 831HF75Edwards CO-Set+ (only with 23001A/B) contact Edwards Lifesciences for informationInjectate Probes 2.4m injectate temp. probe (reusable) 23001A0.5m injectate temp. probe (reusable) 23001BIce bath temp. probe 23002ATranspulmonary ThermodilutionC.O. Interface Cables 2.4 m + 2.4 m cable M1643APULSION Pressure Transducer Kits (pressure line available in various lengths)Contact PULSION for informationPressure Interface Cable for disposable pressure transducerPULSION PMK 206
35 Accessories382Mainstream CO2 AccessoriesSidestream CO2 AccessoriesDescription Part No.CO2 Sensor M2501AAdult/Pediatric Airway Adapter (reusable) M2513AInfant Airway Adapter (reusable) M2516AAdult Airway Adapter (single-patient use) M2533AInfant Airway Adapter (single-patient use) M2536ADescription Part No.CO2 Sensor M2741ANasal and Oral-Nasal CannulasCO2 Nasal Cannula, Adult M2744ACO2 Nasal Cannula, Pediatric M2745ACO2 Nasal Cannula, Infant M2746ACO2 / O2 Nasal Cannula, Adult M2750ACO2 / O2 Nasal Cannula, Pediatric M2751ACO2 / O2 Nasal Cannula, Infant 989803144471CO2 Oral-Nasal Cannula, Adult M2756ACO2 Oral-Nasal Cannula, Pediatric M2757ACO2 / O2 Oral-Nasal Cannula, Adult M2760ACO2 / O2 Oral-Nasal Cannula, Pediatric M2761AAirway AdaptersAirway Adapter Set, ET > 4.0 mm M2768AAirway Adapter Set, ET =< 4.0 mm 989803144531Airway Adapter Set H, ET > 4.0 mm M2772AAirway Adapter Set H, ET =< 4.0 mm M2773AStraight Sample LinesStraight Sample Line M2776AStraight Sample Line H M2777A
35 Accessories383Mainstream CO2 Accessories (for M3016A)Microstream CO2 Accessories• "FilterLine Set" is a combination of a FilterLine with an Airway Adapter.• "H" in the accessory name indicates suitability for humidified ventilation and longer usage due to the active removal of humidity from the sample line.• "Smart CapnoLine" is a combined oral-nasal FilterLine.• "Smart CapnoLine O2" is a combined oral-nasal-O2-CO2 FilterLine.• "NIV Line" is a nasal FilterLine suitable for mask ventilation (for example, C-PAP).• The accessories are supplied in packs of 25.• Extension is not compatible with the M2786A Infant/Neonatal Flow Sensor for the spirometry measurement (M1014A).Description Part No.CO2 Sensor M1460AStandard Airway Adapter (reusable) M1465ASmall Airway Adapter (reusable) 14363AMicrostream accessory selection flowchartIs the patient intubated?Yes NoDoes the patient need oxygen?Yes NoShort-term(up to 6 hours)Long-term(up to 72 hours)Short-term(up to 8 hours)Long-term(up to 24 hours)Long-term(up to 24 hours)Short-term(up to 8 hours)Short-term(up to 8 hours)Oral/Nasal Nasal Nasal Oral/Nasal NasalKey Applications
35 Accessories384Spirometry AccessoriesMeasurement of CO2 and Spirometry with NeonatesFor measurement of CO2 and Spirometry with neonates, the use of the M3014A Mainstream CO2 Extension, the M1014A Spirometry Module and the M2782A Combined CO2/Flow Sensor is recommended.The M1923A Filterline H Set Infant/Neonatal used for Microstream CO2 measurement with the M3015A Extension is not compatible with the M2786A Infant/Neonatal Flow Sensor for the spirometry measurement (M1014A).Critical Care OR, EMS, ED Procedural Sedation, Critical Care, EMS, EDCritical Care, Sleep Lab, Long-term Pain ManagementCritical Care, Sleep LabProcedural Sedation, Critical Care, EMS, EDEMS, EDPhilips part numbers (A = Adult, P= Pediatric, I = Infant, N = Neonate)FilterLine Set:A/P: M1920AFilterLine Set Long:A/P:989803160241*FilterLine:M1925A*FilterLine H Set:A/P: M1921AI/N: M1923AFilterLine H Set LongA/P:989803160251*I/N:989803160261*VitaLine H Set:A/P:989803159571*I/N: 989803159581*FilterLine H:M1926A*Smart CapnoLine O2:A: M2522AP: M2520ASmart CapnoLine O2 LongA:989803160281*P:989803160271*CapnoLine HO2:A: M4680AP: M4681ACapnoLine H:A: M4689AP: M4690AI/N: M4691ASmart CapnoLine:A: M2526AP: M2524ASmart CapnoLine Plus LongA:989803160301*NIV Line:A: 4686AP: M4687A*Not available in all geographies.Microstream accessory selection flowchartDescription Part No.Adult/Pediatric Flow Sensor M2785ANeonatal Flow Sensor M2786AAdult/Pediatric CO2/Flow Sensor M2781ANeonatal CO2/Flow Sensor M2782APediatric CO2/Flow Sensor M2783A
35 Accessories385tcGas AccessoriesThis symbol indicates that the specified transducer (but not its membranes) is designed to have special protection against electric shocks (particularly regarding allowable leakage currents), and is defibrillator proof.1May not be available in all countries due to pending regulatory clearanceEEG AccessoriesDescription Part No.tcpO2/CO2 transducer M1918AAccessory Kit for M1918A (O-ring remover, absorbent paper, electrolyte solution, 12 replacement membranes)15209-60010Application Kit for M1918A (4x25 disposable fixation rings, contact fluid) 15209-60020tcpO2/CO2 transducer M1918B1Accessory Kit for M1918B (10 replacement membranes, electrolyte solution) 9898031519511Application Kit for M1918B (4x25 disposable fixation rings, contact fluid) 9898031519611Calibration gas - 6 gas bottles 15210-60010Calibration gas - 6 gas bottles (Europe and Japan only) 15210-64010Replacement tubing (5 tubes) M2205ACalibration unit 15210BRadiometer TCC3 calibration unit (available from Radiometer) n/aDescription Part No.Trunk Cable 2.7 m M2268ATrunk Cable, 1.0 m M2269AReusable 80-cm-long 5-lead cables with 10 mm silver/silverchloride leadwired cup electrodes (Adult)M1931AReusable 80 cm 5-lead cables with 6 mm silver/silverchloride leadwired cup electrodes (Pediatric/Neonatal)M1932AReusable 80 cm 5-lead cables with clip M1934ADisposable EEG electrodes M1935AEC2™ Electrode Cream (conductive paste) M1937A
35 Accessories386BIS AccessoriesUse only Aspect BIS sensors with the BIS module. The sensor is a silver/silver chloride electrode array that uses Aspect's patented ZipPrep technology and a proprietary connector. The sensor/electrodes are for single patient use only. Check shelf-life before use.The patient interface cable (Philips Ordering No. M1034-61630, Aspect Part No. 186-0131) has an estimated lifetime of one year. Do not scrap it when disposing of the BIS sensor.The sensor cable from the Semi-Reusable Sensor is re-usable but has a maximum number of uses, the electrodes are single patient use only. The monitor displays how many uses remain for the sensor cable.BIS SensorsTo re-order sensors, contact Aspect Medical Systems.Other BIS AccessoriesOrder the following parts from your nearest Philips sales office and quote the Philips ordering numberSO2 Accessories for M1021AContact your local Hospira representative for information on accessories. They are not available from Philips.Description Pieces per packPhilips Ordering No Aspect Part NoBIS and BISx - compatibleBIS Sensor Quatro (formerly Sensor XP) 50 M1997A 186-0106BIS Sensor Plus 50 M4546A 186-0076BIS Sensor Pediatric (4 electrode) 25 989803143581 186-0200BIS Sensor Extend 50 n/a 186-0160Description Philips Ordering NumberPIC PLUS Cable M1034-61630Description Hospira Part No.Optical Module 50131Hospira Opticath® Catheter family (SvO2, ScvO2) Contact Hospira for part numbers of compatible catheters
35 Accessories387SO2 Accessories for M1011AContact your local PULSION or Edwards representative for information on accessories. They are not available from Philips.Recorder AccessoriesBattery AccessoriesDescription Product Number(Order Number)Philips SO2 Optical Module 989803151591Pulsion: CeVOX Fiberoptic Probe family (ScvO2) Contact PULSION for part numbers of compatible probesEdwards: Philips-compatible versions of the PreSep Catheter (ScvO2) or Swan-Ganz Oximetry Catheter (SvO2) familiesContact Edwards for part numbers of compatible cathetersDescription Part No.For M1116B recorder:10 rolls of paper 40477A80 rolls of paper 40477BDescription Part No.Lithium Ion Smart Battery 1Ah (internal battery for X2) M4607ABattery Charger and Conditioner (requires size adapter 4512 610 17451 to charge M4607A battery)865432Size adapter for M4607A battery 4512 610 17451
35 Accessories388
36 Specifications38936SpecificationsThe specifications in this section apply to the MX800 patient monitor.The monitor is not user installable. It must be installed by qualified service personnel.Intended UseThe monitor is intended to be used for monitoring and recording of, and to generate alarms for, multiple physiological parameters of adults, pediatrics, and neonates in health care facilities. The monitor is to be used by trained health care professionals.The monitor is only for use on one patient at a time. It is not intended for home use. Rx only: U.S. Federal Law restricts this device to sale by or on the order of a physician. Not a therapeutic device.The transcutaneous gas measurement (tcGas) is restricted to neonatal patients only.ST segment monitoring is intended for use with adult patients only and is not clinically validated for use with neonatal and pediatric patients.The ECG measurement is intended to be used for diagnostic recording of rhythm and detailed morphology of complex cardiac complexes (according to AAMI EC 11).BIS is intended for use under the direct supervision of a licensed health care practitioner or by personnel trained in its proper use. It is intended for use on adult and pediatric patients within a hospital or medical facility providing patient care to monitor the state of the brain by data acquisition of EEG signals. The BIS may be used as an aid in monitoring the effects of certain anesthetic agents. Use of BIS monitoring to help guide anesthetic administration may be associated with the reduction of the incidence of awareness with recall in adults during general anesthesia and sedation.The SSC Sepsis Protocol, in the ProtocolWatch clinical decision support tool, is intended for use with adult patients only.The derived measurement Pulse Pressure Variation (PPV) is intended for use with sedated patients receiving controlled mechanical ventilation and mainly free from cardiac arrhythmia. The PPV measurement has been validated only for adult patients.The monitor is indicated for use by health care professionals whenever there is a need for monitoring the physiological parameters of patients.WARNINGThe monitor is not intended for use in an MRI environment or in an oxygen-enriched environment (for example, hyperbaric chambers).Manufacturer's InformationYou can write to Philips at this address
36 Specifications390Philips Medizin Systeme Boeblingen GmbHHewlett-Packard-Str. 271034 BoeblingenGermanyVisit our website at: www.healthcare.philips.com/us/.© Copyright 2010. Koninklijke Philips Electronics N.V. All Rights Reserved.BIS Manufacturer's InformationBISx, the BIS engine, the DSC, the Patient Interface Cable and the BIS Sensor are manufactured by Aspect Medical Systems:Aspect Medical Systems, Inc141 Needham StNewton, MA 02464USA1-617-559-7000Free call:1-888-BIS_INDEX1-888-247-4633Email: bis_info@aspectms.comWeb: www.aspectmedical.comAddress of the EU Authorized Representative:Aspect Medical Systems International B.V.Rijnzathe 7d23454 PV De MeernThe NetherlandsPhone: +31.30.662.9140Email: amsint@aspectms.comTrademark AcknowledgementPiCCOTM is a trademark of PULSION Medical Systems AG.Bispectral Index and BIS are trademarks of Aspect Medical Systems Inc, and are registered in the USA, EU and other countries.Microstream®, FilterLine®, and Smart CapnoLine® are trademarks or registered trademarks of Oridion Systems Ltd.Citrix® and ICA® (Independent Computing Architecture) are registered trademarks of Citrix Systems, Inc.The following are trademarks of Nellcor Puritan Bennett Incorporated: Nellcor®, Durasensor®, Dura-Y®, Oxiband®, Oxicliq®, OxiMax®. MAX-FAST® is a trademark of Mallinckrodt Inc.Masimo®, Masimo SET®, and LNOP are federally registered trademarks of the Masimo Corporation.Other product and company names mentioned in this book may be trademarks of their respective owners.
36 Specifications391SymbolsThese symbols can appear on the monitor and its associated equipment.SymbolsRefer to accompanying documentsProtective earth Equipotential groundingStandby FMS power-on indicator Error LEDAlternating current Connection direction indicatorConnection direction indicatorElectrical input indicator(In some cases gas input indicator)Electrical output indicator(In some cases gas output indicator)Connector has special protection against electric shocks and is defibrillator proofGas input indicator Gas output indicator Quick mount releasebuilt-in wireless network USB interface Data input/output symbolNon-ionizing radiation symbolIdentifies year and month of manufactureAlways use separate collection for waste electrical and electronic equipment (WEEE)Pressure connector NBP connector Cardiac Output connectorTemperature connector Monitor supports 12-lead ECGSpO2 connector
36 Specifications392Installation Safety InformationWARNINGIf multiple instruments are connected to a patient, the sum of the leakage currents may exceed the limits given in IEC/EN60601-1, IEC60601-1-1, UL60601-1. Consult your service personnel.ConnectorsThe actual placement of boards and configuration of connections for your monitor depends on how your hardware has been configured. See the symbols table (“Symbols” on page 391) to see which symbols are used to mark the connections.WARNINGConnect only medical devices to the ECG output connector socket.Masimo SET technology Nellcor OxiMax compatibleUses FAST SpO2 algorithmSilence Alarms Alarms On/Off Alarms Switched OffMain Screen SmartKeys Back keyECG Sync Output/Analog ECG Output SymbolsGrounding The monitor must be grounded during operation. If a three-wire receptacle is not available, consult the hospital electrician. Never use a three-wire to two-wire adapter.Equipotential GroundingIf the monitor is used in internal examinations on the heart or brain, ensure that the room incorporates an equipotential grounding system to which the monitor has a separate connections.Combining equipment Combinations of medical equipment with non-medical equipment must comply with IEC 60601-1-1. Never use a multiple portable socket-outlet or extension cord when combining equipment unless the socket outlet is supplied specifically for use with that equipment.Fusing The monitor uses double fusing (line and neutral).Network Cables All network cables must be unshielded.
36 Specifications393Rear of the Monitor1 Serial/MIB (RS232) connectors, type RJ452AC power input3 Protective earth screw hole4 Equipotential ground connector5 Main measurement links (MSL) 6 USB rear connectors (for remote control, keyboard, pointing devices, printer)7 Serial RS232 connector8 Nurse Call 9 Wired network connector10 Video out connector (digital/analog)The following connectors are only present with the iPC11 USB rear connectors (for keyboard, pointing devices, printer)12 Audio in/out13 Local Area Network14 Video out connector (digital/analog)The following connectors are only present with the Independent Display Interface15 Serial RS232 connector for touch16 Video out connector (digital/analog)
36 Specifications394Left side of the MonitorRight side of the Monitor1ECG Sync Output/Analog ECG output connector1 USB side connector (only present with the iPC)
36 Specifications395Monitor Mounting PrecautionsMount the monitor using either the Philips Quick Mount or Fix Mount solution or another approved mounting solution. Select the mounting equipment and the mounting position so that no patient, operator or other person can be harmed by a monitor removed intentionally or released accidentally from the mount. When using the Quick Mount, be aware of the danger of accidental activation of the Quick Mount release button when lifting or moving items located under the monitor, such as pole mounts, etc. If in doubt, use the Philips Fix Mount solution to avoid such situations. Refer to the respective IntelliVue Monitor Service Manual, Installation Instructions chapter, for more details.Altitude SettingAltitude affects tcGas and CO2 measurements. The monitor must be configured at installation to the correct altitude. Monitor Safety SpecificationsThe monitors, together with the Multi-Measurement Modules (M3001A/M3002A), and the Flexible Module Rack (M8048A), all modules and MMS extensions, comply with the Medical Device Directive 93/42/EEC.185-0145-PH Aspect BISx, 185-0111 Aspect BIS Engine and 185-0124 Aspect DSC comply with the requirements of the Council Directive 93/42/EEC of 14 June 1993 (Medical Device Directive).In addition, the product complies with:IEC 60601-1:1988 + A1:1991 + A2:1995; EN60601-1:1990 + A1:1993 + A2:1995; UL 60601-1:2003; CAN/CSA C22.2#601.1-M90 +Suppl. No. 1-94 + Am. 2; IEC 60601-1-1:2000; EN 60601-1-1:2001; IEC 60601-1-2:2001 + A1:2004; EN 60601-1-2:2001 + A1:2006.The possibility of hazards arising from software errors was minimized in compliance with ISO 14971:2007, EN60601-1-4:1996 + A1:1999 and IEC 60601-1-4:1996 + A1:1999.Classification (according to IEC 60601-1): Class 1, Type CF, Continuous Operation. The BIS measurement uses a Type BF applied part.EMC And Radio Regulatory ComplianceThis ISM device complies with Canadian ICES-001. Cet appareil ISM est conforme a la norme NMB-001 du Canada.
36 Specifications396IntelliVue 802.11 Bedside Adapter (Option J35 Wireless Network Adapter)FCC and Industry Canada Radio Compliance: This device complies with Part 15 of the FCC Rules and RSS-210 of Industry Canada. Operation is subject to the following two conditions: (1) this device may not cause harmful interference, and (2) this device must accept any interference received, including interference that may cause undesired operation. Any changes or modifications to this equipment not expressly approved by Philips Medical Systems may cause harmful radio frequency interference and void your authority to operate this equipment.The maximum antenna gain permitted (for devices in the 5250-5350 MHz and 5470-5725 MHz bands) complies with the e.i.r.p. limits as stated in RSS-210.The maximum antenna gain permitted (for devices in the 5725-5825 MHz band) complies with the e.i.r.p. limits specified for point-to-point operation, as stated in RSS-210.The device for the band 5150-5250 MHz is only for indoor usage to reduce potential for harmful interference to co-channel mobile satellite systems.The OEM radio device used in this product is in compliance with the essential requirements and other relevant provisions of Directive 1999/5/EC. This product is intended to be connected to the Publicly Available Interfaces (PAI) and used throughout the EEA.CAUTIONHigh power radars are allocated as primary users (meaning they have priority) of 5250-5350 MHz and 5650-5850 MHz and these radars could cause interference and /or damage to LE-LAN devices.IntelliVue 802.11 Bedside Adapter CE compliances: This device is compliant to Council Directive 73/23/EEC (Low voltage directive) & 89/336/EEC (EMC directive) & 1999/5/EC (Radio Equipment and Telecommunications Terminal Equipment Directive)The radio component contained in this device is compliant to Council Directive 1999/5/EC (Radio Equipment and Telecommunications Terminal Equipment Directive)IntelliVue Instrument Telemetry ISM (2.4GHz)FCC and Industry Canada Radio Compliance: This device complies with Part 15 of the FCC Rules and RSS-210 of Industry Canada. Operation is subject to the following two conditions: (1) this device may not cause harmful interference, and (2) this device must accept any interference received, including interference that may cause undesired operation. Any changes or modifications to this equipment not expressly approved by Philips Medical Systems may cause harmful radio frequency interference and void your authority to operate this equipment.The radio device used in this product is in compliance with the essential requirements and other relevant provisions of Directive 1999/5/EC (Radio Equipment and Telecommunications Terminal Equipment Directive). Class 2 radio equipment. Member states may apply restrictions on putting this device into service or placing it on the market. This product is intended to be connected to the Publicly Available Interfaces (PAI) and used throughout the EEA.
36 Specifications397IntelliVue Instrument Telemetry WMTS (US only)The radio device used in this product complies with part 15 of the FCC Rules. Operation is subject to the condition that these devices do not cause harmful interference. Operation of this equipment requires the prior coordination with a frequency coordinator designated by the FCC for the Wireless Medical Telemetry Service.Short Range Radio Interface (MX800 and 865244 Remote Control)FCC and Industry Canada Radio Compliance: This device complies with Part 15 of the FCC Rules and RSS-210 of Industry Canada. Operation is subject to the following two conditions: (1) this device may not cause harmful interference, and (2) this device must accept any interference received, including interference that may cause undesired operation. Any changes or modifications to this equipment not expressly approved by Philips Medical Systems may cause harmful radio frequency interference and void your authority to operate this equipment. The radio component contained in this device is in compliance with the essential requirements and other relevant provisions of Council Directive 1999/5/EC (Radio Equipment and Telecommunications Terminal Equipment Directive)In addition the product complies with: ETSI EN 300 328; AS/NZS 4771+A1; ARIB STD-T66.Class 1 radio equipment.Physical SpecificationsProduct Max WeightW x H x D CommentsMX800 Monitor <12 kg<26.4 lb<478 x 364 x 152 mm18.82 x 14.33 x 5.98 inwithout cable managementM3001AMulti-Measurement Module (MMS)<650 g<1.4 lb188 x 96.5 x 51.5 mm7.4 x 3.8 x 2 inM3002AMulti-Measurement Module (MMS)<1.25 kg<2.8 lb188 x 99 x 86 mm7.4 x 3.9 x 3.4 inincluding battery, without handle or optionsM3012AHemodynamic MMS Extension<550 g1.2 lb<190 x 98 x 40 mm<7.5 x 4 x 1.6 inM3014ACapnography MMS Extension<500 g<0.99 lb<190 x 98 x 40 mm<7.5 x 4 x 1.6 inM3015AMicrostream CO2 MMS Extension-<550 g<1.21 lb<190 x 98 x 40 mm<7.5 x 4 x 1.6 inM3016AMainstream CO2 MMS Extension<450 g<0.99 lb<190 x 98 x 40 mm<7.5 x 4 x 1.6 inM8048AFlexible Module Rack (FMS)<3500 g<7.7 lb<320 x 135 x 120 mm12.6 x 5.3 x 4.7 inwithout plug-in modulesM8025ARemote Alarm Device<300 g<0.7 lb62 x 125 x 63 mm2.4 x 5 x 2.5 inM1006BInvasive Press Module190 g (6.7 oz)Option #C01: 225 g (7.9 oz)36 x 99.6 x 97.5 mm1.4 x 3.9 x 3.8 in
36 Specifications398M1029ATemperature Module215 g (7.6 oz) 36 x 99.6 x 97.5 mm, 1.4 x 3.9 x 3.8 inM1012ACardiac Output Module225 g (7.9 oz.) 36 x 99.6 x 97.5 mm 1.4 x 3.9 x 3.8 inM1014ASpirometry Module250 g (8.8 oz.) 36 x 99.6 x 97.5 mm1.4 x 3.9 x 3.8 inM1018ATranscutaneous Gas Module350 g (11.3 oz) 72.5 x 99.6 x 97.5 mm, 2.9 x 3.9 x 3.8 inM1020BSpO2 Module<250 g0.55 lb36 x 99.6 x 97.5 mm 1.4 x 3.9 x 3.8 inM1021AMixed Venous Oxygen Saturation Module460 g (13.04 oz)72.5 x 99.6 x 97.5 mm2.9 x 3.9 x 3.8 in)M1011ASO2 Module<200g(7.1 oz)36 x 99.6 x 102.5 mm 1.4 x 3.9 x 4.0 in- Optical Module <200g(7.1 oz)50 x 30 x 120 mm2.0 x 1.2 x 4.7 inincluding 2.9m cableM1027AElectroencephalograph Module210 g (7.4 oz) 36 x 99.6 x 97.5 mm1.4 x 3.9 x 3.8 inM1034ABIS Interface Module215 g7.6 oz36 x 99.6 x 97.5 mm1.4 x 3.9 x 3.8 inwithout cablesBISx 499 g1.1 lb95.3 x 63.5 mm (diameter x height)3.8 x 2.5 inwith PIC Plus Cable (1.22 m, 4 ft) and cable to BIS module- DSC Digital Signal Converter 130 g (4.6 oz) (without cabling)66 x 25 x 107 mm2.6 x 1.0 x 4.25 inwith PIC Plus Cable (1.22 m, 4ft)- BIS Engine 170 g (6.0 oz)43 x 93 x 95 mm1.7 x 3.7 x 3.7 inM1032AVuelink Module240 g (8.4 oz)36 x 99.6 x 97.5 mm1.4 x 3.9 x 3.8 in865115IntelliBridge EC10 Module200 g (7.0 oz)36 x 99.6 x 102.5 mm1.4 x 3.9 x 4.0 in865114IntelliBridge EC5 Module35 g (1.1 oz)35 x 17 x 57 mm1.4 x 0.7 x 2.1 inwith D-Sub 9-pin male or female connector25 g (0.8 oz21.5 x 17 x 65 mm0.9 x 0.7 x 2.6 inwithout cable and strain reliefM1116BThermal Array Recorder Module507.5 g17.9 oz.73 x 99.6 x 97 mm2.9 x 3.6 x 3.9 in.865244Remote Control<250 g 53 x 165 x 23 mm2.1 x 6.5 x 0.9 inwithout navigator knobProduct Max WeightW x H x D Comments
36 Specifications399Environmental SpecificationsThe monitor may not meet the performance specifications given here if stored or used outside the specified temperature and humidity ranges.When the monitor and related products have differing environmental specifications, the effective range for the combined products is that range which is common to the specifications for all products.MX800 MonitorItem Condition RangeTemperature Range Operating 0 to 40°C (32 to 100°F)0 to 35°C (32 to 95°F) when equipped with the iPCStorage -20 to 60°C (-4 to 140°F)Humidity Range Operating 15% to 95% Relative Humidity (RH) (non condensing)Storage 5% to 95% Relative Humidity (RH)Altitude Range Operating -500 m to 3000 m (10000 ft)Storage -500 m to 4600 m (15000 ft)Ingress Protection IPX1X2 (M3002A) and External Power Supply (M8023A)Item Condition RangeTemperature Range Operating 0 to 40°C (32 to 104°F)Storage including transportation-20 to 60°C (-4 to 140°F)Temperature Range when charging the batteryOperating 0 to 35°C (32 to 95°F)Humidity Range Operating 15% to 95% Relative Humidity (RH)Storage including transportation5% to 95% Relative Humidity (RH)Altitude Range Operating -500 m to 3000 m (10000 ft)Storage including transportation-500 m to 4600 m (15000 ft)X2 IP32 (protected against ingress of water when the water is dripping vertically and the monitor is tilted up to 15°)
36 Specifications400Multi-measurement Module M3001A, MMS Extensions M3016A M3015A, M3014A, M3012A, Measurement Modules, and Flexible Module Rack M8048AItem Condition RangeTemperature Range Operating 0 to 45°C (32 to 113°F)Non-operating -40 to 70°C (-40 to 158°F)Humidity Range Operating 95% Relative Humidity (RH) max. @ 40°C (104°F). M3015A only non-condensing.Non-operating 90% Relative Humidity (RH) max. @ 65°C (150°F)Altitude Range Operating -500 m to 4600 m (-1600 to 15000 ft)Non-operating -500 m to 15300 m (-1600 to 50000 ft)Thermal Array Recorder Module M1116BItem Condition RangeTemperature Range Operating +5 to 45°C (41 to 113°F)Non-operating -10 to 70°C (14 to 158°F)Humidity Range Operating 95% Relative Humidity (RH) max @ 40°C (104°F) (non condensing)Non-operating 95% Relative Humidity (RH) max @ 65°C (150°F) (non condensing)Altitude Range Operating up to 3048 m (10000 ft)Non-operating up to 3048 m (10000 ft)Remote Control 865244Item Condition RangeTemperature Range Operating 0 to 40°C (32 to 100°F)Storage -20 to 60°C (-4 to 140°F)Humidity Range Operating 15% to 95% Relative Humidity (RH) (non condensing)Storage 5% to 95% Relative Humidity (RH)Altitude Range Operating -500 m to 3000 m (10000 ft)Storage -500 m to 4600 m (15000 ft)
36 Specifications401Performance SpecificationsMX800 Performance SpecificationsPower Specifications Power Consumption <200 W averageLine Voltage 100 to 240 VCurrent 1.9 to 0.9 AFrequency 50/60 HzIndicators Alarms Off red (crossed out alarms symbol) LEDAlarms red/yellow/light blue (cyan) LEDOn/Standby/Error green/red LED integrated in power switchExternal Power green LEDSounds Audible feedback for user inputPrompt toneQRS tone, or SpO2 modulation tone4 different alarm soundsRemote tone for alarms on other beds in networkTone for Timer expiredTrends Resolution 12, 16, 24 or 32 numerics @ 12 sec, 1 minute, 5 minute resolutionInformation Multiple choices of number of numerics, resolution and duration depending on trend option and application area.For example:neonatal extended 12 numerics, 24 hours @ 12 secs or 32 numerics 32 hours @ 1 minuteintensive care extended: 16 numerics 120 hours @ 5 minutes anesthesia extended 32 numerics 9 hours @ 12 secondsHigh Res Trend Waves Measurements available HR, SpO2, Resp, tcpO2, Pulse, Perf, tcpO2, CO2, A BP, PA P, CVP,  ICP,  C PP, BI S, CC O, AWP, A n es t het ic A gen ts,  De lt a SpO2, inO2Resolution Measurement samples are taken at a resolution of four samples per secondUpdate speed waves are drawn at a speed of 3 cm/minuteEvents Information trigger condition and time, event classification and associated detailed view of episode dataEpisode data configurable, either:4 minutes of high resolution trend or20 minutes of numerics trend @ 12 sec. resolution or15 seconds of 4 waves @ 125 samples/sec. (Snapshot)including all current numerics, alarms and inopsCapacity (max) 25 or 50 events for either 8 or 24 hoursAlarm Signal System delay less than 3 secondsPause duration 1,2,3 minutes or infinite, depending on configurationExtended alarm pause 5 or 10 minutesReview Alarms Information all alarms / inops, main alarms on/off, alarm silence and time of occurrenceCapacity 300 items
36 Specifications402Real Time Clock Range from: January 1, 1997, 00:00 to: December 31, 2080, 23:59Accuracy better than 4 seconds per dayHold Time infinite if powered by AC; otherwise at least 48 hours (typical: >72 hours)Buffered Memory Hold Time if powered by AC: infinitewithout power: at least 8 hours Contents Active settings, trends, patient data, realtime reports, events, review alarmsX2 (M3002A) Performance SpecificationsPower Specifications Power consumption <12 W average<30 W while battery is loadingOperating Voltage 36 to 60 V DC floatingBattery Specifications Operating Time(with new, fully charged battery at 25°C)Basic monitoring configuration: 2.5 hours(Brightness set to optimum, ECG/Resp, SpO2 measurements in use, NBP measurement every 15 minutes)Charge Time When X2 is off: 2 hoursWhen X2 is in use, and connected to a monitor, without extensions: 12 hours approx.When X2 is in use, and connected to the external power supply (M8023A), without extensions: 12 hours approx.Indicators Alarms Off red (crossed-out alarm symbol) LEDAlarms red/yellow/light blue (cyan) LEDOn/Standby / Error green / red LEDAC Power green LEDBattery yellow (charging)/red blinking (empty) LEDExternal Power green LEDSounds Audible feedback for user inputPrompt toneQRS tone, or SpO2 modulation tone4 different alarm soundsTrends Resolution 12 or 16 numerics @ 12 sec, 1 minute, 5 minute resolution.Information Multiple choices of number of numerics, resolution and duration depending on trend option and application area.For example:For neonatal, you can choose between 12 and 16 numerics.Alarm signal System delay less than 3 secondsPause duration 1,2,3 minutes or infinite, depending on configurationExtended alarm pause 5 or 10 minutesReview Alarms Information all alarms / inops, main alarms on/off, alarm silence and time of occurrenceCapacity 300 itemsMX800 Performance Specifications
36 Specifications403Real Time Clock Range from: January 1, 1997, 00:00 to: December 31, 2080, 23:59Accuracy <4 seconds per day (typically)Hold Time infinite if powered by host monitor or external power supply; otherwise at least 48 hoursBuffered Memory Hold Time if powered by host monitor or external power supply: infinitewithout power: at least 48 hours (typical: >72 hours)Contents Active settings, trends, patient data, realtime reports, review alarmsM8023A External Power Supply (for M3002A) Performance SpecificationsPower Specifications Power consumption <12 W average<30 W peakLine Voltage 100 to 240 V ~Current 1.3 to 0.7 AFrequency 50/60 Hz ~Indicators Power green LEDM3001A MMS Performance SpecificationsTrends Trend Data Buffered Memoryif powered by monitor mains connection via MSL: infinitewithout power applied: at least 6 hoursContents trend data, patient identification and all active settingsIntegrated PC (iPC) Performance SpecificationsPC Components Processor Intel Core 2 Duo SP9300/SP9400Hard disk 160 GBRAM 4 GB865244 Remote Control Performance SpecificationsPower (when not connected to the USB interface of the monitor)Two AA primary cellsX2 (M3002A) Performance Specifications
36 Specifications404Interface SpecificationsMX800 Interface SpecificationsNetwork Standard 100-Base-TX (IEEE 802.3 Clause 25)Connector RJ45 (8 pin)Isolation basic insulation (reference voltage: 250 V; test voltage: 1500 V)MIB/RS232 Standard IEEE 1073-3.2-2000Connectors RJ45 (8 pin)Mode Software-controllableBCC (RxD/TxD cross over) orDCC (RxD/TxD straight through)Power 5 V ±5 %, 100 mA (max.)Isolation basic insulation (reference voltage: 250 V; test voltage: 1500 V)USB Interface (4 ports) Standard USB 2.0 full-speed (embedded host)Connector USB series "Standard A" receptaclePower Low power port 4.4V min; max. load for all ports together 500 mAIsolation noneRS232 (Standard) Connector RJ45 (8-pin)Power noneIsolation basic insulation (reference voltage: 250 V; test voltage: 1500 V)RS232 (Independent display interface option)Connector RJ45 (8-pin)Power noneIsolation noneBasic Nurse Call RelayConnector modular Jack 6P6C, active open and closed contactContact <=100 mA, <=24 V DCIsolation basic insulation (reference voltage: 250 V; test voltage: 1500 V)Delay <[Configured Latency +0.5] secIntelliVue Instrument Telemetry Wireless Network (USA only)Type Internal WMTS AdapterTechnology compatible with Philips IntelliVue Telemetry System (ITS), cellular infrastructureFrequency Band WMTS, 1395-1400 MHz and 1427-1432 MHzIntelliVue Instrument Telemetry Wireless Network (except USA)Type Internal ISM AdapterTechnology compatible with Philips IntelliVue Telemetry System (ITS), cellular infrastructureFrequency Band 2.4 GHz ISMIntelliVue 802.11 Bedside Adapter (Wireless Network Adapter)Type Internal Wireless AdapterTechnology IEEE 802.11a/b/gFrequency Band 2.4 GHz and 5 GHz ISM Band
36 Specifications405Short Range Radio InterfaceType Internal SRR interfaceTechnology IEEE 802.15.4Frequency band 2.4 GHz ISM (2.400 - 2.483 GHz)Modulation techniqueDSSS (O -QPSK)Effective radiated powermax. 0 dBm (1 mW)Measurement Link (MSL)Connectors ODU out (Proprietary)Voltage 56V ±10%Power 45 WPower Sync. 5 V CMOS Level; 78.125 kHz (typ.)LAN signals IEEE 802.3 10-Base-T compliantSerial signals RS-422 compliantVideo Interface (standard)Connector DVI (digital and analog, single link)Digital video signals single link TMDSAnalog video signals 0.7 Vpp@75 OhmHSYNC/VSYNC signalsTTLDDC signals noneDDC power 5V +/-5% @0-55mAVideo Interface (Independent display interface option)Connector DVI (digital and analog, single link)Pixel clock frequency 31,5 MHz - 119 MHzDigital video signals single link TMDSAnalog video signals 0.7 Vpp@75 OhmHSYNC/VSYNC signalsTTLDDC signals noneDDC power 5V +/-5% @0-55mAECG Sync Output/Analog ECG Output (1/4" stereo phone jack with tip, ring, sleeve)General Connector 1/4" phone with tip, ring, sleeveIsolation functional isolationMX800 Interface Specifications
36 Specifications406Analog ECG Output(ring, tip)Full scale on display signal gain x measured ECG voltageGain error <15 %Baseline offset <100 mVBandwidth 1 to 100 HzOutput voltage swing ±4 V (min)Signal delay <22 msSignal delay with older versions of the M3001A MMS[identifiable with the serial number prefix DE227 or DE441 and option string #A01]<30 msPacemaker Pulse filtered and included in ECG output signalDigital Pulse Output(ring)Output low voltage level<0.4 V @ I=-1 mAOutput high voltage level>2.4 V @ I=1 mAPulse Width 100 ms±10 ms (active high)Pulse Rise Time <1 ms (from 0.4 V to 2.4 V)Signal delay < 25ms per AAMI EC13Signal delay with older versions of the M3001A MMS[identifiable with the serial number prefix DE227 or DE441 and option string #A01]< 35ms per AAMI EC13X2 (M3002A) Interface SpecificationsMeasurement Link (MSL)Connectors Female ODU (Proprietary)Power 30 V to 60 V inputPower Sync. RS-422 compliant input 78.125 kHz (typical)LAN signals IEEE 802.3 10-Base-T compliantSerial signals RS-422 compliantLocal signals Provided for connecting MMS extensionsMX800 Interface Specifications
36 Specifications4071 The short range radio interface is compatible with the following telemetry devices: TRx4841A/TRx4851A Intellivue Telemetry System TransceiverECG Sync Pulse Output (rectangular pulse)Cable detection YesMarker In NoWave Output NoConnector Binder Series 709/719Output levels Output low <0.8 V @ I = -4 mAOutput high >2.4 V @ I = 4 mAIsolation NonePulse Width 100 +/- 10 ms (high)Delay from R-wave peak to start of pulse20 ms maximum per AAMI EC13Minimum required R-wave amplitude0.5 VWireless Network Device Interface Signals RD+/-, TD+/-: IEEE 802.3 10Base-T, PWR, GND12.5 V ±20%, 3.5 W continuousShort Range Radio Interface1Type Internal SRR interfaceTechnology IEEE 802.15.4Frequency Band 2.4 GHz ISM (2.400 - 2.483 GHz)Modulation Technique DSSS (O -QPSK)Effective radiated powermax. 0 dBm (1 mW)M8023A External Power Supply (for M3002A) Interface SpecificationsMeasurement Link (MSL)Connectors Male ODU (Proprietary)Power 48 V outputPower Sync. RS-422 compliant output 78.125 kHz (typical)LAN signals IEEE 802.3 10-Base-T compliantSerial signals RS-422 compliant output 78.125 kHz (typical)Local signals Not connectedIntegrated PC (iPC) Interface SpecificationsEthernet LAN (external) Connector RJ-45LAN Signals IEE 802.3 1000-Base-T compliantReinforced insulation IEC60601-1 A-k compliantUSB  6 external ports (5 rear, 1 right side)Type A connectorsUSB 2.0 supporting high speed modeAudio microphone input stereo 3.5 mm audio jackheadphone output stereo  3.5 mm audio jackDVI Video with DVI-I connector DVI supports resolutions up to 1920x1200VGA supports resolutions up to 2048x1536X2 (M3002A) Interface Specifications
36 Specifications408Measurement SpecificationsSee the Appendix on Default Settings for a list of the settings the monitor is initially shipped with.ECG/Arrhythmia/ST/QTComplies with IEC 60601-2-25:1993 + A1:1999 /EN60601-2-25:1995 + A1:1999, IEC 60601-2-27:2005/EN60601-2-27:2006, IEC 60601-2-51:2003 /EN 60601-2-51:2003 and AAMI EC11/EC13:1991/2002.Display Specifications19" WSXGA Type 482 mm active matrix color LCD (TFT)Resolution 1680 x 1050 (WSXGA+)Refresh frequency 58 HzUseful screen 409,5 mm x 255.9 mmPixel size 0.244 mm x 0.244 mmECG/Arrhythmia/ST Performance SpecificationsCardiotach Range Adult/pedi: 15 to 300 bpmNeo range: 15 to 350 bpmAccuracy ±1% of rangeResolution 1 bpmSensitivity ≥200 µVpeakPVC Rate Range 0 to 300 bpmResolution 1 bpmST Numeric Range -20 to +20 mmAccuracy ±0.5 mm or 15%, whichever is greaterResolution 0.1 mmQT Numeric Range 200 to 800 msAccuracy ±30 msResolution 8 msQTc Numeric Range 200 to 800 msResolution 1 msΔQTc Numeric Range -600 to +600 msResolution 1 msQT-HR Numeric Range - adult 15 to 300 bpmRange - pediatric and neonatal15 to 350 bpm
36 Specifications409Sinus and SV Rhythm Ranges Brady Adult: 15 to 59 bpmPedi: 15 to 79 bpmNeo: 15 to 89 bpmNormal Adult: 60 to 100 bpmPedi: 80 to 160 bpmNeo: 90 to 180 bpmTachy Adult: >100 bpmPedi: >160 bpmNeo: >180 bpmBandwidth Diagnostic Mode Adult/neo/pedi: 0.05 to 150 HzExtended Monitoring ModeAdult/neo/pedi: 0.5 to 150 HzMonitoring Mode Adult: 0.5 to 40 HzNeo/pedi: 0.5 to 55 HzFilter Mode Adult/neo/pedi: 0.5 to 20 HzBandwidthwhen the ECG is transmitted from a telemetry device via short range radioDiagnostic Mode Adult/neo/pedi: 0.05 to 40 HzExtended Monitoring ModeAdult/neo/pedi: 0.5 to 40 HzMonitoring Mode Adult: 0.5 to 40 HzNeo/pedi: 0.5 to 40 HzFilter Mode Adult/neo/pedi: 0.5 to 20 HzDifferential Input Impedance >2 MΩ RA-LL leads (Resp)>5 MΩ at all other leads (at 10 Hz including patient cable)Common Mode Rejection Ratio Diagnostic mode: >86 dB (with a 51 kΩ/47 nF imbalance).Filter mode: >106 dB (with a 51 kΩ/47 nF imbalance).Electrode Offset Potential Tolerance ±500 mVAuxiliary Current(Leads off Detection)Active electrode: <100 nAReference electrode: <900 nAInput Signal Range ±5 mVECG/Arrhythmia/ST/QT Alarm Specifications Range AdjustmentHR 15 to 300 bpmmaximum delay: 10 seconds according to AAMI EC 13-1992 standardAdult:1 bpm steps (15 to 40 bpm)5 bpm steps (40 to 300 bpm)Pedi/Neo:1 bpm steps (15 to 50 bpm)5 bpm steps (50 to 300 bpm)Extreme Tachy Difference to high limit 0 to 50 bpm 5 bpm stepsClamping at 150 to 300 bpm 5 bpm stepsExtreme Brady Difference to low limit 0 to 50 bpm 5 bpm stepsClamping at 15 to 100 bpm 5 bpm stepsRun PVCs 2 PVCs Not adjustable by userPVCs Rate 1 to 99 PVCs/minute 1 PVCVent Tach HR 20 to 300 bpm 5 bpmVent Tach Run 3 to 99 PVCs/minute 1 PVCECG/Arrhythmia/ST Performance Specifications
36 Specifications410Vent Rhythm Run 3 to 99 PVCs/minute 1 PVCSVT HR 120 to 300 bpm 5 bpmSVT Run 3 to 99 SV beats 1 SV beatST High -19.8 to +20 mm 0.2 mmST Low -20 to +19.8 mm 0.2 mmQTc High 200 ms to 800 ms 10 ms stepsΔQTc High 30 ms to 200 ms 10 ms stepsECG/Arrhythmia/ST Supplemental Information as required by AAMI EC11/13, IEC 60601-2-27Respiration Excitation Waveform Sinusoidal signal, 260 μA, 40.5 kHzNoise Suppression RL drive gain 44 dB max., max. voltage 1.8 VrmsTime to Alarm for TachycardiaVent Tachycardia1mVpp,206 bpmGain 0.5, Range 6.5 to 8.4 seconds, Average 7.2 secondsGain 1.0 Range 6.1 to 6.9 seconds, Average 6.5 secondsGain 2.0, Range 5.9 to 6.7 seconds, Average 6.3 secondsVent Tachycardia2mVpp,195 bpmGain 0.5, Range 5.4 to 6.2 seconds, Average 5.8 secondsGain 1.0, Range 5.7 to 6.5 seconds, Average 6.1 secondsGain 2.0, Range 5.3 to 6.1 seconds, Average 5.7 secondsTall T-Wave Rejection Capability Exceeds ANSI/AAMI EC 13 Sect. 3.1.2.1(c) minimum recommended 1.2 mV T-Wave amplitudeHeart Rate Averaging Method Three different methods are used:Normally, heart rate is computed by averaging the 12 most recent RR intervals.For runs of PVCs, up to 8 RR intervals are averaged to compute the HR.If each of 3 consecutive RR intervals is greater than 1200 ms (that is, rate less than 50 bpm), then the 4 most recent RR intervals are aver\-aged to compute the HR.Response Time of Heart Rate Meter to Change in Heart RateHR change from 80 to 120 bpm:Range: [6.4 to 7.2 seconds] Average: 6.8 secondsHR change from 80 to 40 bpm:Range: [5.6 to 6.4 sec] Average: 6.0 secondsHeart Rate Meter Accuracy and Response to Irregular RhythmVentricular bigeminy: 80 bpmSlow alternating ventricular bigeminy: 60 bpmRapid alternating ventricular bigeminy: 120 bpmBidirectional systoles: 90 bpmAccuracy of Input Signal Reproduction Methods A and D were used to establish overall system error and frequency response.Pacemaker Pulse Rejection Performance Rejection of pacemaker pulses with amplitudes from ±2 mV to ±700 mV and widths from 0.1 ms to 2.0 ms (Method A)ECG/Arrhythmia/ST/QT Alarm Specifications Range Adjustment
36 Specifications411RespirationSpO2Unless otherwise specified, this information is valid for SpO2 measured using the M3001A and M3002A Multi-measurement modules and the M1020B measurement module. The SpO2 Performance Specifications in this section apply to devices with Philips SpO2 technology. For SpO2 Performance Specifications valid for other SpO2 technologies, refer to the instructions for use provided with these devices.Complies with ISO 9919:2005 / EN ISO 9919:2009 (except alarm system; alarm system complies with IEC 60601-2-49:2001).Measurement Validation: The SpO2 accuracy has been validated in human studies against arterial blood sample reference measured with a CO-oximeter. Pulse oximeter measurements are statistically distributed, only about two-thirds of the measurements can be expected to fall within the specified accuracy compared to CO-oximeter measurements. Display Update Period: Typical: 2 seconds, Maximum: 30 seconds. Maximum with NBP INOP suppression on: 60 seconds.Respiration Performance SpecificationsRespiration Rate Range Adult/pedi: 0 to 120 rpmNeo: 0 to 170 rpmAccuracy at 0 to 120 rpm ±1 rpmat 120 to 170 rpm ±2 rpmResolution 1 rpmBandwidth 0.3 to 2.5 Hz (-6 dB)Noise Less than 25 mΩ (rms) referred to the inputRespiration Alarm Specifications Range Adjustment DelayHigh Adult/pedi: 10 to 100  rpmNeo: 30 to 150 rpmunder 20 rpm: 1 rpm stepsover 20 rpm: 5 rpm stepsmax. 14 secondsLow Adult/pedi: 0 to 95 rpmNeo: 0 to 145 rpmunder 20 rpm: 1 rpm stepsover 20 rpm: 5 rpm stepsfor limits from 0 to 20 rpm: max. 4 secondsfor limits above 20 rpm: max. 14 secondsApnea Alarm 10 to 40 seconds 5 second steps
36 Specifications412SpO2 Performance SpecificationsSpO2The specified accuracy is the root-mean-square (RMS) difference between the measured values and the reference valuesRange 0 to 100%Option #A01AccuracyPhilips Reusable Sensors:M1191A, M1191AL, M1191B, M1191BL, M1192A, = 2 % (70 % to 100 %)M1193A, M1194A, M1195A, M1196A = 3 % (70 % to 100 %)M1191T, M1192T, M1193T (Adult), M1196T = 3% (70% to 100%)M1193T (Neonate) = 4 % (70 % to 100 %)Philips Disposable Sensors with M1943A(L):M1132A, M1133A (adult/infant), M1134A (adult/infant) = 2 %M1901B, M1902B, M1903B, M1904B, M1131A, M1133A (neonate), M1134A (neonate) = 3 % (70 % to 100 %)NellcorPB® Sensors with M1943A(L):MAX-A, MAX-AL, MAX-P, MAX-I, MAX-N, D-25, D-20, I-20, N-25, OxiCliq A, P, I, N = 3 % (70 % to 100 %)Masimo Reusable Sensors® with LNOP MP12 or LNC MP10:LNOP DC-I, LNOP DC-IP, LNOP YI (adult/pedi/infant), LNCS DC-1, LNCS DC-IP, LNCS YI (adult/pedi/infant) = 2% (70% to 100%)LNOP YI (neonate), LNCS YI (neonate) = 3% (70% to 100%)LNOP TC-I, LNCS TC-I: 3.5 % (70 % to 100 %)Masimo Disposable Sensors® with LNOP MP12 or LNC MP10:LNOP DC-I, LNOP DC-IP, LNOP YI (adult/pedi/infant, LNCS DC-1, LNCS DC-IP, LNCS YI (adult/pedi/infant) = 2 % (70 % to 100 %)LNOP Neo-L, LNOP NeoPt-L, LNCS Neo-L, LNCS NeoPt-L: 3 % (70 % to 100 %)Option #A02AccuracyPhilips Reusable SensorsM1193AN = 3 % (70 % to 100 %)Philips Disposable Sensors with M1943NL:M1901B (Adult), M1902B, M1903B, M1904B = 2 % (70 % to 100 %)M1901B (Neonate) = 3 %NellcorPB® Sensors with M1943NL:MAX-FAST, MAX-A, MAX-AL, MAX-P, MAX-I, MAX-N (Adult) = 2 % (70 % to 100 %)SC-A, OxiCliq A, P, I, N (Adult) = 2.5 % (70  % to 100 %)MAX-N (Neonate), Dura-Y D-YS (Infant to Adult), DS-100A,Oxiband OXI-A/N (Adult), OXI-P/I = 3 % (70 % to 100 %)MAX-R, OxiCliq N (Neonate), SC-NEO (Neonate), SC-PR (Neonate), Dura-Y D-YS with D-YSE or D-YSPD clip = 3.5 % (70 % to 100 %)Dura-Y D-YS (Neonate), Oxiband OXI-A/N (Neonate) = 4 % (70 % to 100 %)Resolution 1%
36 Specifications413Pulse Range 30 to 300 bpmAccuracy ±2% or 1 bpm, whichever is greaterResolution 1 bpmSensors Wavelength range: 500 to 1000 nmEmitted Light Energy: ≤15 mWInformation about the wavelength range can be especially useful to clinicians (for instance, when photodynamic therapy is performed)Pulse Oximeter Calibration Range70% to 100%SpO2 Alarm Specifications Range Adjustment DelaySpO2Adult: 50 to 100%Pedi/Neo: 30 to 100%1% steps (0, 1, 2, 3,... 30) +4 secondsor Smart Alarm Delay (see table below)Desat Adult: 50 to Low alarm limitPedi/Neo: 30 to Low alarm limit1% steps (0, 1, 2, 3,... 30) +4 secondsPulse 30 to 300 bpm Adult:1 bpm steps (30 to 40 bpm)5 bpm steps (40 to 300 bpm)Pedi/Neo:1 bpm steps (30 to 50 bpm)5 bpm steps (50 to 300 bpm)max. 14 secondsTachycardia Difference to high limit 0 to 50 bpm 5 bpm steps max. 14 secondsClamping at 150 to 300 bpm 5 bpm stepsBradycardia Difference to low limit 0 to 50 bpm 5 bpm steps max. 14 secondsClamping at 30 to 100 bpm 5 bpm stepsSpO2 Smart Alarm Delay SpecificationsThe Smart Alarm Delay functionality is currently not available in the U.S.A. or in clinical environments under FDA control.Deviation from violated alarm limitResulting alarm delayShort Medium Long1% 25 sec (maximum delay)50 sec(maximum delay)100 sec(maximum delay)2% 12 sec 25 sec 50 sec3% 10 sec 16 sec 33 sec4% 10 sec 12 sec 25 sec5% 10 sec 10 sec 20 sec6% 10 sec 10 sec 16 secSpO2 Performance Specifications
36 Specifications414NBPComplies with IEC 60601-2-30:1999/EN60601-2-30:2000.7% 10 sec 10 sec 14 sec8% 10 sec 10 sec 12 sec9% 10 sec 10 sec 11 sec>9% 10 sec 10 sec 10 secSpO2 Smart Alarm Delay SpecificationsThe Smart Alarm Delay functionality is currently not available in the U.S.A. or in clinical environments under FDA control.Deviation from violated alarm limitResulting alarm delayShort Medium LongNBP Performance SpecificationsMeasurement RangesSystolic Adult: 30 to 270 mmHg (4 to 36 kPa) Pedi: 30 to 180 mmHg (4 to 24 kPa) Neo: 30 to 130 mmHg (4 to 17 kPa)Diastolic Adult: 10 to 245 mmHg (1.5 to 32 kPa) Pedi: 10 to 150 mmHg (1.5 to 20 kPa) Neo: 10 to 100 mmHg (1.5 to 13 kPa)Mean Adult: 20 to 255 mmHg (2.5 to 34 kPa) Pedi: 20 to 160 mmHg (2.5 to 21 kPa) Neo: 20 to 120 mmHg (2.5 to 16 kPa)Pulse Rate Adult: 40 to 300Pedi: 40 to 300Neo: 40 to 300Accuracy Max. Std. Deviation: 8 mmHg (1.1 kPa)Max. Mean Error: ±5 mmHg (±0.7 kPa)Pulse Rate Measurement Accuracy 40 to 100 bpm: ±5 bpm101 to 200 bpm: ±5% of reading201 to 300 bpm: ±10% of reading(average over NBP measurement cycle)Pulse Rate Range 40 to 300 bpmMeasurement Time Typical at HR >60 bpmAuto/manual/sequence: 30 seconds (adult)25 seconds (neonatal)Stat: 20 secondsMaximum time: 180 seconds (adult/pediatric)90 seconds (neonates)Cuff Inflation Time Typical for normal adult cuff: Less than 10 secondsTypical for neonatal cuff: Less than 2 secondsInitial Cuff Inflation Pressure Adult: 165 ±15 mmHgPedi: 130 ±15 mmHgNeo: 100 ±15 mmHg
36 Specifications415Measurement Validation: In adult and pediatric mode, the blood pressure measurements determined with this device comply with the American National Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP10 - 1992) in relation to mean error and standard deviation, when compared to intra-arterial or auscultatory measurements (depending on the configuration) in a representative patient population. For the auscultatory reference the 5th Korotkoff sound was used to determine the diastolic pressure.In neonatal mode, the blood pressure measurements determined with this device comply with the American National Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP10 - 1992 and AAMI/ANSI SP10A -1996) in relation to mean error and standard deviation, when compared to intra-arterial measurements in a representative patient population.Invasive Pressure and PulseComplies with IEC 60601-2-34:2000/EN60601-2-34:2000.Auto Mode Repetition Times 1, 2, 2.5, 3, 5, 10, 15, 20, 30, 45, 60 or 120 minutesSTAT Mode Cycle Time 5minutesVenipuncture Mode InflationInflation Pressure Adult 20 to 120 mmHg (3 to 16 kPa)Pediatric 20 to 80 mmHg (3 to 11 kPa)Neonatal 20 to 50 mmHg (3 to 7 kPa)Automatic deflation afterAdult/pediatric 170 secondsNeonatal 85 secondsNBP Alarm Specifications Range AdjustmentSystolic Adult: 30 to 270 mmHg (4 to 36 kPa) 10 to 30 mmHg: 2 mmHg (0.5 kPa)>30 mmHg: 5 mmHg (1 kPa)Pedi: 30 to 180 mmHg (4 to 24 kPa)Neo: 30 to 130 mmHg (4 to 17 kPa)Diastolic Adult: 10 to 245 mmHg (1.5 to 32 kPa)Pedi: 10 to 150 mmHg (1.5 to 20 kPa)Neo: 10 to 100 mmHg (1.5 to 13 kPa)Mean Adult: 20 to 255 mmHg (2.5 to 34 kPa)Pedi: 20 to 160 mmHg (2.5 to 21 kPa)Neo: 20 to 120 mmHg (2.5 to 16 kPa)NBP Overpressure SettingsAdult >300 mmHg (40 kPa) >2 sec not user adjustablePediatric >300 mmHg (40 kPa) >2 secNeonate >150 mmHg (20 kPa) >2 secNBP Performance Specifications
36 Specifications416Invasive Pressure Performance SpecificationsMeasurement Range -40 to 360 mmHgPulse Rate Range 25 to 350 bpmAccuracy ±1% Full RangeResolution 1 bpmInput Sensitivity Sensitivity: 5 µV/V/mmHg (37.5 µV/V/kPa)Adjustment range: ±10%Transducer Load Impedance: 200 to 2000 Ω (resistive)Output Impedance: ≤3000 Ω (resistive)Frequency Response dc to 12.5 Hz or 40 HzZero Adjustment Range ±200 mmHg (±26 kPa)Accuracy ±1 mmHg (±0.1 kPa)Drift Less than 0.1 mmHg/°C (0.013 kPa/°C)Gain Accuracy Accuracy ±1%Drift Less than 0.05%/°CNon linearity and HysteresisError of ≤0.4 %FS (@CAL 200 mmHg)Overall Accuracy (including transducer)±4% of reading or ±4 mmHg (±0.5 kPa), whichever is greaterVolume displacement of CPJ840J6 0.1 mm3 /100 mmHgAnalog output SpecificationsAnalog Outputavailable only with M1006B #C01 (@ CAL 200 mmHg)Range -0.4 V to 3.6 VLevel 1 V / 100 mmHgAccuracy ±3% full scaleOffset ±30 mVResolution 8 Bit (@ 5 V range)Signal delay 20 ms