Philips Medical Systems North America SRRBV1 Dual SRR Module User Manual ait fm manual en 2011 03 24

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In stru ctio ns fo r Use
IntelliVue Patient Monitor
MX600/MX700/MX800
Rel ease H.0 wi th Softwa re Revi sion H.1 x.xx
Patient Monitori ng
Part Number 453564260091
Printed in Germany 05/11
*453564260091*
Table of Contents
1 Introduction
Introducing the Monitor
Devices for Acquiring Measurements
Operating and Navigating
Operating Modes
Understanding Screens
Connecting Additional Displays to the Monitor
Using the XDS Remote Display
Using the Visitor Screen
Understanding Profiles
Understanding Settings
Changing Wave Speeds
Freezing Waves
Using Labels
Entering Measurements Manually
Changing Monitor Settings
Checking Your Monitor Revision
Getting Started
Disconnecting from Power
Networked Monitoring
Using the Integrated PC
Using the X2 or MP5 with a Host Monitor
2 Alarms
Visual Alarm Indicators
Audible Alarm Indicators
Acknowledging Alarms
Pausing or Switching Off Alarms
Alarm Limits
Reviewing Alarms
Latching Alarms
Testing Alarms
Alarm Behavior at Power On
Alarm Recordings
3 Patient Alarms and INOPs
Patient Alarm Messages
Technical Alarm Messages (INOPs)
13
13
15
24
31
32
33
34
34
34
36
37
38
39
42
42
43
43
45
45
46
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49
50
51
53
54
56
60
61
62
62
63
65
65
70
4 Managing Patients
Admitting a Patient
Quick Admitting a Patient
Editing Patient Information
Discharging a Patient
Transferring Patients
Data Upload from an MMS
Care Groups
95
95
96
97
97
98
102
105
5 ECG, Arrhythmia, ST and QT Monitoring
111
Skin Preparation for Electrode Placement
Connecting ECG Cables
Selecting the Primary and Secondary ECG Leads
Checking Paced Status
Understanding the ECG Display
Monitoring Paced Patients
Changing the Size of the ECG Wave
Changing the Volume of the QRS Tone
Changing the ECG Filter Settings
Selecting Positions of Va and Vb Chest Leads (for 6-lead placement)
Choosing EASI or Standard Lead Placement
About ECG Leads
ECG Lead Fallback
ECG Lead Placements
Capture 12-Lead
EASI ECG Lead Placement
ECG and Arrhythmia Alarm Overview
Using ECG Alarms
ECG Safety Information
About Arrhythmia Monitoring
Switching Arrhythmia Analysis On and Off
Choosing an ECG Lead for Arrhythmia Monitoring
Understanding the Arrhythmia Display
Arrhythmia Relearning
Arrhythmia Alarms
About ST Monitoring
Switching ST On and Off
Understanding the ST Display
Updating ST Baseline Snippets
Recording ST Segments
About the ST Measurement Points
ST Alarms
Viewing ST Maps
About QT/QTc Interval Monitoring
QT Alarms
Switching QT Monitoring On and Off
111
111
112
112
112
113
114
115
115
116
116
116
117
117
123
125
126
127
128
129
130
130
132
134
135
139
140
141
142
142
143
145
146
149
152
153
6 Monitoring Pulse Rate
Entering the Setup Pulse Menu
System Pulse Source
Switching Pulse On and Off
Using Pulse Alarms
7 Monitoring Respiration Rate (Resp)
Lead Placement for Monitoring Resp
Understanding the Resp Display
Changing Resp Detection Modes
Changing the Size of the Respiration Wave
Changing the Speed of the Respiration Wave
Using Resp Alarms
Changing the Apnea Alarm Delay
Resp Safety Information
8 Monitoring SpO2
SpO2 Sensors
Applying the Sensor
Connecting SpO2 Cables
Measuring SpO2
SpO2 Signal Quality Indicator (Fast SpO2 only)
Assessing a Suspicious SpO2 Reading
Changing the Averaging Time
Understanding SpO2 Alarms
Pleth Wave
Perfusion Numeric
Perfusion Change Indicator
Setting SpO2/Pleth as Pulse Source
Setting Up Tone Modulation
Setting the QRS Volume
Calculating SpO2 Difference
9 Monitoring NBP
Introducing the Oscillometric NBP Measurement
Preparing to Measure NBP
Starting and Stopping Measurements
Enabling Automatic Mode and Setting Repetition Time
Enabling Sequence Mode and Setting Up The Sequence
Choosing the NBP Alarm Source
Switching Pulse from NBP On/Off
Assisting Venous Puncture
Calibrating NBP
10 Monitoring Temperature
Making a Temp Measurement
155
155
155
156
156
159
159
160
160
161
162
162
162
162
165
165
165
166
166
167
168
168
168
171
171
171
172
172
172
172
173
173
175
176
178
178
178
179
179
179
181
181
Calculating Temp Difference
182
11 Monitoring Invasive Pressure
183
Setting up the Pressure Measurement
Zeroing the Pressure Transducer
Adjusting the Calibration Factor
Displaying a Mean Pressure Value Only
Changing the Pressure Wave Scale
Optimizing the Waveform
Using the Wave Cursor
Non-Physiological Artifact Suppression
Choosing the Pressure Alarm Source
Calibrating Reusable Transducer CPJ840J6
Calculating Cerebral Perfusion Pressure
Calculating Pulse Pressure Variation
Measuring Pulmonary Artery Wedge Pressure
Editing the Wedge
Identifying the Pressure Analog Output Connector
183
184
186
187
187
187
187
188
188
189
191
191
192
193
193
12 Monitoring Cardiac Output
Hemodynamic Parameters
Using the C.O. Procedure Window
Accessing the Setup C.O. and Setup CCO Menus
Entering the HemoCalc Window
Measuring C. O. Using the PiCCO Method
Measuring C.O. Using the Right Heart Thermodilution Method
Documenting C.O. Measurements
C.O. Injectate Guidelines
C.O./CCO Curve Alert Messages
C.O./CCO Prompt Messages
C.O./CCO Warning Messages
C.O./CCO Safety Information
195
195
196
197
198
198
203
206
206
207
209
209
210
13 Monitoring Carbon Dioxide
213
Measurement Principles
Measuring CO2 using M3014A or X2
Measuring Mainstream CO2 using M3016A
Measuring Microstream CO2 using M3015A/B
Setting up all CO2 Measurements
214
214
218
220
222
14 Monitoring Airway Flow, Volume and Pressure
Attaching the Flow Sensor
Zero Calibration
Automatic Purging
Manual Purging
Gas Compensation
225
226
228
228
229
229
Setting up Spirometry
15 Monitoring tcGas
Identifying tcGas Module Components
Setting the tcGas Sensor Temperature
Using the tcGas Site Timer
Setting the tcGas Barometric Pressure
Remembraning the tcGas Transducer
Calibrating the tcGas Transducer
Applying the tcGas Transducer
Finishing tcGas Monitoring
TcGas Corrections
16 Monitoring Intravascular Oxygen Saturation
Selecting a Measurement Label
Preparing to Monitor with the M1021A Wide Module
Preparing to Monitor with the M1011A Narrow Module
Further Information for Both Modules
17 Monitoring EEG
EEG Monitoring Setup
Using the EEG Impedance/Montage Window
About Compressed Spectral Arrays (CSA)
Changing EEG Settings
EEG Reports
EEG Safety Information
EEG and Electrical Interference
18 Monitoring BIS
BIS Monitoring Setup
BIS Continuous Impedance Check
BIS Cyclic Impedance Check
BIS Window
Changing the BIS Smoothing Rate
Switching BIS and Individual Numerics On and Off
Changing the Scale of the EEG Wave
Switching BIS Filters On or Off
BIS Safety Information
19 Assigning a Telemetry Device and a Monitor to One Patient
How Can You Combine Devices?
Functions Available When the Telemetry Data Window is Displayed
General Telemetry-related Functions
Use Models With Telemetry
230
233
233
233
234
235
235
235
237
238
238
241
242
242
246
247
249
249
250
252
253
254
254
255
257
257
259
260
260
261
262
262
262
262
265
265
267
268
269
20 Trends
Viewing Trends
Setting Up Trends
Documenting Trends
Trends Databases
Screen Trends
21 Calculations
Viewing Calculations
Reviewing Calculations
Performing Calculations
Entering Values for Calculations
Documenting Calculations
22 High Resolution Trend Waves
Changing the Hi-Res Trend Waves Displayed
Hi-Res Trend Wave Scales
Hi-Res Trend Waves and OxyCRG
Printing Hi-Res Trend Wave Reports
Hi-Res Trend Wave Recordings
23 Event Surveillance
271
271
274
278
278
279
283
284
285
285
286
287
289
289
289
289
290
290
291
Levels of Event Surveillance
Event Groups
Event Episodes
Events Pop-Up Keys
Event Triggers
The Events Database
Viewing Events
Annotating Events
Documenting Events
291
292
292
293
294
298
298
301
301
24 ProtocolWatch
309
SSC Sepsis Protocol
25 Recording
Central Recording
Starting and Stopping Recordings
Overview of Recording Types
All ECG Waves Recordings
Creating and Changing Recordings Templates
Changing ECG Wave Gain
Recording Priorities
Recording Strip
Reloading Paper
Recorder Status Messages
309
317
317
317
319
319
320
321
321
321
323
323
26 Printing Patient Reports
325
Starting Report Printouts
Stopping Reports Printouts
Setting Up Reports
Setting Up Individual Print Jobs
Checking Printer Settings
Printing a Test Report
Switching Printers On Or Off for Reports
Dashed Lines on Reports
Unavailable Printer: Re-routing Reports
Checking Report Status and Printing Manually
Printer Status Messages
Sample Report Printouts
325
326
327
328
329
329
329
329
330
330
331
332
27 Using the Drug Calculator
337
Accessing the Drug Calculator
Performing Drug Calculations
Charting Infusion Progress
Using the Titration Table
Documenting Drug Calculations
338
338
340
341
341
28 IntelliBridge EC10 Module
343
Connecting an External Device
Changing Waves and Numerics Displayed
Viewing the IntelliBridge Device Data Window
Using Screens with External Device Data
Alarms/INOPs from External Devices
Language Conflict with External Device Drivers
343
344
344
344
345
345
29 VueLink Modules
Connecting an External Device
Changing VueLink Waves and Numerics Displayed
Viewing the VueLink Device Data Window
Using VueLink Screens
Switching VueLink On and Off
Alarms/INOPs From External Devices
Language Conflict with External Device Drivers
30 Using Timers
Viewing Timers
Timer Setup Pop-up Keys
Setting Up Timers
Displaying a Timer On The Main Screen
Displaying A Clock On The Main Screen
347
348
348
349
349
349
350
350
351
351
352
352
353
354
31 Respiratory Loops
355
Viewing Loops
Capturing and Deleting Loops
Showing/Hiding Loops
Changing Loops Display Size
Using the Loops Cursor
Changing Loops Type
Setting Up Source Device
Documenting Loops
355
356
356
356
356
357
357
357
32 Laboratory Data
359
Viewing Received Data
33 Care and Cleaning
General Points
Cleaning the Monitor
Disinfecting the Monitor
Sterilizing the Monitor
Cleaning, Sterilizing and Disinfecting Monitoring Accessories
Cleaning the SO2 Optical Module
Cleaning the Recorder Printhead (M1116B only)
34 Maintenance and Troubleshooting
Inspecting the Equipment and Accessories
Inspecting the Cables and Cords
Maintenance Task and Test Schedule
Troubleshooting
Disposing of the Monitor
Disposing of Empty Calibration Gas Cylinders
35 Accessories
ECG/Resp Accessories
NBP Accessories
Invasive Pressure Accessories
SpO2 Accessories
Temperature Accessories
Cardiac Output (C.O.) Accessories
Mainstream CO2 Accessories
Sidestream CO2 Accessories
Mainstream CO2 Accessories (for M3016A)
Microstream CO2 Accessories
Spirometry Accessories
tcGas Accessories
EEG Accessories
BIS Accessories
SO2 Accessories for M1021A
10
359
361
361
362
362
363
363
363
363
365
365
366
366
367
367
367
369
369
372
375
376
380
381
382
382
383
383
384
385
385
385
386
SO2 Accessories for M1011A
Recorder Accessories
Battery Accessories
386
386
386
36 Specifications
387
Intended Use
Manufacturer's Information
Symbols
Installation Safety Information
Monitor Mounting Precautions
Altitude Setting
Monitor Safety Specifications
EMC And Radio Regulatory Compliance
Physical Specifications
Environmental Specifications
Performance Specifications
Interface Specifications
Measurement Specifications
Safety and Performance Tests
387
387
389
390
393
393
393
393
395
397
399
401
405
424
37 Default Settings Appendix
429
Country-Specific Default Settings
Alarm and Measurement Default Settings
Alarm Default Settings
ECG, Arrhythmia, ST and QT Default Settings
Pulse Default Settings
Respiration Default Settings
SpO2 Default Settings
NBP Default Settings
Temperature Default Settings
Invasive Pressure Default Settings
Cardiac Output Default Settings
CO2 Default Settings
Spirometry Default Settings
tcGas Default Settings
Intravascular Oxygen Saturation
SvO2 Default Settings
ScvO2 Default Settings
EEG Default Settings
BIS Default Settings
VueLink Default Settings
429
436
436
437
438
439
439
440
440
441
443
444
444
445
445
446
446
446
447
447
Index
449
11
12
1
Introduction
These Instructions for Use are for clinical professionals using the IntelliVue MX600/MX700/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 Monitor
The IntelliVue MX600/MX700/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
MX600 uses the navigation knob as primary input device and the MX700/MX800 use the touch
screen as primary input device. All monitors have a remote control for convenient access to the five
main keys and numeric data input.
13
1 Introduction
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.
With 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 Keys
MX600/700:
14
Color coded alarm lamps
Alarms Off lamp
Power on/Standby switch with
integrated LED: Green - On/
Standby, Red - Error
AC power LED
Mounting quick-release lever
(when this is pressed the
monitor is not fixed on the
mounting)
Part number and serial number
Hardkeys (Silence, Alarms Off,
Main Screen)
Navigation knob
1 Introduction
MX800:
Color coded alarm lamps
Alarms Off lamp
Power on/Standby switch with
integrated LED: Green - On/
Standby, Red - Error
AC power LED
Mounting quick-release lever
(when this is pressed the
monitor is not fixed on the
mounting)
Part number and serial number
Devices for Acquiring Measurements
The 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 389.
WARNING
When connecting devices for acquiring measurements, always position cables and tubing carefully to
avoid entanglement or potential strangulation.
Flexible Module Rack (M8048A)
The 8-slot flexible module rack (FMS-8) lets you use up to eight plug-in physiological measurement
modules. For the MX800, you can connect two FMSs to use up to 10 measurement modules.
The maximum number of specific module types that can be used simultaneously in an FMS-8 is: five
pressure modules, four temperature modules, four VueLink or IntelliBridge modules (any
combination).
15
1 Introduction
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.
X1 Multi-Measurement Module
Multi-Measurement Module
mount
Flexible Module Rack FMS-8
Power on LED
Interruption indicator
4-Slot Flexible Module Rack (FMS-4)
The 4-Slot flexible module rack (FMS-4) lets you use up to four plug-in physiological measurement
modules.
The maximum number of specific module types that can be used simultaneously in an FMS-4 is: four
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 (if you have the appropriate option) to connect an additional MMS. Use the
connector on the back to connect to the monitor.
Measurement Modules
You can use up to eight measurement modules with the Flexible Module Rack (M8048A). Available
modules are:
16
•
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)
1 Introduction
•
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.
The 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)
Module name
Setup key LED
Setup 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.
Connector socket for patient cable/transducer
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.
17
1 Introduction
X1 Connectors and Symbols
White ECG/Resp connector
Blue SpO2 connector
Red NBP connector
Combined 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.
NBP STAT key - starts NBP STAT series
of measurements
OR
Zero key - initiates a zero procedure for the
connected pressure transducer when
pressed and held for a second
NBP Start/Stop key - starts or stops NBP
measurements
Silence: acknowledges all active alarms by
switching off audible alarm indicators and
lamps
X2 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.
18
1 Introduction
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.
X2 Overview
On/Standby switch
Power and battery indicators (see “X2
Controls and Indicators” on page 20)
3.5-inch TFT LCD touchscreen QVGA
display
Alarm lamps (see “X2 Controls and
Indicators” on page 20)
Battery eject button
Hard keys (see “X2 Controls and
Indicators” on page 20)
Measurement connectors (see “X2 Patient
Connectors, Right Side” on page 21)
Battery compartment
19
1 Introduction
X2 Controls and Indicators
External power LED. Green when monitor is powered from an external power source.
Battery status LED. Yellow when charging. Flashing red when battery is empty.
On/Standby LED. Green when monitor is on. Red indicates an error.
On/Standby switch. Disabled when X2 is connected to a host monitor
Main Screen key: closes all open menus/windows and returns to the main screen.
SmartKeys key: brings up SmartKeys on the screen.
Alarms key: turns alarms On/Off, or pauses them.
Silence key
Active 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.
20
1 Introduction
X2 Patient Connectors, Right Side
Showing symbols version (international) - English version has text labels
Pressure (option)
Temperature (option)
Noninvasive blood pressure
SpO2
ECG sync pulse output
ECG/Respiration
CO2 (option in place of Pressure and Temperature)
X2 Left Side
Loudspeaker
MSL 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.
MMS Extensions
The 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.
21
1 Introduction
M3014A, M3015A, M3015B and M3016A Capnography MMS Extensions
The 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.
M3014A
22
Pressure connectors (red)
Temperature connector (brown)
Mainstream/sidestream connector CO2
Cardiac Output connector
1 Introduction
The 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.
M3015A
M3015B
Pressure connectors (red) - M3015A optional
Temperature connector (brown) - M3015A optional
Inlet
Microstream connector CO2
Gas sample outlet
The optional M3016A Mainstream CO2 extension adds mainstream capnography and optionally either
pressure or temperature to the MMS.
M3016A
Pressure connectors (red)
Temperature connector (brown)
Mainstream/sidestream connector CO2
(optional)
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 40).
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1 Introduction
The 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 Extension
Cardiac Output (orange; optional)
Connection to MMS
Pressure connectors (red)
Temperature connectors (brown)
The 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 Navigating
Everything 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.
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1 Introduction
Monitor information line
Other screen elements
network connection indicator
(documented in Information
Center Instructions for Use)
10
alarm status area - shows active alarm messages
bed label
11
status line - shows information messages and prompting you for action
patient identification
12
close all open menus and windows and return to main screen
patient category
13
enter Main Setup menu
paced status
14
scroll right to display more SmartKeys
date and time
15
SmartKeys - these change according to your monitor's configuration
access the Profiles menu
16
scroll left to display more SmartKeys
current 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.
adjust 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.
Selecting Screen Elements
Select 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.
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1 Introduction
Using the Touchscreen
Select screen elements by pressing them directly on the monitor's screen.
Disabling Touchscreen Operation
To 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 Trackball
If 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 Windows
You can move windows and menus using the Touchscreen or a mouse. To move a window,
Select the title of the window and keep your finger on the title, or the mouse button pressed.
Move your finger on the Touchscreen, or move the mouse, to move the window.
Take 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 Keys
The monitor has four different types of keys:
Permanent Keys
A 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.
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1 Introduction
SmartKeys
A 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 profile
change Screen, or revert to default
screen
show BIS Sensor
previous Screen
freeze waves
quick admit a patient
set alarm limits
enter patient identification menu to
admit/discharge/transfer
change alarm volume
end case to discharge a patient
change QRS volume
view information for patients in
other beds
enter 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 arrhythmia
change amplitude (size) of ECG
wave
enter cardiac output procedure
- start/stop manual NBP
measurement
- start auto series
- stop current automatic
measurement within series
start NBP STAT measurement
start NBP measurement and
measurement series
stop current NBP measurement
start veni puncture (inflate cuff to
subdiastolic pressure)
set the NBP repeat time
access patient reports
zero invasive pressure transducer
stop automatic or STAT NBP
measurement and measurement
series
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1 Introduction
28
start a delayed recording
access pop-up recording keys
access Vital Signs recording function
access Select Waves recording
function
set wide automatic alarm limits
set narrow automatic alarm limits
access wedge procedure window
access the Loops window
review vital signs trend
review graph trend
access event surveillance
access calculations
access the calculator
access the Drug Calculator
gas analyzer - exit standby mode
suppress zero for all gas
measurements
unpair equipment and continue
central monitoring with the monitor
unpair equipment and continue
central monitoring with the telemetry
device
access the spirometry data window
access ST Map application
start 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
display external device information
access timers
access ProtocolWatch
set standard or EASI lead placement
switch CO2 pump off
new lead setup
enter data manually
start/stop car seat assessment record
open the Histogram window
open Unit Conversion window
1 Introduction
Hardkeys
A 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 Keys
Pop-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.
Using the Remote Control
The remote control provides you with direct access to five hard keys, a navigation knob and a numeric
keypad:
Hardkeys
Silence - acknowledges all active alarms by switching off audible alarm indicators and lamps.
Behavior follows the Silence permanent key configuration.
Alarms Off/Pause Alarms - pauses alarm indicators. Behavior follows the Pause Alarms
permanent key configuration.
Main Screen - close all open menus and windows and return to the main screen.
SmartKeys - display a block of SmartKeys specially configured for remote tasks (see below)
Back - go back one step to the previous menu.
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1 Introduction
Keypad
Type numeric data on the keypad and press the Enter key to enter the data on the monitor.
Navigation knob
Rotate the knob to highlight screen elements, then press to select the highlighted element.
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 or Service mode.
CAUTION
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.
Using the SmartKeys Key
The 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 Keyboard
Use 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.
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Using the On-Screen Calculator
You 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 Modes
When you switch the monitor on, it starts up in monitoring mode. To change to a different mode:
Select the Main Setup menu.
Select Operating Modes and choose the mode you require.
Your monitor has four operating modes. Some are passcode protected.
•
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 Mode
Standby 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.
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1 Introduction
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.
Understanding Screens
Your 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 Screen
To switch to a different Screen, select the current Screen name in the monitor info line, or select
the Change Screen SmartKey.
Choose the new Screen from the pop-up list.
Changing a Screen's Content
If 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,
Select the element you want to change.
From 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.
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1 Introduction
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 menu
or
•
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.
If 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 Monitor
You 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:
Move 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.
Press 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:
Select Profiles in the monitor info line of the first display,
Select 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.
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1 Introduction
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 Display
Using 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.
For more details, including limitations and restrictions, refer to the Instructions for Use for the XDS
Application.
Using the Visitor Screen
If 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 Profiles
Profiles 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.
•
34
Measurement Settings
Each 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).
1 Introduction
•
Monitor Settings
Each 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.
WARNING
If 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 Profile
Select Profiles in the monitor info line, or select the Profiles SmartKey.
In the Profiles menu, select Profile.
Chose a profile from the pop-up list.
Confirm your selection.
Swapping a Settings Block
Select Profiles in the monitor info line, or select the Profiles SmartKey.
In the Profiles menu, select Display or Measmnt.Settings or Monitor Settings to call up a list of
the settings blocks in each category.
Choose a settings block from the pop-up list.
Confirm your selection.
Default Profile
Your 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.
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1 Introduction
Locked Profiles
Some profiles are locked, so that you cannot change them, even in Configuration Mode.
These are indicated by this lock symbol.
Understanding Settings
Each aspect of how the monitor works and looks is defined by a setting. There are a number of
different categories of settings, including,
Screen Settings, to define the selection and appearance of elements on each individual Screen
Measurement settings, to define settings unique to each measurement, for example, high and low
alarm limits
Monitor 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 Settings
Each 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.
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1 Introduction
Switching a Measurement On and Off
When 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.
Enter the measurement's setup menu and select the measurement.
Select the measurement name to switch between on and off. The screen display indicates the active
setting.
Switching Numerics On and Off
For 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.
Adjusting a Measurement Wave
To 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 Speeds
Lowering 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 Speed
The wave speed group setting defines the speed of all the waves in the group.
To change the wave speed of a wave speed group,
Select Main Setup, then select User Interface
Select Global Speed, RespiratorySpeed, or EEG Speed as required
Select a value from the list of available speeds.
Changing Wave Speed for a Channel
To change the wave speed of an individual wave channel,
Enter the Wave menu for a measurement by selecting its wave.
Select Change Speed.
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1 Introduction
To 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 Waves
You 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 Wave
To freeze a wave,
Enter the Wave menu for the measurement by selecting the wave on the screen.
Select Freeze Wave.
The realtime wave is replaced with the frozen wave.
Freezing All Waves
To freeze all waves on the screen,
Select the Freeze Waves SmartKey.
All realtime waves are replaced with frozen waves.
Measuring Frozen Waves
To measure a frozen wave,
Select 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, or
Using 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.
Use 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 Speed
Lowering 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.
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1 Introduction
To change the wave speed:
Select the frozen wave.
Select Change Speed.
Select a speed from the list.
Updating The Frozen Wave
To update the wave, that is freeze the current wave:
Select the frozen wave.
Select Freeze Again.
Releasing Frozen Waves
To release frozen waves,
Select a frozen wave.
Select Unfreeze Waves.
All frozen waves are released.
Using Labels
You 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),
Enter the wave menu of the measurement.
Select Label.
Choose 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 Sets
Your 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 on Pressure and Temperature in these Instructions for
Use 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.
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1 Introduction
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 Conflicts
Each 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.
All 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.
De-activated devices are grayed-out (here
the Temp measurement on the left)
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".
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1 Introduction
When an X2 or MP5 is connected to a host monitor, the measurement selection window looks like
this:
X2 connected to host monitor
MP5 connected to host monitor
WARNING
When 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:
Select the measurement selection key or select Main Setup, then Meas. Selection to display the
Measurement Selection window.
Select the device whose label you want to correct.
Use the measurement selection pop-up keys to resolve the conflict. Select either:
– Change Label: to assign a different label to the conflicting label
– 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 : 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 Compatibility
When 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.
41
1 Introduction
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.
Entering Measurements Manually
You 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,
Select the Enter Values SmartKey or select Main Setup then select Enter MeasValues.
Select the measurement you want to enter values for. The Edit window will open.
If the measurement is switched off, switch it on by selecting the label.
Select Value and enter the value.
Select Date/Time to enter the date and time for the value. The default is always the current date
and time.
For compound labels, for example ABPs, ABPd and ABPm, select the Format field to select
whether all values are required or a single value.
Select 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 Off
To switch a manually entered measurement on or off,
Select the Enter Values SmartKey or select Main Setup then select Enter MeasValues.
Select the measurement you want to switch on or off.
Select the measurement label field to switch between On and Off.
Changing Monitor Settings
To 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.
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1 Introduction
Adjusting the Screen Brightness
Select the Brightness SmartKey.
Select 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 Time
Select the Date, Time screen element from the monitor's info line to enter the Date, Time menu.
Select, 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.
Select 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.
WARNING
Changing the date or time will affect the storage of trends and events.
Checking Your Monitor Revision
Select Main Setup then select Revisions to open the Monitor Revision menu.
Select the correct device from the device pop-up keys.
From the Monitor Revision menu, select the monitor component for which you need revision
information.
Getting Started
Once 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).
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1 Introduction
Inspecting the Monitor
WARNING
If 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.
Before 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.
Plug the power cord into the AC power source.
Check all the functions of the instrument that you need to monitor the patient, and ensure that the
instrument is in good working order.
Switching On
Press the power on/standby switch on the monitor for one second. The monitor performs a self test
during which all lamps will light up and a tone will be sounded, 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.
Power On/Power Off Behavior
The 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 Modules
Decide which measurements you want to make.
Connect the required modules, MMSs, or MMS extensions.
Check 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 Monitoring
After you switch on the monitor,
44
Admit your patient to the monitor.
Check 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.
1 Introduction
Refer to the appropriate measurement chapter for further details of how to perform the
measurements you require.
WARNING
During MR imaging, remove all transducers, sensors and cables from the patient. Induced currents
could cause burns.
Disconnecting from Power
The On/Standby switch does not disconnect the monitor from the ac power source. To disconnect,
unplug the power cable.
Monitoring After a Power Failure
If 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.
Networked Monitoring
You 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).
WARNING
Do 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 265.)
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.
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1 Introduction
Using the Integrated PC
If 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 iPC
Your monitor may be configured to have the iPC start up automatically when the monitor is switched
on. If not:
Select Main Setup then Internal PC.
In the Internal PC menu, select Switch PC On to start the iPC.
Viewing the iPC Desktop on the Monitor Display
If the Desktop is not displayed on the monitor display:
Select the iPC key
, or
Select Main Setup, Internal PC, then Show PC Window.
To hide the Desktop again, select Main Screen.
Adjusting the iPC Audio Volume
The 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.
WARNING
Always 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.
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1 Introduction
Using Input Devices with the iPC and Monitor
You 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. Input devices
connected to the iPC can also be shared with the patient monitor. Sharing input devices and
touchscreen input requires a specific software application; refer to the IntelliVue XDS Application
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 Down
The 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,
Select Main Setup then Internal PC.
In 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,
Select Main Setup then Internal PC.
In 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.
•
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 Monitor
When 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.
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1 Introduction
48
•
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.
2
Alarms
The 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 Alarms
Patient 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).
INOPs
INOPs 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 TeleBatt
All 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.
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2 Alarms
The monitor sounds an audible indicator for the highest priority alarm. If more than one alarm
condition is active in the same measurement, the monitor announces the most severe. Your monitor
may be configured to increase alarm indicator volume automatically during the time when the alarm is
not acknowledged.
Visual Alarm Indicators
WARNING
•
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 Message
An 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 Numeric
The numeric of the measurement in alarm flashes.
Bright Alarm Limits
If the alarm was triggered by an alarm limit violation, the corresponding alarm limit on the monitor
screen is shown more brightly if Show ALarmLimits is enabled and there is sufficient room on the
screen.
Alarm Lamp
A 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:
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2 Alarms
INOP Lamp Color
On
Off
Yellow
1.0 seconds
1.0 seconds
Red
0.25 seconds
0.25 seconds
If 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 Systems
If configured to do so, red, yellow and light blue alarms are indicated on any device connected to the
nurse call relay.
Audible Alarm Indicators
The 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 Configuration
The audible alarm indicators of your monitor are configurable. In the monitor's Configuration Mode,
you can:
•
increase the alarm volume of unacknowledged alarms at regular intervals
•
change the interval between alarm sounds (ISO/IEC Standard alarms only)
•
change the base volume of the red and yellow alarm tones and the INOP tones
•
change the alarm sound to suit the different alarm standards valid in different countries.
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.
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2 Alarms
•
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 INOP
If 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 INOPs
Severe yellow or red INOPs require action to ensure the well-being of the patient. Therefore the
minimum volume for the INOP tone is set to at least alarm volume 8, irrespective of the current alarm
volume setting. The INOP tone will sound even if the monitor alarm volume is set to zero.
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2 Alarms
The 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 Tone
When 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 Alarms
To 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
monitor is configured to re-alarm, a dashed check mark will be shown
. If the
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 INOPs
Acknowledging 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.
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2 Alarms
Alarm Reminder
If Alarm Reminder is configured on for your monitor, you will get an audible reminder of alarm
conditions that remain active after you have acknowledged the alarm. This reminder may take the form
of a repetition of the alarm tone for a limited time, or an unlimited repetition of the alarm tone (this is
the same as a new alarm). Alarm Reminder is 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 Alarms
If you want to temporarily prevent alarms from sounding, for example while you are moving a patient,
you can pause alarms. Depending on your monitor configuration, alarms are paused for one, two, or
three minutes, or infinitely.
To view the alarm pause setting chosen for your unit,
Select Main Setup, Alarms, then Alarm Settings
Check 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 Off
You 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.
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2 Alarms
To Switch Individual Measurement Alarms On or Off
Select the measurement numeric to enter its setup menu.
Select Alarms to switch between on and off.
The alarms off symbol is shown beside the measurement numeric.
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.
Alarms Paused
Alarms Off
•
No alarms are sounded and no alarm messages are shown.
•
INOP messages are shown but no INOP tones are sounded.
The only exceptions are the INOPs CUFF 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 Alarms
To 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 Timeouts
To reset the arrhythmia alarm timeout period, select the Alarms Off or Pause Alarms permanent key
and then reselect it.
Extending the Alarm Pause Time
If 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.
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2 Alarms
To extend the alarm pause time to five or 10 minutes,
Select one of the alarm fields. This calls up the Alarm Messages window.
Select either the pop-up key PauseAl. 5 Min or the pop-up key PauseAl. 10 Min. Each time you
select one of these pop-up keys, the Alarm Pause Time is reset to five (or 10) minutes.
Alarm Limits
The 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.
WARNING
Be 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 Limits
You 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 Limits
The 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.
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2 Alarms
Measurement labels, with alarms off symbol where appropriate
Current alarm limits
Graphic 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 Limits
To change individual measurement alarm limits using the measurement's Setup Menu,
In the measurement's setup menu, select the alarm limit you want to change. This calls up a list of
available values for the alarm limit.
Select a value from the list to adjust the alarm limit.
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.
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2 Alarms
Parameter label
High red alarm (view only)
High yellow alarm field. Select to open a pop-up list of high alarm limits
Alarms On/Off key - select to switch between alarms on or off
Preview Alarm AutoLimits for a measurement before applying
Select to apply wide AutoLimits
Select to apply narrow AutoLimits
Low yellow alarm field. Select to open a pop-up list of low alarm limits
Low red alarm (view only)
10
Graphic view of alarm limits with currently measured value
11
15-min trend, showing alarm limits and monitored measurement values
To change alarm limits,
Enter the Alarm Limits window.
Using 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.
58
2 Alarms
About Automatic Alarm Limits
The 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 nonpathological 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.
Wide alarm limits
Narrow alarm limits
Alarm Limits
Measurement value
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 Delays
The 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.
59
2 Alarms
WARNING
Before using Smart Alarm Delays, make sure that you fully understand how the delay is applied and
what the consequences are.
Documenting Alarm Limits
The 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 Alarms
You 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 Window
The 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 Window
The 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.
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2 Alarms
When 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 Alarms
The alarm latching setting for your monitor defines how the alarm indicators behave when you do not
acknowledge them. When alarms are set to non-latching, their indicators end when the alarm condition
ends. Switching alarm latching on means that visual and/or audible alarm indications are still displayed
or announced by the monitor after the alarm condition ends. The indication lasts until you
acknowledge the alarm.
Viewing the Alarm Latching Settings
To see the alarm latching setting for your monitor
In the monitor's Main Setup menu, select Alarms.
Select Alarm Settings, and see the Visual Latching and Audible Latching settings.
This setting can 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 Latching
Red&Yellow
Red&Yellow
Red&Yellow
Red Only
Red&Yellow
Off
Red Only
Red Only
Red Only
Off
Off
Off
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2 Alarms
Alarm Latching Behavior
Red & Yellow Measurement
Alarms
Non-latching alarms
Alarm has not
been
acknowledged.
Alarm tone on. Alarm lamp on. Alarm tone on. Alarm lamp
Alarm message. Flashing
on. Alarm message. Flashing
numerics.
numerics.
Alarm condition
still present.
Alarm has been
acknowledged.
Visual and audible latching Visual latching, audible
non-latching
Alarm tone on. Alarm lamp
on. Alarm message. Flashing
numerics.
Alarm condition All audible and visual alarm
no longer present. indicators automatically stop.
Alarm tone on.
Alarm lamp on.
Alarm message.
Flashing numerics.
Alarm message. Flashing
numerics.
Audible alarm indicators
automatically stop.
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).
Audible and visual alarm
indicators automatically stop.
Audible and visual alarm
indicators automatically stop.
Alarm tone off. Alarm lamp off.
Alarm message. Flashing
numerics. Audible alarm
reminder (if configured).
Alarm condition Audible and visual alarm
no longer present. indicators automatically stop.
All INOPs are non-latching. See “Yellow Arrhythmia Alarms” on page 136 for information on onestar yellow alarms latching behavior.
Testing Alarms
When 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 On
If the monitor is switched off for longer than one minute and then switched on again (or after a loss of
power lasting longer than one minute, 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.
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2 Alarms
Alarm Recordings
You 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.
Press the Main Setup SmartKey.
Select Alarms from the Main Setup menu.
Select Alarm Recording from the Alarms menu to open the Alarm Recordings menu.
Select 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.
For 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.
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64
3
Patient Alarms and INOPs
This 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 Messages
The 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
** AFIB
ECG/Arrhythmia
Atrial fibrillation waveform detected
yellow alarm lamp, short yellow
audible alarm
*** APNEA
*** APNEA x:yy
*** APNEA >10min
CO2, Resp,
Spirometry
Respiration has stopped for longer than the
preset apnea time. "x:yy" denotes the Apnea
duration in minutes and seconds
numeric flashes, red alarm lamp,
alarm tone
*** ASYSTOLE
ECG
No QRS detected for a period greater than the numeric flashes, red alarm lamp,
asystole threshold (in the absence of Vfib or
alarm tone
chaotic ECG)
** awRR HIGH
CO2, Resp, AGM
The airway respiration rate has exceeded the
high alarm limit.
** awRR LOW
CO2, Resp, AGM
The airway respiration rate has dropped below numeric flashes and low limit is
the low alarm limit.
highlighted, yellow alarm lamp,
alarm tone
numeric flashes and high limit is
highlighted, yellow alarm lamp,
alarm tone
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3 Patient Alarms and INOPs
Alarm Message
From
Condition
Indication
** 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 numeric flashes and low limit is
the low alarm limit.
highlighted, yellow alarm lamp,
alarm tone
** CCO HIGH
** CCI HIGH
CCO
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 LOW
CCO
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 < yy
SpO2
The SpO2 value has fallen below the
numeric flashes, red alarm lamp,
desaturation alarm limit. xx denotes the lowest alarm tone
measured value, and yy is the desaturation limit.
** EC10 ALARM
*** EC10 ALARM
at Information Center
EC10 Intellibridge
A yellow (**) or red (***) patient alarm is
(on monitor) yellow or red alarm
present on the IntelliBridge module. Check the lamp; the alarm text is defined by
monitor display for more detailed alarm
the Intellibridge device driver
information.
** 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 numeric flashes, and low limit is
alarm limit.
highlighted, yellow alarm lamp,
alarm tone
* EVENT
** EVENT
*** EVENT
at Information center
Event 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:
*** EVENT:
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 tone
*** EXTREME BRADY
ECG
The bradycardia limit has been exceeded.
numeric flashes and alarm limit is
highlighted, red alarm lamp, alarm
tone
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3 Patient Alarms and INOPs
Alarm Message
From
Condition
Indication
** 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 HR
ECG/Arrhythmia
Consistently irregular heart rhythm.
numeric flashes, yellow alarm lamp,
short yellow audible alarm
* MISSED BEAT
** MISSED BEAT
ECG/Arrhythmia
No beat detected for 1.75*R-R interval, or if
numeric flashes, yellow alarm lamp,
HR>120bpm no beat detected for one second short yellow audible alarm
(non-paced patients only).
* MULTIFORM PVCs
** MULTIFORM PVCs
ECG/Arrhythmia
Two differently shaped Vs detected, each
numeric flashes, yellow alarm lamp,
occurring at least twice within the last 300 beats short yellow audible alarm
and at least once within the last 60 beats.
** NBP HIGH
NBP
The measured NBP value is above the high
numeric flashes and high limit is
alarm limit.
highlighted, yellow alarm lamp,
s, d, or m after the label indicates whether the alarm tone
systolic, diastolic or mean pressure has crossed
the limit.
** NBP LOW
NBP
The measured NBP value is below the low
numeric flashes and low limit is
highlighted, yellow alarm lamp,
alarm limit.
s, d, or m after the label indicates whether the alarm tone
systolic, diastolic or mean pressure has crossed
the limit.
* NON-SUSTAIN VT
** NON-SUSTAIN VT
ECG/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 CAPT
ECG/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 PACING
ECG/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 PVCs
ECG/Arrhythmia
A non-ventricular contraction, followed by two numeric flashes, yellow alarm lamp,
ventricular contractions, followed by a nonshort yellow audible alarm
ventricular contraction has been detected.
* PAUSE
** PAUSE
ECG/Arrhythmia
No beat detected for a period greater than the
pause threshold.
numeric flashes, yellow alarm lamp,
short yellow audible alarm
***  HIGH PRESS
numeric flashes, high limit is
The measured pressure value is above the
highlighted, red alarm lamp, alarm
extreme high alarm limit.
s, d, or m after the label indicates whether the tone
systolic, diastolic or mean pressure has crossed
the limit.
**  HIGH
The measured pressure value is above the high numeric flashes, high limit is
alarm limit.
highlighted, yellow alarm lamp,
s, d, or m after the label indicates whether the alarm tone
systolic, diastolic or mean pressure has crossed
the limit.
PRESS
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3 Patient Alarms and INOPs
Alarm Message
From
Condition
Indication
***  LOW PRESS
The measured pressure value is below the
numeric flashes and low limit is
extreme low alarm limit.
highlighted, red alarm lamp, alarm
s, d, or m after the label indicates whether the tone
systolic, diastolic or mean pressure has crossed
the limit.
**  LOW
PRESS
The measured pressure value is below the low numeric flashes and low limit is
alarm limit.
highlighted, yellow alarm lamp,
s, d, or m after the label indicates whether the alarm tone
systolic, diastolic or mean pressure has crossed
the limit.
** Pulse HIGH
PRESS, SpO2
The pulse rate has exceeded the high alarm
limit.
numeric flashes and high limit is
highlighted, yellow alarm lamp,
alarm tone
** Pulse LOW
PRESS, SpO2
The 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 HIGH
ECG/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 numeric flashes, yellow alarm lamp,
more than 5 minutes
alarm tone
* R-ON-T PVCs
** R-ON-T PVCs
ECG/Arrhythmia
For HR <100, a PVC with R-R interval < 1/3 numeric flashes, yellow alarm lamp,
the average interval followed by a
short yellow audible alarm
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.).
** RR HIGH
RESP
The respiration rate has exceeded the high
alarm limit.
** RR LOW
RESP
The respiration rate has dropped below the low numeric flashes and low limit is
alarm limit.
highlighted, yellow alarm lamp,
alarm tone
* RUN PVCs HIGH
** RUN PVCs HIGH
ECG/Arrhythmia
A run of PVCs greater than 2 was detected.
numeric flashes, yellow alarm lamp,
short yellow audible alarm
**  HIGH
SvO2/SO2
The the measured intravascular oxygen
saturation has exceeded the high limit.
numeric flashes and high alarm
limit is highlighted, yellow alarm
lamp, alarm tone
**  LOW
SvO2/SO2
The measured intravascular oxygen saturation
has fallen below the low limit.
numeric flashes and low alarm limit
is highlighted, yellow alarm lamp,
alarm tone
**  HIGH
SpO2
The arterial oxygen saturation has exceeded the numeric flashes and high limit is
high alarm limit.
highlighted, yellow alarm lamp,
alarm tone
**  LOW
SpO2
The arterial oxygen saturation has fallen below numeric flashes and low limit is
the low alarm limit.
highlighted, yellow alarm lamp,
alarm tone
** ST- HIGH
ECG/ST
The ST elevation in lead  is higher than the numeric flashes and high alarm
limit.
limit is highlighted, yellow alarm
lamp, alarm tone
68
numeric flashes and high limit is
highlighted, yellow alarm lamp,
alarm tone
3 Patient Alarms and INOPs
Alarm Message
From
Condition
Indication
** ST- LOW
ECG/ST
The ST depression in lead  is lower than
the limit.
numeric flashes and low alarm limit
is highlighted, yellow alarm lamp,
alarm tone
* SVT
** SVT
ECG/Arrhythmia
A run of supraventricular beats greater than the numeric flashes, yellow alarm lamp,
SVT run limit has been detected and the HR
alarm tone
has exceeded the SVT HR limit.
** Tblood HIGH
C.O.
The blood temperature value has exceeded the numeric flashes, high alarm limit is
high alarm limit.
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 HIGH
tcGas
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 LOW
tcGas
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 ALARM
Telemetry
This is a generic alarm from the telemetry
yellow or red alarm lamp and alarm
system. The specific alarm cause is indicated in tone
the alarm message in the Telemetry Data
Window.
**  HIGH TEMP
The temperature has exceeded the high alarm
limit.
**  LOW
TEMP
The temperature has fallen below the low alarm numeric flashes and low limit is
limit.
highlighted, yellow alarm lamp,
alarm tone
* VENT BIGEMINY
** VENT BIGEMINY
ECG/Arrhythmia
numeric flashes, yellow alarm lamp,
A dominant rhythm of N, V, N, V (N =
supraventricular beat, V = ventricular beat) was short yellow audible alarm
detected.
*** VENT FIB/TACH
ECG
A fibrillatory waveform for 4 consecutive
seconds was detected.
numeric flashes, red alarm lamp,
alarm tone
* VENT RHYTHM
** VENT RHYTHM
ECG/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 TRIGEMINY
ECG/Arrhythmia
A dominant rhythm of N, N, V, N, N, V (N = numeric flashes, yellow alarm lamp,
supraventricular beat, V = ventricular beat) was short yellow audible alarm
detected.
*** 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 ALARM
at Information Center
VueLink
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 numeric flashes, yellow alarm lamp,
for more than 5 minutes
alarm tone
numeric flashes and high limit is
highlighted, yellow alarm lamp,
alarm tone
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3 Patient Alarms and INOPs
Alarm Message
From
Condition
Indication
***BRADY/P xxx
DISCONNECT
PRESS
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 ,
ECG/ST
The ST depression or elevation is outside of
the limit in two or more leads  and .
numeric flashes, yellow alarm lamp,
alarm tone
**ST MULTI
at Information Center
ECG/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>yy
or
***TACHY xxx > yy
Press, 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
tone
Technical 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
INOP Message, Indication
What to do
!! CHECK PAIRING
INOP tone
There is a problem with device pairing. Check that the monitor and telemetry device are correctly
paired.
Bad Server Link
INOP tone
1) 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 ONLY
INOP tone
System 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 Lamps
INOP tone
Perform 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 DrugSettings
INOP tone
There was a problem loading the drug settings. Check that the settings are complete and correct.
!!CHECK ECG SOURCE
INOP tone
The 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.
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3 Patient Alarms and INOPs
INOP Message, Indication
What to do
Check Flex Texts
INOP tone
Check 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 Keyboard
INOP tone
Perform a visual and functional check of the keyboard. Contact your service personnel.
Check Main Board 2
INOP tone
There is a problem with the second main board in the monitor. Contact your service personnel.
Check Monitor Func
INOP tone
Potential problem with alarm lamps, display or interfaces detected. Contact your service personnel.
Check Monitor Temp
INOP tone
The 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 Device
INOP tone
Perform a visual and functional check of the mouse input device. Contact your service personnel.
Check MSL Voltage
INOP tone
There is a problem with the voltage of the Measurement Link (MSL). Contact your service personnel.
Check Network Conf
INOP tone
The 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 tone
The 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 Settings
INOP tone
If this INOP appears, check the monitor and patient settings before you resume monitoring. If the
settings are unexpected, there may be a problem with the monitor software. Contact your service
personnel.
Check SpeedPoint
INOP tone
Perform a visual and functional check of the SpeedPoint input device. Contact your service personnel.
Check Touch Input
INOP tone
Perform a visual and functional check of the touch input device. Contact your service personnel.
Check Waves
INOP tone
The 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 Cable
INOP tone
The 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 Connection
INOP tone
Check 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 T
Numeric is displayed with a -?INOP tone
Contact your service personnel.
The ECG in the Telemetry device is faulty.
Internal.Comm.Malf
INOP tone
There is a problem with I2C Bus communication in the monitor. Contact your service personnel.
MCC Reversed
INOP tone
The MSL coupling cable is reversed. Connect the end with the gray connector to the Intelligent
Display.
MCC Unsupported
INOP tone
An MSL coupling cable has been connected to a device which does not support MSL coupling.
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3 Patient Alarms and INOPs
INOP Message, Indication
What to do
Meas. 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 ALARMS
at Information Center
The 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 Off
INOP tone
The 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 Overload
INOP tone
The 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 tone
There 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 tone
There 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 tone
The 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 INTERFERENCE
INOP tone
The short range radio connection has interference from another device. Try using another channel.
SRR INVALID CHAN
INOP tone
The 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 DISABLED
INOP tone
The currently selected telemetry configuration on the monitor does not allow connection of telemetry
devices to the monitor.
TELE CONFIG UNSUPP
INOP tone
Telemetry device not supported (companion mode)
TELE EQUIP MALF
INOP tone
The 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 UNSUPPORTED
INOP tone
This telemetry device is not supported for direct connection to the monitor.
TimeExpired:
INOP tone
The time has expired for the timer indicated in the INOP text. Clearing the timer clears the INOP.
Unsupported LAN
INOP tone
There is a problem with the communication to the network and central monitoring is currently not
possible. Check the connection. If the INOP persists, switch off the monitor and contact your service
personnel.
User I/F Malfunct.
INOP tone
Perform a visual and functional check of all the monitor input devices. Contact your service personnel.
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3 Patient Alarms and INOPs
Battery INOPs
INOP Message, Indication
What to do
Batt 1 MISSING
The monitor requires two batteries but can detect only one battery. Insert the missing battery
Batt 2 MISSING
immediately.
INOP tone
During this INOP, alarms cannot
be paused or switched off.
Batt EMPTY
INOP tone, battery LED flashes
During 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.
BATT EXTENSN MALF
INOP tone
There is a hardware error in the Battery Extension. Contact your service personnel.
Batt INCOMPAT.
INOP tone
The battery cannot be used with this monitor. Replace with the correct battery (M4607A).
Batt LOW
INOP tone
The estimated battery-powered operating time remaining is less than 20 minutes.
Batt MALFUNCTION
INOP tone, battery LED flashes
During 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.
BATTERIES EMPTY
Batt 1 EMPTY
Batt 2 EMPTY
INOP tone, battery LED flashes
During 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.
BATTERIES INCOMPAT
Batt 1 INCOMPAT.
Batt 2 INCOMPAT.
INOP tone
The indicated battery or batteries cannot be used with this monitor. Replace with the correct battery or
batteries as specified in this book.
BATTERIES LOW
Batt 1 LOW
Batt 2 LOW
INOP tone
The estimated battery-powered operating time remaining is less than 20 minutes.
BATTERIES MALFUNC.
Batt 1 MALFUNCTION
Batt 2 MALFUNCTION
INOP tone, battery LED flashes
During 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 reissued two minutes after you acknowledge it.
Charge Batt 1 Now
Charge Batt 2 Now
INOP tone
Battery must be charged. Connect the monitor to mains power or exchange the battery.
CHARGER MALFUNC.
INOP tone, battery LED may
flash
There is a problem with the battery charger in the monitor. Connect the monitor to mains power and
contact your service personnel.
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.
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.
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3 Patient Alarms and INOPs
INOP Message, Indication
What to do
CHECK BATT TEMP
INOP tone
The 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
X2/MP2 only: There is no battery in the battery compartment. You cannot operate the monitor on
!!INSERT BATTERY
AC mains while the battery compartment is open (not sealed with a battery). Load a battery
Severe yellow INOP tone
During this INOP, alarms cannot immediately.
be paused or switched off.
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 personnel.
MMS, MMS Extensions and FMS INOPs
INOP Message, Indication
What to do
FMS UNPLUGGED
INOP tone
Make sure that the Flexible Module Rack is connected to the monitor. All FMS measurements are off
while the FMS is unplugged.
FMS UNSUPPORTED
INOP tone
The Flexible Module Rack is not supported by your monitor. Contact your service personnel.
MEASSRV UNSUPPORTD
INOP tone
The Multi-Measurement module is not supported by the monitor. Contact your service personnel.
MMS Ext. UNPLUGGED
INOP tone
The MMS extension has been disconnected from the Multi-Measurement Module.
MMS Ext. Unpowered
INOP tone
The MMS extension cannot operate while the Multi-Measurement Module is running on battery
power.
MMS Ext.EQUIP MALF
INOP tone
Loss of communication between the Multi-Measurement Module and the MMS extension. Contact
your service personnel.
MMS UNPLUGGED
INOP tone
Make sure that the Multi-Measurement Module is connected to the monitor. All MMS measurements
are off while the MMS is unplugged.
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3 Patient Alarms and INOPs
INOP Message, Indication
What to do
MMS UNSUPPORTED
INOP tone
The Multi-measurement Module is not supported by your monitor. Contact your service personnel.
MMSExt.Unsupported
INOP tone
The 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.
Display INOPs
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.
ECG, Arrhythmia, QT and ST INOPs
INOP Message, Indication
What to do
C LEAD OFF
HR Numeric is replaced by -?for 10 seconds.
INOP tone
The 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 QT
The QT algorithm cannot generate a valid QT value for more than 10 minutes, or 1 minute in the
initial phase.
CANNOT 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 
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 MALF
Numeric is replaced by -?INOP tone
Contact your service personnel.
The ECG hardware is faulty.
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3 Patient Alarms and INOPs
INOP Message, Indication
What to do
 LEAD OFF
!!  LEAD OFF
!!!  LEAD OFF
Numeric is replaced by -?INOP tone
Not all the required leads for ECG monitoring are connected. Check the ECG connections and make
sure that the electrode indicated by  [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 OFF
Check that all of the required ECG leads are attached, and that none of the electrodes have been
displaced.
ECG NOISY SIGNAL
INOP tone
The 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 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.
EcgOut EQUIP MALF
INOP tone
There is a problem with the device connected to the ECG Out connector. Contact your service
personnel.
The LA electrode has become detached from the patient or the lead set has been changed. Reattach
LA LEAD OFF
Numeric is replaced by -?- for 10 the electrode or select New Lead Setup in the Setup ECG menu to confirm the new lead set.
seconds.
INOP tone
LL LEAD OFF
The LL electrode has become detached from the patient or the lead set has been changed. Reattach the
Numeric is replaced by -?- for 10 electrode or select New Lead Setup in the Setup ECG menu to confirm the new lead set.
seconds.
INOP tone
RA LEAD OFF
Numeric is replaced by -?INOP tone
The 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.
The RL electrode has become detached from the patient or the lead set has been changed. Reattach
RL LEAD OFF
Numeric is replaced by -?- for 10 the electrode or select New Lead Setup in the Setup ECG menu to confirm the new lead set.
seconds.
INOP tone
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 OFF
The V electrode (IEC: C electrode) has become detached from the patient or the lead set has been
Numeric is replaced by -?- for 10 changed. Reattach the electrode or select New Lead Setup in the Setup ECG menu to confirm the
new lead set.
seconds.
INOP tone
Pulse INOPs
INOP Message, Indication
What to do
PULSE NO ALARMING
Numeric is replaced by -?INOP tone
Pulse has no alarming because the system pulse is measured by an external device. Select another pulse
source to enable pulse alarming.
76
3 Patient Alarms and INOPs
Resp INOPs
INOP Message, Indication
What to do
Resp EQUIP MALF
Numeric is replaced by -?INOP tone
Contact your service personnel. The RESP hardware is faulty.
Resp ERRATIC
Numeric 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 OFF
Numeric is replaced by -?INOP tone
Not all the required leads for Resp monitoring are attached. Make sure that the RA and LL leads are
attached.
NBP INOPs
INOP Message, Indication
What to do
!! CUFF NOT DEFLAT
!!!CUFF NOT DEFLAT
Numeric is displayed with a -?Severe yellow/red INOP tone
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.
During this INOP, alarms cannot [Adult or pediatric patients: The NBP cuff pressure has exceeded 15 mmHg (2kPa) for more than 3
minutes.
be paused or switched off.
Neonatal patients: The NBP cuff pressure has exceeded 5mmHg (0.7kPa) for more than 90 seconds.]
!! CUFF OVERPRESS
!!!CUFF OVERPRESS
Numeric displayed with -?Severe yellow/red INOP tone
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
During this INOP, alarms cannot started or the Stop All SmartKey is selected.
be paused or switched off.
NBP DEACTIVATED
INOP tone
The 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 MALF
Numeric is replaced by -?INOP tone
Remove 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 INTERRUPTED
Numeric is replaced by -?INOP tone
Check the tubing and cuff for leakages or kinks. Check that you are using the correct cuff size and
placement, and that the correct patient category is selected. Try restarting the measurement.
If the INOP occurs repeatedly, contact your service personnel.
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 FAILED
Numeric may be displayed with a
-?INOP tone
Check that you are using the correct cuff size and placement, and that the correct patient category is
selected. Try restarting the measurement.
You can silence this INOP, but the INOP message remains visible until the next measurement is
started or the Stop All SmartKey is selected.
Check the condition and suitability of the patient for NBP monitoring. Use another cuff to continue
measuring.
77
3 Patient Alarms and INOPs
Temperature INOPs
INOP Message, Indication
What to do
T1, T2, T3, T4 INOPs
See  INOPs
Tamb INOPs
See  INOPs
Tart INOPs
See  INOPs
Tcereb INOPs
See  INOPs
Tcore INOPs
See  INOPs

DEACTIVATED
INOP tone
A 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.
 EQUIP
MALF
Numeric is replaced by -?INOP tone
Contact your service personnel.
The temperature hardware is faulty.
 NO
TRANSDUC
Numeric is replaced by -?INOP tone
Make sure the TEMP probe is connected to the MMS or module.
If you silence this INOP, the measurement will be switched off.

OVERRANGE
Numeric is replaced by -?INOP tone
Try changing the application site of the transducer.

UNPLUGGED
A Temp measurement label has been deactivated, either by unplugging a module, or by deactivating
the label in the Measurement Selection window.
INOP tone
The measurement automatically disappears from the display.
[The temperature is less than -1°C, or greater than 45°C.]
To switch the measurement on again, either replug the module or reactivate the measurement label in
the Measurement Selection window.
Tesoph INOPs
See  INOPs
Tnaso INOPs
See  INOPs
Trect INOPs
See  INOPs
Tskin INOPs
See  INOPs
Ttymp INOPs
See  INOPs
Tven INOPs
See  INOPs
Tvesic INOPs
See  INOPs
78
3 Patient Alarms and INOPs
SpO2 INOPs
INOP Message, Indication
What to do

DEACTIVATED
INOP tone
The 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.
 EQUIP MALF The MMS or module is faulty. Unplug and replug the MMS or module. If the INOP persists, contact
Numeric is replaced by -?your service personnel.
INOP tone
 ERRATIC
Numeric is replaced by -?INOP tone
Check the sensor placement. Try another adapter cable and sensor. If the INOP persists, contact your
service personnel.

EXTD.UPDATE
Numeric 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.

INTERFERNCE
Numeric is replaced by -?INOP tone
There is too much interference, caused by a high level of ambient light and/or electrical interference.
Cover the sensor to minimize ambient light. If the INOP persists, make sure that the sensor cable is
not damaged or positioned too close to power cables.
 LOW PERF
Numeric 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.
 NO SENSOR Make 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.
Numeric is replaced by -?INOP tone
 NOISY SIGN. Excessive patient movement or electrical interference is causing irregular pulse patterns. Try to reduce
Numeric is replaced by -?patient movement or to relieve the cable strain on the sensor.
INOP tone
 NONPULSAT.
Numeric is replaced by -?INOP tone
Check 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.
 POOR
SIGNAL
Numeric is replaced by -?(questionable numeric)
The signal condition of the SpO2 measurement is poor and measurement accuracy may be
compromised.
 PULSE?
Numeric is replaced by -?INOP tone
The detectable pulsations of the SpO2 signal are outside the specified pulse rate range.
 SEARCHING SpO2 is analyzing the patient signal to derive Pulse, SpO2 and Perf values. Please wait until the search
Numeric unavailable
analysis is complete.
 SENSOR
MALF
Numeric is replaced by -?INOP tone
The SpO2 sensor or adapter cable is faulty. Try another adapter cable and sensor. If the INOP persists,
contact your service personnel.
79
3 Patient Alarms and INOPs
INOP Message, Indication
What to do
 SENSOR
OFF
Numeric is replaced by -?INOP tone
The SpO2 sensor is not properly applied to the patient. Apply the sensor following the instructions
supplied by the manufacturer.

UNKN.SENSOR
Numeric is replaced by -?-
The connected sensor or adapter cable is not supported by the SpO2 measurement. Use only specified
sensors and cables.

UNPLUGGED
Numeric is replaced by -?INOP tone
An SpO2 measurement label has been deactivated, either by unplugging a module, or by deactivating
the label in the Measurement Selection window.
 UPGRADE
Numeric is replaced by -?Numeric is unavailable
The SpO2 measurement is currently in upgrade mode. Monitoring is not possible in this mode.
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.
Pressure INOPs
INOP Message, Indication
What to do
ABP INOPs
See  INOPs
Ao INOPs
See  INOPs
ART INOPs
See  INOPs
BAP INOPs
See  INOPs
CPP CHK SOURCES
Numeric is replaced by -?INOP tone
Not all measurements or values required to perform the calculation are available. Check the
measurement sources.
CPP CHK UNITS
Numeric is replaced by -?-
The monitor has detected a conflict in the units used for this calculation. Check the unit settings.
CPP UNPLUGGED
With the default profile settings, the CPP measurement is disabled in the adult profile and enabled in
the pediatric and neonatal profiles. When changing from a pediatric or neonatal profile to an adult
profile, this INOP can occur. Enable CPP in the adult profile to clear the INOP.
CVP INOPs
See  INOPs
FAP INOPs
See  INOPs
IC1 / IC2 INOPs
See  INOPs
ICP INOPs
See  INOPs
LAP INOPs
See  INOPs
P / P1 / P2 / P3 / P4 INOPs
See  INOPs
PAP INOPs
See  INOPs
PPV BAD 
SIGNAL
The arterial pressure source selected for PPV is not providing a pulsatile signal.
PPV BAD SIGNAL
at Information Center
The 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.
 ARTIFACT
Numeric questionable
A non-physiological event (flush or blood sample) is detected. A resulting limit alarm or non-pulsatile
INOP will be suppressed.
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3 Patient Alarms and INOPs
INOP Message, Indication
What to do

DEACTIVATED
INOP tone
A 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.
 EQUIP
MALF
Numeric is replaced by -?INOP tone
Contact your service personnel.
The pressure hardware is faulty.
 NO
TRANSDUCER
Numeric is replaced by -?INOP tone
Make sure that the pressure transducer is connected to the measurement device or module.
If you silence this INOP, the measurement will be switched off.
 NOISY
SIGNAL
Pulse numeric is replaced by -?INOP tone
This 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.
 NONPULSATILE
Pulse numeric is replaced by -?INOP tone
This 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.

OVERRANGE
Numeric is replaced by -?INOP tone
Make 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.
 REDUCE
SIZE
Increase the scale for the pressure wave.

UNPLUGGED
INOP tone
A 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.

ZERO+CHECK CAL
Numeric is replaced by -?-
Perform a zero and check the calibration of the transducer.
RAP INOPs
See  INOPs
UAP INOPs
See  INOPs
UVP INOPs
See  INOPs
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3 Patient Alarms and INOPs
CO2 INOPs
INOP Message, Indication
What to do
!! CO₂ OCCLUSION
!!! CO₂ OCCLUSION
Numeric is replaced by -?INOP tone
The 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 ZERO
Numeric 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 MODE
CO2 numeric displays current
CO2 value for accuracy check
Currently 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 RUNNING
Numeric is replaced by -?-
Wait until calibration is finished.
CO₂ CHECK CAL
Numeric is replaced by -?INOP tone
The CO2 value is outside the measurement range. Perform an accuracy check for both calstick cells
and, if necessary, recalibrate the transducer.
CO₂ CHK ADAPTER
Numeric is replaced by -?INOP tone
Check 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 DEACTIVATED
INOP tone
The 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 MALF
Numeric is replaced by -?INOP tone
The 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 CAL
Numeric is replaced by -?INOP tone
Make 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 SENSOR
from M3014A
Numeric is replaced by -?INOP tone
There is no CO2 sensor connected. If you silence this INOP the CO2 measurement will be switched
off.
CO₂ NO TRANSDUC
from mainstream CO2 (except
M3014A)
Numeric is replaced by -?INOP tone
There 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.
CO₂ NO TUBING
Numeric is replaced by -?INOP tone
Either 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 OVERRANGE
Numeric is replaced by -?INOP tone
The CO2 value is higher than the measurement range. If you suspect a false high value, contact your
service personnel.
CO₂ PUMP OFF
Numeric 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 PURGING
Numeric is replaced by -?INOP tone
The 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.
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3 Patient Alarms and INOPs
INOP Message, Indication
What to do
Wait until the sensor reaches operating temperature and the INOP disappears.
CO₂ SENS.WARMUP
Numeric is replaced by -?Microstream CO2: INOP tone
Mainstream CO2: no INOP tone
CO₂ UPDATE FW
Numeric is replaced by -?INOP tone
The software in the Measurement Extension does not match the software in the MMS. Contact your
service personnel.
CO₂ WAIT CAL2
Numeric 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 FAILED
Numeric is replaced by -?INOP tone
An 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'D
Numeric is replaced by -?INOP tone
Perform 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.
SO2 INOPs
INOP Message, Indication
What to do
 CAL FAILED
The 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 invivo calibration.
Numeric is replaced by -?INOP tone
 CAL MODE
Numeric is replaced by -?INOP tone
Pre-insertion calibration is complete, but the catheter tip is still inside the optical reference. The
catheter is now ready for insertion.
 CANNOT
MEAS
Numeric is replaced by -?INOP tone
The 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.
 CONN
OPTMOD
Numeric is replaced by -?INOP tone
The Optical Module was disconnected during data storage. Reconnect the Optical Module for at least
20 seconds.
 EQUIP MALF
Numeric is replaced by -?INOP tone
The 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.
 INCOMPAT.
INOP tone
The SO2 Module or Optical Module is not supported. Contact your service personnel.
 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.
 LOW LIGHT
Numeric is replaced by -?INOP tone
The 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.
 NO OPTMOD Connect the Optical Module. If the INOP persists, try another Optical Module. Silencing this INOP
Numeric is replaced by -?switches the measurement off.
INOP tone
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3 Patient Alarms and INOPs
INOP Message, Indication
What to do
 OPTMOD
MALF
The 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.
 PRE-INS CAL The pre-insertion calibration is running. This typically takes one minute. During this time alarms are
Numeric is replaced by -?switched off. Wait until the calibration is complete.
INOP tone
 UNPLUGGED
Numeric is replaced by -?INOP tone
Measurement switched on and SO2/SvO2 module unplugged from the rack.
 UPGRADE
INOP tone
The SO2 module is currently in upgrade mode.
Monitoring is not possible in this mode.
 WARMUP
Numeric is replaced by -?-
The Optical Module has not yet reached the operating temperature. Wait a few minutes until warm-up
is finished.
CAL
REQUIRED
Numeric is replaced by -?INOP tone
There is no valid calibration data in the Optical Module. Perform either a pre-insertion or an in-vivo
calibration.
CONFIG
ERROR
Numeric is replaced by -?INOP tone
The Optical Module has been configured to SaO2 Mode. Use Change to Venous in the setup
menu to reconfigure to venous saturation mode.
LIGHT INTENS The intensity changed considerably since the last light intensity calibration. This may indicate that the
Numeric is replaced by -?catheter tip is positioned against a blood vessel wall or that there is low blood flow. Reposition the
INOP tone
catheter (and perform a Light Intensity Calibration).
C.O. INOPs
INOP Message, Indication
What to do
C.O. DEACTIVATED
INOP tone
The 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 MALF
Numeric is replaced by -?INOP tone
There is a problem with the C.O. hardware. Contact your service personnel.
C.O. UNPLUGGED
Numeric is replaced by -?INOP tone
Plug in the C.O. module. Silencing this INOP switches off the measurement.
CCI NO BSA
CCI numeric unavailable
INOP tone
CCI 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 SIGN
Numeric is replaced by -?INOP tone
The 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 CALIBRATION
Numeric is replaced by -?-
The CCO measurement is currently not calibrated.
CCO NO 
Numeric is replaced by -?INOP tone may sound
CCO/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,
BAP, FAP, or UAP.
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3 Patient Alarms and INOPs
INOP Message, Indication
What to do
CCO NO PRESS
at Information Center
CCO/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,
BAP, FAP, or UAP.
CCO NOT SUPPORTED
Numeric is replaced by -?INOP tone
A 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 OVERRANGE
CCI OVERRANGE
Numeric is replaced by -?INOP tone
The measured CCO or CCI value is not within the specified range for CCO/CCI measurement.
CCO PRESS INVALID
at Information Center
The 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 
INVALID
Numeric is replaced by -?INOP tone may sound
The 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 OVERRANG
Numeric is replaced by -?INOP tone
The mean value of the arterial pressure values used for pulse contour calculation for CCO is below 0
mmHg or above 300 mmHg.
CCO PULSE OVERRANG
Numeric is replaced by -?INOP tone
The pulse rate of the pressure used for pulse contour calculation for CCO is below 30 bpm or above
240 bpm.
CCO RECALIBRATE
Numeric 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 tone
No transducer attached to the module or catheter disconnected.
Tblood NO TRANSDUC
Numeric is replaced by -?INOP tone
No transducer attached to the module or catheter disconnected.
Tblood OVERRANGE
Numeric is replaced by -?-
Tblood out of range 17°C - 43°C.
85
3 Patient Alarms and INOPs
tcGas INOPs
INOP Message, Indication
What to do
 CAL FAILED A calibration failed. Check the calibration unit, gas pressure, and tubing connections, then restart the
Numeric is replaced by -?calibration. If the calibration has failed more than once, remembrane the transducer and restart the
INOP tone
calibration. If this INOP persists, contact your service personnel.
 CAL
REQUIRD
Numeric is replaced by -?INOP tone
Calibration 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.
 CAL
RUNNING
Numeric displays first -?-, then
numeric is displayed with a ?
Wait until the tcpO2/tcpCO2 calibration is finished.
 CHANGE
SITE
If Heat Switch Off is
configured to Yes, numeric is
replaced by -?INOP tone
Site 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.
 CHECK
TIME
Site Timer due to time out in 15 minutes or less.
 EQUIP
MALF
Numeric is replaced by -?INOP tone
There is a malfunction in the transducer or module. Connect another transducer. If this INOP persists,
contact your service personnel.
 NO
TRANSDUC
Numeric is replaced by -?INOP tone
No transducer is connected to the tcpO2/tcpCO2 module. Silencing the alarm switches off the
measurement.

STABILIZING
Numeric 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.

UNPLUGGED
Numeric is replaced by -?INOP tone
The measurement is switched on but the module is unplugged.
86
The measurement automatically disappears from the display. Silencing this INOP switches off the
measurement.
3 Patient Alarms and INOPs
EEG INOPs
INOP Message, Indication
What to do
EEG EQUIP MALF
INOP tone
The EEG hardware is faulty. Contact your service personnel.
EEG IMPEDANCE HIGH
EEG1 IMPED. HIGH
EEG2 IMPED. HIGH
The 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 NOISE
EEG1 LINE NOISE
EEG2 LINE NOISE
Excessive 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 NOISE
EEG1MUSCLE NOISE
EEG2MUSCLE NOISE
Too 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 TRANSDUC
INOP tone
The trunk cable is disconnected from the EEG plug-in module. Reconnect the trunk cable. Silencing
this INOP switches the measurement off.
EEG UNPLUGGED
INOP tone
Plug in module. Silencing this INOP switches off the measurement.
EEG1 LEAD OFF 
EEG2 LEAD OFF 
[n = electrode]
Reconnect specified electrode.
EEG1 LEAD OFF
EEG2 LEAD OFF
at Information Center
One 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 OFF
EEG2 LEADS OFF
Two or more electrodes are not connected. Check in the EEG Impedance / Montage window
which electrodes are affected and reconnect the electrodes.
EEG1 OVERRANGE
EEG2 OVERRANGE
Input signal is too high in one or both channels. This is usually caused by interfering signals such as
line noise or electrosurgery.
BIS INOPs
INOP Message, Indication
What to do
BIS CABLE INCOMPAT
INOP tone
The semi-reusable sensor cable connected is unknown or not supported by your software revision.
Replace it with a Philips-supported sensor cable.
BIS CABLE USAGE
INOP tone
The semi-reusable sensor cable has exceeded the maximum number of uses. Replace the cable.
BIS DSC DISCONN
INOP tone
DSC 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 INCOMPT
INOP tone
DSC 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 UPDATE
INOP tone
DSC 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.
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3 Patient Alarms and INOPs
INOP Message, Indication
What to do
BIS ELECTR. DISC.
INOP tone
One or more electrodes are not connected to the semi-reusable sensor cable. Check all electrode
connections.
BIS ENGINE DISCONN
INOP tone
BIS 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 INCOMPT
INOP tone
BIS engine software is not supported. A software upgrade may be required. Contact your service
personnel.
MP20/30 - BIS engine not supported.
BIS ENGINE MALFUNC
INOP tone
Malfunction in the BIS engine hardware. Disconnect and reconnect the BIS engine. If the INOP
persists, replace BIS engine.
BIS EQUIP MALF
INOP tone
There is a malfunction in the BIS hardware. Unplug and replug the BIS module. If the INOP persists,
contact your service personnel.
BIS HIGH IMPEDANCE
INOP tone may sound
Impedance 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 CHCK
INOP tone may sound
The 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 OFF
INOP tone may sound
One 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 OVERCURRENT
INOP tone
Unplug 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.
BIS SENSOR DISCONN
INOP tone
The 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 INCOMPT
INOP tone
Unsupported sensor connected or sensor type unknown or not supported by your software revision.
Replace the sensor, using only Philips supported sensors.
BIS SENSOR MALFUNC
INOP tone
Malfunction 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 USAGE
INOP tone
Excessive sensor usage. Replace sensor.
A Cyclic Impedance Check will start automatically.
BIS SQI < 15% (INOP tone)
OR
BIS 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).
88
3 Patient Alarms and INOPs
INOP Message, Indication
What to do
BIS UNPLUGGED
INOP tone
Plug in the BIS module. Silencing this INOP switches off the measurement.
BISx DISCONNECTED
INOP tone
The BISx is not connected to the BIS module or the BIS interface board. Silencing this INOP switches
the measurement off.
BISx INCOMPATIBLE
INOP tone
The 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 MALFUNCTION
INOP tone
The 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.
Spirometry INOPs
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.
SPIRO 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.
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 chapter.
SPIRO UPGRADE
The module is running a firmware upgrade. Wait until upgrade is completed before resuming
monitoring.
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3 Patient Alarms and INOPs
VueLink INOPs
INOP Message, Indication
What to do
VueLink ALARM
at Information Center
A technical alarm is present on the VueLink module. The INOP text on the monitor is defined by the
VueLink device driver.
 CHECK No information was received from the external device. The device may be switched off or
SETUP
disconnected.
INOP tone
VueLink INOP abbreviations may differ slightly depending on the device category.
 CHK
CABLE
INOP tone
No 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.
 CHK
CONF.
INOP tone
The 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.
 EQUIP
MALF
INOP tone
Malfunction 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.
 NO
CONFIG
INOP tone
The 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.

UNPLUGGED
INOP tone
The 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.
IntelliBridge INOPs
INOP Message, Indication
What to do
DEVICE CHECK CONF.
INOP tone
Device identification completed, but communication could not be established due to error.
DEVICE CHECK SETUP
INOP tone
Device identification completed, but communication could not be established due to timeout.
DEVICE DEMO DATA
INOP tone
The device connected to the IntelliBridge module reports demo data but the monitor is not in DEMO
mode.
DEVICE REAL DATA
INOP tone
The monitor is in DEMO mode but the device connected to the IntelliBridge module reports data that
are not flagged as demo data.
DEVICE UNSUPPORTED
INOP tone
Device identification completed, but no appropriate device driver installed.
 EQUIP
MALF
INOP tone
Malfunction in the IntelliBridge module. If this message appears repeatedly, the module must be
replaced. Contact your service personnel.
90
IntelliBridge INOP abbreviations may differ slightly depending on the device category.
IntelliBridge INOP abbreviations may differ slightly depending on the device category.
IntelliBridge INOP abbreviations may differ slightly depending on the device category.
3 Patient Alarms and INOPs
INOP Message, Indication
What to do
EC10 INOP
!! EC10 INOP
!!! EC10 INOP
at Information Center
A 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.

UNPLUGGED
INOP tone
The IntelliBridge module has been unplugged from the rack, or the whole rack has been disconnected.
Silencing this INOP switches off the measurement.
NO DEVICE DATA
Communication with connected device has been lost.
TEXT UPLOAD FAILED
INOP tone
Incoming 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.
IntelliBridge INOP abbreviations may differ slightly depending on the device category.
Telemetry INOPs
INOP Message, Indication
What to do
!! REPLACE BATT. T
!!!REPLACE BATT. T
Severe yellow/red INOP tone
The battery in the telemetry device is almost empty and must be replaced.
During this INOP, alarms cannot
be paused or switched off.
!! TELE INOP
!!! TELE INOP
Severe yellow/red INOP tone
Check 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 Settings
INOP tone
Synchronization 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 signals
Chk SpO₂T Settings
INOP tone
Synchronization of SpO2T settings between the monitor and Information Center has failed. Check
that the SpO2T settings in use are appropriate.
INVALID LEADSET
The leadset plugged in cannot be used with the telemetry device.
LEADSET 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 DISCONNECT
INOP tone
Telemetry 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 tone
The 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.
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3 Patient Alarms and INOPs
ProtocolWatch INOPs
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 correctly.
PW:Action Required
The protocol currently running requires a user response. Check which pop-up window is displayed and
provide the appropriate response.
Calculated Values INOPs
INOP Message, Indication
What to do
Sp-vO₂ CHK SOURCES
Numeric is replaced by -?-
Not all measurements or values required to perform the calculation are available. Check measurement
sources.
Sp-vO₂ CHK UNITS
Numeric is replaced by -?-
The monitor has detected a conflict in the units used for this calculation. Check the unit settings.
SVR CHK SOURCES
SVRI CHK SOURCES
Numeric is replaced by -?-
Not all measurements or values required to perform the calculation are available. Check measurement
sources.
SVR CHK UNITS
SVRI CHK UNITS
Numeric is replaced by -?-
The monitor has detected a conflict in the units used for this calculation. Check the unit settings.
SVR SET CVP USED
SVRISET CVP USED
A 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 SOURCES
Numeric is replaced by -?-
Not all measurements or values required to perform the calculation are available. Check measurement
sources.
ΔSpO₂ CHK UNITS
The monitor has detected a conflict in the units used for this calculation. Check the unit settings.
Numeric is replaced by -?ΔTemp CHK SOURCES
Numeric is replaced by -?-
Not all measurements or values required to perform the calculation are available. Check measurement
sources.
ΔTemp CHK UNITS
Numeric is replaced by -?-
The monitor has detected a conflict in the units used for this calculation. Check the unit settings.
Cableless Measurement Device INOPs
INOP 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.
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3 Patient Alarms and INOPs
INOP Message, Indication
What to do
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 battery.
cl 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.
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4
Managing Patients
Use 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 Patient
The 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.
NOTE
It 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,
Select the patient name field or select the Admit/Dischrg SmartKey to open the Patient
Demographics window.
Clear 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.
Select Admit Patient.
Enter 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.
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4 Managing Patients
–
–
–
–
–
–
–
–
–
–
–
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, or other alternatives. 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 Status
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.
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.
WARNING
Patient 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 category
Changing 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 status
For 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 Patient
You 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 Patient
Use 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.
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4 Managing Patients
Select the Quick Admit SmartKey.
Enter the required data (ID fields or last name depending on configuration) with the keyboard or a
barcode scanner.
Select Enter.
In the confirmation window, select Confirm to discharge the previous patient (if confirmation is
configured).
Check 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 Information
To 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 Patient
WARNING
Always 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 Patient
Select the patient name field or select the Admit/Dischrg SmartKey to open the Patient
Demographics window and associated pop-up keys.
Select the pop-up key for either:
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4 Managing Patients
–
–
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
printed when you select End Case. See “Setting Up Auto Reports” on page 327 for
information on setting up end case reports.
Dischrge Patient - to discharge the patient without printing any reports.
New Patient Check
The 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 period
whether a new patient is now being monitored. The pop-up window is entitled Is This A New
Patient?. The monitor offers a Yes key to discharge the previous patient and begin monitoring a new
patient and a No key to continue monitoring with the current patient data and settings.
The time periods for the three conditions can be configured independently.
Transferring Patients
To 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 MultiMeasurement Module. Understanding this will help you to understand what happens to patient data
when you transfer patients.
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Patient Information
Stored in Monitor
Stored in MMS and
extensions
Patient demographics (name, yes
DOB, patient IDs)
yes
yes
no
Monitor settings (alarm
pause time, alarm volume)
Measurement settings for all yes
measurements (alarm limits,
measurement on/off, etc.)
Trend data
yes, for all MMS and extensions
measurements
yes, for all MMS and extensions most recent 8 hours of
measurements (up to a
information, for all MMS and
maximum of 16 or 32,
extensions measurements
depending on your database
configuration)
Calculation data (HemoCalc yes
data)
no
yes
no
Events data
WARNING
If the monitor is not battery-powered, you cannot monitor during transport.
Transferring a Centrally-Monitored Patient
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.
Before 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.
Remove the MMS and any connected extensions from the monitor.
Connect the MMS to the transfer monitor and monitor your patient during the move.
At 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?.
Select 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.
Verify that the settings for patient category and paced mode are correct.
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Transferring a Centrally-Monitored Patient with X2 or MP5
WARNING
Measurements 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.
Before 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.
Remove the X2/MP5 and any connected extensions from the monitor.
Move the patient using the X2/MP5 as the transport monitor.
At 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?.
Select 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.
Verify that the settings for patient category and paced mode are correct.
Transferring a Centrally-Monitored Patient with X2 or MP5 using IIT
WARNING
Measurements 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.
NOTE
The Transfer key is not available while the X2/MP5 is connected to a host monitor (Companion
Mode is indicated).
100
Remove the X2/MP5 and any connected extensions from the host monitor.
Move the patient using the X2/MP5 as the transport monitor.
At 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 Patients
–
wait until the transfer has completed.
Connect 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?.
Select 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.
Verify 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.
Disconnect 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.
Connect the X1 to the transport monitor and move the patient.
At the new monitoring location, remove the X1 from the transport monitor and connect it to the
new monitor.
If 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)
WARNING
Measurements 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.
Disconnect 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.
Move the patient using the X2/MP5 as the transport monitor.
At the new monitoring location, connect the X2/MP5 to the new host monitor.
If 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
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patient 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 MMS
The 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 Centers
You 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 Mismatch
When 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.
WARNING
102
When 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.
It 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 Patients
the 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 Mismatch
The 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.
WARNING
After 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 Correct
If 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.
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Patient demographics
Patient category and paced status
Same Patient - see “Patient Mismatch - If Both Patient Data Sets Are Correct” on page 104.
New Patient - see “Patient Mismatch - If Neither Patient Data Set is Correct” on page 104.
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 Correct
A 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 Correct
A 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 IDs
Screen Notes
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4 Managing Patients
Patient Information
This information is taken from...
Patient Category
the Multi-Measurement Module, if connected, otherwise the data is
taken from the monitor.
Date of Birth
Height
Weight
Gender
Paced 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.
Automatically Resolving Patient Mismatch
Your 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 Groups
If 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 Centers
Monitors 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.
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4 Managing Patients
Understanding the Care Group Overview Bar
The 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. Some screens may show
the Care Group monitors grouped together in a tabular format on the right hand side of the screen.
Care Group Symbols (four alternative display possibilities
depending on space available)
No data from this bed
The alarms are on but there are no currently
active alarms at this monitor
The highest priority alarm at this monitor is a
standard INOP
The highest priority alarm at this monitor is a
short yellow alarm
The highest priority alarm at this monitor is a
yellow alarm
The highest priority alarm at this monitor is a
red alarm
The highest priority alarm at this bed is a
yellow INOP
The highest priority alarm at this bed is a red
INOP
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4 Managing Patients
Care Group Symbols (four alternative display possibilities
depending on space available)
The alarms at this monitor are suspended
The monitor is in standby mode
The monitor is in Demonstration mode
The current monitor
Care 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.
Viewing the My Care Group Window
This 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.
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4 Managing Patients
Use 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 Window
The 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:
Select Main Setup then Network followed by Auto Window
Select Disabled
When 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.
•
108
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 Patients
Note 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 Keys
Select 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.)
WARNING
The 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.
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4 Managing Patients
Care Group Alarms
Changes 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:
Select the network symbol on the monitor screen to call up the Network menu.
Select 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.
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ECG, Arrhythmia, ST and QT
Monitoring
The 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 129), ST monitoring (see “About ST Monitoring” on
page 139) and QT monitoring (see “About QT/QTc Interval Monitoring” on page 149).
Skin Preparation for Electrode Placement
Good electrode-to-skin contact is important for a good, noise-free ECG signal, as the skin is a poor
conductor of electricity.
Select sites with intact skin, without impairment of any kind.
Clip or shave hair from sites as necessary.
Wash 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.
Dry skin thoroughly.
Gently abrade the skin using ECG skin preparation paper to remove dead skin cells to improve the
conductivity of the electrode site.
Connecting ECG Cables
Attach 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.
Place the electrodes on the patient according to the lead placement you have chosen.
Attach the electrode cable to the patient cable.
Plug the patient cable into the white ECG connector. An ECG waveform and numeric appears on
the monitor display.
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CAUTION
To 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 Leads
The 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:
•
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
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 Status
It 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.
WARNING
Pace 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 Display
Your display may be configured to look slightly different.
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5 ECG, Arrhythmia, ST and QT Monitoring
Lead label of the displayed wave
1 mV calibration bar
Pacer spikes
Pace pulse markers
Current heart rate
Current heart rate alarm limits
EASI lead placement label (located here when present)
ECG Filter label
ECG 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.
Pacer spikes configured to have a fixed size
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 Patients
An ECG optimized for monitoring a paced patient should look like this:
Normal Beats
Pace Pulses/Pace Beats
You should choose a lead as primary or secondary lead that has these characteristics:
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•
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)
In the Setup ECG menu, select Paced to toggle between Yes and No.
Paced
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.
Non-Paced
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.
Avoiding Pace Pulse Repolarization Tails
Some 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.
Repolarization tail (note width)
Changing the Size of the ECG Wave
If 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.
Changing 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.
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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 Wave
Select the wave segment you want to change. This calls up the lead menu for this segment.
In 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 Waves
To change the size of all the ECG waves on the screen by a fixed adjustment factor,
In the Setup ECG menu, select Adjust Size.
Select 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 Tone
The 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 Settings
The 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.
–
Filter: The filter reduces interference to the signal. It should be used if the signal is distorted
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.
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
usually leads to a wandering or rough baseline. In the operating room, the Filter reduces
artifacts and interference from electrosurgical units. Under normal measurement conditions,
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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.
In the Setup ECG menu, select Va Lead.
Select the position used from the list.
Select Vb Lead and select the position used from the list.
Choosing EASI or Standard Lead Placement
You 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 125 for electrode placement diagrams.
About ECG Leads
To 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.
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ECG Leads Monitored
If you are using
these leads are available:
Resp is measured
between electrodes:
a 3-electrode set
I, II, III
RA and LL
a 5-electrode set
I, II, III, aVR, aVL, aVF, V and MCL
RA and LL
a 6-electrode set
I, II, III, aVR, aVL, aVF, Va, Vb
RA and LL
a 10-electrode set
I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6 RA and LL
an EASI 5-electrode set
I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6 I and A
Changing Lead Sets
To 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 Fallback
If 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 Placements
The 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.
Electrode labels
Electrode colors
AAMI
EASI
IEC
AAMI
IEC
RA
White
Red
LA
Black
Yellow
LL
Red
Green
RL
Green
Black
Brown
White
V1
C1
Brown/Red
White/Red
V2
C2
Brown/Yellow
White/Yellow
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Electrode labels
AAMI
EASI
V3
Electrode colors
IEC
AAMI
IEC
C3
Brown/Green
White/Green
V4
C4
Brown/Blue
White/Brown
V5
C5
Brown/Orange
White/Black
V6
C6
Brown/Violet
White/Violet
Standard 3-Lead Placement
118
RA placement: directly below the clavicle and
near the right shoulder
LA placement: directly below the clavicle and
near the left shoulder
LL placement: on the left lower abdomen
5 ECG, Arrhythmia, ST and QT Monitoring
Standard 5-Lead Placement
RA placement: directly below the clavicle and
near the right shoulder
LA placement: directly below the clavicle and
near the left shoulder
RL placement: on the right lower abdomen
LL placement: on the left lower abdomen
V placement: on the chest, the position
depends on your required lead selection
6-Lead Placement
For 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.
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Chest Electrode Placement
V1 on the fourth intercostal space at the right
sternal border
V2 on the fourth intercostal space at the left
sternal border
V3 midway between the V2 and V4 electrode
positions
V4 on the fifth intercostal space at the left
midclavicular line
V5 on the left anterior axillary line, horizontal
with the V4 electrode position
V6 on the left midaxillary line, horizontal with the
V4 electrode position
V3R -V6R on the right side of the chest in
positions corresponding to those on the left
VE over the xiphoid process
A - Angle of Lewis
V7 on posterior chest at the left posterior axillary
line in the fifth intercostal space
V7R on posterior chest at the right posterior
axillary line in the fifth intercostal space
For accurate chest electrode placement and measurement, it is important to locate the fourth
intercostal space.
Locate 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.
Palpate and count down the chest until you locate the fourth intercostal space.
10-Lead Placement
When 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.
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Conventional 12-Lead ECG
V1 - V6
LA
RA
RL
LL
In 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 border
V2 - on the 4th intercostal space at the left sternal border
V3 - midway between the V2 and V4 electrode positions
V4 - on the 5th intercostal space at the left midclavicular line
V5 - on the left anterior axillary line, horizontal with the V4 electrode position
V6 - on the left midaxillary line, horizontal with the V4 electrode position
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Modified 12-Lead ECG
LA
V1-V6
LL
RL
RA
Angle of Lewis
If 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 Placement
If 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.
WARNING
Do 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.
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Capture 12-Lead
You 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 ECG
To 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:
Select the Admit Patient pop-up key, then
Enter the information in the Patient Demographics window.
Open 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
“Changing the ECG Filter Settings” on page 115) is changed to the 12-Lead filter setting (see “Setting
Up the 12-Lead ECG” on page 124).
Capturing the 12-Lead ECG
To 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 125).
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.
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Setting Up the 12-Lead ECG
In 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.
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 1
Defines which lead will be used as rhythm lead 1, 2 or 3.
Rhythm Lead 2
Rhythm Lead 3
Choices are Primary, Secondary, I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6,
V, MCL.
Lead Sequence
Defines the sequence in which the leads are presented.
This setting is only relevant when 3X4 1R or 3X4 3R is selected as Format.
Choices are Cabrera and Internat.
Storing and Sending the 12-Lead ECG
You 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 ECG
Print a dedicated 12-Lead ECG report by selecting the Print Report pop-up key.
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Capture 12-Lead Pop-up Keys
Here is a summary of all the pop-up keys available during 12-Lead ECG procedure:
Pop-up Keys
Selecting this pop-up key lets you
Admit 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.
EASI ECG Lead Placement
Using 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.
WARNING
EASI-derived 12-lead ECGs and their measurements are approximations to conventional 12-lead
ECGs. As the 12-lead ECG derived with EASI is not exactly identical to the 12-lead conventional
ECG obtained from an electrocardiograph, it should not be used for diagnostic interpretations.
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 Conditions
If 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.
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EASI Electrode Placement
E (V) - on the lower sternum at the level of
the fifth intercostal space
A (LL) - on the left midaxillary line at the
same level as the E electrode
S (LA) - on the upper sternum
I (RA) - on the right midaxillary line at the
same level as the E electrode
N - reference electrode - can be anywhere,
usually below the sixth rib on the right hip
ECG and Arrhythmia Alarm Overview
The ECG and arrhythmia alarms available depend on which measurements are switched on, and the
arrhythmia option enabled for your monitor.
126
•
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 monitor
5 ECG, Arrhythmia, ST and QT Monitoring
Cardiotach Alarms
Additional Alarms with Basic Additional Alarms with
Arrhythmia Option
Enhanced Arrhythmia Option
***Asystole
***Ventricular Tachycardia
**Afib
***Ventricular Fibrillation/
Tachycardia
**Pacer Not Capture
**Supraventricular Tach
**Pacer Not Pacing
**Missed Beat
***Extreme Bradycardia
**PVCs/min HIGH (PVC >
limit/min)
**Pause
***Extreme Tachycardia
**Irregular HR
**High heart rate
**Ventricular Rhythm
**Low heart rate
**Run PVCs High
**Pair PVCs
**R-on-T PVCs
**Ventricular bigeminy
**Ventricular trigeminy
**Non-sustain VT
**Multiform PVCs
Using ECG Alarms
ECG 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 Limits for Heart Rate
The extreme rate alarms, Extreme Tachy and Extreme Brady, generated by the active alarm source,
either HR or Pulse, are set in Configuration Mode by adding a set value (the Δ value) to the high and
low alarm limits.
Extreme Brady Limit
Low Limit
High Limit
Extreme Tachy Limit
Δ Extreme Brady
Δ Extreme Tachy
You need to know which value has been configured for your monitor. Changing the high and low
alarm limits automatically changes the extreme alarm limits within the allowed range.
To see the extreme rate alarms set for your monitor, in the Setup ECG menu, see the menu items Δ
ExtrTachy and Δ ExtrBrady.
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ECG Alarms Off Disabled
Be 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 Off
When 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 Detection
In 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 Information
CAUTION
Interference from instruments near the patient and ESU interference can cause problems with the
ECG wave. See the monitor specifications for more information.
WARNING
Defibrillation 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.
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During 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 Monitoring
Arrhythmia 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 singlelead or multi-lead arrhythmia analysis. During arrhythmia analysis, the monitor continuously
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•
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 Options
Your 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 126, the rhythm and
ectopic messages detected are listed in “Arrhythmia Status Messages” on page 132.
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 Off
In the Setup Arrhythmia menu, select Arrhythmia to toggle between On and Off.
Select 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 Monitoring
It 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:
–
–
–
130
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 Monitoring
To 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 Beats
As 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 Alarm
The 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 well
Atrial 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 Block
Bundle 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.
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Understanding the Arrhythmia Display
Your monitor screen may look slightly different from the illustration.
Beat label
Pace pulse marks
Rhythm status message
PVC Numeric
HR Numeric
Ectopic status message
Delayed arrhythmia wave
Viewing Arrhythmia Waves
To 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 Labels
Arrhythmia beat labels tell you how the monitor is classifying beats.
N = Normal
V = Ventricular Ectopic
S = Supra-ventricular Premature
P = Paced
' = Pacer spike
" = Biventricular Pacer Spike
L = Learning patient's ECG
A = Artifact (noisy episode)
? = Insufficient information to classify beats
I = Inoperative condition (e.g., LEADS OFF)
M = Pause or missed beat
Arrhythmia Status Messages
The monitor displays two types of status messages:
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•
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 Messages
The label B or E indicates basic (B) or enhanced (E) arrhythmia capability.
Rhythm Status Message Description
B or E
Asystole
No QRS for 4 consecutive seconds in absence of vent fib or
chaotic signal
B, E
Vent Fib/Tach
A fibrillatory wave for 4 consecutive seconds
B, E
Vtach
A dominant rhythm of adjacent Vs and a HR > the V-Tach
Heart Rate Limit
B, E
Sustained VT
Ventricular tachycardia rhythm for more than 15 seconds
Vent Rhythm
A dominant rhythm of adjacent PVCs and a HR ≤ the V-Tach E
HR Limit
Vent Bigeminy
A dominant rhythm of N, V, N, V
Vent Trigeminy
A dominant rhythm of N, N, V, N, N, V
Paced Rhythm
A dominant rhythm of paced beats
B, E
Irregular HR
Consistently irregular rhythm
Sinus Brady
Sinus Rhythm
Sinus Tach
A dominant rhythm of SV beats preceded by P-waves
B, E
SV Brady
SV Rhythm
SV Tach
A dominant rhythm of SV beats not preceded by P-waves
B, E
Unknown ECG Rhythm
Rhythm cannot be determined
B, E
Learning ECG
Algorithm is learning the ECG beat morphology
B, E
Learning Rhythm
Algorithm is learning the rhythm of the classified beats
B, E
CANNOT ANALYZE ECG
ECG signal is predominantly invalid and therefore cannot be
analyzed
B, E
Ectopic Status Messages
The label B or E indicates basic (B) or enhanced (E) arrhythmia capability.
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Ectopic Status Message Explanation
B or E
(No message displayed)
No ectopic activity within the last minute
Run PVCs
More than 2 consecutive PVCs within the last minute
Pair PVCs
Pair PVCs within the last minute
Pacer Not Capt
Pause with pace pulse (paced patient only) within the last
minute
B, E
Pacer Nt Pacing
Pause without pace pulse (paced patient only) within the last
minute
B, E
Pause
No beat detected for 1.75 x average R-R interval for HR <120, E
or
No beat for 1 second with HR >120 (non-paced patient only),
or
No beat detected for more than the set pause threshold.
R-On-T PVCs
R-ON-T detected within the last minute
Multiform PVCs
Multiform PVCs detected within the last minute
Frequent SVPBs
SVPB count within last minute is greater than 5
SVPBs
1-5 SVPBs in the last minute with a sinus rhythm and no Vs
SV Beats
SV count within last minute and rhythm status is paced
B, E
Paced Beats
Paced beat count within last minute and rhythm status is not
paced
B, E
Arrhythmia Relearning
During 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 Manually
To 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.
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Automatic Arrhythmia Relearn
Arrhythmia 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 Fallback
Lead fallback triggers an automatic arrhythmia relearn.
WARNING
If 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 VFib.
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 Alarms
Arrhythmia 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).
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Yellow Arrhythmia Alarms
Yellow 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.
WARNING
When arrhythmia analysis is on, all yellow ECG and arrhythmia alarms are short yellow alarms (onestar). 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 Latching
When 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 Off
Some arrhythmia alarms can be individually switched on or off:
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 Off
All 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 Limits
Some arrhythmia alarms have limits which can be individually adjusted:
VTach HR, VTach Run, PVCs/min, Vent Rhythm, SVT HR, SVT Run, Asystole Thresh., Pause
Threshold
To adjust alarm limits, in the Setup Arrhythmia menu, select the alarm to be adjusted.
Select the appropriate setting from the pop-up list.
Arrhythmia Alarm Timeout Periods
Normally, 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:
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•
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 138 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 138.
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 Period
To 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:
Alarm Condition Example
Short yellow alarm tone sounds Alarm message
displayed
Single alarm
instance
Non-sustained Vtach
when alarm condition is initially
detected
for 3 minutes (latching
time)
Continuous alarm
condition
PVCs/min HIGH when alarm condition is initially
detected and - as an alarm
reminder - every time the
configured timeout period has
expired
until the alarm
condition stops, plus a
maximum of three
minutes latching time
Same intermittent
alarm condition
Pair of PVCs
each time the alarm condition is
detected, provided that the
configured timeout period has
expired
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.
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Arrhythmia Alarm Chaining
When 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 126 for information on which alarms are
included in the different arrhythmia options. See “Arrhythmia Alarm Timeout Periods” on page 136
for an explanation of how alarm timeouts work.
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–
–
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 Alarms
PVC-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 Monitoring
The 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.
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WARNING
Some 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 Off
To 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 Analysis
You 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:
Enter the Setup ST Analysis menu.
Select 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:
Select the Add key at the bottom of the Setup ST Leads window. This opens the Choices pop-up
window.
Choose 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:
Choose a lead from the list in the Setup ST Leads window.
Select the Delete key. This removes this lead from the list.
NOTE
The 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,
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In the Setup ST Leads menu, choose a lead from the list.
Select the Sort Up or Sort Down key to move the lead up or down in the list.
5 ECG, Arrhythmia, ST and QT Monitoring
Understanding the ST Display
Your monitor screen may be configured to look slightly different from the illustrations.
ST numerics
Current HR alarm limits
Current heart rate
ST Numerics
Up 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 Index
The 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 Snippets
ST 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 Window
The 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.
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ST label and numeric
Baseline ST numeric
Difference between current values and baseline values
1 mV calibration bar
Current snippet
ST baseline
Timestamp of most recently stored baseline snippet
Updating ST Baseline Snippets
ST 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,
Select an ST snippet to open the ST Baseline window.
In 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 Segments
To record all currently available ST snippets and baselines, in the ST Baseline window, select the popup key Record ST.
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About the ST Measurement Points
The 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.
R-wave peak at 0 msec
J point, for example, 48 msec
Difference = ST value
ST measurement point, for
example, J + 60 msec
Isoelectric point set to -80 msec
CAUTION
The 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 Points
Depending 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,
In 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.
Select 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.
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Use 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.
ST label and the ST numeric that would apply using the current points
1mV calibration bar
Cursors for adjusting ST points
Timestamp of most recent ST point adjustment
Highlighted ST point
The 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.
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To 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.
Select 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.
To update the ST snippet shown in the Adjust ST Points window, select the Update pop-up key.
ST Alarms
ST 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 Alarming
Be 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 Limits
The 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.
In the Setup ST Analysis menu, select ST Alarm Mode and select Single ST or Multi ST.
Select the alarm to be adjusted.
Select the appropriate setting.
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Viewing ST Maps
The 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 View
In 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.
Alarm status indicator
EASI Limb Leads
EASI Chest Leads
ST index (for EASI)
ST label, value and polarity of corresponding lead
ST map
If an ST lead is switched off, its axis is not shown in the map.
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If 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 View
In 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.
Limb Leads
Chest Leads
current ST values
trending interval
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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.
Viewing an ST Map
To display an ST map,
•
In the Main Setup menu, select ST Map.
Working in the ST Map Task Window
You 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 Views
To 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 276.
Displaying an ST Reference Baseline
You 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 Baseline
To update the baseline,
•
In the Setup ST Analysis menu, select ST Baseline then select Update Baseline.
Changing the Scale of the ST Map
To change scale,
•
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Select Size Up or Size Down to alter the size at which monitor displays the map.
5 ECG, Arrhythmia, ST and QT Monitoring
Changing the Trending Interval
To determine how frequently the monitor displays a trended sample,
In Trend view, select Select Interval.
Select the required interval from the menu. The interval ranges between 12 seconds to 30 minutes.
Printing an ST Map Report
To print the most recently viewed (current or trend) window,
Select Main Setup then select Reports.
Select ST Map.
Press Print.
About QT/QTc Interval Monitoring
The QT interval is defined as the time between the beginning of the Q-wave and the end of the Twave. 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 Algorithm
The 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).
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Because 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 Monitoring
Of 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 Monitoring
Some 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 variation
For 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.
WARNING
QT/QTc measurements should always be verified by a qualified clinician.
Selecting The QT Leads
For QT Monitoring you can select one of the following three modes:
150
•
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 Monitoring
•
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,
Select the QT numeric to enter the Setup QT Analysis window.
Select 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 View
In 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 Set
To view one set of waves in a larger scale, you can cycle through the different views,
Select Current view to see the set of current waves.
Select Baseline view to see the set of baseline waves.
Select Split view to return to the combined view with current and baseline waves.
Setting The QT Baseline
In 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.
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To 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 Waves
To start a printout,
•
Select Print QT.
Recording The QT Waves
To start a recording,
•
Select Record QT.
QT Alarms
There 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.
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Additional Message
Cause of Invalid QT Measurement
QT Startup
QT monitoring was just turned on or has been reset
Asystole or Leads Off
Not all specified leads needed to perform QT analysis are
available, or
Asystole condition is detected
Insufficient Valid Leads
Not enough valid QRS complexes to generate a QT measurement
Invalid Rhythm for QTc
Not enough valid RR intervals to generate QT-HR, the averaged HR
used for QTc calculation
High 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 small
Small T Wave
T-wave of the signal is too small
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Additional Message
Cause of Invalid QT Measurement
End of T not Detected
End of the T-Wave cannot be accurately detected
QT 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 stable
Switching Individual QTc Alarms On and Off
Each 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 Limits
Set the high alarm limits based on your assessment of the patient's clinical condition, unit protocols,
physician orders or medication specified limits.
In the Setup QT Analysis menu, select QTc High Limit.
Select the appropriate setting.
Select ΔQTc High Limit.
Select the appropriate setting.
Switching QT Monitoring On and Off
To switch all QT monitoring on or off, in the Setup QT Analysis menu, select QT Analysis to switch
between On and Off.
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6
Monitoring Pulse Rate
The 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 Monitoring Invasive Pressure
chapter for an explanation of the pressure labels). The displayed pulse numeric is labeled and colorcoded 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 Menu
If 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 Source
The 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,
In the Setup Pulse menu, select System Pulse.
Select 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.
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Switching Pulse On and Off
To 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,
Enter the Setup Pulse menu by selecting the Pulse numeric or by selecting Pulse in the Setup
SpO₂ menu.
In the Setup Pulse menu, select the correct pulse label, e.g. Pulse (SpO₂), to toggle between On
and Off.
Using Pulse Alarms
You 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 measured
and
– 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.
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WARNING
Selecting 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 126, 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 Disabled
If 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 Limits
As 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 Limits for Heart Rate
The extreme rate alarms, *** EXTREME TACHY and *** EXTREME BRADY, generated by the active
alarm source, either HR or Pulse, are set in Configuration Mode by adding a set value 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 Tone
The 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.
WARNING
The 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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7
Monitoring 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 Resp
Correct 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 Resp
If 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 Overlay
Cardiac 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.
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7 Monitoring Respiration Rate (Resp)
Lateral Chest Expansion
Some 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 Breathing
Some 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 Display
The 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.
Resp wave label
One Ohm calibration bar
Manually-set Resp detection level
Resp numeric and label
Changing Resp Detection Modes
The 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 Mode
In 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,
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7 Monitoring Respiration Rate (Resp)
•
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 Mode
In 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 Overlay
In 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 160.
Changing the Size of the Respiration Wave
WARNING
When 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.
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7 Monitoring Respiration Rate (Resp)
Changing the Speed of the Respiration Wave
Resp 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 Alarms
Resp 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 Delay
The 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.
In the Setup Resp menu, select Apnea Time.
Select the appropriate setting.
Resp Safety Information
WARNING
Respiration detection level
If 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.
Apnea
The 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.
Interference
If 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
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7 Monitoring Respiration Rate (Resp)
To 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 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.
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7 Monitoring Respiration Rate (Resp)
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8
Monitoring SpO2
Philips 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 Sensors
Depending 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 Accessories chapter
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.
CAUTION
Do 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 Sensor
Follow the SpO2 sensor's instructions for use, adhering to all warnings and cautions.
Remove colored nail polish from the application site.
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8 Monitoring SpO2
Apply 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.
Check that the light emitter and the photodetector are directly opposite each other. All light from
the emitter must pass through the patient's tissue.
WARNING
Proper Sensor Fit: 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 regularly.
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 Cables
Connect 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.
CAUTION
Extension 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.
Measuring SpO2
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Select the correct patient category setting (adult/pediatric and neonatal), as this is used to optimize
the calculation of the SpO2 and pulse numerics.
8 Monitoring SpO2
During 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
•
For fully conscious pediatric or adult patients, who have a normal function of perfusion and
sensory perception at the measurement site:
To ensure skin quality and correct optical alignment of the sensor, inspect the application site
when the measurement results are suspicious or when the patient complains about pressure at
the application site, but at least every 24 hours. Correct the sensor alignment if necessary.
Move the sensor to another site, if the skin quality changes.
•
For all other patients:
Inspect the application site every two to three hours to ensure skin quality and correct optical
alignment. Correct the sensor alignment if necessary. 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 or 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.
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Assessing a Suspicious SpO2 Reading
Traditionally, 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.
WARNING
With 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 Time
Depending 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.
In the Setup SpO₂ menu, select Average.
Select the required averaging time from the list.
Understanding SpO2 Alarms
This refers to SpO2 specific alarms. See the Alarms chapter 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.
CAUTION
If 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.
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Alarm Delays
There 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 169 for details on how this works.
See “Performance Specifications” on page 399 for delay specifications.
About Smart Alarm Delays
The 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.
WARNING
Before 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 exceeded
If 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.
Examples
In 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.
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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.
Configuration
To 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.
Adjusting the Alarm Limits
In the Setup SpO₂ menu:
170
•
Select High Limit then choose the high alarm limit.
•
Select Low Limit then choose the low alarm limit.
8 Monitoring SpO2
WARNING
High 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 high
alarm off.
Adjusting the Desat Limit Alarm
The Desat alarm is a high priority (red) alarm notifying you of potentially life threatening drops in
oxygen saturation.
In the Setup SpO₂ menu, select Desat Limit.
Adjust the limit.
Pleth Wave
The 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 value
Perfusion Numeric
The 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 Indicator
The 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..
When a reference value has been set, the perfusion change indicator is displayed next to the perfusion
numeric.
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Setting SpO2/Pleth as Pulse Source
In the Setup SpO₂ menu, select Pulse (SpO₂) to enter the Setup Pulse menu.
In the Setup Pulse menu, select System Pulseand select the correct SpO2 label from the pop-up
list.
Setting Up Tone Modulation
If 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 Volume
In the Setup SpO₂ menu, select QRS Volume and set the appropriate QRS tone volume.
Calculating SpO2 Difference
When 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.
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From the Main Setup menu, select Measurements.
From the Setup ΔSpO₂menu, select First SpO₂.
Choose the first measurement source.
Select Second SpO₂.
Choose the second measurement source.
9
Monitoring NBP
This 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 SP101992) 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 Measurement
Oscillometric 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.
WARNING
Patient 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.
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Unattended 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.
CAUTION
If 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 Limitations
Measurements 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 preeclamptic patients.
Measurement Modes
There 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 Method
The 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.
In 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.
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Preparing to Measure NBP
Connect the cuff to the air tubing.
Plug the air tubing into the red NBP connector. Avoid compression or restriction of pressure
tubes. Air must pass unrestricted through the tubing.
Make 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.
Apply 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 Level
To correct the measurement if the limb is not at heart level, to the displayed value
add 0.75 mmHg (0.10 kPa) for each centimeter
higher or
deduct 0.75 mmHg (0.10 kPa) for each
centimeter lower or
add 1.9 mmHg (0.25 kPa) for each inch higher.
deduct 1.9 mmHg (0.25 kPa) for each inch
lower.
Understanding the NBP Numerics
Alarm source
Measurement Mode
Timestamp/Timer
Mean pressure
Diastolic
Systolic
Alarm limits
Depending on the NBP numeric size, not all elements may be visible. Your monitor may be configured
to display only the systolic and diastolic values.
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9 Monitoring NBP
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 Sources
If you have parallel alarm sources, the sources are displayed instead of the alarm limits.
NBP Timestamp
Depending 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 "easyto-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 Measurements
The 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 Measurements
Use the Setup menu, SmartKeys or the MMS hardkey to start and stop measurements.
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9 Monitoring NBP
Action to be performed
NBP Setup menu
Start manual measurement
Start/Stop
Start Auto series
SmartKeys
MMS hardkey
Start/Stop
Start/ Stop
--Start NBP
Start STAT measurement
NBP STAT
NBP STAT
STAT (for MMS
without Pressure/Temp
measurement)
Start STAT
Stop Manual measurements
Start/Stop
Start/Stop
Start/ Stop
Stop NBP
Stop current Auto measurement Start/Stop
Start/Stop
Start/ Stop
Stop NBP
Stop current STAT
measurement and end series
Start/Stop
Start/Stop
Start/ Stop
NBP STAT
NBP STAT
STAT (for MMS
without Pressure/Temp
measurement)
Stop NBP
Stop Auto, Manual or STAT
measurement AND series
Stop All
Stop All
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9 Monitoring NBP
CAUTION
Use 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
Time
In the Setup NBP menu, select Mode and select Auto from the pop-up menu.
For an automatic measurement, select Repeat Time and set the time interval between two
measurements.
Enabling Sequence Mode and Setting Up The
Sequence
In the Setup NBP menu, select Mode and select Sequence from the pop-up menu.
Select 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.
Select each sequence in turn and select the number of measurements and the time interval between
the measurements.
To have measurements continue after the sequence, set the number of measurements for your last
cycle to Continuous and this cycle will run indefinitely.
CAUTION
Be 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 Source
You 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:
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9 Monitoring NBP
Menu option
Pressure value monitored
Sys.
systolic
Dia.
diastolic
Mean
mean
Sys & Dia
systolic and diastolic in parallel
Dia & Mean
diastolic and mean in parallel
Sys & Mean
systolic and mean in parallel
Sys&Dia&Mean
all three pressures in parallel
If 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/Off
In 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 Puncture
You 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.
In the Setup NBP menu select VeniPuncture.
Puncture vein and draw blood sample.
Reselect 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.
NOTE
Performing 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 NBP
NBP 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.
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9 Monitoring NBP
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10
10
Monitoring Temperature
WARNING
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 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 Measurement
Select the correct type and size of probe for your patient.
If you are using a disposable probe, connect the probe to the temperature cable.
Plug the probe or temperature cable into the temperature connector socket.
Apply the probe to the patient. You are advised to use a protective rubber cover on rectal probes.
Select an appropriate temperature label.
Check that the alarm settings (on or off, high and low limits) are appropriate for this patient and
this type of temperature measurement.
WARNING
Make 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 Monitoring
Tell 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.
In the Setup  menu, select Label.
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10 Monitoring Temperature
Select the appropriate label from the list.
Temp
non-specific temperature label
Trect
rectal temperature
Tart
arterial temperature
Tskin
skin temperature
Tcore
core temperature
Tven
venous temperature
Tesoph
esophageal temperature
Tnaso
nasopharyngeal temperature
Extended Temperature Label Set
The 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.
T1, T2, T3, T4
Non-specific temperature labels
Tamb
ambient temperature
Tcereb
cerebral temperature
Ttymp
tympanic temperature
Tvesic
vesical temperature
Calculating Temp Difference
The monitor can calculate and display the difference between two temperature values by subtracting
the second value from the first. The difference is labeled ΔTEMP.
182
In the Main Setup menu, select Measurements.
In the Setup ΔTemp menu, select First Temp.
Label the measurement source as appropriate.
Select Second Temp.
Label the measurement source as appropriate.
11
11
Monitoring Invasive Pressure
WARNING
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 by external power: when
connected to a host monitor, to the external power supply (M8023A) or to the Battery Extension
(865297).
CAUTION
Do 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 Measurement
Plug in the pressure cable.
Prepare the flush solution.
Flush the system to exhaust all air from the tubing. Ensure that the transducer and stopcocks are
free of air bubbles.
WARNING
If air bubbles appear in the tubing system, flush the system with the infusion solution again. Air
bubbles may lead to a wrong pressure reading.
Connect the pressure line to the patient catheter.
If 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.
Position the transducer so that it is level with the heart, approximately at the level of the
midaxillary line.
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11 Monitoring Invasive Pressure
WARNING
If 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 Monitoring
Tell 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.
In the Setup  menu, select Label.
Select the appropriate label from the list.
Label
Description
Label
Description
ABP
Arterial blood pressure
Non-specific pressure label
ART
Arterial blood pressure (alternative)
PAP
Pulmonary artery pressure
Ao
Aortic pressure
RAP
Right atrial pressure
CVP
Central venous pressure
UAP
Umbilical arterial pressure
ICP
Intracranial pressure
UVP
Umbilical venous pressure
LAP
Left atrial pressure
Extended Pressure Label Set
The 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
BAP
Brachial arterial pressure
FAP
Femoral arterial pressure
IC1, IC2
Alternative intracranial pressures
P1, P2, P3, P4
Alternative non-specific pressure labels
Zeroing the Pressure Transducer
To avoid inaccurate pressure readings, the monitor requires a valid zero. Zero the transducer in
accordance with your hospital policy. You must perform a zero:
184
•
when you use a new transducer or tubing
•
every time you reconnect the transducer cable to the monitor
11 Monitoring Invasive Pressure
•
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.
WARNING
If 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 Zero
The 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 Measurement
WARNING
Invasive pressure alarms (and pulse alarms, if derived from invasive pressure) are temporarily
suppressed until 30 seconds after the transducer finishes zeroing.
Turn off the stopcock to the patient.
Vent the transducer to atmospheric pressure, to compensate for the static and atmospheric
pressure exerted on the transducer.
In the setup menu for the pressure, select Zero .
When you see the message  zero done at  on the status line,
close the stopcock to atmospheric pressure, and open the stopcock to the patient.
CAUTION
When 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.
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Using the Zero Hardkey
Pressing 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 Simultaneously
WARNING
Before 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 Zero
The status line lists the probable cause of an unsuccessful zero:
Message
Corrective Action
unable to zero equipment
malfunction
The hardware is faulty. Contact your service personnel.
unable to zero excessive offset
Make 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
unable to zero - no
transducer
Make 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 pressure
Make sure that the transducer is vented to air, not to the patient, and try
again.
unable to zero - timed Try pressing the Zero hardkey or Zero  key again. If this
out
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  menu, select the pressure's label.
Adjusting the Calibration Factor
Each 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.
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11 Monitoring Invasive Pressure
In the Setup  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.
To confirm you want to use the new calibration factor, select the Confirm pop-up key.
Displaying a Mean Pressure Value Only
Use 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 Scale
Select the label of the pressure wave whose scale you want to set to enter the Setup  menu.
In the Setup  menu, (for example ABP) select Scale.
Select 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 Waveform
In the Setup  menu, select Optimum Scale to let the monitor select the best minimum
and maximum scales for the current wave.
Using the Wave Cursor
When 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 cursor
Select the pressure wave.
Select Activate Cursor.
Use 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.
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Non-Physiological Artifact Suppression
Some 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  ARTIFACT, and a question mark is shown beside the
pressure numerics. Pressure alarms and the  NON-PULSATILE INOP are suppressed
during the configured period. The CPP alarms are not suppressed.
Choosing the Pressure Alarm Source
WARNING
Make 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  menu, select Alarms from and choose the source.
Menu option
Pressure value monitored
Sys.
systolic
Dia.
diastolic
Mean
mean
Sys & Dia
systolic and diastolic in parallel
Dia & Mean
diastolic and mean in parallel
Sys & Mean
systolic and mean in parallel
Sys&Dia&Mean
all three pressures in parallel
Select and set the High Limit and Low Limit for the pressure(s) you have selected.
Extreme Alarm Limits for Pressure
The 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.
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11 Monitoring Invasive Pressure
Extreme Low Limit
Low Limit
High Limit
Extreme High Limit
Δ Extreme Low
Δ Extreme High
You 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  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 CPJ840J6
Depending 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.
•
approximately 25cm of tubing.
Making the Pressure Calibration
WARNING
Never perform the invasive pressure calibration while a patient is being monitored.
Zero the transducer.
Connect 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.
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11 Monitoring Invasive Pressure
d. Open the port to the manometer.
1 Tubing to manometer
2 Syringe with heparinised solution
3 To pressure connector on monitor
4 Patient connection stoppered
5 Off
Move the syringe barrel in and raise the mercury to 200 mmHg (30 kPa). 200 mmHg is the
recommended calibration pressure.
In the Setup  menu, select Cal. Press.
Select the calibration pressure from the list, for example 200 mmHg.
Select Confirm to recalculate the calibration factor using the applied pressure.
When the monitor displays  mercury calibr. done at , remove
the manometer tubing, syringe and extra stopcock. We recommend you replace the transducer
dome and tubing with sterile ones.
Label the transducer with the calibration factor shown in the Cal. Factor field in the pressure's
setup menu.
Reconnect the patient and start measuring again.
Troubleshooting the Pressure Calibration
The status line lists the probable cause of an unsuccessful calibration.
190
Message
Corrective Action
unable to calibrate - equipment
malfunction
Contact your service department. The pressure hardware is
faulty.
11 Monitoring Invasive Pressure
Message
Corrective Action
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
transducer
Make sure that the transducer is connected and try again.
unable to calibrate - unstable
signal
Make sure there are no disturbances to the transducer, and
repeat the calibration.
unable to calibrate - perform
zero first
No valid zero. Zero the transducer.
Calculating Cerebral Perfusion Pressure
The monitor can calculate the difference between mean arterial pressure and the intracranial pressure.
The difference is labeled CPP.
In the Main Setup menu, select Measurements.
In the Setup CPP menu, select one of the listed pressures as the arterial pressure source.
Calculating Pulse Pressure Variation
Note: 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 pulse pressure less the minimum pulse pressure divided by the
average of the two. 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 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
To select an arterial pressure as PPV source:
In the Main Setup menu, select Measurements.
In the Setup PPV menu, select ABP, ART, Ao, BAP, P or FAP as the arterial pressure source.
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11 Monitoring Invasive Pressure
CAUTION
Older Multi-Measurement modules cannot supply a beat-to-beat arterial pressure value. In this case the
monitor shows a NO PPV FROM MMS or NO PPV FROM FMS INOP.
Measuring Pulmonary Artery Wedge Pressure
Pulmonary Artery Wedge Pressure (PAWP) values, used to assess cardiac function, are affected by:
•
Fluid status
•
Myocardial contractility
•
Valve and pulmonary circulation integrity
Obtain 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.
WARNING
The 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,
192
In the Main Setup menu, select Wedge to display the wedge procedure window.
Prepare and check the pressure line according to your hospital policy.
Use the Refernce Wave 1 and Refernce Wave 2 pop-up keys to select any ECG or respiratory
wave as reference waves.
Select 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.
Select 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.
Inflate 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
11 Monitoring Invasive Pressure
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.
Deflate the balloon when the monitor prompts you: Ready for balloon deflation and verify that
the waveform returns to pulmonary artery shape.
If you need to start a new measurement, select Restart Wedge.
Editing the Wedge
Select the Edit Wedge pop-up key to see the stored waveforms.
The 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.
Select Change Speed if you want to change the speed (resolution) of the displayed wave.
Move the cursors up, down, right and left to set them on the correct wedge position.
Select Store Wedge to store the PAWP value.
Select 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.
WARNING
Prolonged 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.
Identifying the Pressure Analog Output Connector
Analog output (module M1006B, option C01 only)
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194
12
12
Monitoring Cardiac Output
The 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 #C10
The PiCCO method additionally lets you measure Continuous Cardiac Output (CCO) by performing
pulse contour analysis on the blood pressure waveform.
Hemodynamic Parameters
This 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.
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12 Monitoring Cardiac Output
Measured and Calculated Hemodynamic
Parameters and Indexes
PiCCO Method (Transpulmonary
Thermodilution)
Right Heart Thermodilution
Continuous?
Main
Screen
HemoCalc
Main
Continuous?
Window
Screen
HemoCalc
Window
Blood Temperature (Tblood)
C.O./C.I.: Cardiac Output
CCO/CCI: Continuous Cardiac Output
Y (in the
C.O. field)
Not available
SVR/SVRI: Systemic Vascular Resistance
N and Y
SV/SI: Stroke Volume/SV Index
N and Y
SVV: Stroke Volume Variation
Not available
*dPmax: Left Ventricular Contractility Index
Not available
CFI: Cardiac Function Index
Not available
PPV: Pulse Pressure Variation
Not available
ITBV/ITBVI: Intrathoracic Blood Volume
Not available
EVLW/EVLWI: Extravascular Lung Water
Not available
GEDV/GEDVI: Global End-Diastolic Volume N
Not available
*PVPI: Pulmonary Vascular Permeability Index N
Not available
*GEF: Global Ejection Fraction
Not available
*RLShnt: Right-Left-Shunt Fraction
Not available
PVR/PVRI: Pulmonary Vascular Resistance
Not available
LCW/LCWI: Left Cardiac Work
RCW/RCWI: Right Cardiac Work
Not available
RVSW/RVSWI: Right Ventricular Stroke Work Not available
* currently not available in the U.S.A. or in clinical environments under FDA control.
Using the C.O. Procedure Window
The 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,
196
•
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.
12 Monitoring Cardiac Output
Average - column of averaged values
Unit column
Continuously measured numeric
Prompt message field
Thermodilution curve of current trial
Curve alert message field
Current trial number
Setup information
Trial numbers for the trial curves
10 Trial curves
11 Results table of current trial
12 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 Menus
C.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.
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CCO/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 Window
From the procedure window, select the pop-up key Hemo Calc to open the Hemo Calculations
window.
Measuring C. O. Using the PiCCO Method
The 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 Output
Every 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 Resistance
The 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 Variation
Note: 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.
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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.
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
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Setting Up the PiCCO C.O. Measurement
10
C.O. Module
C.O. Interface Cable
PULSION Pressure Transducer
Press Module
Pressure Adapter Cable
Thermistor Connection Cable
Thermistor Connection
PULSION Arterial Catheter
CVP Line
Injectate Temperature Probe
Housing
11 Injectate Syringe
12 Injectate Temperature Probe
13 Remote Switch
200
Set 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.
Set up the central venous line.
Connect the injectate temperature probe housing to the venous line.
Plug 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.
12 Monitoring Cardiac Output
If 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.
Check 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.
Check 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.
Check 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.
Make 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. Measurements
Always 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.
Enter the procedure window.
When 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.
When 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.
When 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.
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Editing PiCCO C.O. Measurements
It 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.
Review 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.
Reject 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. Measurements
When 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.
WARNING
CCO 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 Indicators
Each 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.
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For 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.
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)
Measuring C.O. Using the Right Heart
Thermodilution Method
In 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.
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Setting up RH C.O. Measurements
204
C.O. Module
C.O. Interface Cable
Remote Start Switch
Thermistor Connector
Thermistor Connection Cable
PA Catheter
Injectate Temperature Probe
Housing
Injectate Syringe
Injectate Temperature Probe
Set up the PA line using a PA catheter.
Attach the injectate temperature probe housing to the PA line.
Plug 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.
Plug the thermistor connection cable of the PA catheter into the thermistor connector.
Connect the injectate temperature probe to the injectate temperature probe housing.
Check 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.
12 Monitoring Cardiac Output
Ice-Bath Setup for RH Thermodilution C.O. Measurements
If 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 Constant
Check 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. Measurements
Enter the procedure window.
When 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.
When 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.
When 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. Measurements
It 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.
Review 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.
Reject 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.
Save 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.
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Documenting C.O. Measurements
You can document C.O. measurements on the default printer or recorder.
In the procedure window, select the pop-up key Print/ Record.
From 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 Guidelines
The 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. Injectate
If 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. Injectate
If 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 ETVI
The 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.
Weight
Use the table below as a guide in choosing an injectate volume appropriate for the patient weight.
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Patient
Weight
Cold Injectate
Room Temperature Injectate
ETVI < 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
C.O./CCO Curve Alert Messages
After 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.
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C.O./CCO Curve Alert
Messages
Possible Causes
Tinj 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
required
The 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.
208
High ETVI, use cold injectate
or greater inj. volume
The 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
(“Guidelines for PiCCO C.O. Injectate” on page 206).
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).
Check Injectate Temperature
Probe Type
The recorded Tinj signal is uncharacteristic for the M1646 injectate
temperature probe. An incorrect probe type may have been used.
12 Monitoring Cardiac Output
C.O./CCO Curve Alert
Messages
Possible Causes
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.
If 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 Messages
Prompt messages appear in the procedure window if a C.O. measurement trial must be terminated.
C.O./CCO Prompt Messages
Possible Causes
Curve below baseline,
measurement terminated
May be caused by thermal baseline drift. No C.O. value
calculated.
Excessive curve height,
measurement terminated
The 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.
C.O./CCO Warning Messages
Warning messages contain important information about the C.O. measurement.
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C.O./CCO Warning Messages
Possible Causes
Next measurement erases older
curve
Six 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 possible
Poor 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
replaced
A 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.
C.O./CCO Safety Information
WARNING
Catheter 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.
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CAUTION
During 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.
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13
13
Monitoring Carbon Dioxide
WARNING
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 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.
WARNING
Correlation: 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.
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Low 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 Principles
For 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 X2
The 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.
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WARNING
Altitude 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.
CAUTION
Use the CO2 measurement with Philips approved accessories only. Refer to the instructions for use
provided with the accessory.
Preparing to Measure Mainstream CO2
You must perform a zero as described in this procedure each time you use a new airway
adapter.
Attach the sensor connector to the CO2 connector on the MMS extension, or on the X2 (when
the optional CO2 measurement is integrated).
Wait 2 minutes, allowing the sensor to reach its operating temperature and a stable thermal
condition.
Choose 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.
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13 Monitoring Carbon Dioxide
–
When you see the message CO₂ calibration done at  on the status line, the
zero calibration is finished and you can begin monitoring.
Install the airway adapter at the proximal end of the circuit between the elbow and the ventilator Ysection.
WARNING
To 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 CO2
216
Plug the sensor cable into the monitor's CO2 input connector. Allow the sensor two minutes warm
up time
Connect the cannula, airway adapter, or sample line as appropriate, to the sensor. It will click into
place when seated correctly.
To zero the sensor:
13 Monitoring Carbon Dioxide
–
–
–
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 CO₂ calibration done at  on the status line, the
zero calibration is finished and you can begin monitoring.
For 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.
WARNING
Always 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.
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13 Monitoring Carbon Dioxide
CAUTION
Always disconnect the cannula, airway adapter or sample line from the sensor when not in use.
Using the Sidestream Sensor Holder
The holder delivered with the sensor can be used to clamp the sensor onto an IV pole or a shelf.
Push the sensor into the holder until it clicks into position.
Clamp 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 System
WARNING
Anesthetics: 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 M3016A
The 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.
WARNING
Infra-red radiation: Do not expose the airway adapter or M1460A transducer to infra-red radiation
during use. This may cause incorrect readings.
Preparing to Measure Mainstream CO2
218
Attach the transducer connector to the CO2 connector on the M3016A extension.
13 Monitoring Carbon Dioxide
Wait 20 minutes, allowing the transducer to reach its operating temperature and a stable thermal
condition.
Perform an accuracy check and then, if necessary, calibrate the transducer.
Checking Transducer Accuracy
WARNING
Check transducer accuracy at least once a week or if you doubt the CO2 readings.
In Setup CO₂ menu, select Cal. Mode to switch on calibration mode.
Look 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.
Place 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.
Place 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.
If 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 Transducer
Check that the windows on the calstick are clean and clear.
Place the transducer on one of the calstick cells and select Start CAL1.
Enter the calibration value printed on the calstick then press Confirm to start calibration.
When the message CO₂ CAL1 calibration done -- Start CAL2 calibration appears, put the
transducer on the other cell and select Start CAL2 then press Confirm.
When you see the message CO₂ calibration completed - leave Cal. Mode, calibration is
complete.
Select Cal. Mode to switch calibration mode off. You cannot monitor in calibration mode.
Attaching and Removing the CO2 Transducer
Open 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
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CO₂ SENS.WARMUP message until the transducer reaches operating temperature. Wait until this
disappears before starting the measurement.
To remove the transducer from the airway adapter, open the latch and pull out the airway adapter.
WARNING
To 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/B
The 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.
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Preparing to Measure Microstream CO2
Use 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 Accessories
The 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 Adapter
WARNING
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.
Attach the female Luer connector to the CO2 inlet connector by pushing the socket cover aside
and screwing the connector into place.
Check that the FilterLine is not kinked.
Change 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 (“Suppressing Sampling (not Mainstream CO2)”
on page 223).
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.
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Removing Exhaust Gases from the System
WARNING
Anesthetics: 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 Calibration
To 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 Measurements
These tasks are common to all CO2 measurements except where otherwise noted.
Adjusting the CO2 Wave Scale
In the CO₂ Wave menu or the Setup CO₂ menu, select Scale.
Choose a suitable scale range from the pop-up list.
Setting up CO2 Corrections
Temperature, 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.
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Correction
Altitude
(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..
N2 O
(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.
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 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).
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.
Suppressing 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 Alarms
This refers to CO2 specific alarms. See theAlarms section for general alarm information.
In the Setup CO₂ menu, select etCO₂ High or imCO₂ High and choose the high alarm limit.
Select etCO₂ Low and choose the low alarm limit.
Changing the Apnea Alarm Delay
This determines the time limit after which the monitor alarms if the patient stops breathing.
In the Setup CO₂ menu, select awRR.
In Setup awRR menu, select Apnea Time.
Choose the apnea alarm delay time.
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WARNING
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.
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 awRR
In the Setup CO₂ menu, select awRR.
In the Setup awRR menu, select Alarms.
Choose On to derive alarms from the airway respiration signal or Off to disable them.
Changing awRR Alarm Limits
224
In the Setup CO₂ menu, select awRR.
Select High Limit to set the upper alarm limit.
Select Low Limit to set the lower alarm limit.
Select the appropriate setting.
14
14
Monitoring Airway Flow,
Volume and Pressure
The 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 ratio
The measurement also provides pressure-volume loops, flow-volume loops and pressure-flow loops.
Please see “Respiratory Loops” on page 355 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 Monitoring Carbon Dioxide chapter for details
on the CO2 measurement and the Accessories chapter for a list of compatible accessories.
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WARNING
Electrical 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 Sensor
CAUTION
Use the M1014A Spirometry Module with Philips approved accessories only. Refer to the instructions
for use provided with the accessory.
Select the appropriate flow sensor. Make sure that you are using the correct sensor for the
respective patient category. Otherwise accuracy may be reduced.
Pediatric/Adult Flow Sensor (M2785A). Color: clear
For intubated patients with endotracheal tube diameters >4 mm. Adds
approximately 6.5 cc of deadspace.
Infant/Neonatal Flow Sensor (M2786A) Color: violet
For intubated patients with endotracheal tube diameters ≤ 4 mm. Adds less
than 1 cc of deadspace.
You can also use combined CO2/flow sensors. Note that the M3014A Capnography Extension is
required to measure CO2.
Pediatric/Adult Combined CO2/Flow Sensor (M2781A). Color: clear
For intubated patients with endotracheal tube diameters >5.5 mm. Adds
8 cc of deadspace.
Pediatric Combined CO2/Flow Sensor (M2783A): Color: green
For 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: violet
For intubated patients with endotracheal tube diameters of 2.5 -4 mm. Adds
less than 1 cc of deadspace.
226
If 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.
Click the connector into place in the flow sensor receptacle on the monitor before connecting to
the breathing circuit.
14 Monitoring Airway Flow, Volume and Pressure
Install 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 sensor
2 Pediatric sensor
3 Infant/Neonatal sensor
WARNING
To 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.
•
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.
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14 Monitoring Airway Flow, Volume and Pressure
•
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 Calibration
The 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
Automatic Purging
A 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.
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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 performed
Adult Mode
The 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 Modes
The 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 Purging
Occasionally, 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 Compensation
Temperature 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.
NOTE
If 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:
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14 Monitoring Airway Flow, Volume and Pressure
Actual Gas Composition
N2
O2
60
40
40
Gas Compensation Setting
N2O
Agent
60
Difference between
measured and actual
values
15%
Incorrect Balance Gas Setting (N2O instead of N2)
N2
O2
N2O
Agent
Actual Gas Composition
55
40
Gas Compensation Setting
60
40
Difference between
measured and actual
values
15%
Incorrect Agent Percentage Setting
Setting up Spirometry
The following settings can be accessed through the Setup Spirometry menu.
Optimizing Scale Settings
In the Setup Spirometry menu, select Optimize Scales. The scale settings for all three spirometry
waves (AWF, AWP, AWV) will be optimized.
Spirometry Values Window
You can view all spirometry measurement data in the spirometry data window. In the Setup
Spirometry menu, select Show All Values.
Alarms and Alarm Limits
Alarms 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 Delay
This determines the time limit after which the monitor alarms if the patient stops breathing.
230
In the Setup Spirometry menu, select RRspir.
In Setup RRspir menu, select Apnea Time.
Choose the apnea alarm delay time.
14 Monitoring Airway Flow, Volume and Pressure
WARNING
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.
WARNING
If 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 Suppression
If 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 Components
In the Setup Spirometry menu, select AWV.
Select 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).
NOTE
If MV and TV are set to off, there will be no alarming for these parameters.
Setting the Gas Compensation Mode
In the Setup Spirometry menu, select Gas Compensation.
Select 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 Gas
In the Setup Spirometry menu, select Gas Compensation.
Select Balance Gas to change the type of balance gas.
Select the appropriate setting (N2 or N2O).
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14 Monitoring Airway Flow, Volume and Pressure
Changing the Concentration of Inspired O2 and the Inspired Agents
In the Setup Spirometry menu, select Gas Compensation.
Select Inspired O₂ to change the concentration of inspired O2.
Select Inspired Agent to change the concentration of the inspired agent(s).
Select the appropriate setting.
Changing the Temperature of the Inspired Gas
Depending 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:
In the Setup Spirometry menu, select Gas Compensation.
Select Inspired Temp to change the temperature of the inspired gas.
Select the appropriate temperature setting.
NOTE
Changing the temperature setting unintentionally will result in approximately 3% reduced accuracy per
10°C (18°F) temperature setting change.
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15
15
Monitoring tcGas
The 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 Components
Press to enter Setup tcGas menu
Press to start calibration
Calibration chamber
Transducer connector
Setting the tcGas Sensor Temperature
In the Setup tcGas menu, select Transducer Temp..
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15 Monitoring tcGas
Choose 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 Timer
Availability and behavior of the site timer depend on your monitor's configuration.
WARNING
Prolonged 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 Timer
The 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.
In the Setup tcGas menu, select Site Time.
Choose 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  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 SiteTimer
To restart the site timer without recalibration (for example, after the site time has elapsed):
234
In the Setup tcGas menu, select Site Time.
Enter and confirm your desired time.
15 Monitoring tcGas
Disabling the tcGas Site Timer
Depending 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.
In Setup tcGas menu, select Site Timer and switch this to Disabled.
Select the Confirm pop-up key.
Setting the tcGas Barometric Pressure
Altitude 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.
In the Setup tcGas menu, select Ambient Pressure.
Enter the current barometric pressure reading indicated by your barometer.
Select the Confirm pop-up key.
Remembraning the tcGas Transducer
Follow the instructions supplied with the transducer.
New/Dried Out Transducers
Remembrane 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 Transducers
If 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 Transducer
You 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.
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15 Monitoring tcGas
Connect 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.
Plug 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.
On 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.
Press 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  CAL RUNNING
disappears, press the green arrow button again.
Calibration Failure
If calibration fails, the monitor displays  transducer or cal. unit malfunction and the
 CAL FAILED INOP for the measurement.
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15 Monitoring tcGas
Troubleshooting tcGas Calibration
Perform each of the following steps, in order, until calibration is successful.
Check 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.
If 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.
Calibrate a second time.
If Step 2 is unsuccessful, calibrate again. This calibration may be required to stabilize the
electrochemical system in the transducer.
Only 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 Transducer
Peel 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.
Align 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.
Apply 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.
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15 Monitoring tcGas
WARNING
You must either remove the transducer before defibrillating, or remembrane and calibrate the
transducer after defibrillating.
CAUTION
To avoid transducer damage, remove it from the patient during high frequency surgical procedures.
Selecting the tcGas HeatPowerDisplay Mode
The 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  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 Power
When 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 Monitoring
Replace 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 Corrections
Transcutaneous 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 tcpCO2
The transducer temperature causes an increase in partial CO2 pressure. Your monitor may be
configured to correct this.
•
238
In the Setup tcGas menu, look at the menu item CO₂ Correction. If correction is enabled, it is set
to On.
15 Monitoring tcGas
Metabolism Correction for tcpCO2
CO2 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.
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15 Monitoring tcGas
240
16
Monitoring Intravascular
Oxygen Saturation
16
Depending 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.
M1011A
M1021A
WARNING
Injected 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.
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16 Monitoring Intravascular Oxygen Saturation
Do 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.
CAUTION
Use the modules with Philips approved accessories only. Refer to the instructions for use provided
with the accessory.
Selecting a Measurement Label
Always 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 247) 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:
Select Main Setup then Measurements followed by 
Select Label.
Select the appropriate label for the catheter/probe location.
Preparing to Monitor with the M1021A Wide
Module
In 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.
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16 Monitoring Intravascular Oxygen Saturation
Optical module
Balloon inflation stopcock
Hospira fiber optic catheter
Optical reference
Enter setup/calibration
Connect 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 preinsertion calibration.
Carrying out a Pre-insertion Calibration
WARNING
It 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.
Remove outer wrapping from catheter tray to uncover optical connector.
Place the optical module on the catheter tray in the space provided and open the lid.
Place the optical connector into the optical module (with the label "TOP" facing upwards) and
close the lid.
In the Setup  menu, select Start Pre-InsCal. Ensure that the tip of the catheter is
still in the optical reference.
Insert the catheter when you see the message  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.
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16 Monitoring Intravascular Oxygen Saturation
Inserting the Catheter
Remove the inner cover of the catheter tray.
Remove the catheter tip from the optical reference. Check the catheter's proper operation (for
example: the balloon tip).
Prepare 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 Calibration
Perform 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  menu, select Start Light Cal.
Calibration is complete after a few seconds. If you doubt existing light intensity readings, recalibrate.
Performing In-Vivo Calibration
Perform 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 Calibration
Check for:
244
•
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 Saturation
Making the In-Vivo Calibration
Be prepared to draw a blood sample from the patient.
In the Setup  menu, select Start In-VivoCal.
To clear the distal lumen, draw off and discard at least 2 ml of blood before taking the sample.
Draw a blood sample from the distal port of the catheter and flush the line according to standard
hospital practice.
Obtain laboratory analysis of the sample using direct measurements.
Select CalibrationValue and select from the list the value received from the lab.
Complete 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 Calibration
Check 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.
In the Setup  menu, select Catheter Factor.
Enter the correction factor.
Making the In-Vivo Calibration
Be prepared to draw a blood sample from the patient.
In the Setup  menu, select Start In-VivoCal.
To clear the distal lumen, draw off and discard at least 2 ml of blood before taking the sample.
Draw a blood sample from the distal port of the catheter and flush the line according to standard
hospital practice.
Obtain laboratory analysis of the sample using direct measurements.
Select CalibrationValue and select from the list the value received from the lab.
Select 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 246 below.
Complete 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.
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Changing the Lab Value Required for Entry
You can change the lab value required to be entered: Hb [g/dl], Hb [mmol/l] or Hct [%].
In the Setup  menu, select Hb/Hct Entry.
Select your preferred lab value and unit.
Preparing to Monitor with the M1011A Narrow
Module
In 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 Module
Connect 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.
Position the optical module to avoid contact with liquids. Fluid entering the catheter-optical
module connection will impair measurement performance.
Place the optical module on the catheter tray in the space provided and open the lid.
For instructions on the placement of fiber optic catheters/probes, refer to the documentation
provided with the accessory.
After Insertion
The 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.
The probe/catheter should be replaced after it has been in place for 72 hours.
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16 Monitoring Intravascular Oxygen Saturation
CAUTION
Do not apply excessive tension to any sensor cable or part of the catheter.
Performing In-Vivo Calibration
Perform 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 Modules
Checking Suspicious Values
If 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 Extraction
Oxygen 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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16 Monitoring Intravascular Oxygen Saturation
248
17
17
Monitoring EEG
The 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 Setup
Plug the trunk cable into the EEG module.
Prepare 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.
Select the desired electrode montage in the Setup EEG menu or in the EEG Impedance / Montage
window.
Attach the reference electrode first.
Place 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.
Connect the electrode connector end to the trunk cable.
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17 Monitoring EEG
Check the electrode-to-skin impedance in the EEG Impedance / Montage window.
For good signal quality, keep all lead wires together and away from other electric devices and
metallic bodies.
Using the EEG Impedance/Montage Window
To 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.
Electrode locations on the patient's head. The symbols represent the electrode-to-skin impedance.
Wiring and impedance values for the selected montage
Choosing an EEG Electrode Montage
To 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.
Attach the electrodes as illustrated in the EEG Impedance / Montage window.
The five default electrode montage configurations can be modified and renamed in Configuration
Mode.
Montage Name
EEG1+
EEG1-
Label1
EEG2+
EEG2-
Label2
Montage A
Fp1
T3
Fp1-T3
Fp2
T4
Fp2-T4
Montage B
O1
T3
O1-T3
O2
T4
O2-T4
Montage C
F3
C3
F3-C3
F4
C4
F4-C4
Montage D
C3
P3
C3-P3
C4
P4
C4-P4
Montage E
Fp1
T5
Fp1-T5
Fp2
T6
Fp2-T6
The electrode locations are labeled according to the international 10-20 electrode placement system.
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17 Monitoring EEG
Changing the Impedance Limit
The 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 Impedance
Electrode-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.
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17 Monitoring EEG
Impedance Indicators
Electrode/Skin
Impedance
Symbol
Color
Displayed
Impedance
Value
Action
Electrode not connected
red
no value
connect electrode
Noisy signal
gray
60 kΩ (fixed)
check electrode-to-skin
connections
Electrode connected,
impedance above limit
yellow
measured value
(e.g. 15 kΩ)
check limit, check
electrode-to-skin
contact
Electrode connected,
impedance at or below limit
green
measured value
(e.g. 3 kΩ)
no action necessary
About 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.
252
•
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.
17 Monitoring EEG
The CSA contains the following information
Lead label
Status line
for example, Fp1-T3, Fp2-T4
CSA label
CSA1 or CSA2 according to EEG channel
Montage label
for example, Montage A
Filter settings
for example, 1-30 Hz
Buffer label and time
the buffer and interval between spectral lines on the CSA
Current SEF Threshold
can only be changed in Configuration Mode
Spectral lines
The energy at each frequency is computed and displayed as a spectral line
Trendlines
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)
INOP marker
Filter change marker
Annotations:
Montage change marker
Changing CSA Settings
When 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.
Setup CSA Window
This menu entry lets you
Buffer
choose one of the three pre-configured buffers. A buffer defines the
interval between the spectral lines displayed in the CSA.
On/Off SEF
On/Off MDF
On/Off PPF
switch the trendline of the specific numeric on or off
Changing EEG Settings
Be aware that any changes made to EEG settings apply to both EEG channels.
Switching EEG Numerics On and Off
Each EEG numeric can be individually switched on or off in the Setup EEG menu.
In the Setup EEG menu, select the numeric label.
Select On or Off to switch between the settings.
Changing the Scale of the EEG Waves for Display
This only changes the visual appearance of the wave. It does not affect the signal analyzed by the
monitor or printed in reports or recordings.
In the Setup EEG menu, select Wave Scale to call up a list of wave scales.
Select the required scale from this list.
Scaling information is displayed with each EEG wave.
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17 Monitoring EEG
•
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 Frequencies
The 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:
In the Setup EEG menu, select Low Filter or High Filter to call up a list of available frequencies.
Select the required frequency from this list.
Changing the Speed of the EEG Wave
The 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 Reports
The 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 you
Buffer
choose one of the three pre-configured buffer times
Trend SEF
Trend MDF
Trend PPF
switch the trendline of the specific numeric on or off
EEG Safety Information
WARNING
Do 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.
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17 Monitoring EEG
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 Interference
CAUTION
Interference 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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256
18
18
Monitoring BIS
Bispectral 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 derived
SQI 15% to 50%: the numerics cannot be reliably derived
SQI 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 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 Setup
There are two BIS solutions available for use with the M1034A BIS module: using the Digital Signal
Converter (DSC) and BIS Engine or using the BISx.
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Monitoring BIS Using the DSC and BIS Engine
BIS Engine Cable
BIS Module
BIS Engine
Digital Signal Converter (DSC)
Patient Interface Cable
BIS Sensor
If 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).
Attach 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.
Connect 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.
Monitoring BIS using the BISx
258
BIS Module
BISx
Patient Interface Cable
BIS Sensor
18 Monitoring BIS
If you are monitoring BIS using the BISx,
a. Connect the BISx to the BIS module
b. Use the clip on the rear of the BISx to affix it in a position convenient for your patient, not
above the patient's head.
Attach 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.
CAUTION
Ensure 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.
Attach the patient interface cable (PIC) to the BISx.
Connect the BIS sensor to the PIC.
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.
Manufacturer's Information
BIS Engine, DSC, BISx, the Patient Interface Cable and the BIS Sensors are manufactured by Aspect
Medical Systems.
BIS Continuous Impedance Check
This 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:
In the Setup BIS menu, select Cont. Imp. Check.
Select On or Off as required.
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CAUTION
Switching 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.
BIS Cyclic Impedance Check
This 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 Check
The 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 Check
The 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.
BIS Window
To 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 recentlymeasured 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.
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Reference Electrode
Ground Electrode
Signal Electrode(s)
Time of the most recent cyclic check
BIS Impedance Indicators
Electrode-to-Skin
Impedance
Symbol
Color
Action
Electrode has no skin contact
red
Reconnect electrode, or check the sensorto-skin contact. If necessary, clean and dry
skin.
Too much signal noise,
impedance cannot be
measured
gray
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
In addition to the symbols, the impedance value in kOhm is also displayed.
Changing the BIS Smoothing Rate
The 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.
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Switching BIS and Individual Numerics On and Off
To 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 Wave
Changing 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.
In the Setup BIS menu, select Scale to call up a list of wave scales.
Select the required scale from this list.
– When gridlines are switched off, you can choose from the available scale values: 50 µV,
100 µV, 200 µV, and 500 µV. 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 µV, ± 50 µV, ±
100 µV, or ± 250 µV. Scaling information is shown in the form of gridlines.
Switching BIS Filters On or Off
The 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.
In the Setup BIS menu, select Filters.
Select On or Off as required.
BIS Safety Information
For 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 Use
Due 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.
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WARNING
Conductive 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 electrosurgical 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.
CAUTION
Revisions: 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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19
Assigning a Telemetry
Device and a Monitor to One
Patient
19
It 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 MX600/700/800 host monitor
the data arrive with a minimal delay on the monitor screen.
Indirect Connection - Manual Pairing
The 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:
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19 Assigning a Telemetry Device and a Monitor to One Patient
Select Main Setup then Measurements
Select Telemetry
The Setup Telemetry menu will appear with only one entry Paired Equipment.
Enter 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 Window
The measurements from the telemetry device are shown in the telemetry data window on the monitor.
A current alarm generated by the telemetry device.
Delayed - indication that data in the window is delayed
Telemetry data window
WARNING
All 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 Pairing
The following direct connections are possible:
•
an MP5 or X2, declared as a telemetry device, and connected with an MSL cable to a monitor.
WARNING
266
•
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.
•
When a telemetry device is connected to the monitor, arrhythmia relearning is initiated, and again
when the telemetry device is disconnected.
19 Assigning a Telemetry Device and a Monitor to One Patient
•
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 Monitor
An 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 265.
Refer also to “Use Models With Telemetry” on page 269 for further related use modes.
Functions Available When the Telemetry Data
Window is Displayed
Controlling the Telemetry Device from the Bedside
You can change settings for a paired telemetry device at the monitor:
Select the telemetry data screen element
Select the Setup Tele pop-up key
The 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 Bedside
When 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.
If 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:
Select the telemetry screen element.
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19 Assigning a Telemetry Device and a Monitor to One Patient
Select the Silence Bed pop-up key.
Depending on your Information Center configuration, the Silence Bed key may silence both telemetry
alarms and bedside alarms.
WARNING
Even 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 Alarms
When 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 Standby
When 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 Functions
The following functions are valid for directly and indirectly connected telemetry devices.
ECG Source Tracking at the Information Center
The 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 and the Setup ECG
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.
In case of ambiguity, a yellow INOP message !!CHECK ECG SOURCE indicates that more than one
valid ECG source is active.
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19 Assigning a Telemetry Device and a Monitor to One Patient
Synchronized Settings
If 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:
Heart Rate
HR/Pulse Alarm On/Off, Heart Rate High/Low Limit,
ECG
Primary Lead, Secondary Lead, Va Lead1, Vb Lead1, Lead Placement
Arrhythmia
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/Off
ST
ST Analysis On/Off, ST Alarm On/Off, ISO Point, J point, ST point, ST
Priority List, Single ST Alarm Limit, Multi ST Alarm Limit
QT
QT analysis On/Off, QT Lead, QTc High Alarm On/Off, ΔQTc Alarm
On/Off, QTc High Limit, ΔQTc High Limit, QTc Formula2, QT Baseline
SpO2T
SpO2 Alarms on/off, SpO2 Alarm limits
NBP Alarm Suppression On/Off, Pulse(SpO2) On/Off
1Va 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
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 V6
If 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.
Use Models With Telemetry
The 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:
The monitor is paired with a telemetry transceiver - indirect connection
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19 Assigning a Telemetry Device and a Monitor to One Patient
–
telemetry data appear on the monitor
An MP5 or X2 is declared as a telemetry device and paired with an MX600/700/800 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/X2
A telemetry transceiver directly connected (SRR or for MP5 cable) to an MP5 or X2, that is
connected (Companion Mode) to an MX600/700/800 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 label
The different variations require different configuration settings; refer to the Configuration Guide for
details.
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20
20
Trends
Trends 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 aperiodicallymeasured parameters, such as Cardiac Output.
Viewing Trends
Trend 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.
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20 Trends
Trends Pop-Up Keys
When 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.
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.
Viewing Graphic Trends
A 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.
To use the trend cursor to navigate in time through the trends database,
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20 Trends
Select the graphical trend or the arrow pop-up keys to activate the cursor.
Use the arrow pop-up keys to move the trend cursor backwards and forwards in time, or
Place the cursor at a specific time by touching the graph.
Viewing Vital Signs Trends
Aperiodic values are shown with a timestamp
The 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 277):
With the Vital Signs trend open, select Interval.
Select NBP from the pop-up list.
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Viewing Histogram Trends
The 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 Trends
Trends 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 Settings
The Graphical Trends window is divided into measurement segments, each of which has its own
settings.
To enter the segment menu,
•
274
select the left hand column of the segment, where the measurement label is displayed.
20 Trends
Expanded View
To 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 Measurements
To change the trend scales for a measurement in the current segment:
In the Segment menu, select the measurement label
Select Upper to change the upper limit of the scale or Lower to change the lower limit of the scale.
Optimum Scale
To 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 Group
To add or remove measurements for this trend group or change the order of the existing
measurements:
In the Segment menu, select Change Group.
Use the Add, Change, Sort Up and Sort Down pop-up keys to change or re-order the group as
required.
No. of Segments
In 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 Groups
The 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.
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To change the selection of measurements in a trend group, either use the Change Group setting in the
Segment menu or:
Select Main Setup, Trends, then Trend Groups.
Select 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,
Select Main Setup, Trends, then Trend Groups.
Select the Trend Group and then the measurement you want to move and use the Sort Up/Sort
Down pop-up keys.
Trend Interval
The 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 Priority
The 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,
In the Main Setup menu, select Trends.
Select Trend Priority.
To add measurements to the priority list,
Select the pop-up key Add and choose from the pop-up list of available measurements.
Use the Sort Up and Sort Down pop-up keys to change the priority order.
Trend Parameter Scales
Parameter 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:
276
In the Main Setup menu, select Trends.
Select Parameter Scales.
Select the measurement or parameter you want to change from the list.
Select the pop-up key Change to call up the Scale menu.
In 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 Trends
Graphical Trend Presentation
Graphical 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,
Select Main Setup then select Trends.
Select 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 Measurement
You 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:
Select Main Setup then Trends.
In the Trends menu, select Setup VitalSigns.
In the Vital Signs menu, select Column and then NBP from the pop-up menu.
Setting Measurement and Period for Histograms
To set the default for the measurement data to be used in the histogram,
Select Main Setup then select Trends.
Select Setup Histogram.
Select Data Source.
Select either a realtime SpO2 or Trended Data. From the trended data list select the required
measurement.
To set the default period for the histogram,
Select Main Setup then select Trends.
Select Histogram.
Select 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.
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Documenting Trends
To 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 popup key.
Vital Signs recordings print the trend data for the current group and trend period shown in the Vital
Signs window.
Trends Databases
Depending 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 configuration
In 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 Database
Aperiodic 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.
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Trending Multiple-Value Measurements
Some measurements generate multiple values, for example invasive pressure measurements can
provide systolic, diastolic, and mean values. These values are trended as separate measurements.
Screen Trends
Trends 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 Time
To set the ScreenTrend Time for all graphical, histogram and horizon screen trends ("global" trend
time),
Select a screen trend then select Setup Trend, or select Main Setup then select Trends.
Select 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,
Select a screen trend.
Select Change TrendTime
Select the required trend time.
Selecting Global leaves the trend time set to the global screen trend time.
Changing the Selection of Screen Trends Displayed
Select the screen trend.
Select 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,
Select the screen trend to open the screen trend menu,
Select Change Trend followed by Add Trend and select a screen trend from the pop-up list.
Activating the Cursor for Screen Trends
To activate the cursor for Screen Trends:
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Select the screen trend.
Select 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 View
To switch between tabular, graphic, histogram and horizon views, select the screen trend then select
Change View and select the required view.
Tabular View
Aperiodic 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 View
The 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 View
The 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:
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•
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
(10 minutes, 5 minutes or 2 minutes) (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 Horizon
The horizon is the reference value to which deviations in the measurements are compared.
To set the horizon, select the horizon trend.
Select
– 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 Scale
The 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,
Select the horizon trend.
Select 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 Arrow
The time period for which the trend indicator arrow is displayed can be set in the Trends window.
Select Main Setup then select Trends.
Select HorizonArrowTime.
Select 10, 5 or 2 minutes.
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21
21
Calculations
Calculations 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.
Hemodynamic
Oxygenation
Ventilation
Cardiac Index (C.I.)
Arterial Oxygen Content (CaO2)
Minute Volume (MINVOL)
Stroke Volume (SV)
Venous Oxygen Content (CvO2)
Compliance (COMP)
Stroke Index (SI)
Dead Space (Vd)
Systemic Vascular Resistance (SVR)
Arteriovenous Oxygen Content
(CavO2)
Systemic Vascular Resistance Index (SVRI)
Oxygen Availability Index (DO2I)
Pulmonary Vascular Resistance (PVR)
Oxygen Consumption (VO2)
Pulmonary Vascular Resistance Index (PVRI)
Oxygen Consumption Index
(VO2I)
Left Cardiac Work (LCW)
Left Cardiac Work Index (LCWI)
Left Ventricular Stroke Work (LVSW)
Left Ventricular Stroke Work Index (LVSWI)
Right Cardiac Work (RCW)
Dead Space/Tidal Volume
Ratio (Vd/Vt)
Alveolar Ventilation
(ALVENT)
Oxygen Extraction Ratio (O2ER)
Alveolar-Arterial Oxygen
Difference (AaDO2)
Percent Arteriovenous Shunt
(Qs/Qt)
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)
The hemodynamic calculations available depend on the Cardiac Output measurement method being
used and the regulatory standards that apply for your hospital: see the Monitoring Cardiac Output
chapter for availability details.
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Viewing Calculations
•
Select the Calcs SmartKey to open the Calculations window.
•
Select the Calc Type field and select the required calculation type for display.
Calculations Windows
This example calculations window shows the Hemodynamic Calculations window. The ventilation
and oxygenation windows are similar.
Height used for the calculations
Weight used for the calculations
Calculation Time
Calculations input values
Output values
Indexed calculation values
Calculations Pop-Up Keys
Depending 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.
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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 database
Print/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.
Reviewing Calculations
To 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 Calculations
You must check that all input values are appropriate for your patient before performing calculations.
Select the Calcs SmartKey to open the Calculations window.
Check 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.
Enter 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. Manuallyentered values are marked with an asterisk (*).
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Entering Values for Calculations
The 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 Substitution
If 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 Conversion
The 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 Conversion
If you need to convert units for other purposes you can use the Unit Conversion window:
Select Main Setup then select Calculations.
Select Unit Conversion.
Select 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 Formula
Your 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.
•
286
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.
21 Calculations
Comparing Dynamic Compliance Values
If 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 Calculations
To 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.
Patient information
Calculation group
Three columns of calculations input and output values, with times, units and ranges, where
appropriate
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22
High Resolution Trend Waves
High 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 Displayed
To change the selection of hi-res trend waves on the Screen:
Select a displayed hi-res trend wave.
Select 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 Scales
Hi-res trend waves are either compressed realtime waves or fast numeric trends.
•
Hi-res trend waves from compressed realtime waves include: Resp, CO2, ABP, PAP, CVP, 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 OxyCRG
OxyCRG is a combination of three hi-res trend waves, btbHR, SpO2, and Resp, mainly used in
neonatal monitoring.
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Printing Hi-Res Trend Wave Reports
To 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 Printing Patient Reports chapter for more information on setting up reports.
Hi-Res Trend Wave Recordings
The selection of waves in hi-res trend wave recordings and the recording speed are defined by the preconfigured HiResTrd recording template. See the Recording chapter for more information.
To start a hi-res trend waves recording,
290
select the Recor- dings SmartKey, if configured, or select Main Setup then select Recordings.
select the HiRes Recordng pop-up key.
23
23
Event Surveillance
Events 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 293 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 Surveillance
The 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.
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Basic Event
Surveillance
Option C06
Neonatal Event Review
Advanced Event Surveillance
(NER)
Option C07
Option C04
6 (one group can be configured NER
to NER)
3 (plus 1 for episode
recording)
Triggers per measurement 1
Event Functionality
Event groups
Measurements per group
Trigger types
Simple ("at least one")
Combined ("at least two")
Simple ("at least one")
Annotation
no
yes
yes
Average trend
Snapshot events
Average trend
High resolution trend
Snapshot events
High Resolution Trend
Types of event episode
Graphic Event Review
window, Graphic Event
Episode window
Summary view, graphic and
tabular Event Review window,
graphic and tabular Event
Episode window
Graphic and tabular Event
Review window, graphic
and tabular Event Episode
window
25 events for 24 hours
25 events for 24 hours
25 events for 8 hours
50 events for 8 hours
50 events for 24 hours
25 events for 24 hours
25 events for 8 hours
50 events for 8 hours
50 events for 24 hours
no
yes
no
Event views
Database capability
Event Notification
Event Groups
The 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 Episodes
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When 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-time
Average trend
2 minutes
18 minutes
20 minutes, five samples per minute
4 minutes
16 minutes
6 minutes
14 minutes
8 minutes
12 minutes
10 minutes
10 minutes
12 minutes
8 minutes
14 minutes
6 minutes
16 minutes
4 minutes
18 minutes
2 minutes
HiResTrend
1 minute
3 minutes
Four minutes, four samples per second.
Neonatal Event Review (NER) is a type of
HiResTrend
2 minutes
2 minutes
3 minutes
1 minute
Realtime Wave Snapshot
5 seconds
10 seconds
15 seconds
10 seconds
5 seconds
Events Pop-Up Keys
Depending 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.
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.
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Pop-Up Keys
Start CAR
Selecting this pop-up key lets you....
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 histogram
move 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
View
Table
Review
Graphic
Review
toggle between a tabular and graphic version of the Event Episode window
currently viewed.
CAR
Review
toggle 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.
Event Triggers
You 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.
If 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.
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The trigger condition for event groups is set in the monitor's Configuration Mode.
If You Use Alarm Limits As Event Triggers
The 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 Triggers
You 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" Triggers
You can set aperiodic measurements (such as NBP) or procedures (such as Cardiac Output) to trigger
an event whenever they start.
If You Set Use-defined Deviation Triggers
You 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 Retriggering
If a condition that triggered an event persists and the values remain beyond the trigger threshold, a
new event will not be triggered.
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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 Surveillance
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Group Name
Episode Type
Measurements used as event triggers
Select Main Setup then Event Surveill. followed by Setup Events to enter the Event Setup
window.
Select the name of the current episode type to set the episode pre/post time.
Set 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.
Set the trigger status to Activated to start event triggering. If the status is Deactivated event
surveillance is effectively switched off.
Select Confirm to confirm your changes.
23 Event Surveillance
Setting Triggers and Notification for Advanced Event Surveillance
Group Name
Group Type
Notification Type
Episode Type
Trigger Condition
Measurements used as event triggers
Select the group name to enter the setup window for that group.
Set the trigger status to Activated, to have this event group trigger events, or Deactivated.
Set 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.
Set 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.
Select Confirm to confirm your changes.
Triggering Events Manually
To 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.
Running a Car Seat Assessment Record
In 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:
Select the Start CAR pop-up key or SmartKey.
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Select the required time period for the assessment.
Select 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 274. 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 Database
The 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 SmartKey
and then select the event view you require from the list.
Event Summary and Event Counter
Vertical 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.
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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-Events
If 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) Events
For 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
meaning
group activated, notification set to ***alarm
group activated, notification set to **alarm
group activated, notification set to *alarm
group activated, notification set to screen prompt
group is activated, notification is switched off
no symbol
group not activated
Selecting 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.
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Event Review Window
To 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 Window
To enter the Event Episode window, select the pop-up key Show Episode.
Depending 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.
300
Follow-on event values
Trigger event values,
highlighted
Timeline, showing
episode Pre/Post-time
Active event group
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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 71
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 Events
To annotate an event, in the Event Episode window, select the pop-up key Select Annotatn.
Select 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 Events
You 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 Review
In the Event Review window, select the pop-up key Print/ Record. This calls up the event
documentation pop-up keys.
For 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 key
To print an Event Report, select the Print Review pop-up key.
Documenting an Event Episode
In the Event Episode window, select the pop-up key Print/ Record. This calls up the event
documentation pop-up keys.
To make an Event Episode recording, select the Record pop-up key.
To print an Event Episode, select the Print Episode pop-up key.
Event Recordings
Event recordings can be sent to a locally-connected M1116B recorder module.
Event Review Recordings
Each 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.
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Event total per event group
Event types
Total events in database
Event groups
Recording strip code
Patient information and medical record no.
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).
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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 Recordings
Event 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.
The 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.
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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 Reports
Event reports can be printed on A4 and letter size paper on a printer connected locally or centrally to
your monitor.
Event Review Reports
The event review report documents all the events stored in the event database for a selected group.
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Event Episode Reports
The event episode report documents the patient information from the currently-selected event. See the
“Event Recordings” on page 301 for an explanation of the report elements.
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Event 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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ProtocolWatch
ProtocolWatch (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 status
ProtocolWatch notifies you when certain conditions or combinations of conditions occur and it
documents developments in a log which can be printed.
SSC Sepsis Protocol
The 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.
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Depending 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.
WARNING
Always 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 Sepsis
Orientation On The Screen
At 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 Phases
If 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.
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CAUTION
It 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 Hours
To suspend the protocol for 24 hours:
Select Main Setup then ProtocolWatch followed by Suspend for 24 hours.
Select Confirm.
The protocol will resume activity after 24 hours with Severe Sepsis Screening.
Severe Sepsis Screening
As 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 4hour 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 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.
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Select 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 Conditions
The 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 Confirmed
If 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 Measurement
To 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 Evaluation
If 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?.
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If 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 Review
To 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 Bundle
The 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 reference
If 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 Recommendations
When 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.
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Select 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 fulfills 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 Window
During 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 Bundle
At 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 Bundle
When 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 Bundle
The stabilization recommendations from the Sepsis Management Bundle are presented and the
implementation of the recommendations is monitored.
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When 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 Recommendations
When 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 Bundle
The 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.
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After 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 Log
The 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 Log
You 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 line
When 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 Patients
It 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.
316
25
25
Recording
The 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.
M1116B Plug-in Recorder
Continue LED - flashes if a continuous recording is
ongoing
RUN/CONT key - starts a delayed recording or
makes the current recording continuous
STOP key - stops the current recording
Central Recording
For 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 Recordings
The 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.
The selection of pop-up keys available depends on the monitor you are using.
317
25 Recording
Delayed Recordng
Vital Signs
RT A Recordng
Alarm Limits
RT B Recordng
ST Segments
RT C Recordng
ECG QT
Select Waves
Setup Recordng
HiRes Recordng
Stop All Recordng
All ECG Waves
Quickstarting Recordings
To 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 Recordings
Timed (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.
M1116B •
only
You can also make an ongoing recording continuous by pressing the Run/Cont key on the
recorder module.
Stopping Recordings
Recordings 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.
•
M1116B •
only
To manually stop a recording, select the Recor- dings SmartKey and then select the pop-up key
Stop All Recordng.
You can also stop a recording by pressing the Stop key on the recorder module.
Recording Without a Template
To record without a pre-configured template, selecting the waves you require,
318
Either: Select the Recor- dings SmartKey then select the pop-up key Select Waves.
Or: Select the SmartKey Record Waves.
25 Recording
Use 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.
Select one of the recording speed pop-up keys to set the required recording speed.
Select 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 Types
This table details settings for local recordings. For details on recordings made on the central recorder,
see your Information Center Instructions for Use.
Type of
recording
Delayed
Alarm
Realtime (RT)
All ECG
Waves
HiRes Trend
Procedure or
Context
manual
automatic, triggered by
defined alarm conditions
manual
manual
manual
manual, use the
context
window's popup keys to start
Recording local recorder and local recorder and printer
Destination central
central
local recorder and local recorder
central
only
local recorder
only
local recorder
only
Information from the start
recorded
trigger minus the
delay time
from the start
trigger minus the
delay time
n/a
from the start
trigger
from the start
trigger, in
realtime
from the start
trigger minus
delay time
defined by the
context
Number of
waves
up to 3
up to 3
n/a
up to 3
all ECG waves
currently
monitored and
available
up to 3 highresolution trends
(beat-to-beat)
waves
up to 3 waves,
or specific to
the context, e.g.
a wedge
procedure
Speed
50, 25, 12.5, 6.25, 50, 25, 12.5, 6.25, n/a
2.5 mm/sec
2.5 mm/sec
50, 25, 12.5, 6.25, 25 mm/sec
2.5 mm/sec
1, 2, 2.5, 3, 6 cm/ defined by the
min
context
Runtime
15, 20, 25, or 30
seconds
15, 20, 25, or 30
seconds
n/a
6, 8, 10, 15
seconds or
continuously
4 seconds per
wave
10 minutes, or
continuously
Stops
automatically
automatically
n/a
automatically if
limited, manually
if continuous
automatically
automatically if defined by the
limited, manually context
if continuous
Delay Time 10, 15 seconds
10, 15 seconds
n/a
none
none
6, 5, 4, 3, 2, 1
minutes
defined by the
context
Overlap
up to 3 waves
n/a
up to 3 waves
none
up to 3 waves
defined by the
context
up to 3 waves
defined by the
context
n/a = not applicable
All ECG Waves Recordings
An 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.
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25 Recording
Creating and Changing Recordings Templates
To 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.
Select the Main Setup permanent key to call up the Main Setup menu.
Select Recordings to enter the Setup Recording menu.
Select 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.
Design 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 4Ch 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 319. 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.
Central Config: if available in the General menu, select this setting to use the recording settings made
for the centrally-connected recorder.
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25 Recording
Changing ECG Wave Gain
The 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,
In the Setup Recording menu select General.
Select ECG Gain.
Select 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 Priorities
Manually-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 Strip
The 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 Code
The 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.
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25 Recording
Recording type
Operating mode
Application area
Patient category
Code
Meaning
90
Realtime
8A
Delayed
0B
Alarm
91
Context (Procedures)
Monitoring
Demo
Configuration
Service
ICU
OR
CCU
NICU
Adult
Pediatric
Neonatal
Recorded Waveforms
A 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 Strips
Recording 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.
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25 Recording
Reloading Paper
M1116B
Use the latch on the right side of the recorder door to pull the door
open.
Remove the empty core.
Insert 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.
Pull 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.
Feed the paper through and pull some paper out from the top of the
roller.
Close the recorder door.
To 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
Recorder Status Messages
Explanation
For example:
The named recording is currently running.
Local alarm recording running
No Central alarm recording available
No local alarm recording available
No alarm recording available
No 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 recorder available. Alarm recordings will be lost.
Try configuring Printer as the alarm recording
destination.
Central Recorder out of paper
The named recorder is out of paper.
Local Recorder out of paper
Central Recorder door open
The door of the specified recorder is open.
Local Recorder door open
 not supported
The M1116A recorder is not supported. Connect a
M1116B plug-in recorder.
323
25 Recording
324
26
26
Printing Patient Reports
Starting Report Printouts
Most 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 up
Select Main Setup then select Reports
Select 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 330.
– 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 330.
Printout Location
Depending 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.
325
26 Printing Patient Reports
Starting the Different Types of Report
Report types
Report contents
How to start printing reports
Vital Signs Report
depends on selected trend group, data
resolution, and period.
In the Vital Signs window, select Print/ Record, then select
Print.
In the Graphical Trends window, select Print.
Graphic Trends
Report
Events Reports
Event Episode
Graphic or tabular Event Review
In the Event Episode or Event Review window, select the
pop-up key Print/ Record, then select Print Review or Print
Episode.
EEG Report
EEG Waves, numerics, CSAs, montage
information and impedance values
In 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
Review
In the Calculations windows, select the Print/ Record popup key.
Drug Calculator
Report
Titration Table
In the Titration Table window, select the Print Titr.Tbl popup 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 limits
In the Alarm Limits window, select Print Limits.
Realtime Reports,
including oxyCRG
Reports
patient data and numerics, and either:
Select the Realtime Report SmartKey, if configured.
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)
Loops Report
Individual Loops diagram with timestamp,
currently measured numerics
In the Loops window, select Print Loop.
Battery Report
Battery serial numbers, information on the
currently-measured and potential charge
status of the battery or batteries
In the Battery Status window, select Print Status.
Central Report A/B/C These are reports configured at the
In the Main Setup select Reports then Central Report A,
Information Center. Monitors connected via Central Report B or Central Report C.
the IntelliVue Instrument Telemetry wireless
network can have these reports available.
Stopping Reports Printouts
•
326
To stop Reports printing, in the Reports menu, select
– Delete Report to stop the current print job
– Delete All Repts to cancel all queued report printouts
26 Printing Patient Reports
–
Scheduled Rep. to select Off and switch off scheduled reports.
Setting Up Reports
As 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 Reports
The settings you choose in the ECG Reports menu apply for all ECG reports printed. To set up ECG
Reports,
Select 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.
Select ECG Gain and set the required ECG gain to define how ECG waves will appear on the ECG
report printouts.
Select Speed and select the report print speed.
Select Annotation and switch to On if the printed ECG wave should be annotated with beat labels.
See the ECG, Arrhythmia, ST and QT Monitoring chapter 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 Reports
The 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..
Select Trend Group and select the group you want to print on the report. The groups available
depend on your monitor's trend configuration.
Select 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.
Select Interval (Vital Signs Reports only) and select the resolution of the trend data printed on the
report,
Setting Up Auto Reports
Auto 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,
327
26 Printing Patient Reports
Select Main Setup, Reports, then Auto Reports and select the Auto Report you want to set up (A,
B, C, or D).
Select Report and assign a report type to the Auto Report.
Select 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.
Select 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.
Repeat 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 Jobs
To adjust the appearance of individual print jobs, in the Reports menu,
Select Main Setup, Reports, then Setup Reports to enter the Setup Reports menu.
328
Select Report and then select the report you want to set up.
Select 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 events
Alarm Limits: a list of all currently set alarm limits.
26 Printing Patient Reports
Select 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.
Select Orientation to set the orientation of the report printout: Unspecified to use the default size
for the template chosen, Landscape or Portrait.
Select 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 Settings
The 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 Report
A test report can be printed in Configuration mode, refer to the Service Guide for details.
Switching Printers On Or Off for Reports
You can enable or disable printer status to switch individual printers on or off for report printouts.
In 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.
Select 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 Reports
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26 Printing Patient Reports
If 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 Reports
If 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.
Checking Report Status and Printing Manually
A 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.
CAUTION
The 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.
330
26 Printing Patient Reports
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 Manually
Those 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,
In the Reports Job List, select the required report
Select Print Report.
Selecting Print All Reps will send all reports to the printer.
Printer Status Messages
Printer Status Message
Possible causes and suggested action
Print job queued for 
The report has been placed in the queue for the named printer.
Print job could not be queued
(insufficient resources)
The printer queue is full and the monitor cannot accept another report request.
Wait until some more reports have been printed, then try again, OR
Print job could not be queued
(queue is full)
A 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.
Print job could not be queued (no
matching printer found)
Cancelling all print jobs
Delete All Reps has been selected in the Reports menu, OR
The 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 discharge
When a patient is discharged, all queued reports are canceled except those
stored in the print database.
Cancelling # print jobs due to
hotstart
The 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 ...
A report is in progress, or the monitor is waiting for the central printer to accept
the print job.
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26 Printing Patient Reports
Printer Status Message
Possible causes and suggested action
Printer 
unavailable -> job suspended
The 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
suspended
The 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 330). Alternatively you can delete another report from the Reports Job
List (using the Delete Report key) to create space for your report.
Job on  failed
(data unavailable)
A report cannot be started on the requested printer.
One of three reasons is shown in the status message:
Job on  failed
(printer unavailable)
•
data unavailable - the connected X2 or MP5 has been removed before the
data for the report was transferred.
Job on  failed
(data requisition error)
•
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 
done
The report has been printed.
Sample Report Printouts
Each 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.
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26 Printing Patient Reports
Alarm Limits Report
Measurement labels, with alarms off symbol where alarms are switched off
Graphic view of current alarm limits in relation to currently monitored measurement value
333
26 Printing Patient Reports
Realtime Report
334
Patient demographic information, time stamp
Active Alarms and INOPs, followed by vital signs
Measurement waves section
26 Printing Patient Reports
Cardiac Output Report
ECG Reports
Patient information
Numeric block
Wave area
Below 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 Sizes
12-Lead ECG
3X4 landscape
A4, letter, A3, ledger
6X2 landscape
A4, letter, A3, ledger
12X1 portrait
A4 and letter only
12X1 landscape
A4, letter, A3, ledger
12X1 (2P) landscape
A4, letter (2 pages)
2X4 landscape
A4, letter, A3, ledger
8X1 portrait
A4 and letter only
8X1 landscape
A4, letter, A3, ledger
Multi-lead ECG
Other Reports
See the sections on Trends and Calculations and the chapter on Event Surveillance for other example
reports.
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26 Printing Patient Reports
336
27
27
Using the Drug Calculator
Drug 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.
Term
Definition
Units
Dose
total quantity of drug to be delivered to amount units per time or per kg/
the patient over time
time, if the drug is weightdependent
Rate
volume of the mixture to be delivered to ml/hour
the patient over time
Amount
amount of drug to be added to diluent
to make up a mixture
Volume
quantity of mixture of diluent and drug ml
Concentration
ratio of the amount of drug to the
solution volume
amount units per ml
Standardized Rate
1ml volume of the mixture to be
delivered to the patient per hour
ml/hr
ng, mcg*, mg, g, mUnit, Unit,
where g stands for gram
*Be aware that your hospital may use either 'µg' or 'mcg' as an abbreviation for microgram. These
abbreviations are equivalent.
WARNING
Before 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.
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27 Using the Drug Calculator
Accessing the Drug Calculator
To access the Drug Calculator, select Main Setup then Calculations followed by Drug Calculator, or
select the
Drug Calc SmartKey, if configured.
Performing Drug Calculations
Using the service Support Tool, a list of drugs can be configured for the monitor containing predefined 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 Six
If 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.
CAUTION
JCAHO 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:
338
•
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 Calculator
Performing Calculations for a Non-Specific Drug
If 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.
Enter three of these four values: dose, amount, volume, 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.
If 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.
When 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 Drug
Select the arrow beside ANY DRUG, then select the required drug from the list of drugs. This
opens the window for the selected drug.
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27 Using the Drug Calculator
Select 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.
Enter 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 onscreen 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.
When 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 Progress
The 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 - - :- - : - - .
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27 Using the Drug Calculator
Using the Titration Table
Use 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.
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27 Using the Drug Calculator
342
28
28
IntelliBridge EC10 Module
An 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.
module name
setup indicator LED
setup/data viewing key
connection status LED
external device cable connector
See the documentation supplied with the IntelliBridge module for a list of supported devices and
accessories, and for configuration information.
Connecting an External Device
Insert the module into the FMS or integrated module slot.
Check that you have the correct EC5 ID module for the external device - indicated on the EC5
label.
Connect the EC5 ID module to the external device.
Connect the EC5 to the EC10 module using the supplied cable.
Switch the external device on.
The 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.
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28 IntelliBridge EC10 Module
Changing Waves and Numerics Displayed
To change the waves and numerics from the IntelliBridge module displayed on the Screen,
Select Main Setup, Measurements, then  to enter the setup menu for the
connected device.
Select Setup Driver.
Select Setup Wavesor Setup Numerics and make the changes required.
Close the setup menu. The monitor takes a few seconds to activate the change.
Viewing the IntelliBridge Device Data Window
To 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  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 Data
Your 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.
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28 IntelliBridge EC10 Module
Alarms/INOPs from External Devices
The 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.
the monitor is configured to accept external device alarms, but the alarms are
switched off at the external device.
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 Module
INOP Text
INOP Condition
!!NO DEVICE DATA
!!!NO DEVICE DATA
Communication has been lost to a connected device when
NO 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
installed
DEVICE CHECK CONF.
Device identification completed but communication could not be
established due to errors
DEVICE CHECK SETUP
Device identification completed but communication could not be
established due to timeout
–
–
!! a medium priority INOP or patient alarm was present
!!! a high priority INOP or patient alarm was present
Language Conflict with External Device Drivers
You 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.
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28 IntelliBridge EC10 Module
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29
29
VueLink Modules
A 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.
Numeric
External Devices
Auxiliary
standalone measurement module
Ventilator
ventilators
Gas Analyzer
gas analyzers
Anesthesia
Machine
anesthesia machines
Auxiliary Plus
external multi-measurement devices
module name
device label
selection LED
setup key
external device cable connector
setup indicator LED
module type (A or B)
The 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.
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29 VueLink Modules
See the documentation supplied with the VueLink module for a list of supported devices and
accessories, and for configuration information.
Connecting an External Device
Insert the module into the FMS or integrated module slot.
Check 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.
In the device setup menu, select Device, select the correct device from the list, and confirm the
selection.
Connect 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.
CAUTION
Selecting 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 Displayed
To change the waves and numerics from the VueLink module displayed on the Screen,
348
Select Main Setup, Measurements and then the name of the connected device to enter its setup
menu.
Select the item you want to change, then select the new item from the pop-up list,
or
Select Show Device Data to view the device data window.
Close the setup menu. The monitor takes a few seconds to activate the change.
29 VueLink Modules
Viewing the VueLink Device Data Window
Mode information from external device
Name of external device
Type of external device
Device Alarms Accepted
To 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  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 Screens
Your 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.
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29 VueLink Modules
Alarms/INOPs From External Devices
The 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, depending on the configuration setting, either Device Alarms Ignored or Device Alarms
Accepted or, when the external device is not supplying alarm data, No Alarms Available. When
Device Alarms Ignored is set, alarms from the external device will not be displayed on the monitor
and will not be transmitted to the Information Center. 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
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.
•
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 Drivers
You 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:
350
•
measurement labels in the monitor language
•
alarm and INOP texts in the VueLink module device driver language.
30
30
Using Timers
With the Timers function you can set timers to notify you when a specific time period has expired.
CAUTION
Do not use the timers to schedule critical patient-related tasks.
Viewing Timers
You 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 SmartKey
or
•
Select Main Setup then select Timer
The 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 Types
There 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.
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30 Using Timers
Timer Setup Pop-up Keys
When 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.
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
Setting Up Timers
The 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 Label
You 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:
Select the required timer and display the Setup window.
Select Label.
Select a specific or non-specific label from the list.
Run Time
The 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:
352
Select the required timer and display the Setup window.
Select Run Time.
Select a run time from the list.
30 Using Timers
Timer Counting Direction
Timers 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:
Select the required timer and display the Setup window.
Select Direction to switch between Up and Down.
Notification
When 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 timer
Sound: A single tone indicates the expiry of the timer
No Sound: No additional notification
To set the additional notification, in the Timers window:
Select the required timer and display the Setup window.
Select 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 Volume
For all Timers with the notification setting Sound, you can set the volume of the tone.
To set the volume, in the Timers window:
Select the required timer and display the Setup window.
Select Timer Volume and select a volume setting from the list.
Displaying a Timer On The Main Screen
If 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.
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30 Using Timers
To display a timer on the Main Screen:
Select the numeric you want to substitute.
Select Change Numeric.
Select Any Timer.
Main Screen Timer Pop-up Keys
When you select a timer displayed on the Main Screen, additional pop-up keys become available:
Pop-Up Keys
Selecting this pop-up key lets you....
Setup 
enter the setup screen for the currently selected timer.
Change Timer
select a different timer for display.
Timers
enter the Timers window.
Displaying A Clock On The Main Screen
In 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:
Select the numeric you want to substitute.
Select Change Numeric.
Select Clock.
When you select the clock on the Main Screen you can select Date, Time in the menu to set the date
and time.
354
31
31
Respiratory Loops
Using 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 Loops
In 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.
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31 Respiratory Loops
To 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 Loops
Up 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 Loops
Colored 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 Size
To 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 size
This does not affect the size of loops printed in reports.
Using the Loops Cursor
To view the coordinates for any point on a stored loop,
Select the pop-up key Select Loop.
Select the required loop from the list of available loops.
Use 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.
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31 Respiratory Loops
Changing Loops Type
To 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,
In the Loops window, select the Setup Device pop-up key to enter the setup window for the
external device.
Select Wave 1 and select pressure, flow, or volume waves as required. Repeat for Wave 2.
Setting Up Source Device
The 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 Loops
In the Loops window, select the pop-up key Print Loop
From the list of available loops, select an individual loop, or select Print All to print a report of all
For 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.
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31 Respiratory Loops
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32
32
Laboratory Data
Laboratory 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 42. 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 Data
When 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 Diagnostics
If 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 (*).
359
32 Laboratory Data
360
33
33
Care and Cleaning
Use 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 PublicSafety 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 Points
Keep 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.
WARNING
If 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.
361
33 Care and Cleaning
Cleaning the Monitor
Clean 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.
CAUTION
To 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 Monitor
CAUTION
Solutions: 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
Ingredients
Isopropanol
liquid
Isopropanol 80%
Bacillol®
liquid, spray
100 g concentrate contains:
Propan-1-ol 45.0 g; Propan-2-ol 25.0 g; Ethanol 4.7 g
Bacillol®25
liquid
Ethanol 100 mg/g
Propan-2-ol (= 2-Propanol) 90 mg/g; Propan-1-ol (= 1Propanol) 60 mg/g
Meliseptol®
spray
50% 1-Propanol
Accel TB RTU
liquid
0.5% accelerated hydrogen peroxide
Oxivir®
Tb Cleaner Disinfectant
spray
0.5% accelerated hydrogen peroxide
Oxivir®
Tb Wipes
wipes
0.5% accelerated hydrogen peroxide
spray
0.5% accelerated hydrogen peroxide
Carpe
AF
DiemTM/MC
Tb
Ready-to-Use General Virucide,
Bactericide, Tuberculocide,
Fungicide, Sanitizer
362
33 Care and Cleaning
Product Name
Product Type
Ingredients
Carpe DiemTM/MC Tb Wipes
wipes
0.5% accelerated hydrogen peroxide
Super Sani-Cloth
wipes
isopropanol 55%
quaternary ammonium chlorides 0.5%
wipes
isopropanol 15%
quaternary ammonium chlorides 0.25%
wipes
isopropanol < 0.15%
quaternary ammonium chlorides 0.14%
Germicidal Disposable Wipes
SANI-CLOTH® PLUS
Germicidal Disposable Wipes
SANI-CLOTH® HB Germicidal
Germicidal Disposable Wipes
Sterilizing the Monitor
Sterilization 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
Accessories
To clean, disinfect and sterilize reusable transducers, sensors, cables, leads, and so forth, refer to the
instructions delivered with the accessory.
Cleaning the SO2 Optical Module
The 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.
Remove the recorder.
Open the recorder door and un-thread the paper from behind the rubber roller.
Tear off or roll up the excess paper into the roll chamber to get it out of your way.
363
33 Care and Cleaning
364
Thread 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.
Close the recorder door, aligning both ends of the strip over the top of the door.
Holding the top end of the cleaning strip between your thumb and forefinger, pull the strip
through and out of the recorder.
Open the door and ensure that the paper cavity is dust-free. Re-thread the paper and replace the
recorder.
34
34
Maintenance and
Troubleshooting
WARNING
Schedule: 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 Accessories
You should perform a visual inspection before every use, and in accordance with your hospital's policy.
With the monitor switched off:
Examine 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.
Inspect all accessories (cables, transducers, sensors and so forth). If any show signs of damage, do
not use.
Switch 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.
If 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.
WARNING
Electrical 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.
365
34 Maintenance and Troubleshooting
Inspecting the Cables and Cords
Examine 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.
Inspect 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.
Inspect the cable connecting the MMS to the monitor. Make sure the connectors are properly
engaged.
Inspect 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.
Apply 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 Schedule
The 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
Frequency
Monitor Tests
Safety checks. Selected tests on the
basis of IEC 60601-1
At 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 Maintenance
Check 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 Tests
Performance 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 Maintenance
366
NBP calibration
At least once every two years, or as specified by local laws.
Microstream CO2 calibration and
performance test
At 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 Troubleshooting
Troubleshooting
If you suspect a problem with an individual measurement, read the Instructions for Use and doublecheck 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,
In the Main Setup menu, select Revisions.
Select the pop-up key corresponding to the status log you want to consult, for example, for the
MMS or the monitor.
View the status log by selecting Status Log from the Monitor Revision window.
Disposing of the Monitor
WARNING
To 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.wpd
The 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 Cylinders
Empty 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.
When the cylinder is empty, either remove the valve stem from the fill (or regulator) hole, or drill a
hole in the cylinder.
Write "Empty" on the cylinder and dispose of it appropriately for scrap metal.
367
34 Maintenance and Troubleshooting
WARNING
Ensure that the cylinder is completely empty before trying to remove the valve stem or drill a hole in
the cylinder.
368
35
Accessories
35
You can order parts and accessories from Philips supplies at www.medical.philips.com or consult your
local Philips representative for details.
WARNING
Reuse: Never reuse disposable transducers, sensors, accessories and so forth that are intended for
single use, or single patient use only. Reuse may compromise device functionality and system
performance and cause a potential hazard.
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 Accessories
This 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 Cables
Trunk Cables
3-Electrode Cable 5-Electrode Cable 6-Electrode Cable 10-Electrode
Set
Set
Set
Cable set
(5+5)
10-Electrode
Cable set
(6+4)
Part No.
M1669A
M1668A
M1667A
M1663A
M1665A
Length
2.7 m
2.7 m
2.7 m
2.0 m
2.7 m
369
35 Accessories
3-Electrode Cable Sets
Description
Length
AAMI Part No.
IEC Part No.
OR Grabber shielded
1.0 m
M1675A
M1678A
ICU Grabber shielded
1.0 m
M1671A
M1672A
ICU snap shielded
1.0 m
M1673A
M1674A
ICU Clip non-shielded
0.45 m
M1622A
--
ICU Clip non-shielded
0.7 m
M1624A
M1626A
Description
Length
AAMI Part No.
IEC Part No.
OR Grabber shielded
1.0 m/1.6 m
M1973A
M1974A
ICU Grabber shielded
1.0 m/1.6 m
M1968A
M1971A
ICU Snap shielded
1.0 m/1.6 m
M1644A
M1645A
ICU Miniclip non-shielded
0.7 m/1.3 m
M1647A
M1648A
Description
Length
AAMI Part No.
IEC Part No.
OR Grabber
1.0 m/1.6 m
M1684A
M1685A
ICU Grabber
1.0 m/1.6 m
M1680A
M1681A
ICU Snap
1.0 m/1.6 m
M1682A
M1683A
Description
Length
AAMI Part No.
IEC Part No.
ICU Grabber, chest, shielded
1.0 m
M1976A
M1978A
ICU Snap, chest, shielded
1.0 m
M1602A
M1604A
OR Grabber, chest, shielded
1.0 m
M1979A
M1984A
Description
Length
AAMI Part No.
IEC Part No.
ICU Grabber, chest, shielded
1.0 m
M1532A
M1533A
ICU Snap, chest, shielded
1.0 m
M1537A
M1538A
OR Grabber, chest, shielded
1.0 m
M1557A
M1558A
5-Electrode Cable Sets
6-Electrode Cable Sets
10-Electrode (5+5)Cable Sets
For Limb Leads see 5-electrode cable sets
10-Electrode (6+4)Cable Sets
For Limb Leads see 6-electrode cable sets
370
35 Accessories
One-piece Cables
Description
Length
AAMI Part No.
IEC Part No.
3-lead Grabber, ICU
1.0 m
989803143181
989803143171
5-lead Grabber, ICU
1.0 m
989803143201
989803143191
Radio-translucent Cables
Pack of five single wires, radio-translucent, 0.9 m, M1649A
Set Combiners and Organizers
Set combiners and organizers
Part No.
Set combiner
Set organizer for shielded leadsets - grabber and snap
Set organizer for non-shielded lead sets - miniclip
3-electrode
M1501A
5-electrode
M1502A
3-electrode
M1503A
4-electrode
M1664A
5-electrode
M1504A
6-electrode
M1679A
3-electrode
M1636A
5-electrode
M1638A
Bedsheet clip
M1509A
Replacement red cover for trunk cable (for 5-electrode cable sets)
989808148861
Supported Cables
Trunk Cables
Length
3-Electrode Cable Set
5-Electrode Cable Set
AAMI Part No.
IEC Part No.
AAMI Part No.
IEC Part No.
0.9 m
M1540C
M1550C
M1560C
M1570C
2.7 m
M1500A
M1510A
M1520A
M1530A
3-Electrode Cable Sets
Description
Length
AAMI Part No.
IEC Part No.
OR
1.0 m
M1601A
M1611A
ICU Grabber shielded
1.0 m
M1603A
M1613A
ICU snap shielded
1.0 m
M1605A
M1615A
ICU Clip non-shielded
0.45 m
M1608A
M1618A
ICU Clip non-shielded
0.7 m
M1609A
M1619A
371
35 Accessories
5-Electrode Cable Sets
Description
Length
AAMI Part No.
IEC Part No.
OR Grabber shielded
1.0 m/1.6 m
M1621A
M1631A
ICU Grabber shielded
1.0 m/1.6 m
M1623A
M1633A
ICU Snap shielded
1.0 m/1.6 m
M1625A
M1635A
ICU Clip non-shielded
0.7 m/1.3 m
M1629A
M1639A
AAMI 3-Electrode One Length
Piece Cables
AAMI Part No.
IEC 3-electrode One
Piece Cables
IEC Part No.
OR Grabber
1.9 m
M1970A
OR Grabber
M1980A
ICU Snap
1.9 m
M1972A
ICU Grabber
M1981A
3-Electrode One Piece Cables
5-Electrode One Piece Cables
AAMI 5-electrode One
Piece Cables
Length
AAMI Part No.
IEC 5-electrode One
Piece Cables
IEC Part No.
OR Grabber
2.5 m
M1975A
OR Grabber
M1985A
ICU Snap
2.5 m
M1977A
ICU Grabber
M1986A
Set Combiners and Organizers
Set combiners and organizers
Part No.
Set combiner
3-electrode
M1501A
5-electrode
M1502A
Shielded 3-electrode
M1503A
Shielded 5-electrode
M1504A
Set organizer
Bedsheet clip
372
M1509A
35 Accessories
NBP Accessories
These 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 Reusable Comfort Cuffs
Patient Category
Limb Circumference
Part No.
Tubing
Adult (Thigh)
42 to 54 cm
M1576A
Large Adult
34 to 43 cm
M1575A
Adult
27 to 35 cm
M1574A
M1598B (1.5 m)
or
M1599B (3 m)
Small Adult
20.5 to 28 cm
M1573A
Pediatric
14 to 21.5 cm
M1572A
Infant
10 to 15 cm
M1571A
Adult/Pediatric Reusable Comfort Cuff Kits
Cuff Kits
Part No.
Infant, pediatric, small adult, adult
M1577A
Small adult, adult, large adult, thigh
M1578A
Infant, pediatric, small adult, adult, large adult, thigh
M1579A
Adult/Pediatric Reusable EasyCare Cuffs
Patient Category
Limb Circumference
Part No.
(Pack of five)
Tubing
Adult Thigh
44 - 56 cm
M4559B (M4559B5)
Large Adult X-Long
35 - 45 cm
M4558B (M4558B5)
Large Adult
35 - 45 cm
M4557B (M4557B5)
M1598B (1.5 m)
or
M1599B (3 m)
Adult X-Long
27.5 - 36 cm
M4556B (M4556B5)
Adult
27.5 - 36 cm
M4555B (M4555B5)
Small Adult
20.5 - 28.5 cm
M4554B (M4554B5)
Pediatric
14 - 21.5 cm
M4553B (M4553B5)
Infant
10 - 15 cm
M4552B (M4552B5)
373
35 Accessories
Adult/Pediatric Single Patient Cuffs
Patient Category
Limb Circumference
Part No.
Tubing
Adult (Thigh)
42 to 54 cm
M1879A
Large Adult
34 to 43 cm
M1878A
Adult
27 to 35 cm
M1877A
M1598B (1.5 m)
or
M1599B (3 m)
Small Adult
20.5 to 28 cm
M1876A
Pediatric
14 to 21.5 cm
M1875A
Infant
10 to 15 cm
M1874A
Adult/Pediatric Single Patient, Soft Cuffs
Patient Category
Limb Circumference
Part No.
Tubing
Adult (Thigh)
44 - 56 cm
M4579B
Large Adult X-Long
35 - 45 cm
M4578B
Large Adult
35 - 45 cm
M4577B
M1598B (1.5 m)
or
M1599B (3 m)
Adult X-Long
27.5 - 36 cm
M4576B
Adult
27.5 - 36 cm
M4575B
Small Adult
20.5 - 28.5 cm
M4574B
Pediatric
14.0 - 21.5 cm
M4573B
Infant
10 - 15 cm
M4572B
Neonatal/Infant Single Patient Cuffs
Cuffs
Limb Circumference
Part No.
A - Luer connector
B - ISO 80369-1 compliant
connector
Tubing
Size 1
3.1 to 5.7 cm
M1866A/B
For A-version cuffs:
Size 2
4.3 to 8.0 cm
M1868A/B
Size 3
5.8 to 10.9 cm
M1870A/B
M1596B (1.5 m) or M1597B
(3 m)
Size 4
7.1 to 13.1 cm
M1872A/B
For B-version cuffs:
Size 5 (Infant)
10 to 15 cm
M1873B
M1596C (1.5 m) or M1597C
(3 m)
374
35 Accessories
Neonatal/Infant Single Patient, Soft Cuffs
Cuffs
Limb Circumference
Part No.
Tubing
Size 1
3.1 to 5.7 cm
M1866S
Size 2
4.3 to 8.0 cm
M1868S
Size 3
5.8 to 10.9 cm
M1870S
M1596C (1.5 m)
or
M1597C (3 m)
Size 4
7.1 to 13.1 cm
M1872S
Size 5 (Infant)
10 to 15 cm
M1873S
Neonatal/Infant Cuff Kits
Cuff Kits
Part No.
Standard, Single Patient, Luer connector: 10 x M1866A, 10 x M1868A, 10 x M1872A,
and 20 x M1870A
M1820-60020
Standard, Single Patient, ISO 80369-1 compliant connector: 5 x M1866B, 10 x M1868B, 989803167541
20 x M1870B, 10 x M1872B, and 5 x M1873B
Soft, Single Patient, ISO 80369-1 compliant connector: 5 x M1866S, 10 x M1868S,
20 x M1870S, 10 x M1872S, 5 x M1873S
989803167551
Invasive Pressure Accessories
These 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.
Transducer, accessories, sensor kits
Part No.
Reusable pressure transducer 5 µV/V/mmHg sensitivity
CPJ840J6
Sterile disposable pressure domes for CPJ840J6 (pack of 50)
CPJ84022
Transducer holder for CPJ840J6 (pack of 4)
CPJ84046
IV pole mount for CPJ840J6
CPJ84447
Monitoring Line Set for CPJ840J6
CPJ84026
Single channel disposable sensor kit (20) - (EU/EFTA only)
M1567A
Dual channel disposable sensor kit (20) (EU/EFTA only)
M1568A
Transducer holder for M1567/8A (EU/EFTA only)
M2271A
IV pole mount for M1567/8A (EU/EFTA only)
M2272C
Adapter cable for disposable sensor kit 3,0m for M1567/8A
M1634A
375
35 Accessories
Transducer, accessories, sensor kits
Part No.
Pressure transducer kits
PiCCO monitoring kit, 30cm pressure line, includes PV4046 injectate temperature sensor
housing for M1646A
PV8103
PiCCO monitoring kit, 150cm pressure line, includes PV4046 injectate temperature sensor
housing for M1646A
PV8115
PiCCO monitoring kit, 150cm pressure line, includes PV4046 injectate temperature sensor
housing for M1646A and central venous pressure line
PV8115CVP
PULSION Pressure Interface Cable for disposable pressure transducer
PMK 206
SpO2 Accessories
This 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.
376
35 Accessories
Product Number
Description
Compatible with
Opt. A01
Opt. A02
Comments
Philips reusable sensors.
M1191A/B
Adult sensor (2 m cable), for patients over
50 kg. Any finger, except thumb.
yes
no
M1191AL/BL
M1191A/B with longer cable (3 m)
yes
no
M1192A
Small adult, pediatric sensor (1.5 m cable)
for patients between 15 kg and 50 kg. Any
finger except thumb.
yes
no
M1193A
Neonatal sensor (1.5 m cable) for patients
between 1kg and 4 kg. Hand or foot.
yes
no
M1194A
Ear sensor (1.5 m cable) for patients more
than 40 kg.
yes
no
M1195A
Infant sensor (1.5 m cable) for patients
between 4kg and 15 kg. Any finger except
thumb.
yes
no
M1196A
Adult clip sensor (3 m cable) for patients
over 40 kg. Any finger except thumb.
yes
no
M1191T
Adult sensor (0.45 m cable), for patients
over 50 kg. Any finger, except thumb.
yes
no
M1192T
Small adult, pediatric sensor (0.45 m cable) yes
for patients between 15 kg and 50 kg. Any
finger except thumb.
no
M1193T
Neonatal sensor (0.9 m cable) for patients
between 1 kg and 4 kg. Hand or foot.
yes
no
M1196T
Adult clip sensor (0.9 m cable) for patients
over 40 kg. Any finger except thumb.
yes
no
No adapter cable
required.
Requires M1943 (1 m)
or M1943AL (3 m)
adapter cable
Philips disposable sensors. Not available in the USA.
M1904B
Identical to OxiMax MAX-A
yes
yes
Option A01: Use
adapter cable M1943A
or M1943AL.
M1903B
Identical to OxiMax MAX-P
yes
yes
M1902B
Identical to OxiMax MAX-I
yes
yes
M1901B
Identical to OxiMax MAX-N
yes
yes
M1131A
Adult/Pediatric finger sensor, 0.45 m cable yes
(patient size > 20 kg)
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 cable
yes
Foot or hand for neonates < 3 kg
Big toe or thumb for patients between 10 kg
and 20 kg
Any finger except thumb for patients > 40
kg
no
Use adapter cable
M1943A or M1943AL.
Option A02: Must use
adapter cable
M1943NL.
Philips disposable sensors. Available worldwide.
377
35 Accessories
Product Number
Description
Compatible with
Opt. A01
M1134A
Adhesive-free, Adult/Infant/Neonatal, 0.9 yes
m cable
Foot or hand for neonates < 3 kg
Big toe or thumb for patients between 10 kg
and 20 kg
Any finger except thumb for patients > 40
kg
Comments
Opt. A02
no
Use adapter cable
M1943A or M1943AL.
Option A01: Use
adapter cable M1943A
or M1943AL.
NELLCOR disposable sensors (must be ordered from Nellcor)
OxiMax MAX-A
Adult finger sensor (patient size > 30 kg)
yes
yes
OxiMax
MAX-AL
OxiMax MAX-A with long cable
yes
yes
OxiMax MAX-P
Pediatric foot/hand sensor (patient size 10- yes
50 kg)
yes
OxiMax MAX-I
Infant foot/hand sensor (patient size 3-20
kg)
yes
yes
OxiMax MAX-N
Adult finger or neonatal foot/hand sensor
(patient size > 40 kg or < 3 kg)
yes
yes
MAX-FAST
Forehead sensor
no
yes
OxiMax MAX-R
Adult nasal sensor
no
yes
OxiMax SC-A
Adult SoftCare sensor
no
yes
OxiMax SC-NEO
Neonatal SoftCare sensor
no
yes
OxiMax SC-PR
Pre-term infant SoftCare sensor
no
yes
Oxisensor II D-25 Adult sensor (patient size > 30 kg)
yes
no
Oxisensor II D-20 Pediatric sensor (patient size 10-50 kg)
yes
no
Oxisensor II I-20
yes
no
Oxisensor II N-25 Neonatal sensor (patient size < 3 kg or > 40 yes
kg)
no
OxiCliq A
See OxiMax MAX-A
yes
yes
OxiCliq P
See OxiMax MAX-P
yes
yes
OxiCliq I
See OxiMax MAX-I
yes
yes
OxiCliq N
See OxiMax MAX-N
yes
yes
Infant sensor (patient size 3-20 kg)
Option A02: Must use
adapter cable
M1943NL.
Must use M1943NL
adapter cable.
Must use M1943A or
M1943 AL adapter
cable.
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.
Oxiband OXI-A/
Adult / neonatal sensor
no
yes
Oxiband OXI-P/I Pediatric / infant sensor
no
yes
Durasensor
DS100A
Adult finger clip sensor
no
yes
Dura-Y D-YS
Y-sensor
no
yes
378
Must use M1943NL
adapter cable.
35 Accessories
Product Number
Description
Compatible with
Opt. A01
Opt. A02
Comments
Extension / Adapter Cables for Philips and Nellcor Sensors
M1941A
Extension cable (2 m)
yes
yes
For use with Philips
reusable sensors and
M1943A adapter cable.
M1943A
Adapter cable (1.1 m cable)
yes
no
M1943AL
Adapter cable (3 m cable)
yes
no
Adapter cable for
Philips/Nellcor
disposable sensors.
M1943NL
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 Number
Description
Compatible with
Opt. A01
Opt. A02
Philips Part Number
MASIMO LNOP® reusable sensors.
LNOP DCI
Adult Finger Sensor (> 30 kg)
yes
no
n/a
LNOP DCIP
Pediatric Finger Sensor (10 - 50 kg)
yes
no
n/a
LNOP YI
Multi-Site Sensor (> 1kg)
yes
no
n/a
LNOP TC-I
Ear Sensor (> 30 kg)
yes
no
n/a
MASIMO LNCS® reusable sensors.
LNCS DCI
Adult Finger Sensor (> 30 kg)
yes
no
n/a
LNCS DCIP
Pediatric Finger Sensor (10 - 50 kg)
yes
no
n/a
LNCS YI
Multi-Site Sensor (> 1kg)
yes
no
n/a
LNCS TC-I
Ear Sensor (> 30 kg)
yes
no
n/a
MASIMO LNOP® disposable adhesive sensors.
LNOP Adt
Adult Sensor (> 30 kg)
yes
no
n/a
LNOP Adtx
Adult Sensor (> 30 kg)
yes
no
n/a
LNOP Pdt
Pediatric Sensor (10 - 50 kg)
yes
no
n/a
LNOP Pdtx
Pediatric Sensor (10 - 50 kg)
yes
no
n/a
LNOP Inf-L
Infant Toe Sensor (3 - 20 kg)
yes
no
n/a
LNOP Neo-L
Neonatal Sensor (< 3 kg)
or Adult adhesive Sensor (> 40 kg)
yes
no
n/a
LNOP NeoPt-L
Neonatal Pre-Term Sensitive Skin Sensors
(< 1 kg)
yes
no
n/a
MASIMO LNCS® disposable adhesive sensors.
LNCS Adtx
Adult Finger Sensor, 18 inch (> 30 kg)
yes
no
n/a
LNCS Adtx-3
Adult Finger Sensor, 3 feet (> 30 kg)
yes
no
n/a
LNCS Pdtx
Pediatric Finger Sensor, 18 inch (10 - 50 kg) yes
no
n/a
379
35 Accessories
Product Number
Description
Compatible with
Opt. A01
Opt. A02
Philips Part Number
LNCS Pdtx-3
Pediatric Finger Sensor, 3 feet (10 - 50 kg)
yes
no
n/a
LNCS Inf
Infant Toe Sensor, 18 inch (3 - 20 kg)
yes
no
n/a
LNCS Inf-3
Infant Toe Sensor, 3 feet (3 - 20 kg)
yes
no
n/a
LNCS Neo
Neonatal Foot Sensor, 18 inch (< 3 kg)
or Adult Finger Sensor 18 inch(> 40 kg)
yes
no
n/a
LNCS Neo-3
Neonatal Foot Sensor, 3 feet (< 3 kg)
or Adult Finger Sensor, 3 feet(> 40 kg)
yes
no
n/a
LNCS NeoPt
Neonatal pre-term sensitive skin Sensor
18 inch (< 1 kg)
yes
no
n/a
LNCS NeoPt-3
Neonatal pre-term sensitive skin Sensor
3 feet (< 1 kg)
yes
no
n/a
Adapter Cable for MASIMO sensors.
LNOP MP12
LNOP MP Series Patient Cable (3.6 m)
Adapter Cable for Masimo LNOP Sensors
yes
no
451261000761
LNC MP10
LNCS MP Series Patient Cable (3.0 m)
Adapter Cable for Masimo LNCS Sensors
yes
no
989803148221
The 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 Accessories
Temperature Probes
Part No.
Minimum measurement
time for accurate
readings
General purpose probe
21075A
90 sec
Small flexible vinyl probe (Infant/Pediatric)
21076A
60 sec
Attachable surface probe
21078A
60 sec
General purpose probe
M1837A
90 sec
Skin probe
21091A
60 sec
Esophageal/Stethoscope Probe (French 12)
21093A
180 sec
Esophageal/Stethoscope Probe (French 18)
21094A
210 sec
Esophageal/Stethoscope Probe (French 24)
21095A
310 sec
Reusable
Disposable
380
35 Accessories
Temperature Probes
Part No.
Minimum measurement
time for accurate
readings
Esophageal/Rectal Probe (French 12)
21090A
90 sec
Foley Catheter Probe (12 French)
M2255A
180 sec
Foley Catheter Probe (16 French)
21096A
180 sec
Foley Catheter Probe (18 French)
21097A
180 sec
Adapter cable 1.5m
21082B
Adapter cable 3.0m
21082A
Cardiac Output (C.O.) Accessories
See Pressure accessories for PULSION continuous cardiac output accessories.
Description
Part No.
Accessories common to both methods
Accessories
Set of ice buckets
14455A
Remote handswitch
15244A
Latex free
M1646A
2.7 meter cable
M1642A
2.4 m + 2.4 m cable
M1643A
Right heart catheter for thermodilution
(from Edwards Lifesciences)
831HF75
Edwards CO-Set+ (only with 23001A/B)
contact Edwards Lifesciences for
information
Injectate Probes
2.4m injectate temp. probe (reusable)
23001A
0.5m injectate temp. probe (reusable)
23001B
Ice bath temp. probe
23002A
2.4 m + 2.4 m cable
M1643A
PiCCO inline temperature probe
Right Heart Thermodilution
C.O. Interface Cables
Transpulmonary Thermodilution
C.O. Interface Cables
PULSION Pressure Transducer Kits (pressure line Contact PULSION for information
available in various lengths)
Pressure Interface Cable for disposable pressure
transducer
PULSION PMK 206
381
35 Accessories
Mainstream CO2 Accessories
Description
Part No.
CO2 Sensor
M2501A
Adult/Pediatric Airway Adapter (reusable)
M2513A
Infant Airway Adapter (reusable)
M2516A
Adult Airway Adapter (single-patient use)
M2533A
Infant Airway Adapter (single-patient use)
M2536A
Sidestream CO2 Accessories
Description
Part No.
CO2 Sensor
M2741A
Nasal and Oral-Nasal Cannulas
CO2 Nasal Cannula, Adult
M2744A
CO2 Nasal Cannula, Pediatric
M2745A
CO2 Nasal Cannula, Infant
M2746A
CO2 / O2 Nasal Cannula, Adult
M2750A
CO2 / O2 Nasal Cannula, Pediatric
M2751A
CO2 / O2 Nasal Cannula, Infant
989803144471
CO2 Oral-Nasal Cannula, Adult
M2756A
CO2 Oral-Nasal Cannula, Pediatric
M2757A
CO2 / O2 Oral-Nasal Cannula, Adult
M2760A
CO2 / O2 Oral-Nasal Cannula, Pediatric
M2761A
Airway Adapters
Airway Adapter Set, ET > 4.0 mm
M2768A
Airway Adapter Set, ET =< 4.0 mm
989803144531
Airway Adapter Set H, ET > 4.0 mm
M2772A
Airway Adapter Set H, ET =< 4.0 mm
M2773A
Straight Sample Lines
Straight Sample Line
M2776A
Straight Sample Line H
M2777A
382
35 Accessories
Mainstream CO2 Accessories (for M3016A)
Description
Part No.
CO2 Sensor
M1460A
Standard Airway Adapter (reusable)
M1465A
Small Airway Adapter (reusable)
14363A
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).
383
35 Accessories
Microstream accessory selection flowchart
Is the patient intubated?
Yes
No
Does the patient need oxygen?
Yes
Short-term
(up to 6 hours)
Long-term
(up to 72 hours)
No
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
Nasal
Procedural
Sedation, Critical
Care, EMS, ED
Critical Care, Sleep Critical Care, Sleep Procedural
Lab, Long-term
Lab
Sedation, Critical
Pain Management
Care, EMS, ED
Key Applications
Critical Care
OR, EMS, ED
EMS, ED
Philips part numbers (A = Adult, P= Pediatric, I = Infant, N = Neonate)
FilterLine Set:
FilterLine H Set:
A/P: M1920A
FilterLine Set
Long:
A/
P:989803160241*
FilterLine:
M1925A*
CapnoLine HO2:
CapnoLine H:
Smart CapnoLine: NIV Line:
A/P: M1921A
Smart CapnoLine
O2:
A: M4680A
A: M4689A
A: M2526A
A: 4686A
I/N: M1923A
A: M2522A
P: M4681A
P: M4690A
P: M2524A
P: M4687A
FilterLine H Set
Long
P: M2520A
I/N: M4691A
Smart CapnoLine
Plus Long
A/
P:989803160251*
Smart CapnoLine
O2 Long
A:989803160301*
A:989803160281*
P:989803160271*
I/
N:989803160261*
VitaLine H Set:
A/
P:989803159571*
I/N:
989803159581*
FilterLine H:
M1926A*
*Not available in all geographies.
Spirometry Accessories
Description
Part No.
Adult/Pediatric Flow Sensor
M2785A
Neonatal Flow Sensor
M2786A
Adult/Pediatric CO2/Flow Sensor
M2781A
Neonatal CO2/Flow Sensor
M2782A
Pediatric CO2/Flow Sensor
M2783A
384
35 Accessories
Measurement of CO2 and Spirometry with Neonates
For 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).
tcGas Accessories
This 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.
Description
Part No.
tcpO2/CO2 transducer
M1918A
Accessory Kit for M1918A (O-ring remover, absorbent paper, electrolyte solution, 12
replacement membranes)
15209-60010
Application Kit for M1918A (4x25 disposable fixation rings, contact fluid)
15209-60020
tcpO2/CO2 transducer
M1918B1
Accessory Kit for M1918B (10 replacement membranes, electrolyte solution)
9898031519511
Application Kit for M1918B (4x25 disposable fixation rings, contact fluid)
9898031519611
Calibration gas - 6 gas bottles
15210-60010
Calibration gas - 6 gas bottles (Europe and Japan only)
15210-64010
Replacement tubing (5 tubes)
M2205A
Calibration unit
15210B
Radiometer TCC3 calibration unit (available from Radiometer)
n/a
1May
not be available in all countries due to pending regulatory clearance
EEG Accessories
Description
Part No.
Trunk Cable 2.7 m
M2268A
Trunk Cable, 1.0 m
M2269A
Reusable 80-cm-long 5-lead cables with 10 mm silver/silverchloride leadwired cup electrodes M1931A
(Adult)
385
35 Accessories
Description
Part No.
Reusable 80 cm 5-lead cables with 6 mm silver/silverchloride leadwired cup electrodes
(Pediatric/Neonatal)
M1932A
Reusable 80 cm 5-lead cables with clip
M1934A
Disposable EEG electrodes
M1935A
EC2™ Electrode Cream (conductive paste)
M1937A
BIS Accessories
To re-order sensors, contact Aspect Medical Systems. BIS sensors are not available from Philips.
SO2 Accessories for M1021A
Contact your local Hospira representative for information on accessories. They are not available from
Philips.
Description
Hospira Part No.
Optical Module
50131
Hospira
Opticath®
Catheter family (SvO2, ScvO2)
Contact Hospira for part numbers of compatible catheters
SO2 Accessories for M1011A
Contact your local PULSION or Edwards representative for information on accessories. They are not
available from Philips.
Description
Product Number (Order Number)
Philips SO2 Optical Module
989803151591
Pulsion: CeVOX Fiberoptic Probe family (ScvO2)
Contact PULSION for part numbers of compatible
probes
Edwards: Philips-compatible versions of the PreSep
Catheter (ScvO2) or Swan-Ganz Oximetry Catheter
(SvO2) families
Contact Edwards for part numbers of compatible
catheters
Recorder Accessories
Description
Part No.
For M1116B recorder:
10 rolls of paper
40477A
80 rolls of paper
40477B
386
35 Accessories
Battery Accessories
Description
Part No.
Lithium Ion Smart Battery 1Ah (internal battery for X2)
M4607A
Battery Charger and Conditioner (requires size adapter 4512 610 17451 to charge
M4607A battery)
865432
Size adapter for M4607A battery
4512 610 17451
387
35 Accessories
388
36 Specifications
36
Specifications
The specifications in this section apply to the MX600, MX700 and MX800 patient monitors.
The monitors are not user installable. They must be installed by qualified service personnel.
Intended Use
The 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.
WARNING
The monitor is not intended for use in an MRI environment or in an oxygen-enriched environment
(for example, hyperbaric chambers).
Manufacturer's Information
You can write to Philips at this address
389
36 Specifications
Philips Medizin Systeme Boeblingen GmbH
Hewlett-Packard-Str. 2
71034 Boeblingen
Germany
Visit our website at: www.healthcare.philips.com/us/.
© Copyright 2011. Koninklijke Philips Electronics N.V. All Rights Reserved.
BIS Manufacturer's Information
BISx, the BIS Engine, the DSC, the Patient Interface Cable and the BIS Sensor are manufactured by
Aspect Medical Systems:
Aspect Medical Systems, Inc
141 Needham St
Newton,
MA 02464
USA
1-617-559-7000
Free call:
1-888-BIS_INDEX
1-888-247-4633
Email: bis_info@aspectms.com
Web: www.aspectmedical.com
Address of the EU Authorized Representative:
Aspect Medical Systems International B.V.
Rijnzathe 7d2
3454 PV De Meern
The Netherlands
Phone: +31.30.662.9140
Email: amsint@aspectms.com
Trademark Acknowledgement
PiCCOTM 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®, DuraY®, 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.
390
36 Specifications
Symbols
These symbols can appear on the monitor and its associated equipment.
Symbols
Refer to accompanying
documents
Protective earth
Equipotential grounding
Standby
FMS power-on indicator
Error LED
Alternating current
Connection direction
indicator
Connection direction
indicator
Electrical 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
proof
Gas input indicator
Gas output indicator
Quick mount release
built-in wireless network
USB interface
Data input/output symbol
Non-ionizing radiation
symbol
Identifies year and month
of manufacture
Always use separate
collection for waste
electrical and electronic
equipment (WEEE)
Pressure connector
NBP connector
Cardiac Output connector
Temperature connector
Monitor supports 12-lead
ECG
SpO2 connector
391
36 Specifications
Symbols
Masimo SET technology
Nellcor OxiMax
compatible
Uses FAST SpO2
algorithm
Silence Alarms
Alarms On/Off
Alarms Switched Off
Main Screen
SmartKeys
Back key
ECG Sync Output/
Analog ECG Output
Installation Safety Information
WARNING
If 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.
Grounding
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 Grounding
If 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.
Connectors
The 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 389) to see which
symbols are used to mark the connections.
WARNING
Connect only medical devices to the ECG output connector socket.
392
36 Specifications
Rear of the Monitor
Serial/MIB (RS232) interface cards, type RJ45 or Flexible Nurse Call interface card or
combination of both (optional)
AC power input
Protective earth screw hole
Equipotential ground connector
Measurement link connectors (MSL)
(Two standard in MX800, one standard in MX600/700)
USB rear connectors (for remote control, keyboard, pointing devices, printer)
Serial RS232 connector
Nurse Call
Wired network connector
10
Video out connector (digital/analog)
The following connectors are only present with the iPC
11
USB rear connectors (for keyboard, pointing devices, printer)
12
Audio in/out
13
Local Area Network
14
Video out connector (digital/analog)
The following connectors are only present with the Independent Display Interface
15
Serial RS232 connector for touch
16
Video out connector (digital/analog)
393
36 Specifications
Left side of the Monitor
ECG Sync Output/Analog ECG output connector
Right side of the Monitor
394
USB side connector (only present with the iPC)
36 Specifications
Monitor Mounting Precautions
Mount 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 Setting
Altitude affects tcGas and CO2 measurements. The monitor must be configured at installation to the
correct altitude.
Monitor Safety Specifications
The 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.
Aspect BISx, Aspect BIS Engine and 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 Compliance
This ISM device complies with Canadian ICES-001. Cet appareil ISM est conforme à la norme NMB001 du Canada.
395
36 Specifications
IntelliVue 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.
CAUTION
High 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.
396
36 Specifications
IntelliVue Instrument Telemetry WMTS (US only)
FCC Radio Compliance: This device complies with Part 15 of the FCC Rules. 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.
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 (MX600/700/800 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 Specifications
Product
Maximum Weight
WxHxD
Comments
MX800 Monitor
<12 kg (<26.4 lb)
<478 x 364 x 152 mm
<18.82 x 14.33 x 5.98 in
without cable
management
MX600/MX700 Monitor
<9.5 kg (<20.9 lb)
<392 x 321 x 163 mm
<15.43 x 12.64 x 6.42 in
without cable
management
M3001A
Multi-Measurement Module (MMS)
<650 g (<1.4 lb)
188 x 96.5 x 51.5 mm
7.4 x 3.8 x 2 in
M3002A
Multi-Measurement Module (MMS)
<1.25 kg (<2.8 lb)
188 x 99 x 86 mm
7.4 x 3.9 x 3.4 in
M3012A
Hemodynamic MMS Extension
<550 g (<1.2 lb)
<190 x 98 x 40 mm
<7.5 x 4 x 1.6 in
M3014A
Capnography MMS Extension
<500 g (<0.99 lb)
<190 x 98 x 40 mm
<7.5 x 4 x 1.6 in
M3015A
Microstream CO2 MMS Extension-
<550 g (<1.21 lb)
<190 x 98 x 40 mm
<7.5 x 4 x 1.6 in
M3016A
Mainstream CO2 MMS Extension
<450 g (<0.99 lb)
<190 x 98 x 40 mm
<7.5 x 4 x 1.6 in
M8048A
8-Slot Flexible Module Rack (FMS-8)
<3500 g (<7.7 lb)
<320 x 135 x 120 mm
12.6 x 5.3 x 4.7 in
without plug-in
modules
865243
4-Slot Flexible Module Rack (FMS-4)
<950 g (<2.09 lb)
<194 x 139 x 110 mm
<7.64 x 5.47 x 4.33 in
without MMS Mount
including battery,
without handle or
options
397
36 Specifications
Product
Maximum Weight
WxHxD
M8025A
Remote Alarm Device
<300 g (<0.7 lb)
62 x 125 x 63 mm
2.4 x 5 x 2.5 in
M1006B
Invasive Press Module
190 g (6.7 oz)
Option #C01: 225 g (7.9 oz)
36 x 99.6 x 97.5 mm
1.4 x 3.9 x 3.8 in
M1029A
Temperature Module
215 g (7.6 oz)
36 x 99.6 x 97.5 mm
1.4 x 3.9 x 3.8 in
M1012A
Cardiac Output Module
225 g (7.9 oz)
36 x 99.6 x 97.5 mm
1.4 x 3.9 x 3.8 in
M1014A
Spirometry Module
250 g (8.8 oz)
36 x 99.6 x 97.5 mm
1.4 x 3.9 x 3.8 in
M1018A
Transcutaneous Gas Module
350 g (11.3 oz)
72.5 x 99.6 x 97.5 mm
2.9 x 3.9 x 3.8 in
M1020B
SpO2 Module
<250 g (<0.55 lb)
36 x 99.6 x 97.5 mm
1.4 x 3.9 x 3.8 in
M1021A
Mixed Venous Oxygen Saturation Module
460 g (13.04 oz)
72.5 x 99.6 x 97.5 mm
2.9 x 3.9 x 3.8 in
M1011A
SO2 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 mm
2.0 x 1.2 x 4.7 in
M1027A
Electroencephalograph Module
210 g (7.4 oz)
36 x 99.6 x 97.5 mm
1.4 x 3.9 x 3.8 in
M1034A
BIS Interface Module
215 g (7.6 oz)
36 x 99.6 x 97.5 mm
1.4 x 3.9 x 3.8 in
without cables
BISx
499 g (1.1 lb)
diameter x height:
95.3 x 63.5 mm
3.8 x 2.5 in
with 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 mm
2.6 x 1.0 x 4.25 in
- BIS Engine
170 g (6.0 oz)
43 x 93 x 95 mm
1.7 x 3.7 x 3.7 in
M1032A
Vuelink Module
240 g (8.4 oz)
36 x 99.6 x 97.5 mm
1.4 x 3.9 x 3.8 in
865115
IntelliBridge EC10 Module
200 g (7.0 oz)
36 x 99.6 x 102.5 mm
1.4 x 3.9 x 4.0 in
865114
IntelliBridge EC5 Module
35 g (1.1 oz)
35 x 17 x 57 mm
1.4 x 0.7 x 2.1 in
with D-Sub 9-pin male
or female connector
25 g (0.8 oz)
21.5 x 17 x 65 mm
0.9 x 0.7 x 2.6 in
without cable and
strain relief
M1116B
Thermal Array Recorder Module
507.5 g (17.9 oz)
73 x 99.6 x 97 mm
2.9 x 3.6 x 3.9 in.
865244
Remote Control
<250 g (<8.8 oz)
53 x 165 x 23 mm
2.1 x 6.5 x 0.9 in
398
Comments
including 2.9m cable
with PIC Plus Cable
(1.22 m, 4 ft)
without navigator
knob
36 Specifications
Environmental Specifications
The 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.
MX600/700/800 Monitor
Item
Condition
Range
Temperature Range
Operating
0 to 40°C (32 to 100°F)
0 to 35°C (32 to 95°F) when equipped with the iPC
Humidity Range
Altitude Range
Storage
-20 to 60°C (-4 to 140°F)
Operating
15% to 95% Relative Humidity (RH) (non condensing)
Storage
5% to 95% Relative Humidity (RH)
Operating
-500 m to 3000 m (10000 ft)
Storage
-500 m to 4600 m (15000 ft)
Ingress Protection
IPX1
X2 (M3002A) and External Power Supply (M8023A)
Item
Condition
Range
Temperature 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 battery
Operating
0 to 35°C (32 to 95°F)
Humidity Range
Operating
15% to 95% Relative Humidity (RH)
Storage including transportation
5% to 95% Relative Humidity (RH)
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°)
Altitude Range
Multi-measurement Module M3001A, MMS Extensions M3016A M3015A, M3014A, M3012A, Measurement
Modules, and 8-Slot Flexible Module Rack M8048A
Item
Condition
Range
Temperature Range
Operating
0 to 45°C (32 to 113°F)
Non-operating
-40 to 70°C (-40 to 158°F)
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)
Operating
-500 m to 4600 m (-1600 to 15000 ft)
Non-operating
-500 m to 15300 m (-1600 to 50000 ft)
Humidity Range
Altitude Range
399
36 Specifications
4-Slot Flexible Module Rack 865243
Item
Condition
Range
Temperature Range
Operating
0 to 40°C (32 to 100°F)
Storage
-20 to 60°C (-4 to 140°F)
Operating
15% to 95% Relative Humidity (RH) (non condensing)
Storage
5% to 95% Relative Humidity (RH)
Humidity Range
Altitude Range
Operating
-500 m to 3000 m (10000 ft)
Storage
-500 m to 4600 m (15000 ft)
Ingress Protection
IPX1
Thermal Array Recorder Module M1116B
Item
Condition
Range
Temperature Range
Operating
+5 to 45°C (41 to 113°F)
Non-operating
-10 to 70°C (14 to 158°F)
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)
Operating
up to 3048 m (10000 ft)
Non-operating
up to 3048 m (10000 ft)
Item
Condition
Range
Temperature Range
Operating
0 to 40°C (32 to 100°F)
Humidity Range
Altitude Range
Remote Control 865244
Humidity Range
Altitude Range
400
Storage
-20 to 60°C (-4 to 140°F)
Operating
15% to 95% Relative Humidity (RH) (non condensing)
Storage
5% to 95% Relative Humidity (RH)
Operating
-500 m to 3000 m (10000 ft)
Storage
-500 m to 4600 m (15000 ft)
36 Specifications
Performance Specifications
MX600/700/800 Performance Specifications
Power Specifications
Indicators
Power Consumption
<200 W average
Line Voltage
100 to 240 V
Current
1.9 to 0.9 A
Frequency
50/60 Hz
Alarms Off
red (crossed out alarms symbol) LED
Alarms
red/yellow/light blue (cyan) LED
On/Standby/Error
green/red LED integrated in power switch
External Power
green LED
Sounds
Audible feedback for user input
Prompt tone
QRS tone, or SpO2 modulation tone
4 different alarm sounds
Remote tone for alarms on other beds in network
Tone for Timer expired
Trends
Resolution
12, 16, 24 or 32 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:
neonatal extended 12 numerics, 24 hours @ 12 secs or
32 numerics 32 hours @ 1 minute
intensive care extended: 16 numerics 120 hours @ 5 minutes
anesthesia extended 32 numerics 9 hours @ 12 seconds
High Res Trend Waves
Events
Alarm Signal
Review Alarms
Measurements available
HR, SpO2, Resp, tcpO2, Pulse, Perf, tcpO2, CO2, ABP, PAP,
CVP, ICP, CPP, BIS, CCO, AWP, Anesthetic Agents, Delta
SpO2, inO2
Resolution
Measurement samples are taken at a resolution of four samples
per second
Update speed
waves are drawn at a speed of 3 cm/minute
Information
trigger condition and time, event classification and associated
detailed view of episode data
Episode data
configurable, either:
4 minutes of high resolution trend or
20 minutes of numerics trend @ 12 sec. resolution or
15 seconds of 4 waves @ 125 samples/sec. (Snapshot)
including all current numerics, alarms and inops
Capacity (max.)
25 or 50 events for either 8 or 24 hours
System delay
less than 3 seconds
Pause duration
1,2,3 minutes or infinite, depending on configuration
Extended alarm pause
5 or 10 minutes
Information
all alarms / inops, main alarms on/off, alarm silence and time
of occurrence
Capacity
300 items
401
36 Specifications
MX600/700/800 Performance Specifications
Real Time Clock
Buffered Memory
Range
from: January 1, 1997, 00:00 to: December 31, 2080, 23:59
Accuracy
better than 4 seconds per day
Hold Time
infinite if powered by AC; otherwise at least 48 hours (typical:
>72 hours)
Hold Time
if powered by AC: infinite
Contents
Active settings, trends, patient data, realtime reports, events,
review alarms
without power: at least 8 hours
X2 (M3002A) Performance Specifications
Power Specifications
Power consumption
<12 W average
Operating Voltage
36 to 60 V DC floating
Operating Time
Basic monitoring configuration: 2.5 hours
(with new, fully charged battery at
25°C)
(Brightness set to optimum, ECG/Resp, SpO2 measurements
in use, NBP measurement every 15 minutes)
Charge Time
When X2 is off: 2 hours
<30 W while battery is loading
Battery Specifications
When 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) LED
Alarms
red/yellow/light blue (cyan) LED
On/Standby / Error
green / red LED
AC Power
green LED
Battery
yellow (charging)/red blinking (empty) LED
External Power
green LED
Sounds
Trends
Audible feedback for user input
Prompt tone
QRS tone, or SpO2 modulation tone
4 different alarm sounds
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
Review Alarms
402
System delay
less than 3 seconds
Pause duration
1,2,3 minutes or infinite, depending on configuration
Extended alarm pause
5 or 10 minutes
Information
all alarms / inops, main alarms on/off, alarm silence and time
of occurrence
Capacity
300 items
36 Specifications
X2 (M3002A) Performance Specifications
Real Time Clock
Buffered Memory
Range
from: January 1, 1997, 00:00 to: December 31, 2080, 23:59
Accuracy
<4 seconds per day (typically)
Hold Time
infinite if powered by host monitor or external power supply;
otherwise at least 48 hours
Hold Time
if powered by host monitor or external power supply: infinite
Contents
Active settings, trends, patient data, realtime reports, review
alarms
without power: at least 48 hours (typical: >72 hours)
M8023A External Power Supply (for M3002A) Performance Specifications
Power Specifications
Power consumption
<12 W average
<30 W peak
Indicators
Line Voltage
100 to 240 V ~
Current
1.3 to 0.7 A
Frequency
50/60 Hz ~
Power
green LED
M3001A MMS Performance Specifications
Trends
Trend Data Buffered Memory
if powered by monitor mains connection via MSL: infinite
without power applied: at least 6 hours
Contents
trend data, patient identification and all active settings
Integrated PC (iPC) Performance Specifications
PC Components
Processor
Intel Core 2 Duo SP9300/SP9400
Solid-state drive
100 GB or above
RAM
4 GB
865244 Remote Control Performance Specifications
Power (when not connected to the USB interface of the monitor)
Two AA primary cells
Interface Specifications
MX600/700/800 Interface Specifications
Network
Standard
100-Base-TX (IEEE 802.3 Clause 25)
Connector
RJ45 (8 pin)
Isolation
basic insulation (reference voltage: 250 V; test voltage: 1500 V)
403
36 Specifications
MX600/700/800 Interface Specifications
MIB/RS232
USB Interface (4 ports)
RS232 (Standard)
RS232 (Independent display
interface option)
Basic Nurse Call Relay
Flexible Nurse Call Relay
IntelliVue Instrument
Telemetry Wireless Network
(USA only)
IntelliVue Instrument
Telemetry Wireless Network
(except USA)
Standard
IEEE 1073-3.2-2000
Connectors
RJ45 (8 pin)
Mode
Software-controllable
BCC (RxD/TxD cross over) or
DCC (RxD/TxD straight through)
Power
5 V ±5 %, 100 mA (max.)
Isolation
basic insulation (reference voltage: 250 V; test voltage: 1500 V)
Standard
USB 2.0 full-speed (embedded host)
Connector
USB series "Standard A" receptacle
Power
Low power port 4.4V min; max. load for all ports together
500 mA
Isolation
none
Connector
RJ45 (8-pin)
Power
none
Isolation
basic insulation (reference voltage: 250 V; test voltage: 1500 V)
Connector
RJ45 (8-pin)
Power
none
Isolation
none
Connector
modular Jack 6P6C, active open and closed contact
Contact
<=100 mA, <=24 V DC
Isolation
basic insulation (reference voltage: 250 V; test voltage: 1500 V)
Delay
<[Configured Latency +0.5] sec
Connector
20 pin MDR (Mini D-Ribbon), active open and closed contacts
Contact
<=100 mA, <=24 V DC
Isolation
basic insulation (reference voltage: 250 V; test voltage: 1500 V)
Delay
<[Configured Latency +0.5] sec
Type
Internal WMTS Adapter
Technology
compatible with Philips IntelliVue Telemetry System (ITS),
cellular infrastructure
Frequency Band
WMTS, 1395-1400 MHz and 1427-1432 MHz
Type
Internal ISM Adapter
Technology
compatible with Philips IntelliVue Telemetry System (ITS),
cellular infrastructure
Frequency Band
2.4 GHz ISM
IntelliVue 802.11 Bedside
Adapter (Wireless Network
Adapter)
Type
Internal Wireless Adapter
Technology
IEEE 802.11a/b/g
Frequency Band
2.4 GHz and 5 GHz ISM Band
Short Range Radio Interface
Type
Internal SRR interface
Technology
IEEE 802.15.4
Frequency band
2.4 GHz ISM (2.400 - 2.483 GHz)
Modulation technique
DSSS (O -QPSK)
Effective radiated power
max. 0 dBm (1 mW)
404
36 Specifications
MX600/700/800 Interface Specifications
Measurement Link (MSL)
Video Interface (standard)
Video Interface (Independent
display interface option)
Connectors
ODU out (Proprietary)
Voltage
56 V ±10 %
Power
45 W
Power Sync.
5 V CMOS Level; 78.125 kHz (typ.)
LAN signals
IEEE 802.3 10-Base-T compliant
Serial signals
RS-422 compliant
Connector
DVI (digital and analog, single link)
Digital video signals
single link TMDS
Analog video signals
0.7 Vpp@75 Ohm
HSYNC/VSYNC signals
TTL
DDC signals
none
DDC power
5 V +/-5% @0-55 mA
Connector
DVI (digital and analog, single link)
Pixel clock frequency
31,5 MHz - 119 MHz
Digital video signals
single link TMDS
Analog video signals
0.7 Vpp@75 Ohm
HSYNC/VSYNC signals
TTL
DDC signals
none
DDC power
5 V +/-5% @0-55 mA
ECG Sync Output/Analog ECG Output (1/4" stereo phone jack with tip, ring, sleeve)
General
Analog ECG Output
(ring, tip)
Connector
1/4" phone with tip, ring, sleeve
Isolation
functional isolation
Full scale on display
signal gain x measured ECG voltage
Gain error
<15 %
Baseline offset
<100 mV
Bandwidth
1 to 100 Hz
Output voltage swing
±4 V (min)
Signal delay
<22 ms
Signal delay with older versions of <30 ms
the M3001A MMS
[identifiable with the serial number
prefix DE227 or DE441 and
option string #A01]
Pacemaker Pulse
filtered and included in ECG output signal
405
36 Specifications
MX600/700/800 Interface Specifications
Digital Pulse Output
(ring)
Output low voltage level
<0.4 V @ I=-1 mA
Output high voltage level
>2.4 V @ I=1 mA
Pulse 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 EC13
Signal delay with older versions of < 35ms per AAMI EC13
the M3001A MMS
[identifiable with the serial number
prefix DE227 or DE441 and
option string #A01]
X2 (M3002A) Interface Specifications
Measurement Link (MSL)
ECG Sync Pulse Output
(rectangular pulse)
Connectors
Female ODU (Proprietary)
Power
30 V to 60 V input
Power Sync.
RS-422 compliant input 78.125 kHz (typical)
LAN signals
IEEE 802.3 10-Base-T compliant
Serial signals
RS-422 compliant
Local signals
Provided for connecting MMS extensions
Cable detection
Yes
Marker In
No
Wave Output
No
Connector
Binder Series 709/719
Output levels
Output low <0.8 V @ I = -4 mA
Output high >2.4 V @ I = 4 mA
Isolation
None
Pulse Width
100 +/- 10 ms (high)
Delay from R-wave peak to start of 20 ms maximum per AAMI EC13
pulse
Minimum required R-wave
amplitude
0.5 V
Wireless Network Device
Interface
Signals
RD+/-, TD+/-: IEEE 802.3 10Base-T, PWR, GND
12.5 V ±20%, 3.5 W continuous
Short Range Radio Interface1
Type
Internal SRR interface
Technology
IEEE 802.15.4
Frequency Band
2.4 GHz ISM (2.400 - 2.483 GHz)
Modulation Technique
DSSS (O -QPSK)
Effective radiated power
max. 0 dBm (1 mW)
The short range radio interface is compatible with the following telemetry devices: TRx4841A/TRx4851A Intellivue
Telemetry System Transceiver
406
36 Specifications
M8023A External Power Supply (for M3002A) Interface Specifications
Measurement Link (MSL)
Connectors
Male ODU (Proprietary)
Power
48 V output
Power Sync.
RS-422 compliant output 78.125 kHz (typical)
LAN signals
IEEE 802.3 10-Base-T compliant
Serial signals
RS-422 compliant output 78.125 kHz (typical)
Local signals
Not connected
Integrated PC (iPC) Interface Specifications
Ethernet LAN (external)
USB
Connector
RJ-45
LAN Signals
IEE 802.3 1000-Base-T compliant
Reinforced insulation
IEC60601-1 A-k compliant
6 external ports (5 rear, 1 right
side)
USB 2.0 supporting high speed mode
Type A connectors
Audio
DVI Video with DVI-I
connector
microphone input stereo
3.5 mm audio jack
headphone output stereo
3.5 mm audio jack
DVI
supports resolutions up to 1920x1200
VGA
supports resolutions up to 2048x1536
Display Specifications
19" WSXGA+
15" WXGA
Type
482 mm active matrix color LCD (TFT)
Resolution
1680 x 1050 (WSXGA+)
Refresh frequency
58 Hz
Useful screen
409,5 mm x 255.9 mm
Pixel size
0.244 mm x 0.244 mm
Type
389 mm active matrix color LCD (TFT)
Resolution
1280 x 768 (WXGA)
Refresh frequency
59.9 Hz
Useful screen
334.1 mm x 200.5 mm
Pixel size
0.261 mm x 0.261 mm
Measurement Specifications
See the Appendix on Default Settings for a list of the settings the monitor is initially shipped with.
ECG/Arrhythmia/ST/QT
Complies with IEC 60601-2-25:1993 + A1:1999 /EN60601-2-25:1995 + A1:1999, IEC 60601-227:2005/EN60601-2-27:2006, IEC 60601-2-51:2003 /EN 60601-2-51:2003 and AAMI EC11/
EC13:1991/2002.
407
36 Specifications
ECG/Arrhythmia/ST Performance Specifications
Cardiotach
PVC Rate
ST Numeric
QT Numeric
QTc Numeric
ΔQTc Numeric
QT-HR Numeric
Sinus and SV Rhythm Ranges
Bandwidth
Bandwidth
Range
Adult/pedi: 15 to 300 bpm
Neo range: 15 to 350 bpm
Accuracy
±1% of range
Resolution
1 bpm
Sensitivity
≥200 µVpeak
Range
0 to 300 bpm
Resolution
1 bpm
Range
-20 to +20 mm
Accuracy
±0.5 mm or 15%, whichever is greater
Resolution
0.1 mm
Range
200 to 800 ms
Accuracy
±30 ms
Resolution
8 ms
Range
200 to 800 ms
Resolution
1 ms
Range
-600 to +600 ms
Resolution
1 ms
Range - adult
15 to 300 bpm
Range - pediatric and neonatal
15 to 350 bpm
Brady
Adult: 15 to 59 bpm
Pedi: 15 to 79 bpm
Neo: 15 to 89 bpm
Normal
Adult: 60 to 100 bpm
Pedi: 80 to 160 bpm
Neo: 90 to 180 bpm
Tachy
Adult: >100 bpm
Pedi: >160 bpm
Neo: >180 bpm
Diagnostic Mode
Adult/neo/pedi: 0.05 to 150 Hz
Extended Monitoring Mode
Adult/neo/pedi: 0.5 to 150 Hz
Monitoring Mode
Adult: 0.5 to 40 Hz
Neo/pedi: 0.5 to 55 Hz
Filter Mode
Adult/neo/pedi: 0.5 to 20 Hz
Diagnostic Mode
Adult/neo/pedi: 0.05 to 40 Hz
when the ECG is transmitted from Extended Monitoring Mode
a telemetry device via short range Monitoring Mode
radio
Filter Mode
Differential Input Impedance
408
Adult/neo/pedi: 0.5 to 40 Hz
Adult: 0.5 to 40 Hz
Neo/pedi: 0.5 to 40 Hz
Adult/neo/pedi: 0.5 to 20 Hz
>2 MΩ RA-LL leads (Resp)
>5 MΩ at all other leads (at 10 Hz including patient cable)
36 Specifications
ECG/Arrhythmia/ST Performance Specifications
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 mV
Auxiliary Current
(Leads off Detection)
Active electrode: <100 nA
Reference electrode: <900 nA
Input Signal Range
±5 mV
ECG/Arrhythmia/ST/QT
Alarm Specifications
Range
Adjustment
HR
15 to 300 bpm
Adult: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)
maximum delay: 10 seconds
according to AAMI EC 13-1992
standard
Extreme Tachy
Extreme Brady
Difference to high limit 0 to
50 bpm
5 bpm steps
Clamping at 150 to 300 bpm
5 bpm steps
Difference to low limit 0 to
50 bpm
5 bpm steps
Clamping at 15 to 100 bpm
5 bpm steps
Run PVCs
None, fixed setting 2 PVCs
Not adjustable by user
PVCs Rate
1 to 99 PVCs/minute
1 PVC
Vent Tach HR
20 to 300 bpm
5 bpm
Vent Tach Run
3 to 99 PVCs/minute
1 PVC
Vent Rhythm Run
3 to 99 PVCs/minute
1 PVC
SVT HR
120 to 300 bpm
5 bpm
SVT Run
3 to 99 SV beats
1 SV beat
ST High
-19.8 to +20 mm
0.2 mm
ST Low
-20 to +19.8 mm
0.2 mm
QTc High
200 ms to 800 ms
10 ms steps
ΔQTc High
30 ms to 200 ms
10 ms steps
ECG/Arrhythmia/ST Supplemental Information as required by AAMI EC11/13, IEC 60601-2-27
Respiration Excitation Waveform
Sinusoidal signal, 260 μA, 40.5 kHz
Noise Suppression
RL drive gain 44 dB max., max. voltage 1.8 Vrms
Time to Alarm for Tachycardia Vent Tachycardia
1 mVpp,206 bpm
Gain 0.5, Range 6.5 to 8.4 seconds, Average 7.2 seconds
Gain 1.0 Range 6.1 to 6.9 seconds, Average 6.5 seconds
Gain 2.0, Range 5.9 to 6.7 seconds, Average 6.3 seconds
Vent Tachycardia
2 mVpp,195 bpm
Gain 0.5, Range 5.4 to 6.2 seconds, Average 5.8 seconds
Gain 1.0, Range 5.7 to 6.5 seconds, Average 6.1 seconds
Gain 2.0, Range 5.3 to 6.1 seconds, Average 5.7 seconds
Tall T-Wave Rejection Capability
Exceeds ANSI/AAMI EC 13 Sect. 3.1.2.1(c) minimum
recommended 1.2 mV T-Wave amplitude
409
36 Specifications
ECG/Arrhythmia/ST Supplemental Information as required by AAMI EC11/13, IEC 60601-2-27
Heart 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 Rate
HR change from 80 to 120 bpm:
Range: [6.4 to 7.2 seconds] Average: 6.8 seconds
HR change from 80 to 40 bpm:
Range: [5.6 to 6.4 sec] Average: 6.0 seconds
Heart Rate Meter Accuracy and Response to Irregular Rhythm
Ventricular bigeminy: 80 bpm
Slow alternating ventricular bigeminy: 60 bpm
Rapid alternating ventricular bigeminy: 120 bpm
Bidirectional systoles: 90 bpm
Accuracy 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)
Respiration
Respiration Performance Specifications
Respiration Rate
Range
Adult/pedi: 0 to 120 rpm
Neo: 0 to 170 rpm
Accuracy
at 0 to 120 rpm ±1 rpm
at 120 to 170 rpm ±2 rpm
Resolution
1 rpm
Bandwidth
0.3 to 2.5 Hz (-6 dB)
Noise
Less than 25 mΩ (rms) referred to the input
Respiration Alarm
Specifications
Range
Adjustment
Delay
High
Adult/pedi: 10 to 100 rpm
Neo: 30 to 150 rpm
under 20 rpm: 1 rpm steps
over 20 rpm: 5 rpm steps
max. 14 seconds
Low
Adult/pedi: 0 to 95 rpm
Neo: 0 to 145 rpm
under 20 rpm: 1 rpm steps
over 20 rpm: 5 rpm steps
for limits from 0 to 20 rpm:
max. 4 seconds
for limits above 20 rpm: max.
14 seconds
Apnea Alarm
10 to 40 seconds
5 second steps
410
36 Specifications
SpO2
Unless 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.
411
36 Specifications
SpO2 Performance Specifications
SpO2
Range
The specified accuracy is Option #A01
the root-mean-square
Accuracy
(RMS) difference between
the measured values and
the reference values
0 to 100%
Philips 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 #A02
Accuracy
Philips Reusable Sensors
M1193AN = 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 OXIA/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
412
1%
36 Specifications
SpO2 Performance Specifications
Pulse
Range
30 to 300 bpm
Accuracy
±2% or 1 bpm, whichever is greater
Resolution
1 bpm
Sensors
Wavelength range: 500 to 1000 nm
Emitted Light Energy: ≤15 mW
Information about the wavelength range can be especially useful to clinicians
(for instance, when photodynamic therapy is performed)
Pulse Oximeter
Calibration Range
SpO2 Alarm
Specifications
70% to 100%
Range
Adjustment
Delay
Adult: 50 to 100%
Pedi/Neo: 30 to 100%
1% steps
(0, 1, 2, 3,... 30) +4 seconds
Desat
Adult: 50 to Low alarm limit
Pedi/Neo: 30 to Low alarm limit
1% steps
(0, 1, 2, 3,... 30) +4 seconds
Pulse
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 seconds
Tachycardia
Difference to high limit 0 to
50 bpm
5 bpm steps
max. 14 seconds
Clamping at 150 to 300 bpm
5 bpm steps
Difference to low limit 0 to
50 bpm
5 bpm steps
Clamping at 30 to 100 bpm
5 bpm steps
SpO2
Bradycardia
or Smart Alarm Delay (see table
below)
max. 14 seconds
SpO2 Smart Alarm Delay Specifications
The Smart Alarm Delay functionality is currently not available in the U.S.A. or in clinical environments under FDA control.
Deviation from violated alarm limit
Resulting alarm delay
Short
Medium
Long
1%
25 sec
(maximum delay)
50 sec
(maximum delay)
100 sec
(maximum delay)
2%
12 sec
25 sec
50 sec
3%
10 sec
16 sec
33 sec
4%
10 sec
12 sec
25 sec
5%
10 sec
10 sec
20 sec
6%
10 sec
10 sec
16 sec
413
36 Specifications
SpO2 Smart Alarm Delay Specifications
The Smart Alarm Delay functionality is currently not available in the U.S.A. or in clinical environments under FDA control.
Deviation from violated alarm limit
Resulting alarm delay
Short
Medium
Long
7%
10 sec
10 sec
14 sec
8%
10 sec
10 sec
12 sec
9%
10 sec
10 sec
11 sec
>9%
10 sec
10 sec
10 sec
NBP
Complies with IEC 60601-2-30:1999/EN60601-2-30:2000.
NBP Performance Specifications
Measurement Ranges
Systolic
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 300
Pedi: 40 to 300
Neo: 40 to 300
Accuracy
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 bpm
101 to 200 bpm: ±5% of reading
201 to 300 bpm: ±10% of reading
(average over NBP measurement cycle)
Pulse Rate Range
40 to 300 bpm
Measurement Time
Typical at HR >60 bpm
Auto/manual/sequence: 30 seconds (adult)
25 seconds (neonatal)
Stat: 20 seconds
Maximum time: 180 seconds (adult/pediatric)
90 seconds (neonates)
Cuff Inflation Time
Typical for normal adult cuff: Less than 10 seconds
Typical for neonatal cuff: Less than 2 seconds
Initial Cuff Inflation Pressure
Adult: 165 ±15 mmHg
Pedi: 130 ±15 mmHg
Neo: 100 ±15 mmHg
Auto Mode Repetition Times
1, 2, 2.5, 3, 5, 10, 15, 20, 30, 45, 60 or 120 minutes
STAT Mode Cycle Time
5 minutes
414
36 Specifications
NBP Performance Specifications
Venipuncture Mode Inflation
Inflation Pressure
Automatic deflation
after
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)
Adult/pediatric
170 seconds
Neonatal
85 seconds
Measurement 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.
NBP Alarm Specifications
Range
Adjustment
Systolic
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 Settings
Adult
>300 mmHg (40 kPa) >2 sec
Pediatric
>300 mmHg (40 kPa) >2 sec
Neonate
>150 mmHg (20 kPa) >2 sec
not user adjustable
Invasive Pressure and Pulse
Complies with IEC 60601-2-34:2000/EN60601-2-34:2000.
Invasive Pressure Performance Specifications
Measurement Range
Pulse Rate
-40 to 360 mmHg
Range
25 to 350 bpm
Accuracy
±1% Full Range
Resolution
1 bpm
415
36 Specifications
Invasive Pressure Performance Specifications
Input 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 Hz
Zero Adjustment
Gain Accuracy
Overall Accuracy
Range
±200 mmHg (±26 kPa)
Accuracy
±1 mmHg (±0.1 kPa)
Drift
Less than 0.1 mmHg/°C (0.013 kPa/°C)
Accuracy
±1%
Drift
Less than 0.05%/°C
Non linearity and
Hysteresis
Error of ≤0.4 %FS (@CAL 200 mmHg)
(including transducer)
±4% of reading or ±4 mmHg (±0.5 kPa), whichever is greater
Volume displacement of CPJ840J6
0.1 mm3 /100 mmHg
Analog output Specifications
Analog Output
Range
-0.4 V to 3.6 V
available only with
M1006B #C01 (@ CAL
200 mmHg)
Level
1 V / 100 mmHg
Accuracy
±3% full scale
Offset
±30 mV
Resolution
8 Bit (@ 5 V range)
Signal delay
20 ms
Invasive Pressure Alarm Specifications
Invasive Pressure Alarm
Range
Specifications
Pressure
-40 to 360 mmHg
(-5.0 to 48 kPa)
Adjustment
Delay
-40 to 50 mmHg
2 mmHg (0.5 kPa)
max. 12 seconds
>50 mmHg
5 mmHg (1 kPa)
Extreme High
Extreme Low
Pulse
416
Difference to high limit 0 to
25 mmHg
5 mmHg steps (0.5 kPa)
Clamping at -40 to 360 mmHg
5 mmHg steps (1.0 kPa)
Difference to low limit 0 to
25 mmHg
5 mmHg steps (0.5 kPa)
Clamping at -40 to 360 mmHg
5 mmHg steps (1.0 kPa)
25 to 300 bpm
Adult:
1 bpm steps (25 to 40 bpm)
5 bpm steps (40 to 300 bpm)
Pedi/Neo:
1 bpm steps (25 to 50 bpm)
5 bpm steps (50 to 300 bpm)
36 Specifications
Invasive Pressure Alarm
Range
Specifications
Adjustment
Delay
Tachycardia
Difference to high limit 0 to
50 bpm
5 bpm steps
max. 14 seconds
Clamping at 150 to 300 bpm
5 bpm steps
Difference to low limit 0 to
50 bpm
5 bpm steps
Clamping at 25 to 100 bpm
5 bpm steps
Bradycardia
max. 14 seconds
Temp
Complies with EN 12470-4:2000. Specified without transducer.
Temp Performance Specifications
Temp
Range
-1 to 45°C (30 to 113°F)
Resolution
0.1°C (0.2°F)
Accuracy
±0.1°C (±0.2°F)
Average Time Constant
Temp Alarm Specifications
Temp High/Low Alarms
Less than 10 seconds
Range
Adjustment
-1 to 45°C (30 to 113°F)
-1 to 35°C (30 to 95°F), 0.5°C (1.0°F) steps
35 to 45°C (95 to 113°F), 0.1°C (0.2°F) steps
CO2
The CO2 measurement in M3014A and M3015A complies with EN ISO 21647:2004 + Cor.1:2005
(except alarm system; alarm system complies with IEC 60601-2-49:2001).
M3015A Microstream CO2 Performance Specifications
CO2
awRR
Warm-up Time
Range
0 to 150 mmHg (0 to 20 kPa), or 20% CO2, whichever is lower
Accuracy
Up to 5 minutes during warmup: ±4 mmHg or 12%, whichever is greater
After 5 minutes warmup:
0 to 40 mmHg (0 to 5.3 kPa):±2.2 mmHg (±0.3 kPa)
Above 40 mmHg (5.3 kPa):±(5.5% + (0.08%/mmHg above 40 mmHg)) of
reading
These specifications are valid for 21% O2 and N2 balance, up to 35°C ambient
temperature, up to 60 rpm in adult mode and 100 rpm in neonatal mode.
Outside of these conditions the accuracy reaches at a minimum ±4 mmHg or
±12% of the reading, whichever is greater.
Resolution
Numeric: 1.0 mmHg (0.1 kPa)
Wave: 0.1 mmHg (0.01 kPa)
Stability
Included in Accuracy specifications
Range
0 to 150 rpm
Accuracy
0 to 40 rpm: ±1 rpm
41 to 70 rpm: ±2 rpm
71 to 100 rpm: ±3 rpm
>100 rpm: ±5% of reading
5 minutes for full accuracy specification
417
36 Specifications
M3015A Microstream CO2 Performance Specifications
Rise Time
190 ms for neonatal mode
(measured with FilterLine H for neonatal)
240 ms for adult mode
(measured with FilterLine H for adult)
Sample Flow Rate
50 + 15/-7.5 ml/minute
Gas Sampling Delay Time
Maximum:
3 seconds (2m sample lines)
6 seconds (4m sample lines)
Sound Pressure
Acoustic noise: <45 dBA
Total System Response Time
The total system response time is the sum of the delay time and the rise time.
Microstream CO2 Humidity Correction Factor
Either BTPS or ATPD can be selected as the humidity correction factor for the Microstream CO2
readings. The formula for the correction calculation is:
where:
PBTPS = partial pressure at body temperature and pressure, saturated
PATPD = partial pressure at ambient temperature and pressure, dry
M3014A Mainstream CO2 Performance Specifications
CO2
Range
0 to 150 mmHg (0 to 20.0 kPa)
Accuracy
after 2 minutes warmup:
For values between 0 and 40 mmHg: ±2.0 mmHg (±0.29 kPa)
For values from 41 to 70 mmHg: ±5% of reading
For values from 71 to 100 mmHg: ±8% of reading
The specifications are valid for standard gas mixtures, balance air, fully hydrated
at 35°C, Pabs = 760 mmHg, flow rate = 2 l/min.
Resolution
Numeric: 1.0 mmHg (0.1 kPa)
Wave: 0.1 mmHg (0.01 kPa)
Stability:
awRR
Short term drift
±0.8 mmHg over four hours
Long term drift
Accuracy specification will be maintained over a 120 hour period
Range
2 to 150 rpm
Accuracy
±1 rpm
Warm-up Time
2 minutes with CO2 transducer attached for full accuracy specification
Response Time
Less than 60 ms (with adult or infant reusable or disposable adapter)
418
36 Specifications
M3014A Sidestream CO2 Performance Specifications
CO2
Range
0 to 150 mmHg (0 to 20.0 kPa)
Accuracy
after 2 minutes warmup:
For values between 0 and 40 mmHg: ±2.0 mmHg (±0.29 kPa)
For values from 41 to 70 mmHg: ±5% of reading
For values from 71 to 100 mmHg: ±8% of reading
For values from 101 to 150 mmHg: ±10% of reading
At respiration rates above 80 rpm, all ranges are ±12% of actual. The
specifications are valid for gas mixtures of CO2, balance N2, dry gas at
760 mmHg within specified operating temperature range.
Resolution
Numeric: 1.0 mmHg (0.1 kPa)
Wave: 0.1 mmHg (0.01 kPa)
Stability:
awRR
Short term drift
±0.8 mmHg over four hours
Long term drift
Accuracy specification will be maintained over a 120 hour period
Range
2 to 150 rpm
Accuracy
±1 rpm
Warm-up Time
2 minutes with CO2 sensor attached for full accuracy specification
Sample Flow Rate
50 ±10 ml/minute
Total System Response Time
3 seconds
Operating Temperature
0 to 40°C (32 to 100°F)
M3014A Mainstream and Sidestream CO2 Humidity Correction Factor
Either BTPS or ATPD can be selected as the humidity correction factor for the CO2 readings. The
formula for the correction calculation is:
where:
PBTPS = partial pressure at body temperature and pressure,
saturated
PATPD = partial pressure at ambient temperature and pressure,
dry
Pabs = absolute pressure
PH2O = 42 mmHg @35°C and 100% RH
M3016A Mainstream CO2 Performance Specifications
CO2
Range
-4 to 150 mmHg (-0.5 to 20.0 kPa)
Accuracy
after 20 minutes warmup and calibration:
For values between 0 and 40 mmHg: ±2.2 mmHg (±0.29 kPa)
For values between 40 and 76 mmHg: ±5.5% of reading
The specifications are valid for 45% O2 and N2 or N2O balance. Outside these
conditions the accuracy reaches at a minimum the requirements of EN864/
ISO9918.
Resolution
Numeric: 1.0 mmHg (0.1 kPa)
Wave: 0.1 mmHg (0.01 kPa)
Stability
±1.0 mmHg over a 7 day period
419
36 Specifications
M3016A Mainstream CO2 Performance Specifications
awRR
Range
0 to 150 rpm
Accuracy
±2 rpm
Warm-up Time
20 minutes with CO2 transducer attached for full accuracy specification
Response Time
Less than 125 ms (for step from 10% to 90%)
Mainstream CO2 Humidity Correction Factor
Either BTPS or ATPD can be selected as the humidity correction factor for the Mainstream CO2
readings. The formula for the correction calculation is:
where:
PBTPS = partial pressure at body temperature and pressure,
saturated
PATPD = partial pressure at ambient temperature and pressure,
dry
Pabs = absolute pressure
PH2O = 42 mmHg @35°C and 100% RH
CO2 Alarm
Specifications
Range
Adjustment
Delay
etCO2 High
20 to 95 mmHg (2 to 13 kPa)
1 mmHg (0.1 kPa)
etCO2 Low
10 to 90 mmHg (1 to 12 kPa)
M3002A/M3014A/M3016A: less
than 14 seconds
M3015A: less than 21 seconds.
imCO2 High
2 to 20 mmHg
(0.3 to 3.0 kPa)
steps of 1 mmHg (0.1 kPa)
M3002A/M3014A/M3016A: less
than 14 seconds
M3015A: less than 21 seconds.
awRR High
Adult/pedi: 10 to 100 rpm
Neo: 30 to 150 rpm
under 20 rpm: 1 rpm steps
over 20 rpm:5 rpm steps
M3002A/M3014A/M3016A: less
than 14 seconds
M3015A: less than 21 seconds.
awRR Low
Adult/pedi: 0 to 95 rpm
Neo: 0 to 145 rpm
M3015A:
settings <20 rpm: less than
8 seconds
>20 rpm: less than 21 seconds
M3002A/M3014A/M3016A
settings <20 rpm: less than
4 seconds
>20 rpm: less than 14 seconds
Apnea delay
10 to 40 seconds
5 second steps
set apnea delay time + 4 seconds
(M3002A/M3014A/M3016A) or
8 seconds (M3015A with 2 m
sample lines) or 11 seconds
(M3015A with 4 m sample lines).
Interfering Gas and Vapor Effects On CO2 Measurement Values
The specified deviations for M3002A/M3014A are valid when the appropriate corrections are switched on and set
correctly.
420
36 Specifications
Gas or Vapor
Gas Level
(% volume fraction)
Nitrous Oxide
60%
M3002A/M3014A
M3015A
Additional deviation due to gas interference, measured at 0 40 mmHg CO2
±1 mmHg
±5%
Halothane
4%
±2 mmHg
±5%
Enflurane
5%
±2 mmHg
±5%
Isoflurane
5%
±2 mmHg
±5%
Sevoflurane
5%
±2 mmHg
±5%
Xenon
80%
-5 mmHg
±5%
Helium
50%
±1 mmHg
±5%
Metered dose inhaler
propellants
not specified for use
Desflurane
15%
+5 mmHg
±5%
Ethanol
0.1%
±1 mmHg
±5%
Isopropanol
0.1%
±1 mmHg
±5%
Acetone
0.1%
±1 mmHg
±5%
Methane
1.0%
±1 mmHg
±5%
Spirometry
The following specifications apply for 760 mmHg ambient pressure and patient gas: room air at 35°C,
unless otherwise noted
Spirometry Performance Specifications
Flow Wave (AWF)
Volume Wave (AWV)
Range
±25 l/min (neonatal)
±100 l/min (pediatric)
±180 l/min (adult)
Accuracy
±3% or
0.125 l/min (neonatal)
0.25 l/min (pediatric)
0.5 l/min (adult)
Scales
±10, ±20, ±40, ±60, ±80, ±100, ±120, ±150 l/min
Scale Default
±20 l/min (neonatal)
±100 l/min (pediatric)
±150 l/min (adult)
Range
0 to 100 ml (neonatal)
0 to 400 ml (pediatric)
0 to 3000 ml (adult)
Accuracy
±5% or
±3 ml (neonatal)
±12 ml (pediatric)
±90 ml (adult),
whichever is greater
Scales
50, 100, 200, 600, 800, 1000, 2000, 3000 ml
Scale Default
50 ml (neonatal)
200 ml (pediatric)
800 ml (adult)
421
36 Specifications
Spirometry Performance Specifications
Pressure Wave (AWP)
Respiration Rate
numeric (RRspir)
Range
-20 to 120 cmH2O
Accuracy
±2% or ±0.5 cmH2O whichever is greater
Scales
10, 20, 40, 60, 80, 100, 120 cmH2O
Scale Default
20 cmH2O (neonatal)
40 cmH2O (pediatric)
40 cmH2O (adult)
Range
2 to 120 breaths/min
Resolution
1 breath/min
Inspired Minute Volume Range
numeric (MVin)
Resolution
Expired Minute Volume Range
numeric (MVexp)
0.01 to 5 l/min (neonatal)
0.06 to 30 l/min (pediatric)
0.4 to 60 l/min (adult)
0.01 l/min (neonatal/pediatric)
0.1 l/min (adult)
0.01 to 5 l/min (neonatal)
0.06 to 30 l/min (pediatric)
0.4 to 60 l/min (adult)
Resolution
0.01 l/min (neonatal/pediatric)
0.1 l/min (adult)
Range
5 to 100 ml (neonatal)
30 to 400 ml (pediatric)
200 to 3000 ml (adult)
Resolution
1 ml (neonatal/pediatric)
10 ml (adult)
Range
5 to 100 ml (neonatal)
30 to 400 ml (pediatric)
200 to 3000 ml (adult)
Resolution
1 ml (neonatal/pediatric)
10 ml (adult)
Lung Compliance
numeric
Range
0 to 500 ml/cmH2O
Resolution
1 ml/cmH2O
Airway Resistance
numeric
Range
0 to 500 cmH2O/l/s (neonatal)
0 to 250 cmH2O/l/s (pediatric)
0 to 100 cmH2O/l/s (adult)
Inspired Volume
numeric (TVin)
Expired Volume
numeric (TVexp)
Peak Inspiratory
Pressure numeric (PIP)
Resolution
1 cmH2O/l/s
Range
0 to 120 cmH2O
Resolution
1 cmH2O
Range
-20 to 0 cmH2O
Negative Inspiratory
Pressure numeric
Resolution
1 cmH2O
Mean Airway Pressure
Range
0 to 120 cmH2O
Resolution
1 cmH2O
Range
0 to 120 cmH2O
Resolution
1 cmH2O
Plateau Pressure
numeric
Positive End-Expiratory Range
Pressure numeric
Resolution
(PEEP)
422
0 to 99 cmH2O
1 cmH2O
36 Specifications
Spirometry Performance Specifications
Barometric Pressure
numeric (PB)
Range
Resolution
1 mmHg
Peak Inspiratory Flow
numeric (PIF)
Range
0.3 to 25 l/min (neonatal)
1 to 100 l/min (pediatric)
2 to 180 l/min (adult)
Resolution
0.1 l/min (neonatal)
1 l/min (pediatric/adult)
Range
0.3 to 25 l/min (neonatal)
1 to 100 l/min (pediatric)
2 to 180 l/min (adult)
Resolution
0.1 l/min (neonatal)
1 l/min (pediatric/adult)
Peak Expiratory Flow
numeric (PEF)
Inspiration to
Range
Expiration ratio numeric Resolution
(I:E)
400 to 800 mmHg
1: 0.2 ... 9.9
0.1
Cardiac Output / Continuous Cardiac Output
C.O./CCO Performance Specifications
C.O. (right heart)
C.O. (transpulmonary)
EVLW
ITBV
CCO
Range
0.1 to 20.0 l/min
Accuracy
Instrument Specification (electrical): ±3% or 0.1 l/min
System Specification: ±5%.or 0.2 l/min
Repeatability
Instrument Specification (electrical): ±2% or 0.1 l/min
System Specification: ±3%.or 0.1 l/min
Range
0.1 to 25.0 l/min
Accuracy
Instrument Specification (electrical): ±4% or 0.15 l/min
System Specification: ±5% or 0.2 l/min
Repeatability
Instrument Specification (electrical): ±2% or 0.1 l/min
System Specification: ±3% or 0.1 l/min
Range
10 to 5000 ml
Standard Deviation
10% or 1 ml/kg
Range
50 to 6000 ml
Accuracy
±10% or 30 ml
Repeatability
±5% or 20 ml
Range
0.1 to 25.0 l/min
Standard Deviation
10% or 0.3 l/min
Display Update
2 seconds nominal
Blood Temperature
Range
17.0 to 43°C (62.6 to 109,5°F)
Injectate Temperature
Range
-1 to 30°C (30.2 to 86.0°F)
423
36 Specifications
C.O./CCO Alarm
Specifications
Range
Adjustment
Delay
TBlood
17 to 43°C
Steps of 0.5°C (17 to 35°C)
Steps of 0.1°C (35 to 43°C)
10 seconds after the value exceeds
the set limit range
Steps of 1°F (63 to 95°F)
Steps of 0.2°F (95 to 109°F)
CCO
0.1 to 25.0 l/min
0.1 l/min (0.1 to 10.0 l/min)
0.5 l/min (10.0 to 25.0 l/min)
10 seconds after the value exceeds
the set limit range
tcGas
Complies with IEC 60601-2-23:1999/EN60601-2-23:2000.
tcGas Performance Specifications
tcpO2
Range
0 to 750 mmHg (0 to 100 kPa)
Resolution
1 mmHg (0.1 kPa)
Overall Accuracy
(incl. transducer)
0 to 20.9% O2 better than +5 mmHg (+0.7 kPa)
Above 20.9% O2 better than +10% of reading
tcpO2 Test Signal
60 mmHg (8.0 kPa)
tcpO2 Drift, including transducer
Typically 1.25%/h
tcpO2 response time, including transducer
Typically 30 s
tcpCO2
Range
5 to 200 mmHg (0.7 to 26.7 kPa)
Resolution
1 mmHg (0.1 kPa)
Overall Accuracy
(incl. transducer)
5 to 76 mmHg (0.7 to 10.1 kPa) better than +5 mmHg(+0.7 kPa)
Above 76 mmHg (10.1 kPa) better than +10% of reading
tcpCO2 Test Signal
40 mmHg (5.3 kPa)
tcpCO2 Drift, including transducer
Typically 2.5%/h
tcpCO2 response time, including transducer
Typically 60 s
Warm-up Time
<3 minutes
Site Timer
0.5, 1, 1.5, 2, 2.5, 3, 4, 5, 6, 7, or 8 hours. Change Site alarm when site time is
expired and configurable automatic heating switch-off
Transducer Heating
Available Temperatures 37.0°C, 41.0 to 45°C in steps of 0.5°C
424
36 Specifications
tcGas Alarm
Specifications
tcpO2
Range
Adjustment
Alarm Delay
10 to 745 mmHg
1.0 to 99.5 kPa
10 to 30 mmHg: 1 mmHg
1.0 to 4.0 kPa: 0.1 kPa
10 seconds after the value exceeds
the set limit range.
32 to 100 mmHg: 2 mmHg
4.2 to 13 kPa: 0.2 kPa
105 to 745 mmHg: 5 mmHg
13.5 to 99.5 kPa: 0.5 kPa
tcpCO2
10 to 195 mmHg
1.0 to 26 kPa
10 to 30 mmHg: 1 mmHg
1.0 to 4.0 kPa: 0.1 kPa
32 to 100 mmHg: 2 mmHg
4.2 to 13 kPa: 0.2 kPa
105 to 195 mmHg: 5 mmHg
13.5 to 26 kPa: 0.5 kPa
Intravascular Oxygen Saturation
Performance Specifications
SO2, SvO2, ScvO2
Range
10% to 100%
Accuracy
±2% (i.e. ±2 units), 1 standard deviation over 40% to 100%1 range.
Resolution
1%
Stability (system)
Drift <2% over 24 hours
Response Time (10 % to 90 %)
5 seconds
The accuracy specification for Edwards Lifesciences’ Philips-compatible catheters has been verified
in the saturation range 40%-95%.
Alarm Specifications
Range
Adjustment
Delay
SO2, SvO2, ScvO2
10% to 100%
1%
max. 15 +4 seconds after value
exceeds the set limit range
EEG
Complies with IEC 60601-2-26:1994/EN60601-2-26:1994.
EEG Performance Specifications
Leakage Current
<=10 mA @ 110 Vac
Input Signal Range
1 mVp-p
Differential Input Impedance
>15 MΩ @ 10 Hz
Max. DC Input Offset Voltage
±320 mV
Input Protection
Against defibrillation (5 kV) and electrosurgery
Common Mode Rejection
>105 dB @ 5 kΩ imbalance and 60 Hz
Noise
<0.4 mVRMS (1 to 30 Hz)
Electromagnetic Susceptibility
<10 mVp-p @ 3 V/m, 26-1000 MHz
425
36 Specifications
EEG Performance Specifications
Electrode Impedance
Measurement
Range
0 to 30 kΩ
Accuracy
±1 kΩ
Bandwidth
0.5 Hz to 50 Hz (-3 dB)
Low Filter Cut-Off Frequencies
0.5, 1.0, 2.0, and 5.0 Hz
(12 dB/octave)
High Filter Cut-Off Frequencies
15 Hz (65 dB/octave)
30 Hz (75 dB/octave)
50 Hz (85 dB/octave)
BIS
BIS Performance Specifications
BIS, BISx M1034A
Bispectral Index (BIS) Range
0 - 100
Signal Quality Index (SQI) Range
0 - 100%
EMG Range
0 - 100 dB
Suppression Ratio (SR)
0 - 100%
Spectral Edge Frequency (SEF)
0.5 - 30.0 Hz
Total Power (TP)
0 - 100 dB
Bursts
(BISx only) 0 - 30 /minute
Noise
<0.3 µV RMS (2.0 µV peak-to-peak)
Wave Scale
With gridlines on: ±25 µV, ±50 µV, ±100 µV, ±250 µV
With gridlines off: 50 µV, 100 µV, 200 µV, 500 µV
Update Frequency (BIS Numeric)
2048 ms
Bandwidth
0.25 - 100 Hz (-3 dB)
High Pass Filters
0.25 Hz, 1 Hz, 2 Hz (-3 dB)
Low Pass Filters
30 Hz, 50 Hz, 70 Hz, 100 Hz (-3 dB)
Notch Filters (for line frequency)
50 Hz, 60 Hz
Impedance Measurement Range
0 to 999 kΩ
BIS Alarm
Specifications
Range
Adjustment
Alarm Delay
BIS High/Low Alarm
0 - 100
Max. 2 seconds
Safety and Performance Tests
You must observe any national regulations on the qualification of the testing personnel and suitable
measuring and testing facilities. See the maintenance section for a list of required tests. Safety and
performance tests, and what to do if the instrument does not meet these specifications, are described
in the Service Guide.
426
36 Specifications
Electromagnetic Compatibility (EMC) Specifications
Take special precautions regarding electromagnetic compatibility (EMC) when using medical electrical
equipment. You must operate your monitoring equipment according to the EMC information
provided in this book. Portable and mobile radio frequency (RF) communications equipment can
affect medical electrical equipment.
Accessories Compliant with EMC Standards
All accessories listed in the accessories section comply, in combination with the patient monitor, with
the requirements of IEC 60601-1-2:2001 + A1:2004.
WARNING
Using accessories other than those specified may result in increased electromagnetic emission or
decreased electromagnetic immunity of the monitoring equipment.
Electromagnetic Emissions
The monitor is suitable for use in the electromagnetic environment specified in the table below. You
must ensure that it is used in such an environment.
Emissions test
Compliance
Avoiding Electromagnetic Interference
Radio Frequency (RF) emissions
Group 1
The monitor uses RF energy only for its internal function. Therefore, its
RF emissions are very low and are not likely to cause any interference in
nearby electronic equipment
RF emissions CISPR 11
Class A
Harmonic emissions IEC 61000-3-2
n/a
Voltage fluctuations IEC 61000-3-3
n/a
The monitor is suitable for use in all establishments other than domestic
and those directly connected to the public low-voltage power supply
network that supplies buildings used for domestic purposes
WARNING
The monitor should not be used next to or stacked with other equipment. If you must stack the
monitor, you must check that normal operation is possible in the necessary configuration before you
start monitoring patients.
Avoiding Electromagnetic Interference (Resp and BIS)
The respiration (Resp) and BIS measurements are very sensitive measurements that measure very small
signals. Technological limitations do not allow higher immunity levels than 1 V/m for radiated RF
electromagnetic fields and 1 Vrms for conducted disturbances induced by RF fields. Electromagnetic
fields with field strengths above 1 V/m and conducted disturbances above 1 Vrms may cause
erroneous measurements. Therefore Philips recommends that you avoid using electrically radiating
equipment in the close proximity of these measurements.
Electromagnetic Immunity
The monitor is suitable for use in the specified electromagnetic environment. The user must ensure
that it is used in the appropriate environment as described below.
427
36 Specifications
IEC 60601-1-2
test level
Compliance level
Electromagnetic environment guidance
Electrostatic discharge
(ESD)
IEC 61000-4-2
±6 kV contact
±8 kV air
±6 kV contact
±8 kV air
Floors should be wood, concrete, or
ceramic tile. If floors are covered with
synthetic material, the relative humidity
should be at least 30%.
Electrical fast transient/
burst
IEC 61000-4-4
±2 kV for power supply lines
±1 kV for input/output lines
±2 kV for power supply lines
±1 kV for input/output lines
Mains power quality should be that of a
typical commercial and/or hospital
environment
Surge
IEC 61000-4-5
±1 kV differential mode
±2 kV common mode
±1 kV differential mode
±2 kV common mode
Mains power quality should be that of a
typical commercial and/or hospital
environment
Voltage dips, short
interruptions and voltage
variations on power supply
input lines
IEC 61000-4-11
<5% UT (>95% dip in UT) for <5% UT (>95% dip in UT) for Mains power quality should be that of a
0.5 cycles
0.5 cycles
typical commercial and/or hospital
40% UT (60% dip in UT) for 40% UT (60% dip in UT) for environment. If the user of the monitor
requires continued operation during power
5 cycles
5 cycles
mains interruptions, it is recommended
70% UT (30% dip in UT) for 70% UT (30% dip in UT) for that the monitor is equipped with an
25 cycles
25 cycles
internal battery or is powered from an
<5% UT (>95% dip in UT) for <5% UT (>95% dip in UT) for uninterruptible power supply.
5 sec
5 sec
Power frequency (50/
60 Hz) magnetic field
IEC 61000-4-8
3 A/m
Immunity test
3 A/m
Power frequency magnetic fields should be
a t levels characteristic of a typical location
in a typical commercial and/or hospital
environment
In this table, UT is the a.c. mains voltage prior to application of the test level.
Recommended Separation Distance
WARNING
The monitor, equipped with a wireless network interface, intentionally receives RF electromagnetic
energy for the purpose of its operation. Therefore, other equipment may cause interference, even if
that other equipment complies with CISPR emission requirements.
In the following table, P is the maximum output power rating of the transmitter in watts (W) according
to the transmitter manufacturer and d is the recommended separation distance in meters (m). The
values given in brackets are for respiration and BIS.
Portable and mobile RF communications equipment should be used no closer to any part of the
monitor, including cables, than the recommended separation distance calculated from the equation
appropriate for the frequency of the transmitter.
Field strengths from fixed RF transmitters, as determined by an electromagnetic site survey, should be
less than the compliance level in each frequency range.
Interference may occur in the vicinity of equipment marked with this symbol:
428
36
Immunity test
IEC 60601-1-2
test level
Conducted RF
IEC 61000-4-6
3 VRMS
150 kHz to 80 MHz
Radiated RF
IEC 61000-4-3
3 V/m
80 MHz to 2.5 GHz
Compliance level
Electromagnetic environment guidance
3 VRMS
Recommended separation distance:
(1 VRMS for
respiration and BIS)
d = 1.2√P
3 V/m
Recommended separation distance:
for respiration and BIS:
d = 3.5√P
(1 V/m for respiration 80 MHz to 800 MHz
and BIS)
d = 1.2√P
80 MHz to 800 MHz for respiration and BIS
d = 3.5√P
800 MHz to 2,5 GHz
d = 2.3√P
800 MHz to 2,5 GHz for respiration and BIS
d = 7.0√P
2.0 to 2,3 GHz for short range radio
d = 7.0√P
Field strengths from fixed transmitters, such as base stations for radio (cellular, cordless) telephones
and land mobile radios, amateur radio, AM and FM radio broadcast and TV broadcast cannot be
predicted theoretically with accuracy. To assess the electromagnetic environment due to fixed RF
transmitters, an electromagnetic site survey should be considered. If the measured field strength in the
location in which the monitor is used exceeds the applicable RF compliance level above, the monitor
should be observed to verify normal operation. If abnormal performance is observed, additional
measures may be necessary, such as reorienting or relocating the monitor.
These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption
and reflection from structures, objects, and people.
Recommended separation distances from portable and mobile RF
communication equipment
The monitor is intended for use in an electromagnetic environment in which radiated RF disturbances
are controlled. The customer or user of the monitor can help prevent electromagnetic interference by
maintaining a minimum distance between portable and mobile RF communications equipment and the
monitor as recommended below, according to the maximum output power of the communications
equipment.
In the following table, P is the maximum output power rating of the transmitter in watts (W) according
to the transmitter manufacturer and d is the recommended separation distance in meters (m). The
values given in brackets are for respiration and BIS.
429
36 Specifications
Frequency of transmitter 150 kHz to 80 MHz
80 MHz to 800 MHz
800 MHz to 2,5 GHz
d = 1.2√P
d = 1.2√P
d = 2.3√P
for respiration and BIS:
d = 3.5√P
for respiration and BIS:
d = 3.5√P
for respiration and BIS:
d = 7.0√P
Rated max. output
power of transmitter
Separation distance
Separation distance
Separation distance
0.01 W
0.1 (0.4) m
0.1 (0.4) m
0.2 (0.7) m
0.1 W
0.4 (1.1) m
0.4 (1.1) m
0.7 (2.2) m
1W
1.3 (3.5) m
1.3 (3.5) m
2.3 (7.0) m
10 W
3.8 (11.1) m
3.8 (11.1) m
7.3 (22.1) m
100 W
12.0 (35.0) m
12.0 (35.0) m
23.0 (70.0) m
Equation
Electrosurgery Interference/Defibrillation/Electrostatic Discharge
The equipment returns to the previous operating mode within 10 seconds without loss of any stored
data. Measurement accuracy may be temporarily decreased while performing electrosurgery or
defibrillation. This does not affect patient or equipment safety. Do not expose the equipment to x-ray
or strong magnetic fields (MRI).
Fast Transients/Bursts
The equipment will return to the previous operating mode within 10 seconds without loss of any
stored data (M1032 within 30 seconds). If any user interaction is required, the monitor indicates this
with a technical alarm (INOP).
Restart time
After power interruption, an ECG wave will be shown on the display after 30 seconds maximum.
430
37 Default Settings Appendix
37
Default Settings Appendix
This appendix documents the most important default settings of your monitor as it is delivered from
the factory. For a comprehensive list and explanation of default settings, see the Configuration Guide
supplied with your monitor. The monitor's default settings can be permanently changed in
Configuration Mode.
Note: If your monitor has been ordered pre-configured to your requirements, the settings at delivery
will be different from those listed here.
Country-Specific Default Settings
Certain default settings are specific to a particular country. These are listed here for all countries
alphabetically.
Country-Description
Line Frequency
Units
Weight
Units
Height
ECG Cable Color
50/60 [Hz]
kg, lb
in, cm
IEC, AAMI
Afghanistan
50
kg
cm
AAMI
Åland Islands
50
kg
cm
IEC
Albania
50
kg
cm
IEC
Algeria
50
kg
cm
IEC
American Samoa
60
lb
in
AAMI
Andorra
60
lb
in
AAMI
Angola
50
kg
cm
IEC
Anguilla
60
lb
in
AAMI
Antarctica
60
lb
in
AAMI
Antigua and Barbuda
50
kg
cm
AAMI
Argentina
50
kg
cm
AAMI
Armenia
50
kg
cm
IEC
Aruba
60
kg
cm
AAMI
Australia
50
kg
cm
AAMI
Austria
50
kg
cm
IEC
Azerbaijan
50
kg
cm
IEC
Bahamas, The
60
kg
cm
AAMI
Bahrain
50
kg
cm
AAMI
Bangladesh
60
lb
in
AAMI
Barbados
50
kg
cm
AAMI
Belarus
50
kg
cm
IEC
Belgium
50
kg
cm
IEC
431
37 Default Settings Appendix
Country-Description
Line Frequency
Units
Weight
Units
Height
ECG Cable Color
Belize
60
lb
in
AAMI
Benin
60
lb
in
AAMI
Bermuda
60
kg
cm
AAMI
Bhutan
60
lb
in
AAMI
Bolivia
50
kg
cm
AAMI
Bosnia and Herzegovina
50
kg
cm
IEC
Botswana
50
kg
cm
IEC
Bouvet Island
60
lb
in
AAMI
Brazil
60
kg
cm
AAMI
British Indian Ocean Territory
60
lb
in
AAMI
Brunei
50
kg
cm
IEC
Brunei Darussalam
50
kg
cm
AAMI
Bulgaria
50
kg
cm
IEC
Burkina Faso
50
kg
cm
IEC
Burundi
50
kg
cm
IEC
Cambodia
50
kg
cm
IEC
Cameroon
50
kg
cm
IEC
Canada
60
kg
cm
AAMI
Cape Verde
60
lb
in
AAMI
Cayman Islands
60
kg
cm
AAMI
Central African Republic
50
kg
cm
IEC
Chad
60
lb
in
AAMI
Chile
50
kg
cm
AAMI
China
50
kg
cm
IEC
Christmas Islands
60
lb
in
AAMI
Cocos Keeling Islands
60
lb
in
AAMI
Colombia
60
kg
cm
AAMI
Comoros
60
lb
in
AAMI
Congo
50
kg
cm
IEC
Congo, Democratic Republic of
the
50
kg
cm
IEC
Cook Islands
60
lb
in
AAMI
Costa Rica
60
kg
cm
AAMI
Côte d'Ivoire
50
kg
cm
IEC
Croatia
50
kg
cm
IEC
Cuba
60
kg
cm
IEC
Cyprus
50
kg
cm
IEC
432
37 Default Settings Appendix
Country-Description
Line Frequency
Units
Weight
Units
Height
ECG Cable Color
Czech Republic
50
kg
cm
IEC
Denmark
60
lb
in
AAMI
Djibouti
50
kg
cm
IEC
Dominica
50
kg
cm
AAMI
Dominican Republic
60
kg
cm
AAMI
Ecuador
60
kg
cm
AAMI
Egypt
50
kg
cm
IEC
El Salvador
60
kg
cm
AAMI
Equatorial Guinea
50
kg
cm
IEC
Eritrea
50
kg
cm
IEC
Estonia
50
kg
cm
IEC
Ethiopia
50
kg
cm
IEC
Falkland Islands, Malvinas
60
lb
in
AAMI
Faroe Islands
60
lb
in
AAMI
Fiji
60
lb
in
AAMI
Finland
50
kg
cm
IEC
France
50
kg
cm
IEC
French Guiana
50
kg
cm
IEC
French Polynesia
60
lb
in
AAMI
French Southern Territories
60
lb
in
AAMI
Gabon
50
kg
cm
IEC
Gambia, The
50
kg
cm
IEC
Georgia
60
lb
in
AAMI
Germany
50
kg
cm
IEC
Ghana
50
kg
cm
IEC
Gibraltar
60
lb
in
AAMI
Greece
50
kg
cm
IEC
Greenland
60
lb
in
AAMI
Grenada
50
kg
cm
AAMI
Guadeloupe
50
kg
cm
IEC
Guam
60
lb
in
AAMI
Guatemala
60
kg
cm
AAMI
Guernsey
50
kg
cm
IEC
Guinea
60
lb
in
AAMI
Guinea-Bissau
60
lb
in
AAMI
Guyana
60
kg
cm
AAMI
Haiti
60
kg
cm
AAMI
433
37 Default Settings Appendix
Country-Description
Line Frequency
Units
Weight
Units
Height
ECG Cable Color
Heard Island and McDonald
Islands
60
lb
in
AAMI
Holy See, Vatican City State
60
lb
in
AAMI
Honduras
60
kg
cm
AAMI
Hong Kong
50
kg
cm
IEC
Hungary
50
kg
cm
IEC
Iceland
50
kg
cm
IEC
India
50
kg
cm
IEC
Indonesia
50
kg
cm
IEC
Iran, Islamic Republic of
50
kg
cm
AAMI
Iraq
50
kg
cm
AAMI
Ireland
50
kg
cm
IEC
Isle of Man
50
kg
cm
IEC
Israel
50
kg
cm
IEC
Italy
50
kg
cm
IEC
Jamaica
50
kg
cm
AAMI
Japan
60
kg
cm
IEC
Jersey
50
kg
cm
IEC
Jordan
50
kg
cm
AAMI
Kazakhstan
50
kg
cm
IEC
Kenya
50
kg
cm
IEC
Kiribati
60
lb
in
AAMI
Korea, Democratic People's
Republic of
60
lb
in
AAMI
Korea, Republic of
60
kg
cm
AAMI
Kuwait
50
kg
cm
AAMI
Kyrgyzstan
60
lb
in
AAMI
Lao People's Democratic
Republics
50
kg
cm
IEC
Latvia
50
kg
cm
IEC
Lebanon
50
kg
cm
AAMI
Lesotho
50
kg
cm
IEC
Liberia
50
kg
cm
IEC
Libyan Arab Jamahiriya
60
lb
in
AAMI
Liechtenstein
60
lb
in
AAMI
Lithuania
50
kg
cm
IEC
Luxembourg
50
kg
cm
IEC
Macao
60
lb
in
AAMI
434
37 Default Settings Appendix
Country-Description
Line Frequency
Units
Weight
Units
Height
ECG Cable Color
Macedonia, The former
Yugoslavian Republic of
50
kg
cm
IEC
Madagascar
50
kg
cm
IEC
Malawi
50
kg
cm
IEC
Malaysia
50
kg
cm
IEC
Maldives
60
lb
in
AAMI
Mali
50
kg
cm
IEC
Malta
50
kg
cm
IEC
Marshall Islands
60
lb
in
AAMI
Martinique
60
kg
cm
IEC
Mauritania
50
kg
cm
IEC
Mauritius
60
lb
in
AAMI
Mayotte
60
lb
in
AAMI
Mexico
60
kg
cm
AAMI
Micronesia, Federal States of
60
lb
in
AAMI
Moldova, Republic of
60
lb
in
AAMI
Monaco
60
lb
in
AAMI
Mongolia
60
lb
in
AAMI
Montenegro
50
kg
cm
IEC
Montserrat
50
kg
cm
AAMI
Morocco
50
kg
cm
IEC
Mozambique
50
kg
cm
IEC
Myanmar
60
lb
in
AAMI
Namibia
50
kg
cm
IEC
Nauru
60
lb
in
AAMI
Nepal
60
lb
in
AAMI
Netherlands
50
kg
cm
IEC
Netherlands Antilles
50
kg
cm
AAMI
New Caledonia
60
lb
in
AAMI
New Zealand
50
kg
cm
AAMI
Nicaragua
60
kg
in
AAMI
Niger
50
kg
cm
IEC
Nigeria
50
kg
cm
IEC
Niue
60
lb
in
AAMI
Norfolk Islands
60
lb
in
AAMI
Northern Mariana Islands
60
lb
in
AAMI
Norway
50
kg
cm
IEC
435
37 Default Settings Appendix
Country-Description
Line Frequency
Units
Weight
Units
Height
ECG Cable Color
Oman
50
kg
cm
AAMI
Pakistan
50
kg
cm
IEC
Palau
60
lb
in
AAMI
Palestinian Territory
50
kg
cm
AAMI
Panama
60
lb
in
AAMI
Papua New Guinea
60
lb
in
AAMI
Paraguay
50
kg
cm
AAMI
Peru
60
kg
cm
AAMI
Philippines
60
kg
cm
AAMI
Pitcairn
60
lb
in
AAMI
Poland
50
kg
cm
IEC
Portugal
50
kg
cm
IEC
Puerto Rico
60
lb
in
AAMI
Qatar
50
kg
cm
AAMI
Reunion
60
lb
in
AAMI
Romania
50
kg
cm
IEC
Russian Federation
50
kg
cm
IEC
Rwanda
50
kg
cm
IEC
Saint Helena
60
lb
in
AAMI
Saint Kitts and Nevis
60
kg
cm
AAMI
Saint Lucia
50
kg
cm
AAMI
Saint Pierre and Miquelon
60
lb
in
AAMI
Saint Vincent and the Grenadines 50
kg
cm
AAMI
Samoa
60
lb
in
AAMI
San Marino
60
lb
in
AAMI
Sao Tome and Principe
60
lb
in
AAMI
Saudi Arabia
50
kg
cm
AAMI
Senegal
50
kg
cm
IEC
Serbia
50
kg
cm
IEC
Serbia & Montenegro
50
kg
cm
IEC
Seychelles
60
lb
in
AAMI
Sierra Leone
50
kg
cm
IEC
Singapore
50
kg
cm
IEC
Slovakia
50
kg
cm
IEC
Slovenia
50
kg
cm
IEC
Solomon Islands
60
lb
in
AAMI
Somalia
50
kg
cm
IEC
436
37 Default Settings Appendix
Country-Description
Line Frequency
Units
Weight
Units
Height
ECG Cable Color
South Africa
60
lb
in
AAMI
South Georgia and the South
Sandwich Islands
60
lb
in
AAMI
Spain
50
kg
cm
IEC
Sri Lanka
60
lb
in
AAMI
Sudan
50
kg
cm
IEC
Suriname
60
kg
cm
AAMI
Svalbard and Jan Mayen
60
lb
in
AAMI
Swaziland
60
lb
in
AAMI
Sweden
50
kg
cm
IEC
Switzerland
50
kg
cm
IEC
Syrian Arab Rep
50
kg
cm
AAMI
Taiwan, Province of China
60
kg
cm
AAMI
Tajikistan
60
lb
in
AAMI
Tanzania, United Republic of
60
lb
in
AAMI
Thailand
50
kg
cm
AAMI
Timor-Leste
60
lb
in
AAMI
Togo
60
lb
in
AAMI
Tokelau
60
lb
in
AAMI
Tonga
60
lb
in
AAMI
Trinidad and Tobago
60
lb
in
AAMI
Tunisia
50
kg
cm
IEC
Turkey
50
kg
cm
IEC
Turkmenistan
60
lb
in
AAMI
Turks and Caicos Islands
60
kg
cm
AAMI
Tuvalu
60
lb
in
AAMI
Uganda
60
lb
in
AAMI
Ukraine
60
lb
in
AAMI
United Arab Emirates
50
kg
cm
AAMI
United Kingdom
50
kg
cm
IEC
United States
60
lb
in
AAMI
United States Minor Outlying
Islands
60
lb
in
AAMI
Uruguay
50
kg
cm
AAMI
Uzbekistan
60
lb
in
AAMI
Vanuatu
60
lb
in
AAMI
Venezuela
60
lb
in
AAMI
437
37 Default Settings Appendix
Country-Description
Line Frequency
Units
Weight
Units
Height
ECG Cable Color
Viet Nam
50
kg
cm
IEC
Virgin Islands (British)
50
kg
cm
AAMI
Virgin Islands (US)
60
lb
in
AAMI
Wallis and Futuna Islands
60
lb
in
AAMI
Western Sahara
50
kg
cm
IEC
Yemen
50
kg
cm
AAMI
Zambia
60
lb
in
AAMI
Zimbabwe
60
lb
in
AAMI
Alarm and Measurement Default Settings
The default wave speed for all measurements except Respiration is 25 mm/sec. For Respiration the
default wave speed is 6.25 mm/sec.
In the following tables, settings may be entered only once per table row if they are the same for all
patient categories.
Alarm Default Settings
Alarm Settings
Factory Default H10/H20/H40
Alarm Volume
Alarms Off
2 min
Pause Al. 5Min
Enabled
H30 (deviations from H10/H20/
H40)
Pause Al. 10Min
Enabled
Auto Alarms Off
Off
AlarmOffReminder
Off
Visual Latching
Red&Yellow
Red Only
Audible Latching
Red&Yellow
Off
Alarm Reminder
On
Reminder Time
3 min
Alarm Sounds
Traditional
RedAlarmInterval
10 sec
Yel.Al. Interval
20 sec
Alarm Low
Red Alarm Volume
AlarmVol. +2
Yell.AlarmVolume
AlarmVol. +0
Inop Volume
AlarmVol. +0
AutoIncrease Vol
2 Steps
IncreaseVolDelay
20 sec
438
37 Default Settings Appendix
Alarm Settings
Factory Default H10/H20/H40
Keep Blinking
No
Relay1 Sensitiv.
R&Y&C
Relay2 Sensitiv.
Red&Yellow
Relay3 Sensitiv.
Red
CyanRelayLatency
5 sec
Yel.RelayLatency
2 sec
Alarm Text
Standard
NoCentrMonMinVol
On4
H30 (deviations from H10/H20/
H40)
ECG, Arrhythmia, ST and QT Default Settings
ECG Settings
Factory defaults H10/H20/H40
H30 (deviations from H10/H20/H40)
Adult
Pedi
Neo
High Limit
120 bpm
160 bpm
200 bpm
Low Limit
50 bpm
75 bpm
100 bpm
ECG/Arrhy Alarms
On
On
On
Alarm Source
Auto
Auto
Auto
ECG
On
On
On
QRS Volume
Primary Lead
II
II
II
Secondary Lead
Analysis Mode
Multi Lead
Multi Lead
Multi Lead
Lead Placement
Standard
Standard
Standard
Mod.LeadPlacment
Off
Off
Off
Filter
Monitor
Monitor
Monitor
AutoFilter
Off
Off
Off
Default ECG Size
Size X1
Size X1
Size X1
Color
Green
Green
Green
Asystole Thresh.
4.0 sec
4.0 sec
3.0 sec
Δ ExtrTachy
20 bpm
20 bpm
20 bpm
Tachy Clamp
200 bpm
220 bpm
240 bpm
Δ ExtrBrady
20 bpm
20 bpm
20 bpm
Brady Clamp
40 bpm
40 bpm
50 bpm
ECG AL. OFF Inop
Cyan
Cyan
Cyan
Fallback
On
On
On
Alarms Off
Enabled
Enabled
Enabled
AlarmSource Sel.
Enabled
Enabled
Enabled
Va Lead
V2
V2
V2
Adult
Pedi
Neo
60 bpm
80 bpm
Auto
Filter
40 bpm
439
37 Default Settings Appendix
Factory defaults H10/H20/H40
ECG Settings
H30 (deviations from H10/H20/H40)
Adult
Pedi
Neo
Vb Lead
V5
V5
V5
SyncPulse Sensit
Medium
Medium
Medium
SyncPulse Marker
On
On
On
PulseAlarms Tele
Enabled
Enabled
Enabled
Adult
Pedi
Neo
Pulse Default Settings
Factory defaults H10/H20/H40
Pulse Settings
H30 (deviations from H10/H20/H40)
Adult
Pedi
Neo
Adult
Pedi
Neo
Alarm Source
Auto
Auto
Auto
Auto
Auto
Auto
Pulse (source label)
On
On
On
System Pulse
SpO₂
SpO₂
SpO₂
Auto
Auto
Auto
Alarms Off
Enabled
Enabled
Enabled
AlarmSource Sel.
Enabled
Enabled
Enabled
Pulse Alarm Settings
Factory defaults H10/H20/H40
H30 (deviations from H10/H20/H40)
Adult
Pedi
Neo
Pulse Alarms1
On
On
On
High Limit
120 bpm
160 bpm
200 bpm
Low Limit
50 bpm
75 bpm
100 bpm
Δ ExtrBrady
20 bpm
20 bpm
20 bpm
Brady Clamp
40 bpm
40 bpm
50 bpm
Δ ExtrTachy
20 bpm
20 bpm
20 bpm
Tachy Clamp
200 bpm
220 bpm
240 bpm
1 When
Adult
Pedi
Neo
40 bpm
60 bpm
80 bpm
Pulse is not the alarm source, the alarms will be Off.
Pulse alarms use the settings of the currently selected Pulse alarm source.
Respiration Default Settings
Respiration Settings
Factory defaults H10/H20/H40
H30 (deviations from H10/H20/H40)
Adult
Pedi
Neo
High Limit
30 rpm
30 rpm
100 rpm
Low Limit
8 rpm
8 rpm
30 rpm
Apnea Time
20 sec
20 sec
20 sec
440
Adult
Pedi
Neo
37 Default Settings Appendix
Respiration Settings
Factory defaults H10/H20/H40
H30 (deviations from H10/H20/H40)
Adult
Pedi
Neo
Alarms
On
On
On
Resp
On
On
On
Detection
Auto
(Trigger Mode)
Auto
(Trigger Mode)
Auto
(Trigger Mode)
Color
Yellow
Yellow
Yellow
Adult
Pedi
Neo
Off
Off
Off
White
White
White
SpO2 Default Settings
SpO2 Settings
Factory Defaults
Adult
Pedi
Neo
Mode
Continuous
Continuous
Continuous
Repeat Time
15 min
15 min
15 min
Alarms
On
On
On
QRS Volume
Tone Modulation
Yes
Yes
Yes
Tone Mod. Type
Enhanced
Enhanced
Enhanced
Perfusion
On
On
On
Average
10 sec
10 sec
10 sec
NBP Alarm Suppr.
On
On
On
Extd. Auto OnOff
Disabled
Disabled
Disabled
Color
Cyan (light blue)
Cyan (light blue)
Cyan (light blue)
Average In Mon.
No
No
No
Signal Quality
On
On
On
Setting
Adult
Pedi
Neo
Desat Limit
80
80
80
Low Limit
90
90
85
High Limit
100
100
95
Desat Delay
20 sec
20 sec
20 sec
High Alarm Delay
10 sec
10 sec
10 sec
Low Alarm Delay
10 sec
10 sec
10 sec
SmartAlarmDelay (SAD)
Off
Off
Off
High Alarm Delay (SAD)
Short
Short
Short
Low Alarm Delay (SAD)
Short
Short
Short
Label
SpO₂
SpO₂
SpO₂
On
On
On
SpO2 Alarm Default Settings
Pulse settings
Pulse (SpO₂)
For all other Pulse default settings, refer to the Pulse Default Settings table.
441
37 Default Settings Appendix
NBP Default Settings
NBP Settings
Factory defaults H10/H20/H30
H30 (deviations from H10/H20/H40)
Adult
Pedi
Neo
Pedi
Neo
Mode
Auto
Auto
Manual
Alarms from
Sys.
Sys.
Sys.
High Limit
160/90 (110)
120/70 (90)
90/60 (70)
180/90 (110)
Low Limit
90/50 (60)
70/40 (50)
40/20 (24)
70/50 (65)
Alarms
On
On
On
NBP
On
On
On
Repeat Time
10 min
10 min
10 min
3 min
3 min
3 min
Pulse (NBP)
On
On
On
Unit
mmHg
mmHg
mmHg
Done Tone
Off
Off
Off
On
On
Start Time
Synchronize
Synchronize
Synchronize
NotSynchron NotSynchron. NotSynchron
VP Pressure
60 mmHg
40 mmHg
30 mmHg
Reference
Auscultatory Auscultatory Invasive
Color
Red
Red
Red
Adult
Magenta
Magenta
Magenta
Temperature Default Settings
Temp Settings
Factory defaults H10/H20/H40
H30 (deviations from H10/H20/H40)
Adult
Pedi
Neo
Adult
Pedi
Neo
Low Limit
36
36
36
35
35
35
High Limit
39
39
39
Alarms
On
On
On
Unit
°C
°C
°C
Range
35...43
35...43
35...43
Color
Green
Green
Green
Light Green
Light Green
Light Green
442
37 Default Settings Appendix
Invasive Pressure Default Settings
ABP, P, P1, P2, P3, P4,
Factory defaults H10/H20/H40
UAP, ART, Ao, FAP, BAP
Adult
Pedi
Neo
Settings
H30 (deviations from H10/H20/H40)
Adult
Alarms from
Sys.
Sys.
Sys.
High Limit
160/90 (110)
120/70 (90)
90/60 (70)
180/90 (110)
Low Limit
90/50 (70)
70/40 (50)
55/20 (36)
70/50 (70)
Alarms
On
On
On
Extreme Alarms
Disabled
Disabled
Disabled
Δ Extreme High
15
10
Δ Extreme Low
15
10
Sys. High Clamp/Dia.
High Clamp (Mean
High Clamp)
190/100 (125)
140/80 (100)
105/75 (75)
Sys. Low Clamp/Dia.
80/45 (65)
Low Clamp (Mean Low
Clamp)
60/35 (45)
45/15 (30)
Scale
150
100
100
Mean only
No
No
No
Filter
12 Hz
12 Hz
12 Hz
Mercury Cal
Yes
Yes
Yes
Artifact Suppr.
60 sec
60 sec
60 sec
Unit
mmHg
mmHg
mmHg
Color
Red
Red
Red
Pedi
Neo
65/45 (65)
Pulse settings for all arterial pressures except P1 to P4
Pulse (Press label)
On
On
On
For all other Pulse default settings, refer to the Pulse Default Settings table.
CVP, RAP, LAP, UVP
Settings
Factory defaults H10/H20/H40
Adult
Pedi
Neo
Alarms from
Mean
Mean
Mean
High Limit
14/6 (10)
10/2 (4)
10/2 (4)
Low Limit
6/-4 (0)
2/-4 (0)
2/-4 (0)
Alarms
On
On
On
Extreme Alarms
Disabled
Disabled
Disabled
Δ Extreme High
Δ Extreme Low
Sys. High Clamp/ Dia. 20/10 (15)
High Clamp (Mean
High Clamp)
15/5 (10)
15/5 (10)
Sys. Low Clamp/Dia.
0/-5 (-5)
Low Clamp (Mean Low
Clamp)
0/-5 (-5)
0/-5 (-5)
Scale
30
30
30
H30 (deviations from H10/H20/H40)
Adult
Pedi
Neo
443
37 Default Settings Appendix
CVP, RAP, LAP, UVP
Settings
Factory defaults H10/H20/H40
Adult
Pedi
Neo
Mean only
Yes
Yes
Yes
Filter
12 Hz
12 Hz
12 Hz
Mercury Cal
Yes
Yes
Yes
Artifact Suppr.
60 sec
60 sec
60 sec
Unit
mmHg
mmHg
mmHg
Color
Cyan (light
blue)
Cyan (light
blue)
Cyan (light
blue)
PAP Settings
H30 (deviations from H10/H20/H40)
Adult
Pedi
Neo
Blue
Blue
Blue
Factory Defaults
Adult
Pedi
Neo
Alarms from
Dia.
Dia.
Dia.
High Limit
34/16 (20)
60/4 (26)
60/4 (26)
Low Limit
10/0 (0)
24/-4 (12)
24/-4 (12)
Alarms
On
On
On
Extreme Alarms
Disabled
Disabled
Disabled
Δ Extreme High
Δ Extreme Low
Sys. High Clamp/Dia. High Clamp (Mean
High Clamp)
45/20 (25)
65/5 (35)
65/5 (35)
Sys. Low Clamp/Dia. Low Clamp (Mean
Low Clamp)
5/-5 (-5)
15/-5 (5)
15/-5 (5)
Scale
30
30
30
Mean only
No
No
No
Filter
12 Hz
12 Hz
12 Hz
Mercury Cal
Yes
Yes
Yes
Artifact Suppr.
60 sec
60 sec
60 sec
Unit
mmHg
mmHg
mmHg
Color
Yellow
Yellow
Yellow
Adult
Pedi
Neo
Alarms from
Mean
Mean
Mean
High Limit
14/6 (10)
10/2 (4)
10/2 (4)
Low Limit
6/-4 (0)
2/-4 (0)
2/-4 (0)
Alarms
On
On
On
Extreme Alarms
Disabled
Disabled
Disabled
ICP, IC1, IC2 Settings
Factory Defaults
Δ Extreme High
10
10
10
Δ Extreme Low
10
10
10
Sys. High Clamp/Dia. High Clamp (Mean
High Clamp)
20/10 (15)
15/5 (10)
15/5 (10)
444
37 Default Settings Appendix
Factory Defaults
ICP, IC1, IC2 Settings
Adult
Pedi
Neo
Sys. Low Clamp/Dia. Low Clamp (Mean
Low Clamp)
0/-5 (-5)
0/-5 (-5)
0/-5 (-5)
Scale
30
30
30
Mean only
Yes
Yes
Yes
Filter
12 Hz
12 Hz
12 Hz
Mercury Cal
Yes
Yes
Yes
Artifact Suppr.
60 sec
60 sec
60 sec
Unit
mmHg
mmHg
mmHg
Color
Magenta
Magenta
Magenta
Cardiac Output Default Settings
C.O. Settings
Factory defaults H10/H20/H40
H30 (deviations from H10/H20/H40)
Adult
Pedi
Neo
Adult
Pedi
Neo
Auto-Calibration
On
On
On
Tblood HighLimit
39.0°C
39.0°C
39.0°C
Tblood Low Limit
36.0°C
36.0°C
36.0°C
Tblood Alarms
On
On
On
Temperature Unit
°C
°C
°C
Color
Green
Green
Green
Yellow
Yellow
Yellow
Factory Adult
Factory Pedi
Factory Neo
Alarms From
CCO
CCO
CCO
CCO From
ABP
ABP
ABP
Color
Green
Green
Green
Alarms
On
On
On
CCO High Limit
8.5 l/min
3.7 l/min
1.3 l/min
CCO Low Limit
4.0 l/min
2.6 l/min
0.3 l/min
Alarms
On
On
On
CCI High Limit
4.3 l/min/m2
4.3 l/min/m2
5.2 l/min/m2
CCI Low Limit
2.0 l/min/m2
2.6 l/min/m2
1.2 l/min/m2
CCO/CCI Settings
Settings common to CCO and CCI
CCO
CCI
445
37 Default Settings Appendix
CO2 Default Settings
CO2 Settings
Factory defaults H10/H20/H40
H30 (deviations from H10/H20/H40)
Adult
Pedi
Neo
Adult
Pedi
Neo
etCO₂ Low
30
30
30
25
25
25
etCO₂ High
50
50
50
60
60
60
imCO₂ High
CO₂ Alarms
On
On
On
Unit
mmHg
mmHg
mmHg
Scale
40 mmHg
40 mmHg
40 mmHg
50
50
50
imCO₂
On
On
On
Off
Off
Off
N₂O Corr. (only
M3015A/M3016A)
Off
Off
Off
Oxygen Corr. (only
M3014A)
16%
16%
16%
Gas Corr. (only M3014A) Off
Off
Off
Humidity Corr.
BTPS
BTPS
BTPS
Max Hold
Off
Off
Off
awRR
On
On
On
awRR Alarms
On
On
On
High Limit (awRR)
30
30
60
White
White
White
Low Limit (awRR)
30
Apnea Time
20 sec
20 sec
20 sec
Color
Yellow
Yellow
Yellow
Spirometry Default Settings
Spirometry Settings
Factory Adult
Factory Pedi
Factory Neo
Apnea Time
20
20
20
MVexp Low
4.0 l/min
2.5 l/min
0.4 l/min
MVexp High
8.0 l/min
4.0 l/min
0.8 l/min
PIP High
40
25
20
PEEP Low
PEEP High
25
25
25
High Limit (RRspir)
30
Low Limit (RRspir)
30
30
60
Scale (AWF)
±150 l/min
±100 l/min
±20 l/min
Scale (AWV)
±800 ml
±200 ml
±50 ml
Scale (AWP)
±40 cmH2O
±40 cmH2O
±20 cmH2O
446
37 Default Settings Appendix
tcGas Default Settings
tcGas Settings
Factory Adult
Factory Pedi
Factory Neo
tcpO₂ High Limit
80 mmHg
80 mmHg
80 mmHg
tcpO₂ Low Limit
50 mmHg
50 mmHg
50 mmHg
tcpO₂ Alarms
On
On
On
tcpCO₂ HighLimit
50 mmHg
50 mmHg
50 mmHg
tcpCO₂ Low Limit
30 mmHg
30 mmHg
30 mmHg
tcpCO₂ Alarms
On
On
On
Site Timer
4.0 hours
4.0 hours
4.0 hours
Disable Timer
Not Allowed
Not Allowed
Not Allowed
Heat Switch Off (i.e., after Site Timer elapsed)
No
No
No
Transducer Temp.
43.0°C
43.0°C
43.0°C
CO₂ Correction (Severinghaus)
On
On
On
MetabolismFactor
8 mmHg
8 mmHg
8 mmHg
tcGas Unit
mmHg
mmHg
mmHg
Temperature Unit
°C
°C
°C
tcpO₂ Color
Blue
Blue
Blue
tcpCO₂ Color
Green
Green
Green
Intravascular Oxygen Saturation
SO2 Settings
Factory Adult
Factory Pedi
Factory Neo
Low Limit
70%
70%
70%
HR High Limit
80%
80%
80%
Alarms
On
On
On
Light Intensity
On
On
On
Color
Yellow
Yellow
Yellow
Hb/Hct Entry
Hct [%]
Hct [%]
Hct [%]
Factor Entry
Disabled
Disabled
Disabled
SvO2 Settings
Factory Adult
Factory Pedi
Factory Neo
Low Limit
60%
60%
60%
High Limit
80%
80%
80%
Alarms
On
On
On
Light Intensity
On
On
On
Color
Yellow
Yellow
Yellow
Hb/Hct Entry
Hct [%]
Factor Entry
Disabled
447
37 Default Settings Appendix
ScvO2 Settings
Factory Adult
Factory Pedi
Factory Neo
Low Limit
70%
70%
70%
High Limit
80%
80%
80%
Alarms
On
On
On
Light Intensity
On
On
On
Color
Yellow
Yellow
Yellow
SvO2 Default Settings
SvO2 Settings
Factory Adult
Factory Pedi
Factory Neo
Low Limit
60%
60%
60%
High Limit
80%
80%
80%
Alarms
On
On
On
Light Intensity
On
On
On
Color
Yellow
Yellow
Yellow
Hb/Hct Entry
Hct [%]
Factor Entry
Disabled
ScvO2 Default Settings
ScvO2 Settings
Factory Adult
Factory Pedi
Factory Neo
Low Limit
70%
70%
70%
High Limit
80%
80%
80%
Alarms
On
On
On
Light Intensity
On
On
On
Color
Yellow
Yellow
Yellow
EEG Default Settings
EEG Settings
Factory Adult
Factory Pedi
Factory Neo
TP, SEF
On
On
On
MDF, PPF, Delta, Theta, Alpha, Beta
Off
Off
Off
SEF Threshold
90%
90%
90%
Numeric Average
8 sec
8 sec
8 sec
Wave Scale
100µV (or +/- 50µV if Show Gridlines is configured to Yes)
Show Gridlines
No
No
No
Low Filter
0.5 Hz
0.5 Hz
0.5 Hz
448
37 Default Settings Appendix
EEG Settings
Factory Adult
Factory Pedi
Factory Neo
High Filter
30 Hz
30 Hz
30 Hz
Impedance Limit
5 kOhm
5 kOhm
5 kOhm
Smoothing CSA
On
On
On
Color
Yellow
Yellow
Yellow
BIS Default Settings
Factory defaults H10/H20/H40
BIS Settings
H30 (deviations from H10/H20/H40)
Adult
Pedi
Neo
SQI
On
On
On
EMG
On
On
On
SR
On
On
On
SEF
Off
Off
Off
TP
Off
Off
Off
Bursts
On
On
On
Scale
100µV (or +/- 50µV if Show Gridlines is
configured to Yes)
Show Gridlines
No
No
No
Filters
On
On
On
Low Filter
2 Hz
2 Hz
2 Hz
High Filter
70 Hz
70 Hz
70 Hz
Adult
Pedi
Neo
Off
Off
Off
Notch Filter
On
On
On
High Limit
70
70
70
Low Limit
20
20
20
Alarms
On
On
On
Smoothing Rate
30 sec
30 sec
30 sec
15 sec
15 sec
15 sec
Color
Yellow
Yellow
Yellow
Magenta
Magenta
Magenta
VueLink Default Settings
Device Alarms
Ignored
Color
Green
449
Index
10-Electrode (5+5)Cable Sets 370
10-Electrode (6+4)Cable Sets 370
10-Lead Placement 120
3-Electrode Cable Sets 370, 371
3-Electrode One Piece Cables 372
4-Slot Flexible Module Rack (FMS-4) 16
5-Electrode Cable Sets 370, 372
5-Electrode One Piece Cables 372
6-Electrode Cable Sets 370
6-Lead Placement 119
Abdominal Breathing 160
Aberrantly-Conducted Beats 131
About Arrhythmia Monitoring 129
About Automatic Alarm Limits 59
About Compressed Spectral Arrays
(CSA) 252
About ECG Leads 116
About Electrode-to-Skin Impedance 251
About Label Sets 39
About QT/QTc Interval Monitoring 149
About Smart Alarm Delays 59, 169
About ST Monitoring 139
About the Rule of Six 338
About the ST Measurement Points 143
Accessing the Drug Calculator 338
Accessing the Setup C.O. and Setup CCO
Menus 197
Accessories 369
Accessories Compliant with EMC
Standards 425
Acknowledging Alarms 53
Acknowledging Disconnect INOPs 53
Activating the Cursor for Screen
Trends 279
Adjusting a Measurement Wave 37
Adjusting ST Measurement Points 143
Adjusting the Alarm Limits 170
Adjusting the Arrhythmia Alarm
Limits 136
Adjusting the Calibration Factor 186
Adjusting the CO2 Wave Scale 222
Adjusting the Desat Limit Alarm 171
Adjusting the iPC Audio Volume 46
Adjusting the Screen Brightness 43
Admitting a Centrally-Monitored
Patient 96
Admitting a Patient 95
Adult Mode 229
Adult/Pediatric Reusable Comfort Cuff
Kits 373
Adult/Pediatric Reusable Comfort
Cuffs 373
Adult/Pediatric Reusable EasyCare
Cuffs 373
Adult/Pediatric Single Patient Cuffs 374
Adult/Pediatric Single Patient, Soft
Cuffs 374
After Insertion 246
Alarm and Measurement Default
Settings 436
Alarm Behavior at Power On 62
Alarm Default Settings 436
Alarm Delays 169
Alarm Lamp 50
Alarm Latching Behavior 62
Alarm Limits 56
Alarm Limits Report 333
Alarm Message 50
Alarm Messages Window 60
Alarm Recordings 63
Alarm Reminder 54
Alarm Source Selection Disabled 157
Alarm Sources 176
Alarm Tone Configuration 51
Alarms 49
Alarms and Alarm Limits 230
Alarms/INOPs From External Devices 350
Alarms/INOPs from External Devices 345
All ECG Waves Recordings 319
Altitude Setting 393
Always Discharge Patients 316
Annotating Events 301
Aperiodic Trends Database 278
Applying the Sensor 165
Applying the tcGas Transducer 237
Arrhythmia Alarm Chaining 138
Arrhythmia Alarm Timeout Periods 136
Arrhythmia Alarms 135
Arrhythmia Alarms and Latching 136
Arrhythmia Beat Labels 132
Arrhythmia Options 130
Arrhythmia Relearn and Lead Fallback 135
Arrhythmia Relearning 134
Arrhythmia Status Messages 132
Assessing a Suspicious SpO2 Reading 168
Assigning a Telemetry Device and a
Monitor to One Patient 265
Assisting Venous Puncture 179
Atrial Fibrillation Alarm 131
Attaching and Removing the CO2
Transducer 219
Attaching the Flow Sensor 226
Audible Alarm Indicators 51
Authorized Clinician Review 313
Auto Detection Mode 160
Automatic Alarm Suppression 231
Automatic Arrhythmia Relearn 135
Automatic Purging 228
Automatic Unit Conversion 286
Automatic Value Substitution 286
Automatically Resolving Patient
Mismatch 105
Avoiding Electromagnetic Interference
(Resp and BIS) 425
Avoiding Pace Pulse Repolarization
Tails 114
Battery Accessories 386
Battery INOPs 73
BIS 424
BIS Accessories 385
BIS Continuous Impedance Check 259
BIS Cyclic Impedance Check 260
BIS Default Settings 447
BIS Impedance Indicators 261
BIS INOPs 87
BIS Manufacturer's Information 388
BIS Monitoring Setup 257
BIS Safety Information 262
BIS Window 260
Bright Alarm Limits 50
BSA Formula 286
449
C
C.O. Injectate Guidelines 206
C.O. INOPs 84
C.O./CCO Curve Alert Messages 207
C.O./CCO Prompt Messages 209
C.O./CCO Safety Information 210
C.O./CCO Warning Messages 209
Cableless Measurement Device INOPs 92
Calculated Values INOPs 92
Calculating Cerebral Perfusion
Pressure 191
Calculating Oxygen Extraction 247
Calculating Pulse Pressure Variation 191
Calculating SpO2 Difference 172
Calculating Temp Difference 182
Calculations 283
Calculations Pop-Up Keys 284
Calculations Windows 284
Calibrating NBP 179
Calibrating Reusable Transducer
CPJ840J6 189
Calibrating the tcGas Transducer 235
Calibrating the Transducer 219
Calibration Failure 236
Capture 12-Lead 123
Capture 12-Lead Pop-up Keys 125
Capturing and Deleting Loops 356
Capturing the 12-Lead ECG 123
Cardiac Output (C.O.) Accessories 381
Cardiac Output / Continuous Cardiac
Output 421
Cardiac Output Default Settings 443
Cardiac Output Report 335
Cardiac Overlay 159
Care and Cleaning 361
Care Group Alarms 110
Care Groups 105
Carrying out a Pre-insertion
Calibration 243
CCO Calibration Status Indicators 202
Central Recording 317
Changing a Screen's Content 32
Changing Alarm Limits 57
Changing awRR Alarm Limits 224
Changing CO2 Alarms 223
Changing Conditions 312
Changing CSA Settings 253
Changing ECG Wave Gain 321
Changing EEG Settings 253
Changing Filter Frequencies 254
450
Changing HR/Pulse Alarm Limits 157
Changing Lead Sets 117
Changing Loops Display Size 356
Changing Loops Type 357
Changing Measurement Labels (e.g.
Pressure) 39
Changing Measurement Settings 36
Changing Monitor Settings 42
Changing QTc Alarm Limits 153
Changing Resp Detection Modes 160
Changing ST Alarm Limits 145
Changing the Alarm Tone Volume 52
Changing the Apnea Alarm Delay 162, 223,
230
Changing the Averaging Time 168
Changing the BIS Smoothing Rate 261
Changing the Concentration of Inspired
O2 and the Inspired Agents 232
Changing the ECG Filter Settings 115
Changing the Hi-Res Trend Waves
Displayed 289
Changing the Impedance Limit 251
Changing the Lab Value Required for
Entry 246
Changing the Pressure Wave Scale 187
Changing the Scale of the EEG Wave 262
Changing the Scale of the EEG Waves for
Display 253
Changing the Scale of the ST Map 148
Changing the Screen Trend View 280
Changing the Selection of Screen Trends
Displayed 279
Changing the Size of the ECG Wave 114
Changing the Size of the Respiration
Wave 161
Changing the Speed of the EEG Wave 254
Changing the Speed of the Respiration
Wave 162
Changing the Temperature of the Inspired
Gas 232
Changing the Trending Interval 149
Changing the Type of Balance Gas 231
Changing The View To A Single Wave
Set 151
Changing the Volume of the QRS
Tone 115
Changing the Wave Group Speed 37
Changing The Wave Speed 38
Changing VueLink Waves and Numerics
Displayed 348
Changing Wave Speed for a Channel 37
Changing Wave Speeds 37
Changing Waves and Numerics
Displayed 344
Charting Infusion Progress 340
Checking Paced Status 112
Checking Printer Settings 329
Checking Report Status and Printing
Manually 330
Checking Suspicious Values 247
Checking The Sepsis Resuscitation Bundle
Window 314
Checking Transducer Accuracy 219
Checking Your Monitor Revision 43
Chest Electrode Placement 120
Choosing an ECG Lead for Arrhythmia
Monitoring 130
Choosing an EEG Electrode Montage 250
Choosing EASI or Standard Lead
Placement 116
Choosing Measured AWV
Components 231
Choosing Standard or Modified Electrode
Placement 122
Choosing the NBP Alarm Source 178
Choosing the Pressure Alarm Source 188
Cleaning the Monitor 362
Cleaning the Recorder Printhead (M1116B
only) 363
Cleaning the SO2 Optical Module 363
Cleaning, Sterilizing and Disinfecting
Monitoring Accessories 363
CO2 415
CO2 Default Settings 444
CO2 INOPs 82
Comparing Dynamic Compliance
Values 287
Configuration 170
Connecting Additional Displays to the
Monitor 33
Connecting an External Device 343, 348
Connecting ECG Cables 111
Connecting SpO2 Cables 166
Connecting the Optical Module 246
Connectors 390
Controlling the Telemetry Device from the
Bedside 267
Conventional 12-Lead ECG 121
Correcting the Measurement if Limb is not
at Heart Level 175
Counting Combi-Events 299
Counting Neonatal Event Review (NER)
Events 299
Country-Specific Default Settings 429
Creating and Changing Recordings
Templates 320
Current View 146
Dashed Lines on Reports 329
Data Exchange Between Information
Centers 102
Data Upload from an MMS 102
Default Profile 35
Default Settings Appendix 429
Defining the Column Interval Using the
NBP Measurement 277
Deriving Alarms From awRR 224
Determining a Pressure's Most Recent
Zero 185
Devices for Acquiring Measurements 15
Direct Connection - Automatic
Pairing 266
Disabling the tcGas Site Timer 235
Disabling Touchscreen Operation 26
Discharging a Patient 97
Disconnecting from Power 45
Disinfecting the Monitor 362
Display INOPs 75
Displaying A Clock On The Main
Screen 354
Displaying a Mean Pressure Value
Only 187
Displaying a Timer On The Main
Screen 353
Displaying an ST Reference Baseline 148
Disposing of Empty Calibration Gas
Cylinders 367
Disposing of the Monitor 367
Documenting Alarm Limits 60
Documenting an Event Episode 301
Documenting C.O. Measurements 206
Documenting Calculations 287
Documenting Drug Calculations 341
Documenting Event Review 301
Documenting Events 301
Documenting Loops 357
Documenting Trends 278
During Measurements 176
EASI ECG Lead Placement 125
EASI Electrode Placement 126
ECG Alarms Off Disabled 128
ECG and Arrhythmia Alarm Overview 126
ECG Lead Fallback 117
ECG Lead Placements 117
ECG Leads Monitored 117
ECG Reports 335
ECG Safety Information 128
ECG Source Tracking at the Information
Center 268
ECG, Arrhythmia, QT and ST INOPs 75
ECG, Arrhythmia, ST and QT Default
Settings 437
ECG, Arrhythmia, ST and QT
Monitoring 111
ECG/Arrhythmia/ST/QT 405
ECG/Resp Accessories 369
Ectopic Status Messages 133
Editing and Saving RH C.O.
Measurements 205
Editing Patient Information 97
Editing PiCCO C.O. Measurements 202
Editing the Wedge 193
EEG 423
EEG Accessories 385
EEG and Electrical Interference 255
EEG Default Settings 446
EEG INOPs 87
EEG Monitoring Setup 249
EEG Reports 254
EEG Safety Information 254
Electromagnetic Compatibility (EMC)
Specifications 425
Electromagnetic Emissions 425
Electromagnetic Immunity 425
Electrosurgery Interference/Defibrillation/
Electrostatic Discharge 428
EMC And Radio Regulatory
Compliance 393
Enabling Automatic Mode and Setting
Repetition Time 178
Enabling Sequence Mode and Setting Up
The Sequence 178
Ending The Sepsis Management
Bundle 315
Ending The Sepsis Resuscitation
Bundle 314
Enhanced Asystole Detection 128
Entering Measurements Manually 42
Entering the HemoCalc Window 198
Entering the Setup Pulse Menu 155
Entering Values for Calculations 286
Environmental Specifications 397
Event Episode Recordings 303
Event Episode Reports 305
Event Episode Window 300
Event Episodes 292
Event Groups 292
Event Notification 296
Event Recordings 301
Event Reports 304
Event Retriggering 295
Event Review Recordings 301
Event Review Reports 304
Event Review Window 300
Event Summary and Event Counter 298
Event Summary Reports 306
Event Summary Window 299
Event Surveillance 291
Event Triggers 294
Events Pop-Up Keys 293
Example Module (SpO2) 17
Examples 169
Expanded View 275
Extended Pressure Label Set 184
Extended Temperature Label Set 182
Extending Recordings 318
Extending the Alarm Pause Time 55
Extreme Alarm Limits for Heart Rate 127,
157
Extreme Alarm Limits for Pressure 188
Fast Transients/Bursts 428
Finishing tcGas Monitoring 238
Flashing Numeric 50
Flexible Module Rack (M8048A) 15
Freezing All Waves 38
Freezing An Individual Wave 38
Freezing Waves 38
Functions Available When the Telemetry
Data Window is Displayed 267
Further Information for Both Modules 247
Gas Compensation 229
General Points 361
General Telemetry-related Functions 268
Getting Started 43
Graphical Trend Presentation 277
Guidelines for PiCCO C.O. Injectate 206
Guidelines for Right Heart Thermodilution
C.O. Injectate 206
Hardkeys 29
Hemodynamic Parameters 195
High ETVI 206
High Resolution Trend Waves 289
451
Hi-Res Trend Wave Recordings 290
Hi-Res Trend Wave Scales 289
Hi-Res Trend Waves and OxyCRG 289
Histogram View 280
Horizon View 280
How are Yellow Arrhythmia Alarms
Indicated? 137
How Can You Combine Devices? 265
HR Alarms When Arrhythmia Analysis is
Switched Off 128
Hypotension Evaluation 312
Intravascular Oxygen Saturation 423, 445
Introducing the Monitor 13
Introducing the Oscillometric NBP
Measurement 173
Introduction 13
Invasive Pressure Accessories 375
Invasive Pressure Alarm Specifications 414
Invasive Pressure and Pulse 413
Invasive Pressure Default Settings 441
ISO/IEC Standard Audible Alarms 52
Ice-Bath Setup for RH Thermodilution
C.O. Measurements 205
Identifying tcGas Module
Components 233
Identifying the Pressure Analog Output
Connector 193
If You Set "On Measurement" Triggers 295
If You Set Use-defined Deviation
Triggers 295
If You Set User-defined Threshold
Triggers 295
If You Use Alarm Limits As Event
Triggers 295
Impedance Indicators 252
Indications For Use Of QT Interval
Monitoring 150
Indirect Connection - Manual Pairing 265
Initiating Arrhythmia Relearning
Manually 134
Injectate Volume, Patient Weight and
ETVI Values (PiCCO Only) 206
INOPs from the IntelliBridge Module 345
Inserting the Catheter 244
Inspecting the Cables and Cords 366
Inspecting the Equipment and
Accessories 365
Inspecting the Monitor 44
Installation Safety Information 390
IntelliBridge EC10 Module 343
IntelliBridge INOPs 90
IntelliVue 802.11 Bedside Adapter (Option
J35 Wireless Network Adapter) 394
IntelliVue Instrument Telemetry ISM
(2.4GHz) 394
IntelliVue Instrument Telemetry WMTS
(US only) 395
Intended Use 387
Interface Specifications 401
Interfering Gas and Vapor Effects On CO2
Measurement Values 418
Intermittent Bundle Branch Block 131
452
Label Compatibility 41
Laboratory Data 359
Lactate Measurement 312
Language Conflict with External Device
Drivers 345, 350
Latching Alarms 61
Lateral Chest Expansion 160
Lead Placement for Monitoring Resp 159
Left side of the Monitor 392
Levels of Event Surveillance 291
Limitations For Use Of QT Interval
Monitoring 150
Locked Profiles 36
M3012A Hemodynamic MMS
Extension 24
M3014A, M3015A, M3015B and M3016A
Capnography MMS Extensions 22
Main Screen Timer Pop-up Keys 354
Mainstream CO2 Accessories 382
Mainstream CO2 Accessories (for
M3016A) 383
Maintaining Recording Strips 322
Maintenance and Troubleshooting 365
Maintenance Task and Test Schedule 366
Major Parts and Keys 14
Making a Temp Measurement 181
Making Segment Settings 274
Making the In-Vivo Calibration 245
Making the Pressure Calibration 189
Managing Patients 95
Manual Detection Mode 161
Manual Purging 229
Manual Unit Conversion 286
Manually Resolving Patient Mismatch 103
Manufacturer's Information 259, 387
Measurement Limitations 174
Measurement Modes 174
Measurement Modules 16
Measurement of CO2 and Spirometry with
Neonates 384
Measurement Principles 214
Measurement Specifications 405
Measuring C. O. Using the PiCCO
Method 198
Measuring C.O. Using the Right Heart
Thermodilution Method 203
Measuring CO2 using M3014A or X2 214
Measuring Continuous Cardiac
Output 198
Measuring Frozen Waves 38
Measuring Mainstream CO2 using
M3016A 218
Measuring Microstream CO2 using
M3015A/B 220
Measuring Pulmonary Artery Wedge
Pressure 192
Measuring Pulse Pressure Variation 198
Measuring SpO2 166
Measuring Systemic Vascular
Resistance 198
Metabolism Correction for tcpCO2 239
Microstream CO2 Accessories 383
Minimum Volume for No Central
Monitoring INOP 52
Minimum Volume for Severe Yellow or Red
INOPs 52
MMS Extensions 21
MMS, MMS Extensions and FMS
INOPs 74
Modified 12-Lead ECG 122
Monitor INOPs 70
Monitor Mounting Precautions 393
Monitor Safety Specifications 393
Monitoring After a Power Failure 45
Monitoring Airway Flow, Volume and
Pressure 225
Monitoring BIS 257
Monitoring BIS using the BISx 258
Monitoring BIS Using the DSC and BIS
Engine 258
Monitoring Carbon Dioxide 213
Monitoring Cardiac Output 195
Monitoring EEG 249
Monitoring Intravascular Oxygen
Saturation 241
Monitoring Invasive Pressure 183
Monitoring NBP 173
Monitoring Paced Patients 113
Monitoring Pulse Rate 155
Monitoring Respiration Rate (Resp) 159
Monitoring SpO2 165
Monitoring tcGas 233
Monitoring Temperature 181
Monitoring the Sepsis Management Bundle
Recommendations 315
Monitoring the Sepsis Resuscitation Bundle
Recommendations 313
Moving Windows 26
NBP 412
NBP Accessories 372
NBP Default Settings 440
NBP INOPs 77
NBP Timestamp 176
Neonatal and Pediatric Modes 229
Neonatal/Infant Cuff Kits 375
Neonatal/Infant Single Patient Cuffs 374
Neonatal/Infant Single Patient, Soft
Cuffs 375
Networked Monitoring 45
New Patient Check 98
New/Dried Out Transducers 235
No. of Segments 275
Non-Physiological Artifact
Suppression 188
Notification 353
Nurse Call Systems 51
One-piece Cables 371
Operating and Navigating 24
Operating Modes 31
Optimizing Lead Placement for Resp 159
Optimizing Scale Settings 230
Optimizing the Waveform 187
Optimum Scale 275
Orientation On The Screen 310
Other Bed Pop-Up Keys 109
Other Reports 335
Overview of Recording Types 319
Pairing an X2 or MP5 With a Telemetry
Interface to a Host Monitor 267
Patient Alarm Messages 65
Patient Alarms and INOPs 65
Patient Category and Paced Status 96
Patient Mismatch - If Both Patient Data
Sets Are Correct 104
Patient Mismatch - If Neither Patient Data
Set is Correct 104
Patient Mismatch - If One Set of Patient
Data is Correct 103
Pausing or Switching Off Alarms 54
Performance Specifications 399
Performing a Light Intensity
Calibration 244
Performing Calculations 285
Performing Calculations for a Non-Specific
Drug 339
Performing Calculations for a Specific
Drug 339
Performing Drug Calculations 338
Performing In-Vivo Calibration 244, 247
Performing PiCCO C.O.
Measurements 201
Performing RH C.O. Measurements 205
Perfusion Change Indicator 171
Perfusion Numeric 171
Permanent Keys 26
Physical Specifications 395
Pleth Wave 171
Pop-Up Keys 29
Power Loss Tone 53
Power On/Power Off Behavior 44
Preparing to Measure Mainstream
CO2 215, 218
Preparing to Measure Microstream
CO2 221
Preparing to Measure NBP 175
Preparing to Measure Sidestream CO2 216
Preparing to Monitor with the M1011A
Narrow Module 246
Preparing to Monitor with the M1021A
Wide Module 242
Pressure INOPs 80
Previewing the Sepsis Management
Bundle 314
Printer Status Messages 331
Printing a Test Report 329
Printing an ST Map Report 149
Printing Hi-Res Trend Wave Reports 290
Printing Manually 331
Printing Patient Reports 325
Printing the 12-Lead ECG 124
Printing The QT Waves 152
Printout Location 325
ProtocolWatch 309
ProtocolWatch INOPs 92
Pulse Default Settings 438
Pulse INOPs 76
QRS Tone 157
QT Alarms 152
QT Measurement Algorithm 149
QT View 151
Quick Admitting a Patient 96
Quickstarting Recordings 318
Radio-translucent Cables 371
Realtime Report 334
Rear of the Monitor 391
Recommended Cables 369
Recommended Separation Distance 426
Recommended separation distances from
portable and mobile RF communication
equipment 427
Recorded Waveforms 322
Recorder Accessories 386
Recorder Status Messages 323
Recording 317
Recording Priorities 321
Recording ST Segments 142
Recording Strip 321
Recording Strip Code 321
Recording The QT Waves 152
Recording Without a Template 318
Reference Method 174
Releasing Frozen Waves 39
Reloading Paper 323
Remembraning the tcGas Transducer 235
Removing Exhaust Gases from the
System 218, 222
Resetting Arrhythmia Alarm Timeouts 55
Resetting the Timeout Period 137
Resolving Label Conflicts 40
Resolving Patient Information
Mismatch 102
Resp Detection Modes and Cardiac
Overlay 161
Resp INOPs 77
Resp Safety Information 162
Respiration 408
Respiration Default Settings 439
Respiratory Loops 355
Restart time 428
Restarting Paused Alarms 55
Restarting the tcGas SiteTimer 234
Review Alarms Window 60
Reviewing Alarms 60
Reviewing Calculations 285
453
Rhythm Status Messages 133
Right side of the Monitor 392
Run Time 352
Running a Car Seat Assessment Record 297
Safety and Performance Tests 424
Sample Report Printouts 332
Saving and Calibrating PiCCO C.O.
Measurements 202
Screen Trends 279
ScvO2 Default Settings 446
Selecting a Measurement Label 242
Selecting a Pressure for Monitoring 184
Selecting a Temperature for
Monitoring 181
Selecting Leads for ST Analysis 140
Selecting Positions of Va and Vb Chest
Leads (for 6-lead placement) 116
Selecting Screen Elements 25
Selecting the Active Alarm Source
ECG or Pulse? 156
Selecting the Primary and Secondary ECG
Leads 112
Selecting The QT Leads 150
Selecting the tcGas HeatPowerDisplay
Mode 238
Sepsis Management Bundle 314
Sepsis Resuscitation Bundle 313
Set Combiners and Organizers 371, 372
Setting Measurement and Period for
Histograms 277
Setting SpO2/Pleth as Pulse Source 172
Setting the Computation Constant 205
Setting the Date and Time 43
Setting the Gas Compensation Mode 231
Setting the Horizon 281
Setting the Horizon Trend Scale 281
Setting the Paced Status (Pace Pulse
Rejection) 114
Setting the QRS Volume 172
Setting The QT Baseline 151
Setting the Screen Trend Time 279
Setting the tcGas Barometric Pressure 235
Setting the tcGas Sensor Temperature 233
Setting the tcGas Site Timer 234
Setting the Time Period for the Trend
Indicator Arrow 281
Setting Triggers and Notification for
Advanced Event Surveillance 297
Setting Triggers for NER and Basic Event
Surveillance 296
454
Setting up all CO2 Measurements 222
Setting Up Auto Reports 327
Setting up CO2 Corrections 222
Setting Up ECG Reports 327
Setting Up Individual Print Jobs 328
Setting Up Reports 327
Setting up RH C.O. Measurements 204
Setting Up Source Device 357
Setting up Spirometry 230
Setting Up the 12-Lead ECG 124
Setting Up the In-Vivo Calibration 244,
245
Setting up the Modules 44
Setting Up the PiCCO C.O.
Measurement 200
Setting up the Pressure Measurement 183
Setting Up Timers 352
Setting Up Tone Modulation 172
Setting Up Trends 274
Setting Up Vital Signs and Graphic Trend
Reports 327
Severe Sepsis Screening 311
Short Range Radio Interface (MX600/700/
800 and 865244 Remote Control) 395
Showing/Hiding Loops 356
Shutting the iPC Down 47
Sidestream CO2 Accessories 382
Single- or Multi-lead ST Alarming 145
Skin Preparation for Electrode
Placement 111
SmartKeys 27
SO2 Accessories for M1011A 386
SO2 Accessories for M1021A 386
SO2 INOPs 83
Special Situations at Shutdown 47
Specifications 387
Spirometry 419
Spirometry Accessories 384
Spirometry Default Settings 444
Spirometry INOPs 89
Spirometry Values Window 230
SpO2 409
SpO2 Accessories 376
SpO2 Default Settings 439
SpO2 INOPs 79
SpO2 Sensors 165
SpO2 Signal Quality Indicator (Fast SpO2
only) 167
SSC Sepsis Protocol 309
ST Alarms 145
Standard 3-Lead Placement 118
Standard 5-Lead Placement 119
Standby Mode 31
Starting a Cyclic Impedance Check 260
Starting and Stopping Measurements 176
Starting and Stopping Recordings 317
Starting Monitoring 44
Starting Report Printouts 325
Starting the Different Types of Report 326
Starting the iPC 46
Sterilizing the Monitor 363
Stopping a Cyclic Impedance Check 260
Stopping Recordings 318
Stopping Reports Printouts 326
Storing and Sending the 12-Lead ECG 124
Storing tcGas Transducers 235
Supported Cables 371
Suppressing Sampling (not Mainstream
CO2) 223
Suppressing Zero Calibration 222
Suspending Telemetry Alarms 268
Suspending the Protocol for 24 Hours 311
SvO2 Default Settings 446
Swapping a Complete Profile 35
Swapping a Settings Block 35
Switching a Measurement On and Off 37
Switching All Yellow Arrhythmia Alarms
On or Off 136
Switching Arrhythmia Analysis On and
Off 130
Switching Between ST Map Views 148
Switching BIS and Individual Numerics On
and Off 262
Switching BIS Filters On or Off 262
Switching EEG Numerics On and Off 253
Switching Individual Arrhythmia Alarms
On and Off 136
Switching Individual QTc Alarms On and
Off 153
Switching Manually Entered Measurements
On and Off 42
Switching Numerics On and Off 37
Switching On 44
Switching Printers On Or Off for
Reports 329
Switching Pulse from NBP On/Off 179
Switching Pulse On and Off 156
Switching QT Monitoring On and Off 153
Switching ST On and Off 140
Switching to a Different Screen 32
Switching VueLink On and Off 349
Symbols 389
Synchronized Settings 269
System Pulse Source 155
Tabular View 280
tcGas 422
tcGas Accessories 385
TcGas Corrections 238
tcGas Default Settings 445
tcGas INOPs 86
Technical Alarm Messages (INOPs) 70
Telemetry Data Window 266
Telemetry INOPs 91
Temp 415
Temperature Accessories 380
Temperature Correction for tcpCO2 238
Temperature Default Settings 440
Temperature INOPs 78
Testing Alarms 62
The Events Database 298
Timer Counting Direction 353
Timer Label 352
Timer Setup Pop-up Keys 352
Timer Types 351
Timer Volume 353
To Change the Size of all the ECG
Waves 115
To Change the Size of an Individual ECG
Wave 115
To Discharge a Patient 97
To Pause All Alarms 54
To Switch All Alarms Off 54
To Switch Individual Measurement Alarms
On or Off 55
Trademark Acknowledgement 388
Traditional Audible Alarms (HP/Agilent/
Philips/Carenet) 51
Transferring a Centrally-Monitored
Patient 99
Transferring a Centrally-Monitored Patient
with X2 or MP5 100
Transferring a Centrally-Monitored Patient
with X2 or MP5 using IIT 100
Transferring a Patient with an X1 (no
Information Center) 101
Transferring a Patient with an X2 or MP5
(no Information Center) 101
Transferring Patients 98
Transferring Patients And Moving
Manually Between Phases 310
Trend Group 275
Trend Groups 275
Trend Interval 276
Trend Parameter Scales 276
Trend Priority 276
Trend Scales for Segment
Measurements 275
Trend View 147
Trending Multiple-Value
Measurements 279
Trends 271
Trends Databases 278
Trends Pop-Up Keys 272
Triggering Events Manually 297
Troubleshooting 367
Troubleshooting tcGas Calibration 237
Troubleshooting the Pressure
Calibration 190
Troubleshooting the Zero 186
Trunk Cables 369, 371
Two Or More Infection Signs Or
Symptoms Confirmed 312
Unavailable Printer
Re-routing Reports 330
Understanding Profiles 34
Understanding PVC-Related Alarms 139
Understanding Screens 32
Understanding Settings 36
Understanding SpO2 Alarms 168
Understanding the Arrhythmia
Display 132
Understanding the Care Group Overview
Bar 106
Understanding the ECG Display 112
Understanding the NBP Numerics 175
Understanding the Resp Display 160
Understanding the ST Display 141
Updating an ST Map Reference
Baseline 148
Updating ST Baseline Snippets 142
Updating The Frozen Wave 39
Use Models With Telemetry 269
Using a Mouse or Trackball 26
Using ECG Alarms 127
Using Input Devices with the iPC and
Monitor 47
Using Keys 26
Using Labels 39
Using Microstream Accessories 221
Using Pulse Alarms 156
Using Resp Alarms 162
Using Screens with External Device
Data 344
Using Standby 268
Using the C.O. Procedure Window 196
Using the Drug Calculator 337
Using the EEG Impedance/Montage
Window 250
Using the FilterLine and Airway
Adapter 221
Using the Integrated PC 46
Using the Loops Cursor 356
Using the On-Screen Calculator 31
Using the On-Screen Keyboard 30
Using the Remote Control 29
Using the Sidestream Sensor Holder 218
Using the SmartKeys Key 30
Using the tcGas Site Timer 234
Using the Titration Table 341
Using the Touchscreen 26
Using the Visitor Screen 34
Using the Wave Cursor 187
Using the X2 or MP5 with a Host
Monitor 47
Using the XDS Remote Display 34
Using the Zero Hardkey 186
Using Timers 351
Using VueLink Screens 349
Viewing All Alarm Limits 56
Viewing an ST Map 148
Viewing And Printing The Protocol
Log 316
Viewing and Silencing Telemetry Alarms at
the Bedside 267
Viewing Arrhythmia Waves 132
Viewing Calculations 284
Viewing Events 298
Viewing Graphic Trends 272
Viewing Histogram Trends 274
Viewing Individual Alarm Limits 56
Viewing Loops 355
Viewing Received Data 359
Viewing ST Maps 146
Viewing the Alarm Latching Settings 61
Viewing the IntelliBridge Device Data
Window 344
Viewing the iPC Desktop on the Monitor
Display 46
Viewing the My Care Group Window 107
Viewing the Other Bed Window 108
Viewing the Realtime 12-Lead ECG 123
Viewing the VueLink Device Data
Window 349
455
Viewing Timers 351
Viewing Trends 271
Viewing Vital Signs Trends 273
Visual Alarm Indicators 50
Visual Alarm Status Information in the
Other Bed Window 109
VueLink Default Settings 447
VueLink INOPs 90
VueLink Modules 347
Weight 206
What is a Timeout Period? 137
Where Can I Find More Information? 130,
150
While Alarms are Paused or Off 55
Working in the ST Map Task Window 148
X1 Connectors and Symbols 18
X1 Multi-Measurement Module
(M3001A) 17
X2 Controls and Indicators 20
X2 Left Side 21
X2 Multi-Measurement Module
(M3002A) 18
X2 Overview 19
X2 Patient Connectors, Right Side 21
Yellow Arrhythmia Alarms 136
Zero Calibration 228
Zeroing a Pressure Measurement 185
Zeroing All Pressures Simultaneously 186
Zeroing ICP (or IC1/IC2) 185
Zeroing the Pressure Transducer 184
Zeroing the tcGas Relative Heat Power 238
456

---

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