Philips Medical Systems North America SRRBV2 Single Short Range Radio Module User Manual

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Instructions for Use

IntelliVue Patient Monitor

MX800

Release H.0 with Software Revision H.0x.xx

Patient Monitoring

Draft

Part Number 453564208131

Printed in Germany 07/10

*453564208131*

1Table of Contents

1Introduction 13

Introducing the Monitor 13

Devices for Acquiring Measurements 14

Operating and Navigating 22

Operating Modes 29

Understanding Screens 31

Connecting Additional Displays to the Monitor 32

Using the XDS Remote Display 32

Using the Visitor Screen 33

Understanding Profiles 33

Understanding Settings 34

Changing Wave Speeds 36

Freezing Waves 36

Entering Measurements Manually 40

Changing Monitor Settings 41

Checking Your Monitor Revision 42

Getting Started 42

Disconnecting from Power 43

Networked Monitoring 44

Using the Integrated PC 44

Using the X2 or MP5 with a Host Monitor 46

2Alarms 47

Visual Alarm Indicators 48

Audible Alarm Indicators 49

Acknowledging Alarms 51

Pausing or Switching Off Alarms 52

Alarm Limits 54

Reviewing Alarms 58

Latching Alarms 59

Testing Alarms 60

Alarm Behavior at Power On 60

Alarm Recordings 61

3Patient Alarms and INOPs 63

Patient Alarm Messages 63

Technical Alarm Messages (INOPs) 68

4Managing Patients 93

Admitting a Patient 93

Quick Admitting a Patient 94

Editing Patient Information 95

Discharging a Patient 95

Transferring Patients 96

Data Upload from an MMS 100

Care Groups 103

5ECG, Arrhythmia, ST and QT Monitoring 109

Skin Preparation for Electrode Placement 109

Connecting ECG Cables 109

Selecting the Primary and Secondary ECG Leads 110

Checking Paced Status 110

Understanding the ECG Display 110

Monitoring Paced Patients 111

Changing the Size of the ECG Wave 112

Changing the Volume of the QRS Tone 113

Changing the ECG Filter Settings 113

Selecting Positions of Va and Vb Chest Leads (for 6-lead placement) 114

Choosing EASI or Standard Lead Placement 114

About ECG Leads 114

ECG Lead Fallback 115

ECG Lead Placements 115

Capture 12-Lead 121

EASI ECG Lead Placement 123

ECG and Arrhythmia Alarm Overview 124

Using ECG Alarms 125

ECG Safety Information 126

About Arrhythmia Monitoring 127

Switching Arrhythmia Analysis On and Off 128

Choosing an ECG Lead for Arrhythmia Monitoring 128

Understanding the Arrhythmia Display 130

Arrhythmia Relearning 132

Arrhythmia Alarms 133

About ST Monitoring 137

Switching ST On and Off 138

Understanding the ST Display 139

Updating ST Baseline Snippets 140

Recording ST Segments 140

About the ST Measurement Points 141

ST Alarms 143

Viewing ST Maps 144

About QT/QTc Interval Monitoring 147

QT Alarms 150

Switching QT Monitoring On and Off 151

6Monitoring Pulse Rate 153

Entering the Setup Pulse Menu 153

System Pulse Source 153

Switching Pulse On and Off 154

Using Pulse Alarms 154

7Monitoring Respiration Rate (Resp) 157

Lead Placement for Monitoring Resp 157

Understanding the Resp Display 158

Changing Resp Detection Modes 158

Changing the Size of the Respiration Wave 159

Changing the Speed of the Respiration Wave 160

Using Resp Alarms 160

Changing the Apnea Alarm Delay 160

Resp Safety Information 160

8Monitoring SpO2 163

SpO2 Sensors 163

Applying the Sensor 163

Connecting SpO2 Cables 164

Measuring SpO2 165

SpO2 Signal Quality Indicator (Fast SpO2 only) 165

Assessing a Suspicious SpO2 Reading 166

Changing the Averaging Time 166

Understanding SpO2 Alarms 166

Pleth Wave 169

Perfusion Numeric 169

Perfusion Change Indicator 169

Setting SpO2/Pleth as Pulse Source 170

Setting Up Tone Modulation 170

Setting the QRS Volume 170

Calculating SpO2 Difference 170

9Monitoring NBP 171

Introducing the Oscillometric NBP Measurement 171

Preparing to Measure NBP 173

Starting and Stopping Measurements 174

Enabling Automatic Mode and Setting Repetition Time 176

Enabling Sequence Mode and Setting Up The Sequence 176

Choosing the NBP Alarm Source 176

Switching Pulse from NBP On/Off 177

Assisting Venous Puncture 177

Calibrating NBP 177

10 Monitoring Temperature 179

Making a Temp Measurement 179

Calculating Temp Difference 180

11 Monitoring Invasive Pressure 181

Setting up the Pressure Measurement 181

Zeroing the Pressure Transducer 183

Adjusting the Calibration Factor 185

Displaying a Mean Pressure Value Only 185

Changing the Pressure Wave Scale 185

Optimizing the Waveform 185

Using the Wave Cursor 186

Non-Physiological Artifact Suppression 186

Choosing the Pressure Alarm Source 186

Calibrating Reusable Transducer CPJ840J6 187

Calculating Cerebral Perfusion 189

Calculating Pulse Pressure Variation 189

Measuring Pulmonary Artery Wedge Pressure 190

Editing the Wedge 191

Identifying the Pressure Analog Output Connector 192

12 Monitoring Cardiac Output 193

Hemodynamic Parameters 193

Using the C.O.Procedure Window 194

Accessing the Setup C.O. and Setup CCO Menus 195

Entering the HemoCalc Window 196

Measuring C. O. Using the PiCCO Method 196

Measuring C.O. Using the Right Heart Thermodilution Method 201

Documenting C.O. Measurements 204

C.O. Injectate Guidelines 204

C.O./CCO Curve Alert Messages 205

C.O./CCO Prompt Messages 207

C.O./CCO Warning Messages 207

C.O./CCO Safety Information 208

13 Monitoring Carbon Dioxide 211

Measurement Principles 212

Measuring CO2 using M3014A or X2 212

Measuring Mainstream CO2 using M3016A 216

Measuring Microstream CO2 using M3015A/B 218

Setting up all CO2 Measurements 220

14 Monitoring Airway Flow, Volume and Pressure 223

Attaching the Flow Sensor 224

Zero Calibration 226

Automatic Purging 227

Manual Purging 227

Gas Compensation 227

Setting up Spirometry 228

15 Monitoring tcGas 231

Identifying tcGas Module Components 231

Setting the tcGas Sensor Temperature 231

Using the tcGas Site Timer 232

Setting the tcGas Barometric Pressure 233

Remembraning the tcGas Transducer 233

Calibrating the tcGas Transducer 233

Applying the tcGas Transducer 235

Finishing tcGas Monitoring 236

TcGas Corrections 236

16 Monitoring Intravascular Oxygen Saturation 239

Selecting a Measurement Label 240

Preparing to Monitor with the M1021A Wide Module 240

Preparing to Monitor with the M1011A Narrow Module 244

Further Information for Both Modules 245

17 Monitoring EEG 247

EEG Monitoring Setup 247

Using the EEG Impedance/Montage Window 248

About Compressed Spectral Arrays (CSA) 250

Changing EEG Settings 251

EEG Reports 252

EEG Safety Information 253

EEG and Electrical Interference 253

18 Monitoring BIS 255

BIS Monitoring Setup 255

BIS Continuous Impedance Check 258

BIS Cyclic Impedance Check 258

BIS Window 259

Changing the BIS Smoothing Rate 260

Switching BIS and Individual Numerics On and Off 260

Changing the Scale of the EEG Wave 260

Switching BIS Filters On or Off 260

BIS Safety Information 261

19 Assigning a Telemetry Device and a Monitor to One Patient 263

How Can You Combine Devices? 263

Functions Available When the Telemetry Data Window is Displayed 265

General Telemetry-related Functions 266

Use Models With Telemetry 268

20 Trends 269

Viewing Trends 269

Setting Up Trends 272

Documenting Trends 276

Trends Databases 276

Screen Trends 277

21 Calculations 281

Viewing Calculations 282

Reviewing Calculations 283

Performing Calculations 283

Entering Values for Calculations 284

Documenting Calculations 285

22 High Resolution Trend Waves 287

Changing the Hi-Res Trend Waves Displayed 287

Hi-Res Trend Wave Scales 287

Hi-Res Trend Waves and OxyCRG 287

Printing Hi-Res Trend Wave Reports 288

Hi-Res Trend Wave Recordings 288

23 Event Surveillance 289

Levels of Event Surveillance 289

Event Groups 290

Event Episodes 291

Events Pop-Up Keys 292

Event Triggers 292

The Events Database 296

Viewing Events 296

Annotating Events 299

Documenting Events 299

24 ProtocolWatch 307

SSC Sepsis Protocol 307

25 Recording 315

Central Recording 315

Starting and Stopping Recordings 315

Overview of Recording Types 317

All ECG Waves Recordings 318

Creating and Changing Recordings Templates 318

Changing ECG Wave Gain 319

Recording Priorities 319

Recording Strip 319

Reloading Paper 321

Recorder Status Messages 321

26 Printing Patient Reports 323

Starting Report Printouts 323

Stopping Reports Printouts 324

Setting Up Reports 325

Setting Up Individual Print Jobs 326

Checking Printer Settings 327

Printing a Test Report 327

Switching Printers On Or Off for Reports 328

Dashed Lines on Reports 328

Unavailable Printer: Re-routing Reports 328

Checking Report Status and Printing Manually 329

Printer Status Messages 330

Sample Report Printouts 331

27 Using the Drug Calculator 337

Accessing the Drug Calculator 338

Performing Drug Calculations 338

Charting Infusion Progress 340

Using the Titration Table 341

Documenting Drug Calculations 341

28 IntelliBridge EC10 Module 343

Connecting an External Device 343

Changing Waves and Numerics Displayed 344

Viewing the IntelliBridge Device Data Window 344

Using Screens with External Device Data 344

Alarms/INOPs from External Devices 345

Language Conflict with External Device Drivers 345

29 VueLink Modules 347

Connecting an External Device 348

Changing VueLink Waves and Numerics Displayed 348

Viewing the VueLink Device Data Window 349

Using VueLink Screens 349

Switching VueLink On and Off 349

Alarms/INOPs From External Devices 349

Language Conflict with External Device Drivers 350

30 Using Timers 351

Viewing Timers 351

Timer Setup Pop-up Keys 352

Setting Up Timers 352

Displaying a Timer On The Main Screen 353

Displaying A Clock On The Main Screen 354

31 Respiratory Loops 355

Viewing Loops 355

Capturing and Deleting Loops 356

Showing/Hiding Loops 356

Changing Loops Display Size 356

Using the Loops Cursor 356

Changing Loops Type 357

Setting Up Source Device 357

Documenting Loops 357

32 Laboratory Data 359

Viewing Received Data 359

33 Care and Cleaning 361

General Points 361

Cleaning the Monitor 362

Disinfecting the Monitor 362

Sterilizing the Monitor 363

Cleaning, Sterilizing and Disinfecting Monitoring Accessories 363

Cleaning the SO2 Optical Module 363

Cleaning the Recorder Printhead (M1116B only) 363

34 Maintenance and Troubleshooting 365

Inspecting the Equipment and Accessories 365

Inspecting the Cables and Cords 366

Maintenance Task and Test Schedule 366

Troubleshooting 367

Disposing of the Monitor 367

Disposing of Empty Calibration Gas Cylinders 367

35 Accessories 369

ECG/Resp Accessories 369

NBP Accessories 373

Invasive Pressure Accessories 375

SpO2 Accessories 376

Temperature Accessories 380

Cardiac Output (C.O.) Accessories 381

Mainstream CO2 Accessories 382

Sidestream CO2 Accessories 382

Mainstream CO2 Accessories (for M3016A) 383

Microstream CO2 Accessories 383

Spirometry Accessories 384

tcGas Accessories 385

EEG Accessories 385

BIS Accessories 386

SO2 Accessories for M1021A 386

SO2 Accessories for M1011A 387

Recorder Accessories 387

Battery Accessories 387

36 Specifications 389

Intended Use 389

Manufacturer's Information 389

Symbols 391

Installation Safety Information 392

Monitor Mounting Precautions 395

Altitude Setting 395

Monitor Safety Specifications 395

EMC And Radio Regulatory Compliance 395

Physical Specifications 397

Environmental Specifications 399

Performance Specifications 401

Interface Specifications 404

Measurement Specifications 408

Safety and Performance Tests 427

37 Default Settings Appendix 433

Country-Specific Default Settings 433

Alarm and Measurement Default Settings 440

Alarm Default Settings 440

ECG, Arrhythmia, ST and QT Default Settings 441

Pulse Default Settings 442

Respiration Default Settings 443

SpO2 Default Settings 443

NBP Default Settings 444

Temperature Default Settings 445

Invasive Pressure Default Settings 445

Cardiac Output Default Settings 447

CO2 Default Settings 448

Spirometry Default Settings 449

tcGas Default Settings 449

SO2 Default Settings 450

SvO2 Default Settings 450

ScvO2 Default Settings 450

EEG Default Settings 451

BIS Default Settings 451

VueLink Default Settings 452

Index 453

1Introduction

These Instructions for Use are for clinical professionals using the IntelliVue MX800 patient monitor.

This basic operation section gives you an overview of the monitor and its functions. It tells you how to

perform tasks that are common to all measurements (such as entering data, switching a measurement

on and off, setting up and adjusting wave speeds, working with profiles). The alarms section gives an

overview of alarms. The remaining sections tell you how to perform individual measurements, and

how to care for and maintain the equipment.

Familiarize yourself with all instructions including warnings and cautions before starting to monitor

patients. Read and keep the Instructions for Use that come with any accessories, as these contain

important information about care and cleaning that is not repeated here.

This guide describes all features and options. Your monitor may not have all of them; they are not all

available in all geographies. Your monitor is highly configurable. What you see on the screen, how the

menus appear and so forth, depends on the way it has been tailored for your hospital and may not be

exactly as shown here.

In this guide:

•A warning alerts you to a potential serious outcome, adverse event or safety hazard. Failure to

observe a warning may result in death or serious injury to the user or patient.

•A caution alerts you to where special care is necessary for the safe and effective use of the

product. Failure to observe a caution may result in minor or moderate personal injury or damage

to the product or other property, and possibly in a remote risk of more serious injury.

Introducing the Monitor

The IntelliVue MX800 patient monitor offers a monitoring solution optimized for the high-end

surgical, cardiac, medical and neonatal care environments. Combining patient surveillance and data

management, it allows multi-measurement monitoring by linking separate modules. The MX800 uses

the touch screen as primary input device and has a remote control for convenient access to the five

main keys and numeric data input.

The monitor stores data in trend, event, and calculation databases. You can see tabular trends (vital

signs) and document them on a printer. You can view measurement trend graphs, with up to three

measurements combined in each graph, to help you identify changes in the patient's physiological

condition. You can view fast-changing measurement trends with beat to beat resolution and see up to

four high resolution trend segments. Event surveillance enhances documentation and review of

physiologically significant events by automatically detecting and storing up to 50 user-defined clinical

events over a 24 hour period.

1 Introduction

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

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 391.

WARNING

When connecting devices for acquiring measurements, always position cables and tubing carefully to

avoid entanglement or potential strangulation.

1Color coded alarm lamps

2Alarms Off lamp

3Power on/Standby switch with

integrated LED: Green - On/

Standby, Red - Error

4AC power LED

5Mounting quick-release lever

(when this is pressed the

monitor is not fixed on the

mounting)

6Part number and serial number

1 Introduction

Flexible Module Rack (M8048A)

The flexible module rack (FMS) lets you use up to eight plug-in physiological measurement modules.

The maximum number of specific module types that can be used simultaneously in an FMS is: five

pressure modules, four temperature modules, four VueLink or IntelliBridge modules (any

combination).

Connect the FMS to the monitor via the measurement link cable (MSL). Use the MSL connector on

the left-hand side to connect an additional MMS. Use the connector on the right to connect to the

monitor.

Measurement Modules

You can use up to eight measurement modules with the Flexible Module Rack (M8048A). Available

modules are:

• Invasive blood pressure (M1006B)

• Temperature (M1029A)

• Oxygen saturation of arterial blood (SpO2) (M1020B)

• Cardiac output (M1012A), and Continuous cardiac output with M1012A Option #C10

• Transcutaneous gas (M1018A)

• Mixed venous oxygen saturation - SvO2 (M1021A)

• Intravascular Oxygen Saturation - ScvO2 or SvO2 (M1011A)

• Recorder (M1116B)

• VueLink device interface (M1032A)

• IntelliBridge EC10

• EEG (M1027A)

• Bispectral Index - BIS (M1034A)

• Spirometry (M1014A)

You can plug in and unplug modules during monitoring. Insert the module until the lever on the

module clicks into place. Remove a module by pressing the lever upwards and pulling the module out.

A measurement automatically switches on when you plug the module in, and switches off when you

unplug it. Reconnecting a module to the same monitor restores its label and measurement settings,

such as alarms limits. If you connect it to a different monitor, the module remembers only its label.

1X1 Multi-Measurement Module

2Multi-Measurement Module

mount

3Flexible Module Rack

4Power on LED

5Interruption indicator

1 Introduction

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)

X1 Multi-Measurement Module (M3001A)

The X1 Multi-Measurement Module (MMS) can simultaneously monitor 3-, 5-, 6- or 10-lead ECG

(including arrhythmia and ST monitoring), respiration, SpO2, NBP and either invasive pressure or

temperature.

You can connect it to the monitor via a cable or mount it on the left side of the FMS.

1Module name

2Setup key LED

3Setup key to enter setup menu of measurement modules or

external device data window. Some modules have a second

module-specific key next to this one, for example Zero.

4Connector socket for patient cable/transducer

1 Introduction

X1 Connectors and Symbols

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.

The X2 has the added capability to operate as a stand-alone monitor, and can be powered by a

rechargeable battery. This makes it particularly suited to transport situations. When the X2 is

disconnected from the original host monitor, it continues to monitor the patient as a stand-alone

monitor running on battery power, eliminating the need for a separate transport monitor. When the

X2 is connected to a new host monitor, it resumes its role as MMS, ensuring fully continuous

monitoring. For details of using the X2 as a stand-alone monitor, refer to the IntelliVue X2 Instructions

for Use.

When connected to a host monitor (Companion Mode is indicated), the X2 takes power from the

host, including that required for battery charging. The X2 can also be powered by AC mains when not

connected to a host monitor using the optionally available external power supply (M8023A). See the

IntelliVue X2 Instructions for Use for details.

1White ECG/Resp connector

2Blue SpO2 connector

3Red NBP connector

4Combined pressure (red) and temperature

(brown) connector - connect either invasive

pressure transducer or temperature probe.

You might have a version of the MMS that

does not have this connector.

5NBP STAT key - starts NBP STAT series

of measurements

Zero key - initiates a zero procedure for the

connected pressure transducer when

pressed and held for a second

6NBP Start/Stop key - starts or stops NBP

measurements

7Silence: acknowledges all active alarms by

switching off audible alarm indicators and

lamps

1 Introduction

X2 Overview

X2 Controls and Indicators

1External power LED. Green when monitor is powered from an external power source.

2Battery status LED. Yellow when charging. Flashing red when battery is empty.

3On/Standby LED. Green when monitor is on. Red indicates an error.

4On/Standby switch. Disabled when X2 is connected to a host monitor

1On/Standby switch

2Power and battery indicators (see “X2

Controls and Indicators” on page 18)

33.5-inch TFT LCD touchscreen QVGA

display

4Alarm lamps (see “X2 Controls and

Indicators” on page 18)

5Battery eject button

6Hard keys (see “X2 Controls and

Indicators” on page 18)

7Measurement connectors (see “X2 Patient

Connectors, Right Side” on page 19)

8Battery compartment

1 Introduction

5Main Screen key: closes all open menus/windows and returns to the main screen.

6SmartKeys key: brings up SmartKeys on the screen.

7Alarms key: turns alarms On/Off, or pauses them.

8Silence key

9Active alarm lamp. Red or yellow, depending on alarm level. Blinks until active alarm is

acknowledged.

10 Active INOP alarm lamp in light blue. Blinks until active INOP is acknowledged.

11 Alarms off indicator. When alarms are suspended, the lamp is red, and the alarms off symbol is

shown.

X2 Patient Connectors, Right Side

Showing symbols version (international) - English version has text labels

X2 Left Side

1Pressure (option)

2Temperature (option)

3Noninvasive blood pressure

4SpO2

5ECG sync pulse output

6ECG/Respiration

7CO2 (option in place of Pressure and Temperature)

1Loudspeaker

2MSL Connector. Connects to the external power

supply or a host monitor via the MSL cable for AC

mains operation, battery charging, and

communication with a network.

1 Introduction

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.

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

1Pressure connectors (red)

2Temperature connector (brown)

3Mainstream/sidestream connector CO2

4Cardiac 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.

The optional M3016A Mainstream CO2 extension adds mainstream capnography and optionally either

pressure or temperature to the MMS.

When a capnography extension is connected to an X2 MMS with CO2, the CO2 from the extension

will be automatically deactivated in favor of the one in the X2. If you prefer to use the CO2

measurement on the extension, you can activate it via the measurement selection key (see “Resolving

Label Conflicts” on page 38).

M3015A M3015B

1Pressure connectors (red) - M3015A optional

2Temperature connector (brown) - M3015A optional

3Inlet

4Microstream connector CO2

5Gas sample outlet

M3016A

1Pressure connectors (red)

2Temperature connector (brown)

3Mainstream/sidestream connector CO2

(optional)

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

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.

1Cardiac Output (orange; optional)

2Connection to MMS

3Pressure connectors (red)

4Temperature connectors (brown)

1 Introduction

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.

Monitor information line Other screen elements

1network connection indicator

(documented in Information

Center Instructions for Use)

10 alarm status area - shows active alarm messages

2bed label 11 status line - shows information messages and prompting you for action

3patient identification 12 close all open menus and windows and return to main screen

4patient category 13 enter Main Setup menu

5paced status 14 scroll right to display more SmartKeys

6date and time 15 SmartKeys - these change according to your monitor's configuration

7access the Profiles menu 16 scroll left to display more SmartKeys

8current screen name/enter

Change Screen menu 17 Pause Alarms - pauses alarm indicators. Pause duration depends on monitor

configuration. If pause duration is infinite, this key is labeled Alarms Off. Select again

to immediately re-enable alarm indicators.

9adjust alarm volume/level

indicator 18 Silence - acknowledges all active alarms by switching off audible alarm indicators and

lamps permanently or temporarily, if alarm reminder (ReAlarm) is configured on.

1 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,

1Select the title of the window and keep your finger on the title, or the mouse button pressed.

2Move your finger on the Touchscreen, or move the mouse, to move the window.

3Take your finger off the screen, or release the mouse button, to place the window in the final

position.

The new position is only active until the window or menu is closed. Not all locations on the screen can

be a target position, a window cannot overlap the monitor info line, the alarms and INOPs or the

status line.

Using 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.

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

stop automatic or STAT NBP

measurement and measurement series

start NBP measurement and

measurement series

stop current NBP measurement

start veni puncture (inflate cuff to

subdiastolic pressure)

set the NBP repeat time

1 Introduction

access patient reports zero invasive pressure transducer

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

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.

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

Using the Remote Control

The remote control provides you with direct access to five hard keys, a navigation knob and a numeric

keypad:

The remote control can be used with a USB cable connection to the monitor or without a cable using

short range radio. When used without a cable, the remote control must be assigned to the monitor.

The assignment is made in Configuration mode.

When using a remote control without a cable, it is important that the user knows which remote control

is assigned to which monitor. Use the tethering cable delivered with the remote control to attach it to a

bed rail or IV pole, or label the remote control with the bed or monitor ID.

Hardkeys

1Silence - acknowledges all active alarms by switching off audible alarm indicators and lamps.

Behavior follows the Silence permanent key configuration.

2Alarms Off/Pause Alarms- pauses alarm indicators. Behavior follows the Pause Alarms

permanent key configuration.

3Main Screen - close all open menus and windows and return to the main screen.

4SmartKeys - display a block of SmartKeys specially configured for remote tasks (see below)

5Back - go back one step to the previous menu.

Keypad

6 Type numeric data on the keypad and press the Enter key to enter the data on the monitor.

Navigation knob

7 Rotate the knob to highlight screen elements, then press to select the highlighted element.

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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.

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:

1Select the Main Setup menu.

2Select Operating Modes and choose the mode you require.

Your monitor has four operating modes. Some are passcode protected.

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•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.

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.

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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

1To switch to a different Screen, select the current Screen name in the monitor info line, or select

the Change Screen SmartKey.

2Choose the new Screen from the pop-up list.

Changing a Screen's 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,

1Select the element you want to change.

2From the menu that appears, select Change Wave, Change Numeric, or ChangeHiResTrend, and

then select the wave or numeric you want, or select the high-resolution trend wave you want from

the list of available waves.

If you do not see Change Numeric in the menu, this Screen may be configured to always display

the numeric beside its wave. Changing the wave will automatically change the numeric.

The changed Screen is shown with an asterisk in the monitor info line.

In the Change Screen menu, the changed Screen is shown linked to the original Screen and marked

with an asterisk.

Up to three modified Screens can be accessed via the Change Screen menu.

To recall Screens, either

• select the name of the Screen in the Change Screen menu

• 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.

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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:

1Move the highlight to the Main Screen key and then turn one click further.

The highlighting moves to a special "jump" field at the edge of the Screen.

2Press the navigation knob on the remote control to confirm; the highlighting will automatically

move to the other display.

The content of each Screen can be changed individually as described in the previous section. If you are

operating two displays, you can choose Screens for both displays from one location:

1Select Profiles in the monitor info line of the first display,

2Select Display 1, or Display 2, then select the Screen you want to appear on that display from the

list of available Screens.

When two displays are mounted next to each other or one above the other, a special Screen can be

assigned which spans across both displays. The Screen content for these Tall and Wide Screens can

then use the increased area available with two displays. These Screens appear in the Screen list with a

special Tall Screen or Wide Screen symbol.

Certain windows (for example: cardiac output procedure) can only be shown on one display at a time.

If you try to open one of these windows when it is already shown on another display, you will see a

blank gray window with a cross through it.

Using the XDS Remote 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.

1 Introduction

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.

•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).

•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.

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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

1Select Profiles in the monitor info line, or select the Profiles SmartKey.

2In the Profiles menu, select Profile.

3Chose a profile from the pop-up list.

4Confirm your selection.

Swapping a Settings Block

1Select Profiles in the monitor info line, or select the Profiles SmartKey.

2In the Profiles menu, select Display or Measmnt.Settings or Monitor Settings to call up a list of

the settings blocks in each category.

3Choose a settings block from the pop-up list.

4Confirm your selection.

Default 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.

Locked Profiles

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,

Some profiles are locked, so that you cannot change them, even in Configuration Mode.

These are indicated by this lock symbol.

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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.

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.

1Enter the measurement's setup menu and select the measurement.

2Select the measurement name to switch between on and off. The screen display indicates the active

setting.

Switching Numerics On and 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.

1 Introduction

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,

1Select Main Setup, then select User Interface

2Select Global Speed, RespiratorySpeed, or EEG Speed as required

3Select a value from the list of available speeds.

Changing Wave Speed for a Channel

To change the wave speed of an individual wave channel,

1Enter the Wave menu for a measurement by selecting its wave.

2Select Change Speed.

3To set the speed to the wave group speed, select RespiratorySpeed, EEG Speed, or Global Speed.

To set an individual channel speed, select a numeric value from the list of available speeds. This

overrides the wave group speed setting and set the speed for the individual wave channel on the

monitor Screen. The wave channel speed is independent of the wave (label) depicted in the

channel, if you change the wave, the new wave will retain the set channel speed.

Freezing 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,

1Enter the Wave menu for the measurement by selecting the wave on the screen.

2Select Freeze Wave.

The realtime wave is replaced with the frozen wave.

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Freezing All Waves

To freeze all waves on the screen,

1Select the Freeze Waves SmartKey.

All realtime waves are replaced with frozen waves.

Measuring Frozen Waves

To measure a frozen wave,

1Select the frozen wave.

If you are using touch, this automatically positions the vertical cursor. The cursor can be

repositioned by touching the required point on the wave, or

2Using the SpeedPoint or another pointing device or touch: use the right/left arrow keys to move

the vertical cursor.

The vertical cursor moves through the time axis and the current value is displayed next to the

cursor.

3Use the up/down arrow keys to activate and move the horizontal cursor.

The horizontal cursor measures the wave value, which is displayed above the cursor line. If the

wave is a pressure wave, the cursor value can be stored as a systolic, diastolic or mean pressure

value; if the pressure wave is a PAP wave it can also be stored as a PAWP value; for pressure waves

P, P1 to P8 it can also be stored as an IAP value. The stored value appears in the trend database as

a manually entered value.

Changing The Wave 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.

To change the wave speed:

1Select the frozen wave.

2Select Change Speed.

3Select a speed from the list.

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),

1Enter the wave menu of the measurement.

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2Select Label.

3Choose a label from the list.

The monitor automatically applies the scale, color, etc. settings stored in the Profile for the label you

select. You can change scale settings in Monitoring Mode, but color can only be changed in the

monitor's Configuration Mode.

Any labels already being used in the monitor are shown "grayed-out" in the list and cannot be selected.

About Label 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 in this Instructions for Use on Pressure and Temp for

more information.

If you connect an MMS from a monitor using a Full label set to an IntelliVue monitor using a

Restricted label set or an M3/M4 monitor, any additional labels switch to labels available in the target

monitor. This may cause a label conflict with other monitored measurements.

Be aware that connecting a monitor using the Full label set to an Information Center with certain

software revisions may affect the availability of measurement information from the additional labels on

the Information Center. See the Information Center documentation and your monitor's Configuration

Guide for information on label set compatibility.

Resolving Label 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.

1 Introduction

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.

Any measurement labels causing a label conflict are shown in red. If a measurement device is

connected but currently unavailable, for example, because it was deactivated due to a label conflict, the

device is shown "grayed-out".

When an X2 or MP5 is connected to a host monitor, the measurement selection window looks like

this:

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:

1Select the measurement selection key or select Main Setup, then Meas. Selection to display the

Measurement Selection window.

2Select the device whose label you want to correct.

3Use the measurement selection pop-up keys to resolve the conflict. Select either:

–Change Label: to assign a different label to the conflicting label

De-activated devices are grayed-out (here

the Temp measurement on the left)

X2 connected to host monitor MP5 connected to host monitor

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–De- Activate: to disable the conflicting device. It retains its label for future use but becomes

invisible to the monitor, as though it had been unplugged. When the device has been

deactivated the question marks under the measurement selection key will be replaced by XXX.

–Setup <Measurement Label>: to enter the Setup menu for the measurement and change the

conflicting device's label to a different label.

–Modify Driver (VueLink/IntelliBridge only): - to modify the device driver setup to disable the

conflicting device's label.

Label 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.

If it is critical that the measurement labels are available at the Information Center and after transfers,

the older monitors and the Information Center must be upgraded to the appropriate software revision.

Updating The Frozen Wave

To update the wave, that is freeze the current wave:

1Select the frozen wave.

2Select Freeze Again.

Releasing Frozen Waves

To release frozen waves,

1Select a frozen wave.

2Select Unfreeze Waves.

All frozen waves are released.

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,

1Select the Enter Values SmartKey or select Main Setup then select Enter MeasValues.

2Select the measurement you want to enter values for. The Edit window will open.

3If the measurement is switched off, switch it on by selecting the label.

4Select Value and enter the value.

5Select Date/Time to enter the date and time for the value. The default is always the current date

and time.

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6For compound labels, for example ABPs, ABPd and ABPm, select the Format field to select

whether all values are required or a single value.

7Select Save.

When a manually entered value has been configured to display as a numeric on the screen, you can also

enter a new value for this measurement by selecting the numeric, then selecting Enter MeasValues.

Manually entered measurement values are marked with a * on the display, in trends, and so forth. Each

measurement has a defined measurement interval after which a value becomes invalid (no value is then

displayed). Values can be entered up to two hours after they have been measured or up to the

measurement interval, if this is shorter.

The list of measurement labels which appears in the Enter Measurement Values window is set in

Configuration Mode.

No values can be entered manually on a monitor in companion mode when it is connected to a host

monitor.

Switching Manually Entered Measurements On and Off

To switch a manually entered measurement on or off,

1Select the Enter Values SmartKey or select Main Setup then select Enter MeasValues.

2Select the measurement you want to switch on or off.

3Select the measurement label field to switch between On and Off.

Changing Monitor 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.

Adjusting the Screen Brightness

1Select the Brightness SmartKey.

2Select the appropriate setting for the screen brightness. 10 is the brightest, 1 is the least bright.

Optimum is suitable for most monitoring locations and optimizes power usage for battery

powered monitors.

Your monitor may be configured with a lower brightness for Standby mode and also (for battery

powered monitors) for transport to conserve battery power. These settings can only be changed in the

monitor's Configuration Mode.

If you are using a monitor with an external display, the Brightness SmartKey does not adjust the

brightness of this display. See the instructions supplied with the external display for instructions.

Setting the Date and Time

1Select the Date, Time screen element from the monitor's info line to enter the Date, Time menu.

2Select, in turn, the Year, Month, Day, Hour (in 24 hour format, only) and Minute as necessary.

Select the correct values from the pop-up list.

1 Introduction

3Select 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

1Select Main Setup then select Revisions to open the Monitor Revision menu.

2Select the correct device from the device pop-up keys.

3From the Monitor Revision menu, select the monitor component for which you need revision

information.

Getting 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).

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.

1Before you start to make measurements, carry out the following checks on the monitor including

all connected MMSs, modules, or MMS extensions.

– Check for any mechanical damage.

– Check all the external cables, plug-ins and accessories.

2Plug the power cord into the AC power source.

3Check all the functions of the instrument that you need to monitor the patient, and ensure that the

instrument is in good working order.

Switching On

Press the power on/standby switch on the monitor for one second. The monitor performs a self test

and is then ready to use. If you see a message such as CO₂ SENS.WARMUP wait until it disappears

before starting to monitor that measurement. Connected devices usually take their power from the

monitor. External devices such as gas monitors and those connected via VueLink/IntelliBridge have

their own power switches.

1 Introduction

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

1Decide which measurements you want to make.

2Connect the required modules, MMSs, or MMS extensions.

3Check that you have the correct patient cables and transducers plugged in. The connectors are

color-coded to the patient cables and transducers for easy identification.

Starting Monitoring

After you switch on the monitor,

1Admit your patient to the monitor.

2Check that the profile, alarm limits, alarm and QRS volumes, patient category and paced status and

so forth are appropriate for your patient. Change them if necessary.

3Refer to the appropriate measurement chapter for further details of how to perform the

measurements you require.

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.

1 Introduction

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 263.)

If your monitor is connected to a network, a network symbol is displayed in the upper left corner next

to the bed label. To see details about the Care Group, the monitoring equipment, and technical

information about the network,

• in the monitor info line, select the bed label.

Be aware that some network-based functions may be limited for monitors on wireless networks in

comparison to those on wired networks.

Printout functionality and data export are not guaranteed when using a standard hospital network.

Using the Integrated 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:

1 Introduction

1Select Main Setup then Internal PC.

2In the Internal PC menu, select Switch PC On to start the iPC.

Viewing the iPC Desktop on the Monitor Display

If the Desktop is not displayed on the monitor display:

1Select the iPC icon, or

2Select Main Setup ÎInternal PC ÎShow 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.

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. Sharing input

devices and touchscreen input requires a specific software application; refer to the XDS/iPC

Instructions for Use for details.

If the iPC is switched off when input devices are shared, any input devices connected to it will not be

available for use with the monitor.

Shutting the iPC 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,

1Select Main Setup then Internal PC.

2In the Internal PC menu, select Switch PC Off.

If there is a problem with the shutdown, and you need to switch off the iPC manually,

1Select Main Setup then Internal PC.

2In the Internal PC menu, select Force PC Off to force the iPC to power down.

Special Situations at Shutdown

• If you switch the monitor off and then on again immediately, the iPC will continue running and

will not be shut down.

1 Introduction

• 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.

• 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.

2Alarms

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.

2Alarms

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:

2Alarms

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.

INOP Lamp Color On Off

Yellow 1.0 seconds 1.0 seconds

Red 0.25 seconds 0.25 seconds

2Alarms

• 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.

2Alarms

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 . If the

monitor is configured to re-alarm, a dashed check mark will be shown .

If the condition that triggered the alarm is still present after the alarm has been acknowledged, the

alarm message stays on the screen with a check mark symbol beside it, except for NBP alarms and

alarms from other intermittent measurements. When such an alarm is acknowledged the alarm

message disappears.

If the alarm condition is no longer present, all alarm indicators stop and the alarm is reset.

Switching off the alarms for the measurement in alarm, or switching off the measurement itself, also

stops alarm indication.

Acknowledging Disconnect 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.

2Alarms

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,

1Select Main Setup, Alarms, then Alarm Settings

2Check 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.

2Alarms

To Switch Individual Measurement Alarms On or Off

1Select the measurement numeric to enter its setup menu.

2Select Alarms to switch between on and off.

The alarms off symbol is shown beside the measurement numeric.

While Alarms are Paused or Off

• The red Alarms Paused lamp on the monitor front panel is lit.

In the alarm field, the monitor displays the message ALARMS PAUSED 1:28 or ALARMS OFF,

together with the alarms paused symbol or the alarms off symbol.

• No alarms are sounded and no alarm messages are shown.

• INOP messages are shown but no INOP tones are sounded.

The only exceptions are the INOPs CUFF NOT DEFLATED, NBP CUFF OVERPRESS and INOPs

relating to empty, missing and malfunctioning batteries.

These INOPs switch the alarms on, and the INOP tones are sounded, even if alarms are paused or

off. You need to remove the INOP condition first before you can switch the alarm tones off again.

• The nurse call relay is not active.

If a disconnect INOP is present and alarms are paused or switched off, the measurement in question

may be switched off, depending on monitor configuration.

Restarting Paused 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.

Alarms Paused

Alarms Off

2Alarms

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.

To extend the alarm pause time to five or 10 minutes,

1Select one of the alarm fields. This calls up the Alarm Messages window.

2Select either the pop-up key PauseAl. 5 Min or the pop-up key PauseAl. 10 Min. Each time you

select one of these pop-up keys, the Alarm Pause Time is reset to five (or 10) minutes.

Alarm 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.

2Alarms

1Measurement labels, with alarms off symbol where appropriate

2Current alarm limits

3Graphic 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,

1In the measurement's setup menu, select the alarm limit you want to change. This calls up a list of

available values for the alarm limit.

2Select a value from the list to adjust the alarm limit.

Alternatively, you can use the keys in the measurement alarm limits window, which you access by

selecting the measurement label in the Alarm Limits window.

2Alarms

To change alarm limits,

1Enter the Alarm Limits window.

2Using touch: to set the high alarm limit, select the high yellow alarm field to open a pop-up list of

high alarm limits. Select a limit from the list. Repeat to set the low yellow alarm field.

Using a SpeedPoint or Navigation Point: position the cursor in the high yellow alarm field,

then press the knob inwards. Rotate the knob to the left or right to adjust the limit. Press the knob

again to set the displayed limit. Repeat to set the low yellow alarm limit.

If you set the yellow alarm limit outside the red alarm limit, the monitor will automatically adapt the

red alarm limit.

When an ST measurement is in the alarm limits window there are also two pop-up keys available

labeled All ST Narrow/All ST Wide. With these keys you can set Auto Limits for all ST Leads.

1Parameter label

2High red alarm (view only)

3High yellow alarm field. Select to open a pop-up list of high alarm limits

4Alarms On/Off key - select to switch between alarms on or off

5Preview Alarm AutoLimits for a measurement before applying

6Select to apply wide AutoLimits

7Select to apply narrow AutoLimits

8Low yellow alarm field. Select to open a pop-up list of low alarm limits

9Low 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

2Alarms

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 non-

pathological range. Outside of this range, no auto limits are calculated. To set values outside of the

non-pathological range, limits must be changed manually, based on the clinician's judgment about the

specific patient.

Limits Narrow sets limits close to the currently measured values for situations where it is critical for

you to be informed about small changes in your patient's vital signs.

Limits Wide sets limits further away from the currently measured values for situations where small

changes are not so critical.

Use the keys in the measurement alarm limits window to apply AutoLimits for individual

measurements. These keys are not available if AutoLimits have been disabled for the measurement in

the monitor's Configuration Mode.

AutoLimits are not available for all measurements. The list of measurements for which AutoLimits can

be used is defined in the monitor's Configuration mode.

Use the measurement alarm limits window to check AutoLimits before you apply them to ensure that

they are appropriate for your individual patient and their clinical condition. Once applied, AutoLimits

are shown on the monitor screen just like manually-set alarm limits. If the AutoLimits are not

appropriate for your patient, you must set alarm limits manually. The limits remain unchanged until

you set them again or change them manually.

About Smart Alarm 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.

1Wide alarm limits

2Narrow alarm limits

3Alarm Limits

4Measurement value

2Alarms

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.

2Alarms

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

1In the monitor's Main Setup menu, select Alarms.

2Select Alarm Settings, and see the Visual Latching and Audible Latching settings.

This setting can only be changed in Configuration Mode. You should be aware of the settings chosen

for your unit. There are three possible choices each for visual and audible latching, red, red and yellow,

and off. These choices can be combined to give the following settings:

Visual Latching Audible Latching

Red&Yellow Red&Yellow

Red&Yellow Red Only

Red&Yellow Off

Red Only Red Only

Red Only Off

Off Off

2Alarms

Alarm Latching Behavior

All INOPs are non-latching. See “Yellow Arrhythmia Alarms” on page 134 for information on one-

star 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.

Red & Yellow Measurement

Alarms

Non-latching alarms Visual and audible

latching

Visual latching,

audible non-latching

Alarm has not

been

acknowledged.

Alarm condition

still present.

Alarm tone on. Alarm

lamp on. Alarm

message. Flashing

numerics.

Alarm tone on. Alarm

lamp on. Alarm

message. Flashing

numerics.

Alarm tone on. Alarm

lamp on. Alarm

message. Flashing

numerics.

Alarm condition

no longer present.

All audible and visual

alarm indicators

automatically stop.

Alarm tone on.

Alarm lamp on.

Alarm message.

Flashing numerics.

Alarm message.

Flashing numerics.

Audible alarm indicators

automatically stop.

Alarm has been

acknowledged.

Alarm condition

still present.

Alarm tone off. Alarm

lamp off. Alarm

message. Flashing

numerics. Audible alarm

reminder (if configured).

Alarm tone off. Alarm

lamp off. Alarm

message. Flashing

numerics. Audible alarm

reminder (if configured).

Alarm tone off. Alarm

lamp off. Alarm

message. Flashing

numerics. Audible alarm

reminder (if configured).

Alarm condition

no longer present.

Audible and visual alarm

indicators automatically

stop.

Audible and visual alarm

indicators automatically

stop.

Audible and visual alarm

indicators automatically

stop.

2Alarms

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.

1Press the Main Setup SmartKey.

2Select Alarms from the Main Setup menu.

3Select Alarm Recording from the Alarms menu to open the Alarm Recordings menu.

4Select a measurement from those listed for which you want to change the alarm condition that

triggers an alarm recording. This opens a pop-up list.

5For the desired measurement(s), choose the alarm condition to trigger an alarm recording:

Red Only: an alarm recording will automatically be triggered when the measurement enters a red

alarm condition.

Red&Yellow: both yellow and red alarms will trigger an alarm recording.

Off: disables automatic alarm recording.

Refer to the Recording chapter for details of how to set up a recording.

2Alarms

3Patient 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

asystole threshold (in the absence of Vfib or

chaotic ECG)

numeric flashes, red alarm lamp,

alarm tone

** awRR HIGH CO2, Resp, AGM The airway respiration rate has exceeded the

high alarm limit.

numeric flashes and high limit is

highlighted, yellow alarm lamp,

alarm tone

3 Patient Alarms and INOPs

** awRR LOW CO2, Resp, AGM The airway respiration rate has dropped below

the low alarm limit.

numeric flashes and low limit is

highlighted, yellow alarm lamp,

alarm tone

** BIS HIGH BIS The Bispectral Index value has exceeded the

high alarm limit.

numeric flashes and high limit is

highlighted, yellow alarm lamp,

alarm tone

** BIS LOW BIS The Bispectral Index value has dropped below

the low alarm limit.

numeric flashes and low limit is

highlighted, yellow alarm lamp,

alarm tone

** CCO HIGH

** CCI 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

SpO2The SpO2 value has fallen below the

desaturation alarm limit. xx denotes the lowest

measured value, and yy is the desaturation limit.

numeric flashes, red alarm lamp,

alarm tone

** EC10 ALARM

*** EC10 ALARM

at Information Center

EC10 Intellibridge A yellow (**) or red (***) patient alarm is

present on the IntelliBridge module. Check the

monitor display for more detailed alarm

information.

(on monitor) yellow or red alarm

lamp; the alarm text is defined by

the Intellibridge device driver

** etCO₂ HIGH CO2, Resp, AGM The end tidal CO2 high alarm limit has been

exceeded.

numeric flashes and high limit is

highlighted, yellow alarm lamp,

alarm tone

** etCO₂ LOW CO2, Resp, AGM The end tidal CO2 value has fallen below the

low alarm limit.

numeric flashes and low limit is

highlighted, yellow alarm lamp,

alarm tone

** etO₂ HIGH O2, AGM The end tidal O2 high alarm limit has been

exceeded.

numeric flashes and high limit is

highlighted, yellow alarm lamp,

alarm tone

** etO₂ LOW O2, AGM The end tidal O2 value has fallen below the low

alarm limit.

numeric flashes, and low limit is

highlighted, yellow alarm lamp,

alarm tone

* EVENT

** EVENT

*** 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

Group>

** EVENT:<Event

Group>

*** EVENT:<Event

Group>

Event surveillance An event has occurred and the event

notification is configured to alarm.

event group name flashes, yellow or

red alarm lamp and alarm tone

Alarm Message From Condition Indication

3 Patient Alarms and INOPs

*** EXTREME BRADY ECG The bradycardia limit has been exceeded. numeric flashes and alarm limit is

highlighted, red alarm lamp, alarm

tone

** HR LOW ECG The heart rate has fallen below the low alarm

limit.

numeric flashes and low limit is

highlighted, yellow alarm lamp,

alarm tone. If configured to short

yellow, the sound switches off after

5 seconds if Arrhythmia is switched

on.

* IRREGULAR HR

** IRREGULAR 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

HR>120bpm no beat detected for one second

(non-paced patients only).

numeric flashes, yellow alarm lamp,

short yellow audible alarm

* MULTIFORM PVCs

** MULTIFORM PVCs

ECG/Arrhythmia Two differently shaped Vs detected, each

occurring at least twice within the last 300 beats

and at least once within the last 60 beats.

numeric flashes, yellow alarm lamp,

short yellow audible alarm

** NBP HIGH NBP The measured NBP value is above the high

alarm limit.

s, d, or m after the label indicates whether the

systolic, diastolic or mean pressure has crossed

the limit.

numeric flashes and high limit is

highlighted, yellow alarm lamp,

alarm tone

** NBP LOW NBP The measured NBP value is below the low

alarm limit.

s, d, or m after the label indicates whether the

systolic, diastolic or mean pressure has crossed

the limit.

numeric flashes and low limit is

highlighted, yellow alarm lamp,

alarm tone

* NON-SUSTAIN VT

** NON-SUSTAIN 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

ventricular contractions, followed by a non-

ventricular contraction has been detected.

numeric flashes, yellow alarm lamp,

short yellow audible alarm

* PAUSE

** PAUSE

ECG/Arrhythmia No beat detected for a period greater than the

pause threshold.

numeric flashes, yellow alarm lamp,

short yellow audible alarm

*** <Press Label> HIGH PRESS The measured pressure value is above the

extreme high alarm limit.

s, d, or m after the label indicates whether the

systolic, diastolic or mean pressure has crossed

the limit.

numeric flashes, high limit is

highlighted, red alarm lamp, alarm

tone

** <Press Label> HIGH PRESS The measured pressure value is above the high

alarm limit.

s, d, or m after the label indicates whether the

systolic, diastolic or mean pressure has crossed

the limit.

numeric flashes, high limit is

highlighted, yellow alarm lamp,

alarm tone

Alarm Message From Condition Indication

3 Patient Alarms and INOPs

*** <Press Label> LOW PRESS The measured pressure value is below the

extreme low alarm limit.

s, d, or m after the label indicates whether the

systolic, diastolic or mean pressure has crossed

the limit.

numeric flashes and low limit is

highlighted, red alarm lamp, alarm

tone

** <Press Label> LOW PRESS The measured pressure value is below the low

alarm limit.

s, d, or m after the label indicates whether the

systolic, diastolic or mean pressure has crossed

the limit.

numeric flashes and low limit is

highlighted, yellow alarm lamp,

alarm tone

** Pulse HIGH PRESS, SpO2The pulse rate has exceeded the high alarm

limit.

numeric flashes and high limit is

highlighted, yellow alarm lamp,

alarm tone

** Pulse LOW PRESS, SpO2The pulse rate has dropped below the low

alarm limit.

numeric flashes and low limit is

highlighted, yellow alarm lamp,

alarm tone

* PVCs/min HIGH

** PVCs/min 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

more than 5 minutes

numeric flashes, yellow alarm lamp,

alarm tone

* R-ON-T PVCs

** R-ON-T PVCs

ECG/Arrhythmia For HR <100, a PVC with R-R interval < 1/3

the average interval followed by a

compensatory pause of 1.25 x average R-R

interval or two such Vs without compensatory

pause occurring within 5 minutes of each other.

(When HR >100, 1/3 R-R interval is too short

for detection.).

numeric flashes, yellow alarm lamp,

short yellow audible alarm

** RR HIGH RESP The respiration rate has exceeded the high

alarm limit.

numeric flashes and high limit is

highlighted, yellow alarm lamp,

alarm tone

** RR LOW RESP The respiration rate has dropped below the low

alarm limit.

numeric flashes and low limit is

highlighted, yellow alarm lamp,

alarm tone

* RUN PVCs HIGH

** RUN PVCs HIGH

ECG/Arrhythmia A run of PVCs greater than 2 was detected. numeric flashes, yellow alarm lamp,

short yellow audible alarm

** <SO₂ Label> HIGH SvO2/SO2The the measured intravascular oxygen

saturation has exceeded the high limit.

numeric flashes and high alarm

limit is highlighted, yellow alarm

lamp, alarm tone

** <SO₂ Label> LOW SvO2/SO2The measured intravascular oxygen saturation

has fallen below the low limit.

numeric flashes and low alarm limit

is highlighted, yellow alarm lamp,

alarm tone

** <SpO₂ Label> HIGH SpO2The arterial oxygen saturation has exceeded the

high alarm limit.

numeric flashes and high limit is

highlighted, yellow alarm lamp,

alarm tone

** <SpO₂ Label> LOW SpO2The arterial oxygen saturation has fallen below

the low alarm limit.

numeric flashes and low limit is

highlighted, yellow alarm lamp,

alarm tone

** ST-<n> HIGH ECG/ST The ST elevation in lead <n> is higher than the

limit.

numeric flashes and high alarm

limit is highlighted, yellow alarm

lamp, alarm tone

Alarm Message From Condition Indication

3 Patient Alarms and INOPs

** ST-<n> LOW ECG/ST The ST depression in lead <n> is lower than

the limit.

numeric flashes and low alarm limit

is highlighted, yellow alarm lamp,

alarm tone

* SVT

** SVT

ECG/Arrhythmia A run of supraventricular beats greater than the

SVT run limit has been detected and the HR

has exceeded the SVT HR limit.

numeric flashes, yellow alarm lamp,

alarm tone

** Tblood HIGH C.O. The blood temperature value has exceeded the

high alarm limit.

numeric flashes, high alarm limit is

highlighted, yellow alarm lamp,

alarm tone

** Tblood LOW C.O. The blood temperature value has fallen below

the low alarm limit.

numeric flashes, low alarm limit is

highlighted, yellow alarm lamp,

alarm tone

** tcpO₂ HIGH

** tcpCO₂ 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

system. The specific alarm cause is indicated in

the alarm message in the Telemetry Data

Window.

yellow or red alarm lamp and alarm

tone

** <Temp Label> HIGH TEMP The temperature has exceeded the high alarm

limit.

numeric flashes and high limit is

highlighted, yellow alarm lamp,

alarm tone

** <Temp Label> LOW TEMP The temperature has fallen below the low alarm

limit.

numeric flashes and low limit is

highlighted, yellow alarm lamp,

alarm tone

* VENT BIGEMINY

** VENT BIGEMINY

ECG/Arrhythmia A dominant rhythm of N, V, N, V (N =

supraventricular beat, V = ventricular beat) was

detected.

numeric flashes, yellow alarm lamp,

short yellow audible alarm

*** VENT FIB/TACH ECG A fibrillatory waveform for 4 consecutive

seconds was detected.

numeric flashes, red alarm lamp,

alarm tone

* VENT RHYTHM

** VENT 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 =

supraventricular beat, V = ventricular beat) was

detected.

numeric flashes, yellow alarm lamp,

short yellow audible alarm

*** VTACH ECG, Arrhythmia Ventricular tachycardia has been detected

(Consecutive PVCs exceed V-Tach Run limit

and HR exceeds V-Tach HR limit).

numeric flashes, red alarm lamp,

alarm tone

** VueLink ALARM

*** VueLink 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

for more than 5 minutes

numeric flashes, yellow alarm lamp,

alarm tone

Alarm Message From Condition Indication

3 Patient Alarms and INOPs

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

***BRADY/P xxx<yyy

***BRADY xxx < yyy

Press, SpO2The heart rate from the Pulse signal has fallen

below the bradycardia limit. xxx denotes the

lowest measured value; yyy is the bradycardia

limit.

numeric flashes and alarm limit is

highlighted, red alarm lamp, alarm

tone

***<Pressure>

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 <n>,<n> ECG/ST The ST depression or elevation is outside of

the limit in two or more leads <n> and <n>

numeric flashes, yellow alarm lamp,

alarm tone

**ST 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

***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

Alarm Message From Condition Indication

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.

3 Patient Alarms and INOPs

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 grey 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.

INOP Message, Indication What to do

3 Patient Alarms and INOPs

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:<Timer

Label>

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.

INOP Message, Indication What to do

3 Patient Alarms and INOPs

Battery INOPs

INOP Message, Indication What to do

Batt 1 MISSING

Batt 2 MISSING

INOP tone

During this INOP, alarms cannot

be paused or switched off.

The monitor requires two batteries but can detect only one battery. Insert the missing battery

immediately.

Batt 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.

If the condition persists and the monitor is not connected to mains power, this INOP is re-issued two

minutes after you acknowledge it.

BATT EXTENSN 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.

Place the battery in a different monitor or in a battery charger. If the same INOP is shown, contact

your service personnel.

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.

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 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 re-

issued two minutes after you acknowledge it.

Place the batteries in a different monitor or in a battery charger. If the same INOP is shown, contact

your service personnel.

Charge Batt 1 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.

3 Patient Alarms and INOPs

MMS, MMS Extensions and FMS INOPs

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

!!INSERT BATTERY

Severe yellow INOP tone

During this INOP, alarms cannot

be paused or switched off.

X2/MP2 only: There is no battery in the battery compartment. You cannot operate the monitor on

AC mains while the battery compartment is open (not sealed with a battery). Load a battery

immediately.

MSL Power High The power consumption of the devices connected to the Battery Extension is too high. If this

situation continues, the Battery Extension will be switched off. Contact your service personnel.

MSL Power Off The power consumption of the devices connected to the Battery Extension was too high for too long.

The Battery Extension has been switched off. Contact your service personnel

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.

3 Patient Alarms and INOPs

Display INOPs

ECG, Arrhythmia, QT and ST INOPs

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.

INOP Message, Indication What to do

Indep.Dsp Malfunc. There is a problem with the Independent Display. Check the MSL coupling cable then contact your

service personnel.

Indep.Dsp NotSupp. The monitor does not support a second main display. The monitor software is incompatible. Contact

your service personnel.

Intell.Dsp Malf. There is a problem with the Intelligent Display. Check the MSL coupling cable then contact your

service personnel.

Intell.Dsp Missing The monitor has lost contact with the connected Intelligent Display. Contact your service personnel.

Intell.Dsp Unsupp. The monitor does not support the connected Intelligent Display. The monitor software is

incompatible.

INOP Message, Indication What to do

C LEAD 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 ECG The arrhythmia algorithm cannot reliably analyze the ECG data. Check the ECG signal quality of the

selected primary and secondary leads. If necessary, improve lead position or reduce patient motion.

If you have arrhythmia analysis on, and you are not getting a reliable HR because the signal is below a

minimum amplitude, unstable, or contains artifact, and you have tried to improve the system

performance by choosing another lead and changing electrodes, you should consider turning

arrhythmia analysis off.

CANNOT ANALYZE QT The QT algorithm cannot generate a valid QT value for more than 10 minutes, or 1 minute in the

initial phase.

3 Patient Alarms and INOPs

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 <ECG

Lead>

The ECG signal from the named ECG electrodes [RA, LA, LL, RL, V (or C)] is noisy. Check the ECG

connections and make sure that the electrode indicated is attached.

ECG EQUIP MALF

Numeric is replaced by -?-

INOP tone

Contact your service personnel.

The ECG hardware is faulty.

<ECG Lead> LEAD OFF

!! <ECG Lead> LEAD OFF

!!! <ECG Lead> 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 <ECG lead> [RA, LA, LL, RL, V or C] electrodes is attached. In

EASI mode, all 5 electrodes must be connected.

ECG LEADS OFF

!! ECG LEADS OFF

!!!ECG LEADS 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.

LA LEAD OFF

Numeric is replaced by -?- for 10

seconds.

INOP tone

The LA electrode has become detached from the patient or the lead set has been changed. Reattach

the electrode or select New Lead Setup in the Setup ECG menu to confirm the new lead set.

LL LEAD OFF

Numeric is replaced by -?- for 10

seconds.

INOP tone

The LL electrode has become detached from the patient or the lead set has been changed. Reattach the

electrode or select New Lead Setup in the Setup ECG menu to confirm the new lead set.

RA LEAD 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.

RL LEAD OFF

Numeric is replaced by -?- for 10

seconds.

INOP tone

The RL electrode has become detached from the patient or the lead set has been changed. Reattach

the electrode or select New Lead Setup in the Setup ECG menu to confirm the new lead set.

SOME ECG ALRMS OFF This message appears (if configured to do so) when the on/off settings of the yellow arrhythmia

alarms differ from the current Profile.

V LEAD OFF

Numeric is replaced by -?- for 10

seconds.

INOP tone

The V electrode (IEC: C electrode) has become detached from the patient or the lead set has been

changed. Reattach the electrode or select New Lead Setup in the Setup ECG menu to confirm the

new lead set.

INOP Message, Indication What to do

3 Patient Alarms and INOPs

Pulse INOPs

Resp INOPs

NBP 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.

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.

INOP Message, Indication What to do

!! CUFF NOT DEFLAT

!!!CUFF NOT DEFLAT

Numeric is displayed with a -?-

Severe yellow/red INOP tone

During this INOP, alarms cannot

be paused or switched off.

Remove the cuff from the patient. Make sure that the tubing is not kinked or twisted and that the

correct patient category is selected. Try repeating the measurement.

You can silence the INOP, but the INOP message remains visible until the next NBP measurement is

started or the Stop All SmartKey is selected.

[Adult or pediatric patients: The NBP cuff pressure has exceeded 15 mmHg (2kPa) for more than 3

minutes.

Neonatal patients: The NBP cuff pressure has exceeded 5mmHg (0.7kPa) for more than 90 seconds.]

!! CUFF OVERPRESS

!!!CUFF OVERPRESS

Numeric displayed with -?-

Severe yellow/red INOP tone

During this INOP, alarms cannot

be paused or switched off.

The NBP cuff pressure exceeds the overpressure safety limits. Remove the cuff from the patient. Make

sure that the tubing is not kinked or twisted and that the correct patient category is selected. Try

restarting the measurement.

You can silence this INOP, but the INOP message remains visible until the next measurement is

started or the Stop All SmartKey is selected.

3 Patient Alarms and INOPs

Temperature INOPs

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.

INOP Message, Indication What to do

T1, T2, T3, T4 INOPs See <Temp Label> INOPs

Tamb INOPs See <Temp Label> INOPs

Tart INOPs See <Temp Label> INOPs

Tcereb INOPs See <Temp Label> INOPs

Tcore INOPs See <Temp Label> 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.

<Temp Label> EQUIP

MALF

Numeric is replaced by -?-

INOP tone

Contact your service personnel.

The temperature hardware is faulty.

<Temp Label> 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.

[The temperature is less than -1°C, or greater than 45°C.]

3 Patient Alarms and INOPs

SpO2 INOPs

UNPLUGGED

INOP tone

A Temp measurement label has been deactivated, either by unplugging a module, or by deactivating

the label in the Measurement Selection window.

The measurement automatically disappears from the display.

To switch the measurement on again, either replug the module or reactivate the measurement label in

the Measurement Selection window.

Tesoph INOPs See <Temp Label> INOPs

Tnaso INOPs See <Temp Label> INOPs

Trect INOPs See <Temp Label> INOPs

Tskin INOPs See <Temp Label> INOPs

Ttymp INOPs See <Temp Label> INOPs

Tven INOPs See <Temp Label> INOPs

Tvesic INOPs See <Temp Label> INOPs

INOP Message, Indication What to do

<SpO₂ Label>

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.

<SpO₂ Label> EQUIP MALF

Numeric is replaced by -?-

INOP tone

The MMS or module is faulty. Unplug and replug the MMS or module. If the INOP persists, contact

your service personnel.

<SpO₂ Label> 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.

<SpO₂ Label>

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.

<SpO₂ Label>

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.

<SpO₂ Label> 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.

<SpO₂ Label> NO SENSOR

Numeric is replaced by -?-

INOP tone

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.

<SpO₂ Label> NOISY SIGN.

Numeric is replaced by -?-

INOP tone

Excessive patient movement or electrical interference is causing irregular pulse patterns. Try to reduce

patient movement or to relieve the cable strain on the sensor.

3 Patient Alarms and INOPs

Pressure INOPs

<SpO₂ Label> NON-

PULSAT.

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.

<SpO₂ Label> POOR

SIGNAL

Numeric is replaced by -?-

(questionable numeric)

The signal condition of the SpO2 measurement is poor and measurement accuracy may be

compromised.

<SpO₂ Label> PULSE?

Numeric is replaced by -?-

INOP tone

The detectable pulsations of the SpO2 signal are outside the specified pulse rate range.

<SpO₂ Label> SEARCHING

Numeric unavailable

SpO2 is analyzing the patient signal to derive Pulse, SpO2 and Perf values. Please wait until the search

analysis is complete.

<SpO₂ Label> 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.

<SpO₂ Label> 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.

<SpO₂ Label>

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.

<SpO₂ Label>

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.

The measurement automatically disappears from the display.

To switch the measurement on again, either replug the module or reactivate the measurement label in

the Measurement Selection window.

<SpO₂ Label> UPGRADE

Numeric is replaced by -?-

Numeric is unavailable

The SpO2 measurement is currently in upgrade mode. Monitoring is not possible in this mode.

INOP Message, Indication What to do

ABP INOPs See <Press Label> INOPs

Ao INOPs See <Press Label> INOPs

ART INOPs See <Press Label> INOPs

BAP INOPs See <Press Label> 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.

CVP INOPs See <Press Label> INOPs

3 Patient Alarms and INOPs

FAP INOPs See <Press Label> INOPs

IC1 / IC2 INOPs See <Press Label> INOPs

ICP INOPs See <Press Label> INOPs

LAP INOPs See <Press Label> INOPs

P / P1 / P2 / P3 / P4 INOPs See <Press Label> INOPs

PAP INOPs See <Press Label> INOPs

PPV BAD <Press Label>

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.

<Press Label> ARTIFACT

Numeric questionable

A non-physiological event (flush or blood sample) is detected. A resulting limit alarm or non-pulsatile

INOP will be suppressed.

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.

<Press Label> EQUIP

MALF

Numeric is replaced by -?-

INOP tone

Contact your service personnel.

The pressure hardware is faulty.

<Press Label> 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.

<Press Label> 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.

<Press Label> NON-

PULSATILE

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.

<Press Label> 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.

INOP Message, Indication What to do

3 Patient Alarms and INOPs

CO2 INOPs

ZERO+CHECK CAL

Numeric is replaced by -?-

Perform a zero and check the calibration of the transducer.

RAP INOPs See <Press Label> INOPs

UAP INOPs See <Press Label> INOPs

UVP INOPs See <Press Label> 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.

3 Patient Alarms and INOPs

SO2 INOPs

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.

CO₂ SENS.WARMUP

Numeric is replaced by -?-

Microstream CO2: INOP tone

Mainstream CO2: no INOP tone

Wait until the sensor reaches operating temperature and the INOP disappears.

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.

INOP Message, Indication What to do

<SO₂ Label> CAL FAILED

Numeric is replaced by -?-

INOP tone

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 in-

vivo calibration.

<SO₂ Label> 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.

<SO₂ Label> 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.

<SO₂ Label> 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.

3 Patient Alarms and INOPs

<SO₂ Label> 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.

<SO₂ Label> INCOMPAT.

INOP tone

The SO2 Module or Optical Module is not supported. Contact your service personnel.

<SO₂ Label> IN-VIVO CAL The in-vivo calibration is not yet complete. Lab values must be stored to the Optical Module to

complete the calibration. Either continue with the next steps of the current calibration or recall the

previous calibration.

<SO₂ Label> LOW 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.

<SO₂ Label> NO OPTMOD

Numeric is replaced by -?-

INOP tone

Connect the Optical Module. If the INOP persists, try another Optical Module. Silencing this INOP

switches the measurement off.

<SO₂ Label> 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.

<SO₂ Label> PRE-INS CAL

Numeric is replaced by -?-

INOP tone

The pre-insertion calibration is running. This typically takes one minute. During this time alarms are

switched off. Wait until the calibration is complete.

<SO₂ Label> UNPLUGGED

Numeric is replaced by -?-

INOP tone

Measurement switched on and SO2/SvO2 module unplugged from the rack.

<SO₂ Label> UPGRADE

INOP tone

The SO2 module is currently in upgrade mode.

Monitoring is not possible in this mode.

<SO₂ Label> WARMUP

Numeric is replaced by -?-

The Optical Module has not yet reached the operating temperature. Wait a few minutes until warm-up

is finished.

<SO₂ Label>CAL

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.

<SO₂ Label>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.

<SO₂ Label>LIGHT INTENS

Numeric is replaced by -?-

INOP tone

The intensity changed considerably since the last light intensity calibration. This may indicate that the

catheter tip is positioned against a blood vessel wall or that there is low blood flow. Reposition the

catheter (and perform a Light Intensity Calibration).

INOP Message, Indication What to do

3 Patient Alarms and INOPs

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 <Press Label>

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,

BA P, FA P, o r UA P.

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,

BA P, FA P, o r UA P.

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 <Press Label>

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.

3 Patient Alarms and INOPs

tcGas INOPs

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.

INOP Message, Indication What to do

<tcGas Label> CAL FAILED

Numeric is replaced by -?-

INOP tone

A calibration failed. Check the calibration unit, gas pressure, and tubing connections, then restart the

calibration. If the calibration has failed more than once, remembrane the transducer and restart the

calibration. If this INOP persists, contact your service personnel.

<tcGas Label> CAL

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.

<tcGas Label> CAL

RUNNING

Numeric displays first -?-, then

numeric is displayed with a ?

Wait until the tcpO2/tcpCO2 calibration is finished.

<tcGas Label> 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.

<tcGas Label> CHECK

TIME

Site Timer due to time out in 15 minutes or less.

3 Patient Alarms and INOPs

EEG INOPs

<tcGas Label> 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.

<tcGas Label> 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.

The measurement automatically disappears from the display. Silencing this INOP switches off the

measurement.

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 <n>

EEG2 LEAD OFF <n>

[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.

3 Patient Alarms and INOPs

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.

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.

3 Patient Alarms and INOPs

Spirometry INOPs

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)

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).

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.

INOP Message, Indication What to do

AWFCHANGE SCALE Airway flow signal exceeds range of selected scale. Adjust scale to display complete wave.

AWPCHANGE SCALE Airway pressure signal exceeds range of selected scale. Adjust scale to display complete wave.

AWVCHANGE SCALE Airway volume signal exceeds range of selected scale. Adjust scale to display complete wave.

SPIRO ALARMS SUPPR Alarming is suppressed for the spirometry module.

SPIRO CANNOT MEAS Measurement is at its limit, e.g. ambient pressure out of range.

SPIRO GAS COMPENS? Gas compensation is set to Gas Analyzer but not all gases necessary for compensation are

measured by a gas monitor. Some of the fall-back values provided by the user are used. Measurement

accuracy might be reduced.

SPIRO INCOMPATIBLE Module revision not compatible with the host monitor software revision. Contact your service

personnel.

SPIRO MALFUNCTION Module failure detected. Contact your service personnel.

3 Patient Alarms and INOPs

VueLink INOPs

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” on page 422.

SPIRO PURGE FAILED The purge operation could not be completed successfully. Check for kinked sensor tubings, hard

occlusions and make sure that the pump is running and all valves are switching.

SPIRO PURGING A purge operation is in progress - no data update on the screen. Wait until purge is complete.

SPIRO UNKN. SENSOR An unknown sensor ID code was detected. Use only the sensors listed in the “Accessories” on

page 369 chapter.

SPIRO UPGRADE The module is running a firmware upgrade. Wait until upgrade is completed before resuming

monitoring.

INOP Message, Indication What to do

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.

<VueLink Option> CHECK

SETUP

INOP tone

No information was received from the external device. The device may be switched off or

disconnected.

VueLink INOP abbreviations may differ slightly depending on the device category.

<VueLink Option> CHK

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.

<VueLink Option> 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.

<VueLink Option> 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.

<VueLink Option> 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.

3 Patient Alarms and INOPs

IntelliBridge INOPs

Telemetry INOPs

INOP Message, Indication What to do

DEVICE CHECK CONF.

INOP tone

Device identification completed, but communication could not be established due to error.

IntelliBridge INOP abbreviations may differ slightly depending on the device category.

DEVICE CHECK SETUP

INOP tone

Device identification completed, but communication could not be established due to timeout.

IntelliBridge INOP abbreviations may differ slightly depending on the device category.

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.

IntelliBridge INOP abbreviations may differ slightly depending on the device category.

<EC10 / EC40> EQUIP

MALF

INOP tone

Malfunction in the IntelliBridge module. If this message appears repeatedly, the module must be

replaced. Contact your service personnel.

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.

IntelliBridge INOP abbreviations may differ slightly depending on the device category.

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.

INOP Message, Indication What to do

!! REPLACE BATT. T

!!!REPLACE BATT. T

Severe yellow/red INOP tone

During this INOP, alarms cannot

be paused or switched off.

The battery in the telemetry device is almost empty and must be replaced.

!! TELE INOP

!!! TELE 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.

3 Patient Alarms and INOPs

ProtocolWatch INOPs

Calculated Values INOPs

INVALID LEADSET

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.

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.

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

Numeric is replaced by -?-

The monitor has detected a conflict in the units used for this calculation. Check the unit settings.

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.

3 Patient Alarms and INOPs

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.

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

3 Patient Alarms and INOPs

4Managing 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,

1Select the patient name field or select the Admit/Dischrg SmartKey to open the Patient

Demographics window.

2Clear any previous patient data by selecting the Dischrge Patient or End Case pop-up key and

then Confirm.

If you do not discharge the previous patient, you will not be able to distinguish data from the

previous and current patients, for example, in the trend database.

3Select Admit Patient.

4Enter the patient information: select each field and use the on-screen keyboard or choose from the

pop-up list of alternatives to input information.

If a conventional keyboard or a barcode scanner is connected to the monitor you can use this to

enter patient information.

–Last Name: Enter the patient's last name (family name), for example Doe.

–First Name: Enter the patient's first name, for example Doe, John.

4 Managing 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, etc. Enter the appropriate data for the fields displayed.

–Patient Cat.: Choose the patient category, either Adult, Pedi, or Neo.

–Paced: Choose Yes or No (You must use Yes if your patient has a pacemaker).

–Height: Enter the patient's height.

–Weight: Enter the patient's weight.

–BSA: The monitor calculates the body surface area automatically.

–Date Of Birth: Enter the patient's date of birth. Enter this in the form dd/mm/yyyy.

–Age: The monitor calculates the patient age automatically.

–Gender: Choose Male or Female.

–Notes (1) / Notes (2): Enter any extra information about the patient or treatment.

Select Confirm. The patient's name appears on the monitor info line at the top of the screen.

Patient Category and Paced 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.

1Select the Quick Admit SmartKey.

4 Managing Patients

2Enter the required data (ID fields or last name depending on configuration) with the keyboard or a

barcode scanner.

3Select Enter.

4In the confirmation window, select Confirm to discharge the previous patient (if confirmation is

configured).

5Check that patient category and paced status are correct for the new patient.

If the monitor is connected to an Information Center and only the ID field is entered, the patient name

is set to - - - at the Information Center. Complete the rest of the demographic details as soon as

possible to fully identify the patient on the network, on the monitor and on printed reports. To

complete the details, select Admit Patient again and complete all required fields.

Editing Patient 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

1Select the patient name field or select the Admit/Dischrg SmartKey to open the Patient

Demographics window and associated pop-up keys.

2Select the pop-up key for either:

–End Case - to print any configured end case reports or vital signs recording, discharge the

patient and clear the patient database, then enter standby mode. If an End Case SmartKey is

configured for your monitor, you can also select this instead and then confirm.

To see which end case reports are set up for your monitor, select Main Setup, Reports, then

Auto Reports. For each auto report, if End Case Report is set to On, this report will be

4 Managing Patients

printed when you select End Case. See the section on AutoReports for information on setting

up end case reports.

–Dischrge Patient - to discharge the patient without printing any reports.

New Patient 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 Multi-

Measurement Module. Understanding this will help you to understand what happens to patient data

when you transfer patients.

Patient Information Stored in Monitor Stored in MMS and

extensions

Patient demographics (name,

DOB, patient IDs)

yes yes

Monitor settings (alarm

pause time, alarm volume)

yes no

4 Managing Patients

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.

1Before you disconnect the MMS from the monitor, select the patient name field or select the

Admit/ Dischrge SmartKey to open the Patient Demographics window, then select the Transfer

pop-up key. If the patient is not admitted or not monitored by an Information Center, the

Transfer key is inactive ("grayed-out").

This step preserves the patient's demographic data during the transfer.

2Remove the MMS and any connected extensions from the monitor.

3Connect the MMS to the transfer monitor and monitor your patient during the move.

4At the new location, connect the MMS to the monitor. If the monitor detects a patient mismatch,

a window will open showing your patient's data and asking whether to Complete Transfer Of

This Patient?.

5Select Yes to complete the transfer. This re-admits the patient from the transfer list to the new

monitor. This will upload the patient demographics, and, if configured, the measurement settings

and trend data stored in the MMS to the receiving monitor.

6Verify that the settings for patient category and paced mode are correct.

Measurement settings for all

measurements (alarm limits,

measurement on/off, etc.)

yes yes, for all MMS and extensions

measurements

Trend data yes, for all MMS and extensions

measurements (up to a

maximum of 16 or 32,

depending on your database

configuration)

most recent 8 hours of

information, for all MMS and

extensions measurements

Calculation data (HemoCalc

data)

yes no

Events data yes no

Patient Information Stored in Monitor Stored in MMS and

extensions

4 Managing Patients

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.

1Before you disconnect the X2/MP5 from the host monitor, select the patient name field or select

the Admit/ Dischrge SmartKey to open the Patient Demographics window, then select the

Transfer pop-up key. If the patient is not admitted or not monitored by an Information Center,

the Transfer key is inactive ("grayed-out").

This step preserves the patient's demographic data during the transfer.

2Remove the X2/MP5 and any connected extensions from the monitor.

3Move the patient using the X2/MP5 as the transport monitor.

4At the new location, connect the X2/MP5 to the new host monitor. If the monitor detects a

patient mismatch, a window will open showing your patient's data and asking Complete Transfer

Of This Patient?.

5Select Yes to complete the transfer. This re-admits the patient from the transfer list to the new

monitor. This will upload the patient demographics, and, if configured, the measurement settings

and trend data stored in the X2/MP5 to the receiving monitor.

6Verify that the settings for patient category and paced mode are correct.

Transferring a Centrally-Monitored Patient with X2 or MP5 using 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).

1Remove the X2/MP5 and any connected extensions from the host monitor.

2Move the patient using the X2/MP5 as the transport monitor.

3At the new location, just before connecting the X2/MP5 to the new host monitor:

– open the Patient Demographics window.

– select the Transfer pop-up key.

4 Managing Patients

–wait until the transfer has completed.

4Connect the X2/MP5 to the new host monitor. The monitor detects a patient mismatch and a

window will open showing your patient's data and asking Complete Transfer Of This Patient?.

5Select Yes to complete the transfer. This re-admits the patient from the transfer list to the new

monitor. This will upload the patient demographics, and, if configured, the measurement settings

and trend data stored in the X2/MP5 to the receiving monitor.

6Verify that the settings for patient category and paced mode are correct.

If you accidentally transfer a patient, use Re-Admit to restore this patient's data to the Information

Center. If you are not connected to the network, select Clear Transfer to leave transfer mode. The

patient data remains in the monitor.

Transferring a Patient with an X1 (no Information Center)

Scenario: A patient is moved to another monitoring location using a transport monitor and re-admitted

at the new monitor.

1Disconnect the X1 from the original monitor and silence the resulting UNPLUGGED INOP.

If you are sure that the patient will not be returning to this monitor, you should perform a

discharge or end-case. This prevents data from the next patient accidentally being mixed up with

your current patient's data.

2Connect the X1 to the transport monitor and move the patient.

3At the new monitoring location, remove the X1 from the transport monitor and connect it to the

new monitor.

4If prompted, re-admit the patient to the new monitor: in the Select Patient window, select the

patient in the X1 to retain the data in the X1. This will upload the patient demographics, and, if

configured, the measurement settings and trend data stored in the X1 to the monitor. Verify that

the settings for patient category and paced mode are correct.

Transferring a Patient with an X2 or MP5 (no Information Center)

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.

1Disconnect the X2/MP5 from the original host monitor and silence the resulting UNPLUGGED

INOP.

If you are sure that the patient will not be returning to this monitor, you should perform a

discharge or end-case. This prevents data from the next patient accidentally being mixed up with

your current patient's data.

2Move the patient using the X2/MP5 as the transport monitor.

3At the new monitoring location, connect the X2/MP5 to the new host monitor.

4If prompted, re-admit the patient to the new monitor: in the Select Patient window of the new

monitor, select the patient in the X2/MP5 to retain the data in the X2/MP5. This will upload the

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100

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

1When a monitor is connected to an Information Center by the wireless IntelliVue Instrument

Telemetry interface, the patient data will automatically be merged in the case of a transfer. This

means there is no patient discharge at the monitor and settings and trend data will be retained. You

will see a message on the monitor and the Patient Demographics window will automatically

appear so that you can check the data and change it if necessary.

2It is important to resolve the mismatches as soon as they are identified. Failure to do so could

result in using incorrect/confusing data to make clinical decisions. Certain settings, for example

Paced and Patient Cat., may not match between the Information Center and the monitor. If the

Paced status is set incorrectly, the system could mistake a pace pulse for a QRS and fail to alarm in

4 Managing Patients

101

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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1Patient demographics

2Patient category and paced status

3Same Patient - see “Patient Mismatch - If Both Patient Data Sets Are Correct” on page 102 below.

4New Patient - see “Patient Mismatch - If Neither Patient Data Set is Correct” on page 102 below.

After you resolve the mismatch, the monitor displays a confirmation window that shows the patient

that has been selected and where data will be erased, if applicable. Confirm your choice. The monitor

automatically displays the Patient Demographics window after confirmation. Verify that the settings

shown are correct for the patient.

Patient Mismatch - If Neither Patient Data Set is 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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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.

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.

Patient Information This information is taken from...

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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.

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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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.

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.

Care Group Symbols (four alternative display possibilities

depending on space available)

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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:

1Select Main Setup then Network followed by Auto Window

2Select 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.

• To display the embedded Other Bed screen element, in the Change Screen menu, select a Screen

designed to show the Other Bed information permanently.

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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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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:

1Select the network symbol on the monitor screen to call up the Network menu.

2Select Auto Window to toggle between the settings Enabled and Disabled.

This setting resets to the default at discharge and when the monitor is switched on. Always re-enable

the Auto Window as soon as possible.

109

5ECG, 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 127), ST monitoring (see “About ST Monitoring” on

page 137) and QT monitoring (see “About QT/QTc Interval Monitoring” on page 147).

Skin Preparation for Electrode Placement

Good electrode-to-skin contact is important for a good, noise-free ECG signal, as the skin is a poor

conductor of electricity.

1Select sites with intact skin, without impairment of any kind.

2Clip or shave hair from sites as necessary.

3Wash sites thoroughly with soap and water, leaving no soap residue.

We do not recommend using ether or pure alcohol, because this dries the skin and increases the

resistance.

4Dry skin thoroughly.

5Gently abrade the skin using ECG skin preparation paper to remove dead skin cells to improve the

conductivity of the electrode site.

Connecting ECG Cables

1Attach the clips or snaps to the electrodes before placing them. If you are not using pre-gelled

electrodes, apply electrode gel to the electrodes before placement.

2Place the electrodes on the patient according to the lead placement you have chosen.

3Attach the electrode cable to the patient cable.

4Plug the patient cable into the white ECG connector. An ECG waveform and numeric appears on

the monitor display.

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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:

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.

• 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

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1Lead label of the displayed wave

21 mV calibration bar

3Pacer spikes

4Pace pulse markers

5Current heart rate

6Current heart rate alarm limits

7EASI lead placement label

8ECG 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.

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:

You should choose a lead as primary or secondary lead that has these characteristics:

1Pacer spikes configured to have a fixed size

1Normal Beats

2Pace Pulses/Beats

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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)

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.

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.

In the Setup ECG menu, select Paced to toggle between Yes and No.

You can also change the paced status in the Patient Demographics window.

When Paced is set to Yes:

– Pace Pulse Rejection is switched on. This means that pacemaker

pulses are not counted as extra QRS complexes.

– pace pulse marks are shown on the ECG wave as a small dash (only

when the pacer spikes are not configured to have a fixed size).

– The paced symbol is displayed on the main screen.

When Paced is set to No, pacer spikes are not shown in the ECG wave. Be

aware that switching pace pulse rejection off for paced patients may result in

pace pulses being counted as regular QRS complexes, which could prevent an

asystole event from being detected.

Paced

Non-Paced

1Repolarization tail (note width)

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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.

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

1Select the wave segment you want to change. This calls up the lead menu for this segment.

2In the lead menu, select Size Up to increase wave size or Size Down to decrease the size.

Selecting Auto Size lets the monitor choose the optimal adjustment factor for all available ECG

waves.

To Change the Size of all the ECG Waves

To change the size of all the ECG waves on the screen by a fixed adjustment factor,

1In the Setup ECG menu, select Adjust Size.

2Select the required adjustment factor from the line of pop-up keys.

–Size X0.5 to halve the wave size

–Size X1 to display the wave without zoom

–Size X2 to double the wave size

–Size X4 to multiply the wave size by four

–Previous Size: to return one step to the previous size

–Auto Size: to let the monitor choose the optimal adjustment factor for all the ECG waves.

Changing the Volume of the QRS 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.

–Ext. Monitor: Use when diagnostic quality is required but low frequency interference or a

wandering baseline may be expected. The upper edge frequency is the same as the Diag setting

and the lower edge frequency is the same as the Monitor setting.

–Filter: The filter reduces interference to the signal. It should be used if the signal is distorted

by high frequency or low frequency interference. High frequency interference usually results in

large amplitude spikes making the ECG signal look irregular. Low frequency interference

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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,

selecting Filter may suppress the QRS complexes too much and thus interfere with the clinical

evaluation of the ECG displayed on the monitor. This does not affect the ECG analysis

performed by the monitor.

If AutoFilter is set to On in Configuration Mode, the filter setting will automatically be set to

Filter if electromagnetic interference is detected.

–Diag: Use when diagnostic quality is required. The unfiltered ECG wave is displayed so that

changes such as R-wave notching or discrete elevation or depression of the ST segments are

visible.

The setting Diag selects the highest available ECG bandwidth which is 0.05 to 150 Hz for the

Adult, Pedi and Neo patient category. The term "diagnostic" relates only to the ECG

bandwidth requirements for diagnostic electrocardiographic devices as outlined in the ANSI/

AAMI standard EC11-1991.

Selecting Positions of Va and Vb Chest Leads (for

6-lead placement)

The two chest leads for the 6-lead placement can be positioned at any two of the V1 to V6 positions.

Select the positions you have used in the Setup ECG menu, so that the chest leads will be correctly

labeled.

1In the Setup ECG menu, select Va Lead.

2Select the position used from the list.

3Select Vb Lead and select the position used from the list.

Choosing EASI or Standard Lead 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 123 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

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.

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

Electrode labels Electrode colors

AAMI EASI IEC AAMI IEC

RA I R White Red

LA S L Black Yellow

LL A F Red Green

RL N N Green Black

VECBrown White

V1 C1 Brown/Red White/Red

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Standard 3-Lead Placement

V2 C2 Brown/Yellow White/Yellow

V3 C3 Brown/Green White/Green

V4 C4 Brown/Blue White/Brown

V5 C5 Brown/Orange White/Black

V6 C6 Brown/Violet White/Violet

Electrode labels Electrode colors

AAMI EASI IEC AAMI IEC

1RA placement: directly below the clavicle and

near the right shoulder

2LA placement: directly below the clavicle and

near the left shoulder

3LL placement: on the left lower abdomen

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Standard 5-Lead Placement

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.

1RA placement: directly below the clavicle and

near the right shoulder

2LA placement: directly below the clavicle and

near the left shoulder

3RL placement: on the right lower abdomen

4LL placement: on the left lower abdomen

5V placement: on the chest, the position

depends on your required lead selection

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Chest Electrode Placement

For accurate chest electrode placement and measurement, it is important to locate the fourth

intercostal space.

1Locate the second intercostal space by first palpating the Angle of Lewis (the little bony

protuberance where the body of the sternum joins the manubrium). This rise in the sternum is

where the second rib is attached, and the space just below this is the second intercostal space.

2Palpate and count down the chest until you locate the fourth intercostal space.

10-Lead 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.

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

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

A - Angle of Lewis

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Conventional 12-Lead ECG

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

1V1 - V6

2LA

3RA

4RL

5LL

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Modified 12-Lead ECG

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.

1LA

2V1-V6

3LL

4RL

5RA

6Angle of Lewis

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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:

1Select the Admit Patient pop-up key, then

2Enter the information in the Patient Demographics window.

3Open the 12-Lead ECG window again as described above.

The age and gender will now be displayed in the title bar of the pop-up keys.

To change the way the realtime waves are displayed, select the Change View pop-up key or select the

wave area. You can switch between a one or two column display. The two column display lets you see

a larger representation of the waves.

While the realtime 12-Lead waves are being viewed in the window, the ECG filter mode (see “Viewing

the Realtime 12-Lead ECG” on page 121) is changed to the 12-Lead filter setting (see “Setting Up the

12-Lead ECG” on page 122).

Capturing the 12-Lead 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 123).

You can at any time return to the realtime 12-Lead ECG view by selecting the Show Waves pop-up

key. From there, you return to the preview window by selecting the Show Preview pop-up key.

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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.

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.

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

Rhythm Lead 2

Rhythm Lead 3

Defines which lead will be used as rhythm lead 1, 2 or 3.

Choices are Primary, Secondary, I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6, V,

MCL.

This setting is only relevant when 3X4 1R or 3X4 3R is selected as Format.

Lead Sequence Defines the sequence in which the leads are presented.

Choices are Cabrera and Internat.

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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:

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.

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.

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EASI Electrode Placement

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.

• 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

1E (V) - on the lower sternum at the level of

the fifth intercostal space

2A (LL) - on the left midaxillary line at the

same level as the E electrode

3S (LA) - on the upper sternum

4I (RA) - on the right midaxillary line at the

same level as the E electrode

5N - reference electrode - can be anywhere,

usually below the sixth rib on the right hip

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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

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.

You need to know which value has been configured for your monitor. Changing the high and low

alarm limits automatically changes the extreme alarm limits within the allowed range.

To see the extreme rate alarms set for your monitor, in the Setup ECG menu, see the menu items Δ

ExtrTachy and Δ ExtrBrady.

Cardiotach Alarms Additional Alarms with Basic

Arrhythmia Option

Additional Alarms with

Enhanced Arrhythmia Option

***Asystole

***Ventricular Fibrillation/

Tachycardia

***Extreme Bradycardia

***Extreme Tachycardia

**High heart rate

**Low heart rate

***Ventricular Tachycardia

**Pacer Not Capture

**Pacer Not Pacing

**PVCs/min HIGH (PVC >

limit/min)

**Afib

**Supraventricular Tach

**Missed Beat

**Pause

**Irregular HR

**Ventricular Rhythm

**Run PVCs High

**Pair PVCs

**R-on-T PVCs

**Ventricular bigeminy

**Ventricular trigeminy

**Non-sustain VT

**Multiform PVCs

1Extreme Brady Limit

2Low Limit

3High Limit

4Extreme Tachy Limit

5Δ Extreme Brady

6Δ Extreme Tachy

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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 single-

lead 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 124, the rhythm and

ectopic messages detected are listed in “Arrhythmia Status Messages” on page 130.

Where Can I Find More Information?

See the Application Notes on ST and Arrhythmia supplied on your documentation DVD for detailed

information on the arrhythmia algorithm and its clinical application.

Switching Arrhythmia Analysis On and Off

1In the Setup Arrhythmia menu, select Arrhythmia to toggle between On and Off.

2Select the Confirm pop-up key which appears at the bottom of the screen.

Be aware that when arrhythmia analysis is switched off,

– the message Arrhythmia Off appears beside the ECG wave, if configured to do so

– only the HR-related alarms are detected (the asystole alarm, the ventricular fibrillation/

tachycardia alarm, the extreme tachycardia and extreme bradycardia alarms, the high heart rate

and low heart rate alarms)

– HR High and HR Low alarms behave like normal yellow alarms, no timeout periods are active.

Choosing an ECG Lead for Arrhythmia 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:

– 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.

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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.

1Beat label

2Pace pulse marks

3Rhythm status message

4PVC Numeric

5HR Numeric

6Ectopic status message

7Delayed 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.

Ectopic 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 E

Vent Rhythm A dominant rhythm of adjacent PVCs and a HR ≤ the V-Tach

HR Limit

Vent Bigeminy A dominant rhythm of N, V, N, V E

Vent Trigeminy A dominant rhythm of N, N, V, N, N, V E

Paced Rhythm A dominant rhythm of paced beats B, E

Irregular HR Consistently irregular rhythm E

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

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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.

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 E

Pair PVCs Pair PVCs within the last minute E

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,

No beat for 1 second with HR >120 (non-paced patient only),

No beat detected for more than the set pause threshold.

R-On-T PVCs R-ON-T detected within the last minute E

Multiform PVCs Multiform PVCs detected within the last minute E

Frequent SVPBs SVPB count within last minute is greater than 5 E

SVPBs 1-5 SVPBs in the last minute with a sinus rhythm and no Vs E

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

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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 V-

Fib.

For this reason you should:

• take care to initiate arrhythmia relearning only during periods of predominantly normal rhythm

and when the ECG signal is relatively noise-free

• be aware that arrhythmia relearning can happen automatically

• respond to any INOP messages (for example, if you are prompted to reconnect electrodes)

• be aware that a disconnected EASI electrode triggers an arrhythmia relearn on all leads

• always ensure that the arrhythmia algorithm is labeling beats correctly.

Arrhythmia 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 (one-

star). This means that the yellow alarm lamp and the tones are active for six seconds only, after which

the blinking numeric and the alarm message remain for up to three minutes. The only exception to this

are the HR High and Low alarms which can be configured as standard yellow alarms. Red alarms

behave as usual.

Arrhythmia Alarms and 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. They are:

Non-Sustain, Vent Rhythm, Run PVCs, Pair PVCs, R-On-T PVCs, V.Bigeminy, V.Trigeminy,

Multif.PVCs, Pause, SVT, IrregularHR, Missed Beat, PVCs/min and Afib.

To switch individual alarms on or off, in the Setup Arrhythmia menu, select the alarm from the list to

toggle between On and Off. The monitor displays the INOP message SOME ECG ALRMS OFF, if

configured, when more alarms are switched off than configured in your active profile.

Switching All Yellow Arrhythmia Alarms On or 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. They are:

VTach HR, VTach Run, PVCs/min, Vent Rhythm, SVT HR, SVT Run, Asystole Thresh., Pause

Threshold

1To adjust alarm limits, in the Setup Arrhythmia menu, select the alarm to be adjusted.

2Select the appropriate setting from the pop-up list.

Arrhythmia Alarm Timeout 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 136 for more details on alarm chains.

What is a Timeout Period?

Timeout periods are automatically started when a yellow arrhythmia alarm is detected. During this

period, the same alarm condition will not generate another alarm. Alarm conditions further down the

same arrhythmia alarm chain will also not generate an alarm, but alarms further up the chain will: see

“Arrhythmia Alarm Chaining” on page 136.

To view the timeout period configured for your monitor, in the Setup Arrhythmia menu, see the

menu items TimeOut 1st and TimeOut 2nd.

This setting can only be changed in Configuration Mode.

Resetting the Timeout 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:

If you silence a yellow arrhythmia alarm and the alarm condition still exists, the visual indicators

continue until the condition stops. You will get an alarm reminder every time the configured timeout

period has expired.

If you silence a yellow arrhythmia alarm and the alarm condition has stopped, the visual

indicators are immediately cleared. Silencing an alarm does not reset its timeout period, so you will not

get a realarm for the same condition or lower on the chain until the timeout expires.

Alarm Condition Example Short yellow alarm tone sounds Alarm message

displayed

Single alarm

instance

Non-sustained V-

tach

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

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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 124 for information on which alarms are

included in the different arrhythmia options. See “Arrhythmia Alarm Timeout Periods” on page 134

for an explanation of how alarm timeouts work.

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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:

1Enter the Setup ST Analysis menu.

2Select Setup ST Leads. This opens the Setup ST Leads pop-up window. Leads chosen for ST

monitoring are listed here. There are two pop-up keys at the bottom of the screen, Add and

Delete. If all leads are already selected, the Add pop-up key is disabled.

To choose a lead for ST monitoring:

1Select the Add key at the bottom of the Setup ST Leads window. This opens the Choices pop-up

window.

2Choose a lead from the list for ST monitoring. This closes the Choices window and adds the

selected lead to the list of chosen leads.

To disable ST monitoring for a lead:

1Choose a lead from the list in the Setup ST Leads window.

2Select the Delete key. This removes this lead from the list.

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,

1In the Setup ST Leads menu, choose a lead from the list.

2Select the Sort Up or Sort Down key to move the lead up or down in the list.

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Understanding the ST Display

Your monitor screen may be configured to look slightly different from the illustrations.

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.

1ST numerics

2Current HR alarm limits

3Current heart rate

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1ST label and numeric

2Baseline ST numeric

3Difference between current values and baseline values

41 mV calibration bar

5Current snippet

6ST baseline

7Timestamp 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,

1Select an ST snippet to open the ST Baseline window.

2In the ST Baseline window, select Update Baseline to store all current snippets as baselines. This

deletes all previously-stored baselines.

An ST baseline copy is also stored in the MMS, for transport purposes.

Recording ST Segments

To record all currently available ST snippets and baselines, in the ST Baseline window, select the pop-

up 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.

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.

• directly by selecting a numeric value for the ST point.

In the Adjust ST Points window, you can adjust the ISO and ST point.

The ST Uses setting can only be changed in Configuration Mode.

To adjust the ST measurement points,

1In the Setup ST Analysis menu, select Adjust ST Points to open the Adjust ST Points window.

Alternatively, you can use the Adjust ST Points pop-up key in the ST Baseline window.

2Select a suitable ECG lead for ST measurement, with a visible J-point and a visible P wave. Use the

up and down arrow keys to scroll through the ST snippets for the other ECG leads.

1R-wave peak at 0 msec

2J point, for example, 48 msec

3Difference = ST value

4ST measurement point, for

example, J + 60 msec

5Isoelectric point set to -80 msec

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3Use the Select Point pop-up key to scroll through the points and activate the point you need to

adjust, then use the left and right arrow keys to move the measurement point. Each point is

highlighted while active.

1 ST label and the ST numeric that would apply using the current points

2 1mV calibration bar

3 Cursors for adjusting ST points

4 Timestamp of most recent ST point adjustment

5 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.

4Select the Apply Changes pop-up key to activate the new ST measurement points and recalculate

all ST values.

The most recent ST Points adjustment time is displayed in the Adjust ST Points window. This

information is cleared when a patient is discharged or when a new Profile is loaded into the

monitor.

5To update the ST snippet shown in the Adjust ST Points window, select the Update pop-up key.

ST 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.

1In the Setup ST Analysis menu, select ST Alarm Mode and select Single ST or Multi ST.

2Select the alarm to be adjusted.

3Select the appropriate setting.

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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.

1Alarm status indicator

2EASI Limb Leads

3EASI Chest Leads

4ST index (for EASI)

5ST label, value and polarity of corresponding lead

6ST 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.

1Limb Leads

2Chest Leads

3current ST values

4trending interval

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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 274.

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,

•Select

Size Up or Size Down to alter the size at which monitor displays the map.

In this diagram, V4 was either temporarily switched off, or in INOP,

for around 30 seconds. No data was recorded. Consequently, the

affected maps are not closed.

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Changing the Trending Interval

To determine how frequently the monitor displays a trended sample,

1In Trend view, select Select Interval.

2Select the required interval from the menu. The interval ranges between 12 seconds to 30 minutes.

Printing an ST Map Report

To print the most recently viewed (current or trend) window,

1Select Main Setup then select Reports.

2Select ST Map.

3Press 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 T-

wave. It measures the total duration of the depolarization (QRS duration) and repolarization (ST-T)

phases of the ventricular action potential. QT interval monitoring can assist in the detection of

prolonged QT interval syndrome.

The QT interval (1) has an inverse relationship to heart rate. Faster heart rates shorten the QT interval

and slower heart rates prolong the QT interval. Therefore there are several formulas used to correct

the QT interval for heart rate. The heart rate corrected QT interval is abbreviated as QTc. The monitor

uses as a default the Bazett correction formula and the alternative Fridericia formula can be selected in

Configuration Mode.

For QT interval monitoring to be effective, basic or enhanced arrhythmia monitoring should be turned

on.

QT Measurement 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:

• 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.

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• Single-Lead mode - a single lead selected from all available leads (except the augmented leads) will

be used for QT measurement. QT measurement will stop if the selected lead becomes unavailable.

To select the mode,

1Select the QT numeric to enter the Setup QT Analysis window.

2Select QT Lead and select All, Primary Lead or one of the available single leads.

When using the All Leads mode, make sure when you compare QT values that they are based on the

same set of leads.

Changing the lead(s) used for QT measurements will not cause the baseline to be reset.

QT 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,

1Select Current view to see the set of current waves.

2Select Baseline view to see the set of baseline waves.

3Select Split view to return to the combined view with current and baseline waves.

Setting The QT 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.

Additional Message Cause of Invalid QT Measurement

QT Startup QT monitoring was just turned on or has been reset

Asystole or Leads Off 1Not all specified leads needed to perform QT analysis are

available, or

2Asystole 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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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.

1In the Setup QT Analysis menu, select QTc High Limit.

2Select the appropriate setting.

3Select ΔQTc High Limit.

4Select the appropriate setting.

Switching QT Monitoring On and Off

To switch all QT monitoring on or off, in the Setup QT Analysis menu, select QT Analysis to switch

between On and Off.

End of T not Detected End of the T-Wave cannot be accurately 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

Additional Message Cause of Invalid QT Measurement

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153

6Monitoring 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 pressure section for an explanation

of the pressure labels). The displayed pulse numeric is labeled and color-coded to match its source

wave. If the pulse numeric is not displayed, see the Setup Pulse menu to check whether it is switched

on.

Entering the Setup Pulse 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,

1In the Setup Pulse menu, select System Pulse.

2Select one of the SpO2 or arterial pressure labels from the pop-up list, or select Auto.

If you select Auto, the monitor automatically chooses a pulse rate to be used as system pulse. It

looks through the list from top to bottom and activates the first pulse rate that is switched on and

available.

If your selected pulse source measurement becomes unavailable or is switched off, the monitor will use

the next measurement from the list as system pulse until the selected pulse source measurement

becomes available again.

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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,

1Enter the Setup Pulse menu by selecting the Pulse numeric or by selecting Pulse in the Setup

SpO₂ menu.

2In the Setup Pulse menu, select the correct pulse label, e.g. Pulse (SpO₂), to toggle between On

and Off.

Using Pulse 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 124, including Asystole, Vfib and Vtach

alarms, and the heart rate alarms. This is indicated by the message ECG/ARRH ALARM OFF (unless this

has been configured off for your monitor), and the crossed-out alarm symbol beside the ECG heart

rate numeric. The message ECG/ARRH ALARM OFF can be configured off, or to switch to a yellow

(medium severity) INOP after a fixed number of hours.

High and low pulse rate and extreme bradycardia and extreme tachycardia alarms from pulse are active.

Alarm Source Selection 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

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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157

7Monitoring 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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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.

1Resp wave label

2One Ohm calibration bar

3Manually-set Resp detection level

4Resp 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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• 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 158.

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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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.

1In the Setup Resp menu, select Apnea Time.

2Select 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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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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163

8Monitoring 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 section on

Accessories for a compatibility table.

Familiarize yourself with the instructions for use supplied with your sensor before using it. In

particular, check that the sensor being used is appropriate for your patient category and application

site.

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

1Follow the SpO2 sensor's instructions for use, adhering to all warnings and cautions.

2Remove colored nail polish from the application site.

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3Apply the sensor to the patient. The application site should match the sensor size so that the

sensor can neither fall off, nor apply excessive pressure.

When using the M1195A Infant Finger Sensor, select a finger or toe with a diameter of between 7

and 8 mm (0.27" and 0.31"). When applying a M1193A neonatal sensor do not overtighten the

strap.

4Check that the light emitter and the photodetector are directly opposite each other. All light from

the emitter must pass through the patient's tissue.

WARNING

Loose Sensor: If a sensor is too loose, it might compromise the optical alignment or fall off. If it is

too tight, for example because the application site is too large or becomes too large due to edema,

excessive pressure may be applied. This can result in venous congestion distal from the application site,

leading to interstitial edema, hypoxemia and tissue malnutrition. Skin irritations or lacerations may

occur as a result of the sensor being attached to one location for too long. To avoid skin irritations and

lacerations, periodically inspect the sensor application site and change the application site at least every

four hours.

Venous Pulsation: Do not apply sensor too tightly as this results in venous pulsation which may

severely obstruct circulation and lead to inaccurate measurements.

Ambient Temperature: At elevated ambient temperatures be careful with measurement sites that are

not well perfused, because this can cause severe burns after prolonged application. All listed sensors

operate without risk of exceeding 41°C on the skin if the initial skin temperature does not exceed

35°C.

Extremities to Avoid: Avoid placing the sensor on extremities with an arterial catheter, an NBP cuff

or an intravascular venous infusion line.

Connecting SpO2 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.

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Measuring SpO2

1Select the correct patient category setting (adult/pediatric and neonatal), as this is used to optimize

the calculation of the SpO2 and pulse numerics.

2During measurement, ensure that the application site:

– has a pulsatile flow, ideally with a perfusion indicator value above 1.0.

– has not changed in its thickness (for example, due to edema), causing an improper fit of the

sensor.

WARNING

• Inspect the application site every two to three hours to ensure skin quality and correct optical

alignment. If the skin quality changes, move the sensor to another site. Change the application site

at least every four hours.

• Injected dyes such as methylene blue, or intravascular dyshemoglobins such as methemoglobin

and carboxyhemoglobin may lead to inaccurate measurements.

• Inaccurate measurements may result when the application site for the sensor is deeply pigmented

or deeply colored, for example, with nail polish, artificial nails, dye or pigmented cream.

• Interference can be caused by:

– High levels of ambient light (including IR warmers) or strobe lights or flashing lights (such as

fire alarm lamps). (Hint: cover application site with opaque material.)

–Another SpO

2 sensor in close proximity (e.g. when more than one SpO2 measurement is

performed on the same patient). Always cover both sensors with opaque material to reduce

cross-interference.

– Electromagnetic interference, especially at perfusion indicator values below 1.0 and signal

quality indicator below medium.

– Excessive patient movement and vibration.

SpO2 Signal Quality Indicator (Fast SpO2 only)

The SpO2 numeric is displayed together with a signal quality indicator (if configured and enough space

is available) which gives an indication of the reliability of the displayed values.

The level to which the triangle is filled shows the quality of the signal; the indicator below shows a

medium signal quality, the signal quality is at a maximum when the triangle is completely filled.

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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.

1In the Setup SpO₂ menu, select Average.

2Select the required averaging time from the list.

Understanding SpO2 Alarms

This refers to SpO2 specific alarms. See the chapter on “Alarms” on page 47 for general alarm

information. SpO2 offers high and low limit alarms, and a high priority desat alarm. You cannot set the

low alarm limit below the desat alarm limit.

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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.

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 167 for details on how this works.

See “Performance Specifications” on page 401 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.

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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.

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.

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Adjusting the Alarm Limits

In the Setup SpO₂ menu:

•Select

High Limit then choose the high alarm limit.

•Select

Low Limit then choose the low alarm limit.

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 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.

1In the Setup SpO₂ menu, select Desat Limit.

2Adjust 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..

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When a reference value has been set, the perfusion change indicator is displayed next to the perfusion

numeric.

Setting SpO2/Pleth as Pulse Source

1In the Setup SpO₂ menu, select Pulse (SpO₂) to enter the Setup Pulse menu.

2In the Setup Pulse menu, select System Pulseand select the correct SpO2 label from the pop-up

list.

Setting Up Tone 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.

1From the Main Setup menu, select Measurements.

2From the Setup ΔSpO₂menu, select First SpO₂.

3Choose the first measurement source.

4Select Second SpO₂.

5Choose the second measurement source.

171

9Monitoring 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 SP10-

1992) in relation to mean error and standard deviation, when compared to intra-arterial measurements

in a representative patient population.

The NBP measurement is suitable for use in the presence of electrosurgery and during the discharge of

a cardiac defibrillator according to IEC 601-2-30:1999/EN 60601-2-30:2000.

A physician must determine the clinical significance of the NBP information.

Introducing the Oscillometric NBP 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 pre-

eclamptic 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.

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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.

Preparing to Measure NBP

1Connect the cuff to the air tubing.

2Plug the air tubing into the red NBP connector. Avoid compression or restriction of pressure

tubes. Air must pass unrestricted through the tubing.

3Make sure that you are using a Philips-approved correct sized cuff and that the bladder inside the

cover is not folded or twisted.

A wrong cuff size, and a folded or twisted bladder, can cause inaccurate measurements. The width

of the cuff should be in the range from 37% to 47% of the limb circumference. The inflatable part

of the cuff should be long enough to encircle at least 80% of the limb.

4Apply the cuff to a limb at the same level as the heart. If it is not, you must use the measurement

correction formula to correct the measurement.

The marking on the cuff must match the artery location. Do not wrap the cuff too tightly around

the limb. It may cause discoloration, and ischemia of the extremities. Inspect the application site

regularly to ensure skin quality and inspect the extremity of the cuffed limb for normal color,

warmth and sensitivity. If the skin quality changes, or if the extremity circulation is being affected,

move the cuff to another site or stop the blood pressure measurements immediately. Check more

frequently when making automatic or stat measurements.

Correcting the Measurement if Limb is not at Heart 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 1.9mmHg (0.25kPa) for each inch higher. deduct 1.9mmHg (0.25kPa) for each inch

lower.

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Understanding the NBP Numerics

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.

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 "easy-

to-document" time. For example, if you start the first measurement at 08:23, and the Repeat Time

is set to 10 minutes, the monitor automatically performs the next measurement at 8:30, then 8:40

and so on.

During 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.

1Alarm source

2Measurement Mode

3Timestamp/Timer

4Mean pressure

5Diastolic

6Systolic

7Alarm limits

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Action to be performed NBP Setup menu SmartKeys MMS hardkey

Start manual measurement

Start Auto series

Start/Stop

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

STAT (for MMS

without Pressure/

Temp measurement)

Stop NBP

Stop Auto, Manual or STAT

measurement AND series

Stop All

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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

1In the Setup NBP menu, select Mode and select Auto from the pop-up menu.

2For an automatic measurement, select Repeat Time and set the time interval between two

measurements.

Enabling Sequence Mode and Setting Up The

Sequence

1In the Setup NBP menu, select Mode and select Sequence from the pop-up menu.

2Select Setup Sequence to open the Setup Sequence window.

Up to four measurement cycles can be setup which will run consecutively. For each cycle you can

set the number of measurements and the interval between them. If you want to run less than four

cycles in a sequence, you can set the number of measurements for one or more cycles to Off.

3Select each sequence in turn and select the number of measurements and the time interval between

the measurements.

4To have measurements continue after the sequence, set the number of measurements for your last

cycle to Continuous and this cycle will run indefinitely.

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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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.

1In the Setup NBP menu select VeniPuncture.

2Puncture vein and draw blood sample.

3Reselect VeniPuncture to deflate the cuff.

During measurement, the NBP display shows the inflation pressure of the cuff and the remaining time

in venous puncture mode.

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.

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

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179

10Monitoring 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

1Select the correct type and size of probe for your patient.

2If you are using a disposable probe, connect the probe to the temperature cable.

3Plug the probe or temperature cable into the temperature connector socket.

4Apply the probe to the patient. You are advised to use a protective rubber cover on rectal probes.

5Select an appropriate temperature label.

6Check that the alarm settings (on or off, high and low limits) are appropriate for this patient and

this type of temperature measurement.

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.

1In the Setup <Temp Label> menu, select Label.

10 Monitoring Temperature

180

2Select the appropriate label from the list.

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.

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.

1In the Main Setup menu, select Measurements.

2In the Setup ΔTemp menu, select First Temp.

3Label the measurement source as appropriate.

4Select Second Temp.

5Label the measurement source as appropriate.

Temp non-specific temperature label Trect rectal temperature

Tart arterial temperature Tskin skin temperature

Tcore core temperature Tven venous temperature

Tesoph esophageal temperature Tnaso nasopharyngeal temperature

T1, T2, T3, T4 Non-specific temperature labels

Tamb ambient temperature

Tcereb cerebral temperature

Ttymp tympanic temperature

Tvesic vesical temperature

181

11Monitoring 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

1Plug in the pressure cable.

2Prepare the flush solution.

3Flush the system to exhaust all air from the tubing. Ensure that the transducer and stopcocks are

free of air bubbles.

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.

1Connect the pressure line to the patient catheter.

2If you are using an infusion pressure cuff with the pressure line, attach the pressure cuff to the

fluid to be infused. Inflate it according to your standard hospital procedure, then start the infusion.

11 Monitoring Invasive Pressure

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3Position the transducer so that it is level with the heart, approximately at the level of the

midaxillary line.

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.

1In the Setup <Press Label> menu, select Label.

2Select the appropriate label from the list.

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 Label Description

ABP Arterial blood pressure PNon-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

Label Description

BAP Brachial arterial pressure

FAP Femoral arterial pressure

IC1, IC2 Alternative intracranial pressures

P1, P2, P3, P4 Alternative non-specific pressure labels

11 Monitoring Invasive Pressure

183

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:

• when you use a new transducer or tubing

• every time you reconnect the transducer cable to the monitor

• if you think the monitor's pressure readings are not correct.

When using a pressure module, the zero information is stored in the module. When a pressure module,

with the transducer connected, is plugged into the monitor, the monitor will use the Zero stored in the

module.

Zeroing ICP (or IC1/IC2)

Your hospital guidelines may require you to zero the ICP transducer less frequently than other

transducers, due to the need for aseptic conditions. When you zero an ICP transducer, the zero values

are automatically stored and you will not be prompted to repeat the zero procedure.

If you want to simultaneously zero all pressures except ICP, disconnect the ICP transducer from the

Multi-Measurement module or pressure module while zeroing. Reconnecting the transducer recalls the

stored values.

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.

1Turn off the stopcock to the patient.

2Vent the transducer to atmospheric pressure, to compensate for the static and atmospheric

pressure exerted on the transducer.

3In the setup menu for the pressure, select Zero <Press Label>.

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184

4When you see the message <Press Label> zero done at <date and time> on the status line,

close the stopcock to atmospheric pressure, and open the stopcock to the patient.

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.

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

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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.

1In the Setup <Press Label> menu, select Cal. Factor.

If the value here does not match that on the transducer, select the corresponding value from the

list now in accordance with your hospital's procedure.

2To confirm you want to use the new calibration factor, select the Confirm pop-up key.

Displaying a Mean Pressure Value 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

1Select the label of the pressure wave whose scale you want to set to enter the Setup <Press

Label> menu.

2In the Setup <Press Label> menu, (for example ABP) select Scale.

3Select a value from the pop-up list:

– a positive value sets the top gridline. The bottom gridline is set at zero.

– a negative value sets the bottom gridline. The middle gridline is set at zero.

Optimizing the Waveform

In the Setup <Press Label> menu, select Optimum Scale to let the monitor select the best minimum

and maximum scales for the current wave.

unable to zero - no

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

out

Try pressing the Zero hardkey or Zero <Press Label> key again. If this

fails, replace the transducer and adapter cable and contact your service

personnel.

Switch on first Pressure measurement is switched off. To switch it on, in the Setup <Press

Label> menu, select the pressure's label.

Message Corrective Action

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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

1Select the pressure wave.

2Select Activate Cursor.

3Use the pop-up arrow keys to position the cursor.

Using the pop-up keys you can also change the scale or the speed for the wave, freeze the wave or start

a printout or recording.

Non-Physiological Artifact 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 <Press Label> ARTIFACT, and a question mark is shown beside the

pressure numerics. Pressure alarms and the <Press Label> NON-PULSATILE INOP are suppressed

during the configured period. The CPP alarms are not suppressed.

Choosing the Pressure Alarm 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 <Press Label> menu, select Alarms from and choose the source.

Menu option Pressure value monitored

Sys. systolic

Dia. diastolic

Mean mean

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187

Select and set the High Limit and Low Limit for the pressure(s) you have selected.

Extreme Alarm Limits

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.

1Extreme Low Limit

2Low Limit

3High Limit

4Extreme High Limit

5Δ Extreme Low

6Δ 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 <Press Label> menu, see

the menu items Δ Extreme High and Δ Extreme Low.

The extreme pressure alarms are high priority, red alarms, marked *** in the alarm message.

Calibrating Reusable Transducer 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.

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

Menu option Pressure value monitored

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• approximately 25cm of tubing.

Making the Pressure Calibration

WARNING

Never perform the invasive pressure calibration while a patient is being monitored.

1Zero the transducer.

2Connect the syringe and manometer.

a. Attach the tubing to the manometer.

b. Connect the 3-way stopcock to the stopcock that is not connected to the patient catheter

when you measure a patient.

c. Attach the syringe to one port and the manometer tubing to the other port.

d. Open the port to the manometer.

1 Tubing to manometer

2 Syringe with heparinised solution

3 To pressure connector on monitor

4 Patient connection stoppered

5 Off

3Move the syringe barrel in and raise the mercury to 200 mmHg (30 kPa). 200 mmHg is the

recommended calibration pressure.

4In the Setup <Press Label> menu, select Cal. Press.

5Select the calibration pressure from the list, for example 200 mmHg.

6Select Confirm to recalculate the calibration factor using the applied pressure.

7When the monitor displays <Press Label> mercury calibr. done at <date and time>, remove

the manometer tubing, syringe and extra stopcock. We recommend you replace the transducer

dome and tubing with sterile ones.

8Label the transducer with the calibration factor shown in the Cal. Factor field in the pressure's

setup menu.

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189

9Reconnect the patient and start measuring again.

Troubleshooting the Pressure Calibration

The status line lists the probable cause of an unsuccessful calibration.

Calculating Cerebral Perfusion

The monitor can calculate the difference between mean arterial pressure and the intracranial pressure.

The difference is labeled CPP.

1In the Main Setup menu, select Measurements.

2In the Setup CPP menu, select one of the listed pressures as the arterial pressure source.

Calculating Pulse Pressure 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 pressure less the minimum pressure divided by the average of these

two pressures. The average variation in pulse pressure is calculated over periods of 32 seconds.

WARNING

• This monitor can calculate PPV from beat-to-beat values of any arterial pulsatile pressure. The

circumstances under which the calculation of a PPV value is clinically meaningful, appropriate and

reliable must be determined by a physician.

• The clinical value of the derived PPV information must be determined by a physician. According

to recent scientific literature, the clinical relevance of PPV information is restricted to sedated

patients receiving controlled mechanical ventilation and mainly free from cardiac arrhythmia.

• PPV calculation may lead to inaccurate values in the following situations:

– at respiration rates below 8 rpm

Message Corrective Action

unable to calibrate - equipment

malfunction

Contact your service department. The pressure hardware is

faulty.

unable to calibrate - out of range Make sure that you have selected the value for Cal. Press that

you are applying to the transducer, and repeat the calibration.

unable to calibrate - no

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.

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190

– 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:

1In the Main Setup menu, select Measurements.

2In the Setup PPV menu, select ABP, ART, Ao, BAP, P or FAP as the arterial pressure source.

CAUTION

Older Multi-Measurement modules cannot supply a beat-to-beat arterial pressure value. In this case the

monitor shows a NO PPV FROM<Server> INOP.

Measuring Pulmonary Artery Wedge 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,

1In the Main Setup menu, select Wedge to display the wedge procedure window.

2Prepare and check the pressure line according to your hospital policy.

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191

3Use the Refernce Wave 1 and Refernce Wave 2 pop-up keys to select any ECG or respiratory

wave as reference waves.

4Select Change Speed if you want to change the speed of the displayed wave. The speed can also

be changed in the screen for editing the wedge.

5Select Change Scale to change the wave scale of the PAP. The same scale will be used in the

screen for editing the wedge. If the setting Optimum Scale is used, the wave scale will be

optimized when a wedging waveform is recognized and will revert to the previous scale when the

wedge procedure window is closed.

6Inflate the balloon when the monitor prompts you: Ready for balloon inflation. The waveform

changes from the PAP to the PAWP wave. The measurement takes approximately 12 seconds. On

completion, the monitor stores the PAWP waveform display and prompts you to deflate the

balloon. If the monitor cannot detect a wedging waveform you must use Store Trace to store the

wedge and two reference waves manually.

7Deflate the balloon when the monitor prompts you: Ready for balloon deflation and verify that

the waveform returns to pulmonary artery shape.

8If you need to start a new measurement, select Restart Wedge.

Editing the Wedge

1Select the Edit Wedge pop-up key to see the stored waveforms.

2The monitor displays a cursor in the waveform at the PAWP mean value. It also displays any

previously stored value and the time it was stored.

3Select Change Speed if you want to change the speed (resolution) of the displayed wave.

4Move the cursors up, down, right and left to set them on the correct wedge position.

5Select Store Wedge to store the PAWP value.

6Select Print Wedge to print the PAWP waveform and any reference waves or Record Wedge to

record them. While recording or printing, you cannot perform any more Wedge tasks.

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.

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Identifying the Pressure Analog Output Connector

1Analog output (module M1006B, option C01 only)

193

12Monitoring 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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194

* 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,

•Select

Cardiac Output in the Setup C.O. or Setup CCO menu, or

• Select the Cardiac Output SmartKey on the Screen, if configured, or

• Press the START hardkey on the front of the C.O. plug-in module, if available, or

• Press a remote start switch, if you are using one.

Measured and Calculated Hemodynamic

Parameters and Indexes

PiCCO Method

(Transpulmonary

Thermodilution)

Right Heart Thermodilution

Continuous? Main

Screen

HemoCalc

Window Continuous? Main

Screen

HemoCalc

Window

Blood Temperature (Tblood) Y Y N Y Y N

C.O./C.I.: Cardiac Output N Y Y N Y Y

CCO/CCI: Continuous Cardiac Output Y Y Y (in the

C.O. field)

Not available

SVR/SVRI: Systemic Vascular Resistance N and Y Y Y N N Y

SV/SI: Stroke Volume/SV Index N and Y Y Y N N Y

SVV: Stroke Volume Variation Y Y Y Not available

*dPmax: Left Ventricular Contractility Index Y Y Y Not available

CFI: Cardiac Function Index N Y Y Not available

PPV: Pulse Pressure Variation Y Y Y Not available

ITBV/ITBVI: Intrathoracic Blood Volume N Y Y Not available

EVLW/EVLWI: Extravascular Lung Water N Y Y Not available

GEDV/GEDVI: Global End-Diastolic Volume N Y Y Not available

*PVPI: Pulmonary Vascular Permeability Index N Y Y Not available

*GEF: Global Ejection Fraction N Y Y Not available

*RLShnt: Right-Left-Shunt Fraction N N N Not available

PVR/PVRI: Pulmonary Vascular Resistance Not available N N Y

LCW/LCWI: Left Cardiac Work N N Y N N Y

RCW/RCWI: Right Cardiac Work Not available N N Y

RVSW/RVSWI: Right Ventricular Stroke Work Not available N N Y

12 Monitoring Cardiac Output

195

1Average - column of averaged values

2Unit column

3Continuously measured numeric

4Prompt message field

5Thermodilution curve of current trial

6Curve alert message field

7Current trial number

8Setup information

9Trial 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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197

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

1Set up the arterial line using the arterial catheter (transpulmonary catheter) and the transducer kit

from PULSION Medical Systems. It must be placed in one of the bigger systemic arteries, for

example, the femoral or the axillary artery. You must use the approved catheters and puncture

locations.

2Set up the central venous line.

3Connect the injectate temperature probe housing to the venous line.

4Plug the C.O. interface cable into the C.O. module or measurement extension module and connect

the following devices to the C.O. interface cable:

– Injectate temperature probe

– Thermistor connector

– Remote start switch (if used).

Follow your hospital standards to avoid unintentional extraction of the C.O. catheter. Secure the

cable using the mounting clip shipped with each C.O. interface cable. You may also find it helpful

to loop the C.O. interface cable, tape the loop, and attach it to the undersheet of the patient's bed

using a safety pin.

1C.O.Module

2C.O.Interface Cable

3 PULSION Pressure Transducer

4 Press Module

5 Pressure Adapter Cable

6 Thermistor Connection Cable

7 Thermistor Connection

8 PULSION Arterial Catheter

9CVP Line

10 Injectate Temperature Probe

Housing

11 Injectate Syringe

12 Injectate Temperature Probe

13 Remote Switch

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5If you are measuring CCO, set up the pressure measurement now. The CCO measurement requires

a minimally dampened invasive pressure setup. You must ensure that there are no air bubbles in

the pressure line or dome and use only specified accessories.

6Check that the correct measurement method is selected.

If a catheter is already connected to the Cardiac Output Interface Cable, the monitor automatically

recognizes the method used. If not, in the Setup C.O. menu, select Method and then select

Transpulmnry.

7Check that you are using the correct probe - the M1646. This is the only probe supported for use;

it can be used with room temperature injectate or with cold injectate.

8Check that the correct arterial catheter constant is selected.

If the catheter is recognized by the monitor, the catheter constant is automatically displayed and

cannot be changed manually. If it is not recognized, in the procedure window, select CathCt and

use the pop-up keypad to enter the correct value. The catheter constant is usually written either on

the catheter or on the catheter packaging.

9Make sure that the injectate volume setting matches the injectate volume you will use. To change

the volume, in the procedure window, select InjVol and select the correct injectate volume from

the pop-up list.

If there is a problem with the volume or temperature you have chosen, the monitor will issue a

curve alert message to inform you of this.

10 If you are measuring CCO or CCI, check that the correct pressure source is selected in the Setup

CCO menu. The pressure label under CCO From must match the pressure measured with the

arterial catheter. To change the pressure source, select CCO From to call up a list of available

pressure labels and select the correct label.

11 If you are measuring CCO or CCI, verify that the correct alarm source is selected in the menu item

Alarms From. To change the alarm source, select Alarms From and choose either CCO or CCI.

Performing PiCCO C.O. 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.

1Enter the procedure window.

2When you see the message Ready for new measurement, start the measurement by selecting the

pop-up key Start C.O. or pressing the Start hardkey on the C.O. module, or pressing the remote

start switch. If the measuring mode is set to Auto the Start C.O. key will also enable the automatic

start of consecutive measurements.

3When you hear the ready tone and see the message Stable baseline, inject now!, inject the

solution into the CVP catheter.

At the end of the measurement the thermodilution curve, cardiac output, index values, ITBV and

EVLW values and any curve alerts are displayed and a message will appear Wait before starting

new measurement or in Auto mode Prepare for next injection or press Stop.

4When you see the Stable baseline, inject now! message, repeat the procedure until you have

completed the measurements you want to perform. You can perform a maximum of 6

measurements before editing. If you perform more than 6 measurements without rejecting any, the

oldest will automatically be deleted when a 7th curve is stored.

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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.

1Review the trials. Irregular trials or trials marked with a "?" should be reviewed carefully. Consider

the similarity of the values and the shape of the C.O. curve. A normal C.O. curve has one smooth

peak and returns to the temperature baseline level after the peak.

2Reject unsatisfactory trials: use the Select Trial pop-up key to move between trials, then select the

Accept Reject pop-up key to accept or reject trials. If you are using a touch screen you can accept

or reject trials directly by tipping on the trial curve. Discard conspicuously different values. The

background of rejected trials is red and the background of accepted trials is green. The monitor

recalculates the average values after you reject or accept trials.

If all values are different from each other, there may be true hemodynamic instability caused, for

example, by severe cardiac arrhythmia.

Saving and Calibrating PiCCO C.O. 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.

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.

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)

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Setting up RH C.O. Measurements

1Set up the PA line using a PA catheter.

2Attach the injectate temperature probe housing to the PA line.

3Plug the C.O. interface cable into the C.O. module or measurement extension module and connect

the following devices into the C.O. interface cable:

– injectate temperature probe

– remote start switch (if used).

Follow your hospital standards to avoid unintentional extraction of the C.O. catheter. Secure the

cable using the mounting clip shipped with each C.O. interface cable. You may also find it helpful

to loop the C.O. interface cable, tape the loop, and attach it to the undersheet of the patient's bed

using a safety pin.

4Plug the thermistor connection cable of the PA catheter into the thermistor connector.

5Connect the injectate temperature probe to the injectate temperature probe housing.

6Check that the correct measurement method is selected.

If a catheter is already connected to the Cardiac Output Interface Cable, the monitor automatically

recognizes the method used. If not, in the Setup C.O. menu, select Method and then select Right

Heart.

1C.O.Module

2C.O.Interface Cable

3 Remote Start Switch

4 Thermistor Connector

5 Thermistor Connection Cable

6 PA Catheter

7 Injectate Temperature Probe

Housing

8 Injectate Syringe

9 Injectate Temperature Probe

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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

1Enter the procedure window.

2When you see the message Ready for new measurement, select the pop-up key Start C.O.. If the

measuring mode is set to Auto the Start C.O. key will also enable the automatic start of

consecutive measurements.

3When you hear a ready tone and see the message Inject now!, inject the solution into the right

atrial port of the Swan-Ganz catheter. The optimal injection rate is 2.5 ml/second.

At the end of the measurement the thermodilution curve, cardiac output, index values and curve

alerts (if necessary) are displayed and a message will appear Wait before starting new

measurement or in Auto mode Prepare for next injection or press Stop.

4When you see the Inject now! message, repeat the procedure until you have completed the

measurements you want to perform. You can perform a maximum of six measurements before

editing. If you perform more than six measurements without rejecting any, the oldest will

automatically be deleted when a seventh curve is stored.

Editing and Saving RH C.O. 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.