Philips Medical Systems North America WLANBV3 WLAN Module IEEE 802.11 a/b/g/n User Manual ait fm manual MP2 en 2015 04 20

Philips Medical Systems North America Co. WLAN Module IEEE 802.11 a/b/g/n ait fm manual MP2 en 2015 04 20

Contents

user_manual mp2 english

Instructions for Use IntelliVue Patient MonitorMP2Release L with Software Revision L.xx.xxPatient Monitoring
31Table of Contents1Basic Operation 11Safety Information 12Security Information 13Introducing the IntelliVue MP2 15Controls, Indicators and Connectors 15Extending Measurements 17Operating and Navigating 22Operating Modes 27Understanding Screens 29Using the XDS Remote Display 29Using the Visitor Screen 30Understanding Profiles 30Understanding Settings 31Changing Measurement Settings 32Switching a Measurement On and Off 32Adjusting a Measurement Wave 32Using Labels 33Using IntelliVue Cableless Measurements 35Changing Monitor Settings 37Checking Your Monitor Revision 37Getting Started 37Disconnecting from AC Mains Power 39Monitoring After a Power Failure 39Networked Monitoring 40Capturing Alarm Reports and Printing 402What's New? 41What's New in Release L 41What's New in Release K.2 42What's New in Release J.0 42What's New in Release H.0 44What's New in Release G.0? 44What's New in Release F.0? 453Alarms 47Visual Alarm Indicators 48Audible Alarm Indicators 49Acknowledging Alarms 51Pausing or Switching Off Alarms 51Alarm Limits 54
4Reviewing Alarms 57Latching Alarms 58Testing Alarms 59Alarm Behavior at Power On 59Alarm Recordings 604Patient Alarms and INOPs 61Patient Alarm Messages 61Technical Alarm Messages (INOPs) 685Managing Patients and Equipment 85Patient Concepts 85Equipment Concepts 85Managing Patients 86Transferring Patients 91Managing Equipment 95Information Center Compatibility 1036ECG, Arrhythmia, ST and QT Monitoring 105Skin Preparation for Electrode Placement 105Connecting ECG Cables 105Selecting the Primary and Secondary ECG Leads 106Checking Paced Mode 106Understanding the ECG Display 107Monitoring Paced Patients 108Changing the Size of the ECG Wave 109Changing the Volume of the QRS Tone 110Changing the ECG Filter Settings 110Choosing EASI or Standard Lead Placement 110Selecting Positions of Va and Vb Chest Leads (for 6-lead placement) 111About ECG Leads 111ECG Lead Fallback 112ECG Lead Placements 112Capture 12-Lead 118EASI ECG Lead Placement 122ECG and Arrhythmia Alarm Overview 123Using ECG Alarms 125ECG Safety Information 127About Arrhythmia Monitoring 129Switching Arrhythmia Analysis On and Off 129Choosing an ECG Lead for Arrhythmia Monitoring 129Understanding the Arrhythmia Display 131Arrhythmia Relearning 134Arrhythmia Alarms 135About ST Monitoring 139Switching ST or STE On and Off 140
5Understanding the ST Display and Windows 141Updating ST Baseline Snippets 143About the ST Measurement Points 143ST Alarms 146STE Alarms 147Viewing ST Maps 147About QT/QTc Interval Monitoring 152QT Alarms 155Switching QT Monitoring On and Off 1567Monitoring Pulse Rate 157Entering the Setup Pulse Menu 157System Pulse Source 157Switching Pulse On and Off 158Using Pulse Alarms 1588Monitoring Respiration Rate (Resp) 161Lead Placement for Monitoring Resp 161Understanding the Resp Display 162Changing Resp Detection Modes 163Changing the Size of the Respiration Wave 164Changing the Speed of the Respiration Wave 164Using Resp Alarms 164Changing the Apnea Alarm Delay 164Resp Safety Information 1649Monitoring with the CL Respiration Pod (cmResp) 167Measurement Principles 167Measurement Modes 168Making Measurements 168Understanding the Numerics 168Setting the Measurement Mode 169Setting the Repeat Time 169Switching Posture and Activity Level On and Off 17010 Monitoring SpO2 171SpO2 Sensors 171Applying the Sensor 172Connecting SpO2 Cables 173Measuring SpO2 173Understanding the SpO2 Numerics 174Assessing a Suspicious SpO2 Reading 175Changing the Averaging Time 175Setting the Measurement Mode 176Understanding SpO2 Alarms 176Pleth Wave 181
6Perfusion Numeric 181Perfusion Change Indicator 181Setting SpO2/Pleth as Pulse Source 181Setting Up Tone Modulation 182Setting the QRS Volume 18211 Monitoring NBP 183Introducing the Oscillometric NBP Measurement 183Preparing to Measure NBP 185Starting and Stopping Measurements 187Enabling Automatic Mode and Setting Repetition Time 188Enabling Sequence Mode and Setting Up The Sequence 189Choosing the NBP Alarm Source 189Switching Pulse from NBP On/Off 190Assisting Venous Puncture 190Calibrating NBP 19012 Monitoring Temperature 191Making a Temp Measurement 191Calculating Temp Difference 19213 Monitoring Invasive Pressure 193Setting up the Pressure Measurement 193Overview of Calibration Procedures 195Zeroing the Pressure Transducer 195Calibrating Reusable Transducers 197Adjusting the Calibration Factor 199Displaying a Mean Pressure Value Only 199Changing the Pressure Wave Scale 199Optimizing the Waveform 199Non-Physiological Artifact Suppression 199Choosing the Pressure Alarm Source 200Calculating Cerebral Perfusion Pressure 20114 Monitoring Carbon Dioxide 203Measurement Principles 204Measuring CO2 using the CO2 Option or M3014A 205Measuring Microstream CO2 using M3015A/B 209Setting up all CO2 Measurements 210Understanding the IPI Numeric 21315 Using a Telemetry Device and a Monitor 215How Can You Combine Devices? 215Unpairing the Monitor and Telemetry Device 218Temporarily Stopping the Short Range Radio Connection 218
716 Enhancing Telemetry Monitoring with the Monitor 219Monitor and Telemetry Transceiver Requirements 21917 Trends 221Viewing Trends 221Setting Up Trends 224Documenting Trends 227Trends Databases 227Screen Trends 22818 Recording 231Starting and Stopping Recordings 231Overview of Recording Types 232Creating and Changing Recordings Templates 232Recorder Status Messages 23319 Printing Patient Reports 235Starting Report Printouts 235Stopping Reports Printouts 236Setting Up Reports 236Setting Up Individual Print Jobs 238Checking Printer Settings 238Printing a Test Report 239Switching Printers On or Off for Reports 239Dashed Lines on Reports 239Unavailable Printer: Re-routing Reports 239Checking Report Status and Printing Manually 240Printer Status Messages 241Sample Report Printouts 24220 Care and Cleaning 245General Points 245Cleaning the Monitor 246Disinfecting the Equipment 246Sterilizing the Equipment 247Cleaning, Sterilizing and Disinfecting Monitoring Accessories 247Cleaning Batteries and the Battery Compartment 24721 Using Batteries 249Battery Power Indicators 250Checking Battery Charge 252When Battery Lifetime is Expired 252Replacing a Battery 253Optimizing Battery Performance 254Battery Safety Information 256
822 Maintenance and Troubleshooting 257Inspecting the Equipment and Accessories 257Inspecting the Cables and Cords 258Maintenance Task and Test Schedule 258Troubleshooting 258Disposing of the Monitor 259Disposing of Empty Calibration Gas Cylinders 25923 Accessories 261ECG/Resp Accessories 261NBP Accessories 264Invasive Pressure Accessories 270SpO2 Accessories 273Temperature Accessories 278Mainstream CO2 Accessories 279Sidestream CO2 Accessories 279Microstream CO2 Accessories 280Battery Accessories 28124 Specifications 283Indications for Use 283Use Environment 283Restricted Availability 284Manufacturer's Information 284Symbols 285Installation Safety Information 287Monitor Mounting Precautions 287Altitude Setting 288Monitor Safety Specifications 288EMC and Radio Regulatory Compliance 288Out-Of-Hospital Transport - Standards Compliance 290Physical Specifications 291Environmental Specifications 292Monitor Performance Specifications 293Monitor Interface Specifications 294865297 Battery Extension Specifications 296M4607A Battery Specifications 296M4605A Battery Specifications 297Measurement Specifications 298Safety and Performance Tests 31225 Default Settings Appendix 317Alarm and Measurement Default Settings 317Alarm Default Settings 317ECG, Arrhythmia, ST and QT Default Settings 318Pulse Default Settings 321
9Respiration Default Settings 321SpO2 Default Settings 322NBP Default Settings 322Temperature Default Settings 323Invasive Pressure Default Settings 323CO2 Default Settings 325Index 327
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1111Basic OperationThese Instructions for Use are for clinical professionals using the IntelliVue MP2 (M8102A) 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.This guide may contain descriptions of functionality and features that are not implemented in the equipment currently shipped to Japan and/or of products that are not currently sold in Japan due to limitations and restrictions under the applicable local laws and regulations in Japan. Contact your local sales representative and/or Philips Customer Support for details.In this guide:•A warning alerts you to a potential serious outcome, adverse event or safety hazard. Failure to observe a warning may result in death or serious injury to the user or patient.•A caution alerts you to where special care is necessary for the safe and effective use of the product. Failure to observe a caution may result in minor or moderate personal injury or damage to the product or other property, and possibly in a remote risk of more serious injury.•Monitor refers to the entire patient monitor. Display refers to the physical display unit. Screen refers to everything you see on the monitor's display, such as measurements, alarms, patient data and so forth.For installation, repair, testing and troubleshooting instructions, refer to the Service Guide for your monitor model.Rx only: U.S. Federal Law restricts this device to sale by or on the order of a physician.
1 Basic Operation12Safety InformationThe following warnings apply to the monitors in general. Warnings that apply to specific measurements or procedures can be found in the corresponding chapters.Electrical Hazards and InterferenceWARNINGGrounding: To avoid the risk of electric shock, the monitor must be grounded during operation. If a three-wire receptacle is not available, consult the hospital electrician. Never use a three-wire to two-wire adapter.Electrical shock hazard: Do not open the monitor or measurement device. Contact with exposed electrical components may cause electrical shock. Refer servicing to qualified service personnel.Leakage currents: If multiple instruments are connected to a patient, the sum of the leakage currents may exceed the limits given in:• IEC/EN 60601-1• ANSI/AAMI ES60601-1• CAN/CSA C22.2 No. 60601-1-08Consult your service personnel.Radio frequency interference: The monitor generates, uses and radiates radio-frequency energy, and if it is not installed and used in accordance with its accompanying documentation, may cause interference to radio communications.Use EnvironmentWARNINGExplosion Hazard: Do not use in the presence of flammable anesthetics or gases, such as a flammable anesthetic mixture with air, oxygen or nitrous oxide or in the presence of other flammable substances in combination with air, oxygen-enriched environments, or nitrous oxide. Use of the devices in such environments may present an explosion hazard.Positioning Equipment: The monitor should not be used next to or stacked with other equipment. If you must stack the monitor, check that normal operation is possible in the necessary configuration before you start monitoring patients.Environmental Specifications: The performance specifications for the monitors, measurements and accessories apply only for use within the temperature, humidity and altitude ranges specified in the environmental specifications in the Instructions for Use.Liquid Ingress: If you spill liquid on the equipment, battery, or accessories, or they are accidentally immersed in liquid, contact your service personnel or Philips service engineer. Do not operate the equipment before it has been tested and approved for further use.Prohibited Environments: The monitors are not intended for use in an MRI environment or in an oxygen-enriched environment (for example, hyperbaric chambers).
1 Basic Operation13AlarmsWARNING• 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.• 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.AccessoriesWARNINGPhilips' approval: Use only Philips-approved accessories. Using other accessories may compromise device functionality and system performance and cause a potential hazard.Reuse: Never reuse disposable transducers, sensors, accessories and so forth that are intended for single use, or single patient use only. Reuse may compromise device functionality and system performance and cause a potential cross-infection hazard.Electromagnetic compatibility: Using accessories other than those specified may result in increased electromagnetic emission or decreased electromagnetic immunity of the monitoring equipment.Damage: Do not use a damaged sensor or one with exposed electrical contacts. Do not use damaged accessories. Do not use accessories where the packaging has been damaged or opened.Cables and tubing: Always position cables and tubing carefully to avoid entanglement or potential strangulation.MR Imaging: During MR imaging, remove all transducers, sensors and cables from the patient. Induced currents could cause burns.Use-by date: Do not use accessories where the use-by date has been exceeded.Electrosurgery: Do not use antistatic or conductive endotracheal tubes as they may cause burns in case of electrosurgery.Security InformationProtecting Personal InformationProtecting personal health information is a primary component of a security strategy. Each facility using the monitors must provide the protective means necessary to safeguard personal information consistent with country laws and regulations, and consistent with the facility’s policies for managing this information. Protection can only be realized if you implement a comprehensive, multi-layered strategy (including policies, processes, and technologies) to protect information and systems from external and internal threats.
1 Basic Operation14As per its intended use, the patient monitor operates in the patient vicinity and contains personal and sensitive patient data. It also includes controls to allow you to adapt the monitor to the patient's care model.To ensure the patient's safety and protect their personal health information you need a security concept that includes:•Physical security access measures - access to the monitor must be limited to authorized users. It is essential that you consider physical security measures to ensure that unauthorized users cannot gain access.•Operational security measures - for example, ensuring that patients are discharged after monitoring in order to remove their data from the monitor.•Procedural security measures - for example, assigning only staff with a specific role the right to use the monitors.In addition, any security concept must consider the requirements of local country laws and regulations.Always consider data security aspects of the network topology and configuration when connecting patient monitors to shared networks. Your medical facility is responsible for the security of the network, where sensitive patient data from the monitor may be transferred.When a monitor is returned for repair, disposed of, or removed from your medical facility for other reasons, always ensure that all patient data is removed from the monitor by ending monitoring for the last patient (see “Ending Monitoring for a Patient” on page 89).NOTELog files generated by the monitors and measurement modules are used for system troubleshooting and do not contain protected health data.About HIPAA RulesIf applicable, your facility’s security strategy should include the standards set forth in the Health Insurance Portability and Accountability Act of 1996 (HIPAA), introduced by the United States Department of Health and Human Services. You should consider both the security and the privacy rules and the HITECH Act when designing policies and procedures. For more information, please visit:http://www.hhs.gov/ocr/privacy/.About the EU DirectivesIf applicable, your facility’s security strategy should include the practices set forth in the Directive on the protection of individuals with regard to the processing of personal data and on the free movement of such data (Directive 95/46/EC of the European Parliament and of the Council of 24 October 1995). In addition, your facility should also take into account any additional, more stringent standards put forward by any individual EU countries; that is, Germany, France, and so on.Philips Product Security Policy StatementAdditional security and privacy information can be found on the Philips product security web site at:http://www.healthcare.philips.com/main/support/equipment-performance/product-security/index.wpd
1 Basic Operation15Manufacturer Disclosure Statement for Medical Device Security – MDS2You can view the Manufacturer Disclosure Statements for Medical Device Security (MDS2) for specific devices at:http://www.healthcare.philips.com/main/support/equipment-performance/product-security/index.wpdIntroducing the IntelliVue MP2The Philips IntelliVue MP2 monitor provides a comprehensive set of basic physiological measurements: ECG (including ST analysis and optional 10-lead ECG), NBP, SpO2, and optionally invasive blood pressure, temperature and CO2. Through networking it provides information integration, documentation and information access. The MP2 can be used with adult, pediatric and neonatal patients in a hospital environment and during patient transport both inside and outside hospitals.The monitor stores data in trend databases. You can see tabular trends (vital signs) and document them on a central printer. You can view measurement trend graphs, including horizon trends, to help you identify changes in the patient's physiological condition.The monitor can be powered by a rechargeable battery, or from AC mains using the external power supply (M8023A). For battery charging, care and status information, refer to the chapter “Using Batteries” on page 249.Controls, Indicators and ConnectorsMP2 Overview1On/Standby Switch2Power and battery indicators (see “MP2 Controls and Indicators” on page 16)33.5-inch TFT LCD touchscreen QVGA display
1 Basic Operation164Alarm lamps (see “MP2 Controls and Indicators” on page 16)5Built-in carrying handle6Battery eject button7Keys (see “MP2 Controls and Indicators” on page 16)8Measurement connectors (see “MP2 Patient Connectors, Right Side” on page 17)9BatteryMP2 Controls and Indicators1On/Standby switch2On/Standby LED. Green when monitor is on. Red indicates an error.3Battery status LED. Yellow when charging. Flashing red when battery is empty, or a battery malfunction is detected.4External power LED. Green when monitor is powered from an external power source.5Alarms off indicator. When alarms are suspended, the lamp is red, and the Alarms Off message appears on the screen.6Active INOP alarm lamp in light blue. Stays lit until active INOP is acknowledged.7Active alarm lamp. Red or yellow, depending on alarm level. Stays lit until active alarm is acknowledged.8Silence key9Alarms key: turns alarms On/Off, or pauses them10 SmartKeys key: brings up SmartKeys on the screen11 Main Screen key: closes all open menus/windows and returns to the main screen, or selects current screen.
1 Basic Operation17MP2 Patient Connectors, Right SideMP2 Left SideExtending MeasurementsYour monitor is compatible with Philips measurement extensions for use with other IntelliVue patient monitoring devices. These allow you to add specific measurements to those already integrated into your monitor. These measurement extensions are referred to as MMS extensions. During patient transport, the monitor with the connected MMS extension can be powered by the Battery Extension (see “Using the Battery Extension” on page 20).English version International version1Pressure (option)2Temperature (option)3Noninvasive blood pressure4SpO25ECG sync pulse output (See “Monitor Performance Specifications” on page 293 for specifications)6ECG/Respiration7CO2 (option)1Loudspeaker (do not cover with labels or stickers as this will reduce the loudspeaker volume).2MSL Connector. Connects to the external power supply via the MSL cable for AC mains operation, battery charging, and communication with a network.
1 Basic Operation18MMS Extension M3014A attached to the MP2The MMS extensions connect to the monitor and use the monitor's settings. Trend data and measurement settings from the measurements in the extensions are stored in the monitor.WARNING• Measurements from an MMS extension are only available when the extension is connected to the monitor, and the monitor is running on external power. This is the case when the monitor is running on AC mains via the external power supply (M8023A) or is attached to the Battery Extension (865297). Measurements from an MMS extension connected to the monitor are not available when the monitor is running on its own battery power.• Any measurements on an MMS extension that conflict with those in the monitor cannot be used. For example, only one CO2 measurement is supported.• The Cardiac Output and Continuous Cardiac Output option of the MMS extensions is not available for the MP2 monitor.To separate an extension from the monitor, press the release lever and push the extension forward.
1 Basic Operation19M3014A, M3015A, and M3015B Capnography MMS ExtensionsThe optional M3014A Capnography extension adds mainstream capnography or sidestream capnography, and optionally one pressure plus either a pressure or a temperature to the monitor.The optional M3015A Microstream CO2 extension adds microstream capnography and optionally either pressure or temperature to the monitor. The optional M3015B Microstream CO2 extension adds microstream capnography, two pressures and a temperature to the monitor.M3014A1Pressure connectors (red)2Temperature connector (brown)3Mainstream/sidestream connector CO24Cardiac Output connectorM3015A M3015B1Pressure connectors (red) - M3015A optional2Temperature connector (brown) - M3015A optional3Gas sample outlet4Microstream connector CO2 and Inlet
1 Basic Operation20M3012A Hemodynamic MMS ExtensionWhen attached to the MP2 connected to the external power supply, the optional M3012A Hemodynamic extension adds temperature, pressure, and an additional pressure or a temperature to the monitor.Using the Battery ExtensionTo provide enough power for the use of an MMS Extension during transport, you can use the Battery Extension (865297). The Battery Extension provides additional battery power for situations when no mains power is available and can typically power the monitor with MMS Extension for at least 6 hours.When running from the Battery Extension with no mains supply available, the monitor will not charge its internal battery.Connecting the Battery Extension1Cardiac Output (orange; optional)2Connection to monitor3Pressure connectors (red)4Temperature connectors (brown)To connect to the Battery Extension, place the monitor with MMS Extension onto the Battery Extension, and then slide it across so that the connection is made and it is firmly seated.
1 Basic Operation21LED IndicatorsThe Battery Extension has two LED indicators. The power LED lights green when the Battery Extension is connected to external power.The battery charge led gives battery status information.To remove the monitor with MMS Extension, press the release lever and push the monitor across to release the connection.External power availableLED indication Statusgreen Battery fully charged.yellow Battery charging.red flashing (short on phase) Battery maintenance required.red flashing (long on phase) Battery Extension malfunction.off No battery inserted in the Battery Extension.External power not availableLED indication Statusyellow flashing (short on phase) Battery Extension is charging the monitor battery (monitor is switched off).red flashing (short on-phase) If the monitor is running, this indicates very low battery charge (<10 minutes running time left). If the monitor is not running, this indicates that battery maintenance is required.red flashing (long on-phase) Battery Extension cannot provide power to the monitor. Either the Battery Extension needs charging, or it has a malfunction.
1 Basic Operation22IntelliVue Cableless MeasurementsThe IntelliVue Cableless Measurements (IntelliVue CL SpO2 Pod CL NBP Pod and CL Respiration Pod) are patient-worn measurement devices which communicate measurement values to the monitor using a wireless short range radio (SRR) interface. The CL SpO2 Pod and CL NBP also provide the measurement values on their built-in screen.Measurement Device Main Parts and KeysThe SpO2 Pod and the NBP Pod have an LCD display and three keys for basic operation e.g. to assign the device to a patient:The Respiration Pod has one multi-color LED for status display and one hardkey for basic operation, e.g. to start a measurement:Operating and NavigatingThe principle method of operating your monitor is via the touchscreen. Almost every element on the screen is interactive. Screen elements include measurement numerics, information fields, alarms fields, waveforms and menus. The typical operator's position is in front of the monitor.There are also four keys to the right of the screen (see also “MP2 Controls and Indicators” on page 16).1Integrated monochrome LCD display2Hardkeys3Measurement identifier1Multi-color LED2Hardkey3Indication for built-in RFID tagThese let you: Key with symbol (international)Text replaces symbol (English versions only)• Silence alarms: the Silence key acknowledges all active alarms by switching off audible alarm indicators and lamps.• Switch alarms on or off, or pause alarms.
1 Basic Operation23A typical main screen looks like this:• Call up SmartKeys on the screen (see below).• Close all open menus/windows and return to the main screen.• If you are already in the main screen (no additional menus/windows are open), then pressing this key opens the Change Screen menu, where you can choose from a number of pre-configured screens.• To temporarily disable the touchscreen operation, press and hold this key for 2 seconds. Press the key again to re-enable the touchscreen operation.MP2 Screen ElementsItem Description Comments1 Alarm volume off indicator is displayed when the alarm volume is set to zero (0).These let you: Key with symbol (international)Text replaces symbol (English versions only)
1 Basic Operation24Using the TouchscreenTouch a screen element to get to the actions linked to that element. For example, touch a measurement numeric and the setup menu for that measurement opens. Touch a wave to enter the setup menu for that wave.Measurement Setup MenusEach measurement has a setup menu where you can change settings. Typically, the setup menu window covers the whole screen, except the INOP and alarm message fields, which are always displayed at the top. The following picture is an example, and may not show exactly what you see on the screen. All measurement setup windows are similar and share the same basic layout.2 Patient name / alarm message fieldPatient name can be covered by alarm messages or alarms On/Off/Paused message.If red and yellow alarms are active at the same time, they rotate in the alarm field.3 Patient category and bed label / INOP message fieldPatient category and bed label can be covered by INOP messages. If there are multiple red/yellow/cyan INOPs active at the same time, they rotate in the INOP field.4 Network connection indicatorDocumented in Information Center Instructions for Use.5 Measurement label Touch the measurement to enter the measurement setup menu.6 Paced status Displayed below the HR label.7 Measurement numeric/values Touch the numeric to enter the measurement setup menu.8 Measurement wave Touch the wave to enter the measurement setup menu.9 Status line Shows information and messages prompting you for action.10 Measurement Selection key Opens the Measurement Selection window which shows all measurements and where they are physically located. From here you can also enter the measurement setups.11 Battery status indicator Gives information about remaining battery charge, estimated operating time, maintenance requirements and malfunctions. See the chapter “Using Batteries” on page 249.MP2 Screen ElementsItem Description Comments
1 Basic Operation25Touch the measurement numeric on the screen to enter the setup menu.Main Setup MenuThere is usually more than one way to enter a setup menu for a measurement, to change a setting or to execute a task. Some routes are more direct than others. You can use whichever method you find most convenient. Which routes are available to you, however, can vary depending on your monitor’s configuration.For this reason, this book generally describes entry to a measurement’s setup menu via the Main Setup menu, as this route is always available and is not subject to configuration dependencies. You can get to all setup windows from the Main Setup menu. You enter the Main Setup menu by pressing the SmartKeys key, then selecting the Main Setup SmartKey.Key to measurement setup menu:Item Description Comment1 INOP and alarm message fieldThese are always displayed at the top of the screen.2 Wave/numerics windowThe main measurement numeric and wave (if applicable) are shown in this window so that you do not lose sight of the current measurement while making changes in the menu.3 Status/prompt messageStatus/prompt messages related to the measurement menu are displayed below the wave/numerics. General status/prompt messages on the main screen are covered by the measurement setup menu.4 Next page arrows The menu may have more than one page, as shown here. Move to another page by touching these arrows.5 Measurement menu keysEach button has two lines of text. To perform an operation on a measurement, press one of the keys. Some keys lead directly to a task. For example, pressing the Start/ Stop key for noninvasive blood pressure starts a measurement. Other keys open a pop-up window, which can have more than one page, from which you make a selection. Again, using noninvasive blood pressure as an example, pressing the Repeat Time key for setting the repetition time opens a pop-up window from which you pick a time, scrolling if necessary.
1 Basic Operation26SmartKeysA SmartKey is a configurable graphical key on the screen allowing fast access to frequently used functions. Press the SmartKeys hard key to call up a set of SmartKeys on the screen. Although the selection of SmartKeys available on your monitor depends on the monitor configuration and on the options purchased, the SmartKeys window generally looks like this:1Scroll to see more SmartKeysenter Main Setup menu - you can get to all setup windows using this keyenter standby mode - suspends patient monitoring. All waves and numerics disappear from the display. All settings and patient data information are retained.enter profile menu, orrevert to default profilechange Screen, orrevert to default screenprevious Screen quick admit a patiententer patient identification menu to admit/discharge/transferend case to discharge a patientlock touchscreen operation set alarm limitschange alarm volume change screen brightness (not for independent displays)change QRS volume change amplitude (size) of ECG wavereview beat labels (annotate arrhythmia wave)re-learn arrhythmia- start/stop manual NBP measurement- start auto series- stop current automatic measurement within seriesstart NBP STAT measurement
1 Basic Operation27Pop-Up KeysPop-up keys are task-related graphical keys that appear automatically on the monitor screen when required. For example, the Confirm pop-up key appears only when you need to confirm a change.Using the On-Screen KeyboardUse this as you would a conventional keyboard. Enter the information by selecting one character after another. Use the Shift and capital Lock keys to access uppercase letters. Use the Back key to delete single characters, or use the Clr key to delete entire entries. Select Enter to confirm what you have entered and close the on-screen keyboard.Operating ModesWhen you switch the monitor on, it starts up in monitoring mode. To change to a different mode:1Select the Main Setup menu.2Select Operating Modes and choose the mode you require.stop automatic or STAT NBP measurement and measurement seriesstart NBP measurement and measurement seriesstart veni puncture (inflate cuff to subdiastolic pressure)stop current NBP measurementset the NBP repeat time access patient reportsswitch CO2 pump off zero invasive pressure transducernew lead setup set standard or EASI lead placementreview vital signs trend review graph trendunpair equipment and continue central monitoring with the monitorunpair equipment and continue central monitoring with the telemetry devicestart 12-Lead Capture (only available if Information Center is connected)access ST Map applicationselect measurement device start an SpO2 measurementaccess NBP mode selection and setup, with direct start/stop functionopen the Equipment window
1 Basic Operation28Your monitor has four operating modes. Some are passcode protected.•Monitoring Mode: This is the normal, every day working mode that you use for monitoring patients. You can change elements such as alarm limits, patient category and so forth. When you discharge the patient, these elements return to their default values. Changes can be stored permanently only in Configuration Mode. You may see items, such as some menu options or the altitude setting, that are visible but ‘grayed out’ so that you can neither select nor change them. These are for your information and can be changed only in Configuration Mode.•Demonstration Mode: Passcode protected, this is for demonstration purposes only. You must not change into Demonstration Mode during monitoring. In Demonstration Mode, all stored trend information is deleted from the monitor’s memory.•Configuration Mode: Passcode protected, this mode is for personnel trained in configuration tasks. These tasks are described in the Configuration Guide. During installation the monitor is configured for use in your environment. This configuration defines the default settings you work with when you switch on, the number of waves you see and so forth.• Service Mode: Passcode protected, this is for trained service personnel.When the monitor is in Demonstration Mode, Configuration Mode, or Service Mode, this is indicated by a box with the mode name in the center of the Screen and a symbol in the bottom right-hand corner. Select the mode box in the center of the screen to change to a different mode.Standby ModeStandby mode can be used when you want to temporarily interrupt monitoring.To enter Standby mode,1Press the SmartKeys key .2Either select the Monitor Standby SmartKeyOr select the Main Setup SmartKey, then select Monitor Standby.The Standby screen is a neutral screen with information about the monitor and instructions on how to leave Standby mode.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. The Standby screen is displayed.If a temporary patient location has been entered at the monitor or at the Information Center, this location will also be displayed on the Standby screen.To resume monitoring,• Select anything on the screen or press any key.When monitoring is resumed, alarms are paused for 1 minute to allow time to finish plugging in the measurement cables.
1 Basic Operation29Understanding ScreensYour monitor comes with a set of pre-configured Screens, optimized for common monitoring scenarios such as "OR adult", or "ICU neonatal". A Screen defines the overall selection, size and position of waves, numerics and other elements on the monitor screen when you switch on. You can easily switch between different Screens during monitoring. Screens do NOT affect alarm settings, patient category and so forth.Switching to a Different ScreenTo switch to a different Screen:1After closing any open menus or windows, press the Main Screen key to access the Change Screen menu.2Choose the new Screen from the Change Screen menu.Changing a Screen’s ContentIf you do not want to change the entire Screen content, but only some parts of it, you can substitute individual waves, numerics, 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. For example, touch the wave to enter the wave setup menu, or touch the numeric to enter the numeric setup menu.2From the menu that appears, select Change Wave or Change Numeric, and then select the wave or numeric you want.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, select the name of the Screen in the Change Screen menu.After a patient discharge, the monitor’s default Screen is shown. Modified Screens are still available in the Change Screen menu.If the monitor is switched off and then on again, modified Screens are erased from the monitor’s memory and cannot be recalled. If a modified Screen was the last active Screen when the monitor was switched off, it is retained unless the monitor is configured to revert to the default.Using the XDS Remote DisplayUsing the IntelliVue XDS Solution it is possible to view an independent monitor screen on an external display. The XDS Solution consists of a medical grade PC-based hardware platform, XDS Application software and the XDS connectivity option on the monitor. Depending on the configuration you can also operate the monitor from the external display. The XDS must be connected to the same Local Area Network (LAN) as the monitor.It is also possible to use an existing PC, connected to the same LAN, to host the XDS Application software.For more details, including limitations and restrictions, refer to the IntelliVue XDS Application Instructions for Use.
1 Basic Operation30Using the Visitor ScreenIf a visitor Screen is configured for your monitor, you can use it to clear the screen of all waves and numerics but continue to monitor the patient with active alarms and trend storage at the bedside and Information Center. When the visitor Screen is selected, no automatic pop-up windows will be displayed. You can change the name of the visitor Screen in Configuration Mode.To activate this Screen,1Press the Main Screen key to open the Change Screen menu.2Select 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, or press the Main Screen key, to open the Change Screen menu and then select a Screen from the list.Understanding ProfilesProfiles are predefined monitor configurations. They let you change the configuration of the whole monitor so you can adapt it to different monitoring situations. The changes that occur when you change a complete profile are more far reaching than those made when you change a Screen. Screens affect only what is shown on the display. Profiles affect all monitor and measurement settings.The settings that are defined by Profiles are grouped into three categories. Each category offers a choice of 'settings blocks' customized for specific monitoring situations. These categories are:•Display (screens)Each profile can have a choice of many different predefined screens.When you change the profile, the screen selection configured for the new profile becomes active.•Measurement SettingsEach profile can have a choice of different predefined measurement settings. These relate directly to individual measurements, for example, measurement on/off, measurement color, alarms limits, NBP alarm source, NBP repeat time, temperature unit (°F or °C), pressure unit (mmHg or kPa).•Monitor SettingsEach profile can have a choice of different predefined monitor settings. These relate to the monitor as a whole; for example, display brightness, alarms off/paused, alarm volume, QRS tone volume, tone modulation, prompt tone volume, wave speed, resp wave speed, pulse source.You can change from one complete profile to another or swap individual settings blocks (display/monitor settings/measurement settings) to change a subset of a profile. Changes you make to any element within the settings blocks are not saved when you discharge the patient, unless you save them in Configuration Mode.Depending on your monitor configuration, when you switch on or discharge a patient the monitor either continues with the previous profile, or resets to the default profile configured for that monitor.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.
1 Basic Operation31• If your monitor is configured to show the profile name in the info line at the top of the screen, be aware that individual settings may have been changed by other users or by settings synchronization since the profile was loaded. Hence settings may be different than implied by the profile name.When you leave Demonstration Mode, the monitor uses the default profile.Swapping a Complete Profile1Press the SmartKeys hard key and–Either select Main Setup and then Profiles in the Main Setup menu.–Or select the Profiles SmartKey .2In the Profiles menu, select Profile.3Chose a profile from the pop-up list.4Confirm your selection.Swapping a Settings Block1Select the Main Setup SmartKey and then Profiles in the Main Setup menu.2Select the Profile Details key.3In the Profile Details menu, select Display or Measmnt.Settings or Monitor Settings to call up a list of the settings blocks in each category.4Choose a settings block from the pop-up list.5Confirm your selection.Default ProfileYour monitor has a default profile that it uses when you leave Demonstration mode, or when you discharge a patient. This profile is indicated by a diamond shaped symbol.Understanding SettingsEach aspect of how the monitor works and looks is defined by a setting. There are a number of different categories of settings, including,Screen Settings, to define the selection and appearance of elements on each individual ScreenMeasurement settings, to define settings unique to each measurement, for example, high and low alarm limitsMonitor settings, including settings that affect more than one measurement or Screen and define general aspects of how the monitor works, for example, alarm volume, reports and recordings, and display brightness.You must be aware that, although many settings can be changed in Monitoring Mode, permanent changes to settings can only be done in the monitor's Configuration Mode.
1 Basic Operation32All settings are reset to the stored defaults:• when you discharge a patient• when you load a Profile• when the monitor is switched off for more than one minute (if Automat. Default is set to Yes).Changing Measurement SettingsEach measurement has a setup menu in which you can adjust all of its settings. You can enter a setup menu:• via the measurement numeric - select the measurement numeric to enter its setup menu. For example, to enter the Setup ECG menu, select the HR (heart rate) numeric.•via the Main Setup SmartKey - if you want to setup a measurement when the measurement is switched off, use the Main Setup SmartKey and select Measurements. Then select the measurement name from the pop-up list.• via the Measurement Selection key.Switching a Measurement On and OffWhen a measurement is off, its waves and numerics are removed from the monitor’s screen. The monitor stops data acquisition and alarming for this measurement.1Enter the measurement’s setup menu and select the measurement.2Select the measurement name to toggle between on and off. The screen display indicates the active setting.If you disconnect a transducer, the monitor replaces the measurement numeric with question marks. If you silence the resulting INOP, the measurement is switched off. Also if you pause or switch off alarms, the measurement may be switched off completely, depending on monitor configuration.Adjusting a Measurement WaveTo quickly adjust wave-related measurement settings (such as speed or size), select the measurement wave itself. This displays the measurement wave menu, which has only wave-related measurement settings.Changing Wave SpeedsLowering the wave speed compresses the wave and lets you view a longer time period. Increasing the speed expands the waveform, giving you a more detailed view.The monitor distinguishes two groups of wave speed settings:•RespiratorySpeed, for CO2 waves.•Global Speed, for all waves not included in the other group.
1 Basic Operation33Changing the Wave Group SpeedThe wave speed group setting defines the speed of all the waves in the group.To change the wave speed of a wave speed group,1Select Main Setup and then select User Interface2Select Global Speed or RespiratorySpeed, as required3Select a value from the list of available speeds.Changing Wave Speed for a ChannelTo change the wave speed of an individual wave channel,1Enter the wave menu for a measurement by selecting its wave.2Select Change Speed.3To set the speed to the wave group speed, select RespiratorySpeed 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 sets 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.Using LabelsYou can measure up to three invasive pressures and temperatures simultaneously. The monitor uses the 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.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.Resolving Label ConflictsEach label must be unique, that is, it can only be assigned once. If you have an MMS Extension equipped with a pressure measurement connected to the monitor, there is a potential conflict with, for example, the ABP label. If you manually enter measurement values these may also conflict with existing labels on the monitor.
1 Basic Operation34Depending on your configuration, the monitor will either•display the Measurement Selection window automatically for you to resolve the conflict• take no action, you must enter the Measurement Selection window (using the measurement selection key) and resolve the conflictAll the currently available measurements are depicted in the Measurement Selection window. Any measurement labels causing a label conflict are shown in red. If a measurement is connected but currently unavailable, for example, because it was deactivated due to a label conflict, that measurement is shown "grayed-out". If an MMS Extension is not available, for example if monitor is running on battery power and not an external power source, the MMS Extension is not displayed.1Unavailable measurement shown grayed-outAn MMS Extension is only shown in the Measurement Selection window when the monitor is connected to AC mains via the external power supply (M8023A) or is attached to the Battery Extension (865297).To resolve a label conflict:1Press the SmartKeys key and–Either select Main Setup and then Meas. Selection–Or select the Measmt. Select. SmartKeyto display the Measurement Selection window.2Select the label to be corrected.3Use the measurement selection keys to resolve the conflict. Select either:–Change Label: to assign a different label to the conflicting label.Measurement selection key
1 Basic Operation35–De- Activate: to disable the conflicting measurement. It retains its label for future use but becomes invisible to the monitor, as though it had been unplugged.–Setup <Measurement Label>: to enter the Setup menu for the measurement and change the conflicting device’s label to a different label.Label CompatibilityWhen a new measurement is introduced, or new labels for an existing measurement, these labels will not be shown on older Information Centers, and consequently not on the Overview screen sourced from the Information Center.When a patient is transferred from a monitor with these new labels to one with an older software revision, the labels will be replaced with a generic label for that measurement. The settings for that generic label will then be used.If it is critical that the measurement labels are available at the Information Center and after transfers, the older monitors and the Information Center must be upgraded to the appropriate software revision.Using IntelliVue Cableless MeasurementsThe IntelliVue CL SpO2 Pod, CL NBP Pod and CL Resp Pod, can be used together with a monitor with an SRR interface for continuous monitoring. They communicate their measurement values via short range radio to the monitor. The Cableless Measurements allow the patients more mobility without giving up continuous vital signs monitoring.Adding a Cableless Measurement DeviceWhen using an SpO2 Pod, an NBP Pod or a Respiration Pod for continuous monitoring, you need to assign the cableless measurement device to the monitor.WARNINGShort Range Radio connections are subject to interruption due to interference from other radio sources in the vicinity, including microwaves, bluetooth devices, WLAN devices (802.11b,g,n) and cordless phones. Depending on the strength and duration of the interference, the interruption may occur for an extended period. A loss of connection, due to moving out-of-range, interference, or for other reasons, is indicated with a No Host Monitoring INOP on the NBP or SpO2 Pods, or a cl NBP Disconnect, cl SpO₂ Disconnect or cl Resp Disconnect INOP at the host monitor. Correct channel configuration is important, refer to the Configuration Guide for details.Adding With an RFID Reader and Tagged Cableless DevicesYou can directly add all cableless devices that have RFID tags with a Philips HS1-R RFID/barcode reader. The Respiration Pod has a built-in RFID tag. The SpO2 and NBP Pods can have IntelliVue ProxiTag RFID tags adhesively attached.1Hold the cableless device close to the reader.Depending on its configuration, the reader beeps, vibrates or indicates via the LEDs when it has read the tag.2Press any hardkey on the cableless device.
1 Basic Operation36The cableless measurement device is now added to the monitor.If the corresponding internal measurement in the patient monitor is active, you will be asked to confirm that it should be deactivated in favor of the cableless measurement device by selecting Replace.If a cableless measurement of the same type is already assigned to the monitor, you will be asked to confirm that it should be removed by selecting Replace.Adding Manually1Prepare the SpO2 or NBP Pod for adding by holding the ◄key pressed, or the Respiration Pod by pressing the hardkey.2Select the device key that appears in place of the Measurement Selection key, for example .This displays the Add Cableless window, that shows any available IntelliVue Cableless Measurements and telemetry devices:3Select the cableless measurement device to be added.4Select Add. The device confirms the successful addition with a tone.If the corresponding internal measurement in the patient monitor is active, you will be asked to confirm that it should be deactivated in favor of the cableless measurement device by selecting Replace.If a cableless measurement of the same type is already assigned to the monitor, you will be asked to confirm that it should be removed by selecting Replace.For the SpO2 and NBP Pods, adding can also be done directly on the device. See the IntelliVue Cableless Measurements Instructions for Use for details.Removing a Cableless Measurement DeviceTo remove a cableless measurement device from a monitor and end the assignment:1Select the Measurement Selection key.2Select the cableless measurement device to be removed.3Select the Remove pop-up key.You can also remove cableless measurement devices in the same way as any other devices using the Equipment window, see “Using the Equipment Window” on page 96.
1 Basic Operation37Changing Monitor SettingsTo change monitor settings such as brightness, or QRS tone volume:1Press the SmartKeys key .2Either Select the appropriate SmartKey for the setting you want to changeOr Enter the Main Setup menu by selecting the Main Setup SmartKey; then select User Interface to enter a submenu where you can change the settings.Adjusting the Screen Brightness1Select the Brightness SmartKey.2Select the appropriate setting for the screen brightness. 10 is the brightest, 1 is the least bright. Optimum is suitable for most monitoring locations and optimizes power usage for battery powered monitors.Your monitor may be configured with a lower brightness for Standby mode and also for transport to conserve battery power. These settings can only be changed in the monitor’s Configuration Mode.Setting the Date and TimeEnter the Main Setup menu by selecting the Main Setup SmartKey, then select Date, Time to enter the Date, Time menu.1Select, 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.2Select 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.Checking Your Monitor Revision1Select Main Setup then select Revisions to open the Monitor Revision menu.2Select the correct device from the device pop-up keys.3From the Monitor Revision menu, select the monitor component for which you need revision information.Getting StartedOnce you understand the basic operation principles and have completed the Training Program, you can get ready for monitoring.
1 Basic Operation38Inspecting the MonitorWARNINGIf the monitor is mechanically damaged, or if it is not working properly, do not use it for any monitoring procedure on a patient. Contact your service personnel. 1Before you start to make measurements, carry out the following checks on the monitor. – Check for any mechanical damage.– Check all the external cables, plug-ins and accessories.2Always ensure that the battery is loaded in the battery compartment when monitoring a patient, even when the monitor is running on external power.3If you are using battery power, ensure that the battery has sufficient power for monitoring. When you use a battery for the first time, you must charge it, following the instructions given in the section on charging batteries in the Using Batteries chapter.4Check all the functions of that you need to monitor the patient, and ensure that the monitor is in good working order.NOTEMeasurements from an MMS extension are only available when the extension is connected to the monitor, and the monitor is running on external power. This is the case when the monitor is running on AC mains via the external power supply (M8023A) or is attached to the Battery Extension (865297).Switching OnPress the power on/standby switch on the monitor for one second. The monitor performs a self test during which all lamps will light up and a tone will be sounded, and is then ready to use. If you see a message such as CO₂ Sens Warmup wait until it disappears before starting to monitor that measurement.Power On/Power Off BehaviorThe general rules determining the behavior of the monitor when connected to, or disconnected from power are as follows:• A monitor that was switched on prior to a temporary power loss switches on again when power is restored.• A monitor that was switched off prior to a temporary power loss remains off when power is restored.• When AC mains power is lost, a battery powered monitor continues to run without interruption on battery power.Setting up the Measurements1Decide which measurements you want to make.2Connect the required patient cables and sensors. The connectors are color-coded to the patient cables and sensors for easy identification.
1 Basic Operation39WARNINGWhen connecting devices for acquiring measurements, always position cables and tubing carefully to avoid entanglement or potential strangulation.3If using IntelliVue Cableless Measurements, –apply the SpO2 sensor, Respiration Pod and/or NBP cuff to the patient as described in the cableless measurements Instructions for Use.– assign the cableless measurements to the monitor:- select the Measurement Selection key- select the Add cl Msmt pop-up key- select the cableless measurement device to be assignedIf the internal measurement in the patient monitor is active, you will need to confirm that it should be deactivated in favor of the assigned cableless measurement device.Starting MonitoringAfter you switch on the monitor,1Admit your patient to the monitor.2Check that the profile, alarm limits, alarm and QRS volumes, patient category and paced status and so forth are appropriate for your patient. Change them if necessary.3Refer to the appropriate measurement chapter for further details of how to perform the measurements you require.Disconnecting from AC Mains PowerTo disconnect the monitor from AC mains power, unplug the power cord for the external power supply (M8023A) from the mains socket.Monitoring After a Power FailureIf external power is disconnected or there is a power failure, the monitor continues to run on its rechargeable battery.If the monitor is without any power (no external power or the battery is empty) 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 Basic Operation40Networked MonitoringYou can connect your monitor to an Information Center on a network, using one of the optional interfaces:• Standard wired LAN• Wireless LAN• IntelliVue Instrument Telemetry System (IIT).WARNINGDo not connect patient monitors to the standard hospital network.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 monitoring equipment and technical information about the network, select the Main Setup SmartKey to enter the Main Setup menu, then select Bed Information.Be aware that some network-based functions may be limited for monitors on wireless networks in comparison to those on wired networks.Capturing Alarm Reports and PrintingYou can print out alarm-triggered reports with waves and vital signs, standard reports, and trends with the XDS Printing Service which is part of the IntelliVue XDS Application. This is a software package which allows you to print to a standard, off-the-shelf printer or to an electronic file such as PDF. You can download the IntelliVue XDS Application free-of-charge from the Internet and install it on an existing PC.Capturing Alarm EventsThe monitor can be set up to automatically capture alarm events, triggered by selected alarms.When one of the selected alarms occurs, the monitor automatically captures the alarm and creates a realtime report which is stored in the database. As soon as the monitor is connected to a printer, or to a PC or network with the IntelliVue XDS Application software, it will automatically print the report, or send it to a patient-specific folder as an electronic file.All settings must be made in Configuration mode.The output device for alarm recordings is set to "printer".This automatically makes the alarm event documentation a realtime report.The target device for realtime reports is set to "database"The alarms to trigger the report are set up.The database is set to print automatically when a printer is available.
2412What's New?This section lists the most important new features and improvements to the monitor and its user interface introduced with each release. Further information is provided in other sections of this book.You may not have all of these features, depending on the monitor options purchased by your hospital.What's New in Release LECG EnhancementsExtended Selection for Va and Vb Chest LeadsFor 6-lead placement you now have an extended selection of chest leads: V1 to V9 and V3R to V6R.Specific Label Assignment for V LeadWith standard 5-lead placement, the generic V lead can be configured to display with its specific position (V1 to V9 and V3R to V6R).STE MapThe STE Map adds gender-specific STE limits to ST Map. ST values violating these limits are indicated in red.12-Lead Order ManagementA pop-up key provides access to the order window from the Information Center. You can assign an order number from the pending list to a 12-Lead ECG waiting to be stored.This functionality requires corresponding configuration and licenses at the Information Center. Check with your Philips representative for availability.Lead Selection for Respiration MeasurementIt is now possible to choose between two different lead vectors for the impedance respiration measurement.Stat Admit FunctionThe new Stat Admit function allows you to admit a patient with a temporary patient identification. It can be used in cases when the patient ID is unknown or when the data is not yet available.
2What's New?42What's New in Release K.2Cableless Respiration MeasurementThe new CL Respiration Pod can be used with the monitor. It is a battery-powered, cableless, respiration rate measuring device that is applied to the patient's chest using an adhesive attachment. In addition to the respiration rate it can also provide posture information and optionally a pulse measurement.Hexad Derived 12-lead ECGThe Hexad ECG lead system uses a 6-lead set connected to four limb electrodes (using Mason-Likar placement) and two chest electrodes. The algorithm derives the four remaining V-leads to provide a non-diagnostic 12-lead view, including ECG waves and ST measurements.Accelerated Measurement for NBPAn accelerated measurement is now available. This allows a faster measurement result but requires that the patient keeps the limb in question still. The accelerated measurement must be switched on in Configuration Mode.What's New in Release J.0Flexible, Patient-oriented Workflow (with PIIC iX only)With the IntelliVue Information Center iX, more flexible, patient-oriented workflows are supported for admitting, tracking and transferring patients. This allows you to adapt monitor use to the patient data flow models in your specific facility and department.Managing PatientsWhen the patient monitor is connected to an IntelliVue Information Center iX, an extended comparison of patient data allows more intelligent admission and transfer procedures. A Find Patient key can be used to search through the patient lists at the Information Center and other connected systems and take over the corresponding data found.Flexible TransferA transfer can be initiated in the unit at the monitor, on patient arrival or patient departure, or centrally at the Information Center.Managing EquipmentWhen used together with an Information Center iX, extended equipment management functionality is now available. Depending on how equipment is used in your facility, there are various ways to associate devices with patients, beds or monitors.Additionally there are mechanisms to automatically free up equipment that is no longer used. Using the new Equipment window you have an overview of all equipment being used for a patient, together with patient and caregiver data.
2What's New?43Alarm Functionality Enhancements• Pause Yellow Alarms (with PIIC iX only) - up until now, the Pause Alarms / Alarms Off key switched off or paused all red and yellow alarms. Now an alarm priority configuration setting is available to have only yellow alarms affected.•Pause Alarms / Alarms Off not allowed - when the alarm priority is set to Not Allowed, alarms can no longer be switched off or paused. The Pause Alarms / Alarms Off key is disabled.•Pause Alarms / Alarms Off key can be removed from the screen - a configuration setting removes the permanent key from the screen to avoid unintentional switching off of alarms. Alarms can still be switched off or paused, in the Alarms menu, under Main Setup.• Alarms paused after Standby mode - alarms are automatically paused for 1 minute after Standby mode to allow time for patient connection.Capture 12-Lead ECG Enhancements (with PIIC iX only)The existing 12-Lead ECG capture functionality has been extended to offer:• Download of analysis results from the IntelliVue Information Center.• Download of 12-Lead captures from the IntelliVue Information Center for review at the patient monitor.• Analysis results included in reports and additional report selections with ST Map.• Remote operation of the 12-Lead Export function at the IntelliVue Information Center.• Remote operation of the 12-Lead Lock/Unlock function at the IntelliVue Information Center.• New filter settings that are used as a default for future 12-Lead captures.New "End Afib" and "End Irregular HR" AlarmsThe end of an atrial fibrillation or irregular HR phase is announced with an * End AFIB or * End Irregular HR alarm. The delay time before the alarm is announced can be configured.Integrated Pulmonary Index for Microstream CO2An Integrated Pulmonary Index (IPI) numeric is provided, that is an indication of the patient's overall ventilatory status based on four measurement parameters: etCO2, awRR, pulse rate and SpO2.Improved Visibility of Gridlines in Overlapping WavesVisibility of the gridlines for overlapping waves has been improved, and you can now configure gridlines to be shown in white, if you prefer, in a thin or thick style.Timeout for "Aged" NumericsNBP and SpO2 numerics from intermittent measurements can be configured to be grayed out or to disappear from the screen after a set time. This avoids older numerics being misinterpreted as current data. The time can be set individually for SpO2 and NBP in Configuration mode.
2What's New?44What's New in Release H.0Battery ExtensionThe new Battery Extension provides additional battery power for situations when no mains power is available, for example during transport, and can typically power the monitor with MMS Extension for at least 6 hours.New Design for the User InterfaceThe user interface for the patient monitors has been redesigned to bring the presented information into the foreground, letting the structural elements such as keys and frames retreat into the background. Additionally special regard was given to improved usability and compatibility with standard software products. 12 Lead ECG EnhancementsYou can now preview the 12-Lead ECG at the bedside before you send it to the Information Center. A new dedicated 12-Lead ECG Report can be printed in diagnostic quality from the bedside.Support For Use of IntelliVue Cableless Measurement DevicesThe new Cableless Measurement Devices are patient-worn, battery powered measurement devices for SpO2 and NBP. The devices provide measurement values on the built-in display and communicate them to the monitor using a wireless short range radio (SRR) interface. They can also be controlled via SRR from an assigned patient monitor.Vital Signs Trend Based on NBP Measurement TimesYou can now have the NBP measurement determine the interval between the columns on the Vital Signs trend. Each NBP measurement will generate a column in the trend table. The values for the other measurements are added to the column to provide a complete vital signs set for the NBP measurement time.What's New in Release G.0?Short Range Radio Interface for MP2A short range radio interface is now available for the MP2 monitor. This allows a telemetry transceiver with a short range radio adapter to be assigned to the monitor, resulting in a direct connection. The measurement data from the telemetry transceiver appear directly on the monitor screen with a minimal delay and are combined with the monitor data in one sector at the Information Center.IntelliVue XDS SolutionUsing 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.New Fields in the Admission FormA Middle Name field is now available in the admission form - whether it appears is configurable. Two additional ID fields, Lifetime Id and Encounter Id, can also be configured to appear and their names can be customized to fit hospital requirements.
2What's New?45SpO2 Enhancements• Additional SpO2 Labels - SpO₂pr and SpO₂po labels have been added.• New manual measurement mode when telemetry devices are connected via a short range radio link.• Signal Quality Indicator displayed with the SpO2 numerics.ECG Enhancements•New * AFIB / ** AFIB yellow alarm when an atrial fibrillation waveform is detected.•QT View window - shows current wave and baseline wave with Q and T points marked so that you can verify that the QT algorithm detects correct Q and T points.What's New in Release F.0?QT/QTc Interval MonitoringQT interval monitoring is used to assist in the detection of prolonged QT interval syndrome. The QT interval is measured and the heart-rate corrected QT value, QTc, is calculated. The monitor also provides a ΔQTc value which tracks variation in the QT interval in relation to a baseline value. High alarm limits can be set for QTc and ΔQTc enabling alarm notification.Manual Data EntryMeasurement values (for example lab data or manually measured temperatures) can be entered manually into the monitor and stored in the database. They can then be used for trends, reports and also be displayed as a numeric on screen, if required.Horizon Trend EnhancementsThe trend indicator arrow indicates how the patient trend has developed in a set time period. This period is now configurable and can be set to 10 minutes, 5 minutes or 2 minutes. The horizon (or baseline) can now be set to a range or to a specific value.NBP - Programmable Measurement SequenceUp to four measurement cycles can be set up which will run consecutively. For each cycle you can set the number of measurements and the interval between them. By setting the last cycle to run continuously you can have regular measurements continue after the sequence has run.New Printing Options For ReportsReports can now also be printed via an external PC-based print server or to an internal print database, when no printer is available (for example, during transport). As soon as a printer becomes available, the reports stored in the database will print automatically.Manual Pairing At MonitorPreviously, devices could only be manually paired at the Information Center. You can now pair devices at the monitor as long as the monitor is already connected to the Information Center.Moving Windows And MenusWindows and menus can now be moved on the monitor screen. Using touch or a mouse you can select the title of a window and then "drag" it across the screen. Some positions on the screen are not allowed, such as ones overlapping the alarm field or the monitor info line.
2What's New?46Invasive Pressure ChangesWave cursor - A cursor is now available on the realtime pressure wave to allow you to define a position and store the corresponding value.Reduced alarm limit steps in lower ranges - The alarm limits setting in 2 mmHg steps is now possible in ranges up to 50 mmHg (previously up to 30 mmHg).New Patient CheckThe monitor can be configured to ask you in certain situations: after a specified power-off period, after a specified standby period and when no basic vitals (HR, RR, Pulse, SpO2, NBP) have been measured for a specified period, whether a new patient is now being monitored. By selecting the Yes pop-up key you can discharge the previous patient and reset settings.New Smart KeysA SmartKey is available for New Lead Setup when a new ECG lead set with fewer leads than previously is being used.Better Visibility Of GridlinesThe brightness of the gridlines on the realtime waves has been increased for better visibility.
3473AlarmsThe alarm information here applies to all measurements. Measurement-specific alarm information is discussed in the sections on individual measurements.The monitor has two different types of alarm: patient alarms and INOPs.Patient AlarmsPatient Alarms are red and yellow alarms. A red alarm indicates a high priority patient alarm such as a potentially life threatening situation (for example, asystole). A yellow alarm indicates a lower priority patient alarm (for example, a respiration alarm limit violation). Additionally there are short yellow alarms, most of which are specific to arrhythmia-related patient conditions (for example, ventricular bigeminy).INOPsINOPs are technical alarms, they indicate that the monitor cannot measure or detect alarm conditions reliably. If an INOP interrupts monitoring and alarm detection (for example, Leads Off), the monitor places a question mark in place of the measurement numeric and an audible indicator tone will be sounded. INOPs without this audible indicator indicate that there may be a problem with the reliability of the data, but that monitoring is not interrupted.Most INOPs are light blue, however there are a small number of INOPs which are always yellow or red to indicate a severity corresponding to red and yellow alarms. The following INOPs can also be configured as red or yellow INOPs to provide a severity indication:•ECG Leads Off•NBP Cuff Overpress•Cuff Not Deflated•Occlusion•<SpO₂ Label> No Pulse•<Press Label> No Pulse•Tele Disconnected•Battery Empty / Replace BatteryAll monitors in a unit should have the same severity configured for these INOPs.
3 Alarms48Alarm DelaysThere is a delay between a physiological event at the measurement site and the corresponding alarm indication at the monitor. This delay has two components:•The general measurement delay time is the time between the occurrence of the physiological event and when this event is represented by the displayed numerical values. This delay depends on the algorithmic processing and, for certain measurements (SpO2, EEG and BIS), on 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 sum of the alarm delay configured for the specific measurement plus the system alarm delay. The system alarm delay is the processing time the system needs for any alarm on the monitor to be indicated after the measurement has triggered the alarm. See the performance specifications in the Specifications chapter for the system alarm delay specification.The alarm delay configured for a specific measurement is normally a fixed time. For SpO2 it is also possible to configure a Smart Alarm Delay that is calculated using an intelligent algorithm. See “Smart Alarm Delay” on page 177 in the SpO2 chapter for more details.Multiple AlarmsIf more than one alarm is active, the alarm messages are shown in the alarm status area in succession. An arrow symbol next to the alarm message informs you that more than one message is active. The monitor sounds an audible indicator for the highest priority alarm. If more than one alarm condition is active in the same measurement, the monitor announces the most severe. Your monitor may be configured to increase alarm indicator volume automatically during the time when the alarm is not acknowledged.Visual Alarm IndicatorsAlarm MessageAn alarm message text appears in the alarm status area at the top of the screen indicating the source of the alarm. There is a field for INOPs (light blue, red or yellow) and a field for patient alarms, which is shared for red and yellow alarms. If more than one measurement is in an alarm condition, the message changes every two seconds, and has an arrow at the side. If both red and yellow alarm conditions are active simultaneously, they alternate every two seconds in the patient alarms field. The background color of the alarm message matches the alarm priority: red for red alarms, yellow for yellow alarms, light blue for standard INOPs, red for red INOPs and yellow for yellow INOPs. The asterisk symbols (*) beside the alarm message match the alarm priority: *** for red alarms, ** for yellow alarms, * for short yellow alarms. Standard INOPs do not have a symbol, red and yellow INOPs have exclamation marks beside the alarm message: !!! for red INOPs and !! for yellow INOPs.Depending on how your monitor is configured, it may display alarm limit violation messages:• in text form, for example ** SpO₂ Low or• in numeric form, for example **Pulse xxx>yyy where the first number shows the maximum deviation from the alarm limit, and the second number shows the currently set limit.Flashing NumericThe numeric of the measurement in alarm flashes.
3 Alarms49Bright Alarm LimitsIf the alarm was triggered by an alarm limit violation, the corresponding alarm limit on the monitor screen is shown more brightly if Show ALarmLimits is enabled and there is sufficient room on the screen.Alarm LampA lamp on the monitor's front panel flashes. The alarm lamp is divided into two sections. The right one flashes for a patient alarm, except for short yellow alarms where the lamp will light for approximately six seconds. The color is yellow or red corresponding to the highest priority patient alarm currently present. The left one lights continuously for a light blue INOP and flashes for yellow or red INOPs as follows: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.Audible Alarm IndicatorsThe audible alarm indicators configured for your monitor depend on which alarm standard applies in your hospital. Audible alarm indicator patterns are repeated until you acknowledge the alarm by switching it off or pausing it, or until the alarm condition ceases (if audible alarm indication is set to non-latching).WARNING• Do not rely exclusively on the audible alarm system for patient monitoring. Adjustment of alarm volume to a low level or off during patient monitoring may result in patient danger. Remember that the most reliable method of patient monitoring combines close personal surveillance with correct operation of monitoring equipment.Alarm Tone ConfigurationThe audible alarm indicators of your monitor are configurable. In the monitor's Configuration Mode, you can:• increase the alarm volume of unacknowledged alarms at regular intervals• change the interval between alarm sounds (ISO/IEC Standard alarms only)• change the base volume of the red and yellow alarm tones and the INOP tones• change the alarm sound to suit the different alarm standards valid in different countries.INOP Lamp Color On OffYellow 1.0 seconds 1.0 secondsRed 0.25 seconds 0.25 seconds
3 Alarms50Traditional 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.• 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 VolumeIf you want to change the alarm volume setting, or see where the current setting is on a scale from zero to 10, 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.Minimum Volume for No Central Monitoring INOPIf your monitor is connected to an Information Center, and the connection is interrupted, the INOP message No Central Monit. will appear within 30 seconds, accompanied by an INOP tone. To help ensure that this INOP, and any other active alarm, is not overlooked, the INOP and alarm tones may be configured to have a minimum volume. In this case, INOP and alarm tones will sound even if the monitor alarm volume is set to zero.Minimum Volume for Severe Yellow or Red INOPsSevere yellow or red INOPs require action to ensure the well-being of the patient. Therefore the minimum volume for the INOP tone is set to at least alarm volume 8, irrespective of the current alarm volume setting. The INOP tone will sound even if the monitor alarm volume is set to zero.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 (yellow)Battery Empty / Replace Battery (configurable to light blue, yellow or red)
3 Alarms51Acknowledging AlarmsTo acknowledge all active alarms and INOPs, press the Silence key. This switches off the audible alarm indicators and alarm lamps.A check mark beside the alarm message indicates that the alarm has been acknowledged . If the monitor is configured to re-alarm, a dashed check mark will be shown .If the condition that triggered the alarm is still present after the alarm has been acknowledged, the alarm message stays on the screen with a check mark symbol beside it, except for NBP alarms and alarms from other intermittent measurements. When such an alarm is acknowledged the alarm message disappears.If the alarm condition is no longer present, all alarm indicators stop and the alarm is reset.Switching off the alarms for the measurement in alarm, or switching off the measurement itself, also stops alarm indication.Acknowledging Disconnect INOPsAcknowledging an INOP that results from a disconnected transducer switches off the associated measurement. 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.Alarm ReminderIf Alarm Reminder is configured on for your monitor, you will get an audible reminder of alarm conditions that remain active after you have acknowledged the alarm. This reminder may take the form of a repetition of the alarm tone for a limited time, or an unlimited repetition of the alarm tone (this is the same as a new alarm). Alarm Reminder is not available for standard, light blue INOPs but for yellow and red INOPs.In Configuration Mode, you can set the interval between silencing the alarm and sounding the reminder tone to one, two, or three minutes.The alarm reminder behavior at the Information Center is different to that at the monitor. Refer to the Information Center Instructions for Use for further information.Pausing or Switching Off AlarmsIf you want to temporarily prevent alarms from sounding, for example while you are moving a patient, you can pause alarms. Depending on your monitor configuration, alarms are paused for one, two, or three minutes, or infinitely. Infinite alarm pause is equivalent to switching the alarms off.
3 Alarms52To view the alarm pause setting chosen for your unit,1Select Main Setup, Alarms, then Alarm Settings2Check the Alarms Off setting.This setting can only be changed in Configuration Mode.There are some settings made in Configuration Mode that can affect the availability of the pause alarms functionality.• The Alarms key can be disabled to avoid unintentional switching off of alarms. In this case you can only pause alarms or switch alarms off permanently in the Alarms menu, under Main Setup.• The Alarms key can be configured to pause or switch off red and yellow alarms, yellow alarms only, or not to function at all. If it is configured not to function, you cannot pause alarms or switch alarms off permanently.To Pause All Alarms• Press the Alarms key.• If your monitor is configured to infinite pause time, the lamp next to the alarms off symbol is red or yellow, depending on the configuration, and pressing this key switches alarms off.Depending on the configuration, you may need to select Confirm to complete the change.To Switch All Alarms OffYou can only switch alarms off permanently if your monitor is configured to allow infinite alarms pause.• Press the Alarms key.Pausing alarms infinitely is the same as switching them off.To Switch Individual Measurement Alarms On or Off1Select the measurement numeric to enter its setup menu.2Select Alarms to switch between on and off.The alarms off symbol is shown beside the measurement numeric.
3 Alarms53While Alarms are Paused or OffWhen red 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 Al. Paused x:yy or Alarms Off, together with the alarms paused symbol or the alarms off symbol.When yellow alarms are paused or off:• The yellow Alarms Paused lamp on the monitor front panel is lit.In the alarm field, the monitor displays the message YellowPaused x:yy or Yellow Alarms Off, together with the alarms paused symbol or the alarms off symbol.For red and yellow alarms:• 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.If a disconnect INOP is present and alarms are paused or switched off, the measurement in question may be switched off, depending on monitor configuration.Restarting Paused AlarmsTo manually switch on alarm indication again after a pause, press the Alarms key again.Alarm indication starts again automatically after the pause period expires. If the monitor is configured to stay paused infinitely, you must select Alarms Off again to restart alarm indication.Resetting Arrhythmia Alarm TimeoutsTo reset the arrhythmia alarm timeout period, press the Alarms key and then press it again.Extending the Alarm Pause TimeIf your monitor has extended alarm pause enabled, you can extend the alarm pause time. Use this to prevent alarms being indicated, for example, while you are washing a patient or carrying out a procedure. Only extend the alarm pause time when you are sure that clinical personnel are available to monitor the patient's condition closely.To extend the alarm pause time to five or 10 minutes,1Select one of the alarm fields. This calls up the Alarm Messages window.2Select either the pop-up key PauseAl. 5 min or the pop-up key PauseAl. 10 min. Each time you select one of these pop-up keys, the Alarm Pause Time is reset to five (or 10) minutes. Alarms Paused Alarms Off
3 Alarms54Alarm Settings for Unattended MonitoringWhen monitoring patients that are not continuously attended, use appropriate alarm settings to optimize monitoring:• Always leave alarms switched on when the patient is unattended.• Recommended configuration: Use one of the temporary settings for the Alarms Off setting, not Infinite, and make sure that the AlarmOffReminder and the Alarm Reminder are switched on (these settings are made in Configuration mode).• Set alarm limits so that alarms will be triggered for those changes in the patient condition that you want to be advised of. Setting limits to very high or low values can render the alarm system useless.• Use available notification routes, such as a nurse call system or the connection to an Information Center, or at least select an appropriate alarm volume to ensure that alarms are recognized.Alarm LimitsThe alarm limits you set determine the conditions that trigger yellow and red limit alarms. For some measurements (for example, SpO2), where the value ranges from 100 to 0, setting the high alarm limit to 100 switches the high alarm off. In these cases, the alarms off symbol is not displayed.WARNINGBe aware that the monitors in your care area may each have different alarm settings, to suit different patients. Always check that the alarm settings are appropriate for your patient before you start monitoring.Viewing Individual Alarm LimitsYou can usually see the alarm limits set for each measurement next to the measurement numeric on the main screen.If your monitor is not configured to show the alarm limits next to the numeric, or if the numeric is so small that the limits cannot be displayed, you can see them in the appropriate measurement setup menu. Select the measurement numeric to enter the menu and check the limits.Viewing All Alarm LimitsThe Alarm Limits overview window lists the currently set alarm limits for all measurements. If an Apnea alarm delay time is set, this is also shown. The alarms off symbol is shown beside the measurement label of any measurement whose alarm switched off.To open the Alarm Limits window, either select one of the alarm fields then select the Alarm Limits pop-up key, or select the Alarm Limits SmartKey, if configured.
3 Alarms55Select 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 Lim. Narrow/All Lim. Wide to set narrow or wide alarm AutoLimits for all measurements.These pop-up keys are not available in the window for changing individual alarm limits which you access by selecting the measurement label in the Alarm Limits window.Changing Alarm LimitsTo change individual measurement alarm limits using the measurement's Setup Menu,1In the measurement's setup menu, select the alarm limit you want to change. This calls up a list of available values for the alarm limit.2Select a value from the list to adjust the alarm limit.For example, to change the alarm limits for SpO2:• Touch the high limit on the alarm limits menu button. • Choose the high alarm limit from the pop-up list that opens.• Touch the low limit on the alarm limits menu button. • Choose the low alarm limit from the pop-up list that opens.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.1 Graphic view of current yellow and red alarm limits and currently monitored measurement value. Off indicates the measurement is switched off2 Measurement labels, with alarms off symbol where appropriate3 Set narrow or wide alarm AutoLimits for all measurements
3 Alarms56To change alarm limits,1Enter the Alarm Limits window.2To 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.If you set the yellow alarm limit outside the red alarm limit, the monitor will automatically set the red alarm to the yellow 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.About Automatic Alarm LimitsThe monitor can automatically set alarm limits suited to your individual patient, using the Automatic Alarm Limits function (AutoLimits). This tells the monitor to adapt the alarm limits of selected measurements to the measured vital signs within a defined safe limit. The monitor calculates safe AutoLimits for each patient based on the measured values from the last 12 seconds.The wide and narrow limits have a fixed relationship to the measured value within the non-pathological range. Outside of this range, no auto limits are calculated. To set values outside of the non-pathological range, limits must be changed manually, based on the clinician's judgment about the specific patient.1Parameter label2High red alarm (view only)3High yellow alarm field. Select to open a pop-up list of high alarm limits4Alarms On/Off key - select to toggle between alarms on or off5Preview Alarm AutoLimits for a measurement before applying6Select to apply wide AutoLimits7Select to apply narrow AutoLimits8Low yellow alarm field. Select to open a pop-up list of low alarm limits9Low red alarm (view only)10 Graphic view of alarm limits with currently measured value
3 Alarms57Limits 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.Documenting Alarm LimitsTo print a list of all current alarm limit settings on an available printer:1Select the Main Setup SmartKey.2Select Reports from the Main Setup menu.3Select Alarm Limits.Reviewing AlarmsYou can see which alarms and INOPs are currently active in the respective alarms and INOPs fields at the top of the screen.To review the history of alarms and INOPs, select the alarms or INOPs field to open the Review Alarms window.All alarms and INOPs are erased from the Review Alarms window when you discharge a patient, or if you change to Demonstration Mode.1Wide alarm limits2Narrow alarm limits3Alarm Limits4Measurement value
3 Alarms58Review Alarms WindowThe Review Alarms window contains a list of the most recent alarms and INOPs with date and time information.If configured to do so, each alarm is shown with the alarm limit active when the alarm was triggered and the maximum value measured beyond this limit. The Review Alarms window also shows when the monitor was switched on (after being switched off for longer than 1 minute) and any actions related to switching alarms on and off, entering or leaving Standby mode, silencing alarms or changing the ECG source.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 alert other than a high or low alarm, a help text window opens with more information. 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.Latching AlarmsThe alarm latching setting for your monitor defines how the alarm indicators behave when you do not acknowledge them. When alarms are set to non-latching, their indicators end when the alarm condition ends. Switching alarm latching on means that visual and/or audible alarm indications are still displayed or announced by the monitor after the alarm condition ends. The indication lasts until you acknowledge the alarm.Viewing the Alarm Latching SettingsTo see the alarm latching setting for your 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 only, red and yellow, and off. These choices can be combined to give the following settings:Visual Latching Audible LatchingRed&Yellow Red&YellowRed&Yellow Red OnlyRed&Yellow OffRed Only Red OnlyRed Only OffOff Off
3 Alarms59Alarm Latching BehaviorAll INOPs are non-latching. See “Yellow Arrhythmia Alarms” on page 135 for information on one-star yellow alarms latching behavior.Testing AlarmsWhen you switch the monitor on, a selftest is started. You must check that the alarms lamps light, one after the other, and that you hear a single tone. This indicates that the visible and audible alarm indicators are functioning correctly. For further testing of individual measurement alarms, perform the measurement on yourself (for example SpO2 or CO2) or use a simulator. Adjust alarm limits and check that appropriate alarm behavior is observed.Alarm Behavior at Power OnIf the monitor is switched off for longer than one minute and then switched on again (or after a loss of power lasting longer than one minute, or when a patient is discharged), the monitor can be configured to:• restore the alarm settings from the monitor's configured default Profile,• restore the most recently used alarm settings, or • switch the alarms off. After any of these situations, you should check that the alarm settings are appropriate for your patient and monitoring situation, and if necessary, select the correct Profile and patient category.If power is lost for less than one minute, the alarm on/off condition prior to the power loss is restored.Red & Yellow Measurement AlarmsNon-latching alarms Visual and audible latching Visual latching, audible non-latchingAlarm has not been acknowledged.Alarm condition still present.Alarm tone on. Alarm lamp on. Alarm message. Flashing numerics.Alarm tone on. Alarm lamp on. Alarm message. Flashing numerics.Alarm tone on. Alarm lamp on. Alarm message. Flashing numerics.Alarm condition no longer present.All audible and visual alarm indicators automatically stop.Alarm tone on.Alarm lamp on. Alarm message. Flashing numerics.Alarm message. Flashing numerics.Audible alarm indicators automatically stop.Alarm has been acknowledged.Alarm condition still present.Alarm tone off. Alarm lamp off. Alarm message. Flashing numerics. Audible alarm reminder (if configured).Alarm tone off. Alarm lamp off. Alarm message. Flashing numerics. Audible alarm reminder (if configured).Alarm tone off. Alarm lamp off. Alarm message. Flashing numerics. Audible alarm reminder (if configured).Alarm condition no longer present.Audible and visual alarm indicators automatically stop.Audible and visual alarm indicators automatically stop.Audible and visual alarm indicators automatically stop.
3 Alarms60Alarm RecordingsYou can set up your monitor so that it automatically triggers alarm recordings locally or 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.
4614Patient Alarms and INOPsThis chapter lists patient alarms alphabetically, and technical alarms (INOPs) arranged by the source of the INOP and then alphabetically, irrespective of their priority. All alarms and INOPs are listed here; the ones which can appear on your monitor will depend on the model and the individual options.Patient Alarm MessagesThe measurement labels and abbreviations for pressure, temperature, and SpO2 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".Alarm Message From Condition Indication* AFIB ECG/Arrhythmia Atrial fibrillation waveform detected yellow alarm lamp, short yellow alarm tone** AGT Mix MAC > 3 GM An agent mixture has been detected and the sum of the 2 agent MAC components + MAC (N2O) is ≥ 3 MAC (uncorrected)yellow alarm lamp, alarm tone.*** Apnea*** Apnea x:yy*** Apnea >10 minCO2, Resp, Spirometry, GMRespiration has stopped for longer than the preset apnea time. "x:yy" denotes the Apnea duration in minutes and secondsnumeric flashes, red alarm lamp, alarm tone*** Asystole ECG No QRS detected for a period > the asystole alarm thresholdnumeric flashes, red alarm lamp, alarm tone** awRR High CO2, Resp, AGM, GMThe airway respiration rate has exceeded the high alarm limit.numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone** awRR Low CO2, Resp, AGM, GMThe airway respiration rate has dropped below the low alarm limit.numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone** <BIS Label> 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 Label> 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
4 Patient Alarms and INOPs62*** Brady (Pulse) SpO2, Press, cmRespPulse rate < the extreme brady alarm limit. numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone*** Bradypnea cmRR The respiration rate has dropped below the bradypnea limit.numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone** CCO High** CCI HighCCO Continuous Cardiac Output or CC Index is above the high alarm limit.numeric flashes and high alarm limit is highlighted, yellow alarm lamp, alarm tone** CCO Low** CCI LowCCO Continuous Cardiac Output or CC Index is below the low alarm limit.numeric flashes and low alarm limit is highlighted, yellow alarm lamp, alarm tone** cmRR High cmResp The respiration rate has exceeded the high alarm limit.numeric flashes and high alarm limit is highlighted, yellow alarm lamp, alarm tone** cmRR Low cmResp The respiration rate has dropped below the low alarm limit.numeric flashes and low alarm limit is highlighted, yellow alarm lamp, alarm tone** CPP High CPP The CPP value has exceeded the high alarm limit.numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone** CPP Low CPP The CPP value has fallen below the low alarm limit.numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone*** Desat*** Desat xx < yySpO2The SpO2 value has fallen below the desaturation alarm limit. xx denotes the lowest measured value, and yy is the desaturation limit.numeric flashes, red alarm lamp, alarm tone** EC10 Alarm*** EC10 Alarmat Information CenterEC10 IntelliBridge A yellow (**) or red (***) patient alarm is present on the IntelliBridge module. Check the monitor display for more detailed alarm information.(on monitor) yellow or red alarm lamp; the alarm text is defined by the IntelliBridge device driver* End AFIB ECG/Arrhythmia Atrial fibrillation no longer detected for the configured Afib end delay timeyellow alarm lamp, short yellow alarm tone* End Irregular HR ECG/Arrhythmia Irregular HR no longer detected for the configured irregular HR end delay time.yellow alarm lamp, short yellow alarm tone** et<Agent Label> High GM The end tidal agent high alarm limit has been exceeded.numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone** et<Agent Label> Low GM The end tidal agent value has fallen below the low alarm limitnumeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone** etCO₂ High CO2, AGM, GM 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, AGM, GM 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 toneAlarm Message From Condition Indication
4 Patient Alarms and INOPs63** etO₂ Low O2, AGM The end tidal O2 value has fallen below the low alarm limit.numeric flashes, and low limit is highlighted, yellow alarm lamp, alarm tone* Event** Event*** Eventat Information CenterEvent surveillance An event has occurred and the event notification is configured to alarm. Check on the monitor for more details on event group.(on monitor) event group name flashes, yellow or red alarm lamp and alarm tone* Event:<Event Group>** Event:<Event Group>*** Event:<Event Group>Event surveillance An event has occurred and the event notification is configured to alarm.event group name flashes, yellow or red alarm lamp and alarm tone*** Extreme Brady ECG Heart rate < the extreme brady alarm limit. numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone*** Extreme Tachy ECG Heart rate > the extreme tachy alarm limit. numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone* HR High** HR HighECG Heart rate > the high HR alarm limit numeric flashes and high 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.* HR Low** HR LowECG Heart rate < the low HR 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.** imCO₂ High GM The inspired minimum CO2 high alarm limit has been exceedednumeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone.** in<Agent Label> High GM The inspired agent high alarm limit has been exceedednumeric flashes, high limit is highlighted, yellow alarm lamp, alarm tone** in<Agent Label> Low GM The inspired agent value has fallen below the AGT low alarm limitnumeric flashes, low limit is highlighted, yellow alarm lamp, alarm tone** inN₂O High GM The inspired N2O high alarm limit has been exceeded.numeric flashes, high limit is highlighted, yellow alarm lamp, alarm tone.** inO₂ High GM The inspired O2 high alarm limit has been exceeded.numeric flashes, high limit is highlighted, yellow alarm lamp, alarm tone.** inO₂ Low GM The inspired O2 value has fallen below the low alarm limitnumeric flashes, low limit is highlighted, yellow alarm lamp, alarm tone***inO₂ Low Oxygen GM The inspired O2 value has fallen below 18 vol%.numeric flashes, low limit is highlighted, red alarm lamp, alarm tone** IPI Low CO2The IPI value has fallen below the low alarm limit.numeric flashes, and low limit is highlighted, yellow alarm lamp, alarm toneAlarm Message From Condition Indication
4 Patient Alarms and INOPs64* Irregular HR ECG/Arrhythmia Consistently irregular rhythm (irregular R-R intervals).numeric flashes, yellow alarm lamp, short yellow audible alarm** <iTemp Label> High iTemp The temperature value has exceeded the high alarm limit.numeric flashes and high limit is high-lighted, yellow alarm lamp, alarm tone ** <iTemp Label> Low iTemp The temperature value has dropped below the low alarm limit.numeric flashes and low limit is high-lighted, yellow alarm lamp, alarm tone* Missed Beat ECG/Arrhythmia No beat detected for > 1.75*(the averaged R-R interval), or no beat detected for > one second if HR > 120 (For non-paced patients only).numeric flashes, yellow alarm lamp, short yellow audible alarm* More Alarms** More Alarms*** More Alarmsother assigned devicesThere is more than one physiological alarm of the corresponding severity active on the devices that monitor this patient. For details, check the information displayed at the Information Center.yellow or red alarm lamp and alarm tone* Multiform PVCs ECG/Arrhythmia Two different 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 ECG/Arrhythmia A run of PVCs < the V-Tach run limit and ventricular heart rate > the V-Tach HR limitnumeric flashes, yellow alarm lamp, short yellow audible alarm* OtherMon Alarm** OtherMon Alarm*** OtherMon Alarmanother assigned monitorAnother monitor used for the patient is in an alarm condition. Check the detailed alarm information at the Information Center.yellow or red alarm lamp and alarm tone* Pacer Not Capt ECG/Arrhythmia(paced patients only)No beat detected for > 1.75*(the averaged R-R interval) with detected pace pulse(s). (For paced patients only).numeric flashes, yellow alarm lamp, short yellow audible alarm* Pacer Not Pacing ECG/Arrhythmia(paced patients only)No beat and pace pulse detected for > 1.75*(the averaged R-R interval). (For paced patients only).numeric flashes, yellow alarm lamp, short yellow audible alarm* Pair PVCs ECG/Arrhythmia Two ventricular beats between two non-ventricular beats.numeric flashes, yellow alarm lamp, short yellow audible alarm* Pause ECG/Arrhythmia No beat detected for a period > the pause threshold.numeric flashes, yellow alarm lamp, short yellow audible alarm*** <Press Label> DisconnectPRESS The pressure is non-pulsatile and the mean pressure is continuously less than 10 mmHg (1.3 kPa). This alarm occurs only with arterial pr e s s u r e s ( P, A B P, A R T, Ao, B A P, FA P, PA P, UAP, P1, P2, P3, P4).numeric flashes, red alarm lamp, alarm toneAlarm Message From Condition Indication
4 Patient Alarms and INOPs65*** <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*** <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** <pTemp Label> High pTemp The temperature value has exceeded the high alarm limit.numeric flashes and high limit is high-lighted, yellow alarm lamp, alarm tone ** <pTemp Label> Low pTemp The temperature value has dropped below the low alarm limit.numeric flashes and low limit is high-lighted, yellow alarm lamp, alarm tone ** Pulse High PRESS, SpO2, cmRespThe pulse rate has exceeded the high alarm limit.numeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone** Pulse Low PRESS, SpO2, cmRespThe pulse rate has dropped below the low alarm limit.numeric flashes and low limit is highlighted, yellow alarm lamp, alarm tone* PVCs/min High ECG/Arrhythmia PVCs detected within a minute > the alarm limitnumeric flashes, yellow alarm lamp, short yellow audible alarm** QTc High ECG/QT QTc value has exceeded the QTc high limit for more than 5 minutesnumeric flashes, yellow alarm lamp, alarm tone** ΔQTc High ECG/QT ΔQTc value has exceeded the ΔQTc high limit for more than 5 minutesnumeric flashes, yellow alarm lamp, alarm tone* 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*(the 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 beat 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 toneAlarm Message From Condition Indication
4 Patient Alarms and INOPs66* Run PVCs High ECG/Arrhythmia A run of > 2 PVCs. 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 Multi <n>,<n> ECG/ST Two contiguous ST leads <n> and <n> have exceeded elevation or depression limits for more than 60 seconds. The limit violations for both leads must be with respect to same limit; either both above the high limit or both below the low limit.numeric flashes, yellow alarm lamp, alarm tone**ST Multiat Information CenterECG/ST The ST depression or elevation is outside of the limit in two or more leads. Check on the monitor (on monitor) numeric flashes, yellow alarm lamp, alarm tone**STE <n>,<n> ECG/ST Two contiguous leads <n> and <n> are above their respective STE limitsnumeric flashes, yellow alarm lamp, alarm tone** ST-<n> High ECG/ST The ST elevation in lead <n> is higher than the limit. Lead is not contiguous with any other lead.numeric flashes and high alarm limit is highlighted, yellow alarm lamp, alarm tone** ST-<n> Low ECG/ST The ST depression in lead <n> is lower than the limit. Lead is not contiguous with any other lead.numeric flashes and low alarm limit is highlighted, yellow alarm lamp, alarm tone* SVT ECG/Arrhythmia A run of supraventricular beats > the SVT run limit and heart rate > the SVT HR limit.numeric flashes, yellow alarm lamp, alarm tone*** Tachy (Pulse) SpO2, Press, cmRespPulse rate > the extreme tachy alarm limit. numeric flashes, alarm limit is highlighted, red alarm lamp, alarm tone** Tblood High C.O. The blood temperature value has exceeded the high alarm limit.numeric flashes, high alarm limit is highlighted, yellow alarm lamp, alarm tone** Tblood Low C.O. The blood temperature value has fallen below the low alarm limit.numeric flashes, low alarm limit is highlighted, yellow alarm lamp, alarm tone** tcpO₂ High** tcpCO₂ HightcGas The tcpO2 or tcpCO2 value has exceeded the high alarm limit.numeric flashes, high alarm limit is highlighted, yellow alarm lamp, alarm tone** tcpO₂ Low** tcpCO₂ LowtcGas The tcpO2 or tcpCO2 value has fallen below the low alarm limit.numeric flashes, low alarm limit is highlighted, yellow alarm lamp, alarm tone* Tele Alarm** Tele Alarm*** Tele Alarman assigned telemetry deviceA telemetry device used for the patient is in an alarm condition. Check the detailed alarm information at the Information Center.yellow or red alarm lamp and alarm toneAlarm Message From Condition Indication
4 Patient Alarms and INOPs67** <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* T-Mon Alarm** T-Mon Alarm*** T-Mon Alarman assigned transport monitorA transport monitor used for the patient is in an alarm condition. Check the detailed alarm information at the Information Center.yellow or red alarm lamp and alarm tone** TOFcnt High NMT TOFcnt value has exceeded the high alarm limitnumeric flashes and high limit is highlighted, yellow alarm lamp, alarm tone* Vent Bigeminy ECG/Arrhythmia A dominant rhythm of N, V, N, V (N = supraventricular beat, V = ventricular beat)numeric flashes, yellow alarm lamp, short yellow audible alarm*** Vent Fib/Tach ECG Fibrillatory waveform (sinusoidal wave between 2 - 10 Hz) for 4 consecutive seconds.numeric flashes, red alarm lamp, alarm tone* Vent Rhythm** Vent RhythmECG/Arrhythmia A dominant rhythm of adjacent Vs > the vent rhythm limit and ventricular heart rate < the V-Tach HR limit.numeric flashes, yellow alarm lamp, short yellow audible alarm* Vent Trigeminy ECG/Arrhythmia A dominant rhythm of N, N, V, N, N, V (N = supraventricular beat, V = ventricular beat).numeric flashes, yellow alarm lamp, short yellow audible alarm*** VTach ECG, Arrhythmia A run of PVCs ≥ the V-Tach run limit and heart rate > the V-Tach HR limit.numeric flashes, red alarm lamp, alarm tone** VueLink Alarm*** VueLink Alarmat Information CenterVueLink A yellow (**) or red (***) patient alarm is present on the VueLink module. Check the monitor display for more detailed alarm information.(on monitor) yellow or red alarm lamp; the alarm text is defined by the VueLink device driver***xBrady xxx<yyy Press, SpO2, ECG This is the alternative alarm message for *** Extreme Brady, when the alarm text setting is Enhanced.Heart rate < the extreme bradycardia alarm limit. xxx denotes the lowest measured value; yyy is the extreme bradycardia limit.numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone***xTachy xxx>yyy Press, SpO2, ECG This is the alternative alarm message for *** Extreme Tachy when the alarm text setting is Enhanced.Heart rate >the extreme tachycardia alarm limit. xxx denotes the highest measured value; yyy is the tachycardia limit.numeric flashes, alarm limit is highlighted, red alarm lamp, alarm toneAlarm Message From Condition Indication
4 Patient Alarms and INOPs68Technical Alarm Messages (INOPs)If an INOP interrupts monitoring and alarm detection, the measurement numeric will be replaced by -?-. If an INOP may lead to unreliable measurement values, a ?appears next to the numeric.The measurement labels and abbreviations for pressure, temperature and SpO2 INOP messages are explained in the individual measurement chapters.Monitor INOPsINOP Message, Indication What to do Bad MSLINOP tone1) An MMS with an incompatible software revision is connected to the monitor. This combination does not allow monitoring, OR 2) You cannot use this combination of monitor, MMS and cable. Switch off the monitor and contact your service personnel.Central: Tele OnlyINOP toneSystem connectivity via telemetry device is limited (No alarms, only local numerics) when in companion mode and host monitor does not have system connectivity. Only telemetry device parameters can be displayed at central station.Check Alarm LampsINOP tonePerform a visual check of the alarm lamp to establish whether there is a problem. Contact your service personnel to check the internal connections to the alarm lamps.Check DrugSettingsINOP toneThere was a problem loading the drug settings. Check that the settings are complete and correct.!!Check ECG SourceYellow toneThe telemetry device and the monitor both have valid ECG signals. Unpair the telemetry device and the monitor if they are no longer used for the same patient.!! Check EquipmentINOP tone/Yellow toneThere is an equipment status dispute relating to one or more of the devices assigned to this patient. See the Equipment window for details.Check Flex TextsINOP toneCheck the names of the monitor menus, for example the labels for screens, profiles, event or trend group names, before you resume monitoring. If they are unexpected, there may be a problem with the monitor software. Contact your service personnel.Check KeyboardINOP tonePerform a visual and functional check of the keyboard. Contact your service personnel.Check Main Board 2INOP toneThere is a problem with the second main board in the monitor. Contact your service personnel.Check Monitor FuncINOP tonePotential problem with alarm lamps, display or interfaces detected. Contact your service personnel.Check Monitor TempINOP toneThe temperature inside the monitor is too high. Check that the monitor ventilation is not obstructed. If the situation continues, contact your service personnel.Check MouseINOP tonePerform a visual and functional check of the mouse input device. Contact your service personnel.Check MSL VoltageINOP toneThere is a problem with the voltage of the Measurement Link (MSL). Contact your service personnel.Check Network ConfINOP toneThe monitor is receiving network topology information from more than one source, e.g. the Database Server and an Application Server. Contact your service personnel.!! Check PairingYellow toneThere is a problem with device pairing. Check that the monitor and telemetry device are correctly paired.!!Check Patient IDYellow toneThere is a mismatch between patient data in two connected devices. Resolve the mismatch to allow settings and data synchronization.
4 Patient Alarms and INOPs69Check Screen Res.INOP toneThe Screen you have selected uses a resolution which is not supported by the display. The monitor will show a generic Screen instead until you select a different Screen.Contact your service personnel if you want the Screen deleted from the Profile(s) to avoid this in future.Check SettingsINOP toneIf this INOP appears, check the monitor and patient settings before you resume monitoring. If the settings are unexpected, there may be a problem with the monitor software. Contact your service personnel.Check SpeedPointINOP tonePerform a visual and functional check of the SpeedPoint input device. Contact your service personnel.Check Touch InputINOP tonePerform a visual and functional check of the touch input device. Contact your service personnel.Check WavesINOP toneThe options purchased with this monitor may not support the number of waves required to show the selected Screen, so some waves or high resolution trends are missing from the Screen. Select a different Screen with fewer waves.Contact your service personnel if you want the Screen deleted from the Profile(s) to avoid this in future.Chk ECG Sync CableINOP toneThe ECG Sync is detecting an invalid signal, or the ECG Sync cable is disconnected.Chk IndepDsp Cable The monitor cannot communicate with the D80 Intelligent Display. Check the MSL coupling cable. The end with the gray connector must be connected to the Intelligent Display.Chk <Measurement Label>SettingsSynchronization of the settings for the measurement cited, has failed. Check that settings are appropriate for your patient.Chk MSL ConnectionINOP toneCheck that the MSL cable is properly connected. If this is the case, try using another MSL cable, to check if your cable is defective. If this does not help, the device connected via the MSL cable may be defective, contact your service personnel.Internal.Comm.MalfINOP toneThere is a problem with I2C Bus communication in the monitor. Contact your service personnel.MCC ReversedINOP toneThe MSL coupling cable is reversed. Connect the end with the gray connector to the Intelligent Display.MCC UnsupportedINOP toneAn MSL coupling cable has been connected to a device which does not support MSL coupling.Meas. Deactivated An X2 has been connected to a host monitor (companion mode) and all derived measurements have been deactivated and/or measurements with a label conflict. The measurements can only be reactivated by disconnecting the measurement device from the host monitor.!!More Bed Alarms!!!More Bed Alarmsat Information CenterThe monitor is associated with a telemetry device and is sending data to the Information Center via the telemetry device. There are currently more alarms at the bedside than can be transmitted to the Information Center.More INOPs!! More INOPs!!! More INOPsThere is more than one technical alarm of the corresponding severity active on the devices that monitor this patient. For details check the information displayed at the Information Center.MSL Power High The power consumption of the devices connected to the Measurement Link (MSL) cable is too high. If this situation continues, the MSL will be switched off. Contact your service personnel.MSL Power OffINOP toneThe power consumption of the devices connected to the Measurement Link (MSL) cable was too high for too long and the MSL has been switched off. Contact your service personnel.MSL Power OverloadINOP toneThe power consumption of the devices connected to the Measurement Link (MSL) cable is much too high or there has been a short circuit. The MSL has been switched off. Contact your service personnel.INOP Message, Indication What to do
4 Patient Alarms and INOPs70No Central Monit.INOP toneThere is a problem with the communication to the network. Central monitoring is currently not possible (no patient alarms or information). Check the connection. In case the connection is via a telemetry device, the current telemetry use model does not support central monitoring. Contact your service personnel.No ECG at Central The ECG measured with the monitor ECG is not being sent to the Information Center via the telemetry device.OtherMon INOP!! OtherMon INOP!!! OtherMon INOPAnother monitor assigned to the patient (e.g. a transport monitor) is in an INOP condition. Check the detailed INOP information at the Information Center and resolve the INOP condition(s) at the other monitor.Rem.AlarmDev.Malf.INOP toneThere is a problem with the connection to the remote alarm device. Contact your service personnel to check the remote alarm device and its connections.Settings MalfunctINOP toneThe monitor cannot use the predefined settings for monitoring. Contact your service personnel.Speaker MalfunctINOP toneContact your service personnel to check the speaker and the connection to the speaker.SRR IncompatibleINOP toneThe short range radio component has compatibility problems. Contact your service personnel.SRR InterferenceINOP toneThe short range radio connection has interference from another device. Try using another channel.SRR Invalid ChanINOP toneThe channel configuration of the Short Range Radio is invalid. Check channel and channel mask configuration.SRR MalfunctionINOP toneMalfunction in the short range radio device. If the INOP persists contact your service personnel.TAAP DisabledINOP toneThe currently selected telemetry configuration on the monitor does not allow connection of telemetry devices to the monitor.Tele Config UnsuppINOP toneTelemetry Workflow configuration not supported. Check revision and configuration of monitor and central.Tele Equip MalfINOP toneThe telemetry device has a malfunction. Disconnect and reconnect the telemetry device. If the INOP reappears, replace the telemetry device.Tele Incompatible SRR-enabled telemetry device is not supported by this central software revision. Please check configuration.Tele INOP!! Tele INOP!!! Tele INOPA telemetry device assigned to the patient is in an INOP condition. Check the detailed INOP information at the Information Center and resolve the INOP condition(s) at the telemetry device.Tele UnsupportedINOP toneThis telemetry device is not supported for direct connection to the monitor.<Timer Label> ElapsedINOP toneThe time has expired for the timer indicated in the INOP text. Clearing the timer clears the INOP.T-Mon INOP!! T-Mon INOP!!! T-Mon INOPINOP toneA transport monitor assigned to the patient is in an INOP condition. Check the detailed INOP information at the Information Center and resolve the INOP condition(s) at the transport monitor.TransportEquipment The equipment is ready for transport. See the Equipment window for details.Unsupported LANINOP toneThere is a problem with the communication to the network and central monitoring is currently not possible. Check the connection. If the INOP persists, switch off the monitor and contact your service personnel.User I/F MalfunctINOP tonePerform a visual and functional check of all the monitor input devices. Contact your service personnel.INOP Message, Indication What to do
4 Patient Alarms and INOPs71Battery INOPsINOP Message, Indication What to doBatt 1 MissingBatt 2 MissingINOP toneDuring this INOP, alarms cannot be paused or switched off.The monitor requires two batteries but can detect only one battery. Insert the missing battery immediately.Batt Empty!!Batt Empty!!!Batt EmptyINOP tone, battery LED flashesDuring this INOP, alarms cannot be paused or switched off.The estimated remaining battery-powered operating time is less than 10 minutes. Replace the battery immediately.If the condition persists and the monitor is not connected to mains power, this INOP is re-issued two minutes after you acknowledge it.Batt Extensn MalfINOP toneThere is a hardware error in the Battery Extension. Contact your service personnel.Batt IncompatINOP toneThe battery cannot be used with this monitor. Replace with the correct battery as specified in this book.Batt LowINOP toneThe estimated battery-powered operating time remaining is less than 20 minutes.Batt MalfunctionINOP tone, battery LED flashesDuring this INOP, alarms cannot be paused or switched off unless the monitor is connected to mains power.The monitor cannot determine the battery status. If this INOP persists, replace the faulty battery. If the condition persists and the monitor is not connected to mains power, this INOP is re-issued two minutes after you acknowledge it.Place the battery in a different monitor or in a battery charger. If the same INOP is shown, contact your service personnel.Batteries Empty!!Batteries Empty!!!Batteries EmptyBatt 1 Empty!!Batt 1 Empty!!!Batt 1 EmptyBatt 2 Empty!!Batt 2 Empty!!!Batt 2 EmptyINOP tone, battery LED flashesDuring this INOP, alarms cannot be paused or switched off.The estimated remaining battery-powered operating time of the indicated battery or batteries is less than 10 minutes. Replace the batteries immediately.If the condition persists and the monitor is not connected to mains power, this INOP is re-issued two minutes after you acknowledge it.Batteries IncompatBatt 1 IncompatBatt 2 IncompatINOP toneThe indicated battery or batteries cannot be used with this monitor. Replace with the correct battery or batteries as specified in this book.Batteries LowBatt 1 LowBatt 2 LowINOP toneThe estimated battery-powered operating time remaining is less than 20 minutes.Batteries MalfunctBatt 1 MalfunctionBatt 2 MalfunctionINOP tone, battery LED flashesDuring this INOP, alarms cannot be paused or switched off unless the monitor is connected to mains power.The monitor cannot determine the battery status. If this INOP persists, replace the faulty battery or batteries. If the condition persists and the monitor is not connected to mains power, this INOP is re-issued two minutes after you acknowledge it.Place the batteries in a different monitor or in a battery charger. If the same INOP is shown, contact your service personnel.
4 Patient Alarms and INOPs72MMS, MMS Extensions and FMS INOPsCharge Batt 1 nowCharge Batt 2 nowINOP toneBattery must be charged. Connect the monitor to mains power or exchange the battery.Charger MalfunctINOP tone, battery LED may flashThere is a problem with the battery charger in the monitor. Connect the monitor to mains power and contact your service personnel.Check Batt TempINOP toneThe temperature of one or both batteries is too high. Check that ventilation openings (if applicable) are not blocked and monitor is not exposed to heat.Chk MSL Connection Check the MSL connection between X2/MP2 and the battery extension for damage or loose connections. Check also if a second X1 or X2 has been connected accidentally (e.g. in companion mode). ExtBat Empty!!ExtBat Empty!!!ExtBat EmptyINOP tone, battery LED flashesDuring this INOP, alarms cannot be paused or switched off.The estimated battery-powered operating remaining time is less than 10 minutes. Replace the battery in the battery extension 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.ExtBat Incompat The battery in the battery extension cannot be used. Replace with the correct battery as specified in this book.ExtBat Low The estimated battery-powered operating time remaining is less than 20 minutes.ExtBat MalfunctionINOP tone, battery LED flashesDuring this INOP, alarms cannot be paused or switched off unless the monitor is connected to mains power.The monitor cannot determine the status of the battery in the battery extension. If this INOP persists, replace the faulty battery in the battery extension. If the condition persists and the monitor is not connected to mains power or a host monitor, this INOP is re-issued two minutes after you acknowledge it.ExtBat Missing There is no battery in the Battery Extension!! Insert BatterySevere yellow INOP toneDuring this INOP, alarms cannot be paused or switched off.X2/MP2 only: There is no battery in the battery compartment. You cannot operate the monitor on AC mains or battery extension 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 doINOP Message, Indication What to do MMS Ext. UnpluggedINOP toneThe MMS extension has been disconnected from the Multi-Measurement Module.MMS Ext. UnpoweredINOP toneThe MMS extension cannot operate while the Multi-Measurement Module is running on battery power.MMS Ext. UnsuppINOP toneThe MMS extension is not supported by your monitor. Contact your service personnel.MMS Ext.Equip MalfINOP toneLoss of communication between the Multi-Measurement Module and the MMS extension. Contact your service personnel.
4 Patient Alarms and INOPs73Display INOPsECG, Arrhythmia, QT and ST INOPsINOP 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 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.Cannot Analyze QT The QT algorithm cannot generate a valid QT value for more than 10 minutes, or 1 minute in the initial phase.Cannot Analyze ST The ST algorithm cannot generate a valid ST value. Possible causes are large variations in the measured ST values for consecutive beats, or ventricular paced beats. Review the ECG signal quality and the ST measurement points. If the patient has a ventricular pacemaker, ST analysis is not possible.Cannot Analyze STE The STE algorithm cannot generate valid ST elevation values. 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.ECG Equip MalfNumeric is replaced by -?-INOP toneContact your service personnel.The ECG hardware is faulty.<ECG Lead> Lead Off!! <ECG Lead> Lead Off!!! <ECG Lead> Lead OffIf no ECG lead is measurable, numeric is replaced by -?-INOP toneNot all the required leads for ECG monitoring are connected. Check the ECG connections and make sure that the electrode indicated by <ECG lead> is attached [e.g. RA, LA, LL, RL, V or C electrodes]. With EASI lead placement all 5 electrodes must be connected, and with Hexad lead placement all 6 electrodes must be connected.ECG Leads Off!! ECG Leads Off!!!ECG Leads OffNumeric is replaced by -?-INOP toneCheck that all of the required ECG leads are attached, and that none of the electrodes have been displaced. The INOP may also be caused by a saturated or overloaded ECG amplifier.ECG Noisy Elec <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 Noisy SignalINOP toneThe ECG signal is too noisy. Check that the electrodes are properly placed and have not dried out. Remove any possible sources of signal noise (such as power cords) from the area around the cable and the patient.The ECG signal may be saturated or overloaded.ECG Out Equip MalfINOP toneThere is a problem with the device connected to the ECG Out connector. Contact your service personnel.ECG/Arrh AlarmsOff!!ECG/Ar AlarmsOffAll 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.
4 Patient Alarms and INOPs74Resp INOPsNBP INOPsSome ECG AlarmsOff This message appears (if configured to do so) when the on/off settings of the yellow arrhythmia alarms differ from the current Profile.INOP Message, Indication What to do INOP Message, Indication What to do Resp Equip MalfNumeric is replaced by -?-INOP toneContact your service personnel. The RESP hardware is faulty.Resp ErraticNumeric is replaced by -?-The monitor has detected too many artifacts in the measured Resp signal. Check that the RA and LL electrodes are correctly attached and have not dried out.Resp Leads OffNumeric is replaced by -?-INOP toneNot all the required leads for Resp monitoring are attached. Make sure that the RA, LA, and LL leads are attached.INOP Message, Indication What to do !! Cuff Not Deflat!!!Cuff Not DeflatNumeric is displayed with a -?-Severe yellow/red INOP toneDuring this INOP, alarms cannot be paused or switched off.Remove the cuff from the patient. Make sure that the tubing is not kinked or twisted and that the correct patient category is selected. Try repeating the measurement. You can silence the INOP, but the INOP message remains visible until the next NBP measurement is started or the Stop All SmartKey is selected.[Adult or pediatric patients: The NBP cuff pressure has exceeded 15 mmHg (2 kPa) for more than 3minutes. Neonatal patients: The NBP cuff pressure has exceeded 5 mmHg (0.7 kPa) for more than 90 seconds.]!! Cuff Overpress!!!Cuff OverpressNumeric is displayed with a -?-Severe yellow/red INOP toneDuring this INOP, alarms cannot be paused or switched off.The NBP cuff pressure exceeds the overpressure safety limits. Remove the cuff from the patient. Make sure that the tubing is not kinked or twisted and that the correct patient category is selected. Try restarting the measurement. You can silence this INOP, but the INOP message remains visible until the next measurement is started or the Stop All SmartKey is selected.NBP DeactivatedINOP toneThe NBP measurement label in the measurement device has been deactivated by deactivating the label in the Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, reactivate the measurement label in the Measurement Selection window.NBP Equip MalfNumeric is replaced by -?-INOP toneRemove the cuff from the patient. The NBP hardware is faulty. Contact your service personnel. You can silence this INOP, but the INOP message remains visible until the next measurement is started or the Stop All SmartKey is selected.NBP InterruptedNumeric is replaced by -?-INOP toneCheck the tubing and cuff for leakages or kinks. Check that you are using the correct cuff size and placement, and that the correct patient category is selected. Try restarting the measurement. If the INOP occurs repeatedly, contact your service personnel.You can silence this INOP, but the INOP message remains visible until the next measurement is started or the Stop All SmartKey is selected.This INOP arises when the measurement needed longer than the maximum time for inflation, deflation or the total measurement.NBP Measure FailedNumeric may be replaced by -?-INOP toneCheck that you are using the correct cuff size and placement, and that the correct patient category is selected. Try restarting the measurement.You can silence this INOP, but the INOP message remains visible until the next measurement is started or the Stop All SmartKey is selected.Check the condition and suitability of the patient for NBP monitoring. Use another cuff to continue measuring.
4 Patient Alarms and INOPs75Temperature INOPsSpO2 INOPsINOP Message, Indication What to do T1, T2, T3, T4 INOPs See <Temp Label> INOPsTamb INOPs See <Temp Label> INOPsTart INOPs See <Temp Label> INOPsTcereb INOPs See <Temp Label> INOPsTcore INOPs See <Temp Label> INOPs<Temp Label> DeactivatedINOP toneA Temp measurement label in the measurement device has been deactivated, either by connecting a Pressure transducer in the shared Press/Temp socket, or by deactivating the label in the Measurement Selection window.The measurement automatically disappears from the display.To switch the measurement on again, either reconnect a Temp transducer or reactivate the measurement label in the Measurement Selection window.<Temp Label> Equip MalfNumeric is replaced by -?-INOP toneContact your service personnel.The temperature hardware is faulty.<Temp Label>NoTransducerNumeric is replaced by -?-INOP toneMake sure the Temp probe is connected to the MMS or module.If you silence this INOP, the measurement will be switched off.<Temp Label> OverrangeNumeric is replaced by -?-INOP toneTry changing the application site of the transducer.[The temperature is less than -1°C, or greater than 45°C.]<Temp Label> UnpluggedINOP toneA Temp measurement label has been deactivated, either by unplugging a module, or by deactivating the label in the Measurement Selection window.The measurement automatically disappears from the display.To switch the measurement on again, either replug the module or reactivate the measurement label in the Measurement Selection window.Tesoph INOPs See <Temp Label> INOPsTnaso INOPs See <Temp Label> INOPsTrect INOPs See <Temp Label> INOPsTskin INOPs See <Temp Label> INOPsTtymp INOPs See <Temp Label> INOPsTven INOPs See <Temp Label> INOPsTvesic INOPs See <Temp Label> INOPsINOP Message, Indication What to do <SpO₂ Label> DeactivatedINOP toneThe SpO2 measurement label in the measurement device has been deactivated by deactivating the label in the Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, reactivate the measurement label in the Measurement Selection window.<SpO₂ Label> Equip MalfNumeric is replaced by -?-INOP toneThe MMS or module is faulty. Unplug and replug the MMS or module. If the INOP persists, contact your service personnel.
4 Patient Alarms and INOPs76<SpO₂ Label> ErraticNumeric is replaced by -?-INOP toneCheck the sensor placement. Try another adapter cable and sensor. If the INOP persists, contact your service personnel.<SpO₂ Label> Extd.UpdateNumeric is displayed with a ?(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>InterferenceNumeric is replaced by -?-INOP toneThere is too much interference, caused by a high level of ambient light and/or electrical interference. Cover the sensor to minimize ambient light. If the INOP persists, make sure that the sensor cable is not damaged or positioned too close to power cables.<SpO₂ Label> Low PerfNumeric is displayed with a ?(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 PulseNumeric is replaced by -?-INOP toneCheck the perfusion at measurement site. If necessary, stimulate circulation or change measurement site. If the INOP is due to NBP measurement on the same limb, wait until the NBP measurement is finished.<SpO₂ Label> No SensorNumeric is replaced by -?-INOP toneMake sure the SpO2 sensor is connected. If the INOP persists, try another adapter cable and sensor. If you silence this INOP, the measurement will be switched off.<SpO₂ Label> NoisySignalNumeric is replaced by -?-INOP toneExcessive patient movement or electrical interference is causing irregular pulse patterns. Try to reduce patient movement or to relieve the cable strain on the sensor.<SpO₂ Label> Poor SignalNumeric is displayed with a ?(questionable numeric)The signal condition of the SpO2 measurement is poor and measurement accuracy may be compromised. If the INOP persists, consider changing the application site or using another sensor.<SpO₂ Label> Pulse?Numeric is replaced by -?-INOP toneThe detectable pulsations of the SpO2 signal are outside the specified pulse rate range.<SpO₂ Label> SearchingNumeric is unavailableSpO2 is analyzing the patient signal to derive Pulse, SpO2 and Perf values. Please wait until the search analysis is complete.<SpO₂ Label> Sensor MalfNumeric is replaced by -?-INOP toneThe SpO2 sensor or adapter cable is faulty. Try another adapter cable and sensor. If the INOP persists, contact your service personnel.<SpO₂ Label> Sensor OffNumeric is replaced by -?-INOP toneThe SpO2 sensor is not properly applied to the patient. Apply the sensor following the instructions supplied by the manufacturer.<SpO₂ Label> Unkn.SensorNumeric is replaced by -?-The connected sensor or adapter cable is not supported by the SpO2 measurement. Use only specified sensors and cables.<SpO₂ Label> UnpluggedNumeric is replaced by -?-INOP toneAn SpO2 measurement label has been deactivated, either by unplugging a module, or by deactivating the label in the Measurement Selection window.The measurement automatically disappears from the display.To switch the measurement on again, either replug the module or reactivate the measurement label in the Measurement Selection window.<SpO₂ Label> UpgradeNumeric is replaced by -?-The SpO2 measurement is currently in upgrade mode. Monitoring is not possible in this mode.INOP Message, Indication What to do
4 Patient Alarms and INOPs77Pressure INOPsINOP Message, Indication What to do ABP INOPs See <Press Label> INOPsAo INOPs See <Press Label> INOPsART INOPs See <Press Label> INOPsBAP INOPs See <Press Label> INOPsCPP Chk SourcesNumeric is replaced by -?-INOP toneNot all measurements or values required to perform the calculation are available. Check the measurement sources.CPP Chk UnitsNumeric is replaced by -?-The monitor has detected a conflict in the units used for this calculation. Check the unit settings.CPP Disabled CPP has been disabled, either in the setup in Configuration mode, or by loading settings with CPP disabled. This can happen when changing from a pediatric or neonatal profile to an adult profile, as the default profile settings have the CPP measurement disabled in the adult profile and enabled in the pediatric and neonatal profiles. Enable CPP in the current profile to clear the INOP.CVP INOPs See <Press Label> INOPsFAP INOPs See <Press Label> INOPsIC1 / IC2 INOPs See <Press Label> INOPsICP INOPs See <Press Label> INOPsLAP INOPs See <Press Label> INOPsP / P1 / P2 / P3 / P4 INOPs See <Press Label> INOPsPAP INOPs See <Press Label> INOPsPPV bad <Press Label> Signal The arterial pressure source selected for PPV is not providing a pulsatile signal.PPV bad Signalat Information CenterThe arterial pressure source selected for PPV is not providing a pulsatile signal.PPV Chk Sources The arterial pressure source selected for PPV is unplugged or switched off. When this INOP has displayed for 1 minute PPV will be switched off.<Press Label> ArtifactNumeric questionableA non-physiological event (flush or blood sample) is detected. A resulting limit alarm or non-pulsatile INOP will be suppressed.<Press Label>Change Scale Increase the scale for the pressure wave.<Press Label> DeactivatedINOP toneA Pressure measurement label in the measurement device or extension has been deactivated, either by connecting a Temp transducer in the shared Press/Temp socket, or by deactivating the label in the Measurement Selection window.The measurement automatically disappears from the display.To switch the measurement on again, either reconnect a Pressure transducer or reactivate the measurement label in the Measurement Selection window.<Press Label> Equip MalfNumeric is replaced by -?-INOP toneContact your service personnel.The pressure hardware is faulty.<Press Label> No PulsePulse numeric is replaced by -?-INOP toneThis INOP can only arise when a pressure is selected as the pulse source. It occurs when the pulse rate being measured is less than 25 beats per minute or the amplitude is less than three mmHg.Check the catheter and connections to the patient.<Press Label> No TransducerNumeric is replaced by -?-INOP toneMake sure that the pressure transducer is connected to the measurement device or module.If you silence this INOP, the measurement will be switched off.
4 Patient Alarms and INOPs78CO2 INOPs<Press Label> Noisy SignalPulse numeric is replaced by -?-INOP toneThis INOP can only arise when a pressure is selected as the pulse source. It occurs when the pulse detector finds a pulse rate above 350 bpm. This is usually caused by movement artifact or electrical interference.<Press Label> OverrangeNumeric is replaced by -?-INOP toneMake sure that the measurement has been properly prepared and zeroed, and that the transducer is level with the heart. If this INOP persists, try another transducer.Possible causes are a measured pressure outside the allowed pressure range, or a broken wire to the transducer.<Press Label> UnpluggedINOP toneA Pressure measurement label has been deactivated, either by unplugging a module, or by deactivating the label in the Measurement Selection window.The measurement automatically disappears from the display.To switch the measurement on again, either replug the module or reactivate the measurement label in the Measurement Selection window.<Press Label> Zero+Check CalNumeric is replaced by -?-Perform a zero and check the calibration of the transducer.RAP INOPs See <Press Label> INOPsUAP INOPs See <Press Label> INOPsUVP INOPs See <Press Label> INOPsINOP Message, Indication What to do INOP Message, Indication What to do CO₂ Auto ZeroNumeric is replaced by -?-if the Autozero lasts >15 sec, INOP tone sounds.The automatic zero calibration is in progress. This typically takes 10 seconds. During this time the CO2 values may not be updated, or they may be replaced by -?-. Wait until the zero calibration is complete to resume monitoring.CO₂ Cal FailedNumeric is replaced by -?-INOP toneMake sure that the Cal cell was changed between CAL1 and CAL2. Repeat the calibration. If the INOP reappears, try another transducer. If the INOP persists, contact your service personnel.CO₂ Cal ModeCO2 numeric displays current CO2 value for accuracy checkCurrently no calibration is running. Accuracy can be checked by placing the transducer on the two cells of the calstick and starting calibration. To start monitoring, leave Cal. Mode.CO₂ Cal RunningNumeric is replaced by -?-Wait until calibration is finished.CO₂ Check CalNumeric is replaced by -?-INOP toneThe CO2 value is outside the measurement range. Perform an accuracy check for both calstick cells and, if necessary, recalibrate the transducer.CO₂ Chk AdapterNumeric is replaced by -?-INOP toneCheck that the sensor is connected to the airway adapter, clean the airway adapter, if necessary. Perform a zero calibration. If the INOP persists, contact your service personnel.CO₂ DeactivatedINOP toneThe CO2 measurement label in the measurement device has been deactivated by deactivating the label in the Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, reactivate the measurement label in the Measurement Selection window.CO₂ Equip MalfNumeric is replaced by -?-INOP toneThe Measurement Extension is faulty. Unplug and replug the Multi-Measurement Module with Extension. If you are using the mainstream method, unplug and replug the transducer or try another transducer. If the INOP persists, contact your service personnel.
4 Patient Alarms and INOPs79CO₂ No Sensorfrom M3014ANumeric is replaced by -?-INOP toneThere is no CO2 sensor connected. If you silence this INOP the CO2 measurement will be switched off.CO₂ No TubingNumeric is replaced by -?-INOP toneEither the sample line is disconnected, or an incorrect line is attached. Check the connection. If necessary, connect another sample line (Use only the approved accessories).If you silence this INOP, the measurement will be switched off.!! CO₂ Occlusion!!! CO₂ OcclusionNumeric is replaced by -?-INOP toneThe sample line or exhaust tube is blocked. Check the tubing, then disconnect and reconnect the sample line. If the INOP persists, connect a new sample line.CO₂ OverrangeNumeric is replaced by -?-INOP toneThe CO2 value is higher than the measurement range. If you suspect a false high value, contact your service personnel.CO₂ Pump OffNumeric is replaced by -?-.The pump has been switched off for fifteen minutes. To switch it on again, select Pump On in the Setup CO₂ menu.CO₂ PurgingNumeric is replaced by -?-INOP toneThe Filterline is being purged to remove an occlusion in the line or airway adapter. If the occlusion is removed, the INOP will disappear. If not, the INOP CO₂ Occlusion is displayed.CO₂ Sens WarmupNumeric is replaced by -?-Microstream CO2: INOP toneMainstream CO2: no INOP toneWait until the sensor reaches operating temperature and the INOP disappears.CO₂ Upgrade FWNumeric is replaced by -?-INOP toneThe software in the Measurement Extension does not match the software in the MMS. Contact your service personnel.CO₂ Wait Cal2Numeric is replaced by -?-Calibration on the first calstick cell is complete. Place the transducer on the other calstick cell and start the CAL2 calibration cycle.CO₂ Zero FailedNumeric is replaced by -?-INOP toneAn error occurred during the last zero calibration. Check the airway adapter and clean, if necessary. Perform another zero calibration. If the INOP persists, contact your service personnel.CO₂Change Scale The CO2 wave is clipped. Select a more appropriate wave scale to display the whole wave.CO₂NoTransducerfrom mainstream CO2 (except M3014A)Numeric is replaced by -?-INOP toneThere is no CO2 transducer connected. If you replace the transducer, the new transducer must be calibrated. If you silence this INOP the CO2 measurement will be switched off.CO₂Zero Running Wait until zero calibration is finished.CO₂ZeroRequiredNumeric is replaced by -?-INOP tonePerform zero calibration for the CO2 sensor. If the INOP persists, contact your service personnel.IPI Check Pat. Age For Adult patients: a date of birth has been entered that results in a calculated patient age of less than 12 years. Enter correct date of birth or, if patient is pediatric, correct patient category.For pediatric patients: either no date of birth has been entered (it is required for calculation of IPI for pediatric patients) or the calculated age is below 1 year or above 12 years. Check that correct date of birth is entered.IPI Check Sources The IPI numeric cannot be provided as one or more of the measurement sources required for IPI is not available. Check availability of etCO2, awRR, SpO2, and pulse rate.IPI Neo Patient ? Check patient category. The IPI numeric is not available for neonatal patients.INOP Message, Indication What to do
4 Patient Alarms and INOPs80C.O. INOPsINOP Message, Indication What to do C.O. DeactivatedINOP toneThe Cardiac Output measurement label in the measurement device has been deactivated by deactivating the label in the Measurement Selection window. The measurement automatically disappears from the display. To switch the measurement on again, reactivate the measurement label in the Measurement Selection window.C.O. Equip MalfNumeric is replaced by -?-INOP toneThere is a problem with the C.O. hardware. Contact your service personnel.C.O. UnpluggedNumeric is replaced by -?-INOP tonePlug in the C.O. module. Silencing this INOP switches off the measurement.CCI No BSACCI numeric unavailableINOP toneCCI cannot be calculated because the patient's body surface area is unknown. Enter the patient weight and height to provide the BSA for CCI calculation.CCO BadPressSignalNumeric is replaced by -?-INOP toneThe arterial pressure wave can currently not be used for pulse contour calculation for CCO or CCI measurement. Possible causes are air bubbles in the tubing or a physiological condition, for example severe arrhythmia.CCO No CalibrationNumeric is replaced by -?-The CCO measurement is currently not calibrated.CCO No <Press Label>Numeric is replaced by -?-INOP tone may soundCCO/CCI cannot be calculated. Make sure that the pressure chosen in the Setup CCO menu under CCO from matches the pressure measured with the arterial catheter for CCO measurement. A pressure from an external device cannot be used. Select another pressure label, either ABP, Ao, ART, BA P, FA P, o r UA P.CCO No Pressat Information CenterCCO/CCI cannot be calculated. Make sure that the pressure chosen in the Setup CCO menu under CCO from matches the pressure measured with the arterial catheter for CCO measurement. A pressure from an external device cannot be used. Select another pressure label, either ABP, Ao, ART, BA P, FA P, o r UA P.CCO Not SupportedNumeric is replaced by -?-INOP toneA catheter for transpulmonary C.O. measurements has been unplugged and replaced with a Right Heart C.O. catheter, or the measurement mode has been changed manually. Silencing this INOP switches the measurement off.CCO OverrangeCCI OverrangeNumeric is replaced by -?-INOP toneThe measured CCO or CCI value is not within the specified range for CCO/CCI measurement.CCO Press Invalidat Information CenterThe arterial pressure selected for pulse contour calculation for CCO is available but currently invalid. Make sure the pressure transducer is connected and the zero calibration is valid.CCO <Press Label> InvalidNumeric is replaced by -?-INOP tone may soundThe arterial pressure selected for pulse contour calculation for CCO is available but currently invalid. Make sure the pressure transducer is connected and the zero calibration is valid.CCO PressOverrangeNumeric is replaced by -?-INOP toneThe mean value of the arterial pressure values used for pulse contour calculation for CCO is below 0mmHg or above 300mmHg.CCO PulseOverrangeNumeric is replaced by -?-INOP toneThe pulse rate of the pressure used for pulse contour calculation for CCO is below 30 bpm or above 240 bpm.CCO RecalibrateNumeric is replaced by -?-The most recent CCO or CCI calibration was made over 8 hours ago or the arterial pressure measurement used for CCO calculation has been zeroed after the CCO calibration was performed. You should recalibrate CCO or CCI with transpulmonary C.O. measurements at least every 8 hours or when the hemodynamic condition of the patient has changed. The pressure measurement must be zeroed before a CCO calibration.
4 Patient Alarms and INOPs81Telemetry INOPsCableless Measurement Device INOPsCCO/Tbl NoTransducNumeric is replaced by -?-INOP toneNo transducer attached to the module or catheter disconnected.Tblood OverrangeNumeric is replaced by -?-Tblood out of range 17°C - 43°C.TbloodNoTransducerNumeric is replaced by -?-INOP toneNo transducer attached to the module or catheter disconnected.INOP Message, Indication What to do INOP Message, Indication What to do Check ECG SettingsINOP toneSynchronization of ECG settings between the monitor and Information Center has failed. Check that the ECG settings in use are appropriate.!!Check ECG Source Both the telemetry device and the monitor have valid ECG signalsChk SpO₂T SettingsINOP toneSynchronization of SpO2T settings between the monitor and Information Center has failed. Check that the SpO2T settings in use are appropriate.Invalid Leadset The leadset plugged in cannot be used with the telemetry device.Leadset Unplugged The leadset has been unplugged from the telemetry device.No ECG Source A telemetry device is paired with the monitor but the Information Center is not detecting a valid ECG signal from either of them.!! Repl. Tele Batt!!!Repl. Tele BattSevere yellow/red INOP toneDuring this INOP, alarms cannot be paused or switched off.The battery in the telemetry device is almost empty and must be replaced.Tele Battery Low The battery in the Telemetry device is low and must be replaced soon.!!Tele Disconnect!!!Tele DisconnectSevere yellow/red INOP toneTelemetry transceiver was disconnected or short range radio link was lost. For cable connections; check Telemetry interface, cable connection and setup.For short range radio connections: if the telemetry transceiver has not moved out-of-range, check for interference sources close to the monitor (bluetooth devices, DECT phones, cellular phones, microwaves, etc.). If this INOP persists, ask your service personnel to survey the interference sources.!! Tele INOP!!! Tele INOPSevere yellow/red INOP toneCheck for further details at the Information Center or in the Telemetry Data window on the monitor.Tele Sync Unsupp.INOP toneThe MMS in use does not support synchronization of ECG and SpO2 settings between the monitor and central station after a telemetry device has been paired. Use an MMS with revision E.0 or above.INOP Message, Indication What to do cl NBP Batt Empty!!cl NBP BattEmpty!!!cl NBP BatEmptyCorresponding INOP toneThe remaining battery time of the NBP Pod is below 30 minutes. Charge the battery. cl NBP Batt IncompINOP toneThe battery in use with the NBP Pod is incompatible. Replace it with one approved for use with the NBP Pod.
4 Patient Alarms and INOPs82cl NBP Batt LowINOP toneThe remaining battery time of the NBP Pod is below 2 hours.cl NBP Batt MalfINOP toneThere is a malfunction in the NBP Pod's battery system. Contact your service personnel.cl NBP Batt TempINOP toneThe 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 BattINOP toneThe 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 Chk Chrg IF The interface between the NBP Pod and the Charging Station is not working properly. Try cleaning the contacts and reposition the Pod on the charging station.cl NBP ChkSettings The NBP Pod's settings may have changed or become corrupt. Check the settings.cl NBP DisconnectINOP toneThe NBP Pod has lost the connection to the monitor.cl NBP License Req The NBP Pod requires a valid software license for operating.cl NBP No CradleINOP toneThe NBP Pod is not in its cradle.cl NBP RemoveINOP toneThe 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 BattINOP toneThe 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 Resp Batt Empty!!cl Resp BatEmpty!!!cl Resp BtEmptyCorresponding INOP toneThe remaining battery time of the Respiration Pod is below 30 minutes. Charge the battery.cl Resp Batt IncmpINOP toneThe battery in use with the Respiration Pod is incompatible. Replace it with one approved for use with the Respiration Pod.cl Resp Batt Low The remaining battery time of the Respiration Pod is below 2 hours.cl Resp Batt Malf There is a malfunction in the Respiration Pod's battery system. Contact your service personnel.cl Resp Batt Temp The temperature of the battery in the Respiration 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 Resp Check Batt The battery in the Respiration Pod is nearing the end of its useful life. Only 50 charge/discharge cycles remain. Contact your service personnel to replace the battery.cl Resp Chk ChrgIF The interface between the Respiration Pod and the Charging Station is not working properly. Try cleaning the contacts and reposition the Pod on the charging station.cl Resp Chk Sett The Respiration Pod's settings may have changed or become corrupt. Check the settings.cl Resp Disconnect The Respiration Pod has lost the connection to the monitor.cl Resp Remove The temperature of the battery in the Respiration Pod is too high. Remove the Pod from the patient and contact service personnel.cl Resp Serv Batt The battery in the Respiration 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!!cl SpO₂ BatEmpty!!!cl SpO₂ BtEmptyCorresponding INOP toneThe remaining battery time of the SpO2 Pod is below 30 minutes. Charge the battery.cl SpO₂ Batt IncmpINOP toneThe battery in use with the SpO2 Pod is incompatible. Replace it with one approved for use with the SpO2 Pod.INOP Message, Indication What to do
4 Patient Alarms and INOPs83cl SpO₂ Batt LowINOP toneThe remaining battery time of the SpO2 Pod is below 2 hours.cl SpO₂ Batt MalfINOP toneThere is a malfunction in the SpO2 Pod's battery system. Contact your service personnel.cl SpO₂ Batt TempINOP toneThe 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 BattINOP toneThe 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 Chk ChrgIF The interface between the SpO2 Pod and the Charging Station is not working properly. Try cleaning the contacts and reposition the Pod on the charging station.cl SpO₂ Chk Sett The SpO2 Pod's settings may have changed or become corrupt. Check the settings.cl SpO₂ DisconnectINOP toneThe SpO2 Pod has lost the connection to the monitor.cl SpO₂ No CradleINOP toneThe SpO2 Pod is not in its cradle.cl SpO₂ RemoveINOP toneThe 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 BattINOP toneThe 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.clResp License Req The Respiration Pod requires a valid software license for operating.clSpO₂ License Req The SpO2 Pod requires a valid software license for operating.cmResp NeoPatient? The Respiration Pod cannot be used with neonatal patients. Check the patient category.cmResp No Signal No signal is being detected from the Respiration Pod. Check that the Pod is attached correctly with the adhesive attachment and that it moves with the patient's breathing.cmRespCan'tAnalyze The Respiration Pod algorithm cannot reliably analyze the signal. Respiration rate and pulse rate are affected cmRespPediPatient? The Respiration Pod cannot be used with pediatric patients. Check the patient category.INOP Message, Indication What to do
4 Patient Alarms and INOPs84
5855Managing Patients and EquipmentWhen the monitor is used together with an IntelliVue Information Center, a variety of services are provided to manage the interconnections between patients, equipment, hospital beds, caregivers, and so on.Many services can be used both at the monitor and at the Information Center, resulting in a more efficient workflow.Which services are available will depend on which Information Center you have. The Philips IntelliVue Information Center iX (PIIC iX) provides more services and functionality than the Philips IntelliVue Information Center (PIIC). In these Instructions for Use, information that is only valid for one of the Information Centers will be marked with a corresponding side heading, for examplePIIC iX For a list of the differences between the two Information Centers, see “Information Center Compatibility” on page 103.Patient ConceptsFor a patient to be part of the system their identification data must be entered into the system. A patient can then be assigned to a bed, have equipment assigned directly to him, and have a location set when he is not currently in the bed.Equipment ConceptsDepending on how equipment is used in your facility, there are various ways to associate devices with patients, beds or monitors. Equipment usage must be configured appropriately at the Information Center and the monitoring equipment.PIIC iX By configuration, equipment can be assigned:• permanently to a bed,• on demand to a bed or host monitor, or• directly to a patient.The foundation for a particular equipment use model is laid in the configuration settings in the monitor and the Information Center. Refer to the corresponding configuration guides for further details.
5 Managing Patients and Equipment86Additionally there are mechanisms to automatically free up equipment that is no longer used. This prevents unnecessary patient mismatches when the equipment is used for the next patient and avoids data of different patients getting mixed.PIIC iX When connected to PIIC iX, equipment states are tracked by the system. When the equipment is not assigned to a patient or no patient is admitted at a monitor, the equipment is considered as free equipment in the system. Equipment that is assigned or has a patient admitted is tracked as used (i.e. not free) equipment.The Information Center uses the equipment state (free/not free) to maintain and support workflow and equipment lists.Managing PatientsIn order to attribute collected measurement data to a specific patient, or assign equipment or a bed to a specific patient, each patient in the system must be identified. By admitting a patient, you identify them for the system.When equipment is freed up (for example by discharging the patient, removing a monitor from a patient or using End Case) the collection of data is officially ended for this patient and important settings on the monitor are reset to the defaults.WARNINGAlways perform a discharge or free up the monitor 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.Admitting a PatientThe monitor displays physiological data and stores it in the trends as soon as a patient is connected. This lets you monitor a patient who is not yet admitted. It is however important to admit patients properly so that you can identify your patient on recordings, reports, and networked devices.During admission you enter data that the monitor needs for safe and accurate operation. For example, the patient category setting determines the algorithm the monitor uses to process and calculate some measurements, the safety limits that apply for some measurements, and the alarm limit ranges.NOTEIt is strongly recommended that the same patient data fields be configured to be mandatory at the monitor and the Information Center.When No Patient is AdmittedTo admit a patient:1Select the patient name field or select the Patient Demogr. SmartKey to open the Patient Demographics window.2Select Admit Patient.The Enter Demographics window appears. You can enter data as normal, using the keyboard or a barcode scanner, or, with PIIC iX, use the Find Patient key to search for patient data in connected systems as described in “Using "Find Patient" to Search for Patient Data” on page 87.
5 Managing Patients and Equipment873Enter the patient information: select each field and use the keyboard or barcode scanner or choose from the pop-up list of alternatives to input information.When you enter data, the Information Center will automatically check for corresponding data and will suggest an appropriate action based on what it finds. You can select Confirm to accept the suggestion or Cancel to reject it.–Last Name: Enter the patient's last name (family name).–First Name: Enter the patient's first name.–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 Number, or other alternatives. Enter the appropriate data for the fields displayed.–Patient Cat.: Choose the patient category, either Adult, Pedi, or Neo.–Paced Mode: Choose On or Off (You must use On if your patient has a pacemaker). With PIIC iX there is a third choice: Unconfirmed. When the paced mode is Unconfirmed, the algorithm for paced patients will be used.–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, in the form dd/mmm/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.When admission is complete, the patient's name appears on the monitor info line at the top of the screen together with the symbol indicating the patient category. By clicking on this section of the information line, also when no patient is admitted, you can open the Patient Demographics window at any time. There you can change patient data or set patient category and paced mode as described above.When a Patient is Already AdmittedIf the patient monitor already has a patient admitted, the Admit Patient key is replaced by the New Patient key.When you select New Patient, the monitor is freed. All settings are reset to the defaults, all patient data and trend data are deleted, and monitoring at the Information Center may stop for monitors designated as transport monitors. Depending on your equipment configuration, selecting New Patient may transfer the currently admitted patient out of the bed. A message will appear requiring your confirmation of these actions.After selecting New Patient, you can admit your patient as described in “When No Patient is Admitted” above.Using "Find Patient" to Search for Patient DataPIIC iX You can use the Find Patient key to search for patient data in the Information Center and any connected hospital information systems. The search will look for currently admitted or previously admitted patients matching the search data you enter.
5 Managing Patients and Equipment88To search for patient data:1Select the Find Patient key.A window opens with an on-screen keyboard.2Type in the last name or an ID, or a part of it, and select Enter on the keyboard.The search results will be displayed in a Select Patient window. The system provides a list of all matching patients.3Highlight the patient you want to admit to this bed.4Depending on their current status, you will be asked whether you want to readmit them, or transfer them to this bed.5Select Confirm to complete the admission or transfer.Patient Category and Paced ModeThe 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 mode setting determines whether the monitor shows pacemaker pulses or not. When Paced Mode is set to Off, pace pulses are filtered and therefore do not show in the ECG wave.WARNINGPatient Cat. and Paced Mode will always contain a value, regardless of whether the patient is fully admitted or not. If you do not specify settings for these fields, the monitor uses the default settings from the current profile, which might not be correct for your patient.Patient categoryChanging the patient category may change the arrhythmia and NBP alarm limits. If possible, always load a suitable profile after changing patient category, and always check alarm limits to make sure that they are appropriate for your patient.Paced modeFor paced patients, you must set Paced Mode to On. If it is incorrectly set to Off, the monitor could mistake a pace pulse for a QRS and fail to alarm during asystole. With PIIC iX, the paced mode may be Unconfirmed which will assume a pacemaker is present. You should still set the Paced Mode to On for paced patients to make the status clear.Admitting a Centrally-Monitored PatientYou can admit a patient at either the bedside or the Information Center. When you admit a patient, the patient's name appears on the bedside monitor and the Information Center.If you do not fill in all patient information required by the Information Center, the Information Center may reject the admission. Complete all the required fields and try again to admit the patient.Quick Admitting a PatientUse Quick Admit to quickly admit a patient using only a limited set of demographic data.1Select the Quick Admit SmartKey.2Enter the required data (ID fields or last name depending on configuration) with the keyboard or a barcode scanner.
5 Managing Patients and Equipment893Select Enter.4In the confirmation window, select Confirm to stop monitoring for the previous patient or free up the monitor (if confirmation is configured).5Check that patient category and paced status are correct for the new patient.6Check the current profile and, if necessary, load an appropriate profile.If the monitor is connected to an Information Center and only the ID field is entered, the patient name may be set to - - - at the Information Center, depending on the configuration. Complete the rest of the demographic details as soon as possible to fully identify the patient on the network, on the monitor and on printed reports. To complete the details, open the Patient Demographics window and complete all required fields.Using Stat AdmitStat Admit allows you to admit a patient with a temporary patient identification. It can be used in cases when the patient ID is unknown or when the data is not yet available.The Stat Admit function generates content for a name or ID field using the current date and time. A random lower case letter is added at the end to reduce the chance of creating the same name or ID simultaneously at two monitors. So a name field would be filled with, for example:19:32:45-30MAR15aDepending on your configuration, a name field, an ID field, or all fields defined as mandatory will be filled. The exact format of the date and time data depends on the size of the field being filled and the language of the monitor user interface.Additionally, if configured, Stat Admit can enter the current bed label or equipment label as a record of the location at admission time.Admitting with Stat AdmitIf Stat Admit is available for use, one of the following two methods will be set up:• Using the SmartKey - select the Stat Admit Smartkey.• Using a barcode or RFID label - read the special Stat Admit code.Depending on your configuration, either the temporary ID will appear directly on the monitoring screen or the Enter Patient Demographics window will open for you to confirm the temporary ID.Editing Patient InformationTo edit the patient information after a patient has been admitted, select the patient name field on the Main Screen to open the Patient Demographics window, and make the required changes.PIIC iX If data has been provided by a hospital information system, you will not be able to edit it on the monitor.Ending Monitoring for a PatientThere are several ways to end monitoring for a patient, depending on whether there is an Information Center connection, and on the configuration of the Information Center and the monitor. Discharging a patient and removing the monitor from a patient are described here. You can also end monitoring by admitting a new patient, as described in “When a Patient is Already Admitted” on page 87.
5 Managing Patients and Equipment90Depending on your configuration, monitoring for a patient may end automatically when the monitor has been powered off or in standby mode for a set time, or when no basic measurements have been made for a set time.WARNINGAlways end monitoring for the previous patient (with Dischrge Patient, Remove Monitor, End Case or New Patient) 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.Discharging a PatientThe discharge function is only available when the patient is monitored centrally at an Information Center. A discharge transfers the patient out of the bed and frees all devices used for the patient. The discharge function may be disabled at a monitor designated as a transport monitor, to ensure that a patient cannot be accidentally discharged from the system when the transport monitor is used for another patient.A discharge:– clears the patient demographics– erases all patient measurement 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 a 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.Make sure that you have printed out any required reports before discharging. Check that a functioning local or central printer is available before you use End Case.To Discharge a Patient1Select the patient name field or select the Patient Demogr. 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 printed when you select End Case. See “Setting Up Auto Reports” on page 237 for information on setting up end case reports.–Dischrge Patient - to discharge the patient without printing any reports.
5 Managing Patients and Equipment91Removing the MonitorRemoving a monitor stops using the monitor for the current patient and frees up the monitor and all devices assigned to that monitor.Removing the monitor:– clears the patient demographics in the monitor.– erases all patient measurement data (such as trend, event, and calculation data) from the monitor and devices assigned to the monitor. This ensures that data from a previous patient are not mixed with data from a 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.If the monitor is locked to the bed and is connected to an Information Center, the remove function is not available and you will have to discharge the patient.To Remove a Monitor1Open the Equipment window - either directly in Main Setup or by selecting the bed label in the information line.2Select the monitor.3Select the Remove Monitor pop-up key.New Patient CheckThe monitor can be configured to ask you whether a new patient is now being monitored 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 periodThe pop-up window is entitled Is this a New Patient?. The monitor offers a Yes key to stop monitoring for the previous patient and begin monitoring a new patient and a No key to continue monitoring with the current patient data and settings.The time periods for the three conditions can be configured independently.Transferring PatientsTo save you from having to enter the same patient data multiple times and enable patient transfer without loss of data, patient demographic information is shared between patient monitors and Information Centers.Data Exchange Between Information CentersYou can transfer demographic data and trend data from one IIC to another by selecting Transfer on the patient monitor. Trend data is not shared between Information Centers and monitors.
5 Managing Patients and Equipment92Transferring Patients with IntelliVue Information Center iXPIIC iX There are several ways to transfer a patient from or to another bed. When a patient is transferred to the destination bed, Information Center monitoring continues in the destination bed and equipment that is not transferred with the patient is freed up.Using the Transfer FunctionPIIC iX To transfer a patient using the transfer function provided on the patient monitor by the Information Center:1Select the patient name or the Not Admitted text at the top of the monitor screen to open the Patient Demographics window.2Select the Transfer pop-up key.The Transfer window opens. If a patient is currently admitted, the window offers the possibility to transfer that patient to another bed (To Other Bed). If no patient is currently admitted, the window offers the possibility to transfer a patient from another bed using the patient search as described in “Using "Find Patient" to Search for Patient Data” on page 87.3With To Other Bed, if more than one unit is configured, a list of units will appear. When you have selected a unit, or if only one unit is configured, a list of free beds will appear.4Select a bed from the list.You will be asked to confirm the transfer of the patient to this bed.5Select Confirm to complete the transfer.WARNINGBefore doing a transfer ensure that no other patient is using the destination bed and/or equipment from the destination bed.When a patient is transferred you need to check that the patient has all the required monitoring equipment at the destination bed.Using the New Patient KeyPIIC iX If the monitor at the destination bed is not free:1Select the patient name field at the top of the monitor to open the Patient Demographics window.2Select New Patient to free up the monitor.3Select Find Patient and enter your patient's name to get the patient data from the system.When you select your patient from the list, you will be asked to confirm that the patient should be transferred into this bed. After confirmation the transfer is complete.
5 Managing Patients and Equipment93Transferring Patients with IntelliVue Information CenterTransferring a Centrally-Monitored Patient with the MonitorScenario: A centrally-monitored patient is moved with the monitor to another monitoring location on the same Information Center database server without interrupting the collection of patient trend information.1Select the patient name field or select the Patient Demogr. 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.2At the new location, connect the monitor to the network (only needed for wired networks). If the monitor detects a patient mismatch, a window will open showing your patient's data and asking Complete transfer of this patient?.3Select Yes to complete the transfer.4Verify 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.Resolving Patient Information MismatchWhen you connect together devices which store patient demographic data, for example, 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.WARNING• It is important to resolve the mismatches as soon as they are identified. Failure to do so could result in using incorrect/confusing data to make clinical decisions. Certain settings, for example Paced Mode and Patient Cat., may not match between the Information Center and the monitor. If the Paced Mode is set incorrectly, the system could mistake a pace pulse for a QRS and fail to alarm in 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. A Check Patient ID INOP will appear when a mismatch has not been resolved.• As long as patient mismatch has not been resolved, data integration in the Information Center and the own patient overview functionality might not work as equipment is not assigned correctly to the patient.PIIC • When a monitor is connected to an Information Center by the wireless IntelliVue Instrument Telemetry interface, the patient data will automatically be merged in the case of a transfer. This means there is no patient discharge at the monitor and settings and trend data will be retained. You will see a message on the monitor and the Patient Demographics window will automatically appear so that you can check the data and change it if necessary.
5 Managing Patients and Equipment94Manually Resolving Patient MismatchThe source of the patient mismatch is indicated by question marks (???) and displayed in the status line at the bottom of the screen (Patient ???,Patient Category ??? or Paced Mode ???).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. After 5 minutes a Check Patient ID INOP will appear to remind you to resolve the mismatch.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.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 monitor. Always check the patient demographics after combining patients, to ensure that you are satisfied with the results. Change them if necessary.WARNINGAfter resolving a patient mismatch, check that the monitor settings (especially patient category, paced status and alarm limits) are correct for the patient.Patient Mismatch - If One Set of Patient Data is CorrectIf there is a mismatch between an Information Center and a monitor, choose the data set you want to continue using for this patient by selecting one of the sectors in the Select Patient window.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.
5 Managing Patients and Equipment95Patient Mismatch - If Neither Patient Data Set is CorrectA patient mismatch where neither set of patient data is correct might occur if you connect a new MMS to a monitor in order to prepare for a new patient, before you actually start measuring.Select New Patient if you are sure that none of the information is correct. This uses the bed, monitor and MMS for a new patient, erases all data in both the monitor and MMS, resets all settings to the default Profile, and lets you admit a new patient.Managing EquipmentMultiple pieces of monitoring equipment can be used for a patient. The association between a patient and a device can be made by:• identifying the patient at the device (by entering patient data or using Find Patient to get patient data)• "adding" equipment for an existing patientThe association between a patient and a device can be ended by:• discharging the patient, or selecting End Case.• "removing" the device from the patient.• transferring the patient without the device.• admitting a new patient to the device.• automatic freeing of the device.WARNINGIn all cases listed above, when equipment is freed, all patient identification and measurement data are deleted, all settings are reset to the defaults, and monitoring at the Information Center (if active) is stopped. Any associated devices, e.g. multi measurement modules connected to a monitor, or cableless measurement devices assigned to a monitor, may also be freed, depending on the configuration.Adding Equipment (PIIC iX)By selecting the Add Equipm. key you can display a list of all free equipment (not currently assigned to a patient) and select a device for use with this patient. If you add another monitor, you need to confirm this at the selected monitor.For information on combining equipment when connected to a PIIC, see “Using a Telemetry Device and a Monitor” on page 215.Removing EquipmentThe association between a monitor and the patient can be ended by selecting Remove Monitor. With PIIC iX, the Remove Monitor key is not available when the monitor is locked to a bed.Other equipment such as telemetry devices or IntelliVue Cableless Measurements can be removed by selecting the device then selecting Remove in the menu displayed.
5 Managing Patients and Equipment96Equipment Status DisputesEquipment can come into situations where its status does not match its location. There are three typical situations where this may occur:• PIIC iX only - equipment is locked to a bed, but has been removed and used at another bed.• PIIC iX only - equipment has been configured for use in a specific unit, but is now being used in a different unit.• Equipment has an equipment label but has not been configured at the Information Center and therefore cannot be managed.If a monitor or a companion device is in one of these situations, a Check Equipment INOP will appear and the equipment status will be shown in the Equipment window.The following symbols (in red) are used to show the status in the Equipment window:Using the Equipment WindowIn the Equipment window you have access to patient management, workflow functions (set location, transfer), equipment management functions (add/remove equipment) and caregiver-related functions.You can open the Equipment window directly in Main Setup or by selecting the bed label in the information line.1This bed is Bed 8, the connection to the Information Center is active.2Caregiver area - depending on your network connection, the name of assigned caregiver may be shown.3Patient name, category and paced mode.4This monitor is assigned to the patient and is the one on which you are viewing the window.equipment is locked to another bedequipment is not configured for use in this unitequipment label is not in system configuration, or duplicate equipment labels
5 Managing Patients and Equipment97The top part of the window contains the patient data, with the assigned caregiver and the status of the connection to the Information Center, and the bed label. In the lower part of the window, all equipment for this patient is shown, with the corresponding assignments and connections.The device you are currently viewing the window on is shown with a dark background (in the above example, the monitor with the label wm8).Changing Caregiver AssignmentWhen a caregiver is assigned, the caregiver name may appear next to the caregiver symbol in the Equipment window (depending on your network connection). Whether the name is shown or not, when you select this area of the window, a menu opens offering the following functions:PIIC iX •Select Caregiver - you can select a different caregiver from a list. When a new caregiver is assigned, the patient will be automatically added to that caregiver's Care Group. The availability of the function and the caregiver list depends on the Information Center configuration.•My Patients - opens the My Patients window showing all patients in your Care Group.Using the Patient AreaThe patient name, patient category and paced status are normally shown in the Equipment window. When a patient has been prepared for transfer, the transfer symbol will be shown:When you select this area in the Equipment window, a menu opens giving access to the Enter Demographics window, the Transfer function (see “Transferring Patients” on page 91) and the End Case function.Changing the LocationIf the monitor is currently assigned to a bed, but the patient is in another department for treatment or a diagnostic procedure, you can show a temporary location for the patient.1Select the Information Center area on the Equipment window.2Select the current location from the list.Or alternatively use the Select Location pop-up key.The temporary location is then shown in the Equipment window, on the Standby screen on the monitor, and in the sector at the Information Center. When the patient returns, you can set the location back to the bed number in the same way as described above.When Multiple Equipment is Used for One PatientIt is possible to assign additional monitoring equipment and a telemetry device to the same patient, resulting in the information from multiple devices being combined in one sector at the Information Center. The measurement data from the other devices will be displayed on the monitor screen in the own patient overview window.
5 Managing Patients and Equipment98WARNINGWhen new equipment has been added for a patient, you will be asked to confirm that the device be used for the patient. Always do this as soon as possible to avoid patient data mismatch.If multiple equipment is assigned to the patient, resolving a patient mismatch at the monitor may resolve other pending patient mismatches or remove other associated equipment.Own Patient Overview WindowThe measurements from other monitoring devices and telemetry devices are shown combined in the own patient overview window on the monitor, together with related information derived by the Information Center, such as alarms.1Current alarm and INOP generated by another device.2Own patient overview window3Delayed - indication that data in the window is delayed.WARNINGAll data presented in the own patient overview window are delayed for several seconds.If you need realtime data, for example for defibrillation, always use the host monitor ECG instead of telemetry or ECG from another monitoring device. As long as the ECG is being measured with another device there will be no ECG signal available at the ECG analog output.Visual Alarm Status Information in the Own Patient Overview Window• If individual measurement alarms are switched off at any of the devices in use for the patient, an alarms off symbol on a white background is shown beside the measurement numeric
5 Managing Patients and Equipment99Assigning a Telemetry Transceiver with an SRR Adapter to a MonitorA telemetry device with a short range radio adapter can be assigned to a monitor directly.Monitors which have this capability have a short range radio symbol on the model label.NOTEIf the monitor is using the MBAN frequency band (2.360 - 2.400 GHz, for US / FCC regulated countries only), direct assignment of a telemetry device is not possible. If problems occur with the direct assignment, contact your service personnel to check the frequency band used.To assign a telemetry device to a monitor:1Press the Check button on the telemetry device.The measurement selection key on the monitor will change to show the "add cableless" symbol 2Select the symbol.3In the Add Cableless window, select the correct equipment label for the telemetry device.4Check that the assignment is successful and that transmission has begun:•A Tele Device assigned message appears on the monitor• A tone sounds at the telemetry device and the Leads Off indicators light• The ECG wave appears on the monitorTo confirm that the correct telemetry device has been assigned, open the ECG Setup menu. The title of the menu contains the equipment label of the telemetry device; check that this is the correct label.If a telemetry device is already assigned to a monitor, you cannot assign a further telemetry device to that monitor.If the telemetry device goes out-of-range or loses the short range radio connection, it will switch over to standard telemetry transmission to the Information Center. In this case, the telemetry data is displayed in the Own Patient Overview Window as described above.When a telemetry device with a short range radio adapter is assigned to the patient, the short range radio connection to the monitor is made automatically.If a telemetry device disappears from the list in the Add Cableless menu, press the Check button on the telemetry device again. If the monitor is not configured to be used with a telemetry device, the add cableless symbol will appear crossed out .If the telemetry device is removed (unassigned), the short range radio connection will be ended.WARNINGShort range radio connections are subject to interruption due to interference from other radio sources in the vicinity, including microwaves, bluetooth devices and DECT phones. Outside the operating frequency band and 5% above and below, i.e. the exclusion band according IEC 60601-1-2, section • If all alarms are switched off or paused for one of the devices in use for the patient, an alarms off or alarms paused symbol on a dark gray background is shown beside all affected measurement numerics (if so configured). If all red and yellow alarms are switched off/paused, the symbol is red. If only yellow alarms are switched off/paused, the symbol is yellow.
5 Managing Patients and Equipment10036.202.3a)4), the short range radio connection is immune up to 3V/m in the frequency range from 80 MHz to 2.0 GHz and up to 1V/m in the frequency range from 2.0 to 2.3 GHz. Depending on the strength and duration of the interference, the interruption may occur for an extended period. A loss of connection, due to moving out-of-range, interference, or for other reasons, is indicated with a Tele Disconnected INOP.Correct channel configuration is important, refer to the Configuration Guide for details.If a Tele Disconnected INOP occurs when the telemetry device goes out-of-range, the INOP will disappear (without being silenced) as soon as the ECG signal from the telemetry device is available at the Information Center via standard telemetry transmission.Controlling Other Devices from the BedsideYou can change ECG settings for the current ECG source from the patient monitor.1Select the own patient overview window.2Select the Setup Equipm. pop-up key.A setup menu will appear with the settings available for the current ECG source. If it is a telemetry transmitter or patient monitor connected to the Information Center via LAN or WLAN, the following settings are available: adjust HR alarms, relearn arrhythmia, select primary/secondary ECG lead, select arrhythmia analysis mode, change primary/secondary ECG lead size. PIIC iX only: if the current ECG source is a patient monitor connected to the Information Center via IntelliVue Instrument Telemetry (IIT), only the adjust HR alarms setting is available.Viewing and Silencing Other Device Alarms at the BedsideWhen other devices are assigned to the patient, alarms from those devices will also be indicated on the monitor, in addition to the main indication at the Information Center.If configured, a generic alarm message will appear in the alarm status area with standard alarm tones. The alarm message will have the color and * or ! coding corresponding to the severity of the alarm. The specific alarm message (for example ** HR Low) will appear in the own patient overview window.If configured, alarms generated from another device can be silenced at the bedside. Either the monitor Silence key is configured to silence both monitor and other device alarms (must be configured at the Information Center) or the Silence Bed pop-up key will be available:1Select the own patient overview window.2Select the Silence Bed pop-up key.Depending on your Information Center configuration, the Silence Bed key may silence both other device alarms and bedside alarms.WARNINGEven when the other device data is not visible on the screen, you may be silencing monitor alarms and other device alarms, if the Information Center and monitor are so configured.
5 Managing Patients and Equipment101Switching Off or Pausing Alarms From Other DevicesWhen you select Pause Alarms or Alarms Off at the monitor, the alarms are off or paused for the bedside measurements. When you switch alarms off or pause alarms at the Information Center, both monitor alarms and alarms from other assigned devices are affected.Refer to the Information Center Instructions for Use for more details on the Suspend/Pause alarms behavior of the Information Center.Using StandbyWhen you select Standby mode at the monitor, the bedside goes into Standby mode but other assigned devices may continue monitoring.Refer to the Information Center Instructions for Use for details on how selecting Standby at the Information Center affects the monitor and other devices.ECG Source Tracking at the Information CenterThe Information Center continuously checks whether a valid ECG signal is coming from the monitor or from another assigned device. If you unplug the ECG patient cable from the monitor and plug it into another device, the Information Center will automatically switch to monitoring the ECG from the other device. At the monitor, its own ECG measurement will be deactivated and the Setup ECG menu will no longer be accessible.When you unplug the patient cable from the other device and plug it back into the monitor again, the Information Center will switch back to monitoring the ECG from the monitor. The ECG measurement will be activated again at the monitor. [Note that in this case, as the screen switches back to the monitor's own measurements, the SpO2T measurement (if present) will no longer be displayed].In the same way the source is tracked when a telemetry device is directly connected to a monitor, then disconnected and vice versa.In case of ambiguity, a yellow INOP message !!Check ECG Source indicates that more than one valid ECG source is active.Synchronized SettingsFor some measurements, settings can be synchronized between the monitor and another measurement device. For example, if ECG is measured at the monitor, and then the patient is connected to a telemetry device for monitoring, the Information Center will use the monitor settings for the telemetry device. In general, the following settings will be synchronized:Heart Rate HR/Pulse Alarm On/Off, Heart Rate High/Low LimitECG ECG On/Off1, Primary Lead, Secondary Lead, Va Lead, Vb Lead, Lead PlacementArrhythmia Analysis Mode, Arrhythmia On/Off, Asystole Threshold, Pause Threshold, VTach HR, VTach Run, PVCs/min, Vent. Rhythm, SVT HR, SVT Run, PVCs/min On/Off, Pacer not capture On/Off, Pacer not pace On/Off, Non-Sustain On/Off, Vent. Rhythm On/Off, Run PVCs On/Off, Pair PVCs On/Off, Missed Beat On/Off, Pause On/Off, R-on-T PVCs On/Off, Vent. Bigeminy On/Off, Vent. Trigeminy On/Off, Multiform PVCs On/Off, Irregular HR On/Off, SVT On/Off, Afib On/Off, Afib/IrrHR End Threshold, All ECG Alarm INOP mode.
5 Managing Patients and Equipment102PIIC iX With the IntelliVue Information Center iX, the following additional measurement settings can be synchronized:WARNING• Not all settings are synchronized; after changing the measurement source, always check that the settings are appropriate.If later the patient is disconnected from the other device, and reconnected to the monitor again, any changes in the settings made in the meantime will be passed on to the monitor. In this way, settings continuity is preserved when the measurement source changes.NOTESettings synchronization can be switched off at the monitor in Configuration mode.In certain situations, you will be asked to confirm that synchronization of settings is appropriate.Settings synchronization can only take place when there is no patient information mismatch between the monitor and the Information Center.PIIC If a Check ECG Settings or !! Check Pairing INOP appears always check that the ECG settings, especially the paced setting, are appropriate for your patient.PIIC iX If a Check ECG Settings, Chk SpO₂T Settings, or another check settings INOP appears, always check that the settings, especially the paced setting for ECG, are appropriate for your patient.ST ST Analysis On/Off, ST Alarm On/Off, ISO Point, J point, ST point, ST Alarm Limits, ST-Index On/Off, ISO/J-Point Detection, ST Lead On/Off, ST BaselineQT QT analysis On/Off, QT Lead, QTc High Alarm On/Off, ΔQTc Alarm On/Off, QTc High Limit, ΔQTc High Limit, QT Baseline2SpO2TSpO2 Alarms on/off, SpO2 Alarm limits, SpO2 Low Alarm Delay, SpO2 High Alarm Limit, Desat Alarm LimitNBP Alarm Suppression On/Off, Pulse(SpO2) On/Off1ECG On/Off setting is forced to ON by the monitor, if the local setting is ON.2With PIIC, QT baseline is synchronized, but not QT snippets.ECG/Arrhythmia Some ECG Alarms INOP On/Off, Hexad Reconstruction ModeST STE On/Off, STE Alarm On/OffNBP Sys/Dia/Mean Alarm Limits, Alarms On/ Off, Alarm SourceResp Apnea Time, Alarm Limits, Alarm On/Off, Resp On/OffSpO2SpO2 Alarms on/off, SpO2 Alarm limits, Desat Alarm Limit, NBP Alarm Suppression On/Off, Pulse(SpO2) On/Off, Measurement Mode1, Repetition Time11Measurement Mode and Repetition Time can only be synchronized if SpO2 comes from a Cableless SpO2 Pod or a telemetry device.
5 Managing Patients and Equipment103Information Center CompatibilityThe functionality available for managing patients and equipment depends on the IntelliVue Information Center being used. In the following table the main differences between the PIIC and PIIC iX are shown.PIIC PIIC iXNot available Find Patient - searching for a patient in the Information Center or other connected hospital systems. (With LAN and WLAN connection only)Transfer Patient - patient is moved to transfer list.Transfer Patient - can transfer patient directly to another bed/unit and from another bed/unit. (With LAN and WLAN connection only)Not available A unique patient list provides information about the current status of a patient allowing intelligent prompts and preventing the same patient being admitted twice.Add Equipment - allows only assignment of telemetry devices via manual pairing.Add Equipment - allows assignment of other monitors, telemetry devices and X2 MMS. (With LAN and WLAN connection only)Remove equipment - allows only removal of telemetry devices via Unpair To Mon. and Unpair To Tele.Remove equipment - allows removal of other monitors, telemetry devices and X2 MMS.Not available Select Location - allows a temporary location to be shown when a patient is not in the unit. (With LAN and WLAN connection only)Not available Select Caregiver - allows a Caregiver to be assigned to a patientNot available Paced status Unconfirmed is the initial setting before a paced status has been entered. Unconfirmed will switch pace pulse rejection on but makes the user aware that no paced status has been selected.
5 Managing Patients and Equipment104
61056ECG, Arrhythmia, ST and QT MonitoringThe electrocardiogram (ECG) measures the electrical activity of the heart and displays it on the monitor as a waveform and a numeric. This section also tells you about arrhythmia monitoring (see “About Arrhythmia Monitoring” on page 129), ST monitoring (see “About ST Monitoring” on page 139) and QT monitoring (see “About QT/QTc Interval Monitoring” on page 152).Skin Preparation for Electrode PlacementGood electrode-to-skin contact is important for a good, noise-free ECG signal, as the skin is a poor conductor of electricity.1Select sites with intact skin, without impairment of any kind.2Clip or shave hair from sites as necessary.3Wash sites thoroughly with soap and water, leaving no soap residue.We do not recommend using ether or pure alcohol, because this dries the skin and increases the resistance.4Dry skin thoroughly.Connecting ECG Cables1Attach the clips or snaps to the electrodes before placing them. If you are not using pre-gelled electrodes, apply electrode gel to the electrodes before placement.2Place the electrodes on the patient according to the lead placement you have chosen.3Attach the electrode cable to the patient cable.4Plug the patient cable into the white ECG connector. An ECG waveform and numeric appears on the monitor display.CAUTIONTo 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. Some non-authorized electrodes may be subject to large offset potentials due to polarization.
6 ECG, Arrhythmia, ST and QT Monitoring106Selecting the Primary and Secondary ECG LeadsThe monitor uses the primary and secondary lead to compute HR and to analyze and detect cardiac arrhythmias. They are also available for recordings and for display on the Information Center.The secondary lead is only used if your monitor is configured for multi-lead (instead of single-lead) arrhythmia analysis.You should choose a lead as primary or secondary lead that has the following characteristics:To select a lead as primary or secondary lead:•In the Setup ECG menu, select Primary or Secondary, then select the appropriate lead. You can assign any available lead whether it is currently displayed or not.Checking Paced ModeIt is important to set the paced mode correctly when you start monitoring ECG.• To change the paced mode in the Setup ECG menu, select Paced Mode to switch between On, Off or Unconfirm.WARNINGPace pulse rejection must be switched on for paced patients by setting Paced Mode to On. 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 mode 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.• the QRS complex should be either completely above or below the baseline and it should not be bi-phasic• the QRS complex should be tall and narrow• the P-waves and T-waves should be less than 0.2 mV
6 ECG, Arrhythmia, ST and QT Monitoring107Understanding the ECG DisplayYour display may be configured to look slightly different.1Lead label of the displayed wave2ECG Filter label31 mV calibration bar4Pacer spikes5Pace pulse markers6Current heart rate7Current heart rate alarm limits and paced mode symbol8EASI or Hexad lead placement labelECG HR numeric: This is the heart rate derived from the monitored ECG.Pace pulse markers: These are shown if the Paced Mode status has been set to On, 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.Synchronization pulse marks: When a cable is connected to the ECG sync pulse output connector, and the synchronization pulse is configured to be shown, the synchronization marks appear as vertical lines 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.Hexad lead placement label: When 6-lead placement for a Hexad derived 12-lead ECG is used, the Hexad lead placement label is displayed and all derived leads are marked with a "d" in front of the lead label, for example dV1.1Pacer spikes configured to have a fixed size1Synchronization marks in yellow
6 ECG, Arrhythmia, ST and QT Monitoring108Monitoring Paced PatientsAn ECG optimized for monitoring a paced patient should look like this:You should choose a lead as primary or secondary lead that has these characteristics:• the normal QRS complex should be either completely above or below the baseline and it should not be bi-phasic. 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 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 StatusIn the Setup ECG menu, select Paced Mode to switch between On, Off or Unconfirm.You can also change the paced mode in the Patient Demographics window.1Normal Beats2Pace Pulses/Pace BeatsWhen Paced Mode is set to On:– 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 under the HR label.When Paced Mode is set to Off, 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.When the paced mode has not yet been set for a patient, the paced symbol will have a question mark indicating the Unconfirm mode. When the paced mode is Unconfirm, pace pulse rejection is switched on.Paced Mode OnPaced Mode OffPaced Mode Unconfirmed
6 ECG, Arrhythmia, ST and QT Monitoring109Avoiding Pace Pulse Repolarization TailsSome unipolar pacemakers display pace pulses with repolarization tails. These tails may be counted as QRSs in the event of cardiac arrest or other arrhythmias.If you note a visible repolarization tail, choose a lead that decreases the size of the repolarization tail.Changing the Size of the ECG WaveIf any of the displayed ECG waves is too small or clipped, you can change the size of one or all of the ECG waves on the screen.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 Wave1Select the wave segment you want to change. This calls up the lead menu for this segment.2In the lead menu, select Size Up to increase wave size or Size Down to decrease the size.Selecting Auto Size lets the monitor choose the optimal adjustment factor for all available ECG waves.To Change the Size of all the ECG WavesTo change the size of all the ECG waves on the screen by a fixed adjustment factor,1In the Setup ECG menu, select Adjust Size.2Select the required adjustment factor from the line of pop-up keys.–Size x0.5 to halve the wave size–Size x1 to display the wave without zoom–Size x2 to double the wave size–Size x4 to multiply the wave size by four1Repolarization tail (note width)
6 ECG, Arrhythmia, ST and QT Monitoring110Changing the Volume of the QRS ToneThe QRS tone is derived from either the HR or Pulse, depending on which is currently selected as the alarm source. The QRS volume can be set from 0 to 10 (0 means off).To change the QRS volume, in the Setup ECG menu select QRS Volume and then select the appropriate volume from the pop-up list.Changing the ECG Filter SettingsThe ECG filter setting defines how ECG waves are smoothed. An abbreviation indicating the filter type is shown underneath the lead label on the monitor display. Filter settings do not affect ST measurement.To change the filter setting, in the Setup ECG menu, select Filter and then select the appropriate setting.–Monitor: Use under normal measurement conditions.–Ext. Monitor: Use when diagnostic quality is required but low frequency interference or a wandering baseline may be expected. The upper edge frequency is the same as the Diag setting and the lower edge frequency is the same as the Monitor setting.–Filter: The filter reduces interference to the signal. It should be used if the signal is distorted by high frequency or low frequency interference. High frequency interference usually results in large amplitude spikes making the ECG signal look irregular. Low frequency interference 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.When you are using a telemetry transmitter connected via short range radio to the monitor, the upper bandwidth for all filter settings is limited to 40 Hz.Choosing EASI or Standard Lead PlacementYou must enable either standard lead placement or EASI lead placement.•In the Setup ECG menu, select Placement and then Standard or EASI.EASI is shown beside the 1mV calibration bar on the ECG wave on the display, and EASI is marked on any printouts.See the section on “EASI ECG Lead Placement” on page 122 for electrode placement diagrams.
6 ECG, Arrhythmia, ST and QT Monitoring111Selecting Positions of Va and Vb Chest Leads (for 6-lead placement)6-lead PlacementThe two chest leads for the 6-lead placement can be positioned at any two of the V1 to V9 and V3R to V6R 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.6-Lead Placement for Hexad Derived 12-leadThe Hexad ECG lead system uses a 6-lead set connected to four limb electrodes (using Mason-Likar placement) and two chest electrodes. The algorithm derives the four remaining V-leads to provide a non-diagnostic 12-lead view, including ECG waves and ST/QT measurements.The two chest leads for the 6-lead placement for Hexad must be positioned at two of the V1 to V6 positions. The following combinations of positions can be used:Select the two leads you have used in the Setup ECG menu:1In the Setup ECG menu, select Hexad (Va,Vb).2Select the correct combination of V-lead positions from the list.Making the selection switches the Hexad derived 12-lead ECG on.The Hexad derived 12-lead ECG is intended for use with adult patients only. For this reason, the Hexad (Va,Vb) selection will not be available in neonatal and pediatric modes.About ECG LeadsTo make it possible to compare measured ECG signals, the electrodes (or lead sets) are placed in standardized positions, forming so-called "leads". To obtain ECG signals optimized for use in diagnosis and patient management in different care environments, different lead sets in varying lead placements can be used. You can use either standard lead placements or EASI lead placements with this monitor.When placing electrodes, choose a flat, non-muscular site where the signal will not be interfered with by either movement or bones. Correct lead placement is always important for accurate diagnosis. Especially in the precordial leads, which are close to the heart, QRS morphology can be greatly altered if an electrode is moved away from its correct location.• V1 and V3 • V2 and V5• V1 and V4 • V3 and V5• V1 and V5 • V3 and V6•V2 and V4
6 ECG, Arrhythmia, ST and QT Monitoring112ECG Leads MonitoredChanging Lead SetsTo change the ECG lead set,•When adding leads: place the additional electrodes as required - the monitor automatically recognizes the new lead placement.•When removing leads: there are two possibilities - removing the complete chest leads block or removing individual leads. If you unplug the chest lead block from the trunk cable connector, the monitor will automatically recognize the new lead placement. Remove individual leads by removing the electrodes. The monitor will issue a Lead Off INOP message; select New Lead Setup in the Setup ECG menu and the INOP message will disappear.ECG Lead FallbackIf fallback is configured on and there is a leads off INOP in the primary lead (and in the secondary lead, if you are using multi-lead monitoring) for longer than 10 seconds, and if another lead is available, this available lead automatically becomes the primary lead. This is known as lead fallback. When the Leads Off condition is corrected, the leads are automatically switched back.This setting can only be changed in Configuration Mode.ECG Lead PlacementsThe labels and colors of the ECG electrodes differ according to the standards that apply for your hospital. The electrode placement illustrations in this chapter use the AAMI labels and colors.If you are using these leads are available:a 3-electrode set I, II, IIIa 5-electrode set I, II, III, aVR, aVL, aVF, V, MCL, Vaa 6-electrode set I, II, III, aVR, aVL, aVF, Va, Vba 6-electrode set with the Hexad algorithmI, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6Two V leads are directly measured and four are derived.a 10-electrode set I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6an EASI 5-electrode set I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6Electrode labels Electrode colorsAAMI EASI IEC AAMI IECRA I R White RedLA S L Black YellowLL A F Red GreenRL N N Green BlackVECBrown WhiteV1/Va C1/Ca Brown/Red White/RedV2/Vb C2/Cb Brown/Yellow White/YellowV3 C3 Brown/Green White/Green
6 ECG, Arrhythmia, ST and QT Monitoring113Standard 3-Lead PlacementStandard 5-Lead PlacementV4 C4 Brown/Blue White/BrownV5 C5 Brown/Orange White/BlackV6 C6 Brown/Violet White/VioletElectrode labels Electrode colorsAAMI EASI IEC AAMI IEC1RA placement: directly below the clavicle and near the right shoulder2LA placement: directly below the clavicle and near the left shoulder3LL placement: on the left lower abdomen1RA placement: directly below the clavicle and near the right shoulder2LA placement: directly below the clavicle and near the left shoulder3RL placement: on the right lower abdomen4LL placement: on the left lower abdomen5V placement: on the chest, the position depends on your required lead selection. If configured, the label of the chest lead will be displayed with its exact position (V1 to V6R)
6 ECG, Arrhythmia, ST and QT Monitoring114Standard 6-Lead PlacementUse 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 V9 or V3R to V6R positions shown in the chest electrode diagram below (see “Chest Electrode Placement” on page 115).The Va and Vb lead positions chosen must be selected in the Setup ECG Menu.Hexad 6-Lead PlacementUse the positions from the 5-lead diagram above but with two chest leads. For Hexad derived 12-lead, the two chest leads, Va and Vb, must be positioned at two of the V1 to V6 positions shown in the chest electrode diagram below (see “Chest Electrode Placement” on page 115). The following combinations of positions can be used:The Va and Vb lead positions chosen must be selected in the Setup ECG Menu.When Hexad lead placement is selected, Hexad is shown beside the 1 mV calibration bar on the ECG wave and all derived leads are marked with a "d" in front of the lead label, for example dV1.WARNINGHexad derived 12-lead ECGs and their measurements are approximations to conventional 12-lead ECGs. They should not be used for diagnostic interpretations.• V1 and V3 • V2 and V5• V1 and V4 • V3 and V5• V1 and V5 • V3 and V6•V2 and V4
6 ECG, Arrhythmia, ST and QT Monitoring115Chest Electrode PlacementFor accurate chest electrode placement and measurement, it is important to locate the fourth intercostal space.1Locate the second intercostal space by first palpating the Angle of Louis (the little bony protuberance where the body of the sternum joins the manubrium). This rise in the sternum is where the second rib is attached, and the space just below this is the second intercostal space.2Palpate and count down the chest until you locate the fourth intercostal space.10-Lead PlacementWhen monitoring 12-leads of ECG, using a 10-Electrode Lead Placement, it is important to correctly place electrodes and to label all 12-lead ECG reports with the correct lead placement.V1 on the fourth intercostal space at the right sternal borderV2 on the fourth intercostal space at the left sternal borderV3 midway between the V2 and V4 electrode positionsV4 on the fifth intercostal space at the left midclavicular lineV5 on the left anterior axillary line, horizontal with the V4 electrode positionV6 on the left midaxillary line, horizontal with the V4 electrode positionV3R -V6R on the right side of the chest in positions corresponding to those on the leftVE over the xiphoid processV7 on posterior chest at the left posterior axillary line in the fifth intercostal spaceV7R on posterior chest at the right posterior axillary line in the fifth intercostal spaceV8 posterior lead, level with V7 at the left midscapular lineV9 posterior lead, level with V7 at the left spinal border. A - Angle of Louis
6 ECG, Arrhythmia, ST and QT Monitoring116Conventional 12-Lead ECGIn conventional 12-Lead ECG using 10 electrodes, an electrode is placed on the right arm, left arm, right leg, and left leg. Six V- electrodes are placed on the chest. The right leg electrode is the reference electrode.Limb electrodes:– Place arm electrodes on the inside of each arm, between the wrist and the elbow.– Place leg electrodes inside of each calf, between the knee and the ankle.Chest electrodes:V1 - on the 4th intercostal space at the right sternal borderV2 - on the 4th intercostal space at the left sternal borderV3 - midway between the V2 and V4 electrode positionsV4 - on the 5th intercostal space at the left midclavicular lineV5 - on the left anterior axillary line, horizontal with the V4 electrode positionV6 - on the left midaxillary line, horizontal with the V4 electrode position1V1 - V62LA3RA4RL5LL
6 ECG, Arrhythmia, ST and QT Monitoring117Modified 12-Lead ECGIf your institution uses modified 10-lead ECG electrode placement (the Mason-Likar Lead System), place the four limb electrodes close to the shoulders and lower abdomen.The six V electrodes are placed on the chest in the same position as the conventional 12-lead placement.Choosing Standard or Modified Electrode PlacementWARNINGDo 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.If your institution uses modified 10 Lead ECG electrode placement (the Mason-Likar Lead System), you must set Limb Leads to on Trunk in the monitor.To do this, in the Setup ECG menu, select Limb Leads then select on Trunk.– When Limb Leads is set to on Trunk, 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 Limb Leads is set to on Limbs, 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.1LA2V1-V63LL4RL5RA6Angle of Louis
6 ECG, Arrhythmia, ST and QT Monitoring118WARNINGDo 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.WARNINGDo not use ECG analysis interpretation statements and measurements for 12-lead ECGs obtained using the modified (Mason-Likar) limb electrode placement. This may lead to misdiagnosis since the modified (Mason-Likar) limb electrode placement does not look the same as the conventional 12-lead ECG and may mask inferior infarction due to calculated axis, R, P and T wave magnitudes shifts and ST slope.Do not export 12-lead ECGs obtained using the modified (Mason-Likar) limb electrode placement. Captured 12-Lead ECGs using the modified (Mason-Likar) limb electrode placement exported from the Information Center are not annotated with the Mason-Likar label.Capture 12-LeadYou can view a 12-Lead ECG on the screen, capture a 12-Lead ECG episode, preview the captured ECG data and then store it and send it to a connected Information Center for analysis. You can download the resulting analysis from the Information Center and also other 12-Lead captures for review at the monitor. A 12-Lead report can be printed that also includes the downloaded analysis results and an ST Map. You can operate the 12-Lead Export function and the 12-Lead Lock/Unlock function at the Information Center remotely from the monitor.The monitor can store one 12-Lead ECG episode at any time.Viewing the Realtime 12-Lead ECGTo open the 12-Lead ECG window and view the realtime ECG waves,• Select the Capture 12 Lead SmartKey, or • Select the Main Setup SmartKey then select 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:
6 ECG, Arrhythmia, ST and QT Monitoring1191Select 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.If you are using the Hexad lead placement, you can select the Setup Leads pop-up key to select the positions of the chest leads (Va and Vb or Ca and Cb).While the realtime 12-Lead waves are being viewed in the window, the ECG filter mode (see “Changing the ECG Filter Settings” on page 110) is changed to the 12-Lead filter setting (see “Changing Settings for a Captured 12-Lead ECG” on page 119).Capturing the 12-Lead ECGTo capture the last 10 seconds of ECG data, select the Capture Waves pop-up key. The pop-up key is active as soon as enough wave data is available; until then a progress bar is displayed in the title bar of the pop-up keys. A preview of the captured data appears on the screen (unless your monitor is connected to an Information Center with software release earlier than Revision M — then the captured data is automatically stored and sent to the Information Center).The title bar of the pop-up keys will now show the current filter setting and, if you are using EASI or Hexad lead placement, an EASI or Hexad indicator will appear at the bottom of the captured data.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 Review 12 Lead pop-up key and then selecting the 12-Lead marked with * from the list.Changing Settings for a Captured 12-Lead ECGSelect 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. The changes are only applied temporarily and will not be stored. If you want to change the default settings, see “Setting Up the 12-Lead ECG” on page 122.High Pass Filter Sets the high pass filter for the waveforms.Choices are 0.05 Hz, 0.15 Hz and 0.5 Hz.Low Pass Filter Sets the low pass filter for the waveforms.Choices are 40 Hz, 100 Hz and 150 Hz.AC Filter Switches the AC (line frequency) filter On or Off.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.Limb Leads Sets the position of the limb leads.Choices are on Limbs and on Trunk.
6 ECG, Arrhythmia, ST and QT Monitoring120Storing and Sending the 12-Lead ECGYou can assign an order number that will then be associated and stored with the 12-Lead ECG.If you have an Information Center connected, it may provide order management, in which case an Order (xx) pop-up key is displayed. This opens the order window from the Information Center, showing a list of any pending 12-lead orders for the patient. In this window you can assign and remove orders, in the same way as you would do directly at the Information Center.If no Information Center is connected, you can enter an order number manually. Select the Enter Order # pop-up key and type in the number. The order number will be stored with the capture and displayed in the title bar of the pop-up keys.To store the previewed data on the monitor and send it to a connected Information Center for storage and analysis, select the Store & Send pop-up key.If the monitor is connected to an Information Center, use the Store & Send function before patient transport to store the 12-Lead ECG centrally, as the 12-Lead ECG data will not be uploaded from the MMS to another monitor after transport.If the connection to the Information Center is not active while storing, the 12-Lead ECG will be automatically sent as soon as the connection is established or restored. If a previously stored 12-Lead ECG is waiting to be sent to the Information Center, it will be overwritten when a new 12-Lead ECG is stored and can then not be sent to the Information Center.Printing the 12-Lead ECGPrint a dedicated 12-Lead ECG report by selecting the Print Report pop-up key.When you are working with a PIIC iX that provides 12-Lead analysis data to the monitor, the report contains the 12-Lead analysis results as well as measurement values (e.g. ST values, QT values, HR) that are also downloaded from the PIIC iX.If you work with a PIIC, or a PIIC iX without the necessary license, no 12-Lead analysis data is provided to the monitor. In this case, the report only contains the real-time measurement values from the bedside.Consequently, the measurement values in the report might differ in the two cases, due to the slightly different algorithm approaches of the patient monitor (real-time measurement) and the PIIC iX (diagnostic interpretation of 12-Lead capture).Format Defines the page layout.Choices are 12x1, 6x2, 3x4, 3x4 1R, 3x4 3R,3x4 ST and 3x4 1R ST. 1R and 3R refer to 1 or 3 rhythm leads, ST formats contain an ST map.Time Defines whether all leads show simultaneous or sequential intervals of time, when displaying or printing 2 or more columns.Choices are Sequential and Simultaneous.Rhythm Lead 1Rhythm Lead 2Rhythm Lead 3Defines which lead will be used as rhythm lead 1, 2 or 3.Choices are Primary, Secondary, I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6, V7, V8, V9, V3R, V4R, V5R, V6R, and MCL.This setting is only relevant when 3x4 1R, 3x4 1R ST or 3x4 3R is selected as Format.Lead Sequence Defines the sequence in which the leads are presented.Choices are Cabrera and Internat.
6 ECG, Arrhythmia, ST and QT Monitoring121Downloading Analysis Results (PIIC iX only)Download analysis results from the IntelliVue Information Center by selecting Show Analysis. Return to the previous screen by selecting Hide Analysis.Reviewing Previewed or Stored 12-Lead CapturesTo view 12-Lead captures previewed or stored on the monitor or 12-Lead captures stored at the IntelliVue Information Center (PIIC iX only), select Review 12 Lead. You can then select from a list of 12-Lead captures available for the current patient.The 12-Lead captures in the list may be marked with a symbol, for example an open or closed padlock to indicate unlocked or locked status or a * to indicate preview status.Information Center Remote Export (PIIC iX only)Use the Export key to remotely start the 12-Lead export functionality of the IntelliVue Information Center.Information Center Remote Lock/Unlock (PIIC iX only)Use the Lock key to remotely lock the 12-Lead capture at the IntelliVue Information Center. If it is already locked, the Unlock key will be displayed.Capture 12-Lead Pop-up KeysHere is a summary of all the pop-up keys available during the 12-Lead ECG procedure:Pop-up Keys Selecting this pop-up key lets youAdmit Patient enter the age and gender for the patient, 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.Setup 12 Lead choose settings for filter, gain, display layout, etc.Order (xx) open the order window from the Information Center (if available) and assign order numbers to 12-Lead captures.Enter Order # 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.Review 12 Lead view a list of 12-Lead captures available at the monitor or at the IntelliVue Information Center, and select one for review.Show Analysis download analysis results from the IntelliVue Information Center.Export remotely export 12-Lead ECG data from the IntelliVue Information Center to an ECG management system (see the Information Center Instructions for Use for details).
6 ECG, Arrhythmia, ST and QT Monitoring122Setting Up the 12-Lead ECGYou can make settings that will be stored and used in future as default settings for each 12-Lead ECG capture made.1Select the HR numerics on the screen to enter Setup ECG.2Select 12Lead.3The Setup 12 Lead window opens for you to make the default settings.For a description of the available settings, see “Changing Settings for a Captured 12-Lead ECG” on page 119.EASI ECG Lead PlacementUsing a standard 5-electrode set in EASI lead placement you can monitor up to 12 standard ECG leads simultaneously and continuously at the bedside. EASI provides a monitoring method for trending ST segment changes that can provide an early indication of ischemia.WARNINGEASI-derived 12-lead ECGs and their measurements are approximations to conventional 12-lead ECGs. As the 12-lead ECG derived with EASI is not exactly identical to the 12-lead conventional ECG obtained from an electrocardiograph, it should not be used for diagnostic interpretations.Respiratory monitoring is also possible with the EASI placement; respiration is measured between the I and A electrodes.Place the electrodes as accurately as possible to obtain the best quality EASI measurements.When EASI lead placement is selected, EASI is shown beside the 1 mV calibration bar on the ECG wave on the display, and EASI is marked on any recorder strips and printouts.EASI Monitoring During INOP ConditionsIf one of the derived EASI leads has an INOP condition (for example, Lead Off), a flat line is displayed. After 10 seconds, the directly acquired EASI AI, AS, or ES lead (depending on which is available) is displayed with the corresponding lead label. This causes an arrhythmia relearn.Lock / Unlock remotely lock/unlock the 12-Lead capture at the IntelliVue Information Center.Setup Leads switch between Standard and EASI lead placement and select the positions of the chest leads (Va and Vb or Ca and Cb), when using Hexad lead placement.Pop-up Keys Selecting this pop-up key lets you
6 ECG, Arrhythmia, ST and QT Monitoring123EASI Electrode PlacementECG and Arrhythmia Alarm OverviewThe ECG and arrhythmia alarms available depend on which measurements are switched on, and the arrhythmia option enabled for your monitor.• Cardiotach alarms are available when HR is on and the active alarm source is ECG, but Arrhythmia is switched off• Basic arrhythmia alarms are available when Arrhythmia is switched on• Enhanced arrhythmia alarms are available when Arrhythmia is switched on and the Enhanced Arrhythmia option has been enabled for your monitor1E (V) - on the lower sternum at the level of the fifth intercostal space2A (LL) - on the left midaxillary line at the same level as the E electrode3S (LA) - on the upper sternum4I (RA) - on the right midaxillary line at the same level as the E electrode5N - reference electrode - can be anywhere, usually below the sixth rib on the right hipAlarm Description Arrhythmia ConfigurationArrhythmia OffBasic ArrhythmiaEnhanced Arrhythmia*** Asystole No beat detected for a period > the asystole threshold (2.5 to 4.0 seconds)xxx*** Vent Fib/Tach Fibrillatory wave (sinusoidal wave between 2 - 10 Hz) for 4 consecutive secondsxxx*** VTach A run of consecutive beats labeled as V with run length ≥ the V-Tach Run limit and ventricular HR > V-Tach HR limitxx*** Extreme Tachy Heart Rate > the Extreme Tachy limit x x x*** Extreme Brady Heart Rate < the Extreme Brady limit x x x** HR High Heart rate > the high HR limit x x(see note)x(see note)
6 ECG, Arrhythmia, ST and QT Monitoring124** HR Low Heart rate < the low HR limit x x(see note)x(see note)** Non-Sustain VT A run of consecutive beats labeled as V with run length < the V-Tach Run Limit and ventricular HR > the V-Tach HR limitx** Vent Rhythm A run of consecutive beats labeled as V with run length > the Vent rhythm limit and ventricular HR ≤ the V-Tach HR limitx** Run PVCs High A run of > 2 consecutive beats labeled as V with run length < Vent rhythm run limit and ventricular HR ≤V-Tach HR limit x** Pair PVCs Two ventricular beats labeled as V between two beats not labeled as Vx** R-on-T PVCs For HR < 100, a beat labeled as V with R-R interval < 1/3 of the average R-R interval followed by a compensatory pause > 1.25 times the average R-R interval or 2 such beats labeled as V without a compensatory pause occurring within 5 minutes of each other (Note: When HR > 100, 1/3 of the R-R interval is too short for detection)x** Vent Bigeminy A dominant rhythm of beats labeled as N, V, N, V, Nx** Vent Trigeminy A dominant rhythm of beats labeled as N, N, V, N, N, V, N, Nx** PVCs/min High Within 1 minute, the number of beats labeled as V > the PVCs/min limitxx** Multiform PVCs The occurrence of two differently shaped beats labeled as V within the last 60 beats and each occurring at least twice within the last 300 beatsx** Pause No beat detected for a period > the pause alarm threshold (1.5 to 2.5 seconds)x** Missed Beat No beat detected for a period > 1.75 times the average R-R interval for HR < 120, or no beat detected for > 1 second with HR > 120 (Paced mode off)xAlarm Description Arrhythmia ConfigurationArrhythmia OffBasic ArrhythmiaEnhanced Arrhythmia
6 ECG, Arrhythmia, ST and QT Monitoring125Note: ** HR Low and ** HR High are available only if HR alarms are configured as yellow alarms, and ** HR Low and * HR High are available only if HR alarms are configured as short yellow alarms.Using ECG AlarmsECG alarms can be switched on and off and the high and low alarm limits changed just like other measurement alarms, as described in the “Alarms” chapter. Special alarm features which apply only to ECG are described here.Extreme Alarm Limits for Heart RateThe extreme rate alarms, extreme tachycardia and extreme bradycardia, are generated by the active alarm source, either HR or Pulse.The difference between the low HR alarm limit and the extreme bradycardia limit is unit configured. For example, if the low alarm limit is 60 bpm and the extreme bradycardia limit difference is configured to be 20 bpm, then the extreme bradycardia limit is 40 bpm. If the difference is configured to be 0, there will always be an extreme bradycardia alarm when the HR falls below the HR low limit.** Pacer Not Capt No beat detected for a period > 1.75 times the average R-R interval and pace pulse(s) detected. (Paced mode on)xx**Pacer Not Pacing No beat detected for a period > 1.75 times the average R-R interval and no pace pulse(s) detected (Paced mode on)xx** SVT A run of consecutive beats labeled as S with run length ≥ SVT run limit and ventricular HR > SVT HR limitx* HR High Heart rate > the high HR limit x(see note)x(see note)* HR Low Heart rate < the low HR limit x(see note)x(see note)* AFIB An irregular rhythm of beats labeled as N and variability in P-R intervals and P-wave variability (For adult patient category only)x* End AFIB Atrial Fibrillation no longer detected for the Afib end delay time (For adult patient category only)x** Irregular HR An irregular rhythm of beats labeled as N (irregular R-R intervals changes greater than 12.5%)x* End Irregular HR Irregular HR rhythm no longer detected for the irregular HR end delay timexAlarm Description Arrhythmia ConfigurationArrhythmia OffBasic ArrhythmiaEnhanced Arrhythmia
6 ECG, Arrhythmia, ST and QT Monitoring126The same is true for the difference between the high HR alarm limit and the extreme tachycardia limit. In the same way, the extreme tachycardia limit is determined by adding a difference to the high HR limit.The difference is set in Configuration Mode. You need to know which value has been configured for your monitor. To see the difference value for the extreme rate alarms on your monitor, in the Setup ECG menu, see the menu items Δ ExtrTachy and Δ ExtrBrady.For safety, the extreme bradycardia and extreme tachycardia limits clamp at a configured value. For example, the extreme bradycardia limit for neonates has a default limit clamp at 70 bpm. Thus if the HR low alarm limit is moved to 80 bpm and the extreme bradycardia limit difference is 20 bpm, the extreme bradycardia limit will be 70 bpm. However, if you move the HR low alarm limit below the clamp to 65 bpm, the extreme bradycardia limit will also be 65 bpm and only the extreme bradycardia alarm will occur if the HR falls below this limit.You can view the current limits for the extreme rate alarms, Extreme Tachy and Extreme Brady, in the measurement's alarm limits window:1Select one of the alarm fields.2Select the Alarm Limits pop-up key.3Select HR.The alarm limit window for HR is shown, with the high and low limits and the Extreme Tachy and Extreme Brady limits.ECG Alarms Off DisabledBe aware that your hospital department may have decided to disable the Alarms Off setting for ECG in the monitor's Configuration Mode. In this case, HR alarms cannot be switched off in Monitoring Mode. If you try to switch off the HR alarms, you will see the message To activate enter Config and enable Alarms Off.1Extreme Brady Limit2Low Limit3High Limit4Extreme Tachy Limit5Δ Extreme Brady6Δ Extreme Tachy1High and low alarm limits2Extreme Tachy and Extreme Brady limits
6 ECG, Arrhythmia, ST and QT Monitoring127HR Alarms When Arrhythmia Analysis is Switched OffWhen arrhythmia analysis is switched off, only these HR-related alarms will be detected:• the asystole alarm• the ventricular fibrillation/tachycardia alarm• the extreme tachycardia and extreme bradycardia alarms• the high heart rate and low heart rate alarms.Enhanced Asystole DetectionIn order to improve alarming on asystole under certain conditions, you can set Asystole Detect. in Configuration Mode to Enhanced. In enhanced mode an asystole alarm will be suppressed for up to five seconds if a valid beat-to-beat Pulse is detected from an arterial Pressure.ECG Safety InformationCAUTIONInterference from instruments near the patient and ESU interference can cause problems with the ECG wave. See the monitor specifications for more information.WARNINGDefibrillation and Electrosurgery:Do not touch the patient, or table, or instruments, during defibrillation.After defibrillation, the screen display recovers within 10 seconds if the correct electrodes are used and applied in accordance with the manufacturers instructions.ECG cables can be damaged when connected to a patient during defibrillation. Check cables for functionality before using them again.According to AAMI specifications the peak of the synchronized defibrillator discharge should be delivered within 60 ms of the peak of the R wave. The signal at the ECG output on the IntelliVue patient monitors is delayed by a maximum of 30 ms. Your biomedical engineer should verify that your ECG/Defibrillator combination does not exceed the recommended maximum delay of 60 ms.When using electrosurgical (ES) equipment, never place ECG electrodes near to the grounding plate of the ES device, as this can cause a lot of interference on the ECG signal.General:When you are connecting the electrodes or the patient cable, make sure that the connectors never come into contact with other conductive parts, or with earth. In particular, make sure that all of the ECG electrodes are attached to the patient, to prevent them from contacting conductive parts or earth.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.
6 ECG, Arrhythmia, ST and QT Monitoring128Pacemaker 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:Fusion beats, beats with pace pulse on top of the QRS complex, may not 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.Line isolation monitor transients:When electrodes or lead wires are loose or detached, the monitor becomes susceptible to switching transients from some types of line isolation monitors. Line isolation monitor transients may resemble actual cardiac waveforms and thus inhibit heart rate alarms. To minimize the chance of this occurring, always adhere to the instructions for skin preparation and electrode placement given in this chapter.
6 ECG, Arrhythmia, ST and QT Monitoring129About Arrhythmia MonitoringArrhythmia analysis provides information on your patient's condition, including heart rate, PVC rate, rhythm, and ectopics. The monitor uses the user-selected primary and secondary ECG leads for single-lead or multi-lead arrhythmia analysis. During arrhythmia analysis, the monitor continuously:• optimizes ECG signal quality. This is important for arrhythmia analysis. The monitor continuously filters the ECG signal to remove baseline wander, muscle artifact, and signal irregularities. Also, if the Patient Paced status is set to Yes, pace pulses are filtered out to avoid processing them as QRS beats.• detects beats, for example, QRS complexes, identifying them for further analysis.• measures signal features such as R-wave height, width, and timing.• creates beat templates, and classifies and labels beats to aid in rhythm analysis and alarm detection.• examines the ECG signal for ventricular fibrillation, asystole, and noise.Arrhythmia OptionsYour monitor has either the basic or the enhanced arrhythmia option. Both options provide rhythm and ectopic status messages and beat labeling. The number of rhythms being classified, events being detected, and alarms generated differs according to the option. The alarms available with the different options are listed in the section “ECG and Arrhythmia Alarm Overview” on page 123, the rhythm and ectopic messages detected are listed in “Arrhythmia Status Messages” on page 132.Where Can I Find More Information?See the Application Notes on ST and Arrhythmia supplied on your documentation DVD for detailed information on the arrhythmia algorithm and its clinical application.Switching Arrhythmia Analysis On and Off1In the Setup Arrhy menu, select Arrhythmia to switch between On and Cardiotach.2Select the Confirm pop-up key which appears at the bottom of the screen.Be aware that when arrhythmia analysis is switched to Cardiotach mode,– the message Cardiotach Mode appears beside the ECG wave, if configured to do so– only the HR-related alarms are detected (the asystole alarm, the ventricular fibrillation/tachycardia alarm, the extreme tachycardia and extreme bradycardia alarms, the high heart rate and low heart rate alarms)– HR High and HR Low alarms behave like normal yellow alarms, no timeout periods are active.Choosing an ECG Lead for Arrhythmia MonitoringIt is important to select a suitable lead for arrhythmia monitoring.Guidelines for non-paced patients are:– QRS complex should be tall and narrow (recommended amplitude > 0.5 mV)– R-Wave should be above or below the baseline (but not bi-phasic)– T-wave should be smaller than 1/3 R-wave height– the P-wave should be smaller than 1/5 R-wave height.
6 ECG, Arrhythmia, ST and QT Monitoring130For 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 repolarization.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 IEC 60601-2-27 and AAMI-EC 13 specifications. Adjusting the ECG wave size on the monitor display (gain adjustment) does not affect the ECG signal which is used for arrhythmia analysis. If the ECG signal is too small, you may get false alarms for pause or asystole.Aberrantly-Conducted BeatsAs P-waves are not analyzed, it is difficult and sometimes impossible for the monitor to distinguish between an aberrantly-conducted supraventricular beat and a ventricular beat. If the aberrant beat resembles a ventricular beat, it is classified as ventricular. You should always select a lead where the aberrantly-conducted beats have an R-wave that is as narrow as possible to minimize incorrect calls. Ventricular beats should look different from these 'normal beats'. Instead of trying to select two leads with a narrow R-wave, it may be easier to just select one lead and use single lead arrhythmia monitoring. Extra vigilance is required by the clinician for this type of patient.Atrial Fibrillation AlarmThe monitor performs atrial fibrillation analysis using information about the R-R irregularity, P-R interval variability and P wave variability.In order to generate an Afib alarm the following criteria must be detected for 1 minute:• normal beat R-R intervals must be irregular• P-R interval deviation must be large• P-wave region must not match wellAtrial fibrillation analysis is only available for adult patients and atrial fibrillation detection cannot be performed on PVCs or Paced beats.An * End AFIB alarm will occur when no atrial fibrillation waveform was detected for a configured delay time.Since most atrial flutters have regular R-R intervals, they cannot be detected by the atrial fibrillation algorithm.An * AFIB 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 and * End AFIB alarms 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.
6 ECG, Arrhythmia, ST and QT Monitoring131Intermittent Bundle Branch BlockBundle branch and the other fascicular blocks create a challenge for the arrhythmia algorithm. If the QRS during the block changes considerably from the learned normal, the blocked beat may be incorrectly classified as ventricular, causing false PVC alarms. You should always select a lead where the bundle branch block beats have an R-wave that is as narrow as possible to minimize incorrect calls. Ventricular beats should look different from these 'normal beats'. Instead of trying to select two leads with a narrow R-wave, it may be easier to just select one lead and use single lead arrhythmia monitoring. Extra vigilance is required by the clinician for this type of patient.Understanding the Arrhythmia DisplayYour monitor screen may look slightly different from the illustration.1Beat label2Pace pulse marks3Rhythm status message4PVC Numeric5HR Numeric6Ectopic status message7Delayed arrhythmia waveViewing Arrhythmia WavesTo review arrhythmia beat labels, in the Setup Arrhy menu, select Annotate Arrhy.The wave showing the primary ECG lead will be delayed by six seconds and shown on a gray background. Beat labels will be annotated above the ECG wave and Delayed will be written beside it.To return to the normal ECG primary lead display, select Annotate Arrhy again.Arrhythmia Beat LabelsArrhythmia beat labels tell you how the monitor is classifying beats.Beat LabelArrhythmia OnBeat Classification Beat LabelCardiotach ModeNNormal BVVentricular Ectopic BSSupra-ventricular Premature BPPaced B
6 ECG, Arrhythmia, ST and QT Monitoring132Arrhythmia Status MessagesThe monitor displays two types of status messages:• Rhythm Status Messages -- to indicate the patient's rhythm.• Ectopic Status Messages -- to indicate the presence of ectopic beats.These status messages are shown on the right hand side of the primary ECG wave. They are updated every second, with the exception of the Sinus and Supraventricular (SV) rhythm messages.The Sinus and SV rhythm messages are updated based on the current heart rate, taking into account the patient category (adult, pediatric, or neonatal). For the message to change from one rhythm status to another, the HR must be in the new range for five beats.If you have basic arrhythmia capability, you will get only messages for the alarms provided with this level.Rhythm Status MessagesThe label B or E indicates basic (B) or enhanced (E) arrhythmia capability.'Pacer Spike '"Biventricular Pacer Spike "LLearning patient's ECG LAArtifact (noisy episode) A?Insufficient information to classify beats ?IInoperative condition (e.g., Leads Off) IMPause or missed beat Not applicableBeat LabelArrhythmia OnBeat Classification Beat LabelCardiotach ModeRhythm Status Message Description B or EAsystole No beat detected for a period > the asystole threshold (2.5 - 4.0 seconds)B, EVent Fib/Tach Fibrillatory wave (sinusoidal wave between 2 - 10 Hz) for 4 consecutive secondsB, EVTach A run of consecutive beats labeled as V with run length ≥ the V-Tach Run limit and ventricular HR > V-Tach HR limitB, ESustained VT Ventricular tachycardia rhythm for more than 15 seconds EVent Rhythm A run of consecutive beats labeled as V with run length > the Vent rhythm limit and ventricular HR ≤ the V-Tach HR limitEVent Bigeminy A dominant rhythm of beats labeled as N, V, N, V, N EVent Trigeminy A dominant rhythm of beats labeled as N, N, V, N, N, V, N, NEPaced Rhythm A dominant rhythm of beats labeled as P B, EIrregular HR Consistently irregular rhythm E
6 ECG, Arrhythmia, ST and QT Monitoring133Ectopic Status MessagesThe label B or E indicates basic (B) or enhanced (E) arrhythmia capability.Sinus BradySinus RhythmSinus TachA dominant rhythm of beats labeled as N or S preceded by P-wavesB, ESV BradySV RhythmSV TachA dominant rhythm of beats labeled as N or S not preceded by P-wavesB, EUnknown ECG Rhythm Rhythm cannot be determined B, ELearning ECG Algorithm is learning the ECG beat morphology B, ELearning Rhythm Algorithm is learning the rhythm of the classified beats B, ECannot Analyze ECG ECG signal is predominantly invalid or too noisy and therefore cannot be analyzedB, ERhythm Status Message Description B or EEctopic Status Message Explanation B or E(No message displayed) No ectopic activity within the last minuteRun PVCs More than 2 consecutive beats labeled as V within the last minuteEPair PVCs Two beats labeled as V between two beats not labeled as V EPacer Not Capt No beat detected for a period > 1.75 times the average R-R interval and pace pulse(s) detected. (Paced mode on)B, EPacerNotPacing No beat detected for a period > 1.75 times the average R-R interval and no pace pulse(s) detected (Paced mode on)B, EPause No beat detected for a period > 1.75 times the average R-R interval for HR <120, orNo beat for 1 second with HR >120 (non-paced patient only), orNo beat detected for more than the set pause threshold.ER-on-T PVCs R-ON-T detected within the last minute EMultiform PVCs Within the last minute, the occurrence of two differently shaped beats labeled as V within the last 60 beats and each occurring at least twice within the last 300 beatsEFrequent SVPBs Count of beats labeled as S within last minute is greater than 5ESVPBs 1-5 beats labeled as S in the last minute ESV Beats Count of beats labeled as N or S within last minute and rhythm status is pacedB, EPaced Beats Count of beats labeled as P within last minute and rhythm status is not pacedB, E
6 ECG, Arrhythmia, ST and QT Monitoring134Arrhythmia RelearningDuring a learning phase:• Alarm timeout periods are cleared• Stored arrhythmia templates are cleared• Asystole, Vfib, and HR alarms (when there are enough beats to compute the HR) are active. No other alarms are active.Initiating Arrhythmia Relearning ManuallyTo initiate relearning manually, in the Setup Arrhy 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.Automatic Arrhythmia RelearnArrhythmia relearning is initiated automatically whenever:• ECG monitoring is switched on• The ECG Lead or Lead Label of the primary/secondary lead is changed manually, or when fallback occurs• A Leads Off INOP condition (that has been active for > 60 seconds) ends.If you are monitoring multi-lead arrhythmia and there is a change in one lead only, relearning happens only in the affected lead. During this learning phase, the system will continue monitoring using the other lead. Therefore, the delayed arrhythmia wave is not labeled L and there is no Learning ECG rhythm status message. In addition, alarm timeout periods are maintained, stored arrhythmia templates are maintained for the operative lead, and all alarms switched on are active.Arrhythmia Relearn and Lead FallbackLead fallback triggers an automatic arrhythmia relearn.WARNINGIf arrhythmia learning takes place during ventricular rhythm, the ectopics may be incorrectly learned as the normal QRS complex. This may result in missed detection of subsequent events of V-Tach and V-Fib.For this reason you should:• take care to initiate arrhythmia relearning only during periods of predominantly normal rhythm and when the ECG signal is relatively noise-free• be aware that arrhythmia relearning can happen automatically
6 ECG, Arrhythmia, ST and QT Monitoring135• respond to any INOP messages (for example, if you are prompted to reconnect electrodes)• be aware that a disconnected EASI electrode triggers an arrhythmia relearn on all leads• always ensure that the arrhythmia algorithm is labeling beats correctly.Arrhythmia AlarmsArrhythmia alarms can be switched on and off and the alarm settings changed just like other measurement alarms, as described in the Alarms section. Special alarm features which apply only to arrhythmia are described here.The different alarms detected and generated by the monitor depend on the level of arrhythmia analysis that is enabled. For a complete list of arrhythmia alarms and INOPs, see the “Alarms” chapter.The monitor detects arrhythmia alarm conditions by comparing ECG data to a set of pre-defined criteria. An alarm can be triggered by a rate exceeding a threshold (for example, HR >xx), an abnormal rhythm (for example, Ventricular Bigeminy), or an ectopic event (for example, Pair PVCs).Yellow Arrhythmia AlarmsYellow arrhythmia alarms are short yellow alarms specific to arrhythmia-related patient conditions. The heart rate alarms (High HR and Low HR) can be configured as short yellow or standard yellow alarms. When they are standard yellow alarms they exist independently of the other arrhythmia alarms and no timeout periods apply.WARNINGWhen arrhythmia analysis is on, all yellow ECG and arrhythmia alarms are short yellow alarms (one-star). This means that the yellow alarm lamp and the tones are active for six seconds only, after which the blinking numeric and the alarm message remain for up to three minutes. The only exception to this are the HR High and Low alarms which can be configured as standard yellow alarms. Red alarms behave as usual.Arrhythmia Alarms and LatchingWhen using arrhythmia analysis, Visual Latching and Audible Latching should be on for red alarms, or at least Visual Latching should be on. Because of the transient nature of arrhythmia alarms, many arrhythmia conditions may go unnoticed if alarm latching is off. This setting can only be changed in Configuration Mode.Switching Individual Arrhythmia Alarms On and OffSome arrhythmia alarms can be individually switched on or off:Non-Sustain, Vent Rhythm, Run PVCs, Pair PVCs, R-on-T PVCs, V.Bigeminy, V.Trigeminy, Multif.PVCs, Pacer n.Cap, Pacer n.Pac, Pause, SVT, IrregularHR, Missed Beat, PVCs/min and Afib.To switch individual alarms on or off, in the Setup Arrhy menu, select the alarm from the list to switch between On and Off. Depending on your configuration, some alarms may not be available in the list and cannot be switched on or off here.The monitor displays the INOP message Some ECG AlarmsOff, if configured, when more alarms are switched off than configured in your active profile.
6 ECG, Arrhythmia, ST and QT Monitoring136Switching All Yellow Arrhythmia Alarms On or OffAll yellow arrhythmia alarms can be switched on and off together. To do this,•In the Setup Arrhy menu, select All Yellow Off or All Yellow On.Adjusting the Arrhythmia Alarm LimitsSome arrhythmia alarms have limits which can be individually adjusted:VTach HR, VTach Run, PVCs/min, Vent Rhythm, SVT HR, SVT Run, Asystole Thresh., Pause Threshold, Afib/IHR End Dly.1To adjust alarm limits, in the Setup Arrhy menu, select the alarm to be adjusted.2Select the appropriate setting from the pop-up list.Arrhythmia Alarm Timeout PeriodsNormally, an arrhythmia alarm is announced when an alarm condition is detected. However, there are certain situations that can inhibit the audible and visible indications of the alarm even though the alarm condition was detected. These include:• 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 137 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 137.To view the timeout period configured for your monitor, in the Setup Arrhy menu, see the menu items TimeOut 1st and TimeOut 2nd.This setting can only be changed in Configuration Mode.** AFIB and ** Irregular HR alarms do not have a timeout period. These alarms can be generated immediately after the corresponding end alarm was generated.When ** HR High and ** HR Low alarms are configured as standard yellow alarms, they do not have a timeout period.Resetting the Timeout PeriodTo reset the timeout period, press the Alarms key and then reselect it.
6 ECG, Arrhythmia, ST and QT Monitoring137How 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.Arrhythmia Alarm ChainingWhen arrhythmia analysis is switched on, multiple alarm conditions may be present. Announcing all of the detected alarm conditions would be confusing, and might hide a more serious condition. For this reason, arrhythmia alarms are prioritized in three alarm "chains": PVC Alarms; Beat Detection Alarms, and Rate Alarms.Only the highest priority alarm condition in each chain is announced. Lower priority alarms in the same chain will not be announced while an alarm is active or during the configured timeout period. If alarm conditions of equal severity from different chains are detected, the alarm condition that occurred most recently is announced.See “ECG and Arrhythmia Alarm Overview” on page 123 for information on which alarms are included in the different arrhythmia options. See “Arrhythmia Alarm Timeout Periods” on page 136 for an explanation of how alarm timeouts work.Alarm Condition Example Short yellow alarm tone sounds Alarm message displayed Single alarm instanceNon-Sustained V-tachwhen alarm condition is initially detectedfor 3 minutes (latching time)Continuous alarm conditionPVCs/min HIGH when alarm condition is initially detected and - as an alarm reminder - every time the configured timeout period has expireduntil the alarm condition stops, plus a maximum of three minutes latching timeSame intermittent alarm conditionPair of PVCs each time the alarm condition is detected, provided that the configured timeout period has expired
6 ECG, Arrhythmia, ST and QT Monitoring138Examples of Alarm Chaining Logic– 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.
6 ECG, Arrhythmia, ST and QT Monitoring139Understanding PVC-Related AlarmsPVC-related alarms are detected on the basis of the current ventricular heart rate and the number of consecutive PVCs counted (referred to as PVC Runs).As an example, this diagram illustrates the conditions under which PVC alarms would be generated if the Vent Rhythm Run limit is set to 11, the V-Tach Run Limit is set to 8, and the V-Tach HR Limit is set to 100.You will see that• if both the V-Tach Heart Rate Limit and the V-Tach Run Limit are exceeded, a red V-Tach alarm is generated• if the ventricular heart rate exceeds the V-Tach Heart Rate Limit but not the V-Tach Run Limit, a yellow Non-Sustain VT alarm is generated.About ST MonitoringThe monitor performs ST segment analysis on normal and atrially paced beats and calculates ST segment elevations and depressions. This information can be displayed in the form of ST numerics and snippets on the monitor.The monitor also performs ST Elevation (STE) analysis using automated ISO and J point determination and measuring the ST segment directly at the J point (J +0). This is based on the recommendations for measuring ST Elevation published by the American Heart Association, the American College of Cardiology and the European Society of Cardiology.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.
6 ECG, Arrhythmia, ST and QT Monitoring140WARNINGSome 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 or STE On and OffST and STE analysis can be switched on and off independently.To switch all ST monitoring on or off, in the Setup ST Analysis menu, select ST Analysis to switch between On and Off.To switch all STE monitoring on or off, in the Setup ST Elevation menu, select STE to switch between On and Off.Selecting Leads for ST AnalysisYou select which leads to use for ST analysis in the Setup ST Analysis menu.To see the current list of leads selected for ST analysis:1Enter the Setup ST Analysis menu.2Select Setup ST Leads. This opens the Setup ST Leads pop-up window. Leads chosen for ST monitoring are listed here. There are two pop-up keys at the bottom of the screen, Add and Delete. If all leads are already selected, the Add pop-up key is disabled.To choose a lead for ST monitoring:1Select the Add key at the bottom of the Setup ST Leads window. This opens the Choices pop-up window.2Choose a lead from the list for ST monitoring. This closes the Choices window and adds the selected lead to the list of chosen leads.To disable ST monitoring for a lead:1Choose a lead from the list in the Setup ST Leads window.2Select the Delete key. This removes this lead from the list.
6 ECG, Arrhythmia, ST and QT Monitoring141NOTEThe 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.Understanding the ST Display and WindowsYour monitor screen may be configured to look slightly different from the illustrations.ST NumericsUp to 12 ST numerics plus the ST index can be displayed on the monitor screen. They can be configured to show beside the measurement numerics, beside the ECG wave, or beside the ST snippet.A positive ST value indicates ST segment elevation; a negative value indicates depression.ST numerics are displayed in the order in which you select ST leads for analysis. If there is additional space in the field assigned to ST numerics, the monitor will display extra numerics in the order in which they appear in the list in Setup ST Leads, in the Setup ST Analysis menu. Any ST leads switched on for analysis that do not fit in the assigned numerics field are shown in succession in place of the last ST numeric.ST IndexThe ST index numeric (STindx) is the sum of the absolute values for the ST leads V2, V5, aVF. Because it is based on absolute values, it is always a positive number. If you haven't selected one of the leads V2, V5, and aVF for ST analysis, the ST index numeric will display a question mark "?".To switch the ST index numeric on or off for display, in the Setup ST Analysis menu, select ST-Index to toggle between On and Off.ST SnippetsST snippets show a one second wave segment for each measured ST lead. The most recent snippet is drawn in the same color as the ECG wave, usually green, superimposed over the stored baseline snippet, drawn in a different color. The comparison shows any deviation in the measurement since the baseline snippet was stored, for example as a result of a procedure carried out on the patient. The information is updated once per minute.You can see ST snippets in the Adjust ST Points window or the ST View window.1ST numerics2Current HR alarm limits3Current heart rate
6 ECG, Arrhythmia, ST and QT Monitoring142ST View WindowThe ST View Window shows a current ST snippet and numeric with a baseline snippet and numeric. The two snippets are in different colors, so that you can differentiate between them easily and see at a glance which numerics belong to which snippet. In the upper left corner the current lead and the ISO/J-Point mode for current and baseline snippets is shown. On the right side all available ST numerics are shown. The date and time of the baseline snippet is shown at the bottom of the window. The ST View Window opens with the ST pop-up keys Current / Baseline / Overlap (to select viewing mode), Show Points / Hide Points, Update Baseline, Record ST, STE View, Adjust ST Points, ST Map, Setup ST and arrow keys for scrolling through the available leads.• To view the ST View window, select the ST numerics, then ST View.1Current Lead2ISO/J-point mode for current snippet3ISO/J-point mode for baseline snippet41 mV calibration bar5Current ST snippet and ST baseline snippet overlapped6Timestamp of most recently stored baseline snippet7All available ST numerics for current snippet and baseline snippetThe ST point, J-point and ISO point can be hidden using the Hide Points pop-up key.STE View WindowThe STE View window shows a current ST snippet and STE numeric with an ST baseline snippet. The two snippets are in different colors, so that you can differentiate between them easily. In the upper left corner the current lead is shown. On the right side all available STE numerics are shown. The date and time of the ST baseline snippet is shown at the bottom of the window.
6 ECG, Arrhythmia, ST and QT Monitoring143The STE View window opens with the pop-up keys Current / Baseline / Overlap (to select viewing mode), Show Points/Hide Points, Record STE, ST View, ST Map, Setup ST and arrow keys for scrolling through the available leads.The ST point, J-point and ISO point can be hidden using the Hide Points pop-up key.Updating ST Baseline SnippetsST analysis requires valid samples to measure and store a snippet. ST Snippets and ST values are updated every minute. If there is artifact in the signal, it may take longer for an ST snippet and an ST value to appear.The first baseline is stored automatically after ST monitoring is started, or when a new patient is admitted.To update ST baselines,1Select the ST numerics then ST View to open the ST View window.2In the ST View window, select Update Baseline to store all current snippets as baselines. This deletes all previously-stored baselines.About the ST Measurement PointsThe ST value for each beat complex is the vertical difference between the ISO point and the ST point, as shown in the diagram below. The isoelectric (ISO) point provides the baseline, the ST point is at the midpoint of the ST segment. The J point is where the QRS complex changes its slope; as it is a fixed distance away from the ST point, it can be useful to help you position the ST point correctly.
6 ECG, Arrhythmia, ST and QT Monitoring1441R-wave peak at 0 msec2J point, for example, 48 msec3Difference = ST value4ST measurement point, for example, J + 60 msec5Isoelectric point set to -80 msec6P7Q8S9TCAUTIONIf using ST analysis, 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.Setting ISO and J-Point Detection ModeThere are two modes for ISO and J-point detection: Auto and Manual. In Manual mode you can set the measurement points yourself. In Auto mode the measurement points will be determined automatically.To set the detection mode, in the Setup ST Analysis window,1Select ISO/J Pt.2Select Auto or Manual mode.Adjusting ST Measurement PointsIf the ISO and J-point detection mode is set to Manual, all three measurement points can be set. In Auto mode, only the ST point can be changed.
6 ECG, Arrhythmia, ST and QT Monitoring145To adjust the ST measurement points, in the Setup ST Analysis menu,1Select Adjust ST Points to open the Adjust ST Points window.Alternatively, you can use the Adjust ST points pop-up key in the ST View 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.3Select the ST point you need to adjust by touching the appropriate point on the screen. The current choice is highlighted (ISO point -80 in the screen example).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).1 ST label and the ST numeric that would apply using the current points2 1mV calibration bar3 Cursors for adjusting ST points4 Highlighted ST point
6 ECG, Arrhythmia, ST and QT Monitoring146The 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.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 AlarmsST alarms are yellow alarms. Each ST lead has its own alarm limit. ST alarms are triggered when an ST value exceeds its alarm limit for more than one minute. Switching ST alarms off switches off alarms for all ST leads.If more than one ST measurement is in alarm, the monitor only displays the alarm message of the ST lead which is currently furthest from its set alarm limits.Changing ST Alarm LimitsThe monitor can detect alarms on each ST lead separately, so you can set high and low ST alarm limits individually for each ST lead. When two contiguous leads are available, ST alarms will be generated when ST values of the two contiguous leads are outside the limit. When no contiguous lead is available an ST alarm is generated when the ST value of the single lead is outside the limit.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.
6 ECG, Arrhythmia, ST and QT Monitoring1471In the Setup ST Analysis menu, select the alarm to be adjusted.2Select the appropriate setting.STE AlarmsThe STE alarm is a yellow alarm. It can be switched on and off in the Setup ST Elevation menu but the limits can only be changed in Configuration mode. The STE alarm limits are gender specific and can be set individually for limb leads, V2/V3 leads, V1/V4/V5/V6 leads, V7/V8/V9 leads and V3R, V4R, V5R, V6R leads. The default values, for example on V2 and V3 1.5 mm for females and 2.0 mm for males, are based on the recommendations from the American Heart Association and American College of Cardiology.The ST Elevation measurements with automated J-point determination generate ST Elevation alarms, in addition to the ST measurements at the user-defined ST point (J+offset), which may be useful for ST depression alarms. When ST and STE analysis are both in use, this may result in redundant alarms for ST elevations. Because of the different measurement points, there may be different values obtained. Thus there could be an ST alarm and an STE alarm but the STE alarm may announce sooner based upon the values obtained.Viewing ST MapsThe monitor can derive a multi-axis portrait (map) from the ST analysis to help you detect changes in ST values. Two planes obtained from a multi-lead ECG are displayed in a multi-axis diagram, where each axis represents a lead. The value at the ST 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 an ST map. The contour line and the map shading are shown in the same color as the ECG parameter.Viewing an ST MapTo display an ST map,•In the Main Setup menu, select ST Map.Current ViewIn current view, the monitor displays an ST map that corresponds to the current ST values.The left of the following diagrams shows leads I, II, III, aVR, aVL, and aVF on the limb leads plane. On the right, the V-leads V1, V2, V3, V4, V5, V6 (and V7, V8, V9, V3R, V4R, V5R, V6R, if configured) are on the chest leads plane.
6 ECG, Arrhythmia, ST and QT Monitoring1481ST Alarm status indicator2Limb Leads3Chest Leads4ST index5Label, value and polarity of corresponding lead6ST map 7The position of the current ST measurement pointIf an ST lead is switched off, its axis is not shown in the map.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 if no chest leads are measured) for a second ST map to be displayed, the currently available ST values are displayed in place of the second ST map.
6 ECG, Arrhythmia, ST and QT Monitoring149Additionally, when both ST maps are displayed, you can view the currently available ST values in the ST Map (Current) or ST Map (Trend) window at any time. To do this, select the Show Values pop-up key. The ST values are shown in place of the second ST map, and the pop-up key text changes to Hide Values. Select the Hide Values Hide Values pop-up key and the display shows both ST maps again. Trend ViewIn trend view, you can see up to four trended ST maps, and the current ST map, simultaneously. You can configure the time interval between trended samples. The most recent map is shown in the same color as the parameter itself. Past values change from white through dark gray. In the diagram below, the time interval between trends is one minute. The first trended sample is white and is one minute old. The second trended sample corresponds to the ST values two minutes 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.1Limb Leads2Chest Leads3current ST values4trending intervalIn 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.
6 ECG, Arrhythmia, ST and QT Monitoring150Working in the ST Map Task WindowYou may need to activate the ST map task window to see all the data, and to access the pop-up keys. Select the map view on screen to activate its task window. Once you activate it, you can perform the tasks detailed here.Switching Between ST Map ViewsTo switch between views,•Select Current View or Trend View to toggle between views.If your trend view is empty, you need to adjust the priority of this measurement in the trending priority list. See “Trend Priority” on page 226.Displaying an ST Reference BaselineYou can display an ST reference baseline for the current view, or for the trended view. The baseline is shown in yellow. However, if the ECG color is yellow, the baseline is shown in green. Use this baseline to detect ST changes. The baseline is derived automatically whenever the monitor relearns arrhythmia and also on user request.Select Show Baseline/Hide Baseline to toggle between baseline display on and off.Updating an ST Map Reference BaselineTo update the baseline,•In the Setup ST Analysis menu, select ST View then select Update Baseline.Changing the Scale of the ST MapTo change scale,•Select Size Up or Size Down to alter the size at which monitor displays the map.Changing the Trending IntervalTo determine how frequently the monitor displays a trended sample,1In Trend view, select Select Interval.2Select the required interval from the menu. The interval ranges between 12 seconds to 30 minutes.Printing an ST Map ReportTo print the most recently viewed (current or trend) window,1Select Main Setup then select Reports.2Select ST Map.3Press Print.Viewing STE MapsThe STE Map displays STE values, ST values measured at the J point, together with the STE Limits as configured in the Setup ST Elevation menu for the gender of the current patient. Just like ST Map, it displays two planes obtained from a multi-lead ECG in a multi-axis diagram, where each axis represents a lead. The position of the axes within the diagram correspond to the placement of the
6 ECG, Arrhythmia, ST and QT Monitoring151ECG leads. Each STE value is assigned to either a limb lead, or to a chest lead. Every axis shows the polarity of the lead it represents. The STE limits are indicated by a gray colored area which contains all values that lie above those limits. If the ECG parameter color is white, shades of green are used instead.If two contiguous leads exceed the corresponding STE limits, the violation area between the two STE values and two corresponding limit values is colored in red. If the ECG parameter color is red, green is used instead.If the gender of the patient is not specified, the STE Map does not show any limits and does not indicate any limit violations.The STE Map does not provide Trend View or the ST baseline.1STE Alarm status indicator2Limb Leads3Chest Leads4Label, value and polarity of corresponding lead5STE Limit Violations6STE Limit Area7The position of the current ST measurement point (always J + 0)Viewing an STE MapTo display an STE map,•In the Main Setup menu, select STE Map.Working in the STE Map Task WindowYou may need to activate the STE 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.
6 ECG, Arrhythmia, ST and QT Monitoring152Changing the Scale of the STE MapTo change scale,•Select Size Up or Size Down to alter the size at which monitor displays the map.Printing an STE Map ReportTo print the most recently viewed window,1Select Main Setup then select Reports.2Select STE Map.3Press Print.Switching between STE Map and ST MapIf you are running ST Map or STE Map as an embedded screen application, you can switch back and forth between STE Map and ST Map by selecting the Change Map pop-up key.Note that changes made here will be saved in the current screen.About QT/QTc Interval MonitoringThe QT interval is defined as the time between the beginning of the Q-wave and the end of the T-wave. It measures the total duration of the depolarization (QRS duration) and repolarization (ST-T) phases of the ventricular action potential. QT interval monitoring can assist in the detection of prolonged QT interval syndrome.The QT interval (1) has an inverse relationship to heart rate. Faster heart rates shorten the QT interval and slower heart rates prolong the QT interval. Therefore there are several formulas used to correct the QT interval for heart rate. The heart rate corrected QT interval is abbreviated as QTc. The monitor uses as a default the Bazett correction formula and the alternative Fridericia formula can be selected in Configuration Mode.For QT interval monitoring to be effective, basic or enhanced arrhythmia monitoring should be turned on.QT Measurement AlgorithmThe QT values are updated every five minutes except in the initial phase (first five minutes) where they are updated once per minute. Normal or atrial paced beats and beats with a similar morphology are averaged to form a representative waveform for further processing. Normal beats followed by a premature QRS will be excluded from the measurements to prevent the premature beat from
6 ECG, Arrhythmia, ST and QT Monitoring153obscuring 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).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 MonitoringOf special concern for QT monitoring is the administration of QT prolonging drugs to patients identified with risk factors for Torsade de Pointe. Females, older patients and patients with bradycardia, impaired left ventricular function (ischemia, left ventricular hypertrophy), hypokalemia and hypomagnesemia are in this increased risk category.Limitations For Use Of QT Interval MonitoringSome conditions may make it difficult to achieve reliable QT monitoring, for example:• the T-wave is very flat• T-waves are not well defined due to atrial flutter or atrial fibrillation• the end of the T-wave is difficult to define because of the presence of U-waves• a high heart rate causes the P-wave to encroach on the end of the previous T-wave• noise or high QRS morphology variationFor these cases you should select a lead with a good T-wave amplitude and no visible flutter activity, and without a predominant U-wave or P-wave.Some conditions such as left or right bundle branch block or hypertrophy can lead to a widened QRS complex. If a long QTc is observed you should verify it to ensure that it is not caused by QRS widening.Because normal beats followed by ventricular beats are not included in the analysis, no QT measurement will be generated in the presence of a bigeminy rhythm.If the heart rate is extremely high (over 150 bpm for adults and over 180 bpm for pediatrics and neonates) QT will not be measured.When the heart rate changes, it can take several minutes for the QT interval to stabilize. For reliable QTc calculation it is important to avoid a region where the heart rate is changing.WARNINGQT/QTc measurements should always be verified by a qualified clinician.
6 ECG, Arrhythmia, ST and QT Monitoring154Selecting the QT LeadsFor QT Monitoring you can select one of the following three modes:• All Leads mode - all available leads (I, II, III, V, MCL, V1 - V9, V3R to V6R) 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.• Single-Lead mode - a single lead selected from all available leads (except the augmented leads) will be used for QT measurement. QT measurement will stop if the selected lead becomes unavailable.To select the mode,1Select the QT numeric to enter the Setup QT Analysis window.2Select QT Lead and select All, Primary Lead or one of the available single leads.When using the All Leads mode, make sure when you compare QT values that they are based on the same set of leads.Changing the lead(s) used for QT measurements will not cause the baseline to be reset.QT ViewIn the QT View window you can verify that the QT algorithm detects correct Q and T points.The current waves are shown in the upper half of the window and the baseline waves in a different color below. The Q and T points are marked with a vertical line. By selecting one of the lead labels at the top of the window you can highlight the corresponding wave; the other waves are shown in gray. The underlined lead labels are the leads used for the QT calculation. By selecting the numeric area you can highlight all underlined leads.If EASI or Hexad lead placement is in use, the corresponding lead placement label will be shown.
6 ECG, Arrhythmia, ST and QT Monitoring155Changing The View To A Single Wave SetTo view one set of waves in a larger scale, you can cycle through the different views,1Select Current view to see the set of current waves.2Select Baseline view to see the set of baseline waves.3Select Split view to return to the combined view with current and baseline waves.Setting The QT BaselineIn order to quantify changes in the QTc value, you can set a QTc baseline. For example to assess the effect of medication on the QT interval you can set the current value as the baseline before you begin medication. This baseline will then be used to calculate the ΔQTc value.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 WavesTo start a printout,•Select Print QT.Recording The QT WavesTo start a recording,•Select Record QT.QT AlarmsThere are two QT alarms, QTc high limit alarm and ΔQTc high alarm. The QTc high limit alarm is generated when the QTc value exceeds the set limit for more than 5 minutes. The ΔQTc alarm is generated when the difference between the current value and the baseline value exceeds the set limit for more than 5 minutes.The Cannot Analyze QT INOP and the -?- will be displayed when no QT measurement could be calculated for 10 minutes. Up to this time the previous valid value will be displayed. The following additional messages on the cause of the invalid measurements may also be displayed.Additional Message Cause of Invalid QT MeasurementQT Startup QT monitoring was just turned on or has been resetAsystole or Leads Off 1Not all specified leads needed to perform QT analysis are available, or2Asystole condition is detectedToo few N labeled beats Not enough valid QRS complexes to generate a QT measurement
6 ECG, Arrhythmia, ST and QT Monitoring156Switching Individual QTc Alarms On and OffEach QTc alarm can be switched off individually. To switch an alarm on or off, in the Setup QT Analysis menu, select QTc Alarm or ΔQTc Alarm to toggle between On and Off.Changing QTc Alarm LimitsSet the high alarm limits based on your assessment of the patient's clinical condition, unit protocols, physician orders or medication specified limits.1In the Setup QT Analysis menu, select High Limit.2Select the appropriate setting.3Select ΔHighLimit.4Select the appropriate setting.Switching QT Monitoring On and OffTo switch all QT monitoring on or off, in the Setup QT Analysis menu, select QT Analys. to switch between On and Off.Invalid Rhythm for QTc Not enough valid R-R intervals to generate QT-HR, the averaged HR used for QTc calculationHigh QT-HR QT-HR exceeds the specified upper limit of 150 bpm (for adults) or 180 bpm (for neonates and pediatrics)Small R Wave R-wave of the signal is too smallSmall T Wave T-wave of the signal is too smallEnd of T not Detected End of the T-Wave cannot be accurately detectedQT out of Range QT measurement is outside the specified range of valid QT values (200-800 msec)QTc out of Range QTc measurement is outside the specified range of valid QTc values (200-800 msec)QTc Erratic QTc measurements are not stableAdditional Message Cause of Invalid QT Measurement
71577Monitoring Pulse RateThe pulse numeric counts the arterial pulsations that result from the mechanical activity of the heart in beats per minute (bpm). You can display a pulse from any measured SpO2 signal (pleth wave), from the CL Respiration Pod, or any arterial pressure (P, ABP, ART, Ao, PAP, UAP, FAP, BAP: see the “Monitoring Invasive Pressure” chapter for an explanation of the pressure labels). The displayed pulse numeric is labeled and color-coded to match its source wave. If the pulse numeric is not displayed, see the Setup Pulse menu to check whether it is switched on.Entering the Setup Pulse MenuIf a pulse numeric is displayed on the screen, select it to enter the setup menu for that pulse source. If no pulse numeric is visible, in the setup menu from the measurement, select pulse with the correct source, e.g. Pulse (HR).System Pulse SourceThe currently selected system pulse source is shown in the setup menus of the pulse source measurements. The pulse rate chosen as system pulse:• is monitored as system pulse and generates alarms when you select pulse as the active alarm source• is sent via the network to the Information Center, if available• is trended in the HighRes Trends and stored in the monitor's databases.To define which pulse rate is used as system pulse,1In the Setup Pulse menu, select System Pulse.2Select one of the SpO2, cmResp 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.
7 Monitoring Pulse Rate158Switching Pulse On and OffTo switch a particular pulse numeric on or off, enter the Setup Pulse menu via the measurement setup menu or wave menu of the pulse source. For example, to switch an SpO2 pulse numeric on or off,1Enter the Setup Pulse menu by selecting the Pulse numeric or by selecting Pulse in the Setup SpO₂ menu.2In the Setup Pulse menu, select the correct pulse label, e.g. Pulse (SpO₂), to toggle between On and Off.Using Pulse AlarmsYou can change pulse rate alarm limits in the ECG/Pulse Alarms menu which can be accessed from the Setup Pulse menu or the Setup ECG menu by selecting AlarmSrc(xxx) where xxx is the current 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 Al. Source in the ECG/Pulse Alarms menu, then select•ECG/Arrhythm: if you want the HR to be the alarm source for HR/Pulse.•Pulse: If you select Pulse as the active alarm source, the monitor will prompt you to confirm your choice. Be aware that if you select Pulse as the alarm source, all arrhythmia and ECG HR alarms are switched off.•Auto: If the alarm source is set to Auto, the monitor will use the heart rate from the ECG measurement as the alarm source whenever the ECG measurement is switched on and at least one ECG lead can be measured without an INOP condition.The monitor will automatically switch to Pulse as the alarm source if:– a valid ECG lead can no longer be measuredand– a Pulse source is switched on and available,The monitor then uses the pulse rate from the measurement currently active as system pulse. While Pulse is the alarm source, all arrhythmia and ECG HR alarms are switched off. If an ECG lead becomes available again, the monitor automatically uses HR as alarm source.NOTEIf 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.
7 Monitoring Pulse Rate159WARNINGSelecting 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 123, including Asystole, Vfib and Vtach alarms, and the heart rate alarms. This is indicated by the message ECG/Arrh AlarmsOff (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 AlarmsOff can be configured off, or to switch to a yellow (medium severity) INOP after a fixed number of hours.High and low pulse rate and extreme bradycardia and extreme tachycardia alarms from pulse are active.Alarm Source Selection DisabledIf you cannot change the alarm source, selection of the alarm source may be disabled. If you try to change the source, the monitor displays the message To activate enter Config and enable Alarm Source Selection. This setting can only be changed in Configuration Mode.Changing HR/Pulse Alarm LimitsAs Pulse and HR share the same high and low alarm limits, if you change the alarm limit in the Setup Pulse menu, the high or low alarm limits for HR in the Setup ECG menu change automatically, and vice versa. The only exceptions are caused by a low limit clamp for each measurement: the lowest value for Pulse when derived from SpO2 is 30 bpm; from HR 15 bpm, and from Pressure 25 bpm.Extreme Alarm Limits for Heart RateThe extreme rate alarms, *** Extreme Tachy and *** Extreme Brady, are generated by the active alarm source, either HR or Pulse. The limits are set automatically by adding a set value (the Δ value) to the high and low alarm limits. So, changing the high and low alarm limits automatically changes the extreme alarm limits (within an allowed range, see “Extreme Alarm Limits for Heart Rate” on page 125 for details).You need to know which value has been configured for your monitor.• 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 ΔExtrTachy and ΔExtrBrady.QRS ToneThe active alarm source is also used as a source for the QRS tone. You can change the tone volume in the Setup SpO₂ and Setup ECG menus and the QRS tone modulation in the Setup SpO₂ menu.WARNINGThe audible QRS tone might be influenced by external interference and is not intended to be used as a substitute for ECG based arrhythmia analysis.If arrhythmia detection is needed, do not rely on the audible QRS tone.
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81618Monitoring Respiration Rate (Resp)For the respiratory measurement (Resp), the monitor measures the thoracic impedance between two ECG electrodes on the patient's chest. Changes in the impedance due to thoracic movement produce the Resp waveform on the monitor screen. The monitor counts the waveform cycles to calculate the respiration rate (RR).Lead Placement for Monitoring RespCorrect patient skin preparation techniques for electrode placement are important for Resp measurement: you will find this information in the chapter on ECG.The Resp measurement uses the standard ECG cable sets and lead placements. You can use any of the different types of ECG cable sets - 3-lead, 5-lead, 6-lead or 10-lead, using either standard or EASI™ placement - to measure Resp, as long as you use ICU ECG cables.The Resp signal is always measured between two of the ECG electrodes. Note that at least a standard 3-lead placement is required to measure Resp. The Resp measurement cannot be performed with only two electrodes.Selecting the Resp Lead for MeasurementTo choose the leads for the Resp measurement:In the Setup Resp menu, select Resp Lead and choose one of the following vectors:•I (RA-LA) or•II (RA-LL).Note that if EASI is configured, Respiration will be measured between the I and A electrodes.Optimizing Lead Placement for RespIf you want to measure Resp and you are already measuring ECG, you may need to optimize placement of the two electrodes between which Resp will be measured for some patients. Repositioning ECG electrodes from standard positions, especially when you are using EASI™ ECG electrode placement, results in changes in the ECG waveform and may influence ST and arrhythmia interpretation.
8 Monitoring Respiration Rate (Resp)162Cardiac OverlayCardiac activity that affects the Resp waveform is called cardiac overlay. It happens when the Resp electrodes pick up impedance changes caused by the rhythmic blood flow. Correct electrode placement can help to reduce cardiac overlay: avoid the liver area and the ventricles of the heart in the line between the respiratory electrodes. This is particularly important for neonates.Lateral Chest ExpansionSome patients, especially neonates, expand their chests laterally. In these cases it is best to place the two respiratory electrodes in the right midaxillary and left lateral chest areas at the patient's maximum point of breathing movement to optimize the respiratory wave.Abdominal BreathingSome patients with restricted chest movement breathe mainly abdominally. In these cases, you may need to place the left leg electrode on the left abdomen at the point of maximum abdominal expansion to optimize the respiratory wave.Understanding the Resp DisplayThe Resp measurement is displayed on the monitor as a continuous wave and a numeric respiration rate. If the detected respiration rate is close to the heart rate, this is indicated by the text HR = RR next to the respiration wave if you are in manual monitoring mode. Your monitor screen may look slightly different from the illustration.1Resp wave label2One Ohm calibration bar3Manually-set Resp detection level4Resp numeric and label
8 Monitoring Respiration Rate (Resp)163Changing Resp Detection ModesThe Resp detection level can be set either automatically or manually.• To change the resp detection mode, in the Setup Resp menu, select Detection to toggle between the settings.Auto Detection ModeIn Auto Detection Mode, the monitor adjusts the detection level automatically, depending on the wave height and the presence of cardiac artifact. Note that in Auto Detection Mode,• 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.Use Auto Detection Mode for situations where:• the respiration rate is not close to the heart rate• breathing is spontaneous, with or without continuous positive airway pressure (CPAP)• patients are ventilated, except patients with Intermittent Mandatory Ventilation (IMV).Manual Detection ModeIn Manual Detection Mode you must set the Resp detection level.•In the Setup Resp menu, select Manual Up or Manual Down. Use the dotted detection level line in the Resp waveform to determine when the desired level is reached.Once set, the detection level will not adapt automatically to different respiration depths. It is important to remember that if the depth of breathing changes, you may need to change the detection level.Use Manual Detection Mode for situations where:• the respiration rate and the heart rate are close.• patients have Intermittent Mandatory Ventilation.• respiration is weak. Try repositioning the electrodes to improve the signal.Resp Detection Modes and Cardiac OverlayIn Auto Detection Mode:If you are monitoring Resp and the ECG is switched off, the monitor cannot compare the ECG and Resp rates to detect cardiac overlay. The respiration detection level is automatically set higher to prevent the detection of cardiac overlay as respiration.In Manual Detection Mode:Cardiac overlay can in certain situations trigger the respiration counter. This may lead to a false indication of a high respiration rate or an undetected apnea condition. If you suspect that cardiac overlay is being registered as breathing activity, raise the detection level above the zone of cardiac overlay. If the Resp wave is so small that raising the detection level is not possible, you may need to optimize the electrode placement as described in the section “Lateral Chest Expansion” on page 162.
8 Monitoring Respiration Rate (Resp)164Changing the Size of the Respiration WaveWARNINGWhen monitoring in Manual Detection Mode, make sure to check the respiration detection level after you have increased or decreased the size of the respiration wave.•In the Setup Resp menu, select Size Up to increase the size of the wave or Size Down to decrease it.Changing the Speed of the Respiration WaveResp waveforms are usually viewed at a slower speed than other waveforms. For this reason, the Resp measurement has its own speed control and is not affected by the wave speed settings of the other measurements.• Select the Resp wave to enter the Resp Wave menu, then select Change Speed. Choose the required speed from the pop-up list. This defines the speed at which the wave is drawn across the screen in millimeters per second (mm/s).Using Resp AlarmsResp alarms can be switched on and off and the high and low alarm limits can be changed just like other measurement alarms, as described in the Alarms chapter.Changing the Apnea Alarm DelayThe apnea alarm is a high priority red alarm used to detect apneas. The apnea alarm delay time defines the time period between the point where the monitor cannot detect any respiration activity and the indication of the apnea alarm.1In the Setup Resp menu, select Apnea Time.2Select the appropriate setting.Resp Safety InformationWARNINGRespiration detection levelIf you do not set the detection level for the respiration correctly in manual detection mode, it may not be possible for the monitor to detect apnea. If you set the detection level too low, the monitor is more likely to detect cardiac activity, and to falsely interpret cardiac activity as respiratory activity in the case of apnea.ApneaThe respiration measurement does not recognize obstructive and mixed apneas - it only indicates an alarm when a pre-adjusted time has elapsed since the last detected breath.The safety and effectiveness of the respiration measurement method in the detection of apnea, particularly the apnea of prematurity and apnea of infancy, has not been established.
8 Monitoring Respiration Rate (Resp)165InterferenceIf 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 AccessoriesTo monitor respiration, use only the non-OR ECG accessories listed in the Resp section of the accessories chapter. You cannot measure respiration if you are using an orange OR ECG cable set. This is because of the higher internal impedance of the OR cable set, required for use if electrosurgery is being performed.Rate adaptive pacemakersImplanted pacemakers which can adapt to the Minute Ventilation rate may occasionally react on the Impedance measurement used by patient monitors for the determination of the Resp value and execute pacing with the maximum programmed rate. Switching off the Resp measurement can prevent this.
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91679Monitoring with the CL Respiration Pod (cmResp)The CL Respiration Pod is one of the IntelliVue Cableless measurements and can be used together with the monitor. For information on the general use and application of the pod, refer to “Using IntelliVue Cableless Measurements” on page 35 and the IntelliVue Cableless Measurements Instructions for Use.As the Respiration Pod does not have a display, the measurement results are only presented on the monitor display, and the settings for the measurement can also only be made at the monitor. Information relating to these aspects is contained in this chapter.Measurement PrinciplesThe CL Respiration Pod derives a respiration and pulse signal from the chest and abdomen movements measured with a built-in acceleration sensor. The CL Respiration Pod is attached to the left costal arch on the patient's chest with an adhesive attachment.With the appropriate configuration, the measurement provides:• a respiration waveform (cmResp)• a respiration rate (cmRR)• a pulse numeric (optional)• a posture status - various different postures such as supine, upright and lying on left/right side are detected and updated after a posture change has occurred and posture is stable again.• an activity level numeric - patient activity is determined once per second, and an activity level between 0 and 10 is reported to the monitor and updated once per minute.The activity status information provides only an approximate indication of the actual patient activity.WARNINGThe CL Respiration Pod does not provide apnea alarming.Excessive patient movement and vibration can cause interference with the measured signals. When the patient is mobile, motion artifacts could be interpreted as breathing movements.
9 Monitoring with the CL Respiration Pod (cmResp)168Measurement ModesThere are three different modes available for making respiration/pulse measurements:•Manual Mode - a single respiration measurement is made when Start cmResp is selected at the monitor or when the key on the Respiration Pod is pressed.•Automatic Mode - continually repeated respiration measurements with an adjustable interval between them. The first measurement starts immediately after entering the automatic measurement mode.If configured, when the respiration rate moves outside the defined alarm limits, the measurement mode changes automatically to frequent mode until the respiration rate moves back inside the limits.•Frequent Mode - respiration and pulse are measured continuously. The respiration rate is updated with every new detected breath. The shortest update interval for the pulse rate is 8 seconds.Making MeasurementsFor the procedures for preparing the pod and making measurements, refer to the IntelliVue Cableless Measurements Instructions for Use.To start a measurement from the monitor, select Start cmResp in the Setup cmResp menu. A single measurement can be started at any time, independent of the current measurement mode.Understanding the NumericsIn automatic mode, you may see the time until the next measurement instead of the timestamp, depending on your configuration. The time is shown like this:The cmRR and pulse numerics can be configured to be grayed out or to disappear from the screen after a set time. This avoids older numerics being misinterpreted as current data. The time can be set in Configuration mode.When an automatic measurement is ongoing, the numerics are replaced by horizontal bars, constantly changing from one bar, to two, then to three.1Measurement Mode2Repeat time (only in automatic mode)3Timestamp for numerics4Pulse numeric5cmRR numeric6cmRR alarm limits7Signal Quality indicator
9 Monitoring with the CL Respiration Pod (cmResp)169Signal Quality IndicatorThe cmRR and pulse numerics are 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 maximum signal quality with the triangle completely filled.Activity NumericThe activity level of the patient is indicated by a numeric value between 1 (very low activity) and 10 (very high activity). When a value of 0 is displayed, no signal is available. The numeric is updated once per minute.An activity level value is also displayed at the top of the Setup cmResp menu. Here the "realtime" value is shown, allowing you check that activity is being successfully detected.Posture IndicationThe posture is displayed in text form, with the name of the detected posture and the time since the last posture change was detected. The indication is updated when a posture change is detected and the new posture has been stable for 1 minute.A posture indication is also displayed at the top of the Setup cmResp menu. Here the "realtime" indication is shown, allowing you check that posture changes are being successfully detected.Setting the Measurement ModeTo set the measurement mode:1In the Setup cmResp menu, select Mode.2Select Manual, Auto or Frequent mode.In Auto or Frequent mode, measurements will start immediately after the mode is selected.Setting the Repeat TimeFor Auto mode measurements you can set the interval between measurements:1In the Setup cmResp menu, select Repeat Time.2Select the interval from the list.
9 Monitoring with the CL Respiration Pod (cmResp)170Switching Posture and Activity Level On and OffIn the Setup cmResp menu, select Posture or Activity to switch between On and Off.
1017110Monitoring SpO2Philips pulse oximetry uses a motion-tolerant signal processing algorithm, based on Fourier artifact suppression technology (FAST). It provides four measurements:• Oxygen saturation of arterial blood (SpO2) - percentage of oxygenated hemoglobin in relation to the sum of oxyhemoglobin and deoxyhemoglobin (functional arterial oxygen saturation).• Pleth waveform - visual indication of patient's pulse.• Pulse rate (derived from pleth wave) - detected pulsations per minute.• Perfusion indicator - numerical value for the pulsatile portion of the measured signal caused by arterial pulsation.The monitor is also compatible with an SpO2 technology from another manufacturer: Nellcor™ OxiMax™. Where use of this technology results in different behavior or has different requirements, the differences are described in these Instructions for Use.WARNINGA pulse oximeter should be considered an early warning device. As a trend towards patient deoxygenation is indicated, blood samples should be analyzed by a laboratory CO-oximeter to completely understand the patient's condition.SpO2 SensorsFamiliarize yourself with the instructions for use supplied with your sensor before using it. In particular, check that the sensor being used is appropriate for your patient category and application site.CAUTIONDo not use OxiCliq disposable sensors in a high humidity environment, such as in neonatal incubators or in the presence of fluids, which may contaminate sensor and electrical connections causing unreliable or intermittent measurements. Do not use disposable sensors when there is a known allergic reaction to the adhesive.
10 Monitoring SpO2172Applying the Sensor1Follow the SpO2 sensor's instructions for use, adhering to all warnings and cautions.2Remove colored nail polish from the application site.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.4When 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.5Check that the light emitter and the photodetector are directly opposite each other. All light from the emitter must pass through the patient's tissue.WARNINGProper Sensor Fit: If a sensor is too loose, it might compromise the optical alignment or fall off. If it is too tight, for example because the application site is too large or becomes too large due to edema, excessive pressure may be applied. This can result in venous congestion distal from the application site, leading to interstitial edema, hypoxemia and tissue malnutrition. Skin irritations or lacerations may occur as a result of the sensor being attached to one location for too long. To avoid skin irritations and lacerations, periodically inspect the sensor application site and change the application site regularly.Venous Pulsation: Do not apply sensor too tightly as this results in venous pulsation which may severely obstruct circulation and lead to inaccurate measurements.MRI Scanning: Do not use the pulse oximeter or oximetry sensors during magnetic resonance imaging (MRI) scanning. Induced current could potentially cause burns. The device may affect the MRI image, and the MRI unit may affect the accuracy of the oximetry measurements.Damaged Sensors: Do not use damaged sensors / cables or sensors with exposed optical components.Low Perfusion: With very low perfusion at the monitored site, the performance might be impaired and the SpO2 readings may read lower than arterial oxygen saturation.Conditions Affecting Performance: During hypotension, severe vasoconstriction, severe anemia, or hypothermia of the patient the performance may be impaired. Also in these conditions or when the patient is in cardiac arrest or in shock, it may not be possible to make measurements at all.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.Do not immerse the sensors.Nellcor OxiMax technology: This product contains chemicals known to the state of California to cause cancer and birth defects or other reproductive harm.
10 Monitoring SpO2173Connecting SpO2 CablesConnect the sensor cable to the color-coded socket on the monitor. You can connect some Philips sensors directly to the monitor. For other sensors, use the corresponding adapter cable.CAUTIONExtension cables: Do not use more than one extension cable (M1941A). Do not use an extension cable with Philips reusable sensors or adapter cables with part numbers ending in -L (indicates "long" cable version).Electrical Interference: Position the sensor cable and connector away from power cables, to avoid electrical interference.Humidity: For neonatal patients, make sure that all sensor connectors and adapter cable connectors are outside the incubator. The humid atmosphere inside can cause inaccurate measurements.Measuring SpO21Select the correct patient category setting (adult/pediatric and neonatal), as this is used to optimize the calculation of the SpO2 and pulse numerics.2During measurement, ensure that the application site:– has a pulsatile flow, ideally with a perfusion indicator value above 1.0.– has not changed in its thickness (for example, due to edema), causing an improper fit of the sensor.WARNING• If not specified otherwise in the SpO2 sensor's instructions for use, the following applies:– For fully conscious pediatric or adult patients, who have a normal function of perfusion and sensory perception at the measurement site:To ensure skin quality and correct optical alignment of the sensor, inspect the application site when the measurement results are suspicious or when the patient complains about pressure at the application site, but at least every 24 hours. Correct the sensor alignment if necessary. Move the sensor to another site, if the skin quality changes.– For all other patients:Inspect the application site every two to three hours to ensure skin quality and correct optical alignment. Correct the sensor alignment if necessary. If the skin quality changes, move the sensor to another site.Change the application site at least every four hours.• Injected dyes such as methylene blue, or intravascular dyshemoglobins such as methemoglobin and carboxyhemoglobin may lead to inaccurate measurements.• Inaccurate measurements may result when the application site for the sensor is deeply pigmented or deeply colored, for example, with nail polish, artificial nails, dye or pigmented cream.• Interference can be caused by:– High levels of ambient light (including IR warmers) or strobe lights or flashing lights (such as fire alarm lamps). (Hint: cover application site with opaque material.)
10 Monitoring SpO2174– Another SpO2 sensor in close proximity (e.g. when more than one SpO2 measurement is performed on the same patient). Always cover both sensors with opaque material to reduce cross-interference.– Electromagnetic interference, especially at perfusion indicator values below 1.0 or signal quality indicator below medium.– Excessive patient movement and vibration.Understanding the SpO2 NumericsIn automatic mode, you may see the time until the next measurement instead of the timestamp, depending on your configuration. The time is shown like this:When an automatic measurement is ongoing, the numerics are replaced by horizontal bars (1, 2 or 3 bars, in turn).SpO2 numerics from intermittent measurements (from the IntelliVue CL SpO2 Pod or a telemetry device) can be configured to be grayed out or to disappear from the screen after a set time. This avoids older numerics being misinterpreted as current data. The time can be set in Configuration mode.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.1Measurement Mode (only with the IntelliVue CL SpO2 Pod, in Auto or Manual mode)2Repeat time (only with the IntelliVue CL SpO2 Pod, in Auto mode)3Timestamp for numerics (only with the IntelliVue CL SpO2 Pod or a telemetry device)4Pulse numeric5Perfusion Numeric6Alarms off indicator (here for Pulse alarms)7SpO2 numeric8SpO2 alarm limits9Signal Quality indicator
10 Monitoring SpO2175The 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.Assessing a Suspicious SpO2 ReadingTraditionally, pulse rate from SpO2 was compared with heart rate from ECG to confirm the validity of the SpO2 reading. With newer algorithms, such as FAST-SpO2, this is no longer a valid criteria because the correct calculation of SpO2 is not directly linked to the correct detection of each pulse.When pulse rate is very low, or strong arrhythmia is present, the SpO2 pulse rate may differ from the heart rate calculated from ECG but this does not indicate an inaccurate SpO2 value.If you doubt the measured SpO2, use the signal quality indicator (if available) or the pleth wave and perfusion indicator instead to assess the signal quality.WARNINGWith pulse oximetry, sensor movement, ambient light (especially strobe lights or flashing lights) or electromagnetic interference can give unexpected intermittent readings when the sensor is not attached. Especially bandage-type sensor designs are sensitive to minimal sensor movement that might occur when the sensor is dangling.Comparing Values and WavesBe aware when using two different SpO2 technologies that under certain conditions the displayed values and especially the perfusion values may differ due to the different algorithms used.Changing the Averaging TimeDepending on the monitor configuration, you may be able to change the averaging time for the SpO2 values. The averaging time represents the approximate time period used for the calculation. The exact averaging algorithm depends on the SpO2 technology (option) used and on the signal conditions. The longer the averaging time, the longer the time needed until the SpO2 value reflects the physiological event. Fast averaging is useful for situations where an extremely fast measurement is required or few artifacts are expected. Use slow averaging where you expect the number of artifacts to be relatively high.1In the Setup SpO₂ menu, select Average.2Select the required averaging time from the list.
10 Monitoring SpO2176Setting the Measurement ModeWhen a telemetry device supplies SpO2T to the monitor via short range radio transmission, the monitor will have a manual measurement mode available. This allows SpO2 measurements to be made on request and not continuously, helping to save the telemetry device’s battery power.When an IntelliVue CL SpO2 Pod is providing SpO2 measurement data to the monitor via short range radio, the monitor will have manual and automatic measurement modes available.To set the measurement mode,1In the Setup SpO₂ menu, select Mode.2Select Continuous, Manual or Auto mode (if available).NOTETo ensure there is no gap in SpO2 measurements when moving from standard telemetry transmission to short range radio transmission, the measurement mode will always be set to continuous in this situation unless manual mode is set in both the telemetry device and the monitor.Making a Manual MeasurementWhen the measurement mode is set to manual,•In the Setup SpO₂ menu, select Start SpO₂, or use the Start SpO₂ SmartKey.When manual measurements are made, there will be no continuous SpO2 monitoring or alarming. The manual measurement value reflects a momentary status. The numerics from SpO2T measurements made in manual mode, for example SpO2T, PerfT, PulseT, will remain for a time on the main screen. They are annotated with the time that the measurement was made to distinguish them from continuously measured values.Making an Automatic MeasurementWhen automatic mode is selected, to make a measurement:1Select Repeat or Repeat Time and select the required interval between measurements.2In the Setup SpO₂ menu, select Start SpO₂, or use the Start SpO₂ SmartKey.You can start a manual measurement between automatic measurements, if required, by selecting Start SpO₂ again as described above.To end an automatic series of measurements, change the measurement mode to Manual or Continuous.Understanding SpO2 AlarmsThis refers to SpO2 specific alarms. See the “Alarms” chapter for general alarm information. SpO2 offers high and low limit alarms, and a high priority desat alarm. You cannot set the low alarm limit below the desat alarm limit.
10 Monitoring SpO2177CAUTIONIf you measure SpO2 on a limb that has an inflated noninvasive blood pressure cuff, a non-pulsatile SpO2 INOP can occur. To avoid this, the monitor can be configured to suppress corresponding SpO2 INOPs when it detects an inflated cuff (for FAST SpO2 technology only).If INOPs are suppressed, there may be a delay of up to 60 seconds in indicating a critical status, such as sudden pulse loss or hypoxia.Alarm DelaysThere is a delay between a change in the oxygen saturation at the measurement site and the corresponding alarm indication at the monitor. This delay has two components:•The general measurement delay time is the time between the occurrence of the saturation change and when the new value is represented by the displayed numerical values. This delay depends on the algorithmic processing and the averaging time configured for SpO2. The longer the averaging time configured, the longer the time needed until the numerical values reflect the change in saturation.•The time between the displayed numerical values crossing an alarm limit and the alarm indication on the monitor. This delay is the sum of the alarm delay time configured for SpO2, plus the system alarm delay. The system alarm delay is the processing time the system needs for any alarm to be indicated on the monitor, after the measurement has triggered the alarm. See “Monitor Performance Specifications” on page 293 for the system alarm delay specification.For SpO2 high and low limit alarms, there are two different types of alarm delay time. The standard alarm delay is set to a fixed value. The Smart Alarm Delay varies, based on an intelligent algorithm, and can be used instead of the standard alarm delay.The Desat alarm always uses the standard alarm delay.Standard Alarm DelayThe standard alarm delay time can be configured to a fixed value between 0 and 30 seconds, in 1 second steps.Smart Alarm DelayThe Smart Alarm Delay feature tries to reduce "nuisance" alarms.WARNINGBefore using Smart Alarm Delays, make sure that you fully understand how the delay is applied and what the consequences are.How Does it Work?The monitor assesses the severity of a limit violation by looking at its magnitude and duration, and can delay the alarm, depending on the assessed severity. Examples for the delay are given in the table in the example below.
10 Monitoring SpO2178Clinical ExampleYou are monitoring a patient with a low SpO2 limit of 90%. Then, while sleeping, your patient drops to 89% for 20 seconds, and then recovers.The Smart Alarm Delay would tolerate this limit violation up to 50 seconds (upper shaded cell in the table) before issuing an SpO2 low alarm. So in this case there would be no alarm notification.If the SpO2 drops further (e.g. to 85%), the tolerance time is much lower (10 seconds, see lower shaded cell).Table with Detailed Delays for Specific Limit ViolationsIn the clinical example above, the Medium delay mode has been selected. For less stable or more robust patients, the tolerance time can be adjusted using Short or Long mode.Actual deviation from violated alarm limitResulting alarm notification delay according to selected modeShort Medium Long1% 25 sec (maximum delay) 50 sec (maximum delay) 100 sec (maximum delay)2% 12 sec 25 sec 50 sec3% 10 sec (minimum delay) 16 sec 33 sec4% 10 sec 12 sec 25 sec5% 10 sec 10 sec (minimum delay) 20 sec6% 10 sec 10 sec 16 sec7% 10 sec 10 sec 14 sec8% 10 sec 10 sec 12 sec9% 10 sec 10 sec 11 sec>9% 10 sec 10 sec 10 sec (minimum delay)
10 Monitoring SpO2179Smart Alarm Delay Dynamics1First trigger point - with the smart alarm delay setting "medium", the low alarm is triggered 12 seconds after the SpO2 value has fallen below the low limit.A - ** SpO₂ Low alarm2Second trigger point - with zero desat delay, the alarm is triggered as soon as the SpO2 value falls below the desat limit.B - *** Desat alarmAs long as the SpO2 value stays in the shaded zone, the low alarm is delayed.Setting Smart Alarm Delay ModeTo set the mode for Smart Alarm Delays, in the Setup SpO₂ menu:1Check that SmartAlarmDelay is set to On.This setting is made in Configuration Mode and will be shown in the menu in gray. If it is set to Off, a standard alarm delay is in use.2Select High Alarm Delay and choose Short, Medium, or Long mode.3Select Low Alarm Delay and choose Short, Medium, or Long mode.If you also use monitors with earlier software revisions, be aware that smart alarm delays will not be used after a transfer to one of these monitors. Monitors with earlier software revisions will always use the standard alarm delay. If you are not sure whether a monitor has the Smart Alarm Delay function, check whether there is a SmartAlarmDelay entry in the Setup SpO₂ menu.%SpO2low limitdesat limittime (s)
10 Monitoring SpO2180Smart Alarm Delay IndicatorIf the Smart Alarm Delay is switched on, a special indicator will be displayed next to the SpO2 alarm limits. This indicator consists of a general alarm symbol with three blocks above and below it.The blocks above and below the alarm symbol indicate which Smart Alarm Delay modes have been set:The blocks above the alarm symbol show the delay mode for the high limit, and the blocks below for the low limit.When the SpO2 value crosses an alarm limit, the delay period starts. During the delay period, the symbol is highlighted to indicate that an alarm limit has been violated:If the SpO2 value returns inside the limits during the delay period, the highlighting will be removed and no alarm is indicated. If the SpO2 value is still outside the alarm limit at the end of the delay period, the alarm is indicated and the highlighting will be removed from the symbol.Adjusting the Alarm LimitsIn the Setup SpO₂ menu:• Touch the high limit on the alarm limits menu button. Choose the high alarm limit from the pop-up list that opens.• Touch the low limit on the alarm limits menu button. Choose the low alarm limit from the pop-up list that opens.WARNINGHigh oxygen levels may predispose a premature infant to retrolental fibroplasia. If this is a consideration do NOT set the high alarm limit to 100%, which is equivalent to switching the high alarm off.Indicator Indicator with NumericsShort Medium Long
10 Monitoring SpO2181Adjusting the Desat Limit AlarmThe Desat alarm is a high priority (red) alarm notifying you of potentially life threatening drops in oxygen saturation.1In the Setup SpO₂ menu, select Desat Limit.2Adjust the limit.Pleth WaveThe Pleth wave is autoscaled to maximum display size. It decreases only when the signal quality becomes marginal. It is NOT directly proportional to the pulse volume. If you need an indication of change in pulse volume, use the perfusion indicator.1Minimum size for reliable SpO2 valuePerfusion NumericThe perfusion numeric (Perf) gives a value for the pulsatile portion of the measured signal caused by the pulsating arterial blood flow.As pulse oximetry is based on the pulsatile nature of the signal, you can also use the perfusion numeric as a quality indicator for the SpO2 measurement. Above 1 is optimal, between 0.3-1 is acceptable. Below 0.3 is marginal; reposition the sensor or find a better site.Perfusion Change IndicatorThe perfusion change indicator is a graphic symbol which shows the change in the perfusion value, relative to a reference value which you can set.To set the current perfusion value as the reference value:•In the Setup SpO₂ menu, select Set Perf Ref..When a reference value has been set, the perfusion change indicator is displayed next to the perfusion numeric.Setting SpO2/Pleth as Pulse Source1In the Setup SpO₂ menu, select Pulse (SpO₂) to enter the Setup Pulse menu.2In the Setup Pulse menu, select Syst.Pulse and select SpO₂ from the pop-up list.
10 Monitoring SpO2182Setting Up Tone ModulationIf tone modulation is on, the QRS tone pitch lowers when the SpO2 level drops. Remember, the QRS tone is derived from either heart rate or pulse depending on which is currently selected as the active alarm source.•In the Setup SpO₂ menu, select Tone Mod. to switch between Yes (for on) and No (for off).Setting the QRS VolumeIn the Setup SpO₂ menu, select QRS Volume and set the appropriate QRS tone volume.
1118311Monitoring NBPThis monitor uses the oscillometric method for measuring NBP. In adult and pediatric mode, the blood pressure measurements determined with this device comply with the American National Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP10-1992) in relation to mean error and standard deviation, when compared to intra-arterial or auscultatory measurements (depending on the configuration) in a representative patient population. For the auscultatory reference, the fifth Korotkoff sound was used to determine the diastolic pressure.In neonatal mode, the blood pressure measurements determined with this device comply with the American National Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP10-1992) in relation to mean error and standard deviation, when compared to intra-arterial measurements in a representative patient population.The NBP measurement is suitable for use in the presence of electrosurgery and during the discharge of a cardiac defibrillator according to IEC 601-2-30:1999/EN 60601-2-30:2000.A physician must determine the clinical significance of the NBP information.Introducing the Oscillometric NBP MeasurementOscillometric devices measure the amplitude of pressure changes (oscillations) in the occluding cuff as the cuff deflates from above systolic pressure. The amplitude suddenly increases as the pulse breaks through the occlusion in the artery. As the cuff pressure decreases further, the pulsations increase in amplitude, reach a maximum (which approximates to the mean pressure), and then diminish.Studies show that, especially in critical cases (arrhythmia, vasoconstriction, hypertension, shock), oscillometric devices are more accurate and consistent than devices using other noninvasive measuring techniques.WARNINGPatient Category: Select the correct patient category setting for your patient. Do not apply the higher adult inflation, overpressure limits and measurement duration to neonatal patients.Intravenous infusion: Do not use the NBP cuff on a limb with an intravenous infusion or arterial catheter in place. This could cause tissue damage around the catheter when the infusion is slowed or blocked during cuff inflation.Skin Damage: Do not measure NBP in cases of sickle-cell disease or any condition where skin damage has occurred or is expected.Existing Wounds: Do not apply the cuff over a wound as this can cause further injury.
11 Monitoring NBP184Mastectomy: Avoid applying the cuff on the side of the mastectomy, as the pressure increases the risk of lymphedema. For patients with a bilateral mastectomy, use clinical judgement to decide whether the the benefit of the measurement outweighs the risk.Unattended Measurement: Use clinical judgement to decide whether to perform frequent unattended blood pressure measurements. Too frequent measurements can cause blood flow interference potentially resulting in injury to the patient. In cases of severe blood clotting disorders frequent measurements increase the risk of hematoma in the limb fitted with the cuff.Temporary Loss of Function: The pressurization of the cuff can temporarily cause loss of function of monitoring equipment used simultaneously on the same limb.CAUTIONIf you spill liquid onto the equipment or accessories, particularly if there is a chance that it can get inside the tubing or the measurement device, contact your service personnel.Measurement LimitationsNBP readings can be affected by the position of the patient, their physiological condition, the measurement site, and physical exercise. Thus a physician must determine the clinical significance of the NBP information.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.Measurement ModesThere are four modes for measuring NBP:•Manual - measurement on demand.•Auto - continually repeated measurements (between one minute and 24 hours adjustable interval).•Sequence - up to four measurement cycles which will run consecutively, with number of measurements and interval between them configurable for each cycle.•STAT - rapid series of measurements over a five minute period, then the monitor returns to the previous mode. Use only on supervised patients.
11 Monitoring NBP185Reference MethodThe measurement reference method can be Auscultatory (manual cuff) or Invasive (intra-arterial). For further information, see the Application Note supplied on the monitor documentation DVD.In Neonatal mode, to comply with safety standards, invasive is always used as the reference method. This setting cannot be changed and is not visible in any operating mode.In Adult and Pediatric mode, to check the current setting, select Main Setup, Measurements, then NBP, and check whether the Reference setting is set to Auscult. or Invasive. This setting can only be changed in Configuration Mode.Preparing to Measure NBP1Connect the cuff to the air tubing.2Plug the air tubing into the red NBP connector. Avoid compression or restriction of pressure tubes. Air must pass unrestricted through the tubing.WARNINGKinked or otherwise restricted tubing can lead to a continuous cuff pressure, causing blood flow interference and potentially resulting in injury to the patient.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.WARNINGInspect the application site regularly to ensure skin quality and inspect the extremity of the cuffed limb for normal color, warmth and sensitivity. If the skin quality changes, or if the extremity circulation is being affected, move the cuff to another site or stop the blood pressure measurements immediately. Check more frequently when making automatic or stat measurements.Correcting the Measurement if Limb is not at Heart LevelTo correct the measurement if the limb is not at heart level, to the displayed valueAdd 0.75 mmHg (0.10 kPa) for each centimeter higher orDeduct 0.75 mmHg (0.10 kPa) for each centimeter lower orAdd 1.9 mmHg (0.25 kPa) for each inch higher. Deduct 1.9 mmHg (0.25 kPa) for each inch lower.
11 Monitoring NBP186Recommendations For Measurements Used in Diagnosis of HypertensionTo make a measurement for use in the diagnosis of hypertension, follow the steps below:1Ensure the patient is comfortably seated, with their legs uncrossed, feet flat on the floor and back and arm supported.2Ask the patient to relax and not talk before and during the measurement.3If possible, wait 5 minutes before making the first measurement.Understanding the NBP NumericsDepending on the NBP numeric size, not all elements may be visible. Your monitor may be configured to display only the systolic and diastolic values. If configured to do so, the pulse from NBP will display with the NBP numeric.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.During this hour, measurement values may be grayed out or disappear from the screen after a set time, if configured to do so. This avoids older numerics being misinterpreted as current data. The time can be set in Configuration mode.In Auto mode the measurement values may disappear more quickly (to be replaced by new measurement values), if the repeat time is set to less than one hour.Alarm SourcesIf you have parallel alarm sources, the sources are displayed instead of the alarm limits.NBP TimestampDepending on your configuration, the time shown beside the NBP numeric can be:– the time of the most recent NBP measurement, also known as the "timestamp", or– the time until the next measurement in an automatic series, displayed with a graphic representation of the remaining time, as shown here.1Alarm source2Measurement Mode3Timestamp/Timer4Mean pressure5Diastolic6Systolic7Alarm limits
11 Monitoring NBP187The NBP timestamp will normally show the completion time of the NBP measurement. Only under the following conditions the timestamp shows the beginning of the measurement:•when in Auto or Sequence mode, and• the monitor is configured to synchronize the measurements in a measurement series to an "easy-to-document" time. For example, if you start the first measurement at 08:23, and the Repeat Time is set to 10 minutes, the monitor automatically performs the next measurement at 8:30, then 8:40 and so on.During MeasurementsThe cuff pressure is displayed instead of the units and the repeat time. An early systolic value gives you a preliminary indication of the systolic blood pressure during measurement.When Unexpected Values are MeasuredWhen values measured are higher or lower than expected, check the following potential causes:Starting and Stopping MeasurementsUse the Setup NBP menu or SmartKeys to start and stop measurements.Possible Cause SolutionThe patient was talking or moving before or during the measurement.Allow the patient to rest quietly, then try again after three to five minutes.The incorrect cuff size was used or the cuff was not at heart levelCheck the cuff size, level, and position then repeat the measurement.The noninvasive blood pressure reference method is set incorrectly.Check the reference method (auscultation or intra-arterial) in the Setup NBP menu. If it is incorrect, have it changed in Configuration Mode.Measurement limitations have not been taken into account.Check the list in “Measurement Limitations” on page 184.Action to be performed NBP Setup menu SmartKeysStart manual measurementStart Auto seriesStart/StopStart/ StopStart NBPStart STAT measurement NBP STATNBP STATStart STAT
11 Monitoring NBP188CAUTIONUse clinical judgment to decide whether to perform repeated series of STAT measurements because of the risk of purpura, ischemia and neuropathy in the limb with the cuff.Enabling Automatic Mode and Setting Repetition Time1In the Setup NBP menu, select Mode and select Auto from the pop-up menu.2For an automatic measurement, select Repeat and set the time interval between two measurements.Stop Manual measurements Start/StopStart/ StopStop NBPStop current Auto measurement Start/StopStart/ StopStop NBPStop current STAT measurement and end series Start/StopStart/ StopNBP STATNBP STATStop NBPStop Auto, Manual or STAT measurement AND seriesStop AllStop AllAction to be performed NBP Setup menu SmartKeys
11 Monitoring NBP189Enabling Sequence Mode and Setting Up The Sequence1In the Setup NBP menu, select Mode and select Sequence from the pop-up menu.2Select Setup Sequence to open the Setup Sequence window.Up to four measurement cycles can be set up which will run consecutively. For each cycle you can set the number of measurements and the interval between them. If you want to run less than four cycles in a sequence, you can set the number of measurements for one or more cycles to Off.3Select each sequence in turn and select the number of measurements and the time interval between the measurements.4To have measurements continue after the sequence, set the number of measurements for your last cycle to Continuous and this cycle will run indefinitely.CAUTIONBe aware that, if none of the cycles are set to Continuous, NBP monitoring will end after the last measurement of the cycle.When the NBP measurement mode is set to Sequence, the repetition time for Auto mode cannot be changed.Choosing the NBP Alarm SourceYou can monitor for alarm conditions in systolic, diastolic and mean pressure, either singly or in parallel. Only one alarm is given, with the priority of mean, systolic, diastolic.In the Setup NBP menu, select Al. from and choose from: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.Menu option Pressure value monitoredSys. systolicDia. diastolicMean meanSys & Dia systolic and diastolic in parallelDia & Mean diastolic and mean in parallelSys & Mean systolic and mean in parallelSys&Dia&Mean all three pressures in parallel
11 Monitoring NBP190Switching Pulse from NBP On/OffIn the process of making the NBP measurement, a pulse value can be derived and displayed. The pulse value is displayed together with the time the measurement was made. After one hour the value becomes invalid. There are no alarms associated with pulse from NBP.When the accelerated measurement is in use, no pulse value can be derived.To switch the display of the pulse value on or off:•In the Setup NBP menu select Pulse (NBP).Assisting Venous PunctureYou can use the NBP cuff to cause subdiastolic pressure. The cuff deflates automatically after a set time (adult/pediatric 170 seconds, neonatal 85 seconds) if you do not deflate it.1In the Setup NBP menu select VeniPuncture.2Puncture vein and draw blood sample.3Reselect VeniPuncture to deflate the cuff.During measurement, the NBP display shows the inflation pressure of the cuff and the remaining time in venous puncture mode.NOTEPerforming a venous puncture while automatic or sequence NBP measurements are being made suspends the measurement series for the duration of the venous puncture inflation and for three minutes afterwards.Calibrating NBPNBP is not user-calibrated. NBP 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.
1219112Monitoring TemperatureWARNINGMeasurements from an MMS extension connected to the monitor are not available when the monitor is running on its own battery power. They are only available when the monitor is powered by the external power supply (M8023A) or the Battery Extension (865297).You can measure temperature using the built-in temperature measurement (optional), or one of the MMS extensions.The Temp measurement automatically switches on when you connect a probe. You can switch the measurement off manually.The displayed temperature is the temperature measured directly at the measurement site. No predictions or adjustments are made (direct mode thermometer).Making a Temp Measurement1Select the correct type and size of probe for your patient.2If you are using a disposable probe, connect the probe to the temperature cable.3Plug the probe or temperature cable into the temperature connector socket.4Apply the probe to the patient. You are advised to use a protective rubber cover on rectal probes.5Select an appropriate temperature label.6Check that the alarm settings (on or off, high and low limits) are appropriate for this patient and this type of temperature measurement.WARNINGMake sure you set alarm limits for the correct label. The alarm limits you set are stored for that particular label only. Changing the label may change the alarm limits.
12 Monitoring Temperature192Selecting a Temperature for MonitoringTell the monitor which temperature you want to monitor by selecting its temperature label. The label is a unique identifier for each type of temperature. When you choose a label, the monitor uses that label's stored color and alarm settings.1In the Setup <Temp Label> menu, select Label.2Select the appropriate label from the list.Extended Temperature Label SetThe following additional labels are available if Label Set is set to Full. This setting can only be changed in Configuration Mode.Note that if your monitor is connected to an Information Center, the additional labels in the extended label set may not be correctly displayed. See the Configuration Guide for your monitor for more information.Calculating Temp DifferenceThe monitor can calculate and display the difference between two temperature values by subtracting the second value from the first. The difference is labeled ΔTemp.1In the Main Setup menu, select Measurements.2Select ΔTemp.3In the Setup ΔTemp menu, select First Temp.4Select the appropriate label for the measurement source.5Select Second Temp.6Select the appropriate label for the second measurement source.Temp non-specific temperature label Trect rectal temperatureTart arterial temperature Tskin skin temperatureTcore core temperature Tven venous temperatureTesoph esophageal temperature Tnaso nasopharyngeal temperatureT1, T2, T3, T4 Non-specific temperature labelsTamb ambient temperatureTcereb cerebral temperatureTtymp tympanic temperatureTvesic vesical temperature
1319313Monitoring Invasive PressureWARNINGMeasurements from an MMS extension connected to the monitor are not available when the monitor is running on its own battery power. They are only available when the monitor is powered by the external power supply (M8023A) or the Battery Extension (865297).CAUTIONDo not use a monitor with an M1006A pressure module as an additional monitor for your patient. This may cause interference on the respiration or invasive pressure measurements.You can measure pressure using the monitor's built-in pressure measurement (optional), or one of the MMS extensions.Setting up the Pressure Measurement1Plug in the pressure cable.2Prepare the flush solution.3Flush the system to exhaust all air from the tubing. Ensure that the transducer and stopcocks are free of air bubbles.WARNINGIf air bubbles appear in the tubing system, flush the system with the infusion solution again. Air bubbles may lead to a wrong pressure reading.4Connect the pressure line to the patient catheter.5If 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.6Position the transducer so that it is level with the heart, approximately at the level of the midaxillary line.
13 Monitoring Invasive Pressure194WARNINGIf measuring intracranial pressure (ICP, IC1 or IC2) with a sitting patient, level the transducer with the top of the patient's ear. Incorrect leveling may give incorrect values.Selecting a Pressure for MonitoringTell the monitor the source of the pressure you want to monitor by selecting an appropriate pressure label. The label is a unique identifier for each type of pressure. When you choose a label, the monitor uses that label's stored settings, for example color, wave scale and alarm settings. The label also determines which algorithm is used to process the pressure signal, so an incorrect label can lead to incorrect pressure values.1In the Setup <Press Label> menu, select Label.2Select the appropriate label from the list.Extended Pressure Label SetThe following additional labels are available if Label Set is set to Full. This setting can only be changed in Configuration Mode.Note that if your monitor is connected to an Information Center, the additional labels in the extended label set may not be correctly displayed. See the Configuration Guide for your monitor for more information.Label DescriptionABP Arterial blood pressureART Arterial blood pressure (alternative)Ao Aortic pressureCVP Central venous pressureICP Intracranial pressureLAP Left atrial pressurePNon-specific pressure labelPAP Pulmonary artery pressureRAP Right atrial pressureUAP Umbilical arterial pressureUVP Umbilical venous pressureLabel DescriptionBAP Brachial arterial pressureFAP Femoral arterial pressureIC1, IC2 Alternative intracranial pressuresP1, P2, P3, P4 Alternative non-specific pressure labels
13 Monitoring Invasive Pressure195Overview of Calibration ProceduresCalibration requirements depend on the situation and the type of transducer used. Recommendations for the different calibration procedures are given in the table below.Zeroing the Pressure TransducerTo avoid inaccurate pressure readings, the monitor requires a valid zero. Zero the transducer in accordance with your hospital policy. You must perform a zero:• when you use a new transducer or tubing• every time you reconnect the transducer cable to the monitorif you think the monitor's pressure readings are not correct.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 monitor while zeroing. Reconnecting the transducer recalls the stored values.WARNINGIf you select the label ICP (or IC1/IC2), the measurement device uses the most recently stored zero. Therefore, make sure you zeroed the transducer correctly in accordance with the transducer manufacturer's instructions and your hospital policy. When you use a transducer that you cannot rezero after placement, ensure that you keep the measuring device with the patient so that you are certain you have the correct zero data for this patient.Procedure When to perform For which transducers?Disposable ReusableZero • Every time you use a new or a different transducer or tubing• Every time you reconnect the transducer to the monitor• If you think the monitor's pressure readings are not correctXXCalibration • Every time you use a new or a different transducer• According to your hospital policyXAdjust calibration factor• Can be done instead of the calibration procedure when a calibration factor is marked on your reusable transducerX
13 Monitoring Invasive Pressure196Determining a Pressure's Most Recent ZeroThe monitor displays the most recent zero on the status line. If this has "timed-out" after you have performed a zero, redisplay the information in the status line by entering the pressure's setup menu.Zeroing a Pressure MeasurementWARNINGInvasive pressure alarms (and pulse alarms, if derived from invasive pressure) are temporarily suppressed until 30 seconds after the transducer finishes zeroing.1Turn off the stopcock to the patient.2Vent the transducer to atmospheric pressure, to compensate for the static and atmospheric pressure exerted on the transducer.3In the setup menu for the pressure, select Zero <Press Label>.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.CAUTIONWhen using high frequency ventilation, ensure that the tubing from the ventilator does not touch the arterial line, or connect with it indirectly, while zeroing the pressure. This could cause small pressure variations which can interfere with the zero procedure.Zeroing All Pressures SimultaneouslyWARNINGBefore zeroing all pressures, make sure that all pressure transducers are vented to atmospheric pressure.If you are measuring pressures with more than one measuring device, using the Zero Press SmartKey to initiate the zeroing calls up a list of all active pressures. Select the pressure you want to zero or select All Press to zero all pressures simultaneously.Troubleshooting the ZeroThe status line lists the probable cause of an unsuccessful zero:Message Corrective Action<Press Label> can't zero; equipment malf.The hardware is faulty. Contact your service personnel.<Press Label> can't zero; excessive offsetMake sure the transducer is vented to air and try again. If this fails, the hardware may be faulty. Replace the adapter cable and try again. If it fails, replace the transducer and try again. If it still fails, contact your service personnel.<Press Label> can't zero - unstable signal
13 Monitoring Invasive Pressure197Calibrating Reusable TransducersDepending on your monitor's configuration, you may be able to perform a calibration in monitoring mode. Perform a mercury calibration when you use a new transducer, and at regular intervals according to your hospital policy. You require:• standard sphygmomanometer.• sterile 10cc syringe with heparinised solution.•3-way stopcock.• approximately 25 cm of tubing.NOTEOnly reusable transducers must be calibrated.Making the Pressure CalibrationWARNINGNever perform the invasive pressure calibration while a patient is being monitored.1Zero the transducer.2Connect the syringe and manometer.a. Attach the tubing to the manometer.b. Connect the 3-way stopcock to the stopcock that is not connected to the patient catheter when you measure a patient.c. Attach the syringe to one port and the manometer tubing to the other port.d. Open the port to the manometer.<Press Label> can't zero - no transducerMake sure that the transducer is connected and try again. If this fails, exchange the adapter cable and try again. If this fails, exchange the transducer.<Press Label> can't zero; pulsat. pressureMake sure that the transducer is vented to air, not to the patient, and try again.<Press Label> unable to zero - timed outTry pressing the Zero key again. If this fails, replace the transducer and adapter cable and contact your service personnel.Switch <Press Label> on firstPressure measurement is switched off. To switch it on, in the Setup Pressure menu, select the pressure's label.Message Corrective Action
13 Monitoring Invasive Pressure1981 Tubing to manometer2 Syringe with heparinised solution3 To pressure connector on monitor4 Patient connection stoppered5 Off3Move the syringe barrel in and raise the mercury to 200 mmHg (30 kPa). 200 mmHg is the recommended calibration pressure.4In the Setup <Press Label> menu, select Cal. Press.5Select the calibration pressure from the list, for example 200 mmHg.6Select Confirm to recalculate the calibration factor using the applied pressure.7When the monitor displays <Press Label> mercury calibr. done at <Date and Time>, remove the manometer tubing, syringe and extra stopcock. We recommend you replace the transducer dome and tubing with sterile ones.8Label the transducer with the calibration factor shown in the Cal. Factor field in the pressure's setup menu.9Reconnect the patient and start measuring again.Troubleshooting the Pressure CalibrationThe status line lists the probable cause of an unsuccessful calibration.Message Corrective Action<Press Label> can't calibr.; equipmt malf.Contact your service department. The pressure hardware is faulty.<Press Label> can't calibrate;out of rangeMake sure that you have selected the value for Cal. Press that you are applying to the transducer, and repeat the calibration.<Press Label> can't calibrate; no transd.Make sure that the transducer is connected and try again.
13 Monitoring Invasive Pressure199Adjusting the Calibration FactorEach time you use a reusable transducer, compare the calibration factor written on your transducer with the calibration factor shown on the monitor. To ensure accurate measurement, they must be the same.1In the Setup <Press Label> menu, select Cal. Factor.If the value here does not match that on the transducer, select the corresponding value from the list, in accordance with your hospital's procedure.2To confirm you want to use the new calibration factor, select the Confirm pop-up key.Displaying a Mean Pressure Value OnlyUse this when you want to see only the mean pressure.In the pressure's setup menu, select Mean only. Toggle between On to display mean pressure value only, and Off to display all pressure values (systolic, diastolic and mean).Changing the Pressure Wave Scale1Select the label of the pressure wave whose scale you want to set to enter the Setup <Press Label> menu.2In the Setup <Press Label> menu, (for example ABP) select Scale.3Select a value from the pop-up list:– a positive value sets the top gridline. The bottom gridline is set at zero.– a negative value sets the bottom gridline. The middle gridline is set at zero.Optimizing the WaveformIn the Setup <Press Label> menu, select Optimum Scale to let the monitor select the best minimum and maximum scales for the current wave.Non-Physiological Artifact SuppressionSome clinical procedures may affect blood pressure, for example, a flush procedure or a blood sample. Your monitor may be configured to suppress these non-physiological artifacts for a specified duration (Artifact Suppr. is configured to 30 sec, 60 sec, or 90 sec). During artifact suppression, the monitor shows the INOP message <Press Label> Artifact, and a question mark is shown beside the pressure numerics. Pressure alarms and the <Press Label> No Pulse INOP are suppressed during the configured period. The CPP alarms are not suppressed.<Press Label> can't cal.; unstable signalMake sure there are no disturbances to the transducer, and repeat the calibration.<Press Label> can't calibr.;do zero firstNo valid zero. Zero the transducer.Message Corrective Action
13 Monitoring Invasive Pressure200Choosing the Pressure Alarm SourceWARNINGMake sure you set alarm limits for the correct label. The alarm limits you set are stored for that particular label only. Changing the label may change the alarm limits.You can monitor for alarm conditions in systolic, diastolic and mean pressure, either singly or in parallel. Only one alarm is given at a time, in this order of priority: mean, systolic, diastolic.•In the Setup <Press Label> menu, select Al. from and choose the source.Select and set the High Limit and Low Limit for the pressure(s) you have selected.Extreme Alarm Limits for PressureThe extreme pressure alarms, Extreme High and Extreme Low, can be made available for your monitor in Configuration Mode and are additional to the standard High and Low limit alarms. They are generated by the active pressure alarm source, and are setup in Configuration Mode by adding a set value (the Δ value) to the high and low alarm limits. This value can be set for each pressure label individually.1Extreme Low Limit2Low Limit3High Limit4Extreme High Limit5Δ Extreme Low6Δ Extreme HighMenu option Pressure value monitoredSys. systolicDia. diastolicMean meanSys & Dia systolic and diastolic in parallelDia & Mean diastolic and mean in parallelSys & Mean systolic and mean in parallelSys&Dia&Mean all three pressures in parallel
13 Monitoring Invasive Pressure201You need to know which values have been configured for your monitor. Changing the high and low alarm limits automatically changes the extreme alarm limits within the allowed range.To see the extreme pressure alarms set for your monitor, in the setup menu for that pressure, see the menu items ΔExtr.High and ΔExtr. Low. The extreme pressure alarms are high priority, red alarms, marked *** in the alarm message.Calculating Cerebral Perfusion PressureThe 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.2Select CPP.3In the Setup CPP menu, select which arterial pressure source should be used in the calculation.
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1420314Monitoring Carbon DioxideWARNINGMeasurements from an MMS extension connected to the monitor are not available when the monitor is running on its own battery power. They are only available when the monitor is powered by the external power supply (M8023A) or the Battery Extension (865297).CAUTIONOnly one CO2 measurement at a time is supported.Use the CO2 measurement to monitor the patient's respiratory status and to control patient ventilation.There are two methods for measuring carbon dioxide in the patient's airway:• Mainstream measurement uses a CO2 sensor attached to an airway adapter directly inserted into the patient's breathing system. This method is available using the monitor's built-in CO2 measurement (optional) or the M3014A Capnography Extension.• Sidestream measurement takes a sample of the respiratory gas with a constant sample flow from the patient's airway and analyzes it with a remote CO2 sensor. You can measure sidestream CO2 using the monitor's built-in CO2 measurement (optional) or using the M3014A Capnography Extension, or the M3015A/B Microstream CO2 Extension.WARNINGCorrelation: The etCO2 readings do not always correlate closely with paCO2, especially in neonatal patients and patients with pulmonary disease, pulmonary embolism or inappropriate ventilation.Pharmaceuticals in aerosols: Do not measure CO2 in the presence of pharmaceuticals in aerosols.Explosion Hazard: Do not use in the presence of flammable anesthetics or gases, such as a flammable anesthetic mixture with air, oxygen or nitrous oxide. Use of the devices in such an environment may present an explosion hazard.Failure of operation: if the measurement or a sensor fails to respond as described, do not use it until the situation has been corrected by qualified personnel.
14 Monitoring Carbon Dioxide204Low etCO2 values: Leakages in the breathing system or sampling system may cause the displayed etCO2 values to be significantly too low. Always connect all components securely and check for leaks according to standard clinical procedures. Displacement of the nasal or combined nasal oral cannulas can cause lower than actual etCO2 readings. Even with combined nasal oral cannulas, the etCO2 readings may be slightly lower than actual in patients breathing through the mouth only.Measurement PrinciplesFor both mainstream and sidestream measurements, the measurement principle is infrared transmission, where the intensity of infrared light passing the respiratory gas is measured with a photo detector. As some of the infrared light is absorbed by the CO2 molecules, the amount of light passing the gas probe depends on the concentration of the measured CO2.When using a wet ventilator circuit, monitor mainstream CO2 if available, in preference to sidestream CO2.The partial pressure is calculated from the gas concentration by multiplying the concentration value with the ambient pressure.The measurement provides:•a CO2 waveform.•an end tidal CO2 (etCO2) value: the CO2 value measured at the end of the expiration phase.• an inspired minimum CO2 (imCO2): the smallest value measured during inspiration.• an airway respiration rate (awRR): the number of breaths per minute, calculated from the CO2 waveform.Depending on the Max Hold setting configured for your monitor, the etCO2 numeric shows either the highest CO2 value measured within the configured time period (Max Hold set to 10 sec or 20 sec) or the etCO2 numeric shows breath-to-breath value (Max Hold set to Off).The Microstream method also provides an Integrated Pulmonary Index (IPI) numeric, which is an indication of the patient's overall ventilatory status based on four measurement parameters: etCO2, awRR, pulse rate and SpO2. IPI can thus provide an early indication of a change in ventilatory status which may not be shown by the current value of any of these four parameters individually. The IPI is designed to provide additional information regarding patient status, possibly before etCO2, awRR, SpO2, or pulse rate values reach levels of clinical concern.The IPI is available for all three groups of pediatric patients (1-3 years, 3-6 years, and 6-12 years), and for adult patients. It is displayed as a single value between 1 and 10.Availability of the SpO2 and pulse values for the IPI calculation is not affected by the labels used or the SpO2 technology in the monitor.
14 Monitoring Carbon Dioxide205Measuring CO2 using the CO2 Option or M3014AThe monitor (with the CO2 option) or the M3014A Capnography Extension measures partial pressure of carbon dioxide in a patient's expired gas using the mainstream method or the sidestream method.The mainstream CO2 measurement can be used, with appropriate accessories, with intubated adult, pediatric and neonatal patients. The sidestream CO2 measurement can be used, with appropriate accessories, with intubated and non-intubated adult, pediatric, infant and neonatal patients. With intubated patients, a sample of the respiratory gas is drawn from the patient's breathing circuit through an airway adapter and a gas sampling tube. With non-intubated patients, the gas sample is drawn through a nasal or oral-nasal cannula.WARNINGAltitude Setting: The monitor is not equipped with automatic barometric pressure compensation. Before the CO2 measurement is used for the first time, the altitude must be set to the correct value. An incorrect altitude setting will result in incorrect CO2 readings. The CO2 readings will typically deviate 5% for every 1000 m difference.CAUTIONUse the CO2 measurement with Philips approved accessories only. Refer to the instructions for use provided with the accessory.Preparing to Measure Mainstream CO2You must perform a zero as described in this procedure each time you use a new airway adapter.1Attach the sensor connector to the CO2 connector on the monitor (when the optional CO2 measurement is integrated) or on the extension.2Wait 2 minutes, allowing the sensor to reach its operating temperature and a stable thermal condition.3Choose the appropriate airway adapter and connect it to the sensor head. The airway adapter clicks into place when seated correctly.
14 Monitoring Carbon Dioxide2064Zero the sensor:– Expose the sensor to room air and keep it away from all sources of CO2 including the ventilator, the patient's breath and your own.– In the setup menu for the CO2, select Start Zero Cal.– When you see the message CO₂ calibration done at <Date and Time> on the status line, the zero calibration is finished and you can begin monitoring.5Install the airway adapter at the proximal end of the circuit between the elbow and the ventilator Y-section.WARNINGTo prevent stress on the endotracheal tube, support the sensor and airway adapter.Position sensor cables and tubing carefully to avoid entanglement or potential strangulation. Do not apply excessive tension to any cable.Replace the airway adapter, if excessive moisture or secretions are observed in the tubing or if the CO2 waveform changes unexpectedly without a change in patient status.To avoid infection, use only sterilized, disinfected or disposable airway adapters.Inspect the airway adapters prior to use. Do not use if airway adapter appears to have been damaged or broken. Observe airway adapter color coding for patient population.Preparing to Measure Sidestream CO21Plug the sensor cable into the monitor's CO2 input connector. Allow the sensor two minutes warm up time
14 Monitoring Carbon Dioxide2072Connect the cannula, airway adapter, or sample line as appropriate, to the sensor. It will click into place when seated correctly.3To zero the sensor:– expose the sensor to room air and keep it away from all sources of CO2 including the ventilator, the patient's breath and your own.– in the setup menu for the CO2, select Start Zero Cal.– when you see the message CO₂ calibration done at <Date and Time> on the status line, the zero calibration is finished and you can begin monitoring.4For intubated patients requiring an airway adapter: Install the airway adapter at the proximal end of the circuit between the elbow and the ventilator Y-section. For intubated patients with an integrated airway adapter in the breathing circuit: Connect the male luer connector on the straight sample line to the female port on the airway adapter.For non-intubated patients: Place the nasal cannula onto the patient.For patients prone to mouth breathing use an oral-nasal cannula.For nasal or oral-nasal cannulas with oxygen delivery, place the cannula on the patient as shown then attach the oxygen supply tubing to the oxygen delivery system and set the prescribed oxygen flow.
14 Monitoring Carbon Dioxide208WARNINGAlways connect the airway adapter to the sensor before inserting the airway adapter into the breathing circuit. In reverse, always remove the airway adapter from the breathing circuit before removing the sensor.Make sure that you do not accidentally connect the luer connector of the gas sample line to an infusion link or any other links in the patient vicinity.CAUTIONAlways disconnect the cannula, airway adapter or sample line from the sensor when not in use.Using the Sidestream Sensor HolderThe holder delivered with the sensor can be used to clamp the sensor onto an IV pole or a shelf.1Push the sensor into the holder until it clicks into position.2Clamp the holder onto an IV pole, a shelf or another appropriate location.To remove the sensor from the holder, release the clip and pull the sensor out of the holder.Removing Exhaust Gases from the SystemWARNINGAnesthetics: When using the sidestream CO2 measurement on patients who are receiving or have recently received anesthetics, connect the outlet to a scavenging system, to avoid exposing medical staff to anesthetics.Patient cross-infection: Do not return the sampled gas to the breathing system of the patient.Make sure that you do not accidentally connect the exhaust tube to an infusion link or any other links in the patient vicinity.Use an exhaust tube to remove the sample gas to a scavenging system. Attach it to the sidestream sensor at the outlet connector.
14 Monitoring Carbon Dioxide209Measuring Microstream CO2 using M3015A/BThe M3015A/B Microstream CO2 Extension measures the partial pressure of carbon dioxide in a patient's expired gas using Microstream technology.The measurement is equipped with an automatic barometric pressure compensation.WARNINGWhen using the IPI numeric (available for adult and pediatric patients), always ensure that the patient's date of birth is entered correctly and that the monitor is displaying the current date. These two pieces of information are used to calculate the age of the patient, which affects the algorithm used to provide the IPI numeric.Preparing to Measure Microstream CO2Use appropriate accessories for:• the patient type (adult, pediatric or neonatal),• the ventilation situation (including humidification)• the duration - short term use, up to 24 hours (typically OR), or long term use (typically ICU).All accessories are for single patient use only.Using Microstream AccessoriesThe Microstream measurement can be operated with the special Microstream accessories only. Refer to the instructions for use provided with the accessory.For intubated patient with non-humidified ventilation, you can use a Microstream FilterLine set. For humidified ventilation, use a FilterLine H Set.For non-intubated patients, the gas sample is taken through a Nasal FilterLine, or a Smart CapnoLine (which is a combined oral-nasal FilterLine). In parallel to the measurement of the CO2, oxygen (O2) may be delivered to the patient to support gas exchange. This is done by using an O2/CO2 FilterLine, or a Smart CapnoLine O2 (a combined oral-nasal O2/CO2 FilterLine).Using the FilterLine and Airway AdapterWARNINGMake sure that you do not accidentally connect the luer connector of the gas sample line to an infusion link or any other links in the patient vicinity.1Attach the female Luer connector to the CO2 inlet connector by pushing the socket cover aside and screwing the connector clockwise into the CO2 inlet until it can no longer be turned.This will assure that there is no leak of gases at the connection point during measurement and that measurement accuracy is not compromised. Following connection of the CO2 sampling line, check that CO2 values appear on the monitor display.2Check that the FilterLine is not kinked.
14 Monitoring Carbon Dioxide2103Change the FilterLine if a CO₂ Occlusion INOP appears on the monitor or if the readings become extremely erratic.Disconnect the FilterLine during suctioning and nebulizing therapies or suppress sampling by turning off the pump as described in “Suppressing Sampling (not Mainstream CO2)” on page 211.Check the table in the Microstream CO2 Accessories section of the Accessories chapter for typical usage times for the different Microstream accessories.CO2 values for non-intubated patients using Microstream accessories will always tend to be lower than for intubated patients. If values appear extremely low, check whether the patient is breathing through the mouth or whether one nostril is blocked.Removing Exhaust Gases from the SystemWARNING•Anesthetics: When using the Microstream CO2 measurement on patients who are receiving or have recently received anesthetics, connect the outlet to a scavenging system, or to the anesthesia machine/ventilator, to avoid exposing medical staff to anesthetics.•Patient cross-infection: Do not return the sampled gas to the breathing system of the patient.• Make sure that you do not accidentally connect the exhaust tube to an infusion link or any other links in the patient vicinity.Use an exhaust tube to remove the sample gas to a scavenging system. Attach it to the MMS Extension at the outlet connector.Suppressing Zero CalibrationTo prevent an automatic zero calibration from being started in the next five minutes,•in the Setup CO₂ menu, select No Zero for 5min, or select the Suppress CO₂ Zero SmartKey, if configured.Selecting No Zero for 5min or selecting the Suppress CO₂ Zero SmartKey again before the timer has timed out resets the timer to five minutes, unless an AutoZero became due during the previous suppression.Setting up all CO2 MeasurementsThese tasks are common to all CO2 measurements except where otherwise noted.Adjusting the CO2 Wave Scale1In the CO₂ Wave menu or the Setup CO₂ menu, select Scale.2Choose a suitable scale range from the pop-up list.
14 Monitoring Carbon Dioxide211Setting up CO2 CorrectionsTemperature, water vapor in the patient's breath, barometric pressure, and the proportions of O2, N2O and Helium in the mixture all influence CO2 absorption. If values seem inaccurately high or low, check that the monitor is using the appropriate corrections.Suppressing Sampling (not Mainstream CO2)To temporarily stop sampling, in the Setup CO₂ menu, select Pump 15min Off or use the CO₂ Pump Off SmartKey if available.Selecting Pump 15min Off again before fifteen minutes have passed resets the timer to fifteen minutes.To re-start the pump, in the Setup CO₂ menu, select Pump On.Changing CO2 AlarmsThis refers to CO2 specific alarms. See the Alarms section for general alarm information.To change the etCO2 alarm limits, in the Setup CO₂ menu:1Touch the high limit on the alarm limits menu key. 2Choose the high alarm limit from the pop-up list that opens.3Touch the low limit on the alarm limits menu key. 4Choose the low alarm limit from the pop-up list that opens.CorrectionAltitude(M3014A only)Altitude is set during installation. The monitor automatically applies an appropriate correction.O2(M3014A only)In the Setup CO₂ menu, select Oxy. Corr and select a value between 20% and 100%, the default value is 20%.Humidity At installation, the monitor is configured to automatically apply either Body Temperature Pressure Saturated (BTPS) or Ambient Temperature Pressure Dry (ATPD). To see which, go to the Setup CO₂ menu, and scroll down to look at Hum. Corr or Humidity Corr..N2O(M3015A/B microstream only)In the Setup CO₂ menu, select N₂O Corr. and turn on or off. If N2O is present in the ventilation gas mixture, you must turn this on.If the N2O correction is not available in the Setup CO₂ menu, the CO2 measurement in your MMS Extension does not require N2O correction or it is setup with Gas Corr. (see below).Gas(M3014A only)In the Setup CO₂ menu, select Gas Corr. and select Helium, N₂O or turn off. If Helium or N2O is present in the ventilation gas mixture, you must make the appropriate selection.If the Gas correction is not available in the Setup CO₂ menu, the CO2 measurement in your MMS Extension does not require N2O or Helium correction or the N2O correction is setup with N₂O Corr. (see above).Agent(M3014A only)In the Setup CO₂ menu, select Agt. Corr and select the concentration of the anesthetic agent (between 0.0% and 20.0%). If an anesthetic agent is present in the ventilation gas mixture, you must select the appropriate concentration.
14 Monitoring Carbon Dioxide212To change the imCO2 high limit:•Select imCO₂ High and choose the high alarm limit from the pop-up list that opens.Changing the Apnea Alarm DelayThis determines the time limit after which the monitor alarms if the patient stops breathing.1In the Setup CO₂ menu, select awRR.2In Setup awRR menu, select Apnea Time.3Choose the apnea alarm delay time.WARNINGSafety and effectiveness of the respiration measurement method in the detection of apnea, particularly the apnea of prematurity and apnea of infancy, has not been established.Prolonged delay: The selected apnea alarm delay may be prolonged by up to 17 seconds, if an apnea occurs during the automatic zero process. This applies to the Microstream (M3015A) measurement only.Deriving Alarms From awRR1In the Setup CO₂ menu, select awRR.2In the Setup awRR menu, select Alarms.3Choose On to derive alarms from the airway respiration signal or Off to disable them.Changing awRR Alarm Limits1In the Setup CO₂ menu, select awRR.2Select High Limit to set the upper alarm limit.Select Low Limit to set the lower alarm limit.3Select the appropriate setting.Changing IPI Alarm Limits1In the Setup CO₂ menu, select IPI.2Select Low Limit to set the low alarm limit.3Select a value between 2 and 9.If you also have monitors with earlier software revisions than J.0, the IPI low alarm will not be generated after a transfer to one of these monitors, or when a monitor/MMS with the IPI functionality is connected to one of these monitors in companion mode. In this case, do not rely only on the IPI low alarm but leave the individual alarms switched on (etCO2, awRR, pulse rate and SpO2) so that these alarms can be generated in such situations.
14 Monitoring Carbon Dioxide213Understanding the IPI NumericThe index is modeled on normal healthy patients (ASA Physical Status value of 1 according to the ASA Physical Status Classification System). Patients with ASA Physical Status values of 3 or higher are expected to have low IPI values by definition. Therefore, for patients with an ASA Physical Status value of 3 or higher, the index may have no added value.The value of the Integrated Pulmonary Index given in the IPI numeric is associated with the patient status as follows:NOTEThe interpretation of the patient's IPI score may change in different clinical environments. For example, patients with specific respiratory difficulties (in contrast to normally healthy patients who are being monitored during sedation or pain management) may require a lower IPI Low Alarm threshold to reflect their impaired respiratory capacity.The IPI is available for all three groups of pediatric patients (1-3 years, 3-6 years, and 6-12 years), and for adult patients.WARNINGEnsure that the patient category and date of birth are set correctly before monitoring a patient's IPI. An incorrect patient category or date of birth could produce incorrect IPI data.IPI Patient Status10 Normal8-9 Within normal range7 Close to normal range; requires attention5-6 Requires attention and may require intervention3-4 Requires intervention1-2 Requires immediate intervention.
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1521515Using a Telemetry Device and a MonitorThe information here is for the "monitor plus telemetry" workflow with a PIIC. Refer to “Managing Equipment” on page 95 for information on corresponding workflows with the PIIC iX.It is possible to assign a monitor and a telemetry device to the same patient, resulting in the information from both devices being combined in one sector at the Information Center. This is called "pairing" and when a telemetry device and a monitor are paired, the measurement data from the telemetry device will be displayed on the monitor screen.A telemetry device can be:• any Philips telemetry device (only for indirect connections, see below).• a TRx/TRx+ IntelliVue Telemetry system transceiver.For complete user information, including accessory listings and specifications, for the M4841A/M4851A TRx/TRx+ IntelliVue Telemetry Transceiver, refer to the Instructions for Use provided with the device.How Can You Combine Devices?•With an indirect connection, using standard telemetry transmission - the data are sent to the monitor via the Information Center and arrive with a delay of several seconds at the monitor.•With a direct connection to the monitor, via a short range radio link - the data arrive with a minimal delay on the monitor screen.Indirect Connection - Manual PairingThe telemetry device can be paired with the monitor at the Information Center or at the monitor. For detailed information regarding pairing and configuration at the Information Center, see the Information Center Instructions for Use.To pair the monitor with a telemetry device at the monitor:1Select Main Setup then Measurements2Select TelemetryThe Setup Telemetry menu will appear with only one entry Paired Equipment.3Enter here the equipment label of the telemetry device to be paired.
15 Using a Telemetry Device and a Monitor216Pairing at the monitor is only possible when the monitor already has a connection to the Information Center and the Information Center software version allows pairing at the monitor.Own Patient Overview WindowThe measurements from the telemetry device are shown in the own patient overview window on the monitor when there is no direct connection via short range radio link.See “Own Patient Overview Window” on page 98.Direct Connection - Automatic PairingThe following direct connections are possible:• a TRx+4841A/4851A IntelliVue Telemetry system transceiver connected via short range radio (SRR) link to an MP2 with SRR capability.If a telemetry device is assigned to a monitor via a direct short range radio link, the monitor and the telemetry device are automatically paired at the Information Center (if configured).The measured data from the telemetry device - ECG and, if available, SpO2T - will appear on the monitor screen and will be sent through the monitor to the Information Center. The ECG waves and numerics appear in place of the monitor's own ECG, and SpO2T is displayed as an additional measurement. When ECG is measured with the telemetry device there will be no Respiration measurement derived.WARNING• When ECG is being measured with a telemetry device directly connected to the monitor, there will be no ECG signal available at the ECG analog output or ECG Sync Pulse output and no synchronization marks on the ECG wave. A No ECG Out message will appear in the ECG wave channel.• When a telemetry device is connected to the monitor, arrhythmia relearning is initiated, and again when the telemetry device is disconnected.• Controls on the Telemetry Device (e.g. nurse call) will be inactive when the device is directly connected to the monitor except in the case when the monitor has no network connection and data are transferred via the telemetry device.See the “Enhancing Telemetry Monitoring with the Monitor” chapter.Assigning a Telemetry Transceiver with an SRR Adapter to a MonitorA telemetry device with a short range radio adapter can be assigned to a monitor directly.Monitors which have this capability have a short range radio symbol on the model label.NOTEIf the monitor is using the MBAN frequency band (2.360 - 2.400 GHz, for US / FCC regulated countries only), direct assignment of a telemetry device is not possible. If problems occur with the direct assignment, contact your service personnel to check the frequency band used.
15 Using a Telemetry Device and a Monitor217To assign a telemetry device to a monitor:1Press the Check button on the telemetry device.The measurement selection key on the monitor will change to show the "add cableless" symbol 2Select the symbol.3In the Add Cableless window, select the correct equipment label for the telemetry device.4Check that the assignment is successful and that transmission has begun:•A Tele Device assigned message appears on the monitor• A tone sounds at the telemetry device and the Leads Off indicators light• The ECG wave appears on the monitorTo confirm that the correct telemetry device has been assigned, open the ECG Setup menu. The title of the menu contains the equipment label of the telemetry device; check that this is the correct label.If a telemetry device is already assigned to a monitor, you cannot assign a further telemetry device to that monitor.If the telemetry device goes out-of-range or loses the short range radio connection, it will switch over to standard telemetry transmission to the Information Center. In this case, the telemetry data is displayed in the Own Patient Overview Window as described above.When a telemetry device with a short range radio adapter is assigned to the patient, the short range radio connection to the monitor is made automatically.If a telemetry device disappears from the list in the Add Cableless menu, press the Check button on the telemetry device again. If the monitor is not configured to be used with a telemetry device, the add cableless symbol will appear crossed out .If the telemetry device is removed (unassigned), the short range radio connection will be ended.WARNINGShort range radio connections are subject to interruption due to interference from other radio sources in the vicinity, including microwaves, bluetooth devices and DECT phones. Outside the operating frequency band and 5% above and below, i.e. the exclusion band according IEC 60601-1-2, section 36.202.3a)4), the short range radio connection is immune up to 3V/m in the frequency range from 80 MHz to 2.0 GHz and up to 1V/m in the frequency range from 2.0 to 2.3 GHz. Depending on the strength and duration of the interference, the interruption may occur for an extended period. A loss of connection, due to moving out-of-range, interference, or for other reasons, is indicated with a Tele Disconnected INOP.Correct channel configuration is important, refer to the Configuration Guide for details.If a Tele Disconnected INOP occurs when the telemetry device goes out-of-range, the INOP will disappear (without being silenced) as soon as the ECG signal from the telemetry device is available at the Information Center via standard telemetry transmission.
15 Using a Telemetry Device and a Monitor218Unpairing the Monitor and Telemetry DeviceIf the patient will no longer be monitored with the telemetry device, or only with the telemetry device and no longer with the monitor, you need to end the device pairing. After unpairing, the Information Center will receive data exclusively from the monitor or from the telemetry device:• select the Unpair To Mon. SmartKey to end pairing and have the Information Center receive the measurement data from the monitor• select the Unpair To Tele SmartKey to end pairing and have the Information Center receive the measurement data from the telemetry deviceoruse the Unpair function at the Information Center.NOTEThe SmartKeys and pop-up keys for unpairing appear only on the monitor which is directly involved in pairing.Temporarily Stopping the Short Range Radio ConnectionTo temporarily disable the SRR connection for this device, for example, in case of interference:1Open the Equipment window - either directly in Main Setup or by selecting the bed label in the information line.2Select the telemetry device.3Select Disable SRR in the menu displayed.This closes the SRR connection and the telemetry device switches over to standard telemetry transmission.To return to SRR use:•Select Enable SRR and press the check button on the telemetry transceiver.
1621916Enhancing Telemetry Monitoring with the MonitorYou can use a monitor without a network connection to view measurement data from a telemetry transceiver at the bedside. You can also use the monitor to make additional measurements and send this measurement data to the Information Center via the telemetry transceiver. The monitor can so be used as a mobile viewer and measurement device, and is set up to simplify the assign/unassign procedures when used with short range radio.Monitor and Telemetry Transceiver RequirementsThe monitor and the telemetry transceiver need a direct connection via a short range radio link. Not all revisions of the telemetry transceiver can be used directly with the monitor, if you connect a device that cannot be used you will see a Tele Unsupported INOP.Data Sent to the Information CenterThe data sent to the Information Center includes numerics from NBP, SpO2, Pulse from SpO2 and predictive temperature. INOPs from these measurements, battery INOPs and a general INOP generated by alarms from any other measurement (More Bed Alarms) will also be transmitted.NOTEThe monitor must be configured appropriately to support direct connection to a telemetry transceiver; refer to the Configuration Guide for details.Changing Assignment to a New Telemetry Transceiver1Assign the telemetry transceiver to the monitor; see “Assigning a Telemetry Transceiver with an SRR Adapter to a Monitor” on page 99.2Make the required measurements; the data will be automatically sent to the Information Center via the telemetry transceiver.It is not necessary to unassign the telemetry transceiver. This will happen automatically when the next telemetry transceiver is assigned. The patient is also discharged (if configured), ensuring that the measurement data is erased before data from the next patient appears. Always assign the telemetry transceiver before you start making measurements.
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1722117TrendsTrends are patient data collected over time and displayed in graphic or tabular form to give you a picture of how your patient's condition is developing. Trend information is stored in the trends database for continuously-monitored measurements, such as ECG, as well as for aperiodically-measured parameters, such as Cardiac Output.Viewing TrendsTrend information can be viewed embedded as a screen element on specially-designed Screens, or you can open a trend window over the current Screen.• To view trends embedded as a screen element, enter the Change Screen window, then select a Screen designed to show an embedded trend window.• To open the tabular trends window over the current Screen, select Main Setup, Trends, then Vitals Trend, or select the Vitals Trend SmartKey .• To open the graphic trends window over the current Screen, select the Graph Trend SmartKey .The trend windows open displaying the most recent data and are updated as new data is stored. A timescale along the bottom or the top of the screen shows you where you are in the trends database. The preview column on the right-hand side shows the latest available measurement value. The preview column is updated every five minutes or whenever an NBP or other aperiodic measurement is completed.A question mark (?) beside a value means that the data may not be reliable, due perhaps to an INOP condition in the measurement.Your monitor screen may look slightly different to the examples shown in this chapter.Trends Pop-Up KeysWhen you open the graphic, tabular or histogram trends window, a selection of pop-up keys appears to let you navigate through the stored trend data and carry out trends-related tasks.
17 Trends222Pop-Up Keys Selecting this pop-up key lets you....Select Group see a pop-up list of trend groups and select a group for viewing.Select Interval see a pop-up list of available data resolution settings and select the level of detail shown in the trend view.Print/ Record print a tabular trends report or make a tabular trend recording of the data in the current window. The report will use the current trend interval settings.Print print a graphic trends report or histogram report of the data in the current window. The report will use the current trend interval settings.move the cursor one step to the left or right to navigate through the trends database timeline.move the cursor one page to the left or right to navigate through the trends database timeline.jump to the beginning or the end of the trends database to see the most recent or oldest trend information stored.scroll up and down the screen to see measurement trends that do not fit in the current view.Vital Signs open the current trend view in tabular form. The displayed time period and resolution stay the same.Graph Trend open the current trend view in graphic form. The displayed time period and resolution stay the same.Data Source select a realtime SpO2 or realtime system pulse or trended data for display in the histogram.Period select a time period for the histogram.Select Range define the range of values to be displayed in the histogram by selecting an upper and a lower limit.Column select a column width for the histogram. For each width selection the resulting number of columns is shown.Curve On/Off switch the display of the cumulative value columns in the histogram on or off.Adjust Cursor open a new set of pop-up keys for switching on cursors and setting their positions.
17 Trends223Viewing Graphic Trends1Scroll to view more pop-up keysA cursor spanning all measurements in the trend group helps you to navigate through the trends database and shows you your current position in the database. When the cursor is moved across the time line, the values measured at the cursor time are shown in the right hand column.In graphical trends, aperiodic measurement trends are shown as an asterisk, NBP has a special symbol.To use the trend cursor to navigate in time through the trends database,1Select the graphical trend or the arrow pop-up keys to activate the cursor.2Use the arrow pop-up keys to move the trend cursor backwards and forwards in time, or3Place the cursor at a specific time by touching the graph.Viewing Vital Signs Trends
17 Trends2241Aperiodic values are shown with a timestamp2Scroll to view more pop-up keysThe currently-selected column is highlighted. The values can be configured to display in the same colors as the waves and numerics on the realtime display.Any values available for display before the next scheduled update are shown in the right hand column, with a timestamp in brackets.If more than one value is available for an aperiodic trend for a certain trend period, all measured values are stored in the database and the value closest to the timestamp is shown in the Vital Signs display marked with an arrow.To view the Vital Signs trend with one column for each NBP measurement (see “Defining the Column Interval Using the NBP Measurement” on page 227):1With the Vital Signs trend open, select Interval.2Select NBP from the pop-up list. Setting Up TrendsTrends are set up in Configuration Mode. You can make temporary changes to trends settings such as trend groups, priorities, or scales in Monitoring Mode. The general settings for all Trends are under Main Setup, Trends.Settings for a single segment in graphical trends or for the corresponding trend group can be made more easily in that segment menu.Making Segment SettingsThe Graphical Trends window is divided into measurement segments, each of which has its own settings.To enter the segment menu,• select the left hand column of the segment, where the measurement label is displayed.Expanded ViewTo expand the segment to fill the Graphical Trends window,•in the Segment menu, select Expand to have that segment enlarged to fill the window.In the expanded view, you can also highlight a measurement to make it more easily visible (for example when multiple ST trends are in one segment). To highlight a measurement,•in the Segment menu, select Highlight repeatedly until the highlight is on the required measurement.To return the segment to its original size,•in the Segment menu, select Expand again.Trend Scales for Segment MeasurementsTo change the trend scales for a measurement in the current segment:1In the Segment menu, select the measurement label.2Select Upper to change the upper limit of the scale or Lower to change the lower limit of the scale.
17 Trends225Optimum ScaleTo have the monitor automatically select an optimum scale for viewing, based on current values,•in the Segment menu, select Optimum Scale.This scale change is temporary. When the graphical trend window is closed the scale reverts back to the setting in Parameter Scales.To switch off automatic optimum scaling,•in the Segment menu, select Optimum Scale again.Trend GroupTo add or remove measurements for this trend group or change the order of the existing measurements:1In the Segment menu, select Change Group.2Use the Add, Change, Sort Up and Sort Down pop-up keys to change or re-order the group as required.Number of SegmentsIn an embedded graphical trend window, you can select the number of segments to be displayed in the Segment menu:•In the Segment menu, select No. of Segments.Trend GroupsThe measurements grouped in trend groups define the trends displayed together in the Vital Signs or Graphical Trends windows and printed in trends reports and recordings. The sequence of the measurements in the group defines the order in which they are displayed. Measurements listed between dotted line separators are displayed overlapping. The trend group All contains all available measurements, you cannot change the order or selection of this group.To change the selection of measurements in a trend group, either use the Change Group setting in the Segment menu or:1Select Main Setup, Trends, then Trend Groups.2Select the Trend Group you want to change and use the pop-up keys to Add, Change, or Delete the selection of measurements trended.To temporarily change the order in which the measurements are displayed in a group,1Select Main Setup, Trends, then Trend Groups.2Select the Trend Group and then the measurement you want to move and use the Sort Up/Sort Down pop-up keys.Trend IntervalThe trend interval defines the resolution of trend data shown on the Screen.To set the trend resolution, in the Vital Signs or Graphical Trends window,• Select the Select Interval pop-up key and then select the required interval from the list.
17 Trends226Trend PriorityThe monitor stores trend information for all monitored measurements, if configured to do so. If your configuration restricts the number of measurements trended, you must choose which measurements will be included. A priority list is used to select the trended measurements.To see the measurement priority list for trending,1In the Main Setup menu, select Trends.2Select Trend Priority.To add measurements to the priority list,1Select the pop-up key Add and choose from the pop-up list of available measurements.2Use the Sort Up and Sort Down pop-up keys to change the priority order.Trend Parameter ScalesParameter scales define how the trend waveform will appear on the screen and in trend reports. Separate scales can be set for adult, pediatric, and neonatal patient trends. To change the trend parameter scales settings, either use the Scale setting in the Segment menu or:1In the Main Setup menu, select Trends.2Select Parameter Scales.3Select the measurement or parameter you want to change from the list.4Select the pop-up key Change to call up the Scale menu.5In the Scale menu, select the parameter label you want to define settings for. Select Adult, Pedi, and Neo and use the pop-up keypad to enter new upper and lower scale definitions.Graphical Trend PresentationGraphical trends and screen trends for measurements with compound values (for example ABP or CO2) can be viewed in line or band form.To change the presentation style,1Select Main Setup then select Trends.2Select Global Style and choose•Line to display the trends as a continuous line•Band to fill the area between the trend lines, for example, between the systolic and diastolic pressures, with color.This sample ABP trend shows the continuously-measured values for the systolic, diastolic and mean pressures displayed in band form.
17 Trends227Defining the Column Interval Using the NBP MeasurementYou can have the NBP measurement determine the interval between the columns on the Vital Signs trend. Each NBP measurement will generate a column in the trend table. The values for the other measurements are added to the column to provide a complete vital signs set for the NBP measurement time. To use the NBP measurement to determine the column interval:1Select Main Setup then Trends.2In the Trends menu, select Setup VitalSigns.3In the Vital Signs menu, select Column and then NBP from the pop-up menu.Documenting TrendsTo print a Vital Signs or Graphical Trends report,•in the Vital Signs or Graphical Trends window, select the pop-up key Print to print a report for the trend group currently on the monitor screen.Reports include the most recent information in the trends database and extend backwards in time according to the selected trend interval and your monitor's configuration. Trends reports can be printed on central or local printers.Trends DatabasesThe trend databases store information for up to 16 measurements for up to 48 hours.The values in the trends database are stored as measured by the monitor, they are not averaged values. The trend resolution defines how often a value is stored. In general, if more than one value is available for storage in the trends database, the most recent value is used. Some values in the trends are marked with arrows. This indicates that for this time period, more values were available and the most recent one is shown.Example database configurationIn this example, we see that the monitor stores the most recent data at the highest resolution, older data are stored at a lower resolution."4 hours @ 12 second resolution" means that the monitor stores trend data every 12 seconds, for the most recent four hours.
17 Trends228Aperiodic Trends DatabaseAperiodic trends do not count toward the maximum number of trends allowed by the trend configuration. Trend data for aperiodic measurements is stored in a separate database and timestamped with the measurement time.Trending Multiple-Value MeasurementsSome measurements generate multiple values, for example invasive pressure measurements can provide systolic, diastolic, and mean values. These values are trended as separate measurements.Screen TrendsTrends configured to display permanently on special monitor Screens are called Screen Trends. The selection and number of measurement waves in the Screen Trend segment depends on your monitor configuration. Screen Trends are color-coded to match the measurement wave and numerics, and they can be viewed in graphical, tabular, histogram or horizon format.If you do not see Screen Trends on the monitor Screen, select a different Screen, one that is configured to show Screen Trends. Screen Trends are only available on specially designed Screens.Screen Trend information is taken from the Trends database. If you do not see a Screen Trend for a particular measurement on the Screen, check the trend priority list to ensure that this measurement is being trended.Setting the Screen Trend TimeTo set the ScreenTrend Time for all graphical, histogram and horizon screen trends ("global" trend time),1Select a screen trend then select Setup Trend, or select Main Setup then select Trends.2Select ScreenTrend Time and select the required time: 30 minutes, one, two, four, eight, or twelve hours.This is now the Global screen trend time and defines the period of trend information shown for all screen trends.To set a different ScreenTrend Time for a screen trend or a group of aligned screen trends,1Select a screen trend.2Select Change TrendTime.3Select the required trend time.Selecting Global leaves the trend time set to the global screen trend time.Changing the Selection of Screen Trends Displayed1Select the screen trend.2Select Change Trend and select the required trend from the list of available trends.Select Blank to remove the selected trend from the Screen.If you do not see Change Trend in the screen trend menu, the trend is aligned to display with the measurement wave. Changing the wave automatically changes the trend.
17 Trends229To display two or more screen trends overlapping,1Select the screen trend to open the screen trend menu,2Select Change Trend followed by Add Trend and select a screen trend from the pop-up list.Activating the Cursor for Screen TrendsTo activate the cursor for Screen Trends:1Select the screen trend.2Select Activate Cursor.You can now use the arrow keys to move the cursor across the time line. The values measured at the cursor time are shown next to the cursor.To de-activate the cursor,• Press the Main Screen key.Changing the Screen Trend ViewTo switch between tabular, graphic, histogram and horizon views, select the screen trend then select Change View and select the required view.Tabular ViewAperiodic measurements such as NBP, can be viewed as a screen trend in tabular form. The measured values and their timestamps are shown, with the measurement label.Horizon ViewThe horizon view presents trend information superimposed over a defined baseline or base range. This helps you visualize changes in your patient's condition since the baseline was set.The horizon view is made up of:• a horizon, drawn in white, as a reference point or baseline to help you visualize changes in your patient's condition. The horizon can be set to represent your patient's current condition, or a target condition and can be a single value or a range.• a graphical trend, displaying patient data for the set TrendTime (1).• a trend indicator arrow, indicating how the patient trend has developed in the set time period (10minutes, 5minutes or 2minutes) (2).
17 Trends230• a deviation bar, showing how the currently measured value deviates from the set horizon (3). The height of the deviation bar is an indication of the extent of the change in your patient's condition relative to the (horizon) baseline.Your monitor may not be configured to show all elements of the screen trend horizon view.Setting the HorizonThe horizon is the reference value to which deviations in the measurements are compared.To set the horizon:1Select the horizon trend.2Select–Set High Horizon to select the upper horizon value. If the high and low horizon values are the same, the horizon is a baseline - if the values are different the horizon is a range.–Set Low Horizon to select the lower horizon value.–Auto Horizon to set the horizon for the selected horizon trend to the currently-measured value.–Auto All to reset the horizon for all horizon screen trends to the currently-measured values.–Set Horizon to set the horizon to a specific value from a pop-up list.Setting the Horizon Trend ScaleThe horizon trend scale is defined with respect to the horizon. If your horizon is set to 100 and you select 20 as the horizon scale delta, the upper limit of the horizon scale will be 120 and lower limit 80.To set the horizon trend scale delta,1Select the horizon trend.2Select Set Scale Delta and select a value to define the distance between the horizon and the upper and lower scale limits.Be aware that changing the horizon trend scale can change the angle of the trend indicator, without the patient's condition having changed.If a measurement exceeds the outer limits of the scale, the wave will be clipped and you must either reset the horizon or the horizon trend scale to display the values outside the scale limits.Setting the Time Period for the Trend Indicator ArrowThe time period for which the trend indicator arrow is displayed can be set in the Trends window.1Select Main Setup then select Trends.2Select HorizonArrowTime.3Select 10, 5 or 2 minutes.
1823118RecordingCentralRecording For central recording from the bedside, your monitor must be connected via a network to an Information Center. You can use either the M1116B/C or 862120 2-Channel Recorder or the standalone M3160A 4-Channel Recorder. Recordings made on the M3160A may look slightly different to those described here. See the documentation supplied with the Information Center for information on the 4-Channel Recorder.Starting and Stopping RecordingsThe recordings pop-up keys let you start and stop recordings. Select the Main Setup SmartKey then select Recordings to call up the line of pop-up keys. Scroll right or left to see any pop-up keys not displayed.Recording Without a TemplateTo record without a preconfigured template, selecting the waves you require,1Select the Main Setup SmartKey, then select Recordings.2Select the pop-up key Select Waves.3Use the pop-up keys to choose up to three measurement waves to be printed on the recording. If you want fewer than three waves on the recording, select the waves you want then select the Continue pop-up key.4Select one of the recording speed pop-up keys to set the required recording speed.5Select the Start pop-up key to start the recording.Select Waves recordings use default values for any recorder settings not defined: runtime is continuous, overlapping is set to non-overlapping.Delayed RecordngRT A RecordngRT B RecordngSelect WavesSetup RecordngStop All Recordng
18 Recording232Overview of Recording TypesCreating and Changing Recordings TemplatesTo save you defining recording settings each time you start a recording, you can create templates for commonly-used types of recordings in the Setup Recordings menu. You can create templates for one delayed recording, one alarm recording and two realtime recordings (Realtime A and Realtime B).Changing recordings templates changes the settings that will be used each time a recording of this name is triggered.1Select the Main Setup SmartKey to call up the Main Setup menu.2Select Recordings.3Select the Setup Recordng pop-up key to enter the Setup Recordings menu.4Select the name of the template you want to create or change. Each recording name is linked to a recording type: delayed, alarm, and realtime. Recording names can be changed in the monitor's Configuration Mode.5Design the template by selecting each menu item and entering the information for the template.•Recorder: choose which recorder the recording will print to (Central 2-Ch or Central 4-Ch recorder, or a printer (for realtime reports in alarm recording only)). •Channel 1, Channel 2, etc.: choose which waveform to record in each channel.In addition to the currently available waves, you can choose from several other settings which make an automatic allocation when the recording starts:–Alarm Par will always record the measurement in alarm in the chosen recorder channel–Primary Lead will always record the current primary lead in the chosen recorder channel–SecondryLead will always record the current secondary lead in the chosen recorder channel•Overlap: define whether the recorded waveforms will be printed overlapping or beside each other.Delayed Alarm Realtime (RT)Type of recording manual automatic, triggered by defined alarm conditionsmanualRecording Destinationcentral central printer centralInformation recordedfrom the start trigger minus the delay timefrom the start trigger minus the delay timen/a from the start triggerNumber of waves up to 2 up to 2 n/a up to 2Speed 50, 25, 6.25 mm/sec 25 mm/sec n/a 50, 25, 6.25 mm/secRuntime n/a n/a n/a continuouslyStops automatically automatically n/a manuallyDelay Time 10, 15 seconds 10, 15 seconds n/a noneOverlap OffOn (up to 2 waves)OffOn (up to 2 waves)n/a OffOn (up to 2 waves)n/a = not applicable
18 Recording233•Speed: choose the recording print speed.•Delay Time: Delayed recordings start documenting on the recorder strip from a pre-set time before the recording is started. This interval is called the "Delay Time" and can be set as specified in “Overview of Recording Types” on page 232. This setting can only be changed in Configuration Mode.•Run Time: see how long this type of recording is configured to run. This setting can only be changed in Configuration Mode. Continuous recordings run indefinitely.•Central Config - if available in the General menu, select this setting to use the recording settings made for the centrally-connected recorder.Maintaining Recording StripsRecording ink sometimes fades when covered with transparent tape. Avoid covering any part of a recording that is clinically relevant (annotation or waveforms) when taping a recording strip to a patient record or other patient documentation.Recorder Status MessagesCAUTIONIf no central recorder is available, alarm recordings may be lost. The message No alarm recording available will be displayed. This message is not shown if Printer is configured as the alarm recording destination.Recorder Status Messages Explanation<Recording Name> running The named recording is currently running.No alarm recording available No recorder available. Alarm recordings will be lost.Try configuring Printer as the alarm recording destination.Central Recorder out of paper The named recorder is out of paper.Central Recorder door open The door of the specified recorder is open.
18 Recording234
1923519Printing Patient ReportsStarting Report PrintoutsMost patient reports can be printed by selecting Main Setup then Reports (or the Print Reports SmartKey) and then selecting the report name in the top half of the Reports menu. Report names are shown only for reports that have been correctly set up.Data from the time of the print request is printed, even if the print job is delayed in the printer queue.Your monitor can also be set up to automatically print all reports when a matching printer is available. To set this up1Select Main Setup, then select Reports.2Select Auto Print Dbs.–Always will print all reports when a matching printer is available.–Never will print no reports automatically; all reports stored in the database must be manually sent to the printer. See “Checking Report Status and Printing Manually” on page 240.Printout LocationDepending on availability, reports can be printed:• on printers connected to the Information Center,• to an IntelliVue XDS Application print service,• to an external PC-based print server with Philips server software,• into the print database.Print jobs stored in the database are automatically printed when a print device with a matching paper size becomes available.Print jobs in the print database are not deleted after a patient discharge. A new patient can be admitted and their reports are saved in addition to the previous reports. Always admit your patient so that reports can be clearly assigned to a patient.
19 Printing Patient Reports236Starting the Different Types of ReportStopping Reports PrintoutsTo stop Reports printing, in the Reports menu, select•Delete Report to stop the current print job•Delete All Repts to cancel all queued report printouts•Scheduled Rep. to select Off and switch off scheduled reports.Setting Up ReportsThe content you define in the individual Setup Reports menus will be used in all reports of this type: for example, if you set a print speed of 50 mm/sec in the ECG Reports menu, every ECG report will be printed at this speed, irrespective of format.ECG report layout and Auto Reports settings must be defined in Configuration Mode.Setting Up ECG ReportsThe settings you choose in the ECG Reports menu apply for all ECG-A and ECG-B reports printed. To set up ECG Reports,1Select Main Setup, Reports, then ECG Reports. Note the report layout configured for your monitor, either Internat or Cabrera. This setting is inactive ("grayed-out") in Monitoring Mode and can only be changed in Configuration Mode.Report types Report contents How to start printing reportsVital Signs Report Depends on selected trend group, data resolution, and period.In the Vital Signs window, select Print/ Record, then select Print.Graphic Trends Report In the Graphical Trends window, select Print.ECG Reports Depends on format selected. Select the ECG Report A, or ECG Report B SmartKeys, if configured, or the Print Reports SmartKey followed by ECG Report A or ECG Report B.12-Lead Report Captured ECG waves, measurement values, ST Map (optional) and analysis results from the Information Center (PIIC iX only)In an active 12-Lead application window, select the Print Report pop-up key.ST Map Report ST data in a transversal and/or horizontal multi-axis diagramIn the ST Map (Current) or ST Map (Trend) window, select Print.Alarm Limits Report Graphic and numeric report of all current alarm limitsIn the Alarm Limits window, select Print Limits.Realtime Reports Patient data and numerics, and either: all displayed waves OR all measured waves OR all measured RT wavesSelect the Realtime Report SmartKey, if configured.Battery Report Battery serial number, information on the currently-measured and potential charge status of the batteryIn the Battery Status window, select Print Status.Central Report A/B/C These are reports configured at the Information Center. Monitors connected via the IntelliVue Instrument Telemetry wireless network can have these reports available.In the Main Setup select Reports then Central Report A, Central Report B or Central Report C.
19 Printing Patient Reports2372Select ECG Gain and set the required ECG gain to define how ECG waves will appear on the ECG report printouts.3Select Speed and select the report print speed.4Select Annotation and switch to On if the printed ECG wave should be annotated with beat labels. See the “ECG, Arrhythmia, ST and QT Monitoring” chapter for a list of beat labels. Pace pulse marks are automatically printed beside the wave for paced patients.Setting Up Vital Signs and Graphic Trend ReportsThe settings you choose in the Vital Signs Report and Graphical Trend Report menus apply for all Vital Signs and Graphic Trend reports printed.To set up Vital Signs and Graphic Trend reports,Select Main Setup, Reports, then Vital Signs Rep. or Graph Trend Rep..1Select Trend Group and select the group you want to print on the report. The groups available depend on your monitor's trend configuration.2Select Period and select the period of time for which trend data should be printed on the report. If Automatic Period is configured to On, all trend data for the current patient will be printed, irrespective which trend period is selected.3Select Interval (Vital Signs Reports only) and select the resolution of the trend data printed on the report.Setting Up Auto ReportsAuto Reports print automatically when a specified trigger occurs. There are two types of Auto Reports: Scheduled Reports, which print at predefined intervals, and End Case Reports, which print when a patient is discharged using the End Case function. An Auto Report can be both a Scheduled Report and an End Case report.To set up Auto Reports,1Select Main Setup, Reports, then Auto Reports and select the Auto Report you want to set up (A, B, C, or D).2Select Report and assign a report type to the Auto Report.3Select End Case Report and switch to On if you want the selected report to print automatically when you select End Case to discharge a patient.Switch End Case Report to Off if the report is a Scheduled Report only.4Select Scheduled Rep. and toggle to On if you want the selected report to print at predefined intervals, starting at a predefined time of day. The start time you set applies for every following day. For example, if you set a start time of 07:00 and a repeat time of six hours, the first report will print at 07:00 every day, the next at 13:00 and so on.– To set the time of day at which you want the report to print every day: select Start Hour and Start Minute and select the required time from the pop-up list– To set the time interval in minutes between two scheduled reports: select Rep. Freq. (h) and Rep. Freq. (min) and select the time interval from the pop-up list.If you are setting up an end case report, these settings will be inactive ("grayed-out").Switch Scheduled Rep. to Off if the report is an End Case Report only.5Repeat the procedure for all Auto Reports you want to set up.All Auto Reports or Scheduled Reports set to On print automatically at the predefined trigger.
19 Printing Patient Reports238Be aware that the monitor's memory for reports is limited. The number of reports that can be stored depends on the size of the reports and the size of the printing database; the maximum is 30 reports. If the memory is full, reports cannot be saved on the printing database and therefore cannot be printed.If you set up regular scheduled reports, and you have long case durations, make sure that the print database is configured to Large and plan to print reports at appropriate intervals in order to avoid losing information due to a full memory.Setting Up Individual Print JobsTo adjust the appearance of individual print jobs, in the Reports menu,Select Main Setup, Reports, then Setup Reports to enter the Setup Reports menu.1Select Report and then select the report you want to set up.2Select Report Type and then select the reports template you want the report selected in Step 2 to use. The selection of templates listed depends on the report type selected.Each template includes patient demographic data, and each Realtime Report also includes alarm and INOP information. In addition, the templates include:VisibleWaves: all waves currently visible, in the order they appear on the screen.All Waves: all measured waves.RT Waves: all currently measured realtime waves, according to the monitor's priority list.Vital Signs: trend information in tabular form.Graph Trend: trend information in graphic form.ECG3x4, ECG6x2, ECG12x1, ECG4x2, ECG8x1,ECG12x1 (2P): ECG reports.Alarm Limits: a list of all currently set alarm limits.3Select Report Size to set the paper size to be used for the report: Unspecified to use the default size for the template chosen, Universal, A4, Letter, LrgUniversal, A3, or Ledger. The list of available sizes depends on the report type selected.4Select Orientation to set the orientation of the report printout: Unspecified to use the default size for the template chosen, Landscape or Portrait.5Select Target Device and choose which printer the print job will be sent to: Unspecified to use the default printer, or choose from the list of printer names defined at the Information Center or in the monitor's Configuration Mode (for example, Remote 1 or Database).Some settings may be inactive ("grayed-out") in this menu for reports that can only be started in a special window.Checking Printer SettingsThe printer settings for your monitor are defined in Configuration Mode. The printer settings Paper Size, Resolution, Color Support, and Duplex Option for the active printer are visible but inactive ("grayed-out") in the Setup Printers menu. When Print Database is selected as active printer only the Paper Size setting will be shown.• To enter the Setup Printers menu, in the Reports menu, select Setup Printers.If you are using an IntelliVue XDS Application print service, you may see XDS printers in the Setup Printers menu that have "Local" or "Remote" in their name. Their names and settings can only be configured in the XDS Application. Refer to the IntelliVue XDS Application Installation and Configuration Guide for full details about the configuration possibilities.
19 Printing Patient Reports239Printing a Test ReportA test report can be printed in Configuration mode, refer to the Service Guide for details.Switching Printers On or Off for ReportsYou can enable or disable printer status to switch individual printers on or off for report printouts.1In the Setup Printers menu, select Printer and then select the name of the device you want to switch on or off for Reports printing from the pop-up list.2Select Printer Status to switch between the settings Enabled and Disabled. If you set this to Disabled, no reports will be printed to the named printer.If the monitor detects that no printer of a particular type is available, the Printer Status setting will automatically be set to Disabled and "grayed out".Local printers from the XDS Application print service are always enabled and cannot be disabled here.Dashed Lines on ReportsIf a section of a wave on a report is drawn with dashed lines, this tells you that a setting that affects the appearance of the wave on the screen was changed while the report was printing.For example, if you change the wave scale while a report is printing, the wave scale and wave size are changed immediately on the monitor screen and on the report. To indicate that the scale information printed at the beginning of the report no longer matches the currently used scale, the wave will be printed using dashed lines, starting from the moment the change took place.Some examples of settings that cause dashed lines in reports if changed during printing are: Filter mode, ECG lead placement, wave scale, measurement unit, paced/non-paced setting, and measurement mode. Note that as ECG waves are drawn with a fixed gain on reports (either 10 mm/mV or 20 mm/mV), changing the ECG wave scale will not cause dashed-line reports.To avoid dashed lines on reports, wait 15 seconds after changing a setting before you trigger a report.Unavailable Printer: Re-routing ReportsIf you send a report to be printed on a printer that is not available, for example, because it has run out of paper, this print job is suspended and stored in the monitor's memory.If the target device of this print job was set to Unspecified, the monitor will periodically try to resend the print job to the first printer listed in the Setup Printers menu under Printer that is set to Enabled and that has paper of the correct size.
19 Printing Patient Reports240To allow the report to print, you must either solve the problem with the target printer, or re-route the print job to another printer with paper of the correct size. To re-route a print job,• Enable the new target printer by selecting it in the Setup Printers menu and toggling to Enabled. As the monitor tries to send the report to the printers in the order they are listed, you must make sure that all the printers above the new target printer are disabled.If the target device of the print job was set to a specific printer, re-routing is not possible.Checking Report Status and Printing ManuallyA list of all print requests which are waiting, printing or stored can be viewed in the Report List. To view the list, in the Reports menu, select Report List.The following information is displayed for each print request:• Report title• Patient name (except for system reports such as the battery status report)• Request date and time• Report paper format•Job status: Preparing, Printing, Waiting, In Database, Retry, Cancelling, Error.Individual reports can be deleted from the list with the Delete Report key, and all reports with the Delete All Repts key.CAUTIONThe Report List includes privacy information, in the form of the patient name with the related report title and date. It is advisable to provide controlled access to this data to ensure confidentiality.Printing ManuallyThose jobs shown in black will be printed automatically when a matching printer is available. If the Auto Print Dbs setting is Host Only or Never, some or all reports will not be printed automatically and will be shown in gray. Any jobs shown in gray must be printed manually; to do this,1In the Report List, select the required report2Select Print Report.Selecting Print All Reps will send all reports to the printer.
19 Printing Patient Reports241Printer Status MessagesPrinter Status Message Possible causes and suggested actionPrint job queued for <Printer Name> The report has been placed in the queue for the named printer.Print job can't queue;resources?Print job can't queue;queue fullPrint job can't queue;no printerThe printer queue is full and the monitor cannot accept another report request. Wait until some more reports have been printed, then try again, ORA report has been triggered that uses a paper size unavailable with the target printer. Try another printer, if available, or change the paper size of the print request.Cancelling all print jobs Delete All Reps has been selected in the Reports menu, ORThe Operating Mode has been changed from Monitoring Mode to Demonstration or Service Mode.Cancelling the active print job The current report is being canceled as the result of a user request.Deleted # print jobs;discharge When a patient is discharged, all queued reports are canceled except those stored in the print database. "#" is the number of reports canceled.Deleted # print jobs; hotstart The monitor has restarted and all report requests have been canceled except those stored in the print database. "#" is the number of reports canceled.Print failed;No report configurd A report has been triggered which has not been correctly set up. Enter the setup menu for the report type to set up the report.Printing on <Printer Name>... A report is in progress, or the monitor is waiting for the central printer to accept the print job.NoPrinter <Printer Name>;job susp. The chosen device is unavailable. Check that the printer is properly connected and that paper is available. The requested report will start printing when the printer becomes available.Print database full->job suspnd. The requested report does not fit into the print database. You can select another printer to print the report (see “Unavailable Printer: Re-routing Reports” on page 239). Alternatively you can delete another report from the Report List (using the Delete Report key) to create space for your report.Job <Printer Name> failed; no dataJob <Printer Name> fail;no printerJob <Printer Name> fail;data errorA report cannot be started on the requested printer. One of three reasons is shown in the status message:• data unavailable - the connected X2 has been removed before the data for the report was transferred.• printer unavailable - make sure the printer is plugged in, switched on, and has paper loaded.• data requisition error - an internal error has caused data required for the report to be unavailable, try starting the report again.Print job on <Printer Name> done The report has been printed.
19 Printing Patient Reports242Sample Report PrintoutsEach report header contains the patient's bed label, last name and first name, middle name (if there is enough space) the patient ID, the date and time, and the name of the report. The report footer contains the hospital label and page number, and the last page contains a note to mark the report end.The monitor may be configured to leave a space on the top left or right of the report printout to enable you to stick a patient address label on it. This setting is called the Addressograph and it can only be changed in the monitor's Configuration Mode.Alarm Limits Report1Measurement labels, with alarms off symbol where alarms are switched off2Graphic view of current alarm limits in relation to currently monitored measurement valueRealtime Report1Patient demographic information, time stamp2Active Alarms and INOPs, followed by vital signs3Measurement waves section
19 Printing Patient Reports243ECG Reports1Patient information2Numeric block3Wave areaBelow the header on ECG Reports, the numeric block shows the current HR, PVC, and ST values. The wave area shows the printed waves for all available ECG leads. A 1 mV calibration bar is printed at the beginning of each wave. With the 3X4, 6X2, and 2X4 formats, a rhythm stripe prints a longer section of the ECG wave from the primary ECG lead for ECG rhythm evaluation. The ECG signal bandwidth, the patient's paced status, the ECG gain, and the print speed are printed at the bottom of the wave area. Pace pulse marks are automatically printed beside the wave for paced patients. Beat labels can be set to print on the rhythm stripe. The 12X1 (2P) format prints the report over two pages.ECG Report type Available Formats Available Paper Sizes12-Lead ECG 3X4 landscape A4, letter, A3, ledger6X2 landscape A4, letter, A3, ledger12X1 portrait A4 and letter only12X1 landscape A4, letter, A3, ledger12X1 (2P) landscape A4, letter (2 pages)Multi-lead ECG 2X4 landscape A4, letter, A3, ledger8X1 portrait A4 and letter only8X1 landscape A4, letter, A3, ledger
19 Printing Patient Reports24412-Lead ECG Report1Patient data2Analysis data from the Information Center (PIIC iX only)312-Lead wave area4Data related to the wave presentation5ST Map with related ST numerics (optional)6Administrative data - including optional custom text fields7Hospital ID data - Institution, facility and department, if configuredOther ReportsSee the sections on Trends for other example reports.
2024520Care and CleaningUse only the Philips-approved substances and methods listed in this chapter to clean or disinfect your equipment. Warranty does not cover damage caused by using unapproved substances or methods.Philips makes no claims regarding the efficacy of the listed chemicals or methods as a means for controlling infection. Consult your hospital's Infection Control Officer or Epidemiologist. For comprehensive details on cleaning agents and their efficacy refer to "Guidelines for Prevention of Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to Health Care and Public-Safety Workers" issued by the U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, Atlanta, Georgia, February 1989. See also any local policies that apply within your hospital, and country.General PointsKeep your monitor, cables and accessories free of dust and dirt.After cleaning and disinfection, check the equipment carefully. Do not use if you see signs of deterioration or damage. If you need to return any equipment to Philips, decontaminate it first.Observe the following general precautions:• Always dilute cleaning agents according to the manufacturer's instructions or use lowest possible concentration.• Do not allow liquid to enter the case.• Do not immerse any part of the equipment or any accessories in liquid.• Do not pour liquid onto the system.• Never use abrasive material (such as steel wool or silver polish).• Never use bleach except in an approved product listed in this chapter.WARNINGIf you spill liquid on the equipment, battery, or accessories, or they are accidentally immersed in liquid, contact your service personnel or Philips service engineer. Do not operate the equipment before it has been tested and approved for further use.
20 Care and Cleaning246Cleaning the MonitorClean with a lint-free cloth, moistened with warm water (40°C/104°F maximum) and soap, a diluted non-caustic detergent, tenside, ammonia- or alcohol-based cleaning agent. Do not use strong solvents such as acetone or trichloroethylene.Take extra care when cleaning the screen of the monitor because it is more sensitive to rough cleaning methods than the housing. Do not permit any liquid to enter the monitor case and avoid pouring it on the monitor while cleaning. Do not allow water or cleaning solution to enter the measurement connectors. Wipe around, not over, connector sockets.CAUTIONTo clean the touch-enabled display, disable the touch operation by switching off the monitor during the cleaning procedure, or by pressing and holding the Main Screen key for two seconds. Press the Main Screen key again to re-enable touch operation.Recommended cleaning agents are:Disinfecting the EquipmentCAUTIONSolutions: Do not mix disinfecting solutions (such as bleach and ammonia) as hazardous gases may result.Clean equipment before disinfecting. Recommended types of disinfecting agents are:Tensides (dishwasher detergents) Edisonite Schnellreiniger®, Alconox®Ammonias Dilution of Ammonia <3%, Window cleanerAlcohol Ethanol 70%, Isopropanol 70%, Window cleanerProduct Name Product Type IngredientsIsopropanol liquid Isopropanol 80%Bacillol® AF liquid, spray 100 g concentrate contains:Propan-1-ol 45.0 g; Propan-2-ol 25.0 g; Ethanol 4.7 gBacillol® 25 liquid Ethanol 100 mg/gPropan-2-ol (= 2-Propanol) 90 mg/g;Propan-1-ol (= 1-Propanol) 60 mg/gMeliseptol®spray 50% 1-PropanolAccel TB RTU liquid 0.5% accelerated hydrogen peroxideOxivir® Tb Cleaner Disinfectant spray 0.5% accelerated hydrogen peroxideOxivir® Tb Wipes wipes 0.5% accelerated hydrogen peroxide
20 Care and Cleaning2471 Do not use Clorox ® Hydrogen Peroxide Disinfecting Wipes for snap fits (for example the battery cover) or hinges. Remove all residues with water after the residence time. For repeated or prolonged use, wear rubber or nitrile gloves to protect your hands.Sterilizing the EquipmentSterilization is not allowed for this monitor, related products, accessories or supplies unless otherwise indicated in the Instructions for Use that accompany the accessories and supplies.Cleaning, Sterilizing and Disinfecting Monitoring AccessoriesTo clean, disinfect and sterilize reusable transducers, sensors, cables, leads, and so forth, refer to the instructions delivered with the accessory. If no instructions are delivered with the accessory, the instructions given in this chapter for cleaning, disinfecting and sterilizing the monitor are applicable.Cleaning Batteries and the Battery CompartmentWipe with a lint-free cloth, moistened with warm water (40°C/104°F maximum) and soap. Do not use strong solvents. Do not soak the battery.Carpe DiemTM/MC TbReady-to-Use General Virucide, Bactericide, Tuberculocide, Fungicide, Sanitizerspray 0.5% accelerated hydrogen peroxideCarpe DiemTM/MC Tb Wipes wipes 0.5% accelerated hydrogen peroxideSuper Sani-ClothGermicidal Disposable Wipeswipes isopropanol 55%quaternary ammonium chlorides 0.5%SANI-CLOTH® PLUSGermicidal Disposable Wipeswipes isopropanol 15%quaternary ammonium chlorides 0.25%SANI-CLOTH® HB GermicidalGermicidal Disposable Wipeswipes isopropanol < 0.15%quaternary ammonium chlorides 0.14%Clorox ® Hydrogen Peroxide Disinfecting Wipes 1wipes 1 - 5% hydrogen peroxide1 - 5% benzyl alcoholProduct Name Product Type Ingredients
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2124921Using BatteriesThe Lithium Ion batteries used in your monitor store a large amount of energy in a small package. This allows reliable battery-operated monitoring but also requires care in use and handling of the batteries. Follow the instructions in this chapter and refer for further details to the Service Guide.When monitoring a patient, one Philips M4607A rechargeable Lithium Ion battery must always be inserted into the battery compartment on the right side of the monitor. This applies even when you are running the monitor from the external power supply.The battery seals the battery compartment, preventing the ingress of fluids or foreign bodies. A severe yellow INOP (!! Insert Battery) will be issued if the monitor is connected to AC mains without a battery fully inserted in the battery compartment. This INOP will persist until a battery is inserted.To use the monitor with battery power, disconnect the external power supply, by removing the MSL cable from the monitor.You can switch between battery-powered and mains-powered (AC) operation without interrupting monitoring.The battery recharges automatically when the monitor is connected to the external power supply (M8023A).1Battery compartment
21 Using Batteries250Battery Power IndicatorsThe battery LED and battery status information on the Main Screen, in combination with INOP messages and prompts, help you keep track of the battery power status. The indicators always show the remaining capacity in relation to the battery's actual maximum capacity, which may lessen as the battery ages. You can see the actual capacity in the Battery Status window.Battery LEDThe battery LED on the front panel of the monitor is indicated by a battery symbol.The battery LED is off during regular monitoring, when none of the following situations is present:Battery Status on the Main ScreenThe battery status information includes the battery power remaining and, when the battery is not charging, an estimate of the monitoring time this represents.Battery power gauge:This shows the remaining battery power. It is divided into sections, each representing 20% of the total power. If three sections are filled, as in this example, this indicates that 60% battery power remains. If no battery is detected, a blank battery gauge marked with a flashing red X is displayed. If no data is available from the battery, a question mark is shown in the gauge. If the monitor is powered from the Battery Extension, the battery gauge shows the remaining power for the battery in the Battery Extension.1Battery LEDBattery LED Colors If the monitor is connected to the external power supply (M8023A), this meansIf the monitor is running on battery power, this meansYellow battery chargingRed, flashing less than 10 minutes power remainingRed, flashes intermittentlybattery or charger malfunction battery malfunction
21 Using Batteries251If there are problems or changes in the status of the battery this is indicated by a blank battery gauge containing a symbol. If the symbol is red, this indicates a critical situation. You can check the specific cause of the problem by looking at the symbol(s) displayed in the Battery Status window (see “Battery Status Window” on page 251).Monitoring Time Available: While the monitor is running on battery power, a time is displayed below the battery power gauge. No time is displayed when the monitor is running on external power. This is the estimated monitoring time available with the current battery power. Note that this time fluctuates depending on the system load (the display brightness and how many measurements you carry out). If the remaining operating time is 00:00, the monitor shuts down automatically.Battery Status WindowTo access the Battery Status window and its associated pop-up keys, select the battery status information on the Screen, or select Main Setup then select Battery.If you are using a Battery Extension, status information for both batteries will be shown in the Battery Status window. If the battery in the Battery Extension is completely discharged, there may be no status information available for it.Capacity, remaining tells you how much power is left in the battery.Capacity, fullCharge tells you how much power the battery can hold when fully charged.TimeToEmpty tells you approximately how long you can continue to use the monitor with this battery. Note that this time fluctuates depending on the system load (the display brightness and how many measurements you carry out).TimeToFull is shown in place of TimeToEmpty if the monitor is connected to mains power via a host monitor or the M8023A external power supply, and tells you how much time is left until the battery is charged to 90%. You can use the 865432 Smart Battery Conditioner (previously M8043A) to charge the batteries externally.Battery status/malfunction symbols: If a problem is detected with the battery, an INOP may be issued, and the following symbols are displayed in the Battery Status window, where they may be accompanied by a battery status message providing more details. Messages appear in the line where TimeToFull/TimeToEmpty is shown.Battery status indicator Battery malfunction indicator Alternates with the battery gauge on the Main Screen.Check in the Battery Status window to see which status symbol is displayed for which battery to identify the cause.The red !flashes. Critical battery situation or malfunction. Check in the Battery Status window to see which malfunction indicator is displayed, or refer to the INOP, to identify the cause.Indicator for missing battery (flashing red X). An !! Insert Battery INOP is issued when the battery compartment is empty, and the monitor is connected to external power. This INOP is suppressed for 15 seconds while the monitor is connected to external power, allowing you sufficient time to insert new battery. After silencing, the INOP reappears every 10 seconds until a battery is inserted.
21 Using Batteries252Symbols indicating critical situations are colored red.Printing Battery ReportsTo print the information in the Battery Status window on a connected printer,1Select the battery status information on the Screen to open the Battery Status window2Select the Print Status pop-up key.Checking Battery ChargeTo check the charge status of a battery, refer to the battery power gauge on the screen, or open the Battery Status window.When Battery Lifetime is ExpiredWhen the battery is aged, either after 3 years from manufacturing date or after 500 full charge/discharge cycles, it is recommended to replace the battery. To remind you of this, a message will appear in the Battery Status window. This message will only be displayed at the appropriate time when the date and time on the monitor is correct.WARNINGThe risk of battery failure increases with age, when a battery remains in use longer than 3 years or 500 full charge-discharge cycles. Such failures can result in overheating that in rare cases can cause the battery to ignite or explode.Battery status symbols Battery malfunction symbolsbattery is empty (red) incompatible batterybattery not charging as the temperature is above or below the specified range(red) battery malfunctionbattery requires maintenance (red) battery has no power leftcharging stopped to protect the battery (red) battery temperature too high
21 Using Batteries253Replacing a BatteryTo replace the battery,1Press the battery eject button. This releases the battery. Support the battery with your hand to prevent it from falling out.The INOP !! Insert Battery is suppressed for 15 seconds, allowing you sufficient time to insert a new battery.2Remove the battery from the compartment.3Slide the new battery into position with the contacts facing downwards. It should 'click' into position when it is fully inserted.WARNINGDo not insert your fingers or any objects into the open battery compartment.
21 Using Batteries254Replacing the Battery in the Battery ExtensionTo replace the battery,1Push the battery cover downwards, so that it opens.2Remove the battery from the compartment.3Slide the new battery firmly into position with the label facing downwards.4Close the battery cover and push it upwards, so that it remains closed.Optimizing Battery PerformanceThe performance of rechargeable batteries may deteriorate over time. Battery maintenance as recommended here can help to slow down this process.
21 Using Batteries255Display Brightness Setting1In the Main Setup menu, select User Interface, Brightness, then Optimum. This selects a level of brightness suitable for most monitoring locations that uses less battery power than brighter settings.2Ensure that the current level of brightness is suitable for your monitoring location.Charging a BatteryA battery can be charged in a monitor during monitoring. You can also use the 865432 Smart Battery Conditioner (previously M8043A) to charge batteries.1Insert the battery into a monitor connected to the external power supply (M8023A).2Charge the battery until it is full, the battery LED goes out, and the battery power gauge is filled.In certain situations, internal temperature conditions may mean that the battery will not charge. This is sometimes necessary to protect the battery from damage, and does not indicate a malfunction. In this case you must use the 865432 Smart Battery Conditioner (previously M8043A Smart Battery Conditioner) to charge the battery.Conditioning a BatteryYou must condition a battery when its "battery requires maintenance" symbol shows on the Screen. Do not interrupt the charge or discharge cycle during conditioning. You can condition a battery in a monitor.CAUTIONDo not use a monitor that is being used to condition batteries to monitor patients. The monitor switches off automatically when there is no battery power left.It is, however, preferable to use the 865432 Smart Battery Conditioner (previously M8043A) for external battery conditioning. The Smart Battery Conditioner automatically performs the correct charge or conditioning process and evaluates the capacity when fully charged. For details please see the Instructions for Use for the Smart Battery Conditioner. Do not use any other battery chargers or conditioners.To condition a battery using a monitor,1Insert the battery into a monitor connected to the external power supply (M8023A) that is connected to mains power.2Switch the monitor power off.3Charge the battery until it is completely full. Open the Battery Status window.Check that the Batt fully charged message is displayed.4Disconnect the monitor from mains power and let the monitor run until there is no battery power left and the monitor switches itself off.5Reconnect the monitor to mains power and charge the battery until it is full for use or charge to 50% for storage.To condition the battery from a Battery Extension, use the 865432 Smart Battery Conditioner.
21 Using Batteries256Storing a BatteryA battery should not remain inside the monitor or Battery Extension if it is not used for a longer period of time. If batteries are stored for an extended period of time, they should be stored in a cool place, ideally at 15°C (60°F), with a state of charge of 20% to 40%. Storing batteries in a cool place slows the aging process. The batteries should not be stored at a temperature outside the range of -20°C (-4°F) to 60°C (140°F).Stored batteries should be partially charged to 20% to 40% of their capacity every 6 months. They should be charged to full capacity prior to use.Storing batteries at temperatures above 38°C (100°F) for extended periods of time could significantly reduce the batteries’ life expectancy.NOTEThe battery will discharge over time if it is stored inside the monitor or Battery Extension when not connected to AC power via the external power supply (M8023A). The reported values for "remaining capacity" and "runtime" will become less accurate when the battery is stored in this way for a longer period of time (that is, several weeks).Disposing of Used BatteriesDispose of used batteries promptly and in an environmentally-responsible manner. Discharge the batteries and insulate the terminals with tape before disposal. Do not dispose of the battery in normal waste containers. Consult your hospital administrator to find out about local arrangements.Battery Safety InformationWARNING• Use only Philips batteries specified in the chapter on “Accessories”. Use of a different battery may present a risk of fire or explosion.• Do not open batteries, heat above 60°C (140°F), incinerate batteries, or cause them to short circuit. They may ignite, explode, leak or heat up, causing personal injury.• If battery leakage should occur, use caution in removing the battery. Avoid contact with skin. Refer to qualified service personnel.• Do not expose batteries to liquids.• Do not apply reverse polarity.• Do not crush, drop or puncture batteries - mechanical abuse can lead to internal damage and internal short circuits which may not be visible externally.• If a battery has been dropped or banged against a hard surface, whether damage is visible externally or not:– discontinue use– dispose of the battery in accordance with the disposal instructions above.• Keep batteries out of the reach of children • Keep batteries in their original package until you are ready to use them.
2225722Maintenance and TroubleshootingWARNINGSchedule: Failure on the part of the responsible individual hospital or institution employing the use of this equipment to implement a satisfactory maintenance schedule may cause undue equipment failure and possible health hazards.Contact: If you discover a problem with any of the equipment, contact your service personnel, Philips, or your authorized supplier.Inspecting the Equipment and AccessoriesPerform a visual inspection before every use, and in accordance with your hospital's policy. With the monitor switched off:1Examine unit exteriors for cleanliness and general physical condition. Make sure that the housings are not cracked or broken, that everything is present, that there are no spilled liquids and that there are no signs of abuse.2Inspect all accessories (cables, transducers, sensors and so forth). If any show signs of damage, or the use-by date has been exceeded, do not use.3Switch the monitor on and make sure the backlight is bright enough. Check that screen is at its full brightness. If the brightness is not adequate, contact your service personnel or your supplier.WARNINGElectrical Shock Hazard: Do not open the monitor or measurement device. Contact with exposed electrical components may cause electrical shock. Always turn off and remove power before cleaning the sensor, monitor or measurement device. Do not use a damaged sensor or one with exposed electrical contacts. Refer servicing to qualified service personnel.
22 Maintenance and Troubleshooting258Inspecting the Cables and Cords1Examine all system cables, the power plug and cord for damage. Make sure that the prongs of the plug do not move in the casing. If damaged, replace it with an appropriate Philips power cord.2Inspect the patient cables, leads and their strain reliefs for general condition. Make sure there are no breaks in the insulation. Make sure that the connectors are properly engaged at each end to prevent rotation or other strain.3Apply the transducer or electrodes to the patient, and with the monitor switched on, flex the patient cables near each end to make sure that there are no intermittent faults.Maintenance Task and Test ScheduleThe following tasks are for Philips-qualified service professionals only. All maintenance tasks and performance tests are documented in detail in the service documentation supplied on the monitor documentation DVD.Ensure that these tasks are carried out as indicated by the monitor's maintenance schedule, or as specified by local laws. Contact a Philips-qualified service provider if your monitor needs a safety or performance test. Clean and disinfect equipment to decontaminate it before testing or maintaining it.TroubleshootingIf you suspect a problem with an individual measurement, read the Instructions for Use and double-check that you have set up the measurement correctly.If you suspect an intermittent, system-wide problem call your service personnel. You may be asked for information from the status log. To view the status log,In the Main Setup menu, select Revisions.1Select Status Log.Type Maintenance and Test Activities FrequencyMonitor Tests Safety checks. Selected tests on the basis of IEC 60601-1.At least once every two years, or as needed, after any repairs where the power supply is removed or replaced, or if the monitor has been dropped.Monitor MaintenanceCheck ECG synchronization of the monitor and defibrillator (only if hospital protocol requires use of monitor during defibrillation).At least once every two years, or as needed.Measurement Tests Performance assurance for all measurements not listed below.At least once every two years, or if you suspect the measurement values are incorrect.Measurement MaintenanceNBP calibration At least once every two years, or as specified by local laws.Microstream CO2 calibration and performance testAt least once a year or after 4000 operating hours.Mainstream and sidestream CO2 calibration and sidestream flow checkAt least once a year, or if you suspect the measurement values are incorrect.Battery Maintenance See “Optimizing Battery Performance” on page 254 for battery maintenance activities.
22 Maintenance and Troubleshooting259Disposing of the MonitorWARNINGTo avoid contaminating or infecting personnel, the environment or other equipment, make sure you disinfect and decontaminate the monitor appropriately before disposing of it in accordance with your country's laws for equipment containing electrical and electronic parts. For disposal of parts and accessories such as thermometers, where not otherwise specified, follow local regulations regarding disposal of hospital waste.You can disassemble the monitor as described in the Service Guide.You will find detailed disposal information on the following web page:http://www.healthcare.philips.com/main/about/Sustainability/Recycling/pm.wpdThe Recycling Passports located there contain information on the material content of the equipment, including potentially dangerous materials which must be removed before recycling (for example, batteries and parts containing mercury or magnesium).Do not dispose of electrical and electronic equipment as unsorted municipal waste. Collect it separately, so that it can be safely and properly reused, treated, recycled, or recovered.Disposing of Empty Calibration Gas Cylinders1Empty the cylinder completely by pushing in the pin of the regulator valve or by pulling out the pin of the fill valve using a tire valve stem wrench or a pair of needle nose pliers.2When the cylinder is empty, either remove the valve stem from the fill (or regulator) hole, or drill a hole in the cylinder.3Write "Empty" on the cylinder and dispose of it appropriately for scrap metal.WARNINGEnsure that the cylinder is completely empty before trying to remove the valve stem or drill a hole in the cylinder.
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2326123AccessoriesThis chapter lists Philips-approved accessories for use with patient monitors as described in this document. You can order parts and accessories from Philips supplies at www.medical.philips.com or consult your local Philips representative for details. Some accessories may not be available in all countries.All accessories listed in this chapter comply, in combination with the patient monitor, with the requirements of IEC 60601-1-2.WARNINGReuse: Never reuse disposable transducers, sensors, accessories and so forth that are intended for single use, or single patient use only. Reuse may compromise device functionality and system performance and cause a potential hazard.Philips' approval: Use only Philips-approved accessories. Using non-Philips-approved accessories may compromise device functionality and system performance and cause a potential hazard.Packaging: Do not use a sterilized accessory if its packaging is damaged.Correct Use: Always follow the instructions for use supplied with the accessories.ECG/Resp AccessoriesThis symbol indicates that the cables and accessories are designed to have special protection against electric shocks (particularly regarding allowable leakage currents), and are defibrillator proof.The following cables may not all be available in all countries. Please check availability with your local Philips supplier.Trunk CablesFor use with: Part No. Length3-Electrode Cable Set M1669A 2.7 m3-Electrode Cable Set, OR 989803170171 2.7 m5-Electrode Cable Set M1668A 2.7 m5-Electrode Cable Set, OR 989803170181 2.7 m
23 Accessories2623-Electrode Cable SetsSingle Patient 3-Electrode Cable Sets5-Electrode Cable SetsSingle Patient 5-Electrode Cable Sets6-Electrode Cable Sets6-Electrode Cable Set M1667A 2.7 m10-Electrode Cable set (5+5) M1663A 2.7 m10-Electrode Cable set (6+4) M1665A 2.7 mFor use with: Part No. LengthDescription Length AAMI Part No. IEC Part No.OR Grabber shielded 1.0 m M1675A M1678AICU Grabber shielded 1.0 m M1671A M1672AICU snap shielded 1.0 m M1673A M1674AICU Clip non-shielded 0.45 m M1622A --ICU Clip non-shielded 0.7 m M1624A M1626ADescription Length AAMI Part No. IEC Part No.ICU Grabber shielded 1.0 m 989803173121 989803174201ICU Grabber shielded 0.84 m 989803173141 -Description Length AAMI Part No. IEC Part No.OR Grabber shielded 1.0 m/1.6 m M1973A M1974AICU Grabber shielded 1.0 m/1.6 m M1968A M1971AICU Snap shielded 1.0 m/1.6 m M1644A M1645AICU Miniclip non-shielded 0.7 m/1.3 m M1647A M1648ADescription Length AAMI Part No. IEC Part No.ICU Grabber shielded 1.0 m 989803173131 989803174211ICU Grabber shielded 0.85 m 989803173151 -Description Length AAMI Part No. IEC Part No.OR Grabber 1.0 m/1.6 m M1684A M1685AICU Grabber 1.0 m/1.6 m M1680A M1681AICU Snap 1.0 m/1.6 m M1682A M1683A
23 Accessories26310-Electrode (5+5) Cable Sets10-Electrode (6+4) Cable SetsOne-piece CablesRadio-translucent CablesPack of five single wires, radio-translucent, 0.9 m, M1649ASet Combiners and OrganizersDescription Length AAMI Part No. IEC Part No.ICU Grabber, chest, shielded 1.0 m M1976A M1978AICU Snap, chest, shielded 1.0 m M1602A M1604AOR Grabber, chest, shielded 1.0 m M1979A M1984AFor Limb Leads see 5-electrode cable setsDescription Length AAMI Part No. IEC Part No.ICU Grabber, chest, shielded 1.0 m M1532A M1533AICU Snap, chest, shielded 1.0 m M1537A M1538AOR Grabber, chest, shielded 1.0 m M1557A M1558AFor Limb Leads see 6-electrode cable setsDescription Length AAMI Part No. IEC Part No.3-lead Grabber, ICU 1.0 m 989803143181 9898031431715-lead Grabber, ICU 1.0 m 989803143201 989803143191Description Part No.Set combiner 3-electrode M1501A5-electrode M1502ASet organizer for shielded leadsets - grabber and snap 3-electrode M1503A4-electrode M1664A5-electrode M1504A6-electrode M1679ASet organizer for non-shielded lead sets - miniclip 3-electrode M1636A5-electrode M1638ABedsheet clip M1509AReplacement red cover for trunk cable (for 5-electrode cable sets) 989808148861
23 Accessories2645-Electrode One Piece CablesSet Combiners and OrganizersNBP AccessoriesThese cuffs and tubings are designed to have special protection against electric shocks (particularly regarding allowable leakage currents), and are defibrillator proof. You can use them during electrosurgery.Adult/Pediatric Reusable Comfort Care CuffsAdult/Pediatric Reusable Comfort Care Cuff KitsDescription Length AAMI Part No. IEC Part No.OR Grabber 2.5 m M1975A M1985AICU Snap 2.5 m M1977A M1986ADescription Part No.Set combiner 3-electrode M1501A5-electrode M1502ASet organizer Shielded 3-electrode M1503AShielded 5-electrode M1504ABedsheet clip M1509APatient Category Limb Circumference Part No. TubingAdult (Thigh) 42 to 54 cm M1576A M1598B (1.5 m)orM1599B (3 m)Large Adult 34 to 43 cm M1575ALarge Adult XL 34 to 43 cm M1575XLAdult 27 to 35 cm M1574AAdult XL 27 to 35 cm M1574XLSmall Adult 20.5 to 28 cm M1573ASmall Adult XL 20.5 to 28 cm M1573XLPediatric 14 to 21.5 cm M1572AInfant 10 to 15 cm M1571ACuff Kits Part No.Infant, pediatric, small adult, adult M1577ASmall adult, adult, large adult, thigh M1578AInfant, pediatric, small adult, adult, large adult, thigh M1579ASmall adult XL, adult XL, large adult XL M1579XL
23 Accessories265Adult/Pediatric Reusable Easy Care CuffsAdult/Pediatric Reusable Easy Care Cuff KitsAdult/Pediatric Multi Care CuffsPatient Category Limb Circumference Part No.(Pack of five)TubingAdult Thigh 44 - 56 cm M4559B (M4559B5) M1598B (1.5 m)orM1599B (3 m)Large Adult X-Long 35 - 45 cm M4558B (M4558B5)Large Adult 35 - 45 cm M4557B (M4557B5)Adult X-Long 27.5 - 36 cm M4556B (M4556B5)Adult 27.5 - 36 cm M4555B (M4555B5)Small Adult 20.5 - 28.5 cm M4554B (M4554B5)Pediatric 14 - 21.5 cm M4553B (M4553B5)Infant 10 - 15 cm M4552B (M4552B5)Cuff Kits Part No.Assortment pack of one small adult, one adult, one large adult and one thigh cuff 864288Assortment pack of one infant, one pediatric, one small adult and one adult cuff 864289Assortment pack of one infant, one pediatric, one small adult, one adult, one large adult and one thigh cuff864290Assortment pack of one small adult, one adult, one adult X-long, one large adult, one large adult X-long and one thigh cuff864291Patient Category Limb Circumference Part No. TubingAdult Thigh 42.0 - 54.0 cm 989803183371 M1598B (1.5 m)orM1599B (3 m)Large Adult 34.0 - 43.0 cm 989803183361Large Adult X-Long 27.0 - 35.0 cm 989803183351Adult 27.0 - 35.0 cm 989803183341Small Adult 20.5 - 28.0 cm 989803183331Pediatric 14.0 - 21.5 cm 989803183321Infant 10.0 - 15.0 cm 989803183311
23 Accessories266Adult/Pediatric Single Patient, Gentle Care CuffsAdult/Pediatric Single Care CuffsAdult/Pediatric Value Care CuffsPatient Category Limb Circumference Part No. TubingAdult (Thigh) 44 - 56 cm M4579B M1598B (1.5 m) orM1599B (3 m)Large Adult X-Long 35 - 45 cm M4578BLarge Adult 35 - 45 cm M4577BAdult X-Long 27.5 - 36 cm M4576BAdult 27.5 - 36 cm M4575BSmall Adult 20.5 - 28.5 cm M4574BPediatric 14.0 - 21.5 cm M4573BInfant 10 - 15 cm M4572BPatient Category Limb Circumference Part No. TubingLarge Adult 35.0 - 45.0 cm 989803182321 M1598B (1.5 m) orM1599B (3 m)Adult X-Long 27.5 - 36.0 cm 989803182311Adult 27.5 - 36.0 cm 989803182301Small Adult 20.5 - 28.5 cm 989803182291Pediatric 14.0 - 21.5 cm 989803182281Patient Category Limb Circumference Part No. TubingLarge Adult 34.0 - 43.0 cm 989803160861M1598B (1.5 m)orM1599B (3 m)Adult XL 27.0 - 35.0 cm 989803160851Adult 27.0 - 35.0 cm 989803160841Small Adult 20.5 - 28.0 cm 989803160831Pediatric 14.0 - 21.5 cm 989803160821Infant 10.0 - 15.0 cm 989803160811
23 Accessories267Neonatal/Infant Single Patient CuffsNeonatal/Infant Single Patient, Soft CuffsNeonatal/Infant Cuff KitsIntelliVue CL NBP Pod AccessoriesMobile CL Cuffs and AccessoriesCuffs Limb Circumference Part No.A - Luer connectorB - ISO 80369-1 compliant connectorTubingSize 1 3.1 to 5.7 cm M1866A/B For A-version cuffs:M1596B (1.5 m) or M1597B (3 m)For B-version cuffs:M1596C (1.5 m) or M1597C (3 m)Size 2 4.3 to 8.0 cm M1868A/BSize 3 5.8 to 10.9 cm M1870A/BSize 4 7.1 to 13.1 cm M1872A/BSize 5 (Infant) 10 to 15 cm M1873BCuffs Limb Circumference Part No. TubingSize 1 3.1 to 5.7 cm M1866S M1596C (1.5 m) orM1597C (3 m)Size 2 4.3 to 8.0 cm M1868SSize 3 5.8 to 10.9 cm M1870SSize 4 7.1 to 13.1 cm M1872SSize 5 (Infant) 10 to 15 cm M1873SCuff Kits Part No.Standard, Single Patient, Luer connector: 10 x M1866A, 10 x M1868A, 10 x M1872A, and 20 x M1870AM1820-60020Standard, Single Patient, ISO 80369-1 compliant connector: 5 x M1866B, 10 x M1868B, 20 x M1870B, 10 x M1872B, and 5 x M1873B989803167541Soft, Single Patient, ISO 80369-1 compliant connector: 5 x M1866S, 10 x M1868S, 20 x M1870S, 10 x M1872S, 5 x M1873S989803167551Part Number Description Limb Circumference RangeBladder Width Contents989803163171 Mobile CL Reusable Small Adult Cuff21 - 27 cm 10.5 cm 1 cuff989803163191 Mobile CL Reusable Adult Cuff 26.0 - 34.5 cm 13.0 cm 1 cuff989803163211 Mobile CL Reusable Large Adult Cuff33.5 - 45.0 cm 16.0 cm 1 cuff
23 Accessories268Comfort Reusable CuffsEasy Care Reusable Cuffs989803163181 Mobile CL Single-Patient Small Adult Cuff21 - 27 cm 10.5 cm 20 cuffs989803163201 Mobile CL Single-Patient Adult Cuff26.0 - 34.5 cm 13.0 cm 20 cuffs989803163221 Mobile CL Single-Patient Large Adult Cuff33.5 - 45.0 cm 16.0 cm 20 cuffs989803163251 Mobile CL NBP Cradle Kit - - 20 cradles989803163131 Mobile CL Extension Air Hose, 1.0 m- - 1 extension air hose989803187431 Mobile CL Air Hose - Bayonet Connector- - 1 adapter air hose989803163261 Mobile CL NBP Battery Kit - - 1 Battery1 disassembly tool1 front housing989803137831 Telemetry Pouch with window - - 50 pouches989803140371 Telemetry Pouch with window - - 4 boxes of 50 pouches989803101971(9300-0768-050)White Telemetry Pouch with Snaps; box of 50- - 50 pouches989803101981(9300-0768-200)White Telemetry Pouch with Snaps; 4 boxes of 50--4boxes of 50 pouchesPart Number Description Limb Circumference RangeBladder Width ContentsPart Number Description Limb Circumference RangeM1571A Infant cuff 10.0 - 15.0 cmM1572A Pediatric cuff 14.0 - 21.5 cmM1573A Small adult cuff 20.5 - 28.0 cmM1574A Adult cuff 27.0 - 35.0 cmM1575A Large adult cuff 34.0 - 43.0 cmM1576A Thigh cuff 42.0 - 54.0 cmM1577A Kit of small cuffs (M1571A to M1574A)M1578A Kit of large cuffs (M1573A to M1576A)M1579A Kit of all cuffs (M1571A to M1576A)Part Number Description Limb Circumference RangeM4552B Infant cuff 10.0 - 15.0 cmM4552B5 Pack of 5 M4552B cuffs
23 Accessories269Multi Care CuffsSingle Patient, Gentle Care CuffsM4553B Pediatric cuff 14.0 - 21.5 cmM4553B5 Pack of 5 M4553B cuffsM4554B Small adult cuff 20.5 - 28.5 cmM4554B5 Pack of 5 M4554B cuffsM4555B Adult cuff 27.5 - 36.0 cmM4555B5 Pack of 5 M4555B cuffsM4556B Adult cuff, X-Long 27.5 - 36.0 cmM4556B5 Pack of 5 M4556B cuffsM4557B Large adult cuff 35.0 - 45.0 cmM4557B5 Pack of 5 M4557B cuffsM4558B Large adult cuff, X-Long 35.0 - 45.0 cmM4558B5 Pack of 5 M4558B cuffsM4559B Thigh cuff 44.0 - 56.0 cmM4559B5 Pack of 5 M4559B cuffs864288 Assortment pack of one small adult, one adult, one large adult and one thigh cuff864289 Assortment pack of one infant, one pediatric, one small adult and one adult cuff864290 Assortment pack of one infant, one pediatric, one small adult, one adult, one large adult and one thigh cuff864291 Assortment pack of one small adult, one adult, one adult X-long, one large adult, one large adult X-long and one thigh cuffPart Number Description Limb Circumference RangePart Number Description Limb Circumference Range989803183311 Infant cuff 10.0 - 15.0 cm989803183321 Pediatric cuff 14.0 - 21.5 cm989803183331 Small adult cuff 20.5 - 28.0 cm989803183341 Adult cuff 27.0 - 35.0 cm989803183351 Adult cuff, X-Long 27.0 - 35.0 cm989803183361 Large adult cuff 34.0 - 43.0 cm989803183371 Thigh cuff 42.0 - 54.0 cmPart Number Description Limb Circumference RangeM4572B Infant cuff 10.0 - 15.0 cmM4573B Pediatric cuff 14.0 - 21.5 cm
23 Accessories270Single Care CuffsInvasive Pressure AccessoriesThese transducers and accessories are designed to have special protection against electric shocks (particularly regarding allowable leakage currents), and are defibrillator proof.If you are using the M3012A Hemodynamic MMS Extension, and you want to measure temperature and invasive pressure at the same time, we recommend that you use the pressure transducer CPJ840J6, with a round module connector piece, and not a transducer with a square connector. Pressure transducers with square connectors may make it difficult to connect the adjacent Temperature connector at the same time.M4574B Small adult cuff 20.5 - 28.5 cmM4575B Adult cuff 27.5 - 36.0 cmM4576B Adult cuff, X-Long 27.5 - 36.0 cmM4577B Large adult cuff 35.0 - 45.0 cmM4578B Large adult cuff, X-Long 35.0 - 45.0 cmM4579B Thigh cuff 44.0 - 56.0 cmPart Number Description Limb Circumference RangePart Number Description Limb Circumference Range989803182281 Pediatric cuff 14.0 - 21.5 cm989803182291 Small adult cuff 20.5 - 28.5 cm989803182301 Adult cuff 27.5 - 36.0 cm989803182311 Adult cuff, X-Long 27.5 - 36.0 cm989803182321 Large adult cuff 35.0 - 45.0 cmPressure transducers and accessories Part No.Reusable pressure transducer 5 µV/V/mmHg sensitivity CPJ840J6Sterile disposable pressure domes for CPJ840J6 (pack of 50) CPJ84022Transducer holder for CPJ840J6 (pack of 4) CPJ84046IV pole mount for CPJ840J6 CPJ84447Monitoring Line Set for CPJ840J6 CPJ84026Single channel disposable sensor kit (20) (EU/EFTA only) M1567ADual channel disposable sensor kit (20) (EU/EFTA only) M1568ATransducer holder for M1567/8A (EU/EFTA only) M2271AIV pole mount for M1567/8A (EU/EFTA only) M2272CAdapter cable for disposable sensor kit 3.0 m for M1567/8A M1634A
23 Accessories271Transpac 4 Disposable Pressure Transducer Pressure Monitoring KitsTransducer Pressure Monitoring Kits with SafeSet Blood Sampling/Conservation SystemTranspac and SafeSet are trademarks of ICU Medical, Inc.Pressure transducer kits Part No.PiCCO monitoring kit, 30 cm pressure line, includes PV4046 injectate temperature sensor housing for M1646APV8103PiCCO monitoring kit, 150 cm pressure line, includes PV4046 injectate temperature sensor housing for M1646APV8115PiCCO monitoring kit, 150 cm pressure line, includes PV4046 injectate temperature sensor housing for M1646A and central venous pressure linePV8115CVPPULSION Pressure Interface Cable for disposable pressure transducer PMK 206Description Length Quantity (per box)Part No.Single DPT TP4 with SafeSet, 2 Cannula Sampling Ports, In-line Reservoir213 cm (84 in) 20 989803179741Single DPT TP4 with SafeSet, 2 Luer Sampling Ports, In-line Reservoir213 cm (84 in) 20 989803179751Single DPT TP4 with SafeSet, 1 Cannula Sampling Port, In-line Reservoir152 cm (60 in) 20 989803179761Single DPT TP4 with SafeSet, 2 Cannula Sampling Ports, In-line Reservoir152 cm (60 in) 20 989803179781Single DPT TP4 with SafeSet, 2 Luer Sampling Ports, In-line Reservoir152 cm (60 in) 20 989803179791Single DPT TP4 with SafeSet, Patient Mount, 1 Cannula Sampling Port, In-line Reservoir61 cm (24 in) 20 989803179861Dual DPT TP4 with SafeSet, (Clear/Blue dash tubing) 2 Cannula Sampling Ports, In-line Reservoir213 cm (84 in) 10 989803179801Dual DPT TP4 with SafeSet, (Clear/Blue dash tubing) 2 Luer Sampling Ports, In-line Reservoir213 cm (84 in) 10 989803179811Triple DPT TP4 with SafeSet, 2 Cannula Sampling Ports, In-line Reservoir213 cm (84 in) 10 989803179821Triple DPT TP4 with SafeSet, 2 Luer Sampling Ports, In-line Reservoir213 cm (84 in) 10 989803179831
23 Accessories272Safeset Blood Sampling/Conservation System(Transducer not contained in kit)Transpac 4 Disposable Pressure Transducer Pressure Monitoring KitsDescription Length Quantity (per box)Part No.SafeSet Kit with tubing, 1 In-line Cannula Sampling Port and 10 ml In-line Reservoir152 cm (60 in) 20 989803180851SafeSet Kit with tubing, 2 In-line Cannula Sampling Ports and 10 ml In-line Reservoir213 cm (84 in) 20 989803179891Description StopcocksPrimary Tubing LengthExtension Tubing lengthFlush DeviceDrip ChamberQuantity (per box) Part No.Single DPT TP4, (152 cm, 60 in) Red dash tubingTwo 3-way 122 cm (48 in) 31 cm (12 in) 3 ml/hr, SqueezeMacrodrip 20 989803177901Dual DPT TP4, (183 cm, 72 in) Red/Blue dash tubingFour 3-way 152 cm (60 in) 31 cm (12 in) Two 3 ml/hr, SqueezeMacrodrip 10 989803177911Single DPT TP4, (213 cm, 84 in) Red dash tubingTwo 3-way 183 cm (72 in) 31 cm (12 in) 3 ml/hr, SqueezeMacrodrip 20 989803179721Triple DPT TP4, (152 cm, 60 in) Six 3-way 122 cm (48 in) 31 cm (12 in) 3 ml/hr, SqueezeMacrodrip 10 989803179731Single DPT TP4, (183 cm, 72 in) Red dash tubingTwo 3-way 152 cm (60 in) 31 cm (12 in) 3 ml/hr, SqueezeMacrodrip 20 989803179771Single DPT TP4, (23 cm, 9 in) Patient MountOne 3-way 23 cm (9 in) 3 ml/hr, SqueezeMacrodrip 20 989803179871Single DPT TP4, (61 cm, 24 in) Compartmental PressureOne 4-wayOne 3-way61 cm (24 in) No flush device20 989803181141Single DPT TP4, (152 cm, 60 in), Premium StripeTwo 3-way 122 cm (48 in) 31 cm (12 in) 3 ml/hr, SqueezeMacrodrip 20 989803181211Single DPT TP4, (183 cm, 72 in), Premium StripeTwo 3-way 152 cm (60 in) 31 cm (12 in) 3 ml/hr, SqueezeMacrodrip 20 989803181221Single DPT TP4, (213 cm, 84 in), Premium StripeTwo 3-way 183 cm (72 in) 31 cm (12 in) 3 ml/hr, SqueezeMacrodrip 20 989803181231Dual DPT TP4, (183 cm, 72 in), Premium StripeFour 3-way 152 cm (60 in) 31 cm (12 in) 3 ml/hr, SqueezeMacrodrip 10 989803181241Triple DPT TP4, (152 cm, 60 in), Premium StripeSix 3-way 122 cm (48 in) 31 cm (12 in) 3 ml/hr, SqueezeMacrodrip 10 989803181251Single Neonatal DPT TP4 (61 cm, 24 in)Two 3-way 61 cm (24 in) 30 ml/hr Squeeze20 989803179841Single Neonatal DPT TP4 (31 cm, 12 in)Three 3-way31 cm (12 in) 30 ml/hr Squeeze20 989803179851Single Neonatal DPT TP4 (46 cm, 18 in) one in-line Luer sampling port & 10 ml In-line reservoirThree 3-way46 cm (18 in) 30 ml/hr Squeeze20 989803179881
23 Accessories273Transpac 4 and Safeset Cables and AccessoriesSpO2 AccessoriesSome Nellcor sensors contain natural rubber latex which may cause allergic reactions. See the Instructions for Use supplied with the sensors for more information.Do not use more than one extension cable with any sensors or adapter cables. Do not use an extension cable with:• Masimo adapter cables,• Philips reusable sensors or adapter cables with part numbers ending in -L (indicates "Long" version) or with a cable longer than 2 m.All listed sensors operate without risk of exceeding 41°C on the skin, if the initial skin temperature does not exceed 35°C.Make sure that you use only the accessories that are specified for use with your monitor and measurement technology, otherwise patient injury can result.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. Incorrect sensor application or use may result in inaccurate measurements.In the accessory tables, a column indicates which SpO2 technologies the sensors can be used with, Philips FAST SpO2 (P), or Nellcor OxiMax (N).Description Quantity (per box) Part No.Cable for Philips Monitors 3 m (10 ft) 1 989803177921Cable for Philips Monitors 4.5 m (15 ft) 1 989803179941Cable for Philips Monitors 4.5 m (15 ft) 20 989803179951Trifurcated Cable for Philips Monitors 4.5 m (15 ft) 1 9898031799613-Position Transducer Mount 28 989803177931Transducer Holder for IV Pole 5 989803177941Single Transducer Mount 30 989803179911SafeSet Mounting Bracket 30 989803179901Safeset Shielded Blunt Cannula 50 989803179921SafeSet Shielded Blunt Cannula with Blood Tube Holder 25 989803179931Extension tube, 30 cm 25 989803184971Extension tube, 60 cm 25 989803184981Extension tube, 90 cm 25 989803184991
23 Accessories274Philips Reusable SensorsPhilips Disposable SensorsProduct Number PhilipsNellcor Description CommentsM1191A/B P Adult sensor (2 m cable), for patients over 50 kg. Any finger, except thumb.No adapter cable required.M1191AL/BL P M1191A/B with longer cable (3 m)M1192A P Small adult, pediatric sensor (1.5 m cable) for patients between 15 kg and 50 kg. Any finger except thumb.M1193A P Neonatal sensor (1.5 m cable) for patients between 1 kg and 4 kg. Hand or foot.M1194A P Ear sensor (1.5 m cable) for patients over 40 kg.M1195A P Infant sensor (1.5 m cable) for patients between 4 kg and 15 kg. Any finger except thumb.M1196A P Adult clip sensor (3 m cable) for patients over 40 kg. Any finger except thumb.M1196S P Adult clip sensor (2 m cable) for patients over 40 kg. Any finger except thumb.M1191T P Adult sensor (0.45 m cable), for patients over 50 kg. Any finger, except thumb.Requires M1943A (1 m) or M1943AL (3 m) adapter cableM1192T P Small adult, pediatric sensor (0.45 m cable) for patients between 15 kg and 50 kg. Any finger except thumb.M1193T P Neonatal sensor (0.9 m cable) for patients between 1 kg and 4 kg. Hand or foot.M1196T P Adult clip sensor (0.9 m cable) for patients over 40 kg. Any finger except thumb.Product Number PhilipsNellcor Description CommentsM1901B1P,N Identical to OxiMax MAXN For Philips FAST SpO2: use M1943A (1 m) or M1943AL (3 m) adapter cable.For Nellcor OxiMax SpO2: use M1943NL adapter cable.M1902B1P,N Identical to OxiMax MAXIM1903B1P,N Identical to OxiMax MAXPM1904B1P,N Identical to OxiMax MAXAM1131A P Adult/Pediatric finger sensor, 0.45 m cable (patient size > 20 kg)Use M1943A or M1943AL adapter cable.M1132A P Infant finger or toe sensor, 0.9 m cable (patient size 3 - 10 kg)Use M1943A or M1943AL adapter cable.M1133A P Adult/Infant/Neonatal, 0.9 m cableFoot or hand for neonates < 3 kgBig toe or thumb for patients between 10 kg and 20 kgAny finger except thumb for patients > 40 kgUse M1943A or M1943AL adapter cable.
23 Accessories2751Not available in the USA, Canada and Japan.Nellcor SensorsNellcor sensors must be ordered from Nellcor/Covidien.M1134A P Adhesive-free, Adult/Infant/Neonatal, 0.9 m cableFoot or hand for neonates < 3 kgBig toe or thumb for patients between 10 kg and 20 kgAny finger except thumb for patients > 40 kgUse M1943A or M1943AL adapter cable.Product Number PhilipsNellcor Description CommentsProduct Number PhilipsNellcorDescription CommentsOxiMax MAX-A P,N Adult finger sensor (patient size > 30 kg) For Philips FAST SpO2: use M1943A or M1943AL adapter cable.For Nellcor OxiMax SpO2: use M1943NL adapter cable.OxiMax MAX-AL P,N OxiMax MAX-A with long cableOxiMax MAX-P P,N Pediatric foot/hand sensor (patient size 10 - 50 kg)OxiMax MAX-I P,N Infant foot/hand sensor (patient size 3 - 20 kg)OxiMax MAX-N P,N Adult finger or neonatal foot/hand sensor (patient size >40kg or<3kg)Oxisensor II D-25 P Adult sensor (patient size > 30 kg) Use M1943A or M1943AL adapter cable.Oxisensor II D-20 P Pediatric sensor (patient size 10 - 50 kg)Oxisensor II I-20 P Infant sensor (patient size 3 - 20 kg)Oxisensor II N-25 P Neonatal sensor (patient size < 3 kg or > 40 kg)Oxicliq A P,N See OxiMax MAXA For Philips FAST SpO2: use M1943A or M1943AL adapter cable together with OC-3.For Nellcor OxiMax SpO2: use M1943NL adapter cable together with OC-3.Oxicliq P P,N See OxiMax MAXPOxicliq I P,N See OxiMax MAXIOxicliq N P,N See OxiMax MAXNMAX-R N Adult SpO2 Nasal Sensor Use M1943NL adapter cable.MAXFAST N Forehead SpO2 SensorOxiband OXI-A/N N Adult/Neonatal SpO2 Sensor with WrapsOxiband OXI-P/I N Pediatric-Infant SpO2 Sensor with WrapsSC-A N Adult SpO2 SensorSCNEO-I N Neonatal SpO2 SensorSC-PR-I N Preemie SpO2 SensorDS100A-I N Adult SpO2 SensorDura-Y D-YS N SpO2 Sensor
23 Accessories276Extension Cables and Adapter Cables for Philips and Nellcor SensorsMasimo SensorsThe monitor with Philips FAST SpO2 and Masimo Sensors uses Masimo certified pulse oximetry for reduced noise and low perfusion performance under the Masimo NR&LP protocol. Masimo sensors must be ordered from Masimo or from Masimo's distributors.LNOP Reusable SensorsLNCS Reusable SensorsProduct Number PhilipsNellcor Description CommentsM1941A P Extension cable (2 m) For use with Philips reusable sensors (with cable length ≤2m) and M1943A adapter cable.M1943A P Adapter cable (1.1 m cable) Adapter cable for Philips/Nellcor disposable sensors.M1943AL P Adapter cable (3 m cable)M1943NL N OxiMax adapter cable (3 m cable) Adapter cable for Philips disposable/Nellcor disposable and reusable sensors.OC-3 P,N Adapter Cable for Oxicliq sensors Available from Nellcor/Covidien only.Product Number PhilipsNellcor DescriptionLNOP DCI P Adult Finger Sensor (> 30 kg)LNOP DCIP P Pediatric Finger Sensor (10 - 50 kg)LNOP YI P Multi-Site Sensor (> 1 kg)LNOP TC-I P Ear Sensor (> 30 kg)Product Number PhilipsNellcor DescriptionLNCS DCI P Adult Finger Sensor (> 30 kg)LNCS DCIP P Pediatric Finger Sensor (10 - 50 kg)LNCS YI P Multi-Site Sensor (> 1kg)LNCS TC-I P Ear Sensor (> 30 kg)
23 Accessories277LNOP Disposable Adhesive SensorsLNCS Disposable Adhesive SensorsAdapter Cables for Masimo SensorsProduct Number PhilipsNellcor DescriptionLNOP Adt P Adult Sensor (> 30 kg)LNOP Adtx P Adult Sensor (> 30 kg)LNOP Pdt P Pediatric Sensor (10 - 50 kg)LNOP Pdtx P Pediatric Sensor (10 - 50 kg)LNOP Inf-L P Infant Toe Sensor (3 - 20 kg)LNOP Neo-L P Neonatal Sensor (< 3 kg) or Adult adhesive Sensor (> 40 kg)LNOP NeoPt-L P Neonatal Pre-Term Sensitive Skin Sensors (< 1 kg)Product Number PhilipsNellcor DescriptionLNCS Adtx P Adult Finger Sensor, 18 inch/45 cm (> 30 kg)LNCS Adtx-3 P Adult Finger Sensor, 3 feet/90 cm (> 30 kg)LNCS Pdtx P Pediatric Finger Sensor, 18 inch/45 cm (10 - 50 kg)LNCS Pdtx-3 P Pediatric Finger Sensor, 3 feet/90 cm (10 - 50 kg)LNCS Inf P Infant Toe Sensor, 18 inch/45 cm (3 - 20 kg)LNCS Inf-3 P Infant Toe Sensor, 3 feet/90 cm (3 - 20 kg)LNCS Neo P Neonatal Foot Sensor, 18 inch/45 cm (< 3 kg)or Adult Finger Sensor 18 inch/45 cm (> 40 kg)LNCS Neo-3 P Neonatal Foot Sensor, 3 feet/90 cm (< 3 kg)or Adult Finger Sensor, 3 feet/90 cm (> 40 kg)LNCS NeoPt P Neonatal pre-term sensitive skin Sensor 18 inch/45 cm (< 1 kg)LNCS NeoPt-3 P Neonatal pre-term sensitive skin Sensor 3 feet/90 cm (< 1 kg)Product Number PhilipsNellcor Description Philips Part NumberLNOP MP12 P LNOP MP Series Patient Cable (3.6 m) Adapter Cable for Masimo LNOP Sensors451261000761LNOP MP10 P LNCS MP Series Patient Cable (3.0 m) Adapter Cable for Masimo LNCS Sensors989803148221
23 Accessories278IntelliVue CL SpO2 Pod AccessoriesAll listed sensors operate without risk of exceeding 41°C on the skin, if the initial skin temperature does not exceed 35°C.Make sure that you use only the accessories that are specified for use with this device, otherwise patient injury can result.1 May not be available in all geographiesTemperature AccessoriesPart Number Description Contents989803165941 Mobile CL 20 single patient SpO2 Sensors and Cradles for use on pediatric and adult patients >10 kg20 Single-Patient Mobile CL DSpO2-1A Sensors20 Single-Patient Wristbands20 Single-Patient Cradlespre-assembled989803165921 Mobile CL 20 single patient SpO2 Sensors for use on pediatric and adult patients >10 kg20 Single-Patient Mobile CL DSpO2-1A Sensors9898031659311Mobile CL reusable SpO2 Sensor and Cradles for use on pediatric and adult patients >15kg1 Reusable Mobile CL RSpO2-1A Sensor20 Single-Patient Cradles with pre-attached Wristbands989803165951 Mobile CL 20 SpO2 Cradles (single patient) 20 Single-Patient Cradles with pre-attached Wristbands989803165961 Mobile CL 50 SpO2 Wristbands (single patient)50 Single-Patient Wristbands989803168861 Mobile CL SpO2 Battery Kit 1 Battery1 disassembly tool1 front housingReusable Temperature Probes Part No. Minimum measurement time for accurate readingsGeneral purpose probe 21075A 90 secSmall flexible vinyl probe (Infant/Pediatric) 21076A 60 secAttachable surface probe 21078A 60 secDisposable Temperature Probes Part No. Minimum measurement time for accurate readingsGeneral purpose probe M1837A 90 secSkin probe 21091A 60 secEsophageal/Stethoscope Probe (French 12) 21093A 180 secEsophageal/Stethoscope Probe (French 18) 21094A 210 secEsophageal/Stethoscope Probe (French 24) 21095A 310 sec
23 Accessories279Mainstream CO2 AccessoriesSidestream CO2 AccessoriesEsophageal/Rectal Probe (French 12) 21090A 90 secFoley Catheter Probe (12 French) M2255A 180 secFoley Catheter Probe (16 French) 21096A 180 secFoley Catheter Probe (18 French) 21097A 180 secAdapter cable 1.5 m 21082B --Adapter cable 3.0 m 21082A --Disposable Temperature Probes Part No. Minimum measurement time for accurate readingsCombined Temperature Probes/Feeding Tubes Part No. Response Time per ISO 80601-2-56InnerSense Esophageal Temperature / Feeding Tube, purple (5 French)989803183631 < 150 secondsInnerSense Esophageal Temperature / Feeding Tube, purple (6.5 French)989803183641InnerSense Esophageal Temperature / Feeding Tube, purple (8 French)989803183651InnerSense Esophageal Temperature / Feeding Tube, orange (5 French)989803183561InnerSense Esophageal Temperature / Feeding Tube, orange (6.5 French)989803183571InnerSense Esophageal Temperature / Feeding Tube, orange (8 French)989803183581Description Part No.CO2 Sensor M2501AAdult/Pediatric Airway Adapter (reusable) M2513AInfant Airway Adapter (reusable) M2516AAdult Airway Adapter (single-patient use) M2533AInfant Airway Adapter (single-patient use) M2536ADescription Part No.CO2 Sensor M2741A
23 Accessories280Microstream CO2 Accessories• "FilterLine Set" is a combination of a FilterLine with an Airway Adapter.• "H" in the accessory name indicates suitability for humidified ventilation and longer usage due to the active removal of humidity from the sample line.• "Smart CapnoLine" is a combined oral-nasal FilterLine.• "Smart CapnoLine O2" is a combined oral-nasal-O2-CO2 FilterLine.• "NIV Line" is a nasal FilterLine suitable for mask ventilation (for example, C-PAP).The accessories are supplied in packs of 25.NOTENot all accessories are available in all countries.Nasal and Oral-Nasal Cannulas Part No.CO2 Nasal Cannula, Adult M2744ACO2 Nasal Cannula, Pediatric M2745ACO2 Nasal Cannula, Infant M2746ACO2/O2 Nasal Cannula, Adult M2750ACO2/O2 Nasal Cannula, Pediatric M2751ACO2/O2 Nasal Cannula, Infant 989803144471CO2 Oral-Nasal Cannula, Adult M2756ACO2 Oral-Nasal Cannula, Pediatric M2757ACO2/O2 Oral-Nasal Cannula, Adult M2760ACO2/O2 Oral-Nasal Cannula, Pediatric M2761AAirway Adapters Part No.Airway Adapter Set, ET > 4.0 mm M2768AAirway Adapter Set, ET ≤ 4.0 mm 989803144531Airway Adapter Set H, ET > 4.0 mm M2772AAirway Adapter Set H, ET ≤ 4.0 mm M2773AStraight Sample Lines Part No.Straight Sample Line M2776AStraight Sample Line H M2777AAccessories for Intubated Patients Part Number Part Number for Long VersionFilterLine® SET Adult/Pediatric M1920A 989803160241FilterLine® H SET Adult/Pediatric M1921A 989803160251FilterLine® H SET Infant/Neonatal M1923A 989803160261
23 Accessories281Battery AccessoriesVitaLine™ H SET Adult/Pediatric 989803159571VitaLine™ H SET Infant/Neonate 989803159581Accessories for Intubated Patients Part Number Part Number for Long VersionAccessories for Non-Intubated Patients Part Number Part Number for Long VersionCapnoLine® H Adult M4689ACapnoLine® H Pediatric M4690ACapnoLine® H Infant/Neonatal M4691A 989803178011CapnoLine® H O2 Adult M4680ACapnoLine® H O2 Pediatric M4681ACapnoLine® H O2 Infant/Neonatal 989803178001NIV Line™ Adult M4686ANIV Line™ Pediatric M4687ANasal FilterLine® Infant/Neonatal 989803178021Nasal Filterline® O2 Adult 989803179101 989803179111Nasal Filterline® O2 Pediatric 989803179121Smart CapnoLine® O2 Adult M2522A 989803160281Smart CapnoLine® H O2 Adult 989803177951 989803177961Smart CapnoLine® O2 Pediatric M2520A 989803160271Smart CapnoLine® H O2 Pediatric 989803177971 989803177981Smart CapnoLine® Adult M2526A 989803160301Smart CapnoLine® Pediatric M2524AAccessories for Endoscopic ProceduresSmart CapnoLine® Guard 989803178031Smart CapnoLine® Guard O2989803178041 989803178051Hook and Loop Strap 989803178071Description Part No.Lithium Ion Smart Battery 1Ah (internal battery for X2/MP2) M4607ALithium Ion Smart Battery 6Ah (for 865297 Battery Extension) M4605ABattery Charger and Conditioner (requires size adapter 4512 610 17451 to charge M4607A battery)865432Size adapter for M4607A battery 4512 610 17451
23 Accessories282
2428324SpecificationsThe specifications in this section apply to the MP2 patient monitor.Indications for UseThe monitor is indicated for use by healthcare professionals whenever there is a need for monitoring the physiological parameters of patients.The monitor is intended to be used for monitoring and recording of, and to generate alarms, for, multiple physiological parameters of adults, pediatrics, and neonates. The monitor is intended for use by trained healthcare professionals in a hospital environment.The monitor is also intended for use during patient transport inside and outside of the hospital environment.The monitor is only for use on one patient at a time. It is not intended for home use. Not a therapeutic device. The monitor is for prescription use only.The ECG measurement is intended to be used for diagnostic recording of rhythm and detailed morphology of complex cardiac complexes (according to AAMI EC 11).ST segment monitoring is intended for use with adult patients only and is not clinically validated for use with neonatal and pediatric patients.The Integrated Pulmonary Index (IPI) is intended for use with adult and pediatric (1 to 12 years) patients only. The IPI is an adjunct to and not intended to replace vital sign monitoring.Use EnvironmentHospital EnvironmentThe monitor is suitable for use in all medically used rooms which fulfill the requirements regarding electrical installation according to IEC 60364-7-710 "Requirements for special installations or locations - Medical locations", or corresponding local regulations.EMC EnvironmentAll measurements (except the sidestream CO2 measurement with M2741A sensor) and system interfaces (except short range radio and wireless LAN) are, in addition, suitable for use in establishments directly connected to the public low-voltage supply network that supplies buildings used for domestic purposes (see table in “Electromagnetic Emissions” on page 312).The monitor is indicated for use by health care professionals whenever there is a need for monitoring the physiological parameters of patients.
24 Specifications284WARNINGThe monitor is not intended for use in an MRI environment or in an oxygen-enriched environment (for example, hyperbaric chambers).Restricted AvailabilityFollowing new features and functionality may not be available in all geographies:• Integrated Pulmonary Index for Microstream CO2• IntelliVue Information Center iX• Cableless Respiration MeasurementManufacturer's InformationYou can write to Philips at this addressPhilips Medizin Systeme Boeblingen GmbHHewlett-Packard-Str. 271034 BoeblingenGermanyVisit our website at: www.healthcare.philips.com.© Copyright 2015. Koninklijke Philips N.V. All Rights Reserved.Trademark AcknowledgementMicrostream®, FilterLine®, and Smart CapnoLine® are trademarks or registered trademarks of Oridion Systems Ltd.Nellcor™, Durasensor™, Dura-Y™, Oxiband™, Oxicliq™, OxiMax™, MAX-FAST™, and Softcare™ are trademarks of Nellcor Puritan Bennett LLC, a Covidien company.Masimo®, Masimo SET®, and LNOP® are federally registered trademarks of the Masimo Corporation.Transpac® and SafeSet™ are trademarks of ICU Medical, Inc.Other product and company names mentioned in this book may be trademarks of their respective owners.
24 Specifications285SymbolsThese symbols can appear on the monitor and its associated equipment and packaging (depending on options).SymbolsCaution, refer to accompanying documents On/Off/StandbyAlternating current Rechargeable battery symbolDC power source Battery EjectECG Sync Pulse Output indicator Connection direction indicatorPressure connector Temperature connectorConnection direction indicator Connector has special protection against electric shocks and is defibrillator proofNBP connector SpO2 connectorUses FAST SpO2 algorithm LAN connection indicator for connection to a wired networkMasimo SET technology Nellcor OxiMax compatibleSilence Alarms Alarms On/OffAlarms Switched Off Identifies year and month of manufactureECG connector Error LEDIntelliVue Instrument Telemetry wireless networkAlways use separate collection for waste electrical and electronic equipment (WEEE)
24 Specifications286Monitor supports 12-lead ECG Indicates location of the date of manufacture and/or name and address of manufacturerBuilt-in short range radio interface Built-in wireless networkIndicates location of catalog number Main ScreenFollowed by two alphanumeric characters, indicates ingress protection gradeIndicates location of serial numberIndicates location of service number SmartKeysElectrical input indicator(In some cases gas input indicator)Electrical output indicator(In some cases gas output indicator)Non-ionizing radiation symbol LAN connection indicator for connection to a wired networkStart a measurement Stop a measurementEnter the measurement setup menu Zero the invasive pressure transducerMass in kilogram (kg) Indicates location of batch numberIndicates the location of the "use by" date Not made with natural rubber latexPrescription use only Contents of the packaging are not sterileAtmospheric pressure limitations for storageHumidity limitations for storageTemperature limitations for storageSymbols
24 Specifications287Installation Safety InformationWARNINGIf multiple instruments are connected to a patient, the sum of the leakage currents may exceed the limits given in IEC/EN 60601-1, IEC 60601-1-1, UL 60601-1. Consult your service personnel.ConnectorsThe actual placement of boards and configuration of connections for your monitor depends on how your hardware has been configured. See the symbols table in this chapter to see which symbols are used to mark the connections.WARNING• Connect only medical devices to the ECG output connector socket. • Connecting the ECG sync out to external equipment should only be done by a qualified user. Do not touch the patient when you have contact to the ECG output connector socket.• Always connect the ECG sync cable first to the external device and then to the monitor. Wherever possible, pre-install the cable before the patient is brought into the vicinity of the equipment.Monitor Mounting PrecautionsMount the monitor using either the Philips Quick Mount or Fix Mount solution or another approved mounting solution. Select the mounting equipment and the mounting position so that no patient, operator or other person can be harmed by a monitor removed intentionally or released accidentally from the mount. When using the Quick Mount, be aware of the danger of accidental activation of the Quick Mount release button when lifting or moving items located under the monitor, such as pole mounts, etc. If in doubt, use the Philips Fix Mount solution to avoid such situations. Refer to the respective IntelliVue Monitor Service Manual, Installation Instructions chapter, for more details.Always ensure that the monitor is positioned so that the AC power plug is easily accessible, to allow disconnection of the monitor from the AC power source.Repositioning a Monitor on the Mounting ArmAttempts to reposition the monitor should only be performed as described in the mounting hardware manufacturer’s user documentation. If the mounting arm has a locking mechanism, ensure the locking mechanism is unlocked before attempting to reposition the monitor. Never pull on the monitor to tilt, swivel or otherwise reposition it - always hold on to the mounting hardware itself.Earthing The monitor must be earthed during operation. The earthing is for functional purposes and does not provide protection against electric shock. The protection against electric shock in this device is provided by double and/or reinforced insulation. If a three-wire receptacle is not available, consult the hospital electrician. Never use a three-wire to two-wire adapter.Combining equipment Combinations of medical equipment with non-medical equipment must comply with IEC 60601-1-1. Never use a multiple portable socket-outlet or extension cord when combining equipment unless the socket outlet is supplied specifically for use with that equipment.Network Cables All network cables must be unshielded.
24 Specifications288WARNINGNot adhering to these instructions when repositioning the monitor can cause damage to the monitor. In extreme cases, when force is applied to the monitor, it can result in the monitor falling from the mounting arm.If, at any time, the monitor appears to be loose or insecurely mounted, contact your service personnel.Altitude SettingAltitude affects CO2 measurements. The monitor must be configured at installation to the correct altitude.Monitor Safety SpecificationsThe monitor and MMS Extensions comply with the Medical Device Directive 93/42/EEC.In addition, the product complies with:IEC 60601-1:1988 + A1:1991 + A2:1995EN60601-1:1990 + A1:1993 + A2:1995UL 60601-1:2003CAN/CSA C22.2#601.1-M90 +Suppl. No. 1-94 + Am. 2IEC 60601-1-1:2000EN 60601-1-1:2001IEC 60601-1-2:2001 + A1:2004EN 60601-1-2:2001 + A1:2006.The possibility of hazards arising from software errors was minimized in compliance with:ISO 14971:2007EN60601-1-4:1996 + A1:1999IEC 60601-1-4:1996 + A1:1999.Classification (according to IEC 60601-1): Class II, Type CF, Continuous Operation.EMC and Radio Regulatory ComplianceThis ISM device complies with Canadian ICES-001. Cet appareil ISM est conforme à la norme NMB-001 du Canada.The MP2 including IntelliVue Instrument Telemetry WMTS (US only))The MP2 including IntelliVue Instrument Telemetry WMTS complies with part 15 of the FCC Rules. Operation is subject to the condition that this device does not cause harmful interference. Operation of this equipment requires the prior coordination with a frequency coordinator designated by the FCC for the Wireless Medical Telemetry Service.
24 Specifications289The MP2 including IntelliVue Instrument Telemetry ISM (2.4 GHz)FCC and Industry Canada Radio Compliance: This device complies with Part 15 of the FCC Rules and RSS-210 of Industry Canada. Operation is subject to the following two conditions: (1) this device may not cause harmful interference, and (2) this device must accept any interference received, including interference that may cause undesired operation. Any changes or modifications to this equipment not expressly approved by Philips Medical Systems may cause harmful radiofrequency interference and void your authority to operate this equipment.The radio device used in this product is in compliance with the essential requirements and other relevant provisions of Directive 1999/5/EC (Radio Equipment and Telecommunications Terminal Equipment Directive). Class 2 radio equipment. Member states may apply restrictions on putting this device into service or placing it on the market. This product is intended to be connected to the Publicly Available Interfaces (PAI) and used throughout the EEA.The MP2 Including the IntelliVue 802.11 Wireless Network AdapterFCC and Industry Canada Radio Compliance: This device complies with Part 15 of the FCC Rules and RSS-210 of Industry Canada. Operation is subject to the following two conditions: (1) this device may not cause harmful interference, and (2) this device must accept any interference received, including interference that may cause undesired operation. Any changes or modifications to this equipment not expressly approved by Philips Medical Systems may cause harmful radiofrequency interference and void your authority to operate this equipment.The maximum antenna gain permitted (for devices in the 5250-5350 MHz and 5470-5725 MHz bands) complies with the e.i.r.p. limits as stated in RSS-210.The maximum antenna gain permitted (for devices in the 5725-5825 MHz band) complies with the e.i.r.p. limits specified for point-to-point operation, as stated in RSS-210.The device for the band 5150-5250 MHz is only for indoor usage to reduce potential for harmful interference to co-channel mobile satellite systems.CAUTIONHigh power radars are allocated as primary users (meaning they have priority) of 5250-5350 MHz and 5650-5850 MHz and these radars could cause interference and /or damage to LE-LAN devices.IntelliVue 802.11 Wireless Network Adapter CE ComplianceThe radio device used in this product is in compliance with the essential requirements and other relevant provisions of Directive 1999/5/EC (Radio Equipment and Telecommunications Terminal Equipment Directive). Class 2 radio equipment. Member states may apply restrictions on putting this device into service or placing it on the market. This product is intended to be connected to the Publicly Available Interfaces (PAI) and used throughout the EEA.In addition the product complies with: ETSI EN 300 328; ETSI EN 301 893; AS/NZS 4771+A1; ARIB STD-T66.
24 Specifications290Radiofrequency Radiation Exposure InformationFor body worn operation, this equipment has been tested and meets the FCC RF exposure guidelines when used with the accessories supplied or those approved for use with this product. Use of other accessories may not ensure compliance with FCC RF exposure guidelines.The MP2 and 865244 Remote Control Including the Short Range Radio InterfaceFCC and Industry Canada Radio Compliance: This device complies with Part 15 of the FCC Rules and RSS-210 of Industry Canada. Operation is subject to the following two conditions: (1) this device may not cause harmful interference, and (2) this device must accept any interference received, including interference that may cause undesired operation. Any changes or modifications to this equipment not expressly approved by Philips Medical Systems may cause harmful radiofrequency interference and void your authority to operate this equipment. The radio component contained in this device is in compliance with the essential requirements and other relevant provisions of Council Directive 1999/5/EC (Radio Equipment and Telecommunications Terminal Equipment Directive)In addition the product complies with: ETSI EN 300 328; AS/NZS 4268; ARIB STD-T66.Class 1 radio equipment.To obtain a copy of the original Declaration of Conformity, please contact Philips at the address given in the “Manufacturer's Information” section of these Instructions for UseOut-Of-Hospital Transport - Standards ComplianceThe MP2 patient monitor with measurements and interfaces other than those listed below cannot be used for patient transport outside of the hospital environment.The MP2 patient monitor, with the following measurements and interfaces:– ECG/Respiration, NBP, SpO2, Pressure, Temperature, CO2 (only Mainstream Sensor M2501A)– LAN, internal Batterycan be used in a transport environment such as a road ambulance, airplane or helicopter. For this purpose the monitor fulfils the following additional mechanical, EMC and environmental requirements:•Shock Tests according to IEC TR 60721-4-7, Class 7M3. Test procedure according to IEC/EN 60068-2-27 (peak acceleration up to 100g).•Random Vibration according to IEC TR 60721-4-7, Class 7M3. Test procedure according to IEC/EN 60068-2-64 (RMS acceleration 5g).•Sinusoidal Vibration according to IEC TR 60721-4-7, Class 7M3. Test procedure according to IEC/EN 60068-2-6 (acceleration up to amplitude 2g).•Bump Test according to IEC/EN 60068-2-29 (peak acceleration 15 g, 1000 bumps).•Free Fall Test according to EN1789 (covers also IEC TR 60721-4-7 and Class 7M3). Test procedure according to EN 60068-2-32 (height 0.75 m).•Specification for degrees of protection provided by enclosures according to IEC/EN 60529: IP 32.
24 Specifications291• EN 1789 +A1:2003 Medical vehicles and their equipment - Road ambulances (chapter 6 - Medical Devices).•Radiated susceptibility 20 V/m according to EN ISO 9919 (SpO2) and EN ISO 21647 (CO2).•Altitude Range from -500 to 3000 m operating and -500 to 4600 m storage and transportation.•Extended radiated susceptibility testsThe MP2 patient monitor with its out-of-hospital parameter set provides a general immunity level of 20 V/m with only few restrictions. Details are as listed below:– GSM 900: Immunity at 900 MHz (uplink mobile phone), 20 V/m (ECG:10 V/m), duty cycle 1:8.– GSM 1800: Immunity at 1800 MHz (uplink mobile phone), 20 V/m, duty cycle 1:8.– DECT: Immunity at 1800 MHz (digital cordless phone), 20 V/m, duty cycle 1:24.– AM: 1 kHz Immunity from 80 MHz to 1.0 GHz (any radio communication unit, broadcasting and TV transmitter), 20 V/m, modulation factor 80%. (ECG: 20 V/m except 600-950 MHz where it is 10 V/m and Temperature which holds 3 V/m over the full range).CAUTIONTemperature measurement accuracy may be compromised in the presence of strong electromagnetic fields (>3V/m) in certain small frequency bands.•Magnetic Field emission according to MIL STD 461E, Chapter RE101: Radiated emissions, magnetic field, 30 Hz to 100 kHz. Limit class: Army.•Magnetic Field susceptibility: Radiated susceptibility, magnetic field, 50, 60 and 400 Hz, 18 µT(15 A/m).•Operating ambient temperature testing over the range from 0 to 40°C (32 to 100°F).•Operating ambient humidity testing up to 95 % RH at 40°C (100°F), non condensing.NOTEThere may be additional requirements for transport situations in air, on water or in difficult terrain in certain countries, e.g. EU.Physical SpecificationsProduct Maximum Weight Size (WxHxD) CommentsMP2 Monitor 1.2 kg (2.6 lbs) 199x 146 x 89 mm (7.8 x 5.7 x 3.5 in)including battery, with handle and optionsM8023A External Power Supply 0.6 kg (1.3 lbs) 208x 105 x 135 mm (8.2 x 4.1 x 5.3 in)865297 Battery Extension 1.3 kg (2.9 lbs) 193 x 140 x 132 mm (7.6 x 5.5 x 5.2in)
24 Specifications292Environmental SpecificationsThe monitor may not meet the performance specifications given here if stored or used outside the specified temperature and humidity ranges.The monitor is protected against ingress of objects and fluids according to IEC 60529 IP32 (see specifications below). Do not expose the monitor directly to heavy rain.When the monitor and related products have differing environmental specifications, the effective range for the combined products is that range which is common to the specifications for all products.1 Sufficient for flight altitudes up to 12,000 m with pressurized cabinsItem Condition RangeTemperature Range Operating 0 to 40°C (32 to 104°F)Storage including transportation -20 to 60°C (-4 to 140°F)Temperature Range with the Wireless IntelliVue Adapter or IntelliVue Instrument Telemetry Wireless Network or when charging the batteryOperating 0 to 35°C (32 to 95°F)Humidity Range Operating 15% to 95% Relative Humidity (RH)Storage including transportation 5% to 95% Relative Humidity (RH)Altitude Range Operating -500 m to 3000 m (10000 ft)Storage including transportation -500 m to 4600 m (15000 ft)1Ingress Protection Monitor IP32 (protected against ingress of water when the water is dripping vertically and the monitor is tilted up to 15°and ingress of foreign objects larger than 2.5 mm)External Power Supply (M8023A) IP31(protected against the ingress of solid foreign objects 2.5 mm in diameter or larger, and the ingress of water when the water is dripping vertically) when rested on its rubber feet on a flat, level surface.IP32 when mounted as described in the Service Guide.Battery Extension (865297) IP32 (protected against ingress of water when the water is dripping vertically and the monitor is tilted up to 15°, not protected against heavy rain.)
24 Specifications293Monitor Performance SpecificationsPerformance SpecificationsPower Specifications Power consumption <12 W average<30 W while battery is loadingOperating Voltage 36 to 60 V DC floatingBattery Specifications Operating Time (with new, fully charged battery at 25°C)Basic monitoring configuration: 2.5 hours(Brightness set to Optimum, ECG/Resp, SpO2 measurements in use, NBP measurement every 15 minutes)Charge Time When monitor is off: 2 hoursWhen monitor is in use, and connected to the external power supply (M8023A), without MMS extensions: 12 hours approx.Indicators Alarms Off red or yellow LED with crossed out alarms symbolAlarms red/yellow/light blue (cyan) LEDOn/Standby / Error green / red LEDAC Power green LEDBattery yellow (charging)/red blinking (empty) LEDExternal Power green LEDSounds Audible feedback for user inputPrompt toneQRS tone, or SpO2 modulation tone4 different alarm soundsDisplay Wave Speeds 6.25 mm/s, 12.5 mm/s, 25 mm/s, 50 mm/swith ±5% accuracy (guaranteed only for integrated displays)Trends Resolution 12 or 16 numerics @ 12 sec, 1 minute, 5 minute resolution.Information Multiple choices of number of numerics, resolution and duration depending on trend option and application area.For example:For neonatal, you can choose between 12 and 16 numerics.Alarm signal System alarm delayThe system alarm delay is the processing time the system needs for any alarm to be indicated on the monitor, after the measurement has triggered the alarm.less than 4 secondsDelay for alarm availability on the network This is the time needed after alarm indication on the monitor until the alarm signal is available on the network, to the IntelliVue Information Center or for transmission to other systems.less than 5 secondsPause duration 1,2,3 minutes or infinite, depending on configurationExtended alarm pause 5 or 10 minutesSound pressure range min. 0 dB(A)max. 45-85 dB(A)Review Alarms Information all alarms / inops, main alarms on/off, alarm silence and time of occurrenceCapacity 300 items
24 Specifications294Monitor Interface SpecificationsReal Time Clock Range from: January 1, 1997, 00:00 to: December 31, 2080, 23:59Accuracy <4 seconds per day (typically)Hold Time infinite if powered by external power supply; otherwise at least 48 hoursBuffered Memory Hold Time if powered by external power supply: infinitewithout power: at least 48 hoursContents Active settings, trends, patient data, realtime reports, review alarmsPerformance SpecificationsM8023A External Power Supply Performance SpecificationsPower Specifications Power consumption <12 W average<30 W peakLine Voltage 100 to 240 V ~Current 1.3 to 0.7 AFrequency 50/60 Hz ~Indicators AC Power green LEDDisplay SpecificationsIntegrated QVGA DisplaySweep Speeds 6.25, 12.5, 25 and 50 mm/sResolution 320 x 240Refresh frequency 60 HzUseful screen 72x54mm (2.8x2.1in)Pixel size 0.22 x 0.22 mmMonitor Interface SpecificationsMeasurement Link (MSL)Connectors Female ODU (Proprietary)Power 30 V to 60 V inputPower Sync. RS-422 compliant input 78.125kHz (typical)LAN signals IEEE 802.3 10-Base-T compliantSerial signals RS-422 compliantLocal signals Provided for connecting measurement extensions
24 Specifications2951 See “Connectors” on page 287 for safety-related information)2 The short range radio interface is compatible with the IntelliVue Cableless Measurements and the following devices: TRx4841A/TRx4851A IntelliVue Telemetry System Transceiver and MX40 Patient Wearable Monitor.ECG Sync Pulse Output1Cable detection YesMarker In NoWave Output NoConnector Binder Series 709/719Output levels Output low <0.8 V @ I = -4 mAOutput high >2.4 V @ I = 4 mAIsolation NonePulse Width 100 +/-10 ms (high)Delay from R-wave peak to start of pulse20 ms maximum per AAMI EC13Minimum required R-wave amplitude0.5 VIntelliVue 802.11 Bedside Adapter (Wireless Network Adapter)Type Internal wireless adapterTechnology IEEE 802.11a/b/gFrequency Band USA: 2.400 - 2.483GHz, 5.15 - 5.35GHz, 5.725 - 5.825GHzEurope: 2.400 - 2.483GHz, 5.15 - 5.35GHz, 5.47 - 5.725GHzJapan: 2.400 - 2.483GHz, 2.471 - 2.498GHz, 4.900 - 5.091GHz, 5.150 - 5.250GHz, 5.25 - 5.35GHz, 5.470 - 5.725GHzChina: 2.400 - 2.483GHz, 5.725 -5.85GHzModulation Technique 802.11b/gDSSS (DBPSK, DQPSK, CCK)OFDM (BPSK,QPSK, 16-QAM, 64-QAM)802.11aOFDM (BPSK,QPSK, 16-QAM, 64-QAM)Effective radiated power max 18 dBmShort Range Radio Interface2Type Internal SRR interfaceTechnology IEEE 802.15.4Frequency Band 2.4 GHz ISM (2.400 - 2.483 GHz)Modulation Technique DSSS (O -QPSK)Effective radiated power max. 0 dBm (1 mW)IntelliVue Instrument Telemetry Wireless Network (USA only)Internal WMTS AdapterTechnology compatible with Philips IntelliVue Telemetry System (ITS), cellular infrastructureFrequency Band WMTS, 1395-1400 MHz and 1427-1432 MHzIntelliVue Instrument Telemetry Wireless NetworkInternal ISM Adapter Technology compatible with Philips IntelliVue Telemetry System (ITS), cellular infrastructureFrequency Band 2.4 GHz ISMMonitor Interface Specifications
24 Specifications296865297 Battery Extension SpecificationsM4607A Battery SpecificationsOne battery is required for battery operation of the monitor.The battery lifetime is 3 years from manufacturing date or 500 charge/discharge cycles.M8023A External Power Supply Interface SpecificationsMeasurement Link (MSL)Connectors Male ODU (Proprietary)Power 48 V outputPower Sync. RS-422 compliant output 78.125 kHz (typical)LAN signals IEEE 802.3 10-Base-T compliantSerial signals RS-422 compliant output 78.125 kHz (typical)Local signals Not connected865297 Battery Extension Interface SpecificationsMeasurement Link (MSL)Connectors Male ODU (Proprietary)Power 36 -38 V outputPower Sync. RS-422 compliant output 78.125 kHz (typical)LAN signals IEEE 802.3 10-Base-T compliantSerial signals RS-422 compliantLocal signals Not connectedMeasurement Link (MSL)Connectors Female ODU (Proprietary)Power 30-60 V inputPower Sync. RS-422 compliant input 78.125 kHz (typical)LAN signals IEEE 802.3 10-Base-T compliantSerial signals RS-422 compliantLocal signals Not connected865297 Battery Extension Battery SpecificationsBattery Type M4605AIndicators green power LED and green-yellow-red battery status LEDM4607A Battery SpecificationsPhysical SpecificationsW x D x H 66 mm (2.36 in) x 80 mm (3.15 in) x 20 mm (0.79 in)Weight 160 g ±5%Performance SpecificationsNominal Voltage 10.8 VoltRated Capacity at discharge C/5 1000 mAh (typical)Environmental Specifications
24 Specifications297M4605A Battery SpecificationsThe battery lifetime is 3 years from manufacturing date or 500 charge/discharge cycles.Temperature Range Discharge 0 to 60°C (32 to 122°F)Charge 0 to 60°C (32 to 122°F)Storage and Transportation: -20 to 65°C (-4 to 140°F)Humidity Range Operating: 15% to 95% Relative Humidity (RH)Storage and Transportation: 5% to 95% Relative Humidity (RH)Battery Type Lithium Ion Manganese, 10.8 V, 1000 mAhSafety complies with UL 2054Electromagnetic Compatibility (EMC) complies with the requirements for FCC Type B computing Device, and EN 61000-4-2 and EN 61000-3-2Communication Standard complies with the SMBus specification v1.1M4607A Battery SpecificationsM4605A Battery SpecificationsPhysical SpecificationsW x D x H 149 x 89 x 19.8 mm (5.866 x 3.504 x 0.78 in)Weight 490 g (1.08 lb) per batteryPerformance SpecificationsNominal Voltage 10.8 VoltRated Capacity at discharge C/5 6000 mAhContinuous Discharge Capability 6.5 AEnvironmental SpecificationsTemperature Range Discharge 0 to 50°C (32 to 122°F)Charge 0 to 50°C (32 to 122°F)Storage and Transportation: -20 to 65°C (-4 to 140°F)Humidity Range Operating: 15% to 95% Relative Humidity (RH)Storage and Transportation: 5 % to 95 % Relative Humidity (RH)Battery Type Smart Battery 10.8 V, 6000 mAh, Lithium IonSafety complies with UL 2054Electromagnetic Compatibility (EMC) complies with the requirements for FCC Type B computing Device, and EN 61000-4-2 and EN 61000-3-2Communication Standard complies with the SMBus specification v 1.1
24 Specifications298Measurement SpecificationsSee the “Default Settings Appendix” for a list of the settings the monitor is initially shipped with.ECG/Arrhythmia/ST/QTComplies with:• IEC 60601-2-25:1993 + A1:1999/EN60601-2-25:1995 + A1:1999• IEC 60601-2- 27:2005/EN60601-2-27:2006• IEC 60601-2-51:2003/EN 60601-2-51:2003• AAMI EC11/EC13:1991/2002ECG/Arrhythmia/ST Performance SpecificationsCardiotach Range Adult/pedi: 15 to 300 bpmNeo range: 15 to 350 bpmNote: for rates equal to or less than 15 bpm, the displayed heart rate is 0.Accuracy ±1% of rangeResolution 1 bpmSensitivity ≥200 µVpeakPVC Rate Range 0 to 300 bpmResolution 1 bpmST Numeric Range -20 to +20 mmAccuracy ±0.5 mm or 15%, whichever is greaterResolution 0.1 mmQT Numeric Range 200 to 800 msAccuracy ±30 msResolution 8 msQTc Numeric Range 200 to 800 msResolution 1 msΔQTc Numeric Range -600 to +600 msResolution 1 msQT-HR Numeric Range - adult 15 to 150 bpmRange - pediatric and neonatal 15 to 180 bpmSinus and SV Rhythm Ranges Brady Adult: 15 to 59 bpmPedi: 15 to 79 bpmNeo: 15 to 89 bpmNormal Adult: 60 to 100 bpmPedi: 80 to 160 bpmNeo: 90 to 180 bpmTachy Adult: >100 bpmPedi: >160 bpmNeo: >180 bpm
24 Specifications299Bandwidth Diagnostic Mode Adult/neo/pedi: 0.05 to 150 HzExtended Monitoring Mode Adult/neo/pedi: 0.5 to 150 HzMonitoring Mode Adult: 0.5 to 40 HzNeo/pedi: 0.5 to 55 HzFilter Mode Adult/neo/pedi: 0.5 to 20 HzBandwidthwhen the ECG is transmitted from a telemetry device via short range radioDiagnostic Mode Adult/neo/pedi: 0.05 to 40 HzExtended Monitoring Mode Adult/neo/pedi: 0.5 to 40 HzMonitoring Mode Adult: 0.5 to 40 HzNeo/pedi: 0.5 to 40 HzFilter Mode Adult/neo/pedi: 0.5 to 20 HzDifferential Input Impedance >2 MΩ RA-LL leads (Resp)>5 MΩ at all other leads (at 10 Hz including patient cable)Common Mode Rejection Ratio Diagnostic mode: >86 dB (with a 51 kΩ/47 nF imbalance).Filter mode: >106 dB (with a 51 kΩ/47 nF imbalance).Electrode Offset Potential Tolerance ±500 mVAuxiliary Current(Leads off Detection)Active electrode: <100 nAReference electrode: <900 nAInput Signal Range ±5 mVECG/Arrhythmia/ST Performance SpecificationsECG/Arrhythmia/ST/QT Alarm Specifications Range AdjustmentHR 15 to 300 bpmmaximum delay: 10 seconds according to AAMI EC 13-1992 standardAdult:1 bpm steps (15 to 40 bpm)5 bpm steps (40 to 300 bpm)Pedi/Neo:1 bpm steps (15 to 50 bpm)5 bpm steps (50 to 300 bpm)Extreme Tachy Difference to high limit 0 to 50 bpm5bpm stepsClamping at 150 to 300 bpm 5 bpm stepsExtreme Brady Difference to low limit 0 to 50 bpm5bpm stepsClamping at 15 to 100 bpm 5 bpm stepsRun PVCs None, fixed setting 2 PVCs Not adjustable by userPVCs Rate 1 to 99 PVCs/minute 1 PVCVent Tach HR 20 to 300 bpm 5 bpmVent Tach Run 3 to 99 PVCs/minute 1 PVCVent Rhythm Run 3 to 99 PVCs/minute 1 PVCSVT HR 120 to 300 bpm 5 bpmSVT Run 3 to 99 SV beats 1 SV beatST High -19.8 to +20 mm 0.2 mmST Low -20 to +19.8 mm 0.2 mmSTE Limit -20 to +20 mm 0.2 mmQTc High 200 ms to 800 ms 10 ms stepsΔQTc High 30 ms to 200 ms 10 ms steps
24 Specifications300RespirationECG/Arrhythmia/ST Supplemental Information as required by AAMI EC11/13, IEC 60601-2-27Respiration Excitation Waveform Sinusoidal signal, 260 μA, 40.5 kHzNoise Suppression RL drive gain 44 dB max., max. voltage 1.8 VrmsTime to Alarm for Tachycardia Vent Tachycardia1mVpp,206 bpmGain 0.5, Range 6.5 to 8.4 seconds, Average 7.2 secondsGain 1.0 Range 6.1 to 6.9 seconds, Average 6.5 secondsGain 2.0, Range 5.9 to 6.7 seconds, Average 6.3 secondsVent Tachycardia2mVpp,195 bpmGain 0.5, Range 5.4 to 6.2 seconds, Average 5.8 secondsGain 1.0, Range 5.7 to 6.5 seconds, Average 6.1 secondsGain 2.0, Range 5.3 to 6.1 seconds, Average 5.7 secondsTall T-Wave Rejection Capability Exceeds ANSI/AAMI EC 13 Sect. 3.1.2.1(c) minimum recommended 1.2 mV T-Wave amplitudeHeart Rate Averaging Method Three different methods are used:Normally, heart rate is computed by averaging the 12 most recent R-R intervals.For runs of PVCs, up to 8 R-R intervals are averaged to compute the HR.If each of 3 consecutive R-R intervals is greater than 1200 ms (that is, rate less than 50 bpm), then the 4 most recent R-R intervals are averaged to compute the HR.Response Time of Heart Rate Meter to Change in Heart Rate HR change from 80 to 120 bpm:Range: [6.4 to 7.2 seconds] Average: 6.8 secondsHR change from 80 to 40 bpm:Range: [5.6 to 6.4 sec] Average: 6.0 secondsHeart Rate Meter Accuracy and Response to Irregular Rhythm Ventricular bigeminy: 80 bpmSlow alternating ventricular bigeminy: 60 bpmRapid alternating ventricular bigeminy: 120 bpmBidirectional systoles: 90 bpmAccuracy of Input Signal Reproduction Methods A and D were used to establish overall system error and frequency response.Pacemaker Pulse Rejection Performance Rejection of pacemaker pulses with amplitudes from ±2 mV to ±700 mV and widths from 0.1 ms to 2.0 ms (Method A)Pacemaker Pulse Rejection of fast ECG signals 2.2 V/s RTI (Paced Mode)Minimum input slew rate 2.2 V/s RTIRespiration Performance SpecificationsRespiration Rate Range Adult/pedi: 0 to 120 rpmNeo: 0 to 170 rpmAccuracy at 0 to 120 rpm ±1 rpmat 120 to 170 rpm ±2 rpmResolution 1 rpmBandwidth 0.3 to 2.5 Hz (-6 dB)Noise Less than 25 mΩ (rms) referred to the input
24 Specifications301Respiration from the CL Respiration PodFor the general measurement specifications, refer to the IntelliVue Cableless Measurements Instructions for Use.The alarm specifications for alarms generated by the CL Respiration pod and indicated by the monitor are listed in the table below.SpO2Complies with ISO 9919:2005 / EN ISO 9919:2009 (except alarm system; alarm system complies with IEC 60601-2-49:2001).Measurement ValidationThe SpO2 accuracy has been validated in human studies against arterial blood sample reference measured with a CO-oximeter. Pulse oximeter measurements are statistically distributed, only about two-thirds of the measurements can be expected to fall within the specified accuracy compared to CO-oximeter measurements.Respiration Alarm Specifications Range Adjustment DelayHigh Adult/pedi: 10 to 100 rpmNeo: 30 to 150 rpm< 20 rpm: 1 rpm steps≥ 20 rpm: 5 rpm stepsmax. 14 secondsLow Adult/pedi: 0 to 95 rpmNeo: 0 to 145 rpm< 20 rpm: 1 rpm steps≥ 20 rpm: 5 rpm stepsfor limits from 0 to 20 rpm: max. 4 secondsfor limits above 20 rpm: max. 14 secondsApnea Alarm 10 to 40 seconds 5 second stepscmResp Alarm Specifications Range AdjustmentRespiration Rate 5 to 60 rpm <20 rpm: 1 rpm steps>20rpm: 5rpm stepsBradypnea Difference to high limit 0 to 20 rpm 1 rpm stepsClamping at 5 to 50 rpm <20 rpm: 1 rpm steps>20rpm: 5rpm stepsPulse 30 to 220 bpm 30 to 40 bpm: 1 bpm steps40 to 220 bpm: 5 bpm stepsTachycardia Difference to high limit 0 to 50 bpm 5 bpm stepsClamping at 150 to 220 bpm 5 bpm stepsBradycardia Difference to low limit 0 to 50 bpm 5 bpm stepsClamping at 30 to 100 bpm 5 bpm steps
24 Specifications302Philips FAST SpO2 Performance SpecificationsPhilips FAST SpO2 Performance SpecificationsSpO2The specified accuracy is the root-mean-square (RMS) difference between the measured values and the reference valuesRange 0 to 100%Accuracy Philips Reusable Sensors:M1191A, M1191AL, M1191B, M1191BL, M1192A, = 2% (70% to 100%)M1193A, M1194A, M1195A, M1196A, M1196S = 3% (70% to 100%)M1191T, M1192T, M1193T (Adult), M1196T = 3% (70% to 100%)M1193T (Neonate) = 4% (70% to 100%)Philips Disposable Sensors with M1943A(L):M1132A, M1133A (adult/infant), M1134A (adult/infant) = 2%M1901B, M1902B, M1903B, M1904B, M1131A, M1133A (neonate), M1134A (neonate) = 3% (70% to 100%)NellcorPB® Sensors with M1943A(L):MAX-A, MAX-AL, MAX-P, MAX-I, MAX-N, D-25, D-20, I-20, N-25, OxiCliq A, P, I, N = 3% (70% to 100%)Masimo Reusable Sensors® with LNOP MP12 or LNC MP10:LNOP DC-I, LNOP DC-IP, LNOP YI (adult/pedi/infant), LNCS DC-1, LNCS DC-IP, LNCS YI (adult/pedi/infant) = 2% (70% to 100%)LNOP YI (neonate), LNCS YI (neonate) = 3% (70% to 100%)LNOP TC-I, LNCS TC-I: 3.5% (70% to 100%)Masimo Disposable Sensors® with LNOP MP12 or LNC MP10:LNOP Adt, LNOP Adtx, LNOP Pdt, LNOP Pdtx, LNOP Inf-L, LNOP Neo-L (adult), LNCS Adtx, LNCS Adtx-3, LNCS Pdtx, LNCS Pdtx-3, LNCS Inf, LNCS Inf-3, LNCS Neo (adult), LNCS Neo-3 (adult) = 2% (70% to 100%)LNOP Neo-L (neonate), LNOP NeoPt-L, LNCS Neo (neonate), LNCS Neo-3 (neonate), LNCS NeoPt, LNCS NeoPt-3 = 3% (70% to 100%)Resolution 1%Pulse Range 30 to 300 bpmAccuracy ±2% or 1 bpm, whichever is greaterResolution 1 bpmNumeric Update Rate Typical: 2 seconds, Maximum: 30 seconds. Maximum with NBP INOP suppression on: 60 seconds.Sensors Wavelength range: 500 to 1000 nmEmitted Light Energy: ≤15 mWInformation about the wavelength range can be especially useful to clinicians (for instance, when photodynamic therapy is performed)Pulse Oximeter Calibration Range 70% to 100%
24 Specifications303Nellcor OxiMax Performance Specifications1. M1901B/MAXN:Clinical functionality has been demonstrated on a population of hospitalized neonate patients. The observed SpO2 accuracy was 2.5% in a study of 42 patients with ages of 1 to 23 days, weight from 750 to 4100 grams, and 63 observations made spanning a range of 85 to 99% SaO2 while monitored with Nellcor OxiMax N-595 pulse oximeters.2. The accuracy specification has been determined between saturations of 80%–100%.3. SoftCare SC-PR-I, SCNEO-I:Clinical functionality has been demonstrated on a population of hospitalized neonate and infant patients. The observed SpO2 accuracy was 3.0% in a study of 57 patients with ages of 24 to 40 weeks, weight from 710 to 5,000 grams, and 185 observations made spanning a range of 63 to 100% SaO2 while monitored with Nellcor OxiMax N-595 pulse oximeters.4. Neonatal accuracy: When sensors are used on neonatal subjects as recommended, the specified accuracy range is increased by ± 1 digit, as compared to adult usage, to account for the theoretical effect on oximeter measurements of fetal hemoglobin in neonatal blood. For example, Oxicliq N accuracy on neonates is ± 3.5 digits, rather than ± 2.5.5. Specification applies to the performance of the device. Reading accuracy in the presence of low perfusion (detected IR pulse modulation amplitude 0.03% - 1.5%) was validated using signals supplied by a patient simulator. SpO2 and pulse rate values were varied across the monitoring range over a range of weak signal conditions and compared to the known true saturation and pulse rate of the input signals.Pulse Oximetry Performance SpecificationsSpO2The specified accuracy is the root-mean-square (RMS) difference between the measured values and the reference valuesRange 1 to 100%Accuracy M1901B1, M1902B, M1903B, M1904B, MAXA, MAXAL, MAXP, MAXI, MAXN1, MAXFAST: adult/infant = 2% (70% to 100%)M1902B, M1903B, M1904B, MAXA, MAXAL, MAXP, MAXI, MAXN1, MAXFAST: adult =3% (60% to 80%)MAXN1:neonate = 2% (70% to 100%)Oxicliq A, Oxicliq P, Oxicliq L, Oxicliq N4: adult/infant =2.5% (70% to 100%)Oxicliq N4:neonate = 3.5% (70% to 100%)MAXR2, D-YSE, D-YSPD: adult/infant = 3.5% (70% to 100%)SoftCare SC-A (adult/infant), SoftCare SC-PR-I3 (neonate), SoftCare SCNEO-I3: (neonate) = 2% (70% to 100%)DS-100A-I, D-YS, Oxiband OXI-A/N, Oxiband OXI-P/I:adult/infant = 3% (70% to 100%)D-YS4, Oxiband OXI-A/N4: neonate = 4% (70% to 100%)Low perfusion accuracy52% (70 - 100%)Resolution 1%Pulse Range 25 to 300 bpmAccuracy +/- 3 bpm (25 to 250 bpm)Low perfusion accuracy5+/- 3 bpm (25 to 250 bpm)Resolution 1 bpmNumeric update rate typical 1 second, max ≤60 secondsSensors Wavelength range: 500 to 1000 nmEmitted Light Energy: ≤15 mWInformation about the wavelength range can be especially useful to clinicians (for instance, when photodynamic therapy is performed)
24 Specifications304Nellcor Patents: The monitor with Nellcor OxiMax technology are covered by one or more of the following US Patents and foreign equivalents:5,485,847; 5,676,141; 5,743,263; 6,035,223; 6,226,539, 6,411,833; 6,463,310; 6,591,123; 6,708,049; 7,016,715; 7,039,538; 7,120,479; 7,120,480; 7,142,142; 7,162,288; 7,190,985; 7,194,293; 7,209,774; 7,212,847; 7,400,919.Purchase of the instrument with Nellcor OxiMax technology confers no express or implied license under any Covidien patent to use that instrument with any sensor not manufactured or licensed by Covidien.SpO2 Alarm Specifications1. Refer to “Monitor Performance Specifications” on page 293 for system alarm delay specification.SpO2 Alarm Specifications Range AdjustmentSpO2Adult: 50 to 100%Pedi/Neo: 30 to 100%1% stepsDesat Adult: 50% to Low alarm limitPedi/Neo: 30% to Low alarm limit1% stepsPulse 30 to 300 bpm Adult:1 bpm steps (30 to 40 bpm)5 bpm steps (40 to 300 bpm)Pedi/Neo:1 bpm steps (30 to 50 bpm)5 bpm steps (50 to 300 bpm)Tachycardia Difference to high limit 0 to 50 bpm 5 bpm stepsClamping at 150 to 300 bpm 5 bpm stepsBradycardia Difference to low limit 0 to 50 bpm 5 bpm stepsClamping at 30 to 100 bpm 5 bpm stepsSpO2 Alarm Specifications (cont.) Standard DelaySmart Alarm Delay (alternative to standard alarm delay)Short Mode Medium mode Long ModeSpO2 high and low limit alarms0 to 30 seconds (adjustable in 1 second steps) + system alarm delay110 to 25 seconds + system alarm delay10 to 50 seconds +system alarm delay10 to 100 seconds + system alarm delayDesat 0 to 30 seconds (adjustable in 1 second steps) + system alarm delaynot supportedPulse 10 seconds + system alarm delayTachycardia 10 seconds + system alarm delayBradycardia 10 seconds + system alarm delay
24 Specifications305NBPComplies with IEC 60601-2-30:1999/EN60601-2-30:2000.SpO2 Smart Alarm Delay - Detailed SpecificationsDeviation from violated alarm limit Resulting alarm delay according to selected modeShort Medium Long1% 25 seconds (maximum delay)50 seconds(maximum delay)100 seconds(maximum delay)2% 12 seconds 25 seconds 50 seconds3% 10 seconds 16 seconds 33 seconds4% 10 seconds 12 seconds 25 seconds5% 10 seconds 10 seconds 20 seconds6% 10 seconds 10 seconds 16 seconds7% 10 seconds 10 seconds 14 seconds8% 10 seconds 10 seconds 12 seconds9% 10 seconds 10 seconds 11 seconds>9% 10 seconds 10 seconds 10 secondsNBP Performance SpecificationsMeasurement Ranges Systolic Adult: 30 to 270 mmHg (4 to 36 kPa) Pedi: 30 to 180 mmHg (4 to 24 kPa) Neo: 30 to 130 mmHg (4 to 17 kPa)Diastolic Adult: 10 to 245 mmHg (1.5 to 32 kPa) Pedi: 10 to 150 mmHg (1.5 to 20 kPa) Neo: 10 to 100 mmHg (1.5 to 13 kPa)Mean Adult: 20 to 255 mmHg (2.5 to 34 kPa) Pedi: 20 to 160 mmHg (2.5 to 21 kPa) Neo: 20 to 120 mmHg (2.5 to 16 kPa)Pulse Rate Adult: 40 to 300 bpmPedi: 40 to 300 bpmNeo: 40 to 300 bpmAccuracy Max. Std. Deviation: 8 mmHg (1.1 kPa)Max. Mean Error: ±5 mmHg (±0.7 kPa)Pulse Rate Measurement Accuracy 40 to 100 bpm: ±5 bpm101 to 200 bpm: ±5% of reading201 to 300 bpm: ±10% of reading(average over NBP measurement cycle)Pulse Rate Range 40 to 300 bpm
24 Specifications306Measurement Validation: Clinical investigation according to ISO 81060-2:2013 with the auscultatory reference method:• the 5th Korotkoff sound (K5) was used in adult / adolescent subjects and the 4th Korotkoff sound (K4) was used in pediatric subjects to determine the diastolic reference pressures.• the approximation MAP = (2*DIA + SYS) / 3 was used to calculate reference MAP (mean arterial pressure) values from the systolic and diastolic reference pressures.Clinical investigation according to ISO 81060-2:2013 with the intra-arterial reference method:• the radial artery was used for the intra-arterial reference measurement.• the MAP values displayed by the reference invasive blood pressure monitor were used as MAP reference values.• blood pressure recordings with any dysrhythmias were excluded.Measurement Time Typical at HR >60 bpmAuto/manual/sequence:Adult: 30 secondsNeonatal: 25 secondsStat: 20 secondsMaximum time: Adult/pedi: 180 secondsNeo: 90 secondsCuff Inflation Time Typical for normal adult cuff: Less than 10 secondsTypical for neonatal cuff: Less than 2 secondsInitial Cuff Inflation Pressure Adult: 165 ±15 mmHgPedi: 130 ±15 mmHgNeo: 100 ±15 mmHgMaximum Cuff Pressure Adult/Pedi: 300 mmHgNeo: 150 mmHgAuto Mode Repetition Times 1 min, 2 min, 2.5 min, 3 min, 10 min, 15 min, 20 min, 30 min, 45 min, 1h, 2h, 4h, 8h, 12h, 24hSTAT Mode Cycle Time 5minutesVenipuncture Mode InflationInflation Pressure Adult 20 to 120 mmHg (3 to 16 kPa)Pediatric 20 to 80 mmHg (3 to 11 kPa)Neonatal 20 to 50 mmHg (3 to 7 kPa)Automatic deflation afterAdult/pediatric 170 secondsNeonatal 85 secondsNBP Performance Specifications
24 Specifications307Invasive Pressure and PulseComplies with IEC 60601-2-34:2000/EN60601-2-34:2000.NBP Alarm Specifications Range AdjustmentSystolic Adult: 30 to 270 mmHg (4 to 36 kPa) 10 to 30 mmHg: 2 mmHg (0.5 kPa)>30 mmHg: 5 mmHg (1 kPa)Pedi: 30 to 180 mmHg (4 to 24 kPa)Neo: 30 to 130 mmHg (4 to 17 kPa)Diastolic Adult: 10 to 245 mmHg (1.5 to 32 kPa)Pedi: 10 to 150 mmHg (1.5 to 20 kPa)Neo: 10 to 100 mmHg (1.5 to 13 kPa)Mean Adult: 20 to 255 mmHg (2.5 to 34 kPa)Pedi: 20 to 160 mmHg (2.5 to 21 kPa)Neo: 20 to 120 mmHg (2.5 to 16 kPa)NBP Overpressure SettingsAdult >300 mmHg (40 kPa) >2 sec not user adjustablePediatric >300 mmHg (40 kPa) >2 secNeonate >150 mmHg (20 kPa) >2 secInvasive Pressure Performance SpecificationsMeasurement Range -40 to 360 mmHgPulse Rate Range 25 to 350 bpmAccuracy ±1% Full RangeResolution 1 bpmInput Sensitivity Sensitivity: 5 µV/V/mmHg (37.5 µV/V/kPa)Adjustment range: ±10%Transducer Load Impedance: 200 to 2000 Ω (resistive)Output Impedance: ≤3000 Ω (resistive)Frequency Response dc to 12 Hz or 40 HzZero Adjustment Range ±200 mmHg (±26 kPa)Accuracy ±1 mmHg (±0.1 kPa)Drift Less than 0.1 mmHg/°C (0.013 kPa/°C)Gain Accuracy Accuracy ±1%Drift Less than 0.05%/°CNon linearity and HysteresisError of ≤0.4 %FS (@CAL 200 mmHg)Overall Accuracy (including transducer) ±4% of reading or ±4 mmHg (±0.5 kPa), whichever is greaterVolume displacement of CPJ840J6 0.1 mm3 /100 mmHg
24 Specifications308Invasive Pressure Alarm SpecificationsTempComplies with EN 12470-4:2000. Specified without transducer.Invasive Pressure Alarm Specifications Range Adjustment DelayPressure -40 to 360 mmHg (-5.0 to 48 kPa)-40 to 50 mmHg2mmHg (0.5kPa)>50 mmHg5mmHg (1kPa)max. 12 secondsExtreme High Difference to high limit 0 to 25 mmHg5 mmHg steps (0.5 kPa)Clamping at -40 to 360 mmHg 5 mmHg steps (1.0 kPa)Extreme Low Difference to low limit 0 to 25 mmHg5 mmHg steps (0.5 kPa)Clamping at -40 to 360 mmHg 5 mmHg steps (1.0 kPa)Pulse 25 to 300 bpm Adult:1 bpm steps (25 to 40 bpm)5 bpm steps (40 to 300 bpm)Pedi/Neo:1 bpm steps (25 to 50 bpm)5 bpm steps (50 to 300 bpm)Tachycardia Difference to high limit 0 to 50 bpm5 bpm steps max. 14 secondsClamping at 150 to 300 bpm 5 bpm stepsBradycardia Difference to low limit 0 to 50 bpm5 bpm steps max. 14 secondsClamping at 25 to 100 bpm 5 bpm stepsTemp Performance SpecificationsTemp Range -1 to 45°C (30 to 113°F)Resolution 0.1°C (0.2°F)Accuracy ±0.1°C (±0.2°F)Average Time Constant Less than 10 secondsTemp Alarm Specifications Range AdjustmentTemp High/Low Alarms -1 to 45°C (30 to 113°F) -1 to 30°C (30 to 86°F), 0.5°C (1.0°F) steps30 to 45°C (86 to 113°F), 0.1°C (0.2°F) steps
24 Specifications309CO2The CO2 measurement in the monitor, M3014A and M3015A complies with EN ISO 21647:2004 + Cor.1:2005 (except alarm system; alarm system complies with IEC 60601-2-49:2001).M3015A Microstream CO2Microstream CO2 Humidity Correction FactorEither BTPS or ATPD can be selected as the humidity correction factor for the Microstream CO2 readings. The formula for the correction calculation is:where:PBTPS = partial pressure at body temperature and pressure, saturatedM3015A Microstream CO2 Performance SpecificationsCO2 Range 0 to 150 mmHg (0 to 20 kPa), or 20% CO2, whichever is lowerAccuracy Up to 5 minutes during warmup: ±4 mmHg or 12%, whichever is greaterAfter 5 minutes warmup:0 to 40 mmHg (0 to 5.3 kPa):±2.2 mmHg (±0.3 kPa)Above 40 mmHg (5.3 kPa):±(5.5% + (0.08%/mmHg above 40 mmHg)) of readingThese specifications are valid for 21% O2 and N2 balance, up to 35°C ambient temperature, up to 60 rpm in adult mode and 100 rpm in neonatal mode. Outside of these conditions the accuracy reaches at a minimum ±4 mmHg or ±12% of the reading, whichever is greater.Resolution Numeric: 1.0 mmHg (0.1 kPa)Wave: 0.1 mmHg (0.01 kPa)Stability Included in Accuracy specificationsAwRR Range 0 to 150 rpmAccuracy 0 to 40 rpm: ±1 rpm41 to 70 rpm: ±2 rpm71 to 100 rpm: ±3 rpm>100 rpm: ±5% of readingIPI Range 1 to 10Resolution 1Warm-up Time 5 minutes for full accuracy specificationRise Time 190 ms for neonatal mode (measured with FilterLine H for neonatal)240 ms for adult mode (measured with FilterLine H for adult)Sample Flow Rate 50 + 15/-7.5 ml/minuteGas Sampling Delay TimeMaximum: 3 seconds (2m sample lines)6 seconds (4m sample lines)Sound Pressure Acoustic noise: <45 dBATotal System Response TimeThe total system response time is the sum of the delay time and the rise time.
24 Specifications310PATPD = partial pressure at ambient temperature and pressure, dryM3014A Mainstream CO2M3014A Sidestream CO2M3014A Mainstream CO2 Performance SpecificationsCO2 Range 0 to 150 mmHg (0 to 20.0 kPa)Accuracy after 2 minutes warmup:For values between 0 and 40 mmHg: ±2.0 mmHg (±0.29 kPa)For values from 41 to 70 mmHg: ±5% of readingFor values from 71 to 100 mmHg: ±8% of readingThe specifications are valid for standard gas mixtures, balance air, fully hydrated at 35°C, Pabs = 760 mmHg, flow rate = 2 l/min.Resolution Numeric: 1.0 mmHg (0.1 kPa)Wave: 0.1 mmHg (0.01 kPa)Stability:Short term driftLong term drift±0.8 mmHg over four hoursAccuracy specification will be maintained over a 120 hour periodawRR Range 2 to 150 rpmAccuracy ±1 rpmWarm-up Time 2minutes with CO2 transducer attached for full accuracy specificationResponse Time Less than 60 ms (with adult or infant reusable or disposable adapter)M3014A Sidestream CO2 Performance SpecificationsCO2 Range 0 to 150 mmHg (0 to 20.0 kPa)Accuracy after 2 minutes warmup:For values between 0 and 40 mmHg: ±2.0 mmHg (±0.29 kPa)For values from 41 to 70 mmHg: ±5% of readingFor values from 71 to 100 mmHg: ±8% of readingFor values from 101 to 150 mmHg: ±10% of readingAt respiration rates above 80 rpm, all ranges are ±12% of actual. The specifications are valid for gas mixtures of CO2, balance N2, dry gas at 760 mmHg within specified operating temperature range.Resolution Numeric: 1.0 mmHg (0.1 kPa)Wave: 0.1 mmHg (0.01 kPa)Stability:Short term driftLong term drift±0.8 mmHg over four hoursAccuracy specification will be maintained over a 120 hour periodawRR Range 2 to 150 rpmAccuracy ±1 rpmWarm-up Time 2minutes with CO2 sensor attached for full accuracy specificationSample Flow Rate 50 ±10 ml/minuteTotal System Response Time 3 secondsOperating Temperature 0 to 40°C (32 to 100°F)
24 Specifications311M8102A/M3014A Mainstream and Sidestream CO2 Humidity Correction FactorEither BTPS or ATPD can be selected as the humidity correction factor for the CO2 readings. The formula for the correction calculation is:Where p = partial pressure, Pabs = absolute pressure, and PH2O = 42 mmHg @35°C and 100% RH.CO2 Alarm SpecificationsInterfering Gas and Vapor Effects On CO2 Measurement ValuesThe specified deviations for M8102A/M3014A are valid when the appropriate corrections are switched on and set correctly.Alarm Range Adjustment DelayetCO2 High 20 to 95 mmHg (2 to 13 kPa) 1 mmHg (0.1 kPa) M8102A/M3014A: less than 14 secondsM3015A: less than 21 seconds.etCO2 Low 10 to 90 mmHg (1 to 12 kPa)imCO2 High 2 to 20 mmHg (0.3 to 3.0 kPa)steps of 1 mmHg (0.1 kPa) M8102A/M3014A: less than 14 secondsM3015A: less than 21 seconds.awRR High Adult/pedi: 10 to 100 rpmNeo: 30 to 150 rpm<20 rpm: 1 rpm steps≥20 rpm:5 rpm stepsM8102A/M3014A/M3016A: less than 14 secondsM3015A: less than 21 seconds.awRR Low Adult/pedi: 0 to 95 rpmNeo: 0 to 145 rpmM3015A: settings ≤20 rpm: less than 8 seconds>20 rpm: less than 21 secondsM8102A/M3014Asettings ≤20 rpm: less than 4 seconds>20 rpm: less than 14 secondsIPI Low (M3015A/B only)Adult/pedi: 2 to 9 steps of 1 Maximum 14 seconds after displayed value goes below the low alarm limit setting.Apnea delay 10 to 40 seconds 5 second steps set apnea delay time + 4 seconds (M8102A/M3014A) or 8 seconds (M3015A with 2 m sample lines) or 11 seconds (M3015A with 4 m sample lines).Gas or Vapor Gas Level (% volume fraction)M8102A/M3014A M3015AAdditional deviation due to gas interference, measured at 0 - 40 mmHg CO2Nitrous Oxide 60% ±1 mmHg ±5%Halothane 4% ±2 mmHg ±5%Enflurane 5% ±2 mmHg ±5%Isoflurane 5% ±2 mmHg ±5%Sevoflurane 5% ±2 mmHg ±5%Xenon 80% -5 mmHg ±5%Helium 50% ±1 mmHg ±5%Metered dose inhaler propellants- not specified for use
24 Specifications312Safety and Performance TestsYou must observe any national regulations on the qualification of the testing personnel and suitable measuring and testing facilities. See the maintenance section for a list of required tests. Safety and performance tests, and what to do if the instrument does not meet these specifications, are described in the Service Guide.Electromagnetic Compatibility (EMC) SpecificationsTake special precautions regarding electromagnetic compatibility (EMC) when using medical electrical equipment. You must operate your monitoring equipment according to the EMC information provided in this book. Portable and mobile radiofrequency (RF) communications equipment can affect medical electrical equipment.Accessories Compliant with EMC StandardsAll accessories listed in the accessories section comply, in combination with the monitor, with the requirements of IEC 60601-1-2:2001 + A1:2004.WARNINGUsing accessories other than those specified may result in increased electromagnetic emission or decreased electromagnetic immunity of the monitoring equipment.Electromagnetic EmissionsThe monitor is suitable for use in the electromagnetic environment specified in the table below. You must ensure that it is used in such an environment.Desflurane 15% +5 mmHg ±5%Ethanol 0.1% ±1 mmHg ±5%Isopropanol 0.1% ±1 mmHg ±5%Acetone 0.1% ±1 mmHg ±5%Methane 1.0% ±1 mmHg ±5%Gas or Vapor Gas Level (% volume fraction)M8102A/M3014A M3015AAdditional deviation due to gas interference, measured at 0 - 40 mmHg CO2Emissions test Compliance Avoiding Electromagnetic InterferenceRadiofrequency (RF) emissions Group 1 The monitor uses RF energy only for its internal function. Therefore, its RF emissions are very low and are not likely to cause any interference in nearby electronic equipmentRF emissions CISPR 11 Class A The monitor is suitable for use in all establishments other than those directly connected to the public low-voltage power supply network that supplies buildings used for domestic purposes.
24 Specifications3131. excluding Nellcor OxiMax technologyAvoiding Electromagnetic Interference (Resp)The respiration (Resp) measurement is a very sensitive measurement that measures a very small signal. Technological limitations do not allow higher immunity levels than 1 V/m for radiated RF electromagnetic fields and 1 Vrms for conducted disturbances induced by RF fields. Electromagnetic fields with field strengths above 1 V/m and conducted disturbances above 1 Vrms may cause erroneous measurements. Therefore Philips recommends that you avoid using electrically radiating equipment in the close proximity of this measurement.WARNINGThe monitor should not be used next to or stacked with other equipment. If you must stack the monitor, you must check that normal operation is possible in the necessary configuration before you start monitoring patients.Electromagnetic ImmunityThe monitor is suitable for use in the specified electromagnetic environment. The user must ensure that it is used in the appropriate environment as described below.RF emissions CISPR 11 Class B The monitor, with the following measurements and interfaces:ECG/Respiration, NBP, SpO21, Pressure, Temperature, CO2 (only Mainstream Sensor M2501A), LANis suitable for use in all establishments including those directly connected to the public low-voltage power supply network that supplies buildings used for domestic purposes.Emissions test Compliance Avoiding Electromagnetic InterferenceImmunity test IEC 60601-1-2 test level Compliance level Electromagnetic environment guidanceElectrostatic discharge (ESD) IEC 61000-4-2±6 kV contact±8 kV air±6 kV contact±8 kV airFloors should be wood, concrete, or ceramic tile. If floors are covered with synthetic material, the relative humidity should be at least 30%.Electrical fast transient/burstIEC 61000-4-4±2 kV for power supply lines±1 kV for input/output lines±2 kV for power supply lines±1 kV for input/output linesMains power quality should be that of a typical commercial and/or hospital environmentSurge IEC 61000-4-5±1 kV differential mode±2 kV common mode±1 kV differential mode±2 kV common modeMains power quality should be that of a typical commercial and/or hospital environmentVoltage dips, short interruptions and voltage variations on power supply input linesIEC 61000-4-11<5% UT (>95% dip in UT) for 0.5 cycles<5% UT (>95% dip in UT) for 0.5 cyclesMains power quality should be that of a typical commercial and/or hospital environment. If the user of the monitor requires continued operation during power mains interruptions, it is recommended that the monitor is equipped with an internal battery or is powered from an uninterruptible power supply.40% UT (60% dip in UT) for 5cycles40% UT (60% dip in UT) for 5 cycles70% UT (30% dip in UT) for 25 cycles70% UT (30% dip in UT) for 25 cycles<5% UT (>95% dip in UT) for 5sec<5% UT (>95% dip in UT) for 5sec
24 Specifications314In this table, UT is the a.c. mains voltage prior to application of the test level.Recommended Separation DistanceWARNING• This equipment generates, uses and radiates radio-frequency energy, and if it is not installed and used in accordance with its accompanying documentation, may cause interference to radio communications.• The monitor, equipped with a wireless network interface, intentionally receives RF electromagnetic energy for the purpose of its operation. Therefore, other equipment may cause interference, even if that other equipment complies with CISPR emission requirements.In the following table, P is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer and d is the recommended separation distance in meters (m). The values given in brackets are for respiration.Portable and mobile RF communications equipment should be used no closer to any part of the monitor, including cables, than the recommended separation distance calculated from the equation appropriate for the frequency of the transmitter.Field strengths from fixed RF transmitters, as determined by an electromagnetic site survey, should be less than the compliance level in each frequency range.Interference may occur in the vicinity of equipment marked with this symbol:Power frequency (50/60 Hz) magnetic fieldIEC 61000-4-83 A/m 3 A/m Power frequency magnetic fields should be a t levels characteristic of a typical location in a typical commercial and/or hospital environmentImmunity test IEC 60601-1-2 test level Compliance level Electromagnetic environment guidanceImmunity test IEC 60601-1-2 test level Compliance level Electromagnetic environment guidanceConducted RF IEC 61000-4-63Vrms150 kHz to 80 MHz3Vrms(1 Vrms for respiration)Recommended separation distance:d = 1.2√Pfor respiration:d = 3.5√PRadiated RFIEC 61000-4-33V/m80 MHz to 2.5 GHz3V/m(1 V/m for respiration)For short range radio, see note1.Recommended separation distance:80 MHz to 800 MHz: d = 1.2√P80 MHz to 800 MHz for respiration: d = 3.5√P800 MHz to 2,5 GHz: d = 2.3√P800 MHz to 2,5 GHz for respiration: d = 7.0√P2.0 to 2,3 GHz for short range radio: d = 7.0√P
24 Specifications3151. If ECG/SpO2 signals are acquired from a telemetry device via short range radio the compliance level is 3V/m except in the range 2.0 to 2.3 GHz where it is 1 V/m.Field strengths from fixed transmitters, such as base stations for radio (cellular, cordless) telephones and land mobile radios, amateur radio, AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy. To assess the electromagnetic environment due to fixed RF transmitters, an electromagnetic site survey should be considered. If the measured field strength in the location in which the monitor is used exceeds the applicable RF compliance level above, the monitor should be observed to verify normal operation. If abnormal performance is observed, additional measures may be necessary, such as reorienting or relocating the monitor.These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects, and people.Recommended separation distances from portable and mobile RF communication equipmentThe monitor is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled. The customer or user of the monitor can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment and the monitor as recommended below, according to the maximum output power of the communications equipment.In the following table, P is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer and d is the recommended separation distance in meters (m). The values given in brackets are for respiration.Electrosurgery Interference/Defibrillation/Electrostatic DischargeThe equipment returns to the previous operating mode within 10 seconds without loss of any stored data. Measurement accuracy may be temporarily decreased while performing electrosurgery or defibrillation. This does not affect patient or equipment safety. Do not expose the equipment to x-ray or strong magnetic fields (MRI).Frequency of transmitter 150 kHz to 80 MHz 80 MHz to 800 MHz 800MHz to 2,5GHzEquation d = 1.2√Pfor respiration:d = 3.5√Pd = 1.2√Pfor respiration:d = 3.5√Pd = 2.3√Pfor respiration:d = 7.0√Pfor short range radio in the range 2.0 to 2.3 GHz:d = 7.0√PRated max. output power of transmitter Separation distance Separation distance Separation distance 0.01 W 0.1 (0.4) m 0.1 (0.4) m 0.2 (0.7) m0.1 W 0.4 (1.1) m 0.4 (1.1) m 0.7 (2.2) m1 W 1.3 (3.5) m 1.3 (3.5) m 2.3 (7.0) m10 W 3.8 (11.1) m 3.8 (11.1) m 7.3 (22.1) m100 W 12.0 (35.0) m 12.0 (35.0) m 23.0 (70.0) m
24 Specifications316Fast Transients/BurstsThe equipment will return to the previous operating mode within 10 seconds without loss of any stored data. If any user interaction is required, the monitor indicates with a technical alarm (INOP).Restart timeAfter a power interruption, an ECG wave will be shown on the display after 30 seconds maximum.
2531725Default Settings AppendixThis appendix documents the most important default settings of your monitor as it is delivered from the factory. For a comprehensive list and explanation of default settings, see the Configuration Guide supplied with your monitor. The monitor's default settings can be permanently changed in Configuration Mode.NOTEIf your monitor has been ordered pre-configured to your requirements, the settings at delivery will be different from those listed here.Alarm and Measurement Default SettingsThe default wave speed for all measurements except Respiration is 25 mm/sec. For Respiration the default wave speed is 6.25 mm/sec.In the following tables, settings may be entered only once per table row if they are the same for all patient categories.Alarm Default SettingsAlarm Settings Factory Default H10/H20/H40 H30/H31 (deviations from H10/H20/H40)Alarm Volume 5Alarms Off 2 minPause Al. 5min EnabledPause Al. 10min EnabledAuto Alarms Off OffAlarmOffReminder OffVisual Latching Red&Yellow Red OnlyAudible Latching Red&Yellow OffAlarm Reminder OnReminder Time 3 minAlarm Sounds TraditionalRedAlarmInterval 10 secYel.Al. Interval 20 sec
25 Default Settings Appendix318ECG, Arrhythmia, ST and QT Default SettingsAlarm Low 42Red Alarm Volume AlarmVol. +2Yell.AlarmVolume AlarmVol. +0INOP Volume AlarmVol. +0AutoIncrease Vol 2 StepsIncreaseVolDelay 20 secKeep Blinking NoRelay1 Sensitiv. R&Y&CRelay2 Sensitiv. Red&YellowRelay3 Sensitiv. RedCyanRelayLatency 5secYel.RelayLatency 2secAlarm Text StandardNoCentrMonMinVol OnAlarm Settings Factory Default H10/H20/H40 H30/H31 (deviations from H10/H20/H40)ECG SettingsFactory DefaultsAdult Pedi NeoHigh Limit 120 bpm 160 bpm 200 bpmLow Limit 50 bpm 75 bpm 100 bpmECG/Arrhy Alarms On On OnAlarm Source Auto Auto AutoECG On On OnQRS Volume 111Primary Lead II II IISecondary Lead V V VAnalysis Mode Multi Lead Multi Lead Multi LeadLead Placement Standard Standard StandardMod.LeadPlacment Off Off OffFilter Monitor Monitor MonitorAutoFilter Off Off OffDefault ECG Size Size x1 Size x1 Size x1Color Green Green GreenAsystole Thresh. 4.0 sec 4.0 sec 3.0 secΔ ExtrTachy 20 bpm 20 bpm 20 bpmTachy Clamp 200 bpm 220 bpm 240 bpmΔ ExtrBrady 20 bpm 20 bpm 20 bpmBrady Clamp 40 bpm 40 bpm 50 bpmECG Alm Off INOP Cyan Cyan Cyan
25 Default Settings Appendix319Arrhythmia Default SettingsFallback On On OnAlarms Off Enabled Enabled EnabledAlarmSource Sel. Enabled Enabled EnabledVa Lead V2 V2 V2Vb Lead V5 V5 V5SyncPulse Sensit Medium Medium MediumSyncPulse Marker On On OnPulseAlarms Tele Enabled Enabled EnabledECG SettingsFactory DefaultsAdult Pedi NeoArrhythmia SettingsFactory DefaultsAdult Pedi NeoArrhythmia On On OffPause Threshold 2.0 sec 2.0 sec 1.5 secVTach HR 100 120 150VTach Run 555Vent Rhythm 14 14 14SVT HR 180 200 210SVT Run 555PVCs/min 10 5 5Non-Sustain On On OnVent Rhythm On On OnRun PVCs On On OnPair PVCs On On OnR-on-T PVCs On On OnV.Bigeminy On On OnV.Trigeminy On On OnPVCs/min On On OnMultif.PVCs On On OnPacer n.Cap On On OnPacer n.Pac On On OnPause On On OnMissed Beat On On OnSVT On On OnAfib On On OnIrregular HR On On OnHR Alarms Short Yellow Short Yellow Short YellowTimeOut 1st 3 min 3 min 3 minTimeOut 2nd 10 min 10 min 10 min
25 Default Settings Appendix320ST and QT Default SettingsCardiotach Msg Yes Yes YesSome ECG Al INOP On On OnArrhythmia SettingsFactory DefaultsAdult Pedi NeoLead-independent ST SettingsFactory DefaultsAdult Pedi NeoST Alarm Mode Single ST Single ST Single STAlarms On On OnST Analysis On Off OffST-Index On Off OffISO Point -80 ms -80 ms -80 msJ Point 48 ms 48 ms 48 msST Point J+60 J+60 J+60Lead I, II, III, V, aVR, aVL, V1-6, MCL SettingsFactory DefaultsAdult Pedi NeoST Analysis On Off OffFor Alarm Mode = Single STST (Label) High +2.0 mm +2.0 mm +2.0 mmST (Label) Low -2.0 mm -2.0 mm -2.0 mmFor Alarm Mode = Multi STST (Label) High +1.0 mm +1.0 mm +1.0 mmST (Label) Low +1.0 mm +1.0 mm +1.0 mmQT SettingsFactory DefaultsAdult Pedi NeoQT Lead All All AllQTc High Limit 500 ms 480 ms 460 msΔQTc High Limit 60 ms 60 ms 60 msQTc High Alarm On On OnΔQTc High Alarm On On OnQT Analysis Off Off OffQTc Formula Bazett Bazett Bazett
25 Default Settings Appendix321Pulse Default SettingsPulse alarms use the settings of the currently selected Pulse alarm source.Respiration Default SettingsPulse SettingsFactory DefaultsAdult Pedi NeoAlarm Source Auto Auto AutoPulse (source label) On On OnSystem Pulse SpO₂SpO₂SpO₂Alarms Off Enabled Enabled EnabledAlarmSource Sel. Enabled Enabled EnabledPulse Alarm SettingsFactory Defaults H10/H20/H40Adult Pedi NeoPulse (SpO₂)OnOnOnPulse Alarms Off Off OffHigh Limit 120 bpm 160 bpm 200 bpmLow Limit 50 bpm 75 bpm 100 bpmΔ ExtrBrady 20 bpm 20 bpm 20 bpmBrady Clamp 40 bpm 40 bpm 50 bpmΔ ExtrTachy 20 bpm 20 bpm 20 bpmTachy Clamp 200 bpm 220 bpm 240 bpmRespiration SettingsFactory Defaults Adult Pedi NeoHigh Limit 30 rpm 30 rpm 100 rpmLow Limit 8 rpm 8 rpm 30 rpmApnea Time 20 sec 20 sec 20 secAlarms On On OnResp On On OnDetection Auto(Trigger Mode)Auto(Trigger Mode)Auto(Trigger Mode)Color Yellow Yellow Yellow
25 Default Settings Appendix322SpO2 Default SettingsNBP Default SettingsSpO2 SettingsFactory DefaultsAdult Pedi NeoMode Continuous Continuous ContinuousRepeat Time 15 min 15 min 15 minAlarms On On OnQRS Volume 111Tone Modulation Yes Yes YesTone Mod. Type Enhanced Enhanced EnhancedPerfusion OnOnOnAverage 10 sec 10 sec 10 secNBP Alarm Suppr. OnOnOnExtd. Auto OnOff Disabled Disabled DisabledColor Cyan (light blue) Cyan (light blue) Cyan (light blue)Average in Mon. No No NoSignal Quality OnOnOnSpO2 Alarm Default SettingsSetting Adult Pedi NeoDesat Limit 80 80 80Low Limit 90 90 85High Limit 100 100 95Desat Delay 20 sec 20 sec 20 secHigh Alarm Delay 10 sec 10 sec 10 secLow Alarm Delay 10 sec 10 sec 10 secSmartAlarmDelay (SAD) Off Off OffHigh Alarm Delay (SAD) Short Short ShortLow Alarm Delay (SAD) Short Short ShortLabel SpO₂SpO₂SpO₂Pulse settingsPulse (SpO₂) OnOnOnFor all other Pulse default settings, refer to the Pulse Default Settings table.NBP SettingsFactory Defaults Adult Pedi NeoMode Auto Auto ManualAlarms from Sys. Sys. Sys.High Limit 160/90 (110) 120/70 (90) 90/60 (70)
25 Default Settings Appendix323Temperature Default SettingsInvasive Pressure Default SettingsLow Limit 90/50 (60) 70/40 (50) 40/20 (24)Alarms On On OnNBP On On OnRepeat Time 10 min 10 min 10 minPulse (NBP) On On OnUnit mmHg mmHg mmHgDone Tone Off Off OffStart Time Synchronized Synchronized SynchronizedVP Pressure 60 mmHg 40 mmHg 30 mmHgReference Auscultatory Auscultatory InvasiveColor Red Red RedNBP SettingsFactory Defaults Adult Pedi NeoTemp SettingsFactory DefaultsAdult Pedi NeoLow Limit 36 36 36High Limit 39 39 39Alarms On On OnUnit °C °C °CRange 35...43 35...43 35...43Color Green Green GreenABP, ART, Ao, BAP, FAPP,PP1, P2, P3, P4, UAP SettingsFactory DefaultsAdult Pedi NeoAlarms from Sys. Sys. Sys.High Limit 160/90 (110) 120/70 (90) 90/60 (70)Low Limit 90/50 (70) 70/40 (50) 55/20 (36)Alarms On On OnExtreme Alarms Disabled Disabled DisabledΔ Extreme High 15 10 5Δ Extreme Low 15 10 5Sys. High Clamp 190/100 (125) 140/80 (100) 105/75 (75)Sys. Low Clamp 80/45 (65) 60/35 (45) 45/15 (30)Scale 150 100 100Mean only No No NoFilter 12 Hz 12 Hz 12 Hz
25 Default Settings Appendix324Mercury Cal Yes Yes YesArtifact Suppr. 60 sec 60 sec 60 secUnit mmHg mmHg mmHgColor Red Red RedABP, ART, Ao, BAP, FAPP,PP1, P2, P3, P4, UAP SettingsFactory DefaultsAdult Pedi NeoCVP, RAP, LAP, UVP SettingsFactory Defaults Adult Pedi NeoAlarms from Mean Mean MeanHigh Limit 14/6 (10) 10/2 (4) 10/2 (4)Low Limit 6/-4 (0) 2/-4 (0) 2/-4 (0)Alarms On On OnExtreme Alarms Enabled Enabled EnabledΔ Extreme High 555Δ Extreme Low 555Mean High Clamp 20/10 (15) 15/5 (10) 15/5 (10)Mean Low Clamp 0/-5 (-5) 0/-5 (-5) 0/-5 (-5)Scale 30 30 30Mean only Yes Yes YesFilter 12 Hz 12 Hz 12 HzMercury Cal Yes Yes YesArtifact Suppr. 60 sec 60 sec 60 secUnit mmHg mmHg mmHgColor Cyan (light blue) Cyan (light blue) Cyan (light blue)PAP SettingsFactory DefaultsAdult Pedi NeoAlarms from Dia. Dia. Dia.High Limit 34/16 (20) 60/4 (26) 60/4 (26)Low Limit 10/0 (0) 24/-4 (12) 24/-4 (12)Alarms On On OnExtreme Alarms Enabled Enabled EnabledΔ Extreme High 555Δ Extreme Low 555Dia. High Clamp 45/20 (25) 65/5 (35) 65/5 (35)Dia. Low Clamp 5/-5 (-5) 15/-5 (5) 15/-5 (5)Scale 30 30 30Mean only No No NoFilter 12 Hz 12 Hz 12 HzMercury Cal Yes Yes YesArtifact Suppr. 60 sec 60 sec 60 sec
25 Default Settings Appendix325CO2 Default SettingsUnit mmHg mmHg mmHgColor Yellow Yellow YellowPAP SettingsFactory DefaultsAdult Pedi NeoICP, IC1, IC2 SettingsFactory DefaultsAdult Pedi NeoAlarms from Mean Mean MeanHigh Limit 14/6 (10) 10/2 (4) 10/2 (4)Low Limit 6/-4 (0) 2/-4 (0) 2/-4 (0)Alarms On On OnExtreme Alarms Enabled Enabled EnabledΔ Extreme High 10 10 10Δ Extreme Low 10 10 10Mean Low Clamp 20/10 (-5) 15/5 (-5) 15/5 (-5)Mean High Clamp 0/-5 (0) 0/-5 (0) 0/-5 (0)Scale 30 30 30Mean only Yes Yes YesFilter 12 Hz 12 Hz 12 HzMercury Cal Yes Yes YesArtifact Suppr. 60 sec 60 sec 60 secUnit mmHg mmHg mmHgColor Magenta Magenta MagentaCO2 SettingsFactory DefaultsAdult Pedi NeoetCO₂ Low 25 25 25etCO₂ High 60 60 60imCO₂ High 444CO₂ Alarms On On OnUnit mmHg mmHg mmHgScale 50 mmHg 50 mmHg 50 mmHgimCO₂On On OnN₂O Corr. (only M3015A/M3016A) Off Off OffOxygen Corr. (only M3014A) 20% 20% 20%Gas Corr. (only M3014A) Off Off OffHumidity Corr. BTPS BTPS BTPSMax Hold 20 s 20 s 20 sawRR On On On
25 Default Settings Appendix326awRR Alarms On On OnHigh Limit (awRR) 30 30 60Low Limit (awRR) 8830Apnea Time 20 sec 20 sec 20 secColor Yellow Yellow YellowCO2 SettingsFactory DefaultsAdult Pedi Neo
3271Index#10-lead placement (ECG) 11512-lead placement (ECG) 1153-lead placement (ECG) 1135-lead placement (ECG) 113AAAMI ECG lead labels 112abdominal breathing 162and Resp electrode placement 162aberrantly conducted beats 130accessories10-electrode cable sets 2633-electrode cable sets 2625-electrode cable sets 2625-electrode one piece cables 2646-electrode cable sets 262CO2 209CO2 (mainstream) 279ECG 105NBP 183adult cuffs 266comfort cuffs 264disposable cuffs 266multi-patient comfort cuff kits 264neonatal/infant cuffs (single patient) 267reusable cuffs 264single patient, adult/pediatric soft cuffs 266Pulsion 270resp 261set combiners and organizers 263, 264trunk cables 261active alarms 47address, Philips 284addressograph (printer configuration setting) 242adjusting ST measurement points 143adjusting wave scale (pressure) 199adjusting wave size (CO2) 210admitting a patientquick admit 88airway adapter 209CO2, microstream accessory 209alarm latching 58, 59, 135alarm limits 54, 56checking 54narrow 56report 221ST 139switching auto limits on/off 56using automatic limits 56wide 56alarm source selection, disabled 159alarms 47active 47alphabetical listing 61apnea delay time (Resp) 164arrhythmia 129awrr limits 212chaining 137CO2, awRR 212desat, SpO2 181effect on pressure alarms during zero 196high priority 47INOP 47ISO/IEC standard 50limit, SpO2 301patient messages 61physiological 61recordings 60red 47selftest 59SpO2 specific 176ST 146testing 59tone configuration 49traditional 50yellow 47alphabetical listing of alarms 61analog outputECG 105apnea alarm delayCO2 209apnea alarm delay time (Resp) 164apnea alarms 164and Resp detection modes 163arrhythmia 129aberrantly conducted beats 130analysis, how it works 129atrial fibrillation and flutter 130beat labels 131initiating learning 134intermittent bundle branch block 131learning during ventricular rhythm 134levels of analysis 123, 129monitoring non-paced patients 129monitoring paced patients 129options 129relearning 134relearning and lead fallback 134status messages 132switching on/off 56understanding the display 131arrhythmia alarms 47, 135, 137, 139, 298adjusting alarm limits 136all yellow on/off 136chaining 137latching 58, 59multiple 137PVC-related alarms 139sinus and SV rhythm ranges 300, 301switching on/off 56timeout periods 136arrhythmia monitoring 127and defibrillation 127arrhythmia options 123arrhythmia relearning 122with EASI INOP 122arterial pressure source 201artifact suppression (pressure) 199atrial fibrillation and flutter 130audible latching (arrhythmia alarms) 135auto alarm limits 56switching on/off 56auto detection mode (Resp) 163automatic arrhythmia relearn 134automatic default setting 31automatic NBPrepeat time 186autosize 109ECG wave 109awRR alarm 212limits 212awRR alarms 212CO2 209Bbaseline 150ST map, updating 150basic arrhythmia option 123, 129battery 249, 252, 253, 255, 285and display brightness 255battery reports 252charge status 252conserving power 255
328indicators 47malfunction indicator 250monitoring time 250safety information 127, 164status indicator 250symbol 285time to empty 251time to full 251battery eject symbol 285battery performance 254optimizing 254beat labels 131arrhythmia 129blood pressure. See also NBP (non-invasive) or PRESS (invasive) 183Ccalculating cerebral perfusion 201calculating temperature difference 192calibrating 190calibration 190, 197NBP 183pressure transducer 197cardiac overlay 162, 163and Resp detection modes 163when measuring Resp 162cardiotach alarms 123cerebral perfusion 201chaining 137change screen window 29changing ECG lead sets 112changing Resp detection mode 163changing Resp wave size 164changing Resp wave speed 164checking battery charge 252cleaning 245infection control 245monitoring accessories 247CO2 209airway adapter 209alarms, awRR 212awRR alarm limits 212correction, humidity 211correction, N2O 211corrections 211FilterLine 209measuring microstream 209microstream accessories 209microstream extension 209removing exhaust gases 208, 210wave scale, adjusting 210CO2 (mainstream) 279connecting temperature probe 191connection direction symbol 285connectors 287conventional 12-lead ECG 116correcting the NBP measurement 185CPAP (RESP) 163cuff 185, 186pressure, NBP 186selection, NBP 185current viewST map 147DDC power symbol 285default profile 31default settings 317defibrillation 127and arrhythmia monitoring 127and ECG monitoring 127defibrillator proof symbol 285desat alarm, SpO2 181detection modes (Resp) 163disinfecting 245infection control 245display 131, 141, 162, 186arrhythmia 129ECG 105NBP 183Resp 162ST 139display brightness 255display settings 30dual Temp measurement 192dyshemoglobins 173intravascular (SpO2) 173Eearly systolic blood pressure, NBP 186EASI 122ECG monitoring 122lead placement 161EASI ECG lead labels 112ECG 105alarms off (Config Mode) 126changing lead sets 112choosing electrode sites 111conventional 12-lead 116external pacing electrodes 127fusion beat pacemakers 127intrinsic rhythm 127modified 12-lead 116New Lead Setup 112pacemaker failure 127rate adaptive pacemakers 127wave size 109ECG cable 127for operating room 127ECG cables, connecting 105ECG connector 105ECG electrode colors 112ECG electrode placement 127during electrosurgery 127ECG gain 236ECG lead labels 112ECG leads monitored 112ECG report 236, 243lead layout 236ECG safety information 127ECG source tracking 101ECG wave 109autosize 109calibration bar 109ectopic status messages (arrhythmia monitoring) 133electrical output symbol 285electrode placement (ECG) 105, 116conventional 12-lead 116modified 12-lead 116electrode placement (Resp) 161, 162with abdominal breathing 162with lateral chest expansion 162electrosurgery 127and ECG 127EMC interference 164Resp 162end case reports 237enhanced arrhythmia option 123, 129exclamation mark symbol 285exhaust gases, removing 208, 210external pacing electrodes 127and ECG monitoring 127extreme bradycardia alarm 125extreme rate alarms 125extreme tachycardia alarm 125Ffallback (ECG) 112FilterLine 209CO2, microstream accessory 209flushing invasive pressure accessories 193fusion beat pacemakers 127and ECG monitoring 127Ggas cylinderempty, disposing of 259getting started 37global trend time 228
329Hhorizon trend 228trend time 228HR = RR (Resp) 162HR alarms 127when arrhythmia off 127HR alarms off (Config Mode) 126HR and pulse alarm source selection 159humidity correction 211CO2 209IIEC ECG lead labels 112IMV (Resp) 163indicators 47battery malfunction 250infection control 245disinfecting 245Information Center 93central recording 231transferring patients 93INOPs 47indicators 47installationconnectors 287intermittent bundle branch block 131intermittent mandatory ventilation (Resp) 163interruption symbol 285intravascular dyshemoglobins (SpO2) 173intrinsic rhythm 127ISO point (ST) 144JJ point (ST) 144Kkeyboard, on screen 27keys 27alarms 47pop-up 27Llatching 58, 59alarms 47alarms, behavior 59latching arrhythmia alarms 135lateral chest expansion (neonates) 162monitoring Resp 162lead fallback 134and arrhythmia relearning 134lead fallback (ECG) 112lead labels (ECG) 112lead placement 161for Resp measurement 161leads monitored (ECG) 112Leads Off INOP (ECG) 112levels of arrhythmia analysis 129Mmain setup 25maintenance 257schedule 257malfunction symbolsbattery 252, 255manual detection mode (Resp) 163, 164and apnea alarms 164manufacture date symbol 285manufacturer's information 284map 147ST 139Mason-Likar lead system 116measurement points, ST 143measurement serverECG connector 105measurement settings 30measurement setup menu 24measurements 32, 38menu 24, 25main setup 25measurement setup 24messagesINOP 47methemoglobin (SpO2) 173microstream CO2 209modified 12-lead ECG 116monitor defaults 317monitor revision 37how to find 37monitoringstarting 37NN2O correction 211CO2 209narrow alarm limits 56NBP 183adult cuffs 266ANSI/AAMI SP10-1992 183calibrating 190comfort cuff kits 264comfort cuffs 264cuff pressure 186cuff, applying 185cuff, selecting 185cuff, tightness 185disposable cuffs 266how the measurement works 183measurement correction 185measurement limitations 184measurement methods, auto 184measurement methods, manual 184measurement methods, sequence 184measurement methods, stat 184neonatal cuffs (disposable) 267numerics 186oscillometric method 183pediatric cuffs 266preparing to measure 185repeat time 186reusable cuffs 264single patient, adult/pediatric soft cuffs 266site inspection 173time of last measurement 186units 186venous puncture 190neonates 162Resp electrode placement 162new features 41non-invasive blood pressure. See NBP 183non-paced patients 129arrhythmia monitoring 127numerics 186explanation of NBP display 186Oon-screen keyboard 27operating room ECG cable 127orange ECG cable 127organizers 263, 264oscillometric NBP measurement method 183overlapping screen trends 228Ppace pulse rejection (ECG) 106, 108about 31switching on/off 56paced patients 109, 127, 129arrhythmia monitoring 127repolarization tails 109safety information 127, 164setting status 127paced statuschecking 54pacemaker failure 127parameter scales 226patient 183category, NBP 183
330patient alarm messages 61patient reports 242contents 242performance specifications 298performance test 312perfusion indicator 173, 181Philips contact information 284physiological alarms 47pleth wave 181pop-up keys 27preparing skin 105for ECG 105pressurealarms during zero 196arterial source 201calibration pressure 197cerebral perfusion, calculating 201performance specifications 298wave scale 199wave size 109pressure accessories 270pressure artifact suppression 199pressure of NBP cuff 186pressure transducer 197calibration 190, 197print job 239suspended 239printer 238, 239, 241settings 31, 101, 317status messages 132unavailable 239printing 235ST map reports 150probes 191disposable temperature 191profiles 30, 31default profile 31patient category 30swapping a complete profile 31pulse 157, 158alarms 47system pulse source 157pulse numerics for SpO2 173PVC-related alarms 139QQRS volume, changing 110QT alarms 155QT baseline 155QT measurement algorithm 152QT monitoring 153limitations 153QT/QTc monitoring 152quick admit 88Rradiated field immunity 164Resp 162rate adaptive pacemakers 127and ECG monitoring 127recordingpreventing fading ink 233recording alarms 60relearning arrhythmia 134repolarization tails 109reports 235alarm limits 54, 56battery reports 252contents 242ECG 105re-routing 239scheduled 237ST map 147stopping printouts 236re-routing reports 239resp accessories 261Resp alarms 164apnea alarm delay time 164Resp detection level 164and apnea detection 164Resp detection modes 163and cardiac overlay 162Resp display 162Resp monitoring 162and cardiac overlay 162Resp safety information 164Resp wave 164changing size 164rhythm status messages (arrhythmia monitoring) 132Ssafety information 127, 164batteries 256ECG 105Resp 162safety test 312safety testsvisual inspection 257scale 109, 164ECG wave 109Resp wave 164scales 226for trends waveforms 226scheduled reports 237screen trend 228trend time 228selftest 59alarms 47sequence mode 189set combiners 263, 264setting up the sequence 189settings 31, 101, 317about 31default 317screen settings 31synchronized telemetry and monitor 101settings blocks 30short yellow alarms on/off 136signal quality of SpO2 175sinus and SV rhythm ranges 300, 301skin preparation 105ECG 105SmartKeys symbol 285source tracking 101ECG 105specifications 298arrhythmia 129SpO2alarms specific to SpO2 176assessing suspicious reading 175perfusion indicator 173, 181pleth wave 181pulse numerics 173signal quality 175site inspection 173site selection 172SpO2 desat alarm 181ST 139adjusting alarm limits 136alarms 47ensuring diagnostic quality 139filtering 139measurement points, adjusting 143snippets 141ST display 141ST map 147report, printingprinting 235ST map report 150scale, changing 150scale 109, 164ST map 147task window 150trending interval, changing 150trending priority 150ST maps 147ST point 144standard 10-lead placement 115standard 3-lead placement 113standard 5-lead placement (ECG) 113
331standby symbol 285status logprinting 235status messages 132printer 238, 239, 241status messages (arrhythmia) 132, 133ectopic 133rhythm 132sterilizing 245infection control 245stopping reports printouts 236surgical ECG cable 127suspicious SpO2 reading 175symbols 285battery 252, 255system pulse 157systolic blood pressure, NBP, early 186TTamb 192task window for ST map 150Tcereb 192telemetry alarms 101suspending at bedside 101telemetry deviceunpairing 218temperaturealarm settings 191connecting probe to monitor 191difference, calculating 192dual Temp measurement 192extended label set 192first 192making a measurement 191probe, disposable 191probe, selecting 191second 192temperature probe 191testing alarms 59tone configuration, alarm 49transferring centrally-monitored patients 93transport brightness setting 255trend time 228global 228trend viewST map 147trending interval 150ST map 147trendssetting parameter scales 226trends pop-up keys 221trends priority listST map 147troubleshootingCO2 209trunk cables 261Ttymp 192Tvesic 192Uunpairing 218VV electrode placement (ECG) 115venous puncture 190visual latching (arrhythmia alarms) 135Wwave 199, 210scale (CO2) 210scale (pressure) 199size (CO2) 210size (pressure) 199wave size 109Resp 162wave size (ECG) 109wave speed (Resp) 164what's new 41wide alarms limits 56wired network connection symbol 285Zzero 196effect on pressure alarms 196zeroingpressure transducer 197
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Part Number 453564547171 Published in Germany 04/2015*453564547171*

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