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

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In stru ctio ns fo r Use
IntelliVue Patient Monitor
MP2
Rel ease L with Software Re vision L.x x.xx
Patient Monitori ng
1
1 Basic Operation
Safety Information
Security Information
Introducing the IntelliVue MP2
Controls, Indicators and Connectors
Extending Measurements
Operating and Navigating
Operating Modes
Understanding Screens
Using the XDS Remote Display
Using the Visitor Screen
Understanding Profiles
Understanding Settings
Changing Measurement Settings
Switching a Measurement On and Off
Adjusting a Measurement Wave
Using Labels
Using IntelliVue Cableless Measurements
Changing Monitor Settings
Checking Your Monitor Revision
Getting Started
Disconnecting from AC Mains Power
Monitoring After a Power Failure
Networked Monitoring
Capturing Alarm Reports and Printing
2 What's New?
What's New in Release L
What's New in Release K.2
What's New in Release J.0
What's New in Release H.0
What's New in Release G.0?
What's New in Release F.0?
3 Alarms
Visual Alarm Indicators
Audible Alarm Indicators
Acknowledging Alarms
Pausing or Switching Off Alarms
Alarm Limits
Table of Contents
11
12
13
15
15
17
22
27
29
29
30
30
31
32
32
32
33
35
37
37
37
39
39
40
40
41
41
42
42
44
44
45
47
48
49
51
51
54
Reviewing Alarms
Latching Alarms
Testing Alarms
Alarm Behavior at Power On
Alarm Recordings
4 Patient Alarms and INOPs
Patient Alarm Messages
Technical Alarm Messages (INOPs)
5 Managing Patients and Equipment
Patient Concepts
Equipment Concepts
Managing Patients
Transferring Patients
Managing Equipment
Information Center Compatibility
57
58
59
59
60
61
61
68
85
85
85
86
91
95
103
6 ECG, Arrhythmia, ST and QT Monitoring
105
Skin Preparation for Electrode Placement
Connecting ECG Cables
Selecting the Primary and Secondary ECG Leads
Checking Paced Mode
Understanding the ECG Display
Monitoring Paced Patients
Changing the Size of the ECG Wave
Changing the Volume of the QRS Tone
Changing the ECG Filter Settings
Choosing EASI or Standard Lead Placement
Selecting Positions of Va and Vb Chest Leads (for 6-lead placement)
About ECG Leads
ECG Lead Fallback
ECG Lead Placements
Capture 12-Lead
EASI ECG Lead Placement
ECG and Arrhythmia Alarm Overview
Using ECG Alarms
ECG Safety Information
About Arrhythmia Monitoring
Switching Arrhythmia Analysis On and Off
Choosing an ECG Lead for Arrhythmia Monitoring
Understanding the Arrhythmia Display
Arrhythmia Relearning
Arrhythmia Alarms
About ST Monitoring
Switching ST or STE On and Off
105
105
106
106
107
108
109
110
110
110
111
111
112
112
118
122
123
125
127
129
129
129
131
134
135
139
140
Understanding the ST Display and Windows
Updating ST Baseline Snippets
About the ST Measurement Points
ST Alarms
STE Alarms
Viewing ST Maps
About QT/QTc Interval Monitoring
QT Alarms
Switching QT Monitoring On and Off
141
143
143
146
147
147
152
155
156
7 Monitoring Pulse Rate
157
Entering the Setup Pulse Menu
System Pulse Source
Switching Pulse On and Off
Using Pulse Alarms
8 Monitoring Respiration Rate (Resp)
Lead Placement for Monitoring Resp
Understanding the Resp Display
Changing Resp Detection Modes
Changing the Size of the Respiration Wave
Changing the Speed of the Respiration Wave
Using Resp Alarms
Changing the Apnea Alarm Delay
Resp Safety Information
9 Monitoring with the CL Respiration Pod (cmResp)
Measurement Principles
Measurement Modes
Making Measurements
Understanding the Numerics
Setting the Measurement Mode
Setting the Repeat Time
Switching Posture and Activity Level On and Off
10 Monitoring SpO2
SpO2 Sensors
Applying the Sensor
Connecting SpO2 Cables
Measuring SpO2
Understanding the SpO2 Numerics
Assessing a Suspicious SpO2 Reading
Changing the Averaging Time
Setting the Measurement Mode
Understanding SpO2 Alarms
Pleth Wave
157
157
158
158
161
161
162
163
164
164
164
164
164
167
167
168
168
168
169
169
170
171
171
172
173
173
174
175
175
176
176
181
Perfusion Numeric
Perfusion Change Indicator
Setting SpO2/Pleth as Pulse Source
Setting Up Tone Modulation
Setting the QRS Volume
11 Monitoring NBP
Introducing the Oscillometric NBP Measurement
Preparing to Measure NBP
Starting and Stopping Measurements
Enabling Automatic Mode and Setting Repetition Time
Enabling Sequence Mode and Setting Up The Sequence
Choosing the NBP Alarm Source
Switching Pulse from NBP On/Off
Assisting Venous Puncture
Calibrating NBP
12 Monitoring Temperature
Making a Temp Measurement
Calculating Temp Difference
13 Monitoring Invasive Pressure
Setting up the Pressure Measurement
Overview of Calibration Procedures
Zeroing the Pressure Transducer
Calibrating Reusable Transducers
Adjusting the Calibration Factor
Displaying a Mean Pressure Value Only
Changing the Pressure Wave Scale
Optimizing the Waveform
Non-Physiological Artifact Suppression
Choosing the Pressure Alarm Source
Calculating Cerebral Perfusion Pressure
14 Monitoring Carbon Dioxide
Measurement Principles
Measuring CO2 using the CO2 Option or M3014A
Measuring Microstream CO2 using M3015A/B
Setting up all CO2 Measurements
Understanding the IPI Numeric
15 Using a Telemetry Device and a Monitor
How Can You Combine Devices?
Unpairing the Monitor and Telemetry Device
Temporarily Stopping the Short Range Radio Connection
181
181
181
182
182
183
183
185
187
188
189
189
190
190
190
191
191
192
193
193
195
195
197
199
199
199
199
199
200
201
203
204
205
209
210
213
215
215
218
218
16 Enhancing Telemetry Monitoring with the Monitor
Monitor and Telemetry Transceiver Requirements
17 Trends
Viewing Trends
Setting Up Trends
Documenting Trends
Trends Databases
Screen Trends
18 Recording
Starting and Stopping Recordings
Overview of Recording Types
Creating and Changing Recordings Templates
Recorder Status Messages
19 Printing Patient Reports
Starting Report Printouts
Stopping Reports Printouts
Setting Up Reports
Setting Up Individual Print Jobs
Checking Printer Settings
Printing a Test Report
Switching Printers On or Off for Reports
Dashed Lines on Reports
Unavailable Printer: Re-routing Reports
Checking Report Status and Printing Manually
Printer Status Messages
Sample Report Printouts
20 Care and Cleaning
General Points
Cleaning the Monitor
Disinfecting the Equipment
Sterilizing the Equipment
Cleaning, Sterilizing and Disinfecting Monitoring Accessories
Cleaning Batteries and the Battery Compartment
21 Using Batteries
Battery Power Indicators
Checking Battery Charge
When Battery Lifetime is Expired
Replacing a Battery
Optimizing Battery Performance
Battery Safety Information
219
219
221
221
224
227
227
228
231
231
232
232
233
235
235
236
236
238
238
239
239
239
239
240
241
242
245
245
246
246
247
247
247
249
250
252
252
253
254
256
22 Maintenance and Troubleshooting
Inspecting the Equipment and Accessories
Inspecting the Cables and Cords
Maintenance Task and Test Schedule
Troubleshooting
Disposing of the Monitor
Disposing of Empty Calibration Gas Cylinders
23 Accessories
257
257
258
258
258
259
259
261
ECG/Resp Accessories
NBP Accessories
Invasive Pressure Accessories
SpO2 Accessories
Temperature Accessories
Mainstream CO2 Accessories
Sidestream CO2 Accessories
Microstream CO2 Accessories
Battery Accessories
261
264
270
273
278
279
279
280
281
24 Specifications
283
Indications for Use
Use Environment
Restricted Availability
Manufacturer's Information
Symbols
Installation Safety Information
Monitor Mounting Precautions
Altitude Setting
Monitor Safety Specifications
EMC and Radio Regulatory Compliance
Out-Of-Hospital Transport - Standards Compliance
Physical Specifications
Environmental Specifications
Monitor Performance Specifications
Monitor Interface Specifications
865297 Battery Extension Specifications
M4607A Battery Specifications
M4605A Battery Specifications
Measurement Specifications
Safety and Performance Tests
283
283
284
284
285
287
287
288
288
288
290
291
292
293
294
296
296
297
298
312
25 Default Settings Appendix
317
Alarm and Measurement Default Settings
Alarm Default Settings
ECG, Arrhythmia, ST and QT Default Settings
Pulse Default Settings
317
317
318
321
Respiration Default Settings
SpO2 Default Settings
NBP Default Settings
Temperature Default Settings
Invasive Pressure Default Settings
CO2 Default Settings
Index
321
322
322
323
323
325
327
10
1
Basic Operation
These 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.
11
1 Basic Operation
Safety Information
The 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 Interference
WARNING
Grounding: 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 twowire 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. 60601-1-08
Consult 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 Environment
WARNING
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 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).
12
1 Basic Operation
Alarms
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.
•
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.
Accessories
WARNING
Philips' 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 Information
Protecting Personal Information
Protecting personal health information is a primary component of a security strategy. Each facility
using the monitors must provide the protective means necessary to safeguard personal information
consistent with country laws and regulations, and consistent with the facility’s policies for managing
this information. Protection can only be realized if you implement a comprehensive, multi-layered
strategy (including policies, processes, and technologies) to protect information and systems from
external and internal threats.
13
1 Basic Operation
As 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).
NOTE
Log files generated by the monitors and measurement modules are used for system troubleshooting
and do not contain protected health data.
About HIPAA Rules
If applicable, your facility’s security strategy should include the standards set forth in the Health
Insurance Portability and Accountability Act of 1996 (HIPAA), introduced by the United States
Department of Health and Human Services. You should consider both the security and the privacy
rules and the HITECH Act when designing policies and procedures. For more information, please
visit:
http://www.hhs.gov/ocr/privacy/.
About the EU Directives
If applicable, your facility’s security strategy should include the practices set forth in the Directive on
the protection of individuals with regard to the processing of personal data and on the free movement
of such data (Directive 95/46/EC of the European Parliament and of the Council of
24 October 1995). In addition, your facility should also take into account any additional, more
stringent standards put forward by any individual EU countries; that is, Germany, France, and so on.
Philips Product Security Policy Statement
Additional security and privacy information can be found on the Philips product security web site at:
http://www.healthcare.philips.com/main/support/equipment-performance/product-security/
index.wpd
14
1 Basic Operation
Manufacturer Disclosure Statement for Medical Device Security –
MDS2
You can view the Manufacturer Disclosure Statements for Medical Device Security (MDS2) for
specific devices at:
http://www.healthcare.philips.com/main/support/equipment-performance/product-security/
index.wpd
Introducing the IntelliVue MP2
The 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 Connectors
MP2 Overview
On/Standby Switch
Power and battery indicators (see “MP2 Controls and Indicators” on page 16)
3.5-inch TFT LCD touchscreen QVGA display
15
1 Basic Operation
Alarm lamps (see “MP2 Controls and Indicators” on page 16)
Built-in carrying handle
Battery eject button
Keys (see “MP2 Controls and Indicators” on page 16)
Measurement connectors (see “MP2 Patient Connectors, Right Side” on page 17)
Battery
MP2 Controls and Indicators
On/Standby switch
On/Standby LED. Green when monitor is on. Red indicates an error.
Battery status LED. Yellow when charging. Flashing red when battery is empty, or a battery
malfunction is detected.
External power LED. Green when monitor is powered from an external power source.
Alarms off indicator. When alarms are suspended, the lamp is red, and the Alarms Off message
appears on the screen.
Active INOP alarm lamp in light blue. Stays lit until active INOP is acknowledged.
Active alarm lamp. Red or yellow, depending on alarm level. Stays lit until active alarm is
acknowledged.
Silence key
Alarms key: turns alarms On/Off, or pauses them
10 SmartKeys key: brings up SmartKeys on the screen
11 Main Screen key: closes all open menus/windows and returns to the main screen, or selects
current screen.
16
1 Basic Operation
MP2 Patient Connectors, Right Side
English version
International version
Pressure (option)
Temperature (option)
Noninvasive blood pressure
SpO2
ECG sync pulse output (See
“Monitor Performance
Specifications” on page 293 for
specifications)
ECG/Respiration
CO2 (option)
MP2 Left Side
Loudspeaker (do not cover with labels or stickers as this
will reduce the loudspeaker volume).
MSL Connector. Connects to the external power supply via
the MSL cable for AC mains operation, battery charging,
and communication with a network.
Extending Measurements
Your 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).
17
1 Basic Operation
MMS Extension M3014A attached to the MP2
The 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.
18
1 Basic Operation
M3014A, M3015A, and M3015B Capnography MMS Extensions
The optional M3014A Capnography extension adds mainstream capnography or sidestream
capnography, and optionally one pressure plus either a pressure or a temperature to the monitor.
M3014A
Pressure connectors (red)
Temperature connector (brown)
Mainstream/sidestream connector CO2
Cardiac Output connector
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.
M3015A
M3015B
Pressure connectors (red) - M3015A optional
Temperature connector (brown) - M3015A optional
Gas sample outlet
Microstream connector CO2 and Inlet
19
1 Basic Operation
M3012A Hemodynamic MMS Extension
Cardiac Output (orange; optional)
Connection to monitor
Pressure connectors (red)
Temperature connectors (brown)
When 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 Extension
To 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 Extension
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.
20
1 Basic Operation
To remove the monitor with MMS Extension,
press the release lever and push the monitor
across to release the connection.
LED Indicators
The 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.
External power available
LED indication
Status
green
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 available
LED indication
Status
yellow 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.
21
1 Basic Operation
IntelliVue Cableless Measurements
The 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 Keys
The 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:
Integrated monochrome LCD display
Hardkeys
Measurement identifier
The Respiration Pod has one multi-color LED for status display and one hardkey for basic operation,
e.g. to start a measurement:
Multi-color LED
Hardkey
Indication for built-in RFID tag
Operating and Navigating
The 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).
These let you:
22
•
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.
Key with symbol
(international)
Text replaces
symbol (English
versions only)
1 Basic Operation
These let you:
Key with symbol
(international)
•
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 reenable the touchscreen operation.
Text replaces
symbol (English
versions only)
A typical main screen looks like this:
MP2 Screen Elements
Item
Description
Alarm volume off indicator
Comments
is displayed when the alarm volume is set to zero
(0).
23
1 Basic Operation
MP2 Screen Elements
Item
Description
Comments
Patient name / alarm
message field
Patient 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.
Patient category and bed label Patient category and bed label can be covered by INOP
/ INOP message field
messages. If there are multiple red/yellow/cyan INOPs
active at the same time, they rotate in the INOP field.
Network connection
indicator
Documented in Information Center Instructions for Use.
Measurement label
Touch the measurement to enter the measurement setup
menu.
Paced status
Displayed below the HR label.
Measurement numeric/values Touch the numeric to enter the measurement setup menu.
Measurement wave
Touch the wave to enter the measurement setup menu.
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.
Using the Touchscreen
Touch 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 Menus
Each 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.
24
1 Basic Operation
Touch the measurement numeric on the screen to enter the setup menu.
Key to measurement setup menu:
Item
Description
Comment
INOP and alarm
message field
These are always displayed at the top of the screen.
Wave/numerics
window
The 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.
Status/prompt
message
Status/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.
Next page arrows
The menu may have more than one page, as shown here. Move to
another page by touching these arrows.
Measurement menu
keys
Each 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.
Main Setup Menu
There 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.
25
1 Basic Operation
SmartKeys
A 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:
26
Scroll to see more SmartKeys
enter Main Setup menu - you can get
to all setup windows using this key
enter standby mode - suspends patient
monitoring. All waves and numerics
disappear from the display. All settings
and patient data information are
retained.
enter profile menu, or
revert to default profile
change Screen, or
revert to default screen
previous Screen
quick admit a patient
enter patient identification menu to
admit/discharge/transfer
end case to discharge a patient
lock touchscreen operation
set alarm limits
change alarm volume
change screen brightness (not for
independent displays)
change QRS volume
change amplitude (size) of ECG wave
review beat labels (annotate
arrhythmia wave)
re-learn arrhythmia
- start/stop manual NBP
measurement
- start auto series
- stop current automatic measurement
within series
start NBP STAT measurement
1 Basic Operation
stop automatic or STAT NBP
measurement and measurement series
start NBP measurement and
measurement series
start veni puncture (inflate cuff to
subdiastolic pressure)
stop current NBP measurement
set the NBP repeat time
access patient reports
switch CO2 pump off
zero invasive pressure transducer
new lead setup
set standard or EASI lead placement
review vital signs trend
review graph trend
unpair equipment and continue central
monitoring with the monitor
unpair equipment and continue central
monitoring with the telemetry device
start 12-Lead Capture (only available if
Information Center is connected)
access ST Map application
select measurement device
start an SpO2 measurement
access NBP mode selection and setup,
with direct start/stop function
open the Equipment window
Pop-Up Keys
Pop-up keys are task-related graphical keys that appear automatically on the monitor screen when
required. For example, the Confirm pop-up key appears only when you need to confirm a change.
Using the On-Screen Keyboard
Use this as you would a conventional keyboard. Enter the information by selecting one character after
another. Use the Shift and capital Lock keys to access uppercase letters. Use the Back key to delete single
characters, or use the Clr key to delete entire entries. Select Enter to confirm what you have entered and
close the on-screen keyboard.
Operating Modes
When you switch the monitor on, it starts up in monitoring mode. To change to a different mode:
Select the Main Setup menu.
Select Operating Modes and choose the mode you require.
27
1 Basic Operation
Your monitor has four operating modes. Some are passcode protected.
•
Monitoring Mode: This is the normal, every day working mode that you use for monitoring
patients. You can change elements such as alarm limits, patient category and so forth. When you
discharge the patient, these elements return to their default values. Changes can be stored
permanently only in Configuration Mode. You may see items, such as some menu options or the
altitude setting, that are visible but ‘grayed out’ so that you can neither select nor change them.
These are for your information and can be changed only in Configuration Mode.
•
Demonstration Mode: Passcode protected, this is for demonstration purposes only. You must
not change into Demonstration Mode during monitoring. In Demonstration Mode, all stored
trend information is deleted from the monitor’s memory.
•
Configuration Mode: Passcode protected, this mode is for personnel trained in configuration
tasks. These tasks are described in the Configuration Guide. During installation the monitor is
configured for use in your environment. This configuration defines the default settings you work
with when you switch on, the number of waves you see and so forth.
•
Service Mode: Passcode protected, this is for trained service personnel.
When the monitor is in Demonstration Mode, Configuration Mode, or Service Mode, this is indicated
by a box with the mode name in the center of the Screen and a symbol in the bottom right-hand
corner. Select the mode box in the center of the screen to change to a different mode.
Standby Mode
Standby mode can be used when you want to temporarily interrupt monitoring.
To enter Standby mode,
Press the SmartKeys key
Either select the Monitor Standby SmartKey
Or 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.
28
1 Basic Operation
Understanding Screens
Your monitor comes with a set of pre-configured Screens, optimized for common monitoring
scenarios such as "OR adult", or "ICU neonatal". A Screen defines the overall selection, size and
position of waves, numerics and other elements on the monitor screen when you switch on. You can
easily switch between different Screens during monitoring. Screens do NOT affect alarm settings,
patient category and so forth.
Switching to a Different Screen
To switch to a different Screen:
After closing any open menus or windows, press the Main Screen key to access the Change Screen
menu.
Choose the new Screen from the Change Screen menu.
Changing a Screen’s Content
If you do not want to change the entire Screen content, but only some parts of it, you can substitute
individual waves, numerics, or trends. Be aware that these changes cannot be stored permanently in
Monitoring Mode.
To change the selection of elements on a Screen,
Select the element you want to change. For example, touch the wave to enter the wave setup menu,
or touch the numeric to enter the numeric setup menu.
From 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 Display
Using the IntelliVue XDS Solution it is possible to view an independent monitor screen on an external
display. The XDS Solution consists of a medical grade PC-based hardware platform, XDS Application
software and the XDS connectivity option on the monitor. Depending on the configuration you can
also operate the monitor from the external display. The XDS must be connected to the same Local
Area Network (LAN) as the monitor.
It is also possible to use an existing PC, connected to the same LAN, to host the XDS Application
software.
For more details, including limitations and restrictions, refer to the IntelliVue XDS Application
Instructions for Use.
29
1 Basic Operation
Using the Visitor Screen
If a visitor Screen is configured for your monitor, you can use it to clear the screen of all waves and
numerics but continue to monitor the patient with active alarms and trend storage at the bedside and
Information Center. 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,
Press the Main Screen key to open the Change Screen menu.
Select the name of the visitor Screen configured for your monitor from the list of available
Screens.
To select a Screen with waves and numerics again,
•
Touch the gray box in the center of the screen showing the visitor Screen's name, or press the
Main Screen key, to open the Change Screen menu and then select a Screen from the list.
Understanding Profiles
Profiles are predefined monitor configurations. They let you change the configuration of the whole
monitor so you can adapt it to different monitoring situations. The changes that occur when you
change a complete profile are more far reaching than those made when you change a Screen. Screens
affect only what is shown on the display. Profiles affect all monitor and measurement settings.
The settings that are defined by Profiles are grouped into three categories. Each category offers a
choice of 'settings blocks' customized for specific monitoring situations. These categories are:
•
Display (screens)
Each profile can have a choice of many different predefined screens.
When you change the profile, the screen selection configured for the new profile becomes active.
•
Measurement Settings
Each profile can have a choice of different predefined measurement settings. These relate directly
to individual measurements, for example, measurement on/off, measurement color, alarms limits,
NBP alarm source, NBP repeat time, temperature unit (°F or °C), pressure unit (mmHg or kPa).
•
Monitor Settings
Each profile can have a choice of different predefined monitor settings. These relate to the
monitor as a whole; for example, display brightness, alarms off/paused, alarm volume, QRS tone
volume, tone modulation, prompt tone volume, wave speed, resp wave speed, pulse source.
You can change from one complete profile to another or swap individual settings blocks (display/
monitor settings/measurement settings) to change a subset of a profile. Changes you make to any
element within the settings blocks are not saved when you discharge the patient, unless you save them
in Configuration Mode.
Depending on your monitor configuration, when you switch on or discharge a patient the monitor
either continues with the previous profile, or resets to the default profile configured for that monitor.
WARNING
•
30
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 Operation
•
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 Profile
Press the SmartKeys hard key and
– Either select Main Setup and then Profiles in the Main Setup menu.
– Or select the Profiles SmartKey
In the Profiles menu, select Profile.
Chose a profile from the pop-up list.
Confirm your selection.
Swapping a Settings Block
Select the Main Setup SmartKey and then Profiles in the Main Setup menu.
Select the Profile Details key.
In the Profile Details menu, select Display or Measmnt.Settings or Monitor Settings to call up a list of
the settings blocks in each category.
Choose a settings block from the pop-up list.
Confirm your selection.
Default Profile
Your monitor has a default profile that it uses when you leave Demonstration mode, or when you
discharge a patient. This profile is indicated by a diamond shaped symbol.
Understanding Settings
Each aspect of how the monitor works and looks is defined by a setting. There are a number of
different categories of settings, including,
Screen Settings, to define the selection and appearance of elements on each individual Screen
Measurement settings, to define settings unique to each measurement, for example, high and low
alarm limits
Monitor settings, including settings that affect more than one measurement or Screen and define
general aspects of how the monitor works, for example, alarm volume, reports and recordings, and
display brightness.
You must be aware that, although many settings can be changed in Monitoring Mode, permanent
changes to settings can only be done in the monitor's Configuration Mode.
31
1 Basic Operation
All settings are reset to the stored defaults:
•
when you discharge a patient
•
when you load a Profile
•
when the monitor is switched off for more than one minute (if Automat. Default is set to Yes).
Changing Measurement Settings
Each measurement has a setup menu in which you can adjust all of its settings. You can enter a setup
menu:
•
via the measurement numeric - select the measurement numeric to enter its setup menu. For
example, to enter the Setup ECG menu, select the HR (heart rate) numeric.
•
via the 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 Off
When a measurement is off, its waves and numerics are removed from the monitor’s screen. The
monitor stops data acquisition and alarming for this measurement.
Enter the measurement’s setup menu and select the measurement.
Select 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 Wave
To quickly adjust wave-related measurement settings (such as speed or size), select the measurement
wave itself. This displays the measurement wave menu, which has only wave-related measurement
settings.
Changing Wave Speeds
Lowering the wave speed compresses the wave and lets you view a longer time period. Increasing the
speed expands the waveform, giving you a more detailed view.
The monitor distinguishes two groups of wave speed settings:
32
•
RespiratorySpeed,
•
Global Speed,
for CO2 waves.
for all waves not included in the other group.
1 Basic Operation
Changing the Wave Group Speed
The wave speed group setting defines the speed of all the waves in the group.
To change the wave speed of a wave speed group,
Select Main Setup and then select User Interface
Select Global Speed or RespiratorySpeed, as required
Select a value from the list of available speeds.
Changing Wave Speed for a Channel
To change the wave speed of an individual wave channel,
Enter the wave menu for a measurement by selecting its wave.
Select Change Speed.
To 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 Labels
You 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),
Enter the wave menu of the measurement.
Select Label.
Choose a label from the list.
The monitor automatically applies the scale, color, etc. settings stored in the Profile for the label you
select. You can change scale settings in Monitoring Mode, but color can only be changed in the
monitor's Configuration Mode.
Any labels already being used in the monitor are shown "grayed-out" in the list and cannot be selected.
Resolving Label Conflicts
Each 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.
33
1 Basic Operation
Depending 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 conflict
Measurement selection key
All 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.
Unavailable measurement shown grayed-out
An 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:
34
Press the SmartKeys key and
– Either select Main Setup and then Meas. Selection
– Or select the Measmt. Select. SmartKey
to display the Measurement Selection window.
Select the label to be corrected.
Use the measurement selection keys to resolve the conflict. Select either:
– Change Label: to assign a different label to the conflicting label.
1 Basic Operation
–
–
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 : to enter the Setup menu for the measurement and change the
conflicting device’s label to a different label.
Label Compatibility
When a new measurement is introduced, or new labels for an existing measurement, these labels will
not be shown on older Information Centers, and consequently not on the Overview screen sourced
from the Information Center.
When a patient is transferred from a monitor with these new labels to one with an older software
revision, the labels will be replaced with a generic label for that measurement. The settings for that
generic label will then be used.
If it is critical that the measurement labels are available at the Information Center and after transfers,
the older monitors and the Information Center must be upgraded to the appropriate software revision.
Using IntelliVue Cableless Measurements
The 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 Device
When 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.
WARNING
Short Range Radio connections are subject to interruption due to interference from other radio
sources in the vicinity, including microwaves, bluetooth devices, WLAN devices (802.11b,g,n) and
cordless phones. Depending on the strength and duration of the interference, the interruption may
occur for an extended period. A loss of connection, due to moving out-of-range, interference, or for
other reasons, is indicated with a No Host Monitoring INOP 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 Devices
You 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.
Hold 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.
Press any hardkey on the cableless device.
35
1 Basic Operation
The 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 Manually
Prepare the SpO2 or NBP Pod for adding by holding the ◄ key pressed, or the Respiration Pod by
pressing the hardkey.
Select 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:
Select the cableless measurement device to be added.
Select 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 Device
To remove a cableless measurement device from a monitor and end the assignment:
Select the Measurement Selection key.
Select the cableless measurement device to be removed.
Select the Remove pop-up key.
You can also remove cableless measurement devices in the same way as any other devices using the
window, see “Using the Equipment Window” on page 96.
Equipment
36
1 Basic Operation
Changing Monitor Settings
To change monitor settings such as brightness, or QRS tone volume:
Press the SmartKeys key
Either Select the appropriate SmartKey for the setting you want to change
Or 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 Brightness
Select the Brightness SmartKey.
Select the appropriate setting for the screen brightness. 10 is the brightest, 1 is the least bright.
Optimum is suitable for most monitoring locations and optimizes power usage for battery powered
monitors.
Your monitor may be configured with a lower brightness for Standby mode and also for transport to
conserve battery power. These settings can only be changed in the monitor’s Configuration Mode.
Setting the Date and Time
Enter the Main Setup menu by selecting the Main Setup SmartKey, then select Date, Time to enter the
Date, Time menu.
Select, in turn, the Year, Month, Day, Hour (in 24 hour format, only) and Minute as necessary. Select
the correct values from the pop-up list.
Select Store Date, Time to change the date and time.
If your monitor is connected to an Information Center, the date and time are automatically taken from
this. Once it is set, the internal clock retains the setting even when you switch off the monitor.
Checking Your Monitor Revision
Select Main Setup then select Revisions to open the Monitor Revision menu.
Select the correct device from the device pop-up keys.
From the Monitor Revision menu, select the monitor component for which you need revision
information.
Getting Started
Once you understand the basic operation principles and have completed the Training Program, you
can get ready for monitoring.
37
1 Basic Operation
Inspecting the Monitor
WARNING
If the monitor is mechanically damaged, or if it is not working properly, do not use it for any
monitoring procedure on a patient. Contact your service personnel.
Before you start to make measurements, carry out the following checks on the monitor.
– Check for any mechanical damage.
– Check all the external cables, plug-ins and accessories.
Always ensure that the battery is loaded in the battery compartment when monitoring a patient,
even when the monitor is running on external power.
If 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.
Check all the functions of that you need to monitor the patient, and ensure that the monitor is in
good working order.
NOTE
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).
Switching On
Press the power on/standby switch on the monitor for one second. The monitor performs a self test
during which all lamps will light up and a tone will be sounded, and is then ready to use. If you see a
message such as CO₂ Sens Warmup wait until it disappears before starting to monitor that measurement.
Power On/Power Off Behavior
The general rules determining the behavior of the monitor when connected to, or disconnected from
power are as follows:
•
A monitor that was switched on prior to a temporary power loss switches on again when power is
restored.
•
A monitor that was switched off prior to a temporary power loss remains off when power is
restored.
•
When AC mains power is lost, a battery powered monitor continues to run without interruption
on battery power.
Setting up the Measurements
38
Decide which measurements you want to make.
Connect the required patient cables and sensors. The connectors are color-coded to the patient
cables and sensors for easy identification.
1 Basic Operation
WARNING
When connecting devices for acquiring measurements, always position cables and tubing carefully
to avoid entanglement or potential strangulation.
If 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 assigned
If 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 Monitoring
After you switch on the monitor,
Admit your patient to the monitor.
Check that the profile, alarm limits, alarm and QRS volumes, patient category and paced status and
so forth are appropriate for your patient. Change them if necessary.
Refer to the appropriate measurement chapter for further details of how to perform the
measurements you require.
Disconnecting from AC Mains Power
To 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 Failure
If 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.
39
1 Basic Operation
Networked Monitoring
You can connect your monitor to an Information Center on a network, using one of the optional
interfaces:
•
Standard wired LAN
•
Wireless LAN
•
IntelliVue Instrument Telemetry System (IIT).
WARNING
Do not connect patient monitors to the standard hospital network.
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 Printing
You 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 Events
The monitor can be set up to automatically capture alarm events, triggered by selected alarms.
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.
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.
40
2
What'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 L
ECG Enhancements
Extended Selection for Va and Vb Chest Leads
For 6-lead placement you now have an extended selection of chest leads: V1 to V9 and V3R to V6R.
Specific Label Assignment for V Lead
With 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 Map
The STE Map adds gender-specific STE limits to ST Map. ST values violating these limits are indicated
in red.
12-Lead Order Management
A 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 Measurement
It is now possible to choose between two different lead vectors for the impedance respiration
measurement.
Stat Admit Function
The 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.
41
2 What's New?
What's New in Release K.2
Cableless Respiration Measurement
The 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 ECG
The 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 NBP
An 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.0
Flexible, 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 Patients
When 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 Transfer
A transfer can be initiated in the unit at the monitor, on patient arrival or patient departure, or centrally
at the Information Center.
Managing Equipment
When 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.
42
2 What's New?
Alarm 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 paused after Standby mode - alarms are automatically paused for 1 minute after Standby
mode to allow time for patient connection.
/ 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.
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" Alarms
The 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 CO2
An 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 Waves
Visibility 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" Numerics
NBP 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.
43
2 What's New?
What's New in Release H.0
Battery Extension
The 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 Interface
The 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 Enhancements
You 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 Devices
The 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 Times
You 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 MP2
A 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 Solution
Using the IntelliVue XDS solution it is possible to view an independent monitor screen on an external
display. The XDS solution consists of a medical grade PC-based hardware platform, XDS application
software and the XDS connectivity option on the monitor. Depending on the configuration you can
also operate the monitor from the external display. The XDS must be connected to the same Local
Area Network (LAN) as the monitor.
It is also possible to use an existing PC, connected to the same LAN, to host the XDS Application
software.
New Fields in the Admission Form
A 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.
44
2 What's New?
SpO2 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 Monitoring
QT 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 Entry
Measurement 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 Enhancements
The 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 Sequence
Up to four measurement cycles can be set up which will run consecutively. For each cycle you can set
the number of measurements and the interval between them. By setting the last cycle to run
continuously you can have regular measurements continue after the sequence has run.
New Printing Options For Reports
Reports 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 Monitor
Previously, 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 Menus
Windows 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.
45
2 What's New?
Invasive Pressure Changes
Wave 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 Check
The 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 Keys
A SmartKey is available for New Lead Setup when a new ECG lead set with fewer leads than previously
is being used.
Better Visibility Of Gridlines
The brightness of the gridlines on the realtime waves has been increased for better visibility.
46
3
Alarms
The alarm information here applies to all measurements. Measurement-specific alarm information is
discussed in the sections on individual measurements.
The monitor has two different types of alarm: patient alarms and INOPs.
Patient Alarms
Patient Alarms are red and yellow alarms. A red alarm indicates a high priority patient alarm such as a
potentially life threatening situation (for example, asystole). A yellow alarm indicates a lower priority
patient alarm (for example, a respiration alarm limit violation). Additionally there are short yellow
alarms, most of which are specific to arrhythmia-related patient conditions (for example, ventricular
bigeminy).
INOPs
INOPs are technical alarms, they indicate that the monitor cannot measure or detect alarm conditions
reliably. If an INOP interrupts monitoring and alarm detection (for example, Leads Off), the monitor
places a question mark in place of the measurement numeric and an audible indicator tone will be
sounded. INOPs without this audible indicator indicate that there may be a problem with the reliability
of the data, but that monitoring is not interrupted.
Most INOPs are light blue, however there are a small number of INOPs which are always yellow or
red to indicate a severity corresponding to red and yellow alarms. The following INOPs can also be
configured as red or yellow INOPs to provide a severity indication:
•
ECG Leads Off
•
NBP Cuff Overpress
•
Cuff Not Deflated
•
Occlusion
•
 No Pulse
•
 No Pulse
•
Tele Disconnected
•
Battery Empty
/ Replace Battery
All monitors in a unit should have the same severity configured for these INOPs.
47
3 Alarms
Alarm Delays
There is a delay between a physiological event at the measurement site and the corresponding alarm
indication at the monitor. This delay has two components:
•
The general measurement delay time is the time between the occurrence of the
physiological event and when this event is represented by the displayed numerical values.
This delay depends on the algorithmic processing and, 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 Alarms
If more than one alarm is active, the alarm messages are shown in the alarm status area in succession.
An arrow symbol next to the alarm message informs you that more than one message is active.
The monitor sounds an audible indicator for the highest priority alarm. If more than one alarm
condition is active in the same measurement, the monitor announces the most severe. Your monitor
may be configured to increase alarm indicator volume automatically during the time when the alarm is
not acknowledged.
Visual Alarm Indicators
Alarm Message
An 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 Numeric
The numeric of the measurement in alarm flashes.
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3 Alarms
Bright Alarm Limits
If the alarm was triggered by an alarm limit violation, the corresponding alarm limit on the monitor
screen is shown more brightly if Show ALarmLimits is enabled and there is sufficient room on the
screen.
Alarm Lamp
A lamp on the monitor's front panel flashes. The alarm lamp is divided into two sections. The right
one flashes for a patient alarm, except for short yellow alarms where the lamp will light for
approximately six seconds. The color is yellow or red corresponding to the highest priority patient
alarm currently present. The left one lights continuously for a light blue INOP and flashes for yellow
or red INOPs as follows:
INOP Lamp Color
On
Off
Yellow
1.0 seconds
1.0 seconds
Red
0.25 seconds
0.25 seconds
If only patient alarms are present, and no INOPs, the patient alarms will use both left and right
sections to flash (for red and yellow alarms) or light for approximately six seconds (for short yellow
alarms). If only INOPs are present, and no patient alarms, red and yellow INOPs will use both left and
right sections to flash but light blue INOPs will always light continuously in the left section only.
Audible Alarm Indicators
The audible alarm indicators configured for your monitor depend on which alarm standard applies in
your hospital. Audible alarm indicator patterns are repeated until you acknowledge the alarm by
switching it off or pausing it, or until the alarm condition ceases (if audible alarm indication is set to
non-latching).
WARNING
•
Do not rely exclusively on the audible alarm system for patient monitoring. Adjustment of alarm
volume to a low level or off during patient monitoring may result in patient danger. Remember
that the most reliable method of patient monitoring combines close personal surveillance with
correct operation of monitoring equipment.
Alarm Tone Configuration
The audible alarm indicators of your monitor are configurable. In the monitor's Configuration Mode,
you can:
•
increase the alarm volume of unacknowledged alarms at regular intervals
•
change the interval between alarm sounds (ISO/IEC Standard alarms only)
•
change the base volume of the red and yellow alarm tones and the INOP tones
•
change the alarm sound to suit the different alarm standards valid in different countries.
49
3 Alarms
Traditional Audible Alarms (HP/Agilent/Philips/Carenet)
•
Red alarms and red INOPs: A high pitched sound is repeated once a second.
•
Two-star yellow alarms and yellow INOPs: A lower pitched sound is repeated every two seconds.
•
One-star yellow alarms (short yellow alarms): The audible indicator is the same as for yellow
alarms, but of shorter duration.
•
Standard INOPs: an INOP tone is repeated every two seconds.
ISO/IEC Standard Audible Alarms
•
Red alarms and red INOPs: A high pitched tone is repeated five times, followed by a configurable
pause.
•
Two-star yellow alarms and yellow INOPs: A lower pitched tone is repeated three times, followed
by a configurable pause.
•
One-star yellow alarms (short yellow alarms): The audible indicator is the same as for yellow
alarms, but of shorter duration.
•
Standard INOPs: a lower pitched tone is repeated twice, followed by a pause.
Changing the Alarm Tone Volume
If 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 INOP
If your monitor is connected to an Information Center, and the connection is interrupted, the INOP
message No Central Monit. will appear within 30 seconds, accompanied by an INOP tone. To help
ensure that this INOP, and any other active alarm, is not overlooked, the INOP and alarm tones may
be configured to have a minimum volume. In this case, INOP and alarm tones will sound even if the
monitor alarm volume is set to zero.
Minimum Volume for Severe Yellow or Red INOPs
Severe yellow or red INOPs require action to ensure the well-being of the patient. Therefore the
minimum volume for the INOP tone is set to at least alarm volume 8, irrespective of the current alarm
volume setting. The INOP tone will sound even if the monitor alarm volume is set to zero.
The severe INOPs for which this applies are:
Cuff Not Deflated
(configurable to yellow or red)
NBP Cuff Overpress
!! Insert Battery
Battery Empty
50
(configurable to yellow or red)
(yellow)
/ Replace Battery (configurable to light blue, yellow or red)
3 Alarms
Acknowledging Alarms
To 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
monitor is configured to re-alarm, a dashed check mark will be shown
. If the
If the condition that triggered the alarm is still present after the alarm has been acknowledged, the
alarm message stays on the screen with a check mark symbol beside it, except for NBP alarms and
alarms from other intermittent measurements. When such an alarm is acknowledged the alarm
message disappears.
If the alarm condition is no longer present, all alarm indicators stop and the alarm is reset.
Switching off the alarms for the measurement in alarm, or switching off the measurement itself, also
stops alarm indication.
Acknowledging Disconnect INOPs
Acknowledging an INOP that results from a disconnected transducer switches off the associated
measurement. 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 Reminder
If Alarm Reminder is configured on for your monitor, you will get an audible reminder of alarm
conditions that remain active after you have acknowledged the alarm. This reminder may take the form
of a repetition of the alarm tone for a limited time, or an unlimited repetition of the alarm tone (this is
the same as a new alarm). Alarm Reminder is not available for standard, light blue INOPs but for yellow
and red INOPs.
In Configuration Mode, you can set the interval between silencing the alarm and sounding the
reminder tone to one, two, or three minutes.
The alarm reminder behavior at the Information Center is different to that at the monitor. Refer to the
Information Center Instructions for Use for further information.
Pausing or Switching Off Alarms
If you want to temporarily prevent alarms from sounding, for example while you are moving a patient,
you can pause alarms. Depending on your monitor configuration, alarms are paused for one, two, or
three minutes, or infinitely. Infinite alarm pause is equivalent to switching the alarms off.
51
3 Alarms
To view the alarm pause setting chosen for your unit,
Select Main Setup, Alarms, then Alarm Settings
Check the Alarms Off setting.
This setting can only be changed in Configuration Mode.
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 Off
You 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 Off
Select the measurement numeric to enter its setup menu.
Select Alarms to switch between on and off.
The alarms off symbol is shown beside the measurement numeric.
52
3 Alarms
While Alarms are Paused or Off
When 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:
Alarms Paused
Alarms Off
•
No alarms are sounded and no alarm messages are shown.
•
INOP messages are shown but no INOP tones are sounded.
The only exceptions are the INOPs Cuff Not Deflated, NBP Cuff Overpress and INOPs relating to
empty, missing and malfunctioning batteries.
These INOPs switch the alarms on, and the INOP tones are sounded, even if alarms are paused or off.
You need to remove the INOP condition first before you can switch the alarm tones off again.
If a disconnect INOP is present and alarms are paused or switched off, the measurement in question
may be switched off, depending on monitor configuration.
Restarting Paused Alarms
To manually switch on alarm indication again after a pause, 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 Timeouts
To reset the arrhythmia alarm timeout period, press the Alarms key and then press it again.
Extending the Alarm Pause Time
If your monitor has extended alarm pause enabled, you can extend the alarm pause time. Use this to
prevent alarms being indicated, for example, while you are washing a patient or carrying out a
procedure. Only extend the alarm pause time when you are sure that clinical personnel are available to
monitor the patient's condition closely.
To extend the alarm pause time to five or 10 minutes,
Select one of the alarm fields. This calls up the Alarm Messages window.
Select either the pop-up key PauseAl. 5 min or the pop-up key PauseAl. 10 min. Each time you
select one of these pop-up keys, the Alarm Pause Time is reset to five (or 10) minutes.
53
3 Alarms
Alarm Settings for Unattended Monitoring
When 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
and make sure that the AlarmOffReminder and the Alarm Reminder are switched on (these
settings are made in Configuration mode).
Infinite,
•
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 Limits
The 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.
WARNING
Be aware that the monitors in your care area may each have different alarm settings, to suit different
patients. Always check that the alarm settings are appropriate for your patient before you start
monitoring.
Viewing Individual Alarm Limits
You can usually see the alarm limits set for each measurement next to the measurement numeric on
the main screen.
If your monitor is not configured to show the alarm limits next to the numeric, 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 Limits
The Alarm Limits overview window lists the currently set alarm limits for all measurements. If an Apnea
alarm delay time is set, this is also shown. The alarms off symbol is shown beside the measurement
label of any measurement whose alarm switched off.
To open the Alarm Limits window, either select one of the alarm fields then select the Alarm Limits popup key, or select the Alarm Limits SmartKey, if configured.
54
3 Alarms
Graphic view of current yellow
and red alarm limits and
currently monitored
measurement value. Off
indicates the measurement is
switched off
Measurement labels, with alarms
off symbol where appropriate
Set narrow or wide alarm
AutoLimits for all
measurements
Select Show ST Limits to expand the list of ST leads and view the currently set alarm limits. Selecting
Hide ST Limits hides the list again.
You can use the pop-up keys that open with the Alarm Limits window to perform common tasks:
–
All 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 Limits
To change individual measurement alarm limits using the measurement's Setup Menu,
In the measurement's setup menu, select the alarm limit you want to change. This calls up a list of
available values for the alarm limit.
Select a value from the list to adjust the alarm limit.
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.
55
3 Alarms
Parameter label
High red alarm (view only)
High yellow alarm field. Select to open a
pop-up list of high alarm limits
Alarms On/Off key - select to toggle
between alarms on or off
Preview Alarm AutoLimits for a
measurement before applying
Select to apply wide AutoLimits
Select to apply narrow AutoLimits
Low yellow alarm field. Select to open a
pop-up list of low alarm limits
Low red alarm (view only)
10 Graphic view of alarm limits with currently
measured value
To change alarm limits,
Enter the Alarm Limits window.
To set the high alarm limit, select the high yellow alarm field to open a pop-up list of high alarm
limits. Select a limit from the list. Repeat to set the low yellow alarm field.
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 Limits
The monitor can automatically set alarm limits suited to your individual patient, using the Automatic
Alarm Limits function (AutoLimits). This tells the monitor to adapt the alarm limits of selected
measurements to the measured vital signs within a defined safe limit. The monitor calculates safe
AutoLimits for each patient based on the measured values from the last 12 seconds.
The wide and narrow limits have a fixed relationship to the measured value within the nonpathological range. Outside of this range, no auto limits are calculated. To set values outside of the
non-pathological range, limits must be changed manually, based on the clinician's judgment about the
specific patient.
56
3 Alarms
Wide alarm limits
Narrow alarm limits
Alarm Limits
Measurement value
Limits Narrow sets limits close to the currently measured values for situations where it is critical for you
to be informed about small changes in your patient's vital signs.
sets limits further away from the currently measured values for situations where small
changes are not so critical.
Limits Wide
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 Limits
To print a list of all current alarm limit settings on an available printer:
Select the Main Setup SmartKey.
Select Reports from the Main Setup menu.
Select Alarm Limits.
Reviewing Alarms
You can see which alarms and INOPs are currently active in the respective alarms and INOPs fields at
the top of the screen.
To 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.
57
3 Alarms
Review Alarms Window
The Review Alarms window contains a list of the most recent alarms and INOPs with date and time
information.
If configured to do so, each alarm is shown with the alarm limit active when the alarm was triggered
and the maximum value measured beyond this limit. The Review Alarms window also shows when the
monitor was switched on (after being switched off for longer than 1 minute) and any actions related to
switching alarms on and off, entering or leaving Standby mode, silencing alarms or changing the ECG
source.
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 Alarms
The alarm latching setting for your monitor defines how the alarm indicators behave when you do not
acknowledge them. When alarms are set to non-latching, their indicators end when the alarm condition
ends. Switching alarm latching on means that visual and/or audible alarm indications are still displayed
or announced by the monitor after the alarm condition ends. The indication lasts until you
acknowledge the alarm.
Viewing the Alarm Latching Settings
To see the alarm latching setting for your monitor:
In the monitor's Main Setup menu, select Alarms.
Select Alarm Settings, and see the Visual Latching and Audible Latching settings.
This setting can only be changed in Configuration Mode. You should be aware of the settings chosen
for your unit. There are three possible choices each for visual and audible latching, red only, red and
yellow, and off. These choices can be combined to give the following settings:
58
Visual Latching
Audible Latching
Red&Yellow
Red&Yellow
Red&Yellow
Red Only
Red&Yellow
Off
Red Only
Red Only
Red Only
Off
Off
Off
3 Alarms
Alarm Latching Behavior
Red & Yellow Measurement
Alarms
Non-latching alarms
Alarm has not
been
acknowledged.
Alarm tone on. Alarm lamp on. Alarm tone on. Alarm lamp
Alarm message. Flashing
on. Alarm message. Flashing
numerics.
numerics.
Alarm condition
still present.
Alarm has been
acknowledged.
Visual and audible latching Visual latching, audible
non-latching
Alarm tone on. Alarm lamp
on. Alarm message. Flashing
numerics.
Alarm condition All audible and visual alarm
no longer present. indicators automatically stop.
Alarm tone on.
Alarm lamp on.
Alarm message.
Flashing numerics.
Alarm message. Flashing
numerics.
Audible alarm indicators
automatically stop.
Alarm condition
still present.
Alarm tone off. Alarm lamp
off. Alarm message. Flashing
numerics. Audible alarm
reminder (if configured).
Alarm tone off. Alarm lamp
off. Alarm message. Flashing
numerics. Audible alarm
reminder (if configured).
Audible and visual alarm
indicators automatically stop.
Audible and visual alarm
indicators automatically stop.
Alarm tone off. Alarm lamp off.
Alarm message. Flashing
numerics. Audible alarm
reminder (if configured).
Alarm condition Audible and visual alarm
no longer present. indicators automatically stop.
All INOPs are non-latching. See “Yellow Arrhythmia Alarms” on page 135 for information on onestar yellow alarms latching behavior.
Testing Alarms
When you switch the monitor on, a selftest is started. You must check that the alarms lamps light, one
after the other, and that you hear a single tone. This indicates that the visible and audible alarm
indicators are functioning correctly. For further testing of individual measurement alarms, perform the
measurement on yourself (for example SpO2 or CO2) or use a simulator. Adjust alarm limits and check
that appropriate alarm behavior is observed.
Alarm Behavior at Power On
If the monitor is switched off for longer than one minute and then switched on again (or after a loss of
power lasting longer than one minute, or when a patient is discharged), the monitor can be configured
to:
•
restore the alarm settings from the monitor's configured default Profile,
•
restore the most recently used alarm settings, or
•
switch the alarms off.
After any of these situations, you should check that the alarm settings are appropriate for your patient
and monitoring situation, and if necessary, select the correct Profile and patient category.
If power is lost for less than one minute, the alarm on/off condition prior to the power loss is
restored.
59
3 Alarms
Alarm Recordings
You 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.
Press the Main Setup SmartKey.
Select Alarms from the Main Setup menu.
Select Alarm Recording from the Alarms menu to open the Alarm Recordings menu.
Select a measurement from those listed for which you want to change the alarm condition that
triggers an alarm recording. This opens a pop-up list.
For the desired measurement(s), choose the alarm condition to trigger an alarm recording:
Red Only: an alarm recording will automatically be triggered when the measurement enters a red
alarm condition.
Red&Yellow: both yellow and red alarms will trigger an alarm recording.
Off: disables automatic alarm recording.
Refer to the “Recording” chapter for details of how to set up a recording.
60
4
Patient Alarms and INOPs
This chapter lists patient alarms alphabetically, and technical alarms (INOPs) arranged by the source of
the INOP and then alphabetically, irrespective of their priority. All alarms and INOPs are listed here;
the ones which can appear on your monitor will depend on the model and the individual options.
Patient Alarm Messages
The 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
yellow alarm lamp, alarm tone.
sum of the 2 agent MAC components + MAC
(N2O) is ≥ 3 MAC (uncorrected)
*** Apnea
*** Apnea x:yy
*** Apnea >10 min
CO2, Resp,
Spirometry, GM
Respiration has stopped for longer than the
preset apnea time. "x:yy" denotes the Apnea
duration in minutes and seconds
numeric flashes, red alarm lamp,
alarm tone
*** Asystole
ECG
No QRS detected for a period > the asystole
alarm threshold
numeric flashes, red alarm lamp,
alarm tone
** awRR High
CO2, Resp, AGM,
GM
The 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,
GM
The airway respiration rate has dropped below numeric flashes and low limit is
the low alarm limit.
highlighted, yellow alarm lamp,
alarm tone
**  High
BIS
The Bispectral Index value has exceeded the
high alarm limit.
**  Low
BIS
The Bispectral Index value has dropped below numeric flashes and low limit is
the low alarm limit.
highlighted, yellow alarm lamp,
alarm tone
numeric flashes and high limit is
highlighted, yellow alarm lamp,
alarm tone
61
4 Patient Alarms and INOPs
Alarm Message
From
Condition
Indication
*** Brady (Pulse)
SpO2, Press,
cmResp
Pulse 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 High
CCO
Continuous Cardiac Output or CC Index is
above the high alarm limit.
numeric flashes and high alarm
limit is highlighted, yellow alarm
lamp, alarm tone
** CCO Low
** CCI Low
CCO
Continuous Cardiac Output or CC Index is
below the low alarm limit.
numeric flashes and low alarm limit
is highlighted, yellow alarm lamp,
alarm tone
** 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 numeric flashes and low alarm limit
alarm limit.
is highlighted, yellow alarm lamp,
alarm tone
** CPP High
CPP
The CPP value has exceeded the high alarm
limit.
numeric flashes and high limit is
highlighted, yellow alarm lamp,
alarm tone
** CPP Low
CPP
The CPP value has fallen below the low alarm
limit.
numeric flashes and low limit is
highlighted, yellow alarm lamp,
alarm tone
*** Desat
*** Desat xx < yy
SpO2
The SpO2 value has fallen below the
numeric flashes, red alarm lamp,
desaturation alarm limit. xx denotes the lowest alarm tone
measured value, and yy is the desaturation limit.
** EC10 Alarm
*** EC10 Alarm
EC10 IntelliBridge A yellow (**) or red (***) patient alarm is
(on monitor) yellow or red alarm
present on the IntelliBridge module. Check the lamp; the alarm text is defined by
monitor display for more detailed alarm
the IntelliBridge device driver
information.
* End AFIB
ECG/Arrhythmia
Atrial fibrillation no longer detected for the
configured Afib end delay time
yellow 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 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 Low
GM
The end tidal agent value has fallen below the
low alarm limit
numeric 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 tone
at Information Center
62
4 Patient Alarms and INOPs
Alarm Message
From
Condition
Indication
** etO₂ Low
O2, AGM
The end tidal O2 value has fallen below the low numeric flashes, and low limit is
alarm limit.
highlighted, yellow alarm lamp,
alarm tone
* Event
** Event
*** Event
Event surveillance
An event has occurred and the event
notification is configured to alarm. Check on
the monitor for more details on event group.
(on monitor) event group name
flashes, yellow or red alarm lamp
and alarm tone
* Event:
** Event:
*** Event:
Event surveillance
An event has occurred and the event
notification is configured to alarm.
event group name flashes, yellow or
red alarm lamp and alarm tone
*** Extreme Brady
ECG
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
ECG
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.
ECG
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 exceeded
numeric flashes and high limit is
highlighted, yellow alarm lamp,
alarm tone.
** in High
GM
The inspired agent high alarm limit has been
exceeded
numeric flashes, high limit is
highlighted, yellow alarm lamp,
alarm tone
** in Low
GM
The inspired agent value has fallen below the
AGT low alarm limit
numeric 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 numeric flashes, low limit is
alarm limit
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
CO2
The IPI value has fallen below the low alarm
limit.
numeric flashes, and low limit is
highlighted, yellow alarm lamp,
alarm tone
at Information Center
** HR High
* HR Low
** HR Low
63
4 Patient Alarms and INOPs
Alarm Message
From
Condition
Indication
* Irregular HR
ECG/Arrhythmia
Consistently irregular rhythm (irregular R-R
intervals).
numeric flashes, yellow alarm lamp,
short yellow audible alarm
**  High
iTemp
The temperature value has exceeded the high
alarm limit.
numeric flashes and high limit is
high-lighted, yellow alarm lamp,
alarm tone
**  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 numeric flashes, yellow alarm lamp,
interval), or no beat detected for > one second short yellow audible alarm
if HR > 120 (For non-paced patients only).
* More Alarms
other assigned
devices
There is more than one physiological alarm of yellow or red alarm lamp and alarm
the corresponding severity active on the devices tone
that monitor this patient. For details, check the
information displayed at the Information
Center.
* Multiform PVCs
ECG/Arrhythmia
Two different shaped Vs detected, each
numeric flashes, yellow alarm lamp,
occurring at least twice within the last 300 beats short yellow audible alarm
and at least once within the last 60 beats.
** NBP High
NBP
The measured NBP value is above the high
numeric flashes and high limit is
highlighted, yellow alarm lamp,
alarm limit.
s, d, or m after the label indicates whether the alarm tone
systolic, diastolic or mean pressure has crossed
the limit.
** NBP Low
NBP
numeric flashes and low limit is
The measured NBP value is below the low
highlighted, yellow alarm lamp,
alarm limit.
s, d, or m after the label indicates whether the alarm tone
systolic, diastolic or mean pressure has crossed
the limit.
* Non-Sustain VT
ECG/Arrhythmia
A run of PVCs < the V-Tach run limit and
ventricular heart rate > the V-Tach HR limit
numeric flashes, yellow alarm lamp,
short yellow audible alarm
* OtherMon Alarm
** OtherMon Alarm
*** OtherMon Alarm
another assigned
monitor
Another 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 numeric flashes, yellow alarm lamp,
interval) with detected pace pulse(s). (For paced short yellow audible alarm
patients only).
* 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 nonventricular 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
*** 
Disconnect
PRESS
The pressure is non-pulsatile and the mean
pressure is continuously less than 10 mmHg
(1.3 kPa). This alarm occurs only with arterial
pressures (P, ABP, ART, Ao, BAP, FAP, PAP,
UAP, P1, P2, P3, P4).
numeric flashes, red alarm lamp,
alarm tone
** More Alarms
*** More Alarms
64
4 Patient Alarms and INOPs
Alarm Message
From
Condition
Indication
***  High
PRESS
The measured pressure value is above the
numeric flashes, high limit is
extreme high alarm limit.
highlighted, red alarm lamp, alarm
s, d, or m after the label indicates whether the tone
systolic, diastolic or mean pressure has crossed
the limit.
**  High
PRESS
The measured pressure value is above the high numeric flashes, high limit is
alarm limit.
highlighted, yellow alarm lamp,
s, d, or m after the label indicates whether the alarm tone
systolic, diastolic or mean pressure has crossed
the limit.
***  Low
PRESS
numeric flashes and low limit is
The measured pressure value is below the
highlighted, red alarm lamp, alarm
extreme low alarm limit.
s, d, or m after the label indicates whether the tone
systolic, diastolic or mean pressure has crossed
the limit.
**  Low
PRESS
The measured pressure value is below the low numeric flashes and low limit is
alarm limit.
highlighted, yellow alarm lamp,
s, d, or m after the label indicates whether the alarm tone
systolic, diastolic or mean pressure has crossed
the limit.
**  High
pTemp
The temperature value has exceeded the high
alarm limit.
numeric flashes and high limit is
high-lighted, yellow alarm lamp,
alarm tone
**  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,
cmResp
The pulse rate has exceeded the high alarm
limit.
numeric flashes and high limit is
highlighted, yellow alarm lamp,
alarm tone
** Pulse Low
PRESS, SpO2,
cmResp
The pulse rate has dropped below the low
alarm limit.
numeric flashes and low limit is
highlighted, yellow alarm lamp,
alarm tone
* PVCs/min High
ECG/Arrhythmia
PVCs detected within a minute > the alarm
limit
numeric flashes, yellow alarm lamp,
short yellow audible alarm
** QTc High
ECG/QT
QTc value has exceeded the QTc high limit for numeric flashes, yellow alarm lamp,
more than 5 minutes
alarm tone
** ΔQTc High
ECG/QT
ΔQTc value has exceeded the ΔQTc high limit numeric flashes, yellow alarm lamp,
for more than 5 minutes
alarm tone
* R-on-T PVCs
ECG/Arrhythmia
For HR < 100, a PVC with R-R interval < 1/3 numeric flashes, yellow alarm lamp,
the average interval followed by a
short yellow audible alarm
compensatory pause of 1.25*(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)
** RR High
RESP
The respiration rate has exceeded the high
alarm limit.
** RR Low
RESP
The respiration rate has dropped below the low numeric flashes and low limit is
alarm limit.
highlighted, yellow alarm lamp,
alarm tone
numeric flashes and high limit is
highlighted, yellow alarm lamp,
alarm tone
65
4 Patient Alarms and INOPs
Alarm Message
From
Condition
Indication
* Run PVCs High
ECG/Arrhythmia
A run of > 2 PVCs.
numeric flashes, yellow alarm lamp,
short yellow audible alarm
**  High
SvO2/SO2
The the measured intravascular oxygen
saturation has exceeded the high limit.
numeric flashes and high alarm
limit is highlighted, yellow alarm
lamp, alarm tone
**  Low
SvO2/SO2
The measured intravascular oxygen saturation
has fallen below the low limit.
numeric flashes and low alarm limit
is highlighted, yellow alarm lamp,
alarm tone
**  High
SpO2
The arterial oxygen saturation has exceeded the numeric flashes and high limit is
high alarm limit.
highlighted, yellow alarm lamp,
alarm tone
**  Low
SpO2
The arterial oxygen saturation has fallen below numeric flashes and low limit is
the low alarm limit.
highlighted, yellow alarm lamp,
alarm tone
**ST Multi ,
ECG/ST
Two contiguous ST leads  and  have numeric flashes, yellow alarm lamp,
exceeded elevation or depression limits for
alarm tone
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.
**ST Multi
ECG/ST
The ST depression or elevation is outside of
the limit in two or more leads. Check on the
monitor
**STE ,
ECG/ST
Two contiguous leads  and  are above numeric flashes, yellow alarm lamp,
their respective STE limits
alarm tone
** ST- High
ECG/ST
The ST elevation in lead  is higher than the numeric flashes and high alarm
limit. Lead is not contiguous with any other
limit is highlighted, yellow alarm
lead.
lamp, alarm tone
** ST- Low
ECG/ST
The ST depression in lead  is lower than
numeric flashes and low alarm limit
the limit. Lead is not contiguous with any other is highlighted, yellow alarm lamp,
lead.
alarm tone
* SVT
ECG/Arrhythmia
A run of supraventricular beats > the SVT run numeric flashes, yellow alarm lamp,
limit and heart rate > the SVT HR limit.
alarm tone
*** Tachy (Pulse)
SpO2, Press,
cmResp
Pulse rate > the extreme tachy alarm limit.
** Tblood High
C.O.
The blood temperature value has exceeded the numeric flashes, high alarm limit is
high alarm limit.
highlighted, yellow alarm lamp,
alarm tone
** Tblood Low
C.O.
The blood temperature value has fallen below
the low alarm limit.
numeric flashes, low alarm limit is
highlighted, yellow alarm lamp,
alarm tone
** tcpO₂ High
** tcpCO₂ High
tcGas
The tcpO2 or tcpCO2 value has exceeded the
high alarm limit.
numeric flashes, high alarm limit is
highlighted, yellow alarm lamp,
alarm tone
** tcpO₂ Low
** tcpCO₂ Low
tcGas
The tcpO2 or tcpCO2 value has fallen below
the low alarm limit.
numeric flashes, low alarm limit is
highlighted, yellow alarm lamp,
alarm tone
* Tele Alarm
** Tele Alarm
*** Tele Alarm
an assigned
telemetry device
A telemetry device used for the patient is in an yellow or red alarm lamp and alarm
alarm condition. Check the detailed alarm
tone
information at the Information Center.
at Information Center
66
(on monitor) numeric flashes,
yellow alarm lamp, alarm tone
numeric flashes, alarm limit is
highlighted, red alarm lamp, alarm
tone
4 Patient Alarms and INOPs
Alarm Message
From
Condition
Indication
**  High
Temp
The temperature has exceeded the high alarm
limit.
numeric flashes and high limit is
highlighted, yellow alarm lamp,
alarm tone
**  Low
Temp
The temperature has fallen below the low alarm numeric flashes and low limit is
limit.
highlighted, yellow alarm lamp,
alarm tone
* T-Mon Alarm
** T-Mon Alarm
*** T-Mon Alarm
an assigned
transport monitor
A 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
limit
numeric 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 numeric flashes, red alarm lamp,
2 - 10 Hz) for 4 consecutive seconds.
alarm tone
* Vent Rhythm
** Vent Rhythm
ECG/Arrhythmia
A dominant rhythm of adjacent Vs > the vent numeric flashes, yellow alarm lamp,
rhythm limit and ventricular heart rate < the V- short yellow audible alarm
Tach HR limit.
* 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 Alarm
VueLink
A yellow (**) or red (***) patient alarm is
present on the VueLink module. Check the
monitor display for more detailed alarm
information.
(on monitor) yellow or red alarm
lamp; the alarm text is defined by
the VueLink device driver
***xBrady xxxyyy
Press, SpO2, ECG
This is the alternative alarm message for ***
Extreme Tachy when the alarm text setting is
Enhanced.
numeric flashes, alarm limit is
highlighted, red alarm lamp, alarm
tone
Heart rate >the extreme tachycardia alarm
limit. xxx denotes the highest measured value;
yyy is the tachycardia limit.
67
4 Patient Alarms and INOPs
Technical Alarm Messages (INOPs)
If an INOP interrupts monitoring and alarm detection, the measurement numeric will be replaced
by -?-. If an INOP may lead to unreliable measurement values, a ? appears next to the numeric.
The measurement labels and abbreviations for pressure, temperature and SpO2 INOP messages are
explained in the individual measurement chapters.
Monitor INOPs
INOP Message, Indication
What to do
Bad MSL
1) An MMS with an incompatible software revision is connected to the monitor. This combination
does not allow monitoring, OR
2) You cannot use this combination of monitor, MMS and cable. Switch off the monitor and contact
your service personnel.
Central: Tele Only
System connectivity via telemetry device is limited (No alarms, only local numerics) when in
companion mode and host monitor does not have system connectivity. Only telemetry device
parameters can be displayed at central station.
Check Alarm Lamps
INOP tone
Perform a visual check of the alarm lamp to establish whether there is a problem. Contact your service
personnel to check the internal connections to the alarm lamps.
Check DrugSettings
There was a problem loading the drug settings. Check that the settings are complete and correct.
!!Check ECG Source
The telemetry device and the monitor both have valid ECG signals. Unpair the telemetry device and
the monitor if they are no longer used for the same patient.
!! Check Equipment
There 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 Texts
INOP tone
Check the names of the monitor menus, for example the labels for screens, profiles, event or trend
group names, before you resume monitoring. If they are unexpected, there may be a problem with the
monitor software. Contact your service personnel.
Check Keyboard
Perform a visual and functional check of the keyboard. Contact your service personnel.
Check Main Board 2
There is a problem with the second main board in the monitor. Contact your service personnel.
Check Monitor Func
Potential problem with alarm lamps, display or interfaces detected. Contact your service personnel.
Check Monitor Temp
INOP tone
The temperature inside the monitor is too high. Check that the monitor ventilation is not obstructed.
If the situation continues, contact your service personnel.
Check Mouse
Perform a visual and functional check of the mouse input device. Contact your service personnel.
Check MSL Voltage
There is a problem with the voltage of the Measurement Link (MSL). Contact your service personnel.
Check Network Conf
The monitor is receiving network topology information from more than one source, e.g. the Database
Server and an Application Server. Contact your service personnel.
!! Check Pairing
There is a problem with device pairing. Check that the monitor and telemetry device are correctly
paired.
!!Check Patient ID
There is a mismatch between patient data in two connected devices. Resolve the mismatch to allow
settings and data synchronization.
INOP tone
INOP tone
INOP tone
Yellow tone
INOP tone/Yellow tone
INOP tone
INOP tone
INOP tone
INOP tone
INOP tone
INOP tone
Yellow tone
Yellow tone
68
4 Patient Alarms and INOPs
INOP Message, Indication
What to do
Check Screen Res.
The Screen you have selected uses a resolution which is not supported by the display. The monitor will
show a generic Screen instead until you select a different Screen.
INOP tone
Contact your service personnel if you want the Screen deleted from the Profile(s) to avoid this in
future.
Check Settings
INOP tone
If this INOP appears, check the monitor and patient settings before you resume monitoring. If the
settings are unexpected, there may be a problem with the monitor software. Contact your service
personnel.
Check SpeedPoint
Perform a visual and functional check of the SpeedPoint input device. Contact your service personnel.
Check Touch Input
Perform a visual and functional check of the touch input device. Contact your service personnel.
Check Waves
The options purchased with this monitor may not support the number of waves required to show the
selected Screen, so some waves or high resolution trends are missing from the Screen. Select a
different Screen with fewer waves.
INOP tone
INOP tone
INOP tone
Contact your service personnel if you want the Screen deleted from the Profile(s) to avoid this in
future.
Chk ECG Sync Cable
The ECG Sync is detecting an invalid signal, or the ECG Sync cable is disconnected.
Chk IndepDsp Cable
The monitor cannot communicate with the D80 Intelligent Display. Check the MSL coupling cable.
The end with the gray connector must be connected to the Intelligent Display.
Chk Settings
Synchronization of the settings for the measurement cited, has failed. Check that settings are
appropriate for your patient.
Chk MSL Connection
INOP tone
Check that the MSL cable is properly connected. If this is the case, try using another MSL cable, to
check if your cable is defective. If this does not help, the device connected via the MSL cable may be
defective, contact your service personnel.
Internal.Comm.Malf
There is a problem with I2C Bus communication in the monitor. Contact your service personnel.
MCC Reversed
INOP tone
The MSL coupling cable is reversed. Connect the end with the gray connector to the Intelligent
Display.
MCC Unsupported
An 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 Alarms
The monitor is associated with a telemetry device and is sending data to the Information Center via
the telemetry device. There are currently more alarms at the bedside than can be transmitted to the
Information Center.
More INOPs
There 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.
INOP tone
INOP tone
INOP tone
at Information Center
!! More INOPs
!!! More INOPs
MSL Power High
The power consumption of the devices connected to the Measurement Link (MSL) cable is too high.
If this situation continues, the MSL will be switched off. Contact your service personnel.
MSL Power Off
The power consumption of the devices connected to the Measurement Link (MSL) cable was too high
for too long and the MSL has been switched off. Contact your service personnel.
MSL Power Overload
The power consumption of the devices connected to the Measurement Link (MSL) cable is much too
high or there has been a short circuit. The MSL has been switched off. Contact your service personnel.
INOP tone
INOP tone
69
4 Patient Alarms and INOPs
INOP Message, Indication
What to do
No Central Monit.
There is a problem with the communication to the network. Central monitoring is currently not
possible (no patient alarms or information). Check the connection. In case the connection is via a
telemetry device, the current telemetry use model does not support central monitoring. Contact your
service personnel.
No ECG at Central
The ECG measured with the monitor ECG is not being sent to the Information Center via the
telemetry device.
OtherMon INOP
!! OtherMon INOP
!!! OtherMon INOP
Another 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 tone
There 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 Malfunct
The monitor cannot use the predefined settings for monitoring. Contact your service personnel.
Speaker Malfunct
Contact your service personnel to check the speaker and the connection to the speaker.
SRR Incompatible
The short range radio component has compatibility problems. Contact your service personnel.
SRR Interference
The short range radio connection has interference from another device. Try using another channel.
SRR Invalid Chan
INOP tone
The channel configuration of the Short Range Radio is invalid. Check channel and channel mask
configuration.
SRR Malfunction
Malfunction in the short range radio device. If the INOP persists contact your service personnel.
TAAP Disabled
The currently selected telemetry configuration on the monitor does not allow connection of telemetry
devices to the monitor.
Tele Config Unsupp
Telemetry Workflow configuration not supported. Check revision and configuration of monitor and
central.
Tele Equip Malf
The telemetry device has a malfunction. Disconnect and reconnect the telemetry device. If the INOP
reappears, replace the telemetry device.
Tele Incompatible
SRR-enabled telemetry device is not supported by this central software revision. Please check
configuration.
Tele INOP
!! Tele INOP
!!! Tele INOP
A 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 Unsupported
This telemetry device is not supported for direct connection to the monitor.
 Elapsed
The 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 INOP
A 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 LAN
INOP tone
There is a problem with the communication to the network and central monitoring is currently not
possible. Check the connection. If the INOP persists, switch off the monitor and contact your service
personnel.
User I/F Malfunct
Perform a visual and functional check of all the monitor input devices. Contact your service personnel.
INOP tone
INOP tone
INOP tone
INOP tone
INOP tone
INOP tone
INOP tone
INOP tone
INOP tone
INOP tone
INOP tone
INOP tone
INOP tone
70
4 Patient Alarms and INOPs
Battery INOPs
INOP Message, Indication
What to do
Batt 1 Missing
Batt 2 Missing
The monitor requires two batteries but can detect only one battery. Insert the missing battery
immediately.
Batt Empty
!!Batt Empty
!!!Batt Empty
The estimated remaining battery-powered operating time is less than 10 minutes. Replace the battery
immediately.
Batt Extensn Malf
There is a hardware error in the Battery Extension. Contact your service personnel.
Batt Incompat
INOP tone
The battery cannot be used with this monitor. Replace with the correct battery as specified in this
book.
Batt Low
The estimated battery-powered operating time remaining is less than 20 minutes.
Batt Malfunction
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.
INOP tone
During this INOP, alarms cannot
be paused or switched off.
If the condition persists and the monitor is not connected to mains power, this INOP is re-issued two
INOP tone, battery LED flashes minutes after you acknowledge it.
During this INOP, alarms cannot
be paused or switched off.
INOP tone
INOP tone
INOP tone, battery LED flashes
During this INOP, alarms cannot
be paused or switched off unless
the monitor is connected to
mains power.
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 Empty
Batt 1 Empty
!!Batt 1 Empty
!!!Batt 1 Empty
Batt 2 Empty
!!Batt 2 Empty
!!!Batt 2 Empty
The estimated remaining battery-powered operating time of the indicated battery or batteries is less
than 10 minutes. Replace the batteries immediately.
Batteries Incompat
Batt 1 Incompat
Batt 2 Incompat
The indicated battery or batteries cannot be used with this monitor. Replace with the correct battery or
batteries as specified in this book.
Batteries Low
Batt 1 Low
Batt 2 Low
The estimated battery-powered operating time remaining is less than 20 minutes.
Batteries Malfunct
Batt 1 Malfunction
Batt 2 Malfunction
The monitor cannot determine the battery status. If this INOP persists, replace the faulty battery or
batteries. If the condition persists and the monitor is not connected to mains power, this INOP is reissued two minutes after you acknowledge it.
If the condition persists and the monitor is not connected to mains power, this INOP is re-issued two
minutes after you acknowledge it.
INOP tone, battery LED flashes
During this INOP, alarms cannot
be paused or switched off.
INOP tone
INOP tone
INOP tone, battery LED flashes Place the batteries in a different monitor or in a battery charger. If the same INOP is shown, contact
During this INOP, alarms cannot your service personnel.
be paused or switched off unless
the monitor is connected to
mains power.
71
4 Patient Alarms and INOPs
INOP Message, Indication
What to do
Charge Batt 1 now
Charge Batt 2 now
Battery must be charged. Connect the monitor to mains power or exchange the battery.
Charger Malfunct
There is a problem with the battery charger in the monitor. Connect the monitor to mains power and
contact your service personnel.
Check Batt Temp
The temperature of one or both batteries is too high. Check that ventilation openings (if applicable)
are not blocked and monitor is not exposed to heat.
Chk MSL Connection
Check the MSL connection between X2/MP2 and the battery extension for damage or loose
connections. Check also if a second X1 or X2 has been connected accidentally (e.g. in companion
mode).
ExtBat Empty
!!ExtBat Empty
!!!ExtBat Empty
The estimated battery-powered operating remaining time is less than 10 minutes. Replace the battery in
the battery extension immediately.
ExtBat Incompat
The battery in the battery extension cannot be used. Replace with the correct battery as specified in
this book.
ExtBat Low
The estimated battery-powered operating time remaining is less than 20 minutes.
INOP tone
INOP tone, battery LED may
flash
INOP tone
If the condition persists and the monitor is not connected to mains power, this INOP is re-issued two
INOP tone, battery LED flashes minutes after you acknowledge it.
During this INOP, alarms cannot
be paused or switched off.
ExtBat Malfunction
The monitor cannot determine the status of the battery in the battery extension. If this INOP persists,
INOP tone, battery LED flashes replace the faulty battery in the battery extension. If the condition persists and the monitor is not
During this INOP, alarms cannot connected to mains power or a host monitor, this INOP is re-issued two minutes after you
be paused or switched off unless acknowledge it.
the monitor is connected to
mains power.
ExtBat Missing
There is no battery in the Battery Extension
!! Insert Battery
X2/MP2 only: There is no battery in the battery compartment. You cannot operate the monitor on
Severe yellow INOP tone
AC mains or battery extension while the battery compartment is open (not sealed with a battery). Load
During this INOP, alarms cannot a battery immediately.
be paused or switched off.
MSL Power High
The power consumption of the devices connected to the Battery Extension is too high. If this
situation continues, the Battery Extension will be switched off. Contact your service personnel.
MSL Power Off
The power consumption of the devices connected to the Battery Extension was too high for too long.
The Battery Extension has been switched off. Contact your service personnel.
MMS, MMS Extensions and FMS INOPs
INOP Message, Indication
What to do
MMS Ext. Unplugged
The MMS extension has been disconnected from the Multi-Measurement Module.
MMS Ext. Unpowered
INOP tone
The MMS extension cannot operate while the Multi-Measurement Module is running on battery
power.
MMS Ext. Unsupp
The MMS extension is not supported by your monitor. Contact your service personnel.
MMS Ext.Equip Malf
Loss of communication between the Multi-Measurement Module and the MMS extension. Contact
your service personnel.
INOP tone
INOP tone
INOP tone
72
4 Patient Alarms and INOPs
Display INOPs
INOP Message, Indication
What to do
Indep.Dsp Malfunc.
There is a problem with the Independent Display. Check the MSL coupling cable then contact your
service personnel.
Indep.Dsp NotSupp.
The monitor does not support a second main display. The monitor software is incompatible. Contact
your service personnel.
Intell.Dsp Malf.
There is a problem with the Intelligent Display. Check the MSL coupling cable then contact your
service personnel.
Intell.Dsp Missing
The monitor has lost contact with the connected Intelligent Display. Contact your service personnel.
Intell.Dsp Unsupp.
The monitor does not support the connected Intelligent Display. The monitor software is
incompatible.
ECG, Arrhythmia, QT and ST INOPs
INOP Message, Indication
What to do
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 Malf
Contact your service personnel.
The ECG hardware is faulty.
 Lead Off
!!  Lead Off
!!!  Lead Off
Not all the required leads for ECG monitoring are connected. Check the ECG connections and make
sure that the electrode indicated by  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 Off
Check 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 
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 Signal
The ECG signal is too noisy. Check that the electrodes are properly placed and have not dried out.
Remove any possible sources of signal noise (such as power cords) from the area around the cable and
the patient.
The ECG signal may be saturated or overloaded.
ECG Out Equip Malf
INOP tone
There is a problem with the device connected to the ECG Out connector. Contact your service
personnel.
ECG/Arrh AlarmsOff
!!ECG/Ar AlarmsOff
All ECG alarms have been switched off, or the HR alarm source is not ECG. To resume ECG alarm
generation, switch ECG alarms on or select ECG as the alarm source.
Numeric is replaced by -?INOP tone
If no ECG lead is measurable,
numeric is replaced by -?INOP tone
Numeric is replaced by -?INOP tone
INOP tone
73
4 Patient Alarms and INOPs
INOP Message, Indication
What to do
Some 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.
Resp INOPs
INOP Message, Indication
What to do
Resp Equip Malf
Contact your service personnel. The RESP hardware is faulty.
Resp Erratic
The monitor has detected too many artifacts in the measured Resp signal. Check that the RA and LL
electrodes are correctly attached and have not dried out.
Resp Leads Off
Not all the required leads for Resp monitoring are attached. Make sure that the RA, LA, and LL leads
are attached.
Numeric is replaced by -?INOP tone
Numeric is replaced by -?Numeric is replaced by -?INOP tone
NBP INOPs
INOP Message, Indication
What to do
!! Cuff Not Deflat
!!!Cuff Not Deflat
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.
Numeric is displayed with a -?You can silence the INOP, but the INOP message remains visible until the next NBP measurement is
Severe yellow/red INOP tone
started or the Stop All SmartKey is selected.
During this INOP, alarms cannot [Adult or pediatric patients: The NBP cuff pressure has exceeded 15 mmHg (2 kPa) for more than
3 minutes.
be paused or switched off.
Neonatal patients: The NBP cuff pressure has exceeded 5 mmHg (0.7 kPa) for more than 90 seconds.]
!! Cuff Overpress
!!!Cuff Overpress
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
Numeric is displayed with a -?restarting the measurement.
Severe yellow/red INOP tone
You can silence this INOP, but the INOP message remains visible until the next measurement is
During this INOP, alarms cannot started or the Stop All SmartKey is selected.
be paused or switched off.
NBP Deactivated
The NBP measurement label in the measurement device has been deactivated by deactivating the label
in the Measurement Selection window. The measurement automatically disappears from the display.
To switch the measurement on again, reactivate the measurement label in the Measurement
Selection window.
NBP Equip Malf
Remove the cuff from the patient. The NBP hardware is faulty. Contact your service personnel.
You can silence this INOP, but the INOP message remains visible until the next measurement is
started or the Stop All SmartKey is selected.
NBP Interrupted
Check the tubing and cuff for leakages or kinks. Check that you are using the correct cuff size and
placement, and that the correct patient category is selected. Try restarting the measurement.
If the INOP occurs repeatedly, contact your service personnel.
You can silence this INOP, but the INOP message remains visible until the next measurement is
started or the Stop All SmartKey is selected.
This INOP arises when the measurement needed longer than the maximum time for inflation,
deflation or the total measurement.
NBP Measure Failed
Check that you are using the correct cuff size and placement, and that the correct patient category is
selected. Try restarting the measurement.
You can silence this INOP, but the INOP message remains visible until the next measurement is
started or the Stop All SmartKey is selected.
Check the condition and suitability of the patient for NBP monitoring. Use another cuff to continue
measuring.
INOP tone
Numeric is replaced by -?INOP tone
Numeric is replaced by -?INOP tone
Numeric may be replaced by -?INOP tone
74
4 Patient Alarms and INOPs
Temperature INOPs
INOP Message, Indication
What to do
T1, T2, T3, T4 INOPs
See  INOPs
Tamb INOPs
See  INOPs
Tart INOPs
See  INOPs
Tcereb INOPs
See  INOPs
Tcore INOPs
See  INOPs
 Deactivated
A Temp measurement label in the measurement device has been deactivated, either by connecting a
Pressure transducer in the shared Press/Temp socket, or by deactivating the label in the
Measurement Selection window.
INOP tone
The measurement automatically disappears from the display.
To switch the measurement on again, either reconnect a Temp transducer or reactivate the
measurement label in the Measurement Selection window.
 Equip Malf
Contact your service personnel.
The temperature hardware is faulty.
NoTransducer
Make sure the Temp probe is connected to the MMS or module.
If you silence this INOP, the measurement will be switched off.
 Overrange
Try changing the application site of the transducer.
Numeric is replaced by -?INOP tone
Numeric is replaced by -?INOP tone
Numeric is replaced by -?INOP tone
 Unplugged
INOP tone
[The temperature is less than -1°C, or greater than 45°C.]
A Temp measurement label has been deactivated, either by unplugging a module, or by deactivating
the label in the Measurement Selection window.
The measurement automatically disappears from the display.
To switch the measurement on again, either replug the module or reactivate the measurement label in
the Measurement Selection window.
Tesoph INOPs
See  INOPs
Tnaso INOPs
See  INOPs
Trect INOPs
See  INOPs
Tskin INOPs
See  INOPs
Ttymp INOPs
See  INOPs
Tven INOPs
See  INOPs
Tvesic INOPs
See  INOPs
SpO2 INOPs
INOP Message, Indication
What to do
 Deactivated
The SpO2 measurement label in the measurement device has been deactivated by deactivating the label
in the Measurement Selection window. The measurement automatically disappears from the display.
To switch the measurement on again, reactivate the measurement label in the Measurement
Selection window.
 Equip Malf
The MMS or module is faulty. Unplug and replug the MMS or module. If the INOP persists, contact
your service personnel.
INOP tone
Numeric is replaced by -?INOP tone
75
4 Patient Alarms and INOPs
INOP Message, Indication
What to do
 Erratic
Check the sensor placement. Try another adapter cable and sensor. If the INOP persists, contact your
service personnel.
 Extd.Update
The update period of displayed values is extended due to an NBP measurement on the same limb or
an excessively noisy signal.
Interference
There is too much interference, caused by a high level of ambient light and/or electrical interference.
Cover the sensor to minimize ambient light. If the INOP persists, make sure that the sensor cable is
not damaged or positioned too close to power cables.
 Low Perf
Accuracy may be compromised due to very low perfusion. Stimulate circulation at sensor site. If INOP
persists, change the measurement site.
 No Pulse
Check the perfusion at measurement site. If necessary, stimulate circulation or change measurement
site. If the INOP is due to NBP measurement on the same limb, wait until the NBP measurement is
finished.
 No Sensor
Make sure the SpO2 sensor is connected. If the INOP persists, try another adapter cable and sensor. If
you silence this INOP, the measurement will be switched off.
 NoisySignal
Excessive patient movement or electrical interference is causing irregular pulse patterns. Try to reduce
patient movement or to relieve the cable strain on the sensor.
 Poor Signal
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.
 Pulse?
The detectable pulsations of the SpO2 signal are outside the specified pulse rate range.
 Searching
SpO2 is analyzing the patient signal to derive Pulse, SpO2 and Perf values. Please wait until the search
analysis is complete.
 Sensor Malf
The SpO2 sensor or adapter cable is faulty. Try another adapter cable and sensor. If the INOP persists,
contact your service personnel.
 Sensor Off
The SpO2 sensor is not properly applied to the patient. Apply the sensor following the instructions
supplied by the manufacturer.
 Unkn.Sensor
The connected sensor or adapter cable is not supported by the SpO2 measurement. Use only specified
sensors and cables.
 Unplugged
An SpO2 measurement label has been deactivated, either by unplugging a module, or by deactivating
the label in the Measurement Selection window.
Numeric is replaced by -?INOP tone
Numeric is displayed with a ?
(questionable numeric)
Numeric is replaced by -?INOP tone
Numeric is displayed with a ?
(questionable numeric)
Numeric is replaced by -?INOP tone
Numeric is replaced by -?INOP tone
Numeric is replaced by -?INOP tone
Numeric is displayed with a ?
(questionable numeric)
Numeric is replaced by -?INOP tone
Numeric is unavailable
Numeric is replaced by -?INOP tone
Numeric is replaced by -?INOP tone
Numeric is replaced by -?Numeric is replaced by -?INOP tone
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.
 Upgrade
Numeric is replaced by -?-
76
The SpO2 measurement is currently in upgrade mode. Monitoring is not possible in this mode.
4 Patient Alarms and INOPs
Pressure INOPs
INOP Message, Indication
What to do
ABP INOPs
See  INOPs
Ao INOPs
See  INOPs
ART INOPs
See  INOPs
BAP INOPs
See  INOPs
CPP Chk Sources
Not all measurements or values required to perform the calculation are available. Check the
measurement sources.
CPP Chk Units
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  INOPs
FAP INOPs
See  INOPs
IC1 / IC2 INOPs
See  INOPs
ICP INOPs
See  INOPs
LAP INOPs
See  INOPs
Numeric is replaced by -?INOP tone
Numeric is replaced by -?-
P / P1 / P2 / P3 / P4 INOPs
See  INOPs
PAP INOPs
See  INOPs
PPV bad  Signal The arterial pressure source selected for PPV is not providing a pulsatile signal.
PPV bad Signal
The arterial pressure source selected for PPV is not providing a pulsatile signal.
PPV Chk Sources
The arterial pressure source selected for PPV is unplugged or switched off. When this INOP has
displayed for 1 minute PPV will be switched off.
 Artifact
Numeric questionable
A non-physiological event (flush or blood sample) is detected. A resulting limit alarm or non-pulsatile
INOP will be suppressed.
Change Scale
Increase the scale for the pressure wave.
 Deactivated
A Pressure measurement label in the measurement device or extension has been deactivated, either by
connecting a Temp transducer in the shared Press/Temp socket, or by deactivating the label in the
Measurement Selection window.
at Information Center
INOP tone
The measurement automatically disappears from the display.
To switch the measurement on again, either reconnect a Pressure transducer or reactivate the
measurement label in the Measurement Selection window.
 Equip Malf
Contact your service personnel.
The pressure hardware is faulty.
 No Pulse
This INOP can only arise when a pressure is selected as the pulse source. It occurs when the pulse rate
being measured is less than 25 beats per minute or the amplitude is less than three mmHg.
Check the catheter and connections to the patient.
Numeric is replaced by -?INOP tone
Pulse numeric is replaced by -?INOP tone
 No Transducer Make sure that the pressure transducer is connected to the measurement device or module.
Numeric is replaced by -?INOP tone
If you silence this INOP, the measurement will be switched off.
77
4 Patient Alarms and INOPs
INOP Message, Indication
What to do
 Noisy Signal
This INOP can only arise when a pressure is selected as the pulse source. It occurs when the pulse
detector finds a pulse rate above 350 bpm. This is usually caused by movement artifact or electrical
interference.
 Overrange
Make sure that the measurement has been properly prepared and zeroed, and that the transducer is
level with the heart. If this INOP persists, try another transducer.
Possible causes are a measured pressure outside the allowed pressure range, or a broken wire to the
transducer.
 Unplugged
A Pressure measurement label has been deactivated, either by unplugging a module, or by deactivating
the label in the Measurement Selection window.
Pulse numeric is replaced by -?INOP tone
Numeric is replaced by -?INOP tone
INOP tone
The measurement automatically disappears from the display.
To switch the measurement on again, either replug the module or reactivate the measurement label in
the Measurement Selection window.
 Zero+Check
Cal
Perform a zero and check the calibration of the transducer.
Numeric is replaced by -?RAP INOPs
See  INOPs
UAP INOPs
See  INOPs
UVP INOPs
See  INOPs
CO2 INOPs
INOP Message, Indication
What to do
CO₂ Auto Zero
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 Failed
Make sure that the Cal cell was changed between CAL1 and CAL2. Repeat the calibration. If the
INOP reappears, try another transducer. If the INOP persists, contact your service personnel.
CO₂ Cal Mode
Currently no calibration is running. Accuracy can be checked by placing the transducer on the two cells
of the calstick and starting calibration. To start monitoring, leave Cal. Mode.
CO₂ Cal Running
Wait until calibration is finished.
CO₂ Check Cal
The CO2 value is outside the measurement range. Perform an accuracy check for both calstick cells
and, if necessary, recalibrate the transducer.
CO₂ Chk Adapter
Check that the sensor is connected to the airway adapter, clean the airway adapter, if necessary.
Perform a zero calibration. If the INOP persists, contact your service personnel.
CO₂ Deactivated
The CO2 measurement label in the measurement device has been deactivated by deactivating the label
in the Measurement Selection window. The measurement automatically disappears from the display.
To switch the measurement on again, reactivate the measurement label in the Measurement
Selection window.
CO₂ Equip Malf
The Measurement Extension is faulty. Unplug and replug the Multi-Measurement Module with
Extension. If you are using the mainstream method, unplug and replug the transducer or try another
transducer. If the INOP persists, contact your service personnel.
Numeric is replaced by -?if the Autozero lasts >15 sec,
INOP tone sounds.
Numeric is replaced by -?INOP tone
CO2 numeric displays current
CO2 value for accuracy check
Numeric is replaced by -?Numeric is replaced by -?INOP tone
Numeric is replaced by -?INOP tone
INOP tone
Numeric is replaced by -?INOP tone
78
4 Patient Alarms and INOPs
INOP Message, Indication
What to do
CO₂ No Sensor
There is no CO2 sensor connected. If you silence this INOP the CO2 measurement will be switched
off.
CO₂ No Tubing
Numeric is replaced by -?INOP tone
Either the sample line is disconnected, or an incorrect line is attached. Check the connection. If
necessary, connect another sample line (Use only the approved accessories).
If you silence this INOP, the measurement will be switched off.
!! CO₂ Occlusion
!!! CO₂ Occlusion
The sample line or exhaust tube is blocked. Check the tubing, then disconnect and reconnect the
sample line. If the INOP persists, connect a new sample line.
CO₂ Overrange
The CO2 value is higher than the measurement range. If you suspect a false high value, contact your
service personnel.
from M3014A
Numeric is replaced by -?INOP tone
Numeric is replaced by -?INOP tone
Numeric is replaced by -?INOP tone
CO₂ Pump Off
The pump has been switched off for fifteen minutes. To switch it on again, select Pump On in the
Numeric is replaced by -?-.
Setup CO₂ menu.
CO₂ Purging
The Filterline is being purged to remove an occlusion in the line or airway adapter. If the occlusion is
removed, the INOP will disappear. If not, the INOP CO₂ Occlusion is displayed.
CO₂ Sens Warmup
Wait until the sensor reaches operating temperature and the INOP disappears.
CO₂ Upgrade FW
The software in the Measurement Extension does not match the software in the MMS. Contact your
service personnel.
CO₂ Wait Cal2
Calibration on the first calstick cell is complete. Place the transducer on the other calstick cell and start
the CAL2 calibration cycle.
CO₂ Zero Failed
An error occurred during the last zero calibration. Check the airway adapter and clean, if necessary.
Perform another zero calibration. If the INOP persists, contact your service personnel.
CO₂Change Scale
The CO2 wave is clipped. Select a more appropriate wave scale to display the whole wave.
CO₂NoTransducer
There is no CO2 transducer connected. If you replace the transducer, the new transducer must be
calibrated. If you silence this INOP the CO2 measurement will be switched off.
CO₂Zero Running
Wait until zero calibration is finished.
CO₂ZeroRequired
Perform 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.
Numeric is replaced by -?INOP tone
Numeric is replaced by -?Microstream CO2: INOP tone
Mainstream CO2: no INOP tone
Numeric is replaced by -?INOP tone
Numeric is replaced by -?Numeric is replaced by -?INOP tone
from mainstream CO2 (except
M3014A)
Numeric is replaced by -?INOP tone
Numeric is replaced by -?INOP tone
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.
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4 Patient Alarms and INOPs
C.O. INOPs
INOP Message, Indication
What to do
C.O. Deactivated
The Cardiac Output measurement label in the measurement device has been deactivated by
deactivating the label in the Measurement Selection window. The measurement automatically
disappears from the display. To switch the measurement on again, reactivate the measurement label in
the Measurement Selection window.
C.O. Equip Malf
There is a problem with the C.O. hardware. Contact your service personnel.
C.O. Unplugged
Plug in the C.O. module. Silencing this INOP switches off the measurement.
CCI No BSA
CCI cannot be calculated because the patient's body surface area is unknown. Enter the patient weight
and height to provide the BSA for CCI calculation.
CCO BadPressSignal
Numeric is replaced by -?INOP tone
The arterial pressure wave can currently not be used for pulse contour calculation for CCO or CCI
measurement. Possible causes are air bubbles in the tubing or a physiological condition, for example
severe arrhythmia.
CCO No Calibration
The CCO measurement is currently not calibrated.
CCO No 
CCO/CCI cannot be calculated. Make sure that the pressure chosen in the Setup CCO menu under
CCO from matches the pressure measured with the arterial catheter for CCO measurement. A
INOP tone
Numeric is replaced by -?INOP tone
Numeric is replaced by -?INOP tone
CCI numeric unavailable
INOP tone
Numeric is replaced by -?Numeric is replaced by -?INOP tone may sound
CCO No Press
at Information Center
pressure from an external device cannot be used. Select another pressure label, either ABP, Ao, ART,
BAP, FAP, or UAP.
CCO/CCI cannot be calculated. Make sure that the pressure chosen in the Setup CCO menu under
CCO from matches the pressure measured with the arterial catheter for CCO measurement. A
pressure from an external device cannot be used. Select another pressure label, either ABP, Ao, ART,
BAP, FAP, or UAP.
CCO Not Supported
A catheter for transpulmonary C.O. measurements has been unplugged and replaced with a Right
Heart C.O. catheter, or the measurement mode has been changed manually. Silencing this INOP
switches the measurement off.
CCO Overrange
CCI Overrange
The measured CCO or CCI value is not within the specified range for CCO/CCI measurement.
CCO Press Invalid
The arterial pressure selected for pulse contour calculation for CCO is available but currently invalid.
Make sure the pressure transducer is connected and the zero calibration is valid.
CCO  Invalid
The arterial pressure selected for pulse contour calculation for CCO is available but currently invalid.
Make sure the pressure transducer is connected and the zero calibration is valid.
CCO PressOverrange
The mean value of the arterial pressure values used for pulse contour calculation for CCO is below
0 mmHg or above 300 mmHg.
CCO PulseOverrange
The pulse rate of the pressure used for pulse contour calculation for CCO is below 30 bpm or above
240 bpm.
CCO Recalibrate
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.
Numeric is replaced by -?INOP tone
Numeric is replaced by -?INOP tone
at Information Center
Numeric is replaced by -?INOP tone may sound
Numeric is replaced by -?INOP tone
Numeric is replaced by -?INOP tone
Numeric is replaced by -?-
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4 Patient Alarms and INOPs
INOP Message, Indication
What to do
CCO/Tbl NoTransduc
No transducer attached to the module or catheter disconnected.
Tblood Overrange
Tblood out of range 17°C - 43°C.
TbloodNoTransducer
No transducer attached to the module or catheter disconnected.
Numeric is replaced by -?INOP tone
Numeric is replaced by -?Numeric is replaced by -?INOP tone
Telemetry INOPs
INOP Message, Indication
What to do
Check ECG Settings
INOP tone
Synchronization of ECG settings between the monitor and Information Center has failed. Check that
the ECG settings in use are appropriate.
!!Check ECG Source
Both the telemetry device and the monitor have valid ECG signals
Chk SpO₂T Settings
INOP tone
Synchronization of SpO2T settings between the monitor and Information Center has failed. Check
that the SpO2T settings in use are appropriate.
Invalid Leadset
The leadset plugged in cannot be used with the telemetry device.
Leadset Unplugged
The leadset has been unplugged from the telemetry device.
No ECG Source
A telemetry device is paired with the monitor but the Information Center is not detecting a valid ECG
signal from either of them.
!! Repl. Tele Batt
!!!Repl. Tele Batt
The battery in the telemetry device is almost empty and must be replaced.
Severe yellow/red INOP tone
During this INOP, alarms cannot
be paused or switched off.
Tele Battery Low
The battery in the Telemetry device is low and must be replaced soon.
!!Tele Disconnect
!!!Tele Disconnect
Telemetry transceiver was disconnected or short range radio link was lost.
For cable connections; check Telemetry interface, cable connection and setup.
For short range radio connections: if the telemetry transceiver has not moved out-of-range, check for
interference sources close to the monitor (bluetooth devices, DECT phones, cellular phones,
microwaves, etc.). If this INOP persists, ask your service personnel to survey the interference sources.
!! Tele INOP
!!! Tele INOP
Check for further details at the Information Center or in the Telemetry Data window on the monitor.
Tele Sync Unsupp.
The MMS in use does not support synchronization of ECG and SpO2 settings between the monitor
and central station after a telemetry device has been paired. Use an MMS with revision E.0 or above.
Severe yellow/red INOP tone
Severe yellow/red INOP tone
INOP tone
Cableless Measurement Device INOPs
INOP Message, Indication
What to do
cl NBP Batt Empty
!!cl NBP BattEmpty
!!!cl NBP BatEmpty
The remaining battery time of the NBP Pod is below 30 minutes. Charge the battery.
cl NBP Batt Incomp
The battery in use with the NBP Pod is incompatible. Replace it with one approved for use with the
NBP Pod.
Corresponding INOP tone
INOP tone
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4 Patient Alarms and INOPs
INOP Message, Indication
What to do
cl NBP Batt Low
The remaining battery time of the NBP Pod is below 2 hours.
cl NBP Batt Malf
There is a malfunction in the NBP Pod's battery system. Contact your service personnel.
cl NBP Batt Temp
The temperature of the battery in the NBP Pod is critically high. Check that the Pod is not covered or
exposed to a heat source. If the INOP persists, remove the Pod from the patient and contact your
service personnel.
cl NBP Check Batt
The battery in the NBP Pod is nearing the end of its useful life. Only 50 charge/discharge cycles
remain. Contact your service personnel to replace the battery.
cl NBP 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 Disconnect
The 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 Cradle
The NBP Pod is not in its cradle.
cl NBP Remove
The temperature of the battery in the NBP Pod is too high. Remove the Cableless Measurement
Device from the patient and contact service personnel.
cl NBP Serv Batt
The battery in the NBP Pod has reached the end of its useful life. It can no longer be charged. Contact
your service personnel to replace the battery.
cl Resp Batt Empty
!!cl Resp BatEmpty
!!!cl Resp BtEmpty
The remaining battery time of the Respiration Pod is below 30 minutes. Charge the battery.
cl Resp Batt Incmp
INOP tone
The 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 BtEmpty
The remaining battery time of the SpO2 Pod is below 30 minutes. Charge the battery.
cl SpO₂ Batt Incmp
The battery in use with the SpO2 Pod is incompatible. Replace it with one approved for use with the
SpO2 Pod.
INOP tone
INOP tone
INOP tone
INOP tone
INOP tone
INOP tone
INOP tone
INOP tone
Corresponding INOP tone
Corresponding INOP tone
INOP tone
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4 Patient Alarms and INOPs
INOP Message, Indication
What to do
cl SpO₂ Batt Low
The remaining battery time of the SpO2 Pod is below 2 hours.
cl SpO₂ Batt Malf
There is a malfunction in the SpO2 Pod's battery system. Contact your service personnel.
cl SpO₂ Batt Temp
The temperature of the battery in the SpO2 Pod is critically high. Check that the Pod is not covered or
exposed to a heat source. If the INOP persists, remove the Pod from the patient and contact your
service personnel.
cl SpO₂ Check Batt
The battery in the SpO2 Pod is nearing the end of its useful life. Only 50 charge/discharge cycles
remain. Contact your service personnel to replace the battery.
cl SpO₂ 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 Disconnect
The SpO2 Pod has lost the connection to the monitor.
cl SpO₂ No Cradle
The SpO2 Pod is not in its cradle.
cl SpO₂ Remove
The temperature of the battery in the SpO2 Pod is too high. Remove the SpO2 Pod from the patient
and contact service personnel.
cl SpO₂ Serv Batt
INOP tone
The battery in the SpO2 Pod has reached the end of its useful life. It can no longer be charged. Contact
your service personnel to replace the battery.
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 tone
INOP tone
INOP tone
INOP tone
INOP tone
INOP tone
INOP tone
83
4 Patient Alarms and INOPs
84
5
Managing Patients and
Equipment
When 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
example
PIIC iX
For a list of the differences between the two Information Centers, see “Information Center
Compatibility” on page 103.
Patient Concepts
For 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 Concepts
Depending 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.
85
5 Managing Patients and Equipment
Additionally 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 Patients
In 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.
WARNING
Always 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 Patient
The monitor displays physiological data and stores it in the trends as soon as a patient is connected.
This lets you monitor a patient who is not yet admitted. It is however important to admit patients
properly so that you can identify your patient on recordings, reports, and networked devices.
During admission you enter data that the monitor needs for safe and accurate operation. For example,
the patient category setting determines the algorithm the monitor uses to process and calculate some
measurements, the safety limits that apply for some measurements, and the alarm limit ranges.
NOTE
It is strongly recommended that the same patient data fields be configured to be mandatory at the
monitor and the Information Center.
When No Patient is Admitted
To admit a patient:
86
Select the patient name field or select the Patient Demogr. SmartKey to open the Patient
Demographics window.
Select 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 Equipment
Enter 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 Admitted
If the patient monitor already has a patient admitted, the Admit Patient key is replaced by the New
key.
Patient
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 Data
PIIC 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.
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5 Managing Patients and Equipment
To search for patient data:
Select the Find Patient key.
A window opens with an on-screen keyboard.
Type 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.
Highlight the patient you want to admit to this bed.
Depending on their current status, you will be asked whether you want to readmit them, or
transfer them to this bed.
Select Confirm to complete the admission or transfer.
Patient Category and Paced Mode
The patient category setting determines the algorithm the monitor uses to process and calculate some
measurements, the safety limits that apply for some measurements, and the alarm limit ranges.
The paced 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.
WARNING
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 Cat.
Patient category
Changing 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 mode
For 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 Patient
You can admit a patient at either the bedside or the Information Center. When you admit a patient, the
patient's name appears on the bedside monitor and the Information Center.
If you do not fill in all patient information required by the Information Center, the Information Center
may reject the admission. Complete all the required fields and try again to admit the patient.
Quick Admitting a Patient
Use Quick Admit to quickly admit a patient using only a limited set of demographic data.
88
Select the Quick Admit SmartKey.
Enter the required data (ID fields or last name depending on configuration) with the keyboard or a
barcode scanner.
5 Managing Patients and Equipment
Select Enter.
In the confirmation window, select Confirm to stop monitoring for the previous patient or free up
the monitor (if confirmation is configured).
Check that patient category and paced status are correct for the new patient.
Check 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 Admit
Stat 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:
19:32:45-30MAR15a
Depending 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 Admit
If 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 Information
To edit the patient information after a patient has been admitted, select the patient name field on the
Main Screen to open the Patient Demographics window, and make the required changes.
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 Patient
There 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.
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5 Managing Patients and Equipment
Depending 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.
WARNING
Always 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 Patient
The 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 Patient
1 Select the patient name field or select the Patient Demogr. SmartKey to open the Patient
Demographics window and associated pop-up keys.
Select 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.
–
90
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 Equipment
Removing the Monitor
Removing 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 Monitor
1 Open the Equipment window - either directly in Main Setup or by selecting the bed label in the
information line.
Select the monitor.
Select the Remove Monitor pop-up key.
New Patient Check
The 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 period
The 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 Patients
To 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 Centers
You can transfer demographic data and trend data from one IIC to another by selecting Transfer on
the patient monitor. Trend data is not shared between Information Centers and monitors.
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Transferring Patients with IntelliVue Information Center iX
PIIC 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 Function
PIIC iX
To transfer a patient using the transfer function provided on the patient monitor by the Information
Center:
Select the patient name or the Not Admitted text at the top of the monitor screen to open the
Patient Demographics window.
Select 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.
With 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.
Select a bed from the list.
You will be asked to confirm the transfer of the patient to this bed.
Select Confirm to complete the transfer.
WARNING
Before 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 Key
PIIC iX
92
If the monitor at the destination bed is not free:
Select the patient name field at the top of the monitor to open the Patient Demographics window.
Select New Patient to free up the monitor.
Select 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 Equipment
Transferring Patients with IntelliVue Information Center
Transferring a Centrally-Monitored Patient with the Monitor
Scenario: 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.
Select 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.
At 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?.
Select Yes to complete the transfer.
Verify that the settings for patient category and paced mode are correct.
If you accidentally transfer a patient, use Re-Admit to restore this patient's data to the Information
Center. If you are not connected to the network, select Clear Transfer to leave transfer mode. The
patient data remains in the monitor.
Resolving Patient Information Mismatch
When 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
PIIC
•
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.
•
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.
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Manually Resolving Patient Mismatch
The 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.
WARNING
After resolving a patient mismatch, check that the monitor settings (especially patient category, paced
status and alarm limits) are correct for the patient.
Patient Mismatch - If One Set of Patient Data is Correct
If there is a mismatch between an Information Center and a monitor, 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.
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Patient Mismatch - If Neither Patient Data Set is Correct
A patient mismatch where neither set of patient data is correct might occur if you connect a new MMS
to a monitor in order to prepare for a new patient, before you actually start measuring.
Select New Patient if you are sure that none of the information is correct. This 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 Equipment
Multiple 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 patient
The 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.
WARNING
In 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 Equipment
The 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.
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Equipment Status Disputes
Equipment 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:
equipment is locked to another bed
equipment is not configured for use in this unit
equipment label is not in system configuration, or duplicate equipment labels
Using the Equipment Window
In 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.
96
This bed is Bed 8, the connection to the Information Center is active.
Caregiver area - depending on your network connection, the name of assigned caregiver may be
shown.
Patient name, category and paced mode.
This monitor is assigned to the patient and is the one on which you are viewing the window.
5 Managing Patients and Equipment
The 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 Assignment
When 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 Area
The 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 Location
If 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.
Select the Information Center area on the Equipment window.
Select 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 Patient
It 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.
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WARNING
When 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 Window
The 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.
Current alarm and INOP generated by another device.
Own patient overview window
Delayed
- indication that data in the window is delayed.
WARNING
All 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
•
98
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 Equipment
•
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.
Assigning a Telemetry Transceiver with an SRR Adapter to a Monitor
A 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.
NOTE
If 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:
Press the Check button on the telemetry device.
The measurement selection key on the monitor will change to show the "add cableless" symbol
Select the symbol.
In the Add Cableless window, select the correct equipment label for the telemetry device.
Check 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 monitor
To 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.
WARNING
Short 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
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5 Managing Patients and Equipment
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.
Controlling Other Devices from the Bedside
You can change ECG settings for the current ECG source from the patient monitor.
Select the own patient overview window.
Select 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 Bedside
When 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
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:
Silence
Select the own patient overview window.
Select 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.
WARNING
Even 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.
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Switching Off or Pausing Alarms From Other Devices
When you select Pause Alarms or Alarms Off at the monitor, the alarms are off or paused for the
bedside measurements. When you switch alarms off or pause alarms at the Information Center, both
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 Standby
When 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 Center
The 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 Settings
For 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 Limit
ECG
ECG On/Off1, Primary Lead, Secondary Lead, Va Lead, Vb Lead, Lead
Placement
Arrhythmia
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.
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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 Baseline
QT
QT analysis On/Off, QT Lead, QTc High Alarm On/Off, ΔQTc Alarm
On/Off, QTc High Limit, ΔQTc High Limit, QT Baseline2
SpO2T
SpO2 Alarms on/off, SpO2 Alarm limits, SpO2 Low Alarm Delay, SpO2
High Alarm Limit, Desat Alarm Limit
NBP Alarm Suppression On/Off, Pulse(SpO2) On/Off
ECG On/Off setting is forced to ON by the monitor, if the local setting is ON.
With PIIC, QT baseline is synchronized, but not QT snippets.
PIIC iX
With the IntelliVue Information Center iX, the following additional measurement settings can be
synchronized:
ECG/Arrhythmia
Some ECG Alarms INOP On/Off, Hexad Reconstruction Mode
ST
STE On/Off, STE Alarm On/Off
NBP
Sys/Dia/Mean Alarm Limits, Alarms On/ Off, Alarm Source
Resp
Apnea Time, Alarm Limits, Alarm On/Off, Resp On/Off
SpO2
SpO2 Alarms on/off, SpO2 Alarm limits, Desat Alarm Limit, NBP Alarm
Suppression On/Off, Pulse(SpO2) On/Off, Measurement Mode1,
Repetition Time1
1Measurement
Mode and Repetition Time can only be synchronized if SpO2 comes from a Cableless SpO2 Pod or a
telemetry device.
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.
NOTE
Settings 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.
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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.
5 Managing Patients and Equipment
Information Center Compatibility
The 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 iX
Not 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.
- can transfer patient directly to
another bed/unit and from another bed/unit. (With
LAN and WLAN connection only)
Transfer Patient
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
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
Not available
Select Caregiver - allows
Remove
- allows assignment of other monitors,
telemetry devices and X2 MMS. (With LAN and
WLAN connection only)
- allows a temporary location to be
shown when a patient is not in the unit. (With LAN
and WLAN connection only)
a Caregiver to be assigned to a
patient
Not 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.
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ECG, Arrhythmia, ST and QT
Monitoring
The electrocardiogram (ECG) measures the electrical activity of the heart and displays it on the
monitor as a waveform and a numeric. This section also tells you about arrhythmia monitoring (see
“About Arrhythmia Monitoring” on page 129), ST monitoring (see “About ST Monitoring” on
page 139) and QT monitoring (see “About QT/QTc Interval Monitoring” on page 152).
Skin Preparation for Electrode Placement
Good electrode-to-skin contact is important for a good, noise-free ECG signal, as the skin is a poor
conductor of electricity.
Select sites with intact skin, without impairment of any kind.
Clip or shave hair from sites as necessary.
Wash sites thoroughly with soap and water, leaving no soap residue.
We do not recommend using ether or pure alcohol, because this dries the skin and increases the
resistance.
Dry skin thoroughly.
Connecting ECG Cables
Attach the clips or snaps to the electrodes before placing them. If you are not using pre-gelled
electrodes, apply electrode gel to the electrodes before placement.
Place the electrodes on the patient according to the lead placement you have chosen.
Attach the electrode cable to the patient cable.
Plug the patient cable into the white ECG connector. An ECG waveform and numeric appears on
the monitor display.
CAUTION
To protect the monitor from damage during defibrillation, for accurate ECG information and to
protect against noise and other interference, use only ECG electrodes and cables specified by Philips.
Some non-authorized electrodes may be subject to large offset potentials due to polarization.
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Selecting the Primary and Secondary ECG Leads
The monitor uses the primary and secondary lead to compute HR and to analyze and detect cardiac
arrhythmias. They are also available for recordings and for display on the Information Center.
The secondary lead is only used if your monitor is configured for multi-lead (instead of single-lead)
arrhythmia analysis.
You should choose a lead as primary or secondary lead that has the following characteristics:
•
the QRS complex should be either completely above or
below the baseline and it should not be bi-phasic
•
the QRS complex should be tall and narrow
•
the P-waves and T-waves should be less than 0.2 mV
To select a lead as primary or secondary lead:
•
In the Setup ECG menu, select Primary or Secondary, then select the appropriate lead. You can
assign any available lead whether it is currently displayed or not.
Checking Paced Mode
It 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.
WARNING
Pace 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.
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Understanding the ECG Display
Your display may be configured to look slightly different.
Lead label of the displayed wave
ECG Filter label
1 mV calibration bar
Pacer spikes
Pace pulse markers
Current heart rate
Current heart rate alarm limits and paced mode symbol
EASI or Hexad lead placement label
ECG 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.
Pacer spikes configured to have a fixed size
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.
Synchronization marks in yellow
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.
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Monitoring Paced Patients
An ECG optimized for monitoring a paced patient should look like this:
Normal Beats
Pace Pulses/Pace Beats
You should choose a lead as primary or secondary lead that has these characteristics:
•
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 Status
In 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.
When 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.
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Paced Mode On
Paced Mode Off
Paced Mode
Unconfirmed
6 ECG, Arrhythmia, ST and QT Monitoring
Avoiding Pace Pulse Repolarization Tails
Some unipolar pacemakers display pace pulses with repolarization tails. These tails may be counted as
QRSs in the event of cardiac arrest or other arrhythmias.
If you note a visible repolarization tail, choose a lead that decreases the size of the repolarization tail.
Repolarization tail (note width)
Changing the Size of the ECG Wave
If any of the displayed ECG waves is too small or clipped, you can change the size of one or all of the
ECG waves on the screen.
Changing the adjustment factor only changes the visual appearance of the ECG wave on the screen. It
does not affect the ECG signal analyzed by the monitor.
Comparing the wave size to the 1 mV calibration bar on the ECG wave segment can help you to get an
idea of the true ECG signal strength. If you choose a fixed adjustment factor, the 1 mV calibration bar
will be the same size for all the displayed ECG waves. If you choose Auto Size, or an individual size
using the Size Up/Size Down keys, the calibration bar may be a different size for each wave.
To Change the Size of an Individual ECG Wave
Select the wave segment you want to change. This calls up the lead menu for this segment.
In the lead menu, select Size Up to increase wave size or Size Down to decrease the size.
Selecting Auto Size lets the monitor choose the optimal adjustment factor for all available ECG
waves.
To Change the Size of all the ECG Waves
To change the size of all the ECG waves on the screen by a fixed adjustment factor,
In the Setup ECG menu, select Adjust Size.
Select the required adjustment factor from the line of pop-up keys.
– Size x0.5 to halve the wave size
– Size x1 to display the wave without zoom
– Size x2 to double the wave size
– Size x4 to multiply the wave size by four
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Changing the Volume of the QRS Tone
The QRS tone is derived from either the HR or Pulse, depending on which is currently selected as the
alarm source. The QRS volume can be set from 0 to 10 (0 means off).
To change the QRS volume, in the Setup ECG menu select QRS Volume and then select the appropriate
volume from the pop-up list.
Changing the ECG Filter Settings
The ECG filter setting defines how ECG waves are smoothed. An abbreviation indicating the filter
type is shown underneath the lead label on the monitor display. Filter settings do not affect ST
measurement.
To change the filter setting, in the Setup ECG menu, select Filter and then select the appropriate setting.
–
–
–
–
Monitor:
Use under normal measurement conditions.
Ext. Monitor: Use when diagnostic quality is required but low frequency interference or a
wandering baseline may be expected. The upper edge frequency is the same as the Diag setting
and the lower edge frequency is the same as the Monitor setting.
Filter: The filter reduces interference to the signal. It should be used if the signal is distorted by
high frequency or low frequency interference. High frequency interference usually results in
large amplitude spikes making the ECG signal look irregular. Low frequency interference
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 Placement
You must enable either standard lead placement or EASI lead placement.
•
In the Setup ECG menu, select Placement and then Standard or EASI.
is shown beside the 1mV calibration bar on the ECG wave on the display, and EASI is marked on
any printouts.
EASI
See the section on “EASI ECG Lead Placement” on page 122 for electrode placement diagrams.
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Selecting Positions of Va and Vb Chest Leads (for
6-lead placement)
6-lead Placement
The 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.
In the Setup ECG menu, select Va Lead.
Select the position used from the list.
Select Vb Lead and select the position used from the list.
6-Lead Placement for Hexad Derived 12-lead
The 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:
•
V1 and V3
•
V2 and V5
•
V1 and V4
•
V3 and V5
•
V1 and V5
•
V3 and V6
•
V2 and V4
Select the two leads you have used in the Setup ECG menu:
In the Setup ECG menu, select Hexad (Va,Vb).
Select 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 Leads
To make it possible to compare measured ECG signals, the electrodes (or lead sets) are placed in
standardized positions, forming so-called "leads". To obtain ECG signals optimized for use in
diagnosis and patient management in different care environments, different lead sets in varying lead
placements can be used. You can use either standard lead placements or EASI lead placements with
this monitor.
When placing electrodes, choose a flat, non-muscular site where the signal will not be interfered with
by either movement or bones. Correct lead placement is always important for accurate diagnosis.
Especially in the precordial leads, which are close to the heart, QRS morphology can be greatly altered
if an electrode is moved away from its correct location.
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ECG Leads Monitored
If you are using
these leads are available:
a 3-electrode set
I, II, III
a 5-electrode set
I, II, III, aVR, aVL, aVF, V, MCL, Va
a 6-electrode set
I, II, III, aVR, aVL, aVF, Va, Vb
a 6-electrode set with the
Hexad algorithm
I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6
Two V leads are directly measured and four are derived.
a 10-electrode set
I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6
an EASI 5-electrode set
I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6
Changing Lead Sets
To change the ECG lead set,
•
When adding leads: place the additional electrodes as required - the monitor automatically
recognizes the new lead placement.
•
When removing leads: there are two possibilities - removing the complete chest leads block or
removing individual leads. If you unplug the chest lead block from the trunk cable connector, the
monitor will automatically recognize the new lead placement. Remove individual leads by
removing the electrodes. The monitor will issue a Lead Off INOP message; select New Lead Setup in
the Setup ECG menu and the INOP message will disappear.
ECG Lead Fallback
If fallback is configured on and there is a leads off INOP in the primary lead (and in the secondary
lead, if you are using multi-lead monitoring) for longer than 10 seconds, and if another lead is available,
this available lead automatically becomes the primary lead. This is known as lead fallback. When the
Leads Off condition is corrected, the leads are automatically switched back.
This setting can only be changed in Configuration Mode.
ECG Lead Placements
The labels and colors of the ECG electrodes differ according to the standards that apply for your
hospital. The electrode placement illustrations in this chapter use the AAMI labels and colors.
Electrode labels
112
Electrode colors
AAMI
EASI
IEC
AAMI
IEC
RA
White
Red
LA
Black
Yellow
LL
Red
Green
RL
Green
Black
Brown
White
V1/Va
C1/Ca
Brown/Red
White/Red
V2/Vb
C2/Cb
Brown/Yellow
White/Yellow
V3
C3
Brown/Green
White/Green
6 ECG, Arrhythmia, ST and QT Monitoring
Electrode labels
AAMI
EASI
Electrode colors
IEC
AAMI
IEC
V4
C4
Brown/Blue
White/Brown
V5
C5
Brown/Orange
White/Black
V6
C6
Brown/Violet
White/Violet
Standard 3-Lead Placement
RA placement: directly below the clavicle and
near the right shoulder
LA placement: directly below the clavicle and
near the left shoulder
LL placement: on the left lower abdomen
RA placement: directly below the clavicle and
near the right shoulder
LA placement: directly below the clavicle and
near the left shoulder
RL placement: on the right lower abdomen
LL placement: on the left lower abdomen
V placement: on the chest, the position
depends on your required lead selection. If
configured, the label of the chest lead will be
displayed with its exact position (V1 to V6R)
Standard 5-Lead Placement
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Standard 6-Lead Placement
Use the positions from the 5-lead diagram above but with two chest leads. The two chest leads, Va and
Vb, can be positioned at any two of the V1 to 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 Placement
Use 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:
•
V1 and V3
•
V2 and V5
•
V1 and V4
•
V3 and V5
•
V1 and V5
•
V3 and V6
•
V2 and V4
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.
WARNING
Hexad derived 12-lead ECGs and their measurements are approximations to conventional 12-lead
ECGs. They should not be used for diagnostic interpretations.
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Chest Electrode Placement
V1 on the fourth intercostal space at the right
sternal border
V2 on the fourth intercostal space at the left
sternal border
V3 midway between the V2 and V4 electrode
positions
V4 on the fifth intercostal space at the left
midclavicular line
V5 on the left anterior axillary line, horizontal
with the V4 electrode position
V6 on the left midaxillary line, horizontal with the
V4 electrode position
V3R -V6R on the right side of the chest in
positions corresponding to those on the left
VE over the xiphoid process
A - Angle of Louis
V7 on posterior chest at the left posterior axillary
line in the fifth intercostal space
V7R on posterior chest at the right posterior
axillary line in the fifth intercostal space
V8 posterior lead, level with V7 at the left
midscapular line
V9 posterior lead, level with V7 at the left spinal
border.
For accurate chest electrode placement and measurement, it is important to locate the fourth
intercostal space.
Locate the second intercostal space by first palpating the Angle of 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.
Palpate and count down the chest until you locate the fourth intercostal space.
10-Lead Placement
When monitoring 12-leads of ECG, using a 10-Electrode Lead Placement, it is important to correctly
place electrodes and to label all 12-lead ECG reports with the correct lead placement.
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Conventional 12-Lead ECG
V1 - V6
LA
RA
RL
LL
In conventional 12-Lead ECG using 10 electrodes, an electrode is placed on the right arm, left arm,
right leg, and left leg. Six V- electrodes are placed on the chest. The right leg electrode is the reference
electrode.
Limb electrodes:
–
–
Place arm electrodes on the inside of each arm, between the wrist and the elbow.
Place leg electrodes inside of each calf, between the knee and the ankle.
Chest electrodes:
V1 - on the 4th intercostal space at the right sternal border
V2 - on the 4th intercostal space at the left sternal border
V3 - midway between the V2 and V4 electrode positions
V4 - on the 5th intercostal space at the left midclavicular line
V5 - on the left anterior axillary line, horizontal with the V4 electrode position
V6 - on the left midaxillary line, horizontal with the V4 electrode position
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Modified 12-Lead ECG
LA
V1-V6
LL
RL
RA
Angle of Louis
If your institution uses modified 10-lead ECG electrode placement (the Mason-Likar Lead System),
place the four limb electrodes close to the shoulders and lower abdomen.
The six V electrodes are placed on the chest in the same position as the conventional 12-lead
placement.
Choosing Standard or Modified Electrode Placement
WARNING
Do not use ECG analysis interpretation statements and measurements for 12-lead ECGs obtained
using the modified (Mason-Likar) limb electrode placement. This may lead to misdiagnosis since the
modified (Mason-Likar) limb electrode placement does not look the same as the conventional 12-lead
ECG and may mask inferior infarction due to calculated axis, R, P and T wave magnitudes shifts and
ST slope.
Do not export 12-lead ECGs obtained using the modified (Mason-Likar) limb electrode placement.
Captured 12-Lead ECGs using the modified (Mason-Likar) limb electrode placement exported from
the Information Center are not annotated with the Mason-Likar label.
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.
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WARNING
Do not use ECG analysis interpretation statements and measurements for 12-lead ECGs obtained
using the modified (Mason-Likar) limb electrode placement. This may lead to misdiagnosis since the
modified (Mason-Likar) limb electrode placement does not look the same as the conventional 12-lead
ECG and may mask inferior infarction due to calculated axis, R, P and T wave magnitudes shifts and
ST slope.
Do not export 12-lead ECGs obtained using the modified (Mason-Likar) limb electrode placement.
Captured 12-Lead ECGs using the modified (Mason-Likar) limb electrode placement exported from
the Information Center are not annotated with the Mason-Likar label.
WARNING
Do not use ECG analysis interpretation statements and measurements for 12-lead ECGs obtained
using the modified (Mason-Likar) limb electrode placement. This may lead to misdiagnosis since the
modified (Mason-Likar) limb electrode placement does not look the same as the conventional 12-lead
ECG and may mask inferior infarction due to calculated axis, R, P and T wave magnitudes shifts and
ST slope.
Do not export 12-lead ECGs obtained using the modified (Mason-Likar) limb electrode placement.
Captured 12-Lead ECGs using the modified (Mason-Likar) limb electrode placement exported from
the Information Center are not annotated with the Mason-Likar label.
Capture 12-Lead
You can view a 12-Lead ECG on the screen, capture a 12-Lead ECG episode, preview the captured
ECG data and then store it and send it to a connected Information Center for analysis. You can
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 ECG
To 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:
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Select the Admit Patient pop-up key, then
Enter the information in the Patient Demographics window.
Open the 12-Lead ECG window again as described above.
The age and gender will now be displayed in the title bar of the pop-up keys.
To change the way the realtime waves are displayed, select the Change View pop-up key or select the
wave area. You can switch between a one or two column display. The two column display lets you see
a larger representation of the waves.
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 ECG
To capture the last 10 seconds of ECG data, select the Capture Waves pop-up key. The pop-up key is
active as soon as enough wave data is available; until then a progress bar is displayed in the title bar of
the pop-up keys. A preview of the captured data appears on the screen (unless your monitor is
connected to an Information Center with software release earlier than Revision M — then the
captured data is automatically stored and sent to the Information Center).
The title bar of the pop-up keys will now show the current filter setting and, if you are using EASI 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 ECG
Select the Setup 12 Lead pop-up key to choose settings for filter, gain, etc., if changes are needed. All
changes apply to both the display and the printed 12-Lead report. The changes are only applied
temporarily and will not be stored. If you want to change the default settings, see “Setting Up the 12Lead 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.
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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 1
Defines which lead will be used as rhythm lead 1, 2 or 3.
Rhythm Lead 2
Rhythm Lead 3
Choices are Primary, Secondary, I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6, V7, V8,
V9, V3R, V4R, V5R, V6R, and MCL.
Lead Sequence
Defines the sequence in which the leads are presented.
This setting is only relevant when 3x4 1R, 3x4 1R ST or 3x4 3R is selected as Format.
Choices are Cabrera and Internat.
Storing and Sending the 12-Lead ECG
You 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 ECG
Print 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).
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Downloading 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 Captures
To 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 Keys
Here 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 you
Admit 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).
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Pop-up Keys
Lock
/ Unlock
Setup Leads
Selecting this pop-up key lets you
remotely lock/unlock the 12-Lead capture at the IntelliVue Information
Center.
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.
Setting Up the 12-Lead ECG
You can make settings that will be stored and used in future as default settings for each 12-Lead ECG
capture made.
Select the HR numerics on the screen to enter Setup ECG.
Select 12Lead.
The 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 Placement
Using a standard 5-electrode set in EASI lead placement you can monitor up to 12 standard ECG leads
simultaneously and continuously at the bedside. EASI provides a monitoring method for trending ST
segment changes that can provide an early indication of ischemia.
WARNING
EASI-derived 12-lead ECGs and their measurements are approximations to conventional 12-lead
ECGs. As the 12-lead ECG derived with EASI is not exactly identical to the 12-lead conventional
ECG obtained from an electrocardiograph, it should not be used for diagnostic interpretations.
Respiratory monitoring is also possible with the EASI placement; respiration is measured between the
I and A electrodes.
Place the electrodes as accurately as possible to obtain the best quality EASI measurements.
When EASI lead placement is selected, EASI is shown beside the 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 Conditions
If one of the derived EASI leads has an INOP condition (for example, Lead Off), a flat line is displayed.
After 10 seconds, the directly acquired EASI AI, AS, or ES lead (depending on which is available) is
displayed with the corresponding lead label. This causes an arrhythmia relearn.
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EASI Electrode Placement
E (V) - on the lower sternum at the level of
the fifth intercostal space
A (LL) - on the left midaxillary line at the
same level as the E electrode
S (LA) - on the upper sternum
I (RA) - on the right midaxillary line at the
same level as the E electrode
N - reference electrode - can be anywhere,
usually below the sixth rib on the right hip
ECG and Arrhythmia Alarm Overview
The ECG and arrhythmia alarms available depend on which measurements are switched on, and the
arrhythmia option enabled for your monitor.
•
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 monitor
Alarm
Description
Arrhythmia Configuration
Arrhythmia
Off
Basic
Arrhythmia
Enhanced
Arrhythmia
*** Asystole
No beat detected for a period > the
asystole threshold (2.5 to 4.0 seconds)
*** Vent Fib/Tach
Fibrillatory wave (sinusoidal wave
between 2 - 10 Hz) for 4 consecutive
seconds
*** VTach
A run of consecutive beats labeled as V
with run length ≥ the V-Tach Run limit
and ventricular HR > V-Tach HR limit
*** Extreme Tachy
Heart Rate > the Extreme Tachy limit
*** Extreme Brady
Heart Rate < the Extreme Brady limit
** HR High
Heart rate > the high HR limit
(see note)
(see note)
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Alarm
Description
Arrhythmia Configuration
Arrhythmia
Off
Enhanced
Arrhythmia
(see note)
(see note)
** HR Low
Heart rate < the low HR limit
** 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 limit
** Vent Rhythm
A run of consecutive beats labeled as V
with run length > the Vent rhythm limit
and ventricular HR ≤ the V-Tach HR
limit
** 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
** Pair PVCs
Two ventricular beats labeled as V
between two beats not labeled as V
** 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)
** Vent Bigeminy
A dominant rhythm of beats labeled as
N, V, N, V, N
** Vent Trigeminy
A dominant rhythm of beats labeled as
N, N, V, N, N, V, N, N
** PVCs/min High
Within 1 minute, the number of beats
labeled as V > the PVCs/min limit
** 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 beats
** Pause
No beat detected for a period > the
pause alarm threshold (1.5 to 2.5
seconds)
** 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)
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Basic
Arrhythmia
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Alarm
Description
Arrhythmia Configuration
Arrhythmia
Off
Basic
Arrhythmia
Enhanced
Arrhythmia
** 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)
**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)
** SVT
A run of consecutive beats labeled as S
with run length ≥ SVT run limit and
ventricular HR > SVT HR limit
* HR High
Heart rate > the high HR limit
(see note)
(see note)
* HR Low
Heart rate < the low HR limit
(see note)
(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)
* End AFIB
Atrial Fibrillation no longer detected
for the Afib end delay time (For adult
patient category only)
** Irregular HR
An irregular rhythm of beats labeled as
N (irregular R-R intervals changes
greater than 12.5%)
* End Irregular HR
Irregular HR rhythm no longer
detected for the irregular HR end delay
time
Note: ** 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 Alarms
ECG alarms can be switched on and off and the high and low alarm limits changed just like other
measurement alarms, as described in the “Alarms” chapter. Special alarm features which apply only to
ECG are described here.
Extreme Alarm Limits for Heart Rate
The extreme rate alarms, extreme 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.
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The 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.
Extreme Brady Limit
Low Limit
High Limit
Extreme Tachy Limit
Δ Extreme Brady
Δ Extreme Tachy
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:
Select one of the alarm fields.
Select the Alarm Limits pop-up key.
Select HR.
The alarm limit window for HR is shown, with the high and low limits and the Extreme Tachy and
Extreme Brady limits.
High and low alarm limits
Extreme Tachy and Extreme Brady limits
ECG Alarms Off Disabled
Be aware that your hospital department may have decided to disable the Alarms Off setting for ECG in
the monitor's Configuration Mode. In this case, HR alarms cannot be switched off in Monitoring
Mode. If you try to switch off the HR alarms, you will see the message To activate enter Config and
enable Alarms Off.
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HR Alarms When Arrhythmia Analysis is Switched Off
When arrhythmia analysis is switched off, only these HR-related alarms will be detected:
•
the asystole alarm
•
the ventricular fibrillation/tachycardia alarm
•
the extreme tachycardia and extreme bradycardia alarms
•
the high heart rate and low heart rate alarms.
Enhanced Asystole Detection
In order to improve alarming on asystole under certain conditions, you can set Asystole Detect. in
Configuration Mode to Enhanced. In enhanced mode an asystole alarm will be suppressed for up to
five seconds if a valid beat-to-beat Pulse is detected from an arterial Pressure.
ECG Safety Information
CAUTION
Interference from instruments near the patient and ESU interference can cause problems with the
ECG wave. See the monitor specifications for more information.
WARNING
Defibrillation and Electrosurgery:
Do not touch the patient, or table, or instruments, during defibrillation.
After defibrillation, the screen display recovers within 10 seconds if the correct electrodes are used and
applied in accordance with the manufacturers instructions.
ECG cables can be damaged when connected to a patient during defibrillation. Check cables for
functionality before using them again.
According to AAMI specifications the peak of the synchronized defibrillator discharge should be
delivered within 60 ms of the peak of the R wave. The signal at the ECG output on the IntelliVue
patient monitors is delayed by a maximum of 30 ms. Your biomedical engineer should verify that your
ECG/Defibrillator combination does not exceed the recommended maximum delay of 60 ms.
When using electrosurgical (ES) equipment, never place ECG electrodes near to the grounding plate of
the ES device, as this can cause a lot of interference on the ECG signal.
General:
When you are connecting the electrodes or the patient cable, make sure that the connectors never
come into contact with other conductive parts, or with earth. In particular, make sure that all of the
ECG electrodes are attached to the patient, to prevent them from contacting conductive parts or earth.
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.
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Pacemaker failure:
During complete heart block or pacemaker failure to pace/capture, tall P-waves (greater than 1/5 of
the average R-wave height) may be erroneously counted by the monitor, resulting in missed detection
of cardiac arrest.
Patients exhibiting intrinsic rhythm:
When monitoring paced patients who exhibit only intrinsic rhythm, the monitor may erroneously
count pace pulses as QRS complexes when the algorithm first encounters them, resulting in missed
detection of cardiac arrest.
The risk of missing cardiac arrest may be reduced by monitoring these patients with low heart rate limit
at or slightly above the basic/demand pacemaker rate. A low heart rate alarm alerts you when the
patient's heart rate drops to a level where pacing is needed. Proper detection and classification of the
paced rhythm can then be determined.
Filtered ECG signal from external instruments:
Instruments such as defibrillators or telemetry units produce a filtered ECG signal. When this signal is
used as an input to the bedside monitor, it is filtered again. If this twice-filtered signal is passed to the
arrhythmia algorithm, it may cause the algorithm to fail to detect pace pulses, pacemaker non-capture,
or asystole, thus compromising paced patient monitoring performance.
External pacing electrodes:
When a pacemaker with external pacing electrodes is being used on a patient, arrhythmia monitoring is
severely compromised due to the high energy level in the pacer pulse. This may result in the arrhythmia
algorithm's failure to detect pacemaker noncapture or asystole.
Fusion beat pacemakers:
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.
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About Arrhythmia Monitoring
Arrhythmia analysis provides information on your patient's condition, including heart rate, PVC rate,
rhythm, and ectopics. The monitor uses the user-selected primary and secondary ECG leads for singlelead or multi-lead arrhythmia analysis. During arrhythmia analysis, the monitor continuously:
•
optimizes ECG signal quality. This is important for arrhythmia analysis. The monitor continuously
filters the ECG signal to remove baseline wander, muscle artifact, and signal irregularities. Also, if
the Patient Paced status is set to Yes, pace pulses are filtered out to avoid processing them as QRS
beats.
•
detects beats, for example, QRS complexes, identifying them for further analysis.
•
measures signal features such as R-wave height, width, and timing.
•
creates beat templates, and classifies and labels beats to aid in rhythm analysis and alarm detection.
•
examines the ECG signal for ventricular fibrillation, asystole, and noise.
Arrhythmia Options
Your monitor has either the basic or the enhanced arrhythmia option. Both options provide rhythm
and ectopic status messages and beat labeling. The number of rhythms being classified, events being
detected, and alarms generated differs according to the option. The alarms available with the different
options are listed in the section “ECG and Arrhythmia Alarm Overview” on page 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 Off
In the Setup Arrhy menu, select Arrhythmia to switch between On and Cardiotach.
Select 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 Monitoring
It is important to select a suitable lead for arrhythmia monitoring.
Guidelines for non-paced patients are:
–
–
–
–
QRS complex should be tall and narrow (recommended amplitude > 0.5 mV)
R-Wave should be above or below the baseline (but not bi-phasic)
T-wave should be smaller than 1/3 R-wave height
the P-wave should be smaller than 1/5 R-wave height.
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For paced patients, in addition to the above, the pace pulse should be:
–
–
–
not wider than the normal QRS
the QRS complexes should be at least twice the height of pace pulses
large enough to be detected, with no 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 Beats
As P-waves are not analyzed, it is difficult and sometimes impossible for the monitor to distinguish
between an aberrantly-conducted supraventricular beat and a ventricular beat. If the aberrant beat
resembles a ventricular beat, it is classified as ventricular. You should always select a lead where the
aberrantly-conducted beats have an R-wave that is as narrow as possible to minimize incorrect calls.
Ventricular beats should look different from these 'normal beats'. Instead of trying to select two leads
with a narrow R-wave, it may be easier to just select one lead and use single lead arrhythmia
monitoring. Extra vigilance is required by the clinician for this type of patient.
Atrial Fibrillation Alarm
The monitor performs atrial fibrillation analysis using information about the 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 well
Atrial 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.
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Intermittent Bundle Branch Block
Bundle branch and the other fascicular blocks create a challenge for the arrhythmia algorithm. If the
QRS during the block changes considerably from the learned normal, the blocked beat may be
incorrectly classified as ventricular, causing false PVC alarms. You should always select a lead where
the bundle branch block beats have an R-wave that is as narrow as possible to minimize incorrect calls.
Ventricular beats should look different from these 'normal beats'. Instead of trying to select two leads
with a narrow R-wave, it may be easier to just select one lead and use single lead arrhythmia
monitoring. Extra vigilance is required by the clinician for this type of patient.
Understanding the Arrhythmia Display
Your monitor screen may look slightly different from the illustration.
Beat label
Pace pulse marks
Rhythm status message
PVC Numeric
HR Numeric
Ectopic status message
Delayed arrhythmia wave
Viewing Arrhythmia Waves
To review arrhythmia beat labels, in the Setup 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 Labels
Arrhythmia beat labels tell you how the monitor is classifying beats.
Beat Label
Arrhythmia On
Beat Classification
Beat Label
Cardiotach Mode
Normal
Ventricular Ectopic
Supra-ventricular Premature
Paced
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Beat Label
Arrhythmia On
Beat Classification
Beat Label
Cardiotach Mode
Pacer Spike
Biventricular Pacer Spike
Learning patient's ECG
Artifact (noisy episode)
Insufficient information to classify beats
Inoperative condition (e.g., Leads Off)
Pause or missed beat
Not applicable
Arrhythmia Status Messages
The 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 Messages
The label B or E indicates basic (B) or enhanced (E) arrhythmia capability.
Rhythm Status Message Description
132
B or E
Asystole
No beat detected for a period > the asystole threshold
(2.5 - 4.0 seconds)
B, E
Vent Fib/Tach
Fibrillatory wave (sinusoidal wave between 2 - 10 Hz) for
4 consecutive seconds
B, E
VTach
A run of consecutive beats labeled as V with run length ≥
the V-Tach Run limit and ventricular HR > V-Tach HR
limit
B, E
Sustained VT
Ventricular tachycardia rhythm for more than 15 seconds
Vent Rhythm
A run of consecutive beats labeled as V with run length >
the Vent rhythm limit and ventricular HR ≤ the V-Tach
HR limit
Vent Bigeminy
A dominant rhythm of beats labeled as N, V, N, V, N
Vent Trigeminy
A dominant rhythm of beats labeled as N, N, V, N, N, V, N, E
Paced Rhythm
A dominant rhythm of beats labeled as P
B, E
Irregular HR
Consistently irregular rhythm
6 ECG, Arrhythmia, ST and QT Monitoring
Rhythm Status Message Description
Sinus Brady
Sinus Rhythm
B or E
A dominant rhythm of beats labeled as N or S preceded by B, E
P-waves
Sinus Tach
SV Brady
SV Rhythm
A dominant rhythm of beats labeled as N or S not preceded B, E
by P-waves
SV Tach
Unknown ECG Rhythm
Rhythm cannot be determined
B, E
Learning ECG
Algorithm is learning the ECG beat morphology
B, E
Learning Rhythm
Algorithm is learning the rhythm of the classified beats
B, E
Cannot Analyze ECG
ECG signal is predominantly invalid or too noisy and
therefore cannot be analyzed
B, E
Ectopic Status Messages
The label B or E indicates basic (B) or enhanced (E) arrhythmia capability.
Ectopic Status Message Explanation
B or E
(No message displayed)
No ectopic activity within the last minute
Run PVCs
More than 2 consecutive beats labeled as V within the last
minute
Pair PVCs
Two beats labeled as V between two beats not labeled as V E
Pacer Not Capt
No beat detected for a period > 1.75 times the average R-R B, E
interval and pace pulse(s) detected. (Paced mode on)
PacerNotPacing
No beat detected for a period > 1.75 times the average R-R B, E
interval and no pace pulse(s) detected (Paced mode on)
Pause
No beat detected for a period > 1.75 times the average R-R E
interval for HR <120, or
No beat for 1 second with HR >120 (non-paced patient
only), or
No beat detected for more than the set pause threshold.
R-on-T PVCs
R-ON-T detected within the last minute
Multiform 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 beats
Frequent SVPBs
Count of beats labeled as S within last minute is greater
than 5
SVPBs
1-5 beats labeled as S in the last minute
SV Beats
Count of beats labeled as N or S within last minute and
rhythm status is paced
B, E
Paced Beats
Count of beats labeled as P within last minute and rhythm
status is not paced
B, E
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Arrhythmia Relearning
During a learning phase:
•
Alarm timeout periods are cleared
•
Stored arrhythmia templates are cleared
•
Asystole, Vfib, and HR alarms (when there are enough beats to compute the HR) are active. No
other alarms are active.
Initiating Arrhythmia Relearning Manually
To initiate relearning manually, in the Setup 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 Relearn
Arrhythmia relearning is initiated automatically whenever:
•
ECG monitoring is switched on
•
The ECG Lead or Lead Label of the primary/secondary lead is changed manually, or when
fallback occurs
•
A Leads Off INOP condition (that has been active for > 60 seconds) ends.
If you are monitoring multi-lead arrhythmia and there is a change in one lead only, relearning happens
only in the affected lead. During this learning phase, the system will continue monitoring using the
other lead. Therefore, the delayed arrhythmia wave is not labeled L and there is no Learning ECG
rhythm status message. In addition, alarm timeout periods are maintained, stored arrhythmia templates
are maintained for the operative lead, and all alarms switched on are active.
Arrhythmia Relearn and Lead Fallback
Lead fallback triggers an automatic arrhythmia relearn.
WARNING
If arrhythmia learning takes place during ventricular rhythm, the ectopics may be incorrectly learned as
the normal QRS complex. This may result in missed detection of subsequent events of V-Tach and VFib.
For this reason you should:
134
•
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 Monitoring
•
respond to any INOP messages (for example, if you are prompted to reconnect electrodes)
•
be aware that a disconnected EASI electrode triggers an arrhythmia relearn on all leads
•
always ensure that the arrhythmia algorithm is labeling beats correctly.
Arrhythmia Alarms
Arrhythmia alarms can be switched on and off and the alarm settings changed just like other
measurement alarms, as described in the Alarms section. Special alarm features which apply only to
arrhythmia are described here.
The different alarms detected and generated by the monitor depend on the level of arrhythmia analysis
that is enabled. For a complete list of arrhythmia alarms and INOPs, see the “Alarms” chapter.
The monitor detects arrhythmia alarm conditions by comparing ECG data to a set of pre-defined
criteria. An alarm can be triggered by a rate exceeding a threshold (for example, HR >xx), an abnormal
rhythm (for example, Ventricular Bigeminy), or an ectopic event (for example, Pair PVCs).
Yellow Arrhythmia Alarms
Yellow 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.
WARNING
When arrhythmia analysis is on, all yellow ECG and arrhythmia alarms are short yellow alarms (onestar). This means that the yellow alarm lamp and the tones are active for six seconds only, after which
the blinking numeric and the alarm message remain for up to three minutes. The only exception to this
are the HR High and Low alarms which can be configured as standard yellow alarms. Red alarms
behave as usual.
Arrhythmia Alarms and Latching
When using arrhythmia analysis, Visual Latching and Audible Latching should be on for red alarms, or at
least Visual Latching should be on. Because of the transient nature of arrhythmia alarms, many
arrhythmia conditions may go unnoticed if alarm latching is off. This setting can only be changed in
Configuration Mode.
Switching Individual Arrhythmia Alarms On and Off
Some arrhythmia alarms can be individually switched on or off:
Non-Sustain, Vent Rhythm, Run PVCs, Pair PVCs, R-on-T PVCs, V.Bigeminy, V.Trigeminy, Multif.PVCs, 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.
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Switching All Yellow Arrhythmia Alarms On or Off
All yellow arrhythmia alarms can be switched on and off together. To do this,
•
In the Setup Arrhy menu, select All Yellow Off or All Yellow On.
Adjusting the Arrhythmia Alarm Limits
Some arrhythmia alarms have limits which can be individually adjusted:
VTach HR, VTach Run, PVCs/min, Vent Rhythm, SVT HR, SVT Run, Asystole Thresh., Pause Threshold, Afib/
IHR End Dly.
To adjust alarm limits, in the Setup Arrhy menu, select the alarm to be adjusted.
Select the appropriate setting from the pop-up list.
Arrhythmia Alarm Timeout Periods
Normally, an arrhythmia alarm is announced when an alarm condition is detected. However, there are
certain situations that can inhibit the audible and visible indications of the alarm even though the alarm
condition was detected. These include:
•
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.
and ** Irregular HR alarms do not have a timeout period. These alarms can be generated
immediately after the corresponding end alarm was generated.
** AFIB
When ** HR High and ** HR Low alarms are configured as standard yellow alarms, they do not have a
timeout period.
Resetting the Timeout Period
To reset the timeout period, press the Alarms key and then reselect it.
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How are Yellow Arrhythmia Alarms Indicated?
When a yellow arrhythmia alarm is generated, it triggers visual and audible indicators. Yellow
arrhythmia alarms are always set to latch visually for three minutes except HR High/Low alarms, if
configured to standard yellow. Depending on the alarm condition, audible and visual alarm indicators
will appear as follows:
Alarm Condition Example
Short yellow alarm tone
sounds
Alarm message
displayed
Single alarm
instance
Non-Sustained
V-tach
when alarm condition is initially
detected
for 3 minutes (latching
time)
Continuous alarm
condition
PVCs/min HIGH
when alarm condition is initially
detected and - as an alarm
reminder - every time the
configured timeout period has
expired
until the alarm
condition stops, plus a
maximum of three
minutes latching time
Same intermittent
alarm condition
Pair of PVCs
each time the alarm condition is
detected, provided that the
configured timeout period has
expired
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 Chaining
When arrhythmia analysis is switched on, multiple alarm conditions may be present. Announcing all of
the detected alarm conditions would be confusing, and might hide a more serious condition. For this
reason, arrhythmia alarms are prioritized in three alarm "chains": PVC Alarms; Beat Detection Alarms,
and Rate Alarms.
Only the highest priority alarm condition in each chain is announced. Lower priority alarms in the
same chain will not be announced while an alarm is active or during the configured timeout period. If
alarm conditions of equal severity from different chains are detected, the alarm condition that occurred
most recently is announced.
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.
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Examples of Alarm Chaining Logic
–
–
138
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 Monitoring
Understanding PVC-Related Alarms
PVC-related alarms are detected on the basis of the current ventricular heart rate and the number of
consecutive PVCs counted (referred to as PVC Runs).
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 Monitoring
The monitor performs ST segment analysis on normal and atrially paced beats and calculates ST
segment elevations and depressions. This information can be displayed in the form of ST numerics and
snippets on the monitor.
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.
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WARNING
Some clinical conditions may make it difficult to achieve reliable ST monitoring, for example:
•
if you are unable to get a lead that is not noisy
•
if arrhythmias such as atrial fib/flutter are present, which may cause an irregular baseline
•
if the patient is continuously ventricularly paced
•
if the patient has left bundle branch block.
You should consider switching ST monitoring off if these conditions are present.
This monitor provides ST level change information; the clinical significance of the ST level change
information should be determined by a physician.
ST segment monitoring is intended for use with adult patients only and is not clinically validated for
use with neonatal and pediatric patients. For this reason, the recommended - and default - setting for
ST monitoring in neonatal and pediatric modes is ST Analysis: Off.
Switching ST or STE On and Off
ST 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
and Off.
On
Selecting Leads for ST Analysis
You select which leads to use for ST analysis in the Setup ST Analysis menu.
To see the current list of leads selected for ST analysis:
Enter the Setup ST Analysis menu.
Select Setup ST Leads. This opens the Setup ST Leads pop-up window. Leads chosen for ST
monitoring are listed here. There are two pop-up keys at the bottom of the screen, Add and Delete.
If all leads are already selected, the Add pop-up key is disabled.
To choose a lead for ST monitoring:
Select the Add key at the bottom of the Setup ST Leads window. This opens the Choices pop-up
window.
Choose a lead from the list for ST monitoring. This closes the Choices window and adds the
selected lead to the list of chosen leads.
To disable ST monitoring for a lead:
140
Choose a lead from the list in the Setup ST Leads window.
Select the Delete key. This removes this lead from the list.
6 ECG, Arrhythmia, ST and QT Monitoring
NOTE
The order in which ST leads are listed in the Setup ST Leads menu determines the order in which ST
leads are displayed on the monitor screen.
To change the order in which ST leads are displayed,
In the Setup ST Leads menu, choose a lead from the list.
Select the Sort Up or Sort Down key to move the lead up or down in the list.
Understanding the ST Display and Windows
Your monitor screen may be configured to look slightly different from the illustrations.
ST numerics
Current HR alarm limits
Current heart rate
ST Numerics
Up to 12 ST numerics plus the ST index can be displayed on the monitor screen. They can be
configured to show beside the measurement numerics, beside the ECG wave, or beside the ST snippet.
A positive ST value indicates ST segment elevation; a negative value indicates depression.
ST numerics are displayed in the order in which you select ST leads for analysis. If there is additional
space in the field assigned to ST numerics, the monitor will display extra numerics in the order in
which they appear in the list in Setup ST Leads, in the Setup ST Analysis menu. Any ST leads switched on
for analysis that do not fit in the assigned numerics field are shown in succession in place of the last ST
numeric.
ST Index
The ST index numeric (STindx) is the sum of the absolute values for the ST leads V2, V5, aVF. Because
it is based on absolute values, it is always a positive number. If you haven't selected one of the leads
V2, V5, and aVF for ST analysis, the ST index numeric will display a question mark "?".
To switch the ST index numeric on or off for display, in the Setup ST Analysis menu, select ST-Index to
toggle between On and Off.
ST Snippets
ST snippets show a one second wave segment for each measured ST lead. The most recent snippet is
drawn in the same color as the ECG wave, usually green, superimposed over the stored baseline
snippet, drawn in a different color. The comparison shows any deviation in the measurement since the
baseline snippet was stored, for example as a result of a procedure carried out on the patient. The
information is updated once per minute.
You can see ST snippets in the Adjust ST Points window or the ST View window.
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ST View Window
The 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.
Current Lead
ISO/J-point mode for current snippet
ISO/J-point mode for baseline snippet
1 mV calibration bar
Current ST snippet and ST baseline snippet overlapped
Timestamp of most recently stored baseline snippet
All available ST numerics for current snippet and baseline snippet
The ST point, J-point and ISO point can be hidden using the Hide Points pop-up key.
STE View Window
The 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.
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The 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 Snippets
ST analysis requires valid samples to measure and store a snippet. ST Snippets and ST values are
updated every minute. If there is artifact in the signal, it may take longer for an ST snippet and an ST
value to appear.
The first baseline is stored automatically after ST monitoring is started, or when a new patient is
admitted.
To update ST baselines,
Select the ST numerics then ST View to open the ST View window.
In the ST View window, select Update Baseline to store all current snippets as baselines. This deletes
all previously-stored baselines.
About the ST Measurement Points
The ST value for each beat complex is the vertical difference between the ISO point and the ST point,
as shown in the diagram below. The isoelectric (ISO) point provides the baseline, the ST point is at the
midpoint of the ST segment. The J point is where the QRS complex changes its slope; as it is a fixed
distance away from the ST point, it can be useful to help you position the ST point correctly.
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R-wave peak at 0 msec
J point, for example, 48 msec
Difference = ST value
ST measurement point, for example, J + 60 msec
Isoelectric point set to -80 msec
CAUTION
If 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 Mode
There 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,
Select ISO/J Pt.
Select Auto or Manual mode.
Adjusting ST Measurement Points
If 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.
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To adjust the ST measurement points, in the Setup ST Analysis menu,
Select Adjust ST Points to open the Adjust ST Points window.
Alternatively, you can use the Adjust ST points pop-up key in the ST View window.
Select a suitable ECG lead for ST measurement, with a visible J-point and a visible P wave. Use the
up and down arrow keys to scroll through the ST snippets for the other ECG leads.
Select 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).
ST label and the ST numeric that would apply using the current points
1mV calibration bar
Cursors for adjusting ST points
Highlighted ST point
The ISO-point cursor (1) positions the isoelectric point relative to the R-wave peak. The relation is
shown beside the ISO-point in milliseconds. Position the ISO-point in the middle of the flattest
part of the baseline (between the P and Q waves or in front of the P wave).
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The J-point cursor (2) positions the J-point relative to the R-wave peak. It helps you to correctly
position the ST-point. Position the J-point at the end of the QRS complex and the beginning of
the ST segment.
The J-point cursor is not available if your monitor is configured to let you set the ST point directly.
To position the ST-point (3) relative to the J-point:
select either J+60 or J+80. Select J Point and use the arrow keys to move the J-Point and position
the ST-point at the midpoint of the ST segment.
To position the ST-point directly:
select ST Point and use the left and right arrow keys to position the ST point at the midpoint of the
ST segment.
Select the Apply Changes pop-up key to activate the new ST measurement points and recalculate all
ST values.
The most recent ST Points adjustment time is displayed in the Adjust ST Points window. This
information is cleared when a patient is discharged or when a new Profile is loaded into the
monitor.
To update the ST snippet shown in the Adjust ST Points window, select the Update pop-up key.
ST Alarms
ST alarms are yellow alarms. Each ST lead has its own alarm limit. ST alarms are triggered when an ST
value exceeds its alarm limit for more than one minute. Switching ST alarms off switches off alarms for
all ST leads.
If more than one ST measurement is in alarm, the monitor only displays the alarm message of the ST
lead which is currently furthest from its set alarm limits.
Changing ST Alarm Limits
The monitor can detect alarms on each ST lead separately, so you can set high and low ST alarm limits
individually for each ST lead. 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.
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In the Setup ST Analysis menu, select the alarm to be adjusted.
Select the appropriate setting.
STE Alarms
The 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 Maps
The 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 Map
To display an ST map,
•
In the Main Setup menu, select ST Map.
Current View
In 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.
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ST Alarm status indicator
Limb Leads
Chest Leads
ST index
Label, value and polarity of corresponding lead
ST map
The position of the current ST measurement point
If 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.
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Additionally, 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 View
In trend view, you can see up to four trended ST maps, and the current ST map, simultaneously. You
can configure the time interval between trended samples. The most recent map is shown in the same
color as the parameter itself. Past values change from white through dark gray. In the diagram below,
the time interval between trends is 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.
Limb Leads
Chest Leads
current ST values
trending interval
In this diagram, V4 was either temporarily switched off or in INOP
for around 30 seconds. No data was recorded. Consequently, the
affected maps are not closed.
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Working in the ST Map Task Window
You may need to activate the ST map task window to see all the data, and to access the pop-up keys.
Select the map view on screen to activate its task window. Once you activate it, you can perform the
tasks detailed here.
Switching Between ST Map Views
To switch between views,
•
Select Current View or Trend View to toggle between views.
If your trend view is empty, you need to adjust the priority of this measurement in the trending priority
list. See “Trend Priority” on page 226.
Displaying an ST Reference Baseline
You can display an ST reference baseline for the current view, or for the trended view. The baseline is
shown in yellow. However, if the ECG color is yellow, the baseline is shown in green. Use this baseline
to detect ST changes. The baseline is derived automatically whenever the monitor relearns arrhythmia
and also on user request.
Select Show Baseline/Hide Baseline to toggle between baseline display on and off.
Updating an ST Map Reference Baseline
To update the baseline,
•
In the Setup ST Analysis menu, select ST View then select Update Baseline.
Changing the Scale of the ST Map
To change scale,
•
Select Size Up or Size Down to alter the size at which monitor displays the map.
Changing the Trending Interval
To determine how frequently the monitor displays a trended sample,
In Trend view, select Select Interval.
Select the required interval from the menu. The interval ranges between 12 seconds to 30 minutes.
Printing an ST Map Report
To print the most recently viewed (current or trend) window,
Select Main Setup then select Reports.
Select ST Map.
Press Print.
Viewing STE Maps
The 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
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ECG 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.
STE Alarm status indicator
Limb Leads
Chest Leads
Label, value and polarity of corresponding lead
STE Limit Violations
STE Limit Area
The position of the current ST measurement point (always J + 0)
Viewing an STE Map
To display an STE map,
•
In the Main Setup menu, select STE Map.
Working in the STE Map Task Window
You 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.
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Changing the Scale of the STE Map
To change scale,
•
Select Size Up or Size Down to alter the size at which monitor displays the map.
Printing an STE Map Report
To print the most recently viewed window,
Select Main Setup then select Reports.
Select STE Map.
Press Print.
Switching between STE Map and ST Map
If 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 Monitoring
The QT interval is defined as the time between the beginning of the Q-wave and the end of the Twave. It measures the total duration of the depolarization (QRS duration) and repolarization (ST-T)
phases of the ventricular action potential. QT interval monitoring can assist in the detection of
prolonged QT interval syndrome.
The QT interval (1) has an inverse relationship to heart rate. Faster heart rates shorten the QT interval
and slower heart rates prolong the QT interval. Therefore there are several formulas used to correct
the QT interval for heart rate. The heart rate corrected QT interval is abbreviated as QTc. The monitor
uses as a default the Bazett correction formula and the alternative Fridericia formula can be selected in
Configuration Mode.
For QT interval monitoring to be effective, basic or enhanced arrhythmia monitoring should be turned
on.
QT Measurement Algorithm
The QT values are updated every five minutes except in the initial phase (first five minutes) where they
are updated once per minute. Normal or atrial paced beats and beats with a similar morphology are
averaged to form a representative waveform for further processing. Normal beats followed by a
premature QRS will be excluded from the measurements to prevent the premature beat from
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obscuring the end of the T-wave. If the algorithm cannot form a representative waveform, for example
because the morphology of the beats is too varied, a Cannot Analyze QT INOP will be generated after
10 minutes. This is also the case if normal beats have been falsely labeled so that the algorithm does
not have enough valid beats to make QT measurements. No QT value is calculated if the QT-HR is
>150 bpm (Adult) or >180 bpm (Pedi/Neo).
Because of the different algorithm approaches, a QT/QTc measurement from a diagnostic 12-lead
program may differ from the realtime measurement on the monitor.
Where Can I Find More Information?
See the Application Note on QT/QTc Interval Monitoring and the QT Interval Monitoring Quick
Guide supplied on your documentation DVD for detailed information on the QT algorithm and
performance.
Indications For Use Of QT Interval Monitoring
Of special concern for QT monitoring is the administration of QT prolonging drugs to patients
identified with risk factors for Torsade de Pointe. Females, older patients and patients with
bradycardia, impaired left ventricular function (ischemia, left ventricular hypertrophy), hypokalemia
and hypomagnesemia are in this increased risk category.
Limitations For Use Of QT Interval Monitoring
Some conditions may make it difficult to achieve reliable QT monitoring, for example:
•
the T-wave is very flat
•
T-waves are not well defined due to atrial flutter or atrial fibrillation
•
the end of the T-wave is difficult to define because of the presence of U-waves
•
a high heart rate causes the P-wave to encroach on the end of the previous T-wave
•
noise or high QRS morphology variation
For these cases you should select a lead with a good T-wave amplitude and no visible flutter activity,
and without a predominant U-wave or P-wave.
Some conditions such as left or right bundle branch block or hypertrophy can lead to a widened QRS
complex. If a long QTc is observed you should verify it to ensure that it is not caused by QRS
widening.
Because normal beats followed by ventricular beats are not included in the analysis, no QT
measurement will be generated in the presence of a bigeminy rhythm.
If the heart rate is extremely high (over 150 bpm for adults and over 180 bpm for pediatrics and
neonates) QT will not be measured.
When the heart rate changes, it can take several minutes for the QT interval to stabilize. For reliable
QTc calculation it is important to avoid a region where the heart rate is changing.
WARNING
QT/QTc measurements should always be verified by a qualified clinician.
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Selecting the QT Leads
For QT Monitoring you can select one of the following three modes:
•
All Leads mode - all available leads (I, II, III, V, MCL, V1 - 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,
Select the QT numeric to enter the Setup QT Analysis window.
Select QT Lead and select All, Primary Lead or one of the available single leads.
When using the All Leads mode, make sure when you compare QT values that they are based on the
same set of leads.
Changing the lead(s) used for QT measurements will not cause the baseline to be reset.
QT View
In the QT View window you can verify that the QT algorithm detects correct Q and T points.
The current waves are shown in the upper half of the window and the baseline waves in a different
color below. The Q and T points are marked with a vertical line. By selecting one of the lead labels at
the top of the window you can highlight the corresponding wave; the other waves are shown in gray.
The underlined lead labels are the leads used for the QT calculation. By selecting the numeric area you
can highlight all underlined leads.
If EASI or Hexad lead placement is in use, the corresponding lead placement label will be shown.
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Changing The View To A Single Wave Set
To view one set of waves in a larger scale, you can cycle through the different views,
Select Current view to see the set of current waves.
Select Baseline view to see the set of baseline waves.
Select Split view to return to the combined view with current and baseline waves.
Setting The QT Baseline
In order to quantify changes in the QTc value, you can set a QTc baseline. For example to assess the
effect of medication on the QT interval you can set the current value as the baseline before you begin
medication. This baseline will then be used to calculate the ΔQTc value.
To set the baseline,
•
Select Set Baseline and set the value.
If no baseline has been set for this patient, the first five minute value after the start of monitoring is
automatically set as baseline. If you set a new baseline the previous baseline is discarded. As the ΔQTc
alarm is based on the difference between the baseline and the current value, setting an inappropriate
new baseline may prevent a ΔQTc alarm from being generated. Discharging a patient clears the
baseline.
Printing The QT Waves
To start a printout,
•
Select Print QT.
Recording The QT Waves
To start a recording,
•
Select Record QT.
QT Alarms
There are two QT alarms, QTc high limit alarm and ΔQTc high alarm. The QTc high limit alarm is
generated when the QTc value exceeds the set limit for more than 5 minutes. The ΔQTc alarm is
generated when the difference between the current value and the baseline value exceeds the set limit
for more than 5 minutes.
The Cannot Analyze QT INOP and the -?- will be displayed when no QT measurement could be
calculated for 10 minutes. Up to this time the previous valid value will be displayed. The following
additional messages on the cause of the invalid measurements may also be displayed.
Additional Message
Cause of Invalid QT Measurement
QT Startup
QT monitoring was just turned on or has been reset
Asystole or Leads Off
Not all specified leads needed to perform QT analysis are
available, or
Asystole condition is detected
Too few N labeled beats
Not enough valid QRS complexes to generate a QT measurement
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6 ECG, Arrhythmia, ST and QT Monitoring
Additional Message
Cause of Invalid QT Measurement
Invalid Rhythm for QTc
Not enough valid R-R intervals to generate QT-HR, the averaged
HR used for QTc calculation
High QT-HR
QT-HR exceeds the specified upper limit of 150 bpm (for adults) or
180 bpm (for neonates and pediatrics)
Small R Wave
R-wave of the signal is too small
Small T Wave
T-wave of the signal is too small
End of T not Detected
End of the T-Wave cannot be accurately detected
QT out of Range
QT measurement is outside the specified range of valid QT values
(200-800 msec)
QTc out of Range
QTc measurement is outside the specified range of valid QTc values
(200-800 msec)
QTc Erratic
QTc measurements are not stable
Switching Individual QTc Alarms On and Off
Each QTc alarm can be switched off individually. To switch an alarm on or off, in the Setup QT
menu, select QTc Alarm or ΔQTc Alarm to toggle between On and Off.
Analysis
Changing QTc Alarm Limits
Set the high alarm limits based on your assessment of the patient's clinical condition, unit protocols,
physician orders or medication specified limits.
In the Setup QT Analysis menu, select High Limit.
Select the appropriate setting.
Select ΔHighLimit.
Select the appropriate setting.
Switching QT Monitoring On and Off
To switch all QT monitoring on or off, in the Setup QT Analysis menu, select QT Analys. to switch
between On and Off.
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7
Monitoring Pulse Rate
The pulse numeric counts the arterial pulsations that result from the mechanical activity of the heart in
beats per minute (bpm). You can display a pulse from any measured SpO2 signal (pleth wave), 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 Menu
If a pulse numeric is displayed on the screen, select it to enter the setup menu for that pulse source. If
no pulse numeric is visible, in the setup menu from the measurement, select pulse with the correct
source, e.g. Pulse (HR).
System Pulse Source
The currently selected system pulse source is shown in the setup menus of the pulse source
measurements. The pulse rate chosen as system pulse:
•
is monitored as system pulse and generates alarms when you select pulse as the active alarm source
•
is sent via the network to the Information Center, if available
•
is trended in the HighRes Trends and stored in the monitor's databases.
To define which pulse rate is used as system pulse,
In the Setup Pulse menu, select System Pulse.
Select one of the SpO2, 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.
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7 Monitoring Pulse Rate
Switching Pulse On and Off
To switch a particular pulse numeric on or off, enter the Setup Pulse menu via the measurement setup
menu or wave menu of the pulse source. For example, to switch an SpO2 pulse numeric on or off,
Enter the Setup Pulse menu by selecting the Pulse numeric or by selecting Pulse in the Setup SpO₂
menu.
In the Setup Pulse menu, select the correct pulse label, e.g. Pulse (SpO₂), to toggle between On and
Off.
Using Pulse Alarms
You can change pulse rate alarm limits in the ECG/Pulse Alarms menu which can be accessed from the
Setup Pulse menu or the Setup ECG menu by selecting 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 measured
and
– a Pulse source is switched on and available,
The monitor then uses the pulse rate from the measurement currently active as system pulse.
While Pulse is the alarm source, all arrhythmia and ECG HR alarms are switched off. If an ECG
lead becomes available again, the monitor automatically uses HR as alarm source.
NOTE
If ECG is switched off, the monitor will always change to Pulse as alarm source, if a Pulse is available.
One exception to this rule can arise when you have a telemetry device paired with your monitor. The
monitor ECG is then deactivated but the monitor may be configured to allow only ECG as the active
alarm source. In this case the monitor will not switch to Pulse as alarm source and Pulse will not be
available as a selection in the ECG/Pulse Alarms menu.
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7 Monitoring Pulse Rate
WARNING
Selecting Pulse as the active alarm source for HR/Pulse switches off the arrhythmia alarms listed in the
section “ECG and Arrhythmia Alarm Overview” on page 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 Disabled
If you cannot change the alarm source, selection of the alarm source may be disabled. If you try to
change the source, the monitor displays the message To activate enter Config and enable Alarm Source
Selection. This setting can only be changed in Configuration Mode.
Changing HR/Pulse Alarm Limits
As Pulse and HR share the same high and low alarm limits, if you change the alarm limit in the Setup
Pulse menu, the high or low alarm limits for HR in the Setup ECG menu change automatically, and vice
versa. The only exceptions are caused by a low limit clamp for each measurement: the lowest value for
Pulse when derived from SpO2 is 30 bpm; from HR 15 bpm, and from Pressure 25 bpm.
Extreme Alarm Limits for Heart Rate
The extreme rate alarms, *** Extreme Tachy and *** Extreme Brady, 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 Tone
The active alarm source is also used as a source for the QRS tone. You can change the tone volume in
the Setup SpO₂ and Setup ECG menus and the QRS tone modulation in the Setup SpO₂ menu.
WARNING
The audible QRS tone might be influenced by external interference and is not intended to be used as a
substitute for ECG based arrhythmia analysis.
If arrhythmia detection is needed, do not rely on the audible QRS tone.
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8
Monitoring Respiration Rate
(Resp)
For the respiratory measurement (Resp), the monitor measures the thoracic impedance between two
ECG electrodes on the patient's chest. Changes in the impedance due to thoracic movement produce
the Resp waveform on the monitor screen. The monitor counts the waveform cycles to calculate the
respiration rate (RR).
Lead Placement for Monitoring Resp
Correct patient skin preparation techniques for electrode placement are important for Resp
measurement: you will find this information in the chapter on ECG.
The Resp measurement uses the standard ECG cable sets and lead placements. You can use any of the
different types of ECG cable sets - 3-lead, 5-lead, 6-lead or 10-lead, using either standard or EASI™
placement - to measure Resp, as long as you use ICU ECG cables.
The Resp signal is always measured between two of the ECG electrodes. 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 Measurement
To choose the leads for the Resp measurement:
In the Setup Resp menu, select Resp Lead and choose one of the following vectors:
or
•
I (RA-LA)
•
II (RA-LL).
Note that if EASI is configured, Respiration will be measured between the I and A electrodes.
Optimizing Lead Placement for Resp
If you want to measure Resp and you are already measuring ECG, you may need to optimize
placement of the two electrodes between which Resp will be measured for some patients.
Repositioning ECG electrodes from standard positions, especially when you are using EASI™ ECG
electrode placement, results in changes in the ECG waveform and may influence ST and arrhythmia
interpretation.
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Cardiac Overlay
Cardiac activity that affects the Resp waveform is called cardiac overlay. It happens when the Resp
electrodes pick up impedance changes caused by the rhythmic blood flow. Correct electrode
placement can help to reduce cardiac overlay: avoid the liver area and the ventricles of the heart in the
line between the respiratory electrodes. This is particularly important for neonates.
Lateral Chest Expansion
Some patients, especially neonates, expand their chests laterally. In these cases it is best to place the
two respiratory electrodes in the right midaxillary and left lateral chest areas at the patient's maximum
point of breathing movement to optimize the respiratory wave.
Abdominal Breathing
Some patients with restricted chest movement breathe mainly abdominally. In these cases, you may
need to place the left leg electrode on the left abdomen at the point of maximum abdominal expansion
to optimize the respiratory wave.
Understanding the Resp Display
The Resp measurement is displayed on the monitor as a continuous wave and a numeric respiration
rate. If the detected respiration rate is close to the heart rate, this is indicated by the text HR = RR next
to the respiration wave if you are in manual monitoring mode. Your monitor screen may look slightly
different from the illustration.
162
Resp wave label
One Ohm calibration bar
Manually-set Resp detection level
Resp numeric and label
8 Monitoring Respiration Rate (Resp)
Changing Resp Detection Modes
The Resp detection level can be set either automatically or manually.
•
To change the resp detection mode, in the Setup Resp menu, select Detection to toggle between the
settings.
Auto Detection Mode
In Auto Detection Mode, the monitor adjusts the detection level automatically, depending on the wave
height and the presence of cardiac artifact. Note that in Auto Detection Mode,
•
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 Mode
In Manual Detection Mode you must set the Resp detection level.
•
In the Setup Resp menu, select Manual Up or Manual Down. Use the dotted detection level line in the
Resp waveform to determine when the desired level is reached.
Once set, the detection level will not adapt automatically to different respiration depths. It is important
to remember that if the depth of breathing changes, you may need to change the detection level.
Use Manual Detection Mode for situations where:
•
the respiration rate and the heart rate are close.
•
patients have Intermittent Mandatory Ventilation.
•
respiration is weak. Try repositioning the electrodes to improve the signal.
Resp Detection Modes and Cardiac Overlay
In Auto Detection Mode:
If you are monitoring Resp and the ECG is switched off, the monitor cannot compare the ECG and
Resp rates to detect cardiac overlay. The respiration detection level is automatically set higher to
prevent the detection of cardiac overlay as respiration.
In Manual Detection Mode:
Cardiac overlay can in certain situations trigger the respiration counter. This may lead to a false
indication of a high respiration rate or an undetected apnea condition. If you suspect that cardiac
overlay is being registered as breathing activity, raise the detection level above the zone of cardiac
overlay. If the Resp wave is so small that raising the detection level is not possible, you may need to
optimize the electrode placement as described in the section “Lateral Chest Expansion” on page 162.
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Changing the Size of the Respiration Wave
WARNING
When monitoring in Manual Detection Mode, make sure to check the respiration detection level after
you have increased or decreased the size of the respiration wave.
•
In the Setup Resp menu, select Size Up to increase the size of the wave or Size Down to decrease it.
Changing the Speed of the Respiration Wave
Resp waveforms are usually viewed at a slower speed than other waveforms. For this reason, the Resp
measurement has its own speed control and is not affected by the wave speed settings of the other
measurements.
•
Select the Resp wave to enter the Resp Wave menu, then select Change Speed. Choose the required
speed from the pop-up list. This defines the speed at which the wave is drawn across the screen in
millimeters per second (mm/s).
Using Resp Alarms
Resp alarms can be switched on and off and the high and low alarm limits can be changed just like
other measurement alarms, as described in the Alarms chapter.
Changing the Apnea Alarm Delay
The apnea alarm is a high priority red alarm used to detect apneas. The apnea alarm delay time defines
the time period between the point where the monitor cannot detect any respiration activity and the
indication of the apnea alarm.
In the Setup Resp menu, select Apnea Time.
Select the appropriate setting.
Resp Safety Information
WARNING
Respiration detection level
If you do not set the detection level for the respiration correctly in manual detection mode, it may not
be possible for the monitor to detect apnea. If you set the detection level too low, the monitor is more
likely to detect cardiac activity, and to falsely interpret cardiac activity as respiratory activity in the case
of apnea.
Apnea
The respiration measurement does not recognize obstructive and mixed apneas - it only indicates an
alarm when a pre-adjusted time has elapsed since the last detected breath.
The safety and effectiveness of the respiration measurement method in the detection of apnea,
particularly the apnea of prematurity and apnea of infancy, has not been established.
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8 Monitoring Respiration Rate (Resp)
Interference
If operating under conditions according to the EMC Standard EN 60601-1-2 (Radiated Immunity 3V/
m), field strengths above 1V/m may cause erroneous measurements at various frequencies. Therefore
it is recommended to avoid the use of electrically radiating equipment in close proximity to the
respiration measurement unit.
Resp Accessories
To monitor respiration, use only the non-OR ECG accessories listed in the Resp section of the
accessories chapter. You cannot measure respiration if you are using an orange OR ECG cable set.
This is because of the higher internal impedance of the OR cable set, required for use if electrosurgery
is being performed.
Rate adaptive pacemakers
Implanted pacemakers which can adapt to the Minute Ventilation rate may occasionally react on the
Impedance measurement used by patient monitors for the determination of the Resp value and
execute pacing with the maximum programmed rate. Switching off the Resp measurement can prevent
this.
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8 Monitoring Respiration Rate (Resp)
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9
Monitoring 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 Principles
The 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.
WARNING
The 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.
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9 Monitoring with the CL Respiration Pod (cmResp)
Measurement Modes
There 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 Measurements
For 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 Numerics
Measurement Mode
Repeat time (only in automatic mode)
Timestamp for numerics
Pulse numeric
cmRR numeric
cmRR alarm limits
Signal Quality indicator
In 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.
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9 Monitoring with the CL Respiration Pod (cmResp)
Signal Quality Indicator
The 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 Numeric
The 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 Indication
The 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 Mode
To set the measurement mode:
In the Setup cmResp menu, select Mode.
Select Manual, Auto or Frequent mode.
In Auto or Frequent mode, measurements will start immediately after the mode is selected.
Setting the Repeat Time
For Auto mode measurements you can set the interval between measurements:
In the Setup cmResp menu, select Repeat Time.
Select the interval from the list.
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9 Monitoring with the CL Respiration Pod (cmResp)
Switching Posture and Activity Level On and Off
In the Setup cmResp menu, select Posture or Activity to switch between On and Off.
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10
10
Monitoring SpO2
Philips pulse oximetry uses a motion-tolerant signal processing algorithm, based on Fourier artifact
suppression technology (FAST). It provides four measurements:
•
Oxygen saturation of arterial blood (SpO2) - percentage of oxygenated hemoglobin in relation to
the sum of oxyhemoglobin and deoxyhemoglobin (functional arterial oxygen saturation).
•
Pleth waveform - visual indication of patient's pulse.
•
Pulse rate (derived from pleth wave) - detected pulsations per minute.
•
Perfusion indicator - numerical value for the pulsatile portion of the measured signal caused by
arterial pulsation.
The 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.
WARNING
A 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 Sensors
Familiarize yourself with the instructions for use supplied with your sensor before using it. In
particular, check that the sensor being used is appropriate for your patient category and application
site.
CAUTION
Do not use OxiCliq disposable sensors in a high humidity environment, such as in neonatal
incubators or in the presence of fluids, which may contaminate sensor and electrical connections
causing unreliable or intermittent measurements. Do not use disposable sensors when there is a
known allergic reaction to the adhesive.
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10 Monitoring SpO2
Applying the Sensor
Follow the SpO2 sensor's instructions for use, adhering to all warnings and cautions.
Remove colored nail polish from the application site.
Apply the sensor to the patient. The application site should match the sensor size so that the
sensor can neither fall off, nor apply excessive pressure.
When using the M1195A Infant Finger Sensor, select a finger or toe with a diameter of between 7
and 8 mm (0.27" and 0.31"). When applying a M1193A neonatal sensor do not overtighten the
strap.
Check that the light emitter and the photodetector are directly opposite each other. All light from
the emitter must pass through the patient's tissue.
WARNING
Proper Sensor Fit: If a sensor is too loose, it might compromise the optical alignment or fall off. If it
is too tight, for example because the application site is too large or becomes too large due to edema,
excessive pressure may be applied. This can result in venous congestion distal from the application site,
leading to interstitial edema, hypoxemia and tissue malnutrition. Skin irritations or lacerations may
occur as a result of the sensor being attached to one location for too long. To avoid skin irritations and
lacerations, periodically inspect the sensor application site and change the application site regularly.
Venous Pulsation: Do not apply sensor too tightly as this results in venous pulsation which may
severely obstruct circulation and lead to inaccurate measurements.
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.
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10 Monitoring SpO2
Connecting SpO2 Cables
Connect 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.
CAUTION
Extension cables: Do not use more than one extension cable (M1941A). Do not use an extension
cable with Philips reusable sensors or adapter cables with part numbers ending in -L (indicates "long"
cable version).
Electrical Interference: Position the sensor cable and connector away from power cables, to avoid
electrical interference.
Humidity: For neonatal patients, make sure that all sensor connectors and adapter cable connectors
are outside the incubator. The humid atmosphere inside can cause inaccurate measurements.
Measuring SpO2
Select the correct patient category setting (adult/pediatric and neonatal), as this is used to optimize
the calculation of the SpO2 and pulse numerics.
During measurement, ensure that the application site:
– has a pulsatile flow, ideally with a perfusion indicator value above 1.0.
– has not changed in its thickness (for example, due to edema), causing an improper fit of the
sensor.
WARNING
•
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.)
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–
–
–
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 Numerics
Measurement Mode (only with the IntelliVue CL
SpO2 Pod, in Auto or Manual mode)
Repeat time (only with the IntelliVue CL SpO2
Pod, in Auto mode)
Timestamp for numerics (only with the
IntelliVue CL SpO2 Pod or a telemetry device)
Pulse numeric
Perfusion Numeric
Alarms off indicator (here for Pulse alarms)
SpO2 numeric
SpO2 alarm limits
Signal Quality indicator
In 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.
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The level to which the triangle is filled shows the quality of the signal; the indicator below shows a
medium signal quality, the signal quality is at a maximum when the triangle is completely filled.
Assessing a Suspicious SpO2 Reading
Traditionally, pulse rate from SpO2 was compared with heart rate from ECG to confirm the validity of
the SpO2 reading. With newer algorithms, such as FAST-SpO2, this is no longer a valid criteria because
the correct calculation of SpO2 is not directly linked to the correct detection of each pulse.
When pulse rate is very low, or strong arrhythmia is present, the SpO2 pulse rate may differ from the
heart rate calculated from ECG but this does not indicate an inaccurate SpO2 value.
If you doubt the measured SpO2, use the signal quality indicator (if available) or the pleth wave and
perfusion indicator instead to assess the signal quality.
WARNING
With pulse oximetry, sensor movement, ambient light (especially strobe lights or flashing lights) or
electromagnetic interference can give unexpected intermittent readings when the sensor is not
attached. Especially bandage-type sensor designs are sensitive to minimal sensor movement that might
occur when the sensor is dangling.
Comparing Values and Waves
Be 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 Time
Depending on the monitor configuration, you may be able to change the averaging time for the SpO2
values.
The averaging time represents the approximate time period used for the calculation. The exact
averaging algorithm depends on the SpO2 technology (option) used and on the signal conditions. The
longer the averaging time, the longer the time needed until the SpO2 value reflects the physiological
event. Fast averaging is useful for situations where an extremely fast measurement is required or few
artifacts are expected. Use slow averaging where you expect the number of artifacts to be relatively
high.
In the Setup SpO₂ menu, select Average.
Select the required averaging time from the list.
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Setting the Measurement Mode
When 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,
In the Setup SpO₂ menu, select Mode.
Select Continuous, Manual or Auto mode (if available).
NOTE
To 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 Measurement
When 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 Measurement
When automatic mode is selected, to make a measurement:
Select Repeat or Repeat Time and select the required interval between measurements.
In 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
again as described above.
SpO₂
To end an automatic series of measurements, change the measurement mode to Manual or Continuous.
Understanding SpO2 Alarms
This refers to SpO2 specific alarms. See the “Alarms” chapter for general alarm information. SpO2
offers high and low limit alarms, and a high priority desat alarm. You cannot set the low alarm limit
below the desat alarm limit.
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CAUTION
If you measure SpO2 on a limb that has an inflated noninvasive blood pressure cuff, a non-pulsatile
SpO2 INOP can occur. 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 Delays
There 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 Delay
The standard alarm delay time can be configured to a fixed value between 0 and 30 seconds, in
1 second steps.
Smart Alarm Delay
The Smart Alarm Delay feature tries to reduce "nuisance" alarms.
WARNING
Before 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.
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Clinical Example
You 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).
Actual deviation from
violated alarm limit
Resulting alarm notification delay according to selected mode
Short
Medium
Long
1%
25 sec (maximum delay)
50 sec (maximum delay)
100 sec (maximum delay)
2%
12 sec
25 sec
50 sec
3%
10 sec (minimum delay)
16 sec
33 sec
4%
10 sec
12 sec
25 sec
5%
10 sec
10 sec (minimum delay)
20 sec
6%
10 sec
10 sec
16 sec
7%
10 sec
10 sec
14 sec
8%
10 sec
10 sec
12 sec
9%
10 sec
10 sec
11 sec
>9%
10 sec
10 sec
10 sec (minimum delay)
Table with Detailed Delays for Specific Limit Violations
In 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.
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Smart Alarm Delay Dynamics
% SpO2
low limit
desat limit
time (s)
First 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 alarm
Second trigger point - with zero desat delay, the alarm is triggered as soon as the SpO2 value falls
below the desat limit.
B - *** Desat alarm
As long as the SpO2 value stays in the shaded zone, the low alarm is delayed.
Setting Smart Alarm Delay Mode
To set the mode for Smart Alarm Delays, in the Setup SpO₂ menu:
Check 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.
Select High Alarm Delay and choose Short, Medium, or Long mode.
Select 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.
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Smart Alarm Delay Indicator
If 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.
Indicator
Indicator with Numerics
The blocks above and below the alarm symbol indicate which Smart Alarm Delay modes have been
set:
Short
Medium
Long
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 Limits
In the Setup SpO₂ menu:
•
Touch the high limit on the alarm limits menu button. Choose the high alarm limit from the popup 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.
WARNING
High oxygen levels may predispose a premature infant to retrolental fibroplasia. If this is a
consideration do NOT set the high alarm limit to 100%, which is equivalent to switching the high
alarm off.
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Adjusting the Desat Limit Alarm
The Desat alarm is a high priority (red) alarm notifying you of potentially life threatening drops in
oxygen saturation.
In the Setup SpO₂ menu, select Desat Limit.
Adjust the limit.
Pleth Wave
The Pleth wave is autoscaled to maximum display size. It decreases only when the signal quality
becomes marginal. It is NOT directly proportional to the pulse volume. If you need an indication of
change in pulse volume, use the perfusion indicator.
Minimum size for reliable SpO2 value
Perfusion Numeric
The perfusion numeric (Perf) gives a value for the pulsatile portion of the measured signal caused by
the pulsating arterial blood flow.
As pulse oximetry is based on the pulsatile nature of the signal, you can also use the perfusion numeric
as a quality indicator for the SpO2 measurement. Above 1 is optimal, between 0.3-1 is acceptable.
Below 0.3 is marginal; reposition the sensor or find a better site.
Perfusion Change Indicator
The perfusion change indicator is a graphic symbol which shows the change in the perfusion value,
relative to a reference value which you can set.
To set the current perfusion value as the reference value:
•
In the Setup SpO₂ menu, select Set Perf Ref..
When a reference value has been set, the perfusion change indicator is displayed next to the perfusion
numeric.
Setting SpO2/Pleth as Pulse Source
In the Setup SpO₂ menu, select Pulse (SpO₂) to enter the Setup Pulse menu.
In the Setup Pulse menu, select Syst.Pulse and select SpO₂ from the pop-up list.
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Setting Up Tone Modulation
If tone modulation is on, the QRS tone pitch lowers when the SpO2 level drops. Remember, the QRS
tone is derived from either heart rate or pulse depending on which is currently selected as the active
alarm source.
•
In the Setup SpO₂ menu, select Tone Mod. to switch between Yes (for on) and No (for off).
Setting the QRS Volume
In the Setup SpO₂ menu, select QRS Volume and set the appropriate QRS tone volume.
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11
11
Monitoring NBP
This monitor uses the oscillometric method for measuring NBP. In adult and pediatric mode, the
blood pressure measurements determined with this device comply with the American National
Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP10-1992) in relation to
mean error and standard deviation, when compared to intra-arterial or auscultatory measurements
(depending on the configuration) in a representative patient population. For the auscultatory reference,
the fifth Korotkoff sound was used to determine the diastolic pressure.
In neonatal mode, the blood pressure measurements determined with this device comply with the
American National Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI
SP10-1992) in relation to mean error and standard deviation, when compared to intra-arterial
measurements in a representative patient population.
The NBP measurement is suitable for use in the presence of electrosurgery and during the discharge of
a cardiac defibrillator according to IEC 601-2-30:1999/EN 60601-2-30:2000.
A physician must determine the clinical significance of the NBP information.
Introducing the Oscillometric NBP Measurement
Oscillometric devices measure the amplitude of pressure changes (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.
WARNING
Patient Category: Select the correct patient category setting for your patient. Do not apply the higher
adult inflation, overpressure limits and measurement duration to neonatal patients.
Intravenous infusion: Do not use the NBP cuff on a limb with an intravenous infusion or arterial
catheter in place. This could cause tissue damage around the catheter when the infusion is slowed or
blocked during cuff inflation.
Skin Damage: Do not measure NBP in cases of sickle-cell disease or any condition where skin
damage has occurred or is expected.
Existing Wounds: Do not apply the cuff over a wound as this can cause further injury.
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Mastectomy: 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.
CAUTION
If you spill liquid onto the equipment or accessories, particularly if there is a chance that it can get
inside the tubing or the measurement device, contact your service personnel.
Measurement Limitations
NBP 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 Modes
There are four modes for measuring NBP:
184
- measurement on demand.
•
Manual
•
Auto
•
Sequence - up to four measurement cycles which will run consecutively, with number of
measurements and interval between them configurable for each cycle.
•
STAT
- continually repeated measurements (between one minute and 24 hours adjustable interval).
- rapid series of measurements over a five minute period, then the monitor returns to the
previous mode. Use only on supervised patients.
11 Monitoring NBP
Reference Method
The measurement reference method can be Auscultatory (manual cuff) or Invasive (intra-arterial). For
further information, see the Application Note supplied on the monitor documentation DVD.
In Neonatal mode, to comply with safety standards, invasive is always used as the reference method.
This setting cannot be changed and is not visible in any operating mode.
In Adult and Pediatric mode, to check the current setting, select Main Setup, Measurements, then
and check whether the Reference setting is set to Auscult. or Invasive. This setting can only be
changed in Configuration Mode.
NBP,
Preparing to Measure NBP
Connect the cuff to the air tubing.
Plug the air tubing into the red NBP connector. Avoid compression or restriction of pressure
tubes. Air must pass unrestricted through the tubing.
WARNING
Kinked or otherwise restricted tubing can lead to a continuous cuff pressure, causing blood flow
interference and potentially resulting in injury to the patient.
Make sure that you are using a Philips-approved correct sized cuff and that the bladder inside the
cover is not folded or twisted.
A wrong cuff size, and a folded or twisted bladder, can cause inaccurate measurements. The width
of the cuff should be in the range from 37% to 47% of the limb circumference. The inflatable part
of the cuff should be long enough to encircle at least 80% of the limb.
Apply the cuff to a limb at the same level as the heart. If it is not, you must use the measurement
correction formula to correct the measurement.
The marking on the cuff must match the artery location. Do not wrap the cuff too tightly around
the limb. It may cause discoloration, and ischemia of the extremities.
WARNING
Inspect the application site regularly to ensure skin quality and inspect the extremity of the cuffed
limb for normal color, warmth and sensitivity. If the skin quality changes, or if the extremity
circulation is being affected, move the cuff to another site or stop the blood pressure
measurements immediately. Check more frequently when making automatic or stat measurements.
Correcting the Measurement if Limb is not at Heart Level
To correct the measurement if the limb is not at heart level, to the displayed value
Add 0.75 mmHg (0.10 kPa) for each centimeter
higher or
Deduct 0.75 mmHg (0.10 kPa) for each
centimeter lower or
Add 1.9 mmHg (0.25 kPa) for each inch higher.
Deduct 1.9 mmHg (0.25 kPa) for each inch
lower.
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Recommendations For Measurements Used in Diagnosis of
Hypertension
To make a measurement for use in the diagnosis of hypertension, follow the steps below:
Ensure the patient is comfortably seated, with their legs uncrossed, feet flat on the floor and back
and arm supported.
Ask the patient to relax and not talk before and during the measurement.
If possible, wait 5 minutes before making the first measurement.
Understanding the NBP Numerics
Alarm source
Measurement Mode
Timestamp/Timer
Mean pressure
Diastolic
Systolic
Alarm limits
Depending on the NBP numeric size, not all elements may be visible. Your monitor may be configured
to display only the systolic and diastolic values. 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 Sources
If you have parallel alarm sources, the sources are displayed instead of the alarm limits.
NBP Timestamp
Depending on your configuration, the time shown beside the NBP numeric can be:
–
–
186
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.
11 Monitoring NBP
The NBP timestamp will normally show the completion time of the NBP measurement. Only under
the following conditions the timestamp shows the beginning of the measurement:
•
when in Auto or Sequence mode, and
•
the monitor is configured to synchronize the measurements in a measurement series to an "easyto-document" time. For example, if you start the first measurement at 08:23, and the Repeat Time is
set to 10 minutes, the monitor automatically performs the next measurement at 8:30, then 8:40 and
so on.
During Measurements
The cuff pressure is displayed instead of the units and the repeat time. An early systolic value gives you
a preliminary indication of the systolic blood pressure during measurement.
When Unexpected Values are Measured
When values measured are higher or lower than expected, check the following potential causes:
Possible Cause
Solution
The 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 level
Check 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 intraarterial) 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.
Starting and Stopping Measurements
Use the Setup NBP menu or SmartKeys to start and stop measurements.
Action to be performed
NBP Setup menu
Start manual measurement
Start/Stop
Start Auto series
SmartKeys
Start/ Stop
Start NBP
Start STAT measurement
NBP STAT
NBP STAT
Start STAT
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Action to be performed
NBP Setup menu
Stop Manual measurements
Start/Stop
SmartKeys
Start/ Stop
Stop NBP
Stop current Auto measurement
Start/Stop
Start/ Stop
Stop NBP
Stop current STAT measurement and end series
Start/Stop
Start/ Stop
NBP STAT
NBP STAT
Stop NBP
Stop Auto, Manual or STAT measurement AND
series
Stop All
Stop All
CAUTION
Use clinical judgment to decide whether to perform repeated series of STAT measurements because of
the risk of purpura, ischemia and neuropathy in the limb with the cuff.
Enabling Automatic Mode and Setting Repetition
Time
188
In the Setup NBP menu, select Mode and select Auto from the pop-up menu.
For an automatic measurement, select Repeat and set the time interval between two measurements.
11 Monitoring NBP
Enabling Sequence Mode and Setting Up The
Sequence
In the Setup NBP menu, select Mode and select Sequence from the pop-up menu.
Select Setup Sequence to open the Setup Sequence window.
Up to four measurement cycles can be 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.
Select each sequence in turn and select the number of measurements and the time interval between
the measurements.
To have measurements continue after the sequence, set the number of measurements for your last
cycle to Continuous and this cycle will run indefinitely.
CAUTION
Be aware that, if none of the cycles are set to Continuous, NBP monitoring will end after the last
measurement of the cycle.
When the NBP measurement mode is set to Sequence, the repetition time for Auto mode cannot be
changed.
Choosing the NBP Alarm Source
You can monitor for alarm conditions in systolic, diastolic and mean pressure, either singly or in
parallel. Only one alarm is given, with the priority of mean, systolic, diastolic.
In the Setup NBP menu, select Al. from and choose from:
Menu option
Pressure value monitored
Sys.
systolic
Dia.
diastolic
Mean
mean
Sys & Dia
systolic and diastolic in parallel
Dia & Mean
diastolic and mean in parallel
Sys & Mean
systolic and mean in parallel
Sys&Dia&Mean
all three pressures in parallel
If Mean is not selected as alarm source (Sys., Dia., or Sys & Dia selected), but the monitor can only derive
a mean value, mean alarms will nevertheless be announced using the most recent mean alarm limits.
Check that the mean alarm limits are appropriate for the patient, even when not using mean as the
alarm source. When no value can be derived an NBP Measure Failed INOP will be displayed.
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Switching Pulse from NBP On/Off
In the process of making the NBP measurement, a pulse value can be derived and displayed. The pulse
value is displayed together with the time the measurement was made. After one hour the value
becomes invalid. There are no alarms associated with pulse from NBP.
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 Puncture
You 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.
In the Setup NBP menu select VeniPuncture.
Puncture vein and draw blood sample.
Reselect VeniPuncture to deflate the cuff.
During measurement, the NBP display shows the inflation pressure of the cuff and the remaining time
in venous puncture mode.
NOTE
Performing a venous puncture while automatic or sequence NBP measurements are being made
suspends the measurement series for the duration of the venous puncture inflation and for three
minutes afterwards.
Calibrating NBP
NBP is not user-calibrated. 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.
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12
Monitoring Temperature
WARNING
Measurements 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 Measurement
Select the correct type and size of probe for your patient.
If you are using a disposable probe, connect the probe to the temperature cable.
Plug the probe or temperature cable into the temperature connector socket.
Apply the probe to the patient. You are advised to use a protective rubber cover on rectal probes.
Select an appropriate temperature label.
Check that the alarm settings (on or off, high and low limits) are appropriate for this patient and
this type of temperature measurement.
WARNING
Make sure you set alarm limits for the correct label. The alarm limits you set are stored for that
particular label only. Changing the label may change the alarm limits.
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Selecting a Temperature for Monitoring
Tell the monitor which temperature you want to monitor by selecting its temperature label. The label is
a unique identifier for each type of temperature. When you choose a label, the monitor uses that label's
stored color and alarm settings.
In the Setup  menu, select Label.
Select the appropriate label from the list.
Temp
non-specific temperature label
Trect
rectal temperature
Tart
arterial temperature
Tskin
skin temperature
Tcore
core temperature
Tven
venous temperature
Tesoph
esophageal temperature
Tnaso
nasopharyngeal temperature
Extended Temperature Label Set
The following additional labels are available if Label Set is set to Full. This setting can only be changed
in Configuration Mode.
Note that if your monitor is connected to an Information Center, the additional labels in the extended
label set may not be correctly displayed. See the Configuration Guide for your monitor for more
information.
T1, T2, T3, T4
Non-specific temperature labels
Tamb
ambient temperature
Tcereb
cerebral temperature
Ttymp
tympanic temperature
Tvesic
vesical temperature
Calculating Temp Difference
The monitor can calculate and display the difference between two temperature values by subtracting
the second value from the first. The difference is labeled ΔTemp.
192
In the Main Setup menu, select Measurements.
Select ΔTemp.
In the Setup ΔTemp menu, select First Temp.
Select the appropriate label for the measurement source.
Select Second Temp.
Select the appropriate label for the second measurement source.
13
13
Monitoring Invasive Pressure
WARNING
Measurements 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).
CAUTION
Do 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 Measurement
Plug in the pressure cable.
Prepare the flush solution.
Flush the system to exhaust all air from the tubing. Ensure that the transducer and stopcocks are
free of air bubbles.
WARNING
If air bubbles appear in the tubing system, flush the system with the infusion solution again. Air
bubbles may lead to a wrong pressure reading.
Connect the pressure line to the patient catheter.
If you are using an infusion pressure cuff with the pressure line, attach the pressure cuff to the
fluid to be infused. Inflate it according to your standard hospital procedure, then start the infusion.
Position the transducer so that it is level with the heart, approximately at the level of the
midaxillary line.
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13 Monitoring Invasive Pressure
WARNING
If measuring intracranial pressure (ICP, IC1 or IC2) with a sitting patient, level the transducer with the
top of the patient's ear. Incorrect leveling may give incorrect values.
Selecting a Pressure for Monitoring
Tell the monitor 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.
In the Setup  menu, select Label.
Select the appropriate label from the list.
Label
Description
ABP
Arterial blood pressure
ART
Arterial blood pressure (alternative)
Ao
Aortic pressure
CVP
Central venous pressure
ICP
Intracranial pressure
LAP
Left atrial pressure
Non-specific pressure label
PAP
Pulmonary artery pressure
RAP
Right atrial pressure
UAP
Umbilical arterial pressure
UVP
Umbilical venous pressure
Extended Pressure Label Set
The following additional labels are available if Label Set is set to Full. This setting can only be changed
in Configuration Mode.
Note that if your monitor is connected to an Information Center, the additional labels in the extended
label set may not be correctly displayed. See the Configuration Guide for your monitor for more
information.
194
Label
Description
BAP
Brachial arterial pressure
FAP
Femoral arterial pressure
IC1, IC2
Alternative intracranial pressures
P1, P2, P3, P4
Alternative non-specific pressure labels
13 Monitoring Invasive Pressure
Overview of Calibration Procedures
Calibration requirements depend on the situation and the type of transducer used. Recommendations
for the different calibration procedures are given in the table below.
Procedure
When to perform
For which transducers?
Disposable
Zero
Calibration
•
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 correct
•
Every time you use a new or a
different transducer
•
According to your hospital policy
Adjust
•
calibration factor
Can be done instead of the calibration
procedure when a calibration factor is
marked on your reusable transducer
Reusable
Zeroing the Pressure Transducer
To avoid inaccurate pressure readings, the monitor requires a valid zero. Zero the transducer in
accordance with your hospital policy. You must perform a zero:
•
when you use a new transducer or tubing
•
every time you reconnect the transducer cable to the monitor
if you think the monitor's pressure readings are not correct.
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.
WARNING
If you select the label ICP (or IC1/IC2), the measurement device uses the most recently stored zero.
Therefore, make sure you zeroed the transducer correctly in accordance with the transducer
manufacturer's instructions and your hospital policy. When you use a transducer that you cannot
rezero after placement, ensure that you keep the measuring device with the patient so that you are
certain you have the correct zero data for this patient.
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13 Monitoring Invasive Pressure
Determining a Pressure's Most Recent Zero
The monitor displays the most recent zero on the status line. If this has "timed-out" after you have
performed a zero, redisplay the information in the status line by entering the pressure's setup menu.
Zeroing a Pressure Measurement
WARNING
Invasive pressure alarms (and pulse alarms, if derived from invasive pressure) are temporarily
suppressed until 30 seconds after the transducer finishes zeroing.
Turn off the stopcock to the patient.
Vent the transducer to atmospheric pressure, to compensate for the static and atmospheric
pressure exerted on the transducer.
In the setup menu for the pressure, select Zero .
When you see the message  zero done at  on the status line, close
the stopcock to atmospheric pressure, and open the stopcock to the patient.
CAUTION
When using high frequency ventilation, ensure that the tubing from the ventilator does not touch the
arterial line, or connect with it indirectly, while zeroing the pressure. This could cause small pressure
variations which can interfere with the zero procedure.
Zeroing All Pressures Simultaneously
WARNING
Before zeroing all pressures, make sure that all pressure transducers are vented to atmospheric
pressure.
If you are measuring pressures with more than one measuring device, using the Zero Press SmartKey to
initiate the zeroing calls up a list of all active pressures. Select the pressure you want to zero or select All
Press to zero all pressures simultaneously.
Troubleshooting the Zero
The status line lists the probable cause of an unsuccessful zero:
Message
Corrective Action
 can't zero;
The hardware is faulty. Contact your service personnel.
equipment malf.
 can't zero;
excessive offset
 can't zero
- unstable signal
196
Make sure the transducer is vented to air and try again. If this fails, the
hardware may be faulty. Replace the adapter cable and try again. If it fails,
replace the transducer and try again. If it still fails, contact your service
personnel.
13 Monitoring Invasive Pressure
Message
Corrective Action
 can't zero
Make sure that the transducer is connected and try again. If this fails,
exchange the adapter cable and try again. If this fails, exchange the
transducer.
- no transducer
 can't zero;
pulsat. pressure
 unable to
zero - timed out
Switch  on
first
Make sure that the transducer is vented to air, not to the patient, and try
again.
Try pressing the Zero key again. If this fails, replace the transducer and
adapter cable and contact your service personnel.
Pressure measurement is switched off. To switch it on, in the Setup
Pressure menu, select the pressure's label.
Calibrating Reusable Transducers
Depending on your monitor's configuration, you may be able to perform a calibration in monitoring
mode. Perform a mercury calibration when you use a new transducer, and at regular intervals
according to your hospital policy. You require:
•
standard sphygmomanometer.
•
sterile 10cc syringe with heparinised solution.
•
3-way stopcock.
•
approximately 25 cm of tubing.
NOTE
Only reusable transducers must be calibrated.
Making the Pressure Calibration
WARNING
Never perform the invasive pressure calibration while a patient is being monitored.
Zero the transducer.
Connect the syringe and manometer.
a. Attach the tubing to the manometer.
b. Connect the 3-way stopcock to the stopcock that is not connected to the patient catheter
when you measure a patient.
c.
Attach the syringe to one port and the manometer tubing to the other port.
d. Open the port to the manometer.
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13 Monitoring Invasive Pressure
1 Tubing to manometer
2 Syringe with heparinised solution
3 To pressure connector on monitor
4 Patient connection stoppered
5 Off
Move the syringe barrel in and raise the mercury to 200 mmHg (30 kPa). 200 mmHg is the
recommended calibration pressure.
In the Setup  menu, select Cal. Press.
Select the calibration pressure from the list, for example 200 mmHg.
Select Confirm to recalculate the calibration factor using the applied pressure.
When the monitor displays  mercury calibr. done at , remove the
manometer tubing, syringe and extra stopcock. We recommend you replace the transducer dome
and tubing with sterile ones.
Label the transducer with the calibration factor shown in the Cal. Factor field in the pressure's
setup menu.
Reconnect the patient and start measuring again.
Troubleshooting the Pressure Calibration
The status line lists the probable cause of an unsuccessful calibration.
Message
Corrective Action
 can't calibr.; equipmt
Contact your service department. The pressure hardware is
faulty.
malf.
range
Make sure that you have selected the value for Cal. Press that
you are applying to the transducer, and repeat the calibration.
 can't calibrate; no
Make sure that the transducer is connected and try again.
 can't calibrate;out of
transd.
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13 Monitoring Invasive Pressure
Message
Corrective Action
 can't cal.; unstable
signal
Make sure there are no disturbances to the transducer, and
repeat the calibration.
 can't calibr.;do zero
No valid zero. Zero the transducer.
first
Adjusting the Calibration Factor
Each time you use a reusable transducer, compare the calibration factor written on your transducer
with the calibration factor shown on the monitor. To ensure accurate measurement, they must be the
same.
In the Setup  menu, select Cal. Factor.
If the value here does not match that on the transducer, select the corresponding value from the
list, in accordance with your hospital's procedure.
To confirm you want to use the new calibration factor, select the Confirm pop-up key.
Displaying a Mean Pressure Value Only
Use this when you want to see only the mean pressure.
In the pressure's setup menu, select Mean only. Toggle between On to display mean pressure value only,
and Off to display all pressure values (systolic, diastolic and mean).
Changing the Pressure Wave Scale
Select the label of the pressure wave whose scale you want to set to enter the Setup 
menu.
In the Setup  menu, (for example ABP) select Scale.
Select a value from the pop-up list:
– a positive value sets the top gridline. The bottom gridline is set at zero.
– a negative value sets the bottom gridline. The middle gridline is set at zero.
Optimizing the Waveform
In the Setup  menu, select Optimum Scale to let the monitor select the best minimum and
maximum scales for the current wave.
Non-Physiological Artifact Suppression
Some clinical procedures may affect blood pressure, for example, a flush procedure or a blood sample.
Your monitor may be configured to suppress these non-physiological artifacts for a specified duration
(Artifact Suppr. is configured to 30 sec, 60 sec, or 90 sec). During artifact suppression, the monitor
shows the INOP message  Artifact, and a question mark is shown beside the pressure
numerics. Pressure alarms and the  No Pulse INOP are suppressed during the configured
period. The CPP alarms are not suppressed.
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Choosing the Pressure Alarm Source
WARNING
Make sure you set alarm limits for the correct label. The alarm limits you set are stored for that
particular label only. Changing the label may change the alarm limits.
You can monitor for alarm conditions in systolic, diastolic and mean pressure, either singly or in
parallel. Only one alarm is given at a time, in this order of priority: mean, systolic, diastolic.
•
In the Setup  menu, select Al. from and choose the source.
Menu option
Pressure value monitored
Sys.
systolic
Dia.
diastolic
Mean
mean
Sys & Dia
systolic and diastolic in parallel
Dia & Mean
diastolic and mean in parallel
Sys & Mean
systolic and mean in parallel
Sys&Dia&Mean
all three pressures in parallel
Select and set the High Limit and Low Limit for the pressure(s) you have selected.
Extreme Alarm Limits for Pressure
The extreme pressure alarms, Extreme High and Extreme Low, can be made available for your
monitor in Configuration Mode and are additional to the standard High and Low limit alarms. They
are generated by the active pressure alarm source, and are setup in Configuration Mode by adding a set
value (the Δ value) to the high and low alarm limits. This value can be set for each pressure label
individually.
200
Extreme Low Limit
Low Limit
High Limit
Extreme High Limit
Δ Extreme Low
Δ Extreme High
13 Monitoring Invasive Pressure
You need to know which values have been configured for your monitor. Changing the high and low
alarm limits automatically changes the extreme alarm limits within the allowed range.
To see the extreme pressure alarms set for your monitor, in the setup menu 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 Pressure
The monitor can calculate the difference between mean arterial pressure and the intracranial pressure.
The difference is labeled CPP.
In the Main Setup menu, select Measurements.
Select CPP.
In the Setup CPP menu, select which arterial pressure source should be used in the calculation.
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14
14
Monitoring Carbon Dioxide
WARNING
Measurements 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).
CAUTION
Only one CO2 measurement at a time is supported.
Use the CO2 measurement to monitor the patient's respiratory status and to control patient ventilation.
There are two methods for measuring carbon dioxide in the patient's airway:
•
Mainstream measurement uses a CO2 sensor attached to an airway adapter directly inserted into
the patient's breathing system. This method is available using the 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.
WARNING
Correlation: The etCO2 readings do not always correlate closely with paCO2, especially in neonatal
patients and patients with pulmonary disease, pulmonary embolism or inappropriate ventilation.
Pharmaceuticals in aerosols: Do not measure CO2 in the presence of pharmaceuticals in aerosols.
Explosion Hazard: Do not use in the presence of flammable anesthetics or gases, such as a
flammable anesthetic mixture with air, oxygen or nitrous oxide. Use of the devices in such an
environment may present an explosion hazard.
Failure of operation: if the measurement or a sensor fails to respond as described, do not use it until
the situation has been corrected by qualified personnel.
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14 Monitoring Carbon Dioxide
Low etCO2 values: Leakages in the breathing system or sampling system may cause the displayed
etCO2 values to be significantly too low. Always connect all components securely and check for leaks
according to standard clinical procedures. Displacement of the nasal or combined nasal oral cannulas
can cause lower than actual etCO2 readings. Even with combined nasal oral cannulas, the etCO2
readings may be slightly lower than actual in patients breathing through the mouth only.
Measurement Principles
For both mainstream and sidestream measurements, the measurement principle is infrared
transmission, where the intensity of infrared light passing the respiratory gas is measured with a photo
detector. As some of the infrared light is absorbed by the CO2 molecules, the amount of light passing
the gas probe depends on the concentration of the measured CO2.
When using a wet ventilator circuit, monitor mainstream CO2 if available, in preference to sidestream
CO2.
The partial pressure is calculated from the gas concentration by multiplying the concentration value
with the ambient pressure.
The measurement provides:
•
a CO2 waveform.
•
an end tidal CO2 (etCO2) value: the CO2 value measured at the end of the expiration phase.
•
an inspired minimum CO2 (imCO2): the smallest value measured during inspiration.
•
an airway respiration rate (awRR): the number of breaths per minute, calculated from the CO2
waveform.
Depending on the Max Hold setting configured for your monitor, the etCO2 numeric shows either the
highest CO2 value measured within the configured time period (Max Hold set to 10 sec or 20 sec) or the
etCO2 numeric shows breath-to-breath value (Max Hold set to Off).
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.
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Measuring CO2 using the CO2 Option or M3014A
The 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.
WARNING
Altitude Setting: The monitor is not equipped with automatic barometric pressure compensation.
Before the CO2 measurement is used for the first time, the altitude must be set to the correct value. An
incorrect altitude setting will result in incorrect CO2 readings. The CO2 readings will typically deviate
5% for every 1000 m difference.
CAUTION
Use the CO2 measurement with Philips approved accessories only. Refer to the instructions for use
provided with the accessory.
Preparing to Measure Mainstream CO2
You must perform a zero as described in this procedure each time you use a new airway
adapter.
Attach the sensor connector to the CO2 connector on the monitor (when the optional CO2
measurement is integrated) or on the extension.
Wait 2 minutes, allowing the sensor to reach its operating temperature and a stable thermal
condition.
Choose the appropriate airway adapter and connect it to the sensor head. The airway adapter clicks
into place when seated correctly.
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14 Monitoring Carbon Dioxide
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  on the status line, the zero
calibration is finished and you can begin monitoring.
Install the airway adapter at the proximal end of the circuit between the elbow and the ventilator Ysection.
WARNING
To prevent stress on the endotracheal tube, support the sensor and airway adapter.
Position sensor cables and tubing carefully to avoid entanglement or potential strangulation. Do not
apply excessive tension to any cable.
Replace the airway adapter, if excessive moisture or secretions are observed in the tubing or if the
CO2 waveform changes unexpectedly without a change in patient status.
To avoid infection, use only sterilized, disinfected or disposable airway adapters.
Inspect the airway adapters prior to use. Do not use if airway adapter appears to have been damaged
or broken. Observe airway adapter color coding for patient population.
Preparing to Measure Sidestream CO2
206
Plug the sensor cable into the monitor's CO2 input connector. Allow the sensor two minutes warm
up time
14 Monitoring Carbon Dioxide
Connect the cannula, airway adapter, or sample line as appropriate, to the sensor. It will click into
place when seated correctly.
To zero the sensor:
– expose the sensor to room air and keep it away from all sources of CO2 including the
ventilator, the patient's breath and your own.
– in the setup menu for the CO2, select Start Zero Cal.
–
when you see the message CO₂ calibration done at  on the status line, the zero
calibration is finished and you can begin monitoring.
For intubated patients requiring an airway adapter: Install the airway adapter at the proximal end of the
circuit between the elbow and the ventilator Y-section.
For intubated patients with an integrated airway adapter in the breathing circuit: Connect the male luer
connector on the straight sample line to the female port on the airway adapter.
For non-intubated patients: Place the nasal cannula onto the patient.
For patients prone to mouth breathing use an oral-nasal cannula.
For nasal or oral-nasal cannulas with oxygen delivery, place the cannula on the patient as shown then
attach the oxygen supply tubing to the oxygen delivery system and set the prescribed oxygen flow.
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14 Monitoring Carbon Dioxide
WARNING
Always connect the airway adapter to the sensor before inserting the airway adapter into the breathing
circuit. In reverse, always remove the airway adapter from the breathing circuit before removing the
sensor.
Make sure that you do not accidentally connect the luer connector of the gas sample line to an infusion
link or any other links in the patient vicinity.
CAUTION
Always disconnect the cannula, airway adapter or sample line from the sensor when not in use.
Using the Sidestream Sensor Holder
The holder delivered with the sensor can be used to clamp the sensor onto an IV pole or a shelf.
Push the sensor into the holder until it clicks into position.
Clamp the holder onto an IV pole, a shelf or another appropriate location.
To remove the sensor from the holder, release the clip and pull the sensor out of the holder.
Removing Exhaust Gases from the System
WARNING
Anesthetics: When using the sidestream CO2 measurement on patients who are receiving or have
recently received anesthetics, connect the outlet to a scavenging system, to avoid exposing medical
staff to anesthetics.
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.
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14 Monitoring Carbon Dioxide
Measuring Microstream CO2 using M3015A/B
The M3015A/B Microstream CO2 Extension measures the partial pressure of carbon dioxide in a
patient's expired gas using Microstream technology.
The measurement is equipped with an automatic barometric pressure compensation.
WARNING
When 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 CO2
Use appropriate accessories for:
•
the patient type (adult, pediatric or neonatal),
•
the ventilation situation (including humidification)
•
the duration - short term use, up to 24 hours (typically OR), or long term use (typically ICU).
All accessories are for single patient use only.
Using Microstream Accessories
The Microstream measurement can be operated with the special Microstream accessories only. Refer
to the instructions for use provided with the accessory.
For intubated patient with non-humidified ventilation, you can use a Microstream FilterLine set. For
humidified ventilation, use a FilterLine H Set.
For non-intubated patients, the gas sample is taken through a Nasal FilterLine, or a Smart CapnoLine
(which is a combined oral-nasal FilterLine). In parallel to the measurement of the CO2, oxygen (O2)
may be delivered to the patient to support gas exchange. This is done by using an O2/CO2 FilterLine,
or a Smart CapnoLine O2 (a combined oral-nasal O2/CO2 FilterLine).
Using the FilterLine and Airway Adapter
WARNING
Make sure that you do not accidentally connect the luer connector of the gas sample line to an infusion
link or any other links in the patient vicinity.
Attach the female Luer connector to the CO2 inlet connector by pushing the socket cover aside
and screwing the connector 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.
Check that the FilterLine is not kinked.
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14 Monitoring Carbon Dioxide
Change the FilterLine if a CO₂ Occlusion INOP appears on the monitor or if the readings become
extremely erratic.
Disconnect the FilterLine during suctioning and nebulizing therapies or suppress sampling by turning
off the pump as described in “Suppressing Sampling (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 System
WARNING
•
Anesthetics: When using the Microstream CO2 measurement on patients who are receiving or
have recently received anesthetics, connect the outlet to a scavenging system, or to the anesthesia
machine/ventilator, to avoid exposing medical staff to anesthetics.
•
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 Calibration
To prevent an automatic zero calibration from being started in the next five minutes,
•
in the Setup CO₂ menu, select No Zero for 5min, or select the Suppress CO₂ Zero SmartKey, if
configured.
Selecting No Zero for 5min or selecting the Suppress CO₂ Zero SmartKey again before the timer has
timed out resets the timer to five minutes, unless an AutoZero became due during the previous
suppression.
Setting up all CO2 Measurements
These tasks are common to all CO2 measurements except where otherwise noted.
Adjusting the CO2 Wave Scale
210
In the CO₂ Wave menu or the Setup CO₂ menu, select Scale.
Choose a suitable scale range from the pop-up list.
14 Monitoring Carbon Dioxide
Setting up CO2 Corrections
Temperature, water vapor in the patient's breath, barometric pressure, and the proportions of O2, N2O
and Helium in the mixture all influence CO2 absorption. If values seem inaccurately high or low, check
that the monitor is using the appropriate corrections.
Correction
Altitude
(M3014A only)
Altitude is set during installation. The monitor automatically applies an
appropriate correction.
O2
(M3014A only)
In the Setup CO₂ menu, select Oxy. Corr and select a value between 20% and
100%, the default value is 20%.
Humidity
At installation, the monitor is configured to automatically apply either Body
Temperature Pressure Saturated (BTPS) or Ambient Temperature Pressure
Dry (ATPD). To see which, go to the Setup CO₂ menu, and scroll down to
look at Hum. Corr or Humidity Corr..
N2 O
(M3015A/B
microstream only)
In the Setup CO₂ menu, select N₂O Corr. and turn on or off. If N2O is present
in the ventilation gas mixture, you must turn this on.
Gas
(M3014A only)
In the Setup CO₂ menu, select Gas Corr. and select Helium, N₂O or turn off. If
Helium or N2O is present in the ventilation gas mixture, you must make the
appropriate selection.
If the N2O correction is not available in the Setup CO₂ menu, the CO2
measurement in your MMS Extension does not require N2O correction or it
is setup with Gas Corr. (see below).
If the Gas correction is not available in the Setup CO₂ menu, the CO2
measurement in your MMS Extension does not require N2O or Helium
correction or the N2O correction is setup with N₂O Corr. (see above).
Agent
(M3014A only)
In the Setup CO₂ menu, select Agt. Corr and select the concentration of the
anesthetic agent (between 0.0% and 20.0%). If an anesthetic agent is present
in the ventilation gas mixture, you must select the appropriate concentration.
Suppressing Sampling (not Mainstream CO2)
To temporarily stop sampling, in the Setup CO₂ menu, select Pump 15min Off or use the CO₂ Pump Off
SmartKey if available.
Selecting Pump 15min Off again before fifteen minutes have passed resets the timer to fifteen minutes.
To re-start the pump, in the Setup CO₂ menu, select Pump On.
Changing CO2 Alarms
This refers to CO2 specific alarms. See the Alarms section for general alarm information.
To change the etCO2 alarm limits, in the Setup CO₂ menu:
Touch the high limit on the alarm limits menu key.
Choose the high alarm limit from the pop-up list that opens.
Touch the low limit on the alarm limits menu key.
Choose the low alarm limit from the pop-up list that opens.
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14 Monitoring Carbon Dioxide
To 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 Delay
This determines the time limit after which the monitor alarms if the patient stops breathing.
In the Setup CO₂ menu, select awRR.
In Setup awRR menu, select Apnea Time.
Choose the apnea alarm delay time.
WARNING
Safety and effectiveness of the respiration measurement method in the detection of apnea,
particularly the apnea of prematurity and apnea of infancy, has not been established.
Prolonged delay: The selected apnea alarm delay may be prolonged by up to 17 seconds, if an apnea
occurs during the automatic zero process. This applies to the Microstream (M3015A) measurement
only.
Deriving Alarms From awRR
In the Setup CO₂ menu, select awRR.
In the Setup awRR menu, select Alarms.
Choose On to derive alarms from the airway respiration signal or Off to disable them.
Changing awRR Alarm Limits
In the Setup CO₂ menu, select awRR.
Select High Limit to set the upper alarm limit.
Select Low Limit to set the lower alarm limit.
Select the appropriate setting.
Changing IPI Alarm Limits
In the Setup CO₂ menu, select IPI.
Select Low Limit to set the low alarm limit.
Select 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.
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14 Monitoring Carbon Dioxide
Understanding the IPI Numeric
The 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:
IPI
Patient Status
10
Normal
8-9
Within normal range
Close to normal range; requires attention
5-6
Requires attention and may require intervention
3-4
Requires intervention
1-2
Requires immediate intervention.
NOTE
The 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.
WARNING
Ensure 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.
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15
Using a Telemetry Device and a
Monitor
15
The 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 Pairing
The telemetry device can be paired with the monitor at the Information Center or at the monitor. For
detailed information regarding pairing and configuration at the Information Center, see the
Information Center Instructions for Use.
To pair the monitor with a telemetry device at the monitor:
Select Main Setup then Measurements
Select Telemetry
The Setup Telemetry menu will appear with only one entry Paired Equipment.
Enter here the equipment label of the telemetry device to be paired.
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15 Using a Telemetry Device and a Monitor
Pairing at the monitor is only possible when the monitor already has a connection to the Information
Center and the Information Center software version allows pairing at the monitor.
Own Patient Overview Window
The 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 Pairing
The 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 Monitor
A 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.
NOTE
If 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.
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15 Using a Telemetry Device and a Monitor
To assign a telemetry device to a monitor:
Press the Check button on the telemetry device.
The measurement selection key on the monitor will change to show the "add cableless" symbol
Select the symbol.
In the Add Cableless window, select the correct equipment label for the telemetry device.
Check 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 monitor
To 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.
WARNING
Short 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.
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15 Using a Telemetry Device and a Monitor
Unpairing the Monitor and Telemetry Device
If 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 device
or
use the Unpair function at the Information Center.
NOTE
The SmartKeys and pop-up keys for unpairing appear only on the monitor which is directly involved
in pairing.
Temporarily Stopping the Short Range Radio
Connection
To temporarily disable the SRR connection for this device, for example, in case of interference:
Open the Equipment window - either directly in Main Setup or by selecting the bed label in the
information line.
Select the telemetry device.
Select 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:
•
218
Select Enable SRR and press the check button on the telemetry transceiver.
16
Enhancing Telemetry
Monitoring with the Monitor
16
You 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 Requirements
The 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 Center
The 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.
NOTE
The 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 Transceiver
Assign the telemetry transceiver to the monitor; see “Assigning a Telemetry Transceiver with an
SRR Adapter to a Monitor” on page 99.
Make 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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16 Enhancing Telemetry Monitoring with the Monitor
220
17
17
Trends
Trends 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 aperiodicallymeasured parameters, such as Cardiac Output.
Viewing Trends
Trend information can be viewed embedded as a screen element on specially-designed Screens, or you
can open a trend window over the current Screen.
•
To view trends embedded as a screen element, enter the Change Screen window, then select a
Screen designed to show an embedded trend window.
•
To open the tabular trends window over the current Screen, select Main Setup, Trends, then Vitals
Trend,
•
or select the Vitals Trend SmartKey
To open the graphic trends window over the current Screen, select the Graph Trend SmartKey
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 Keys
When 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.
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17 Trends
Pop-Up Keys
Selecting this pop-up key lets you....
Select Group
see a pop-up list of trend groups and select a group for viewing.
Select Interval
see a pop-up list of available data resolution settings and select the level of
detail shown in the trend view.
Print/ Record
print a tabular trends report or make a tabular trend recording of the data in
the current window. The report will use the current trend interval settings.
Print
print a graphic trends report 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.
222
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 Trends
Viewing Graphic Trends
Scroll to view more pop-up keys
A cursor spanning all measurements in the trend group helps you to navigate through the trends
database and shows you your current position in the database. When the cursor is moved across the
time line, the values measured at the cursor time are shown in the right hand column.
In graphical trends, aperiodic measurement trends are shown as an asterisk, NBP has a special symbol.
To use the trend cursor to navigate in time through the trends database,
Select the graphical trend or the arrow pop-up keys to activate the cursor.
Use the arrow pop-up keys to move the trend cursor backwards and forwards in time, or
Place the cursor at a specific time by touching the graph.
Viewing Vital Signs Trends
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17 Trends
Aperiodic values are shown with a timestamp
Scroll to view more pop-up keys
The currently-selected column is highlighted. The values can be configured to display in the same
colors as the waves and numerics on the realtime display.
Any values available for display before the next scheduled update are shown in the right hand column,
with a timestamp in brackets.
If more than one value is available for an aperiodic trend for a certain trend period, all measured values
are stored in the database and the value closest to the timestamp is shown in the Vital Signs display
marked with an arrow.
To view the Vital Signs trend with one column for each NBP measurement (see “Defining the Column
Interval Using the NBP Measurement” on page 227):
With the Vital Signs trend open, select Interval.
Select NBP from the pop-up list.
Setting Up Trends
Trends are set up in Configuration Mode. You can make temporary changes to trends settings such as
trend groups, priorities, or scales in Monitoring Mode. The general settings for all Trends are under
Main Setup, Trends.
Settings for a single segment in graphical trends or for the corresponding trend group can be made
more easily in that segment menu.
Making Segment Settings
The Graphical Trends window is divided into measurement segments, each of which has its own
settings.
To enter the segment menu,
•
select the left hand column of the segment, where the measurement label is displayed.
Expanded View
To expand the segment to fill the Graphical Trends window,
•
in the Segment menu, select Expand to have that segment enlarged to fill the window.
In the expanded view, you can also highlight a measurement to make it more easily visible (for example
when multiple ST trends are in one segment). To highlight a measurement,
•
in the Segment menu, select Highlight repeatedly until the highlight is on the required
measurement.
To return the segment to its original size,
•
in the Segment menu, select Expand again.
Trend Scales for Segment Measurements
To change the trend scales for a measurement in the current segment:
224
In the Segment menu, select the measurement label.
Select Upper to change the upper limit of the scale or Lower to change the lower limit of the scale.
17 Trends
Optimum Scale
To have the monitor automatically select an optimum scale for viewing, based on current values,
•
in the Segment menu, select Optimum Scale.
This scale change is temporary. When the graphical trend window is closed the scale reverts back to
the setting in Parameter Scales.
To switch off automatic optimum scaling,
•
in the Segment menu, select Optimum Scale again.
Trend Group
To add or remove measurements for this trend group or change the order of the existing
measurements:
In the Segment menu, select Change Group.
Use the Add, Change, Sort Up and Sort Down pop-up keys to change or re-order the group as
required.
Number of Segments
In an embedded graphical trend window, you can select the number of segments to be displayed in the
Segment menu:
•
In the Segment menu, select No. of Segments.
Trend Groups
The measurements grouped in trend groups define the trends displayed together in the Vital Signs or
Graphical Trends windows and printed in trends reports and recordings. The sequence of the
measurements in the group defines the order in which they are displayed. Measurements listed
between dotted line separators are displayed overlapping. The trend group All contains all available
measurements, you cannot change the order or selection of this group.
To change the selection of measurements in a trend group, either use the Change Group setting in the
menu or:
Segment
Select Main Setup, Trends, then Trend Groups.
Select the Trend Group you want to change and use the pop-up keys to Add, Change, or Delete the
selection of measurements trended.
To temporarily change the order in which the measurements are displayed in a group,
Select Main Setup, Trends, then Trend Groups.
Select the Trend Group and then the measurement you want to move and use the Sort Up/Sort
Down pop-up keys.
Trend Interval
The trend interval defines the resolution of trend data shown on the Screen.
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.
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17 Trends
Trend Priority
The 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,
In the Main Setup menu, select Trends.
Select Trend Priority.
To add measurements to the priority list,
Select the pop-up key Add and choose from the pop-up list of available measurements.
Use the Sort Up and Sort Down pop-up keys to change the priority order.
Trend Parameter Scales
Parameter scales define how the trend waveform will appear on the screen and in trend reports.
Separate scales can be set for adult, pediatric, and neonatal patient trends.
To change the trend parameter scales settings, either use the Scale setting in the Segment menu or:
In the Main Setup menu, select Trends.
Select Parameter Scales.
Select the measurement or parameter you want to change from the list.
Select the pop-up key Change to call up the Scale menu.
In the Scale menu, select the parameter label you want to define settings for. Select Adult, Pedi, and
Neo and use the pop-up keypad to enter new upper and lower scale definitions.
Graphical Trend Presentation
Graphical trends and screen trends for measurements with compound values (for example ABP or
CO2) can be viewed in line or band form.
To change the presentation style,
Select Main Setup then select Trends.
Select Global Style and choose
•
Line
•
Band to fill the area between the trend lines, for example, between the systolic and diastolic
pressures, with color.
to display the trends as a continuous line
This sample ABP trend shows the continuously-measured values for the systolic, diastolic and mean
pressures displayed in band form.
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17 Trends
Defining the Column Interval Using the NBP Measurement
You can have the NBP measurement determine the interval between the columns on the Vital Signs
trend. Each NBP measurement will generate a column in the trend table. The values for the other
measurements are added to the column to provide a complete vital signs set for the NBP measurement
time.
To use the NBP measurement to determine the column interval:
Select Main Setup then Trends.
In the Trends menu, select Setup VitalSigns.
In the Vital Signs menu, select Column and then NBP from the pop-up menu.
Documenting Trends
To 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 Databases
The 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 configuration
In this example, we see that the monitor stores the most recent data at the highest resolution, older
data are stored at a lower resolution.
"4 hours @ 12 second resolution" means that the monitor stores trend data every 12 seconds, for the
most recent four hours.
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17 Trends
Aperiodic Trends Database
Aperiodic trends do not count toward the maximum number of trends allowed by the trend
configuration. Trend data for aperiodic measurements is stored in a separate database and
timestamped with the measurement time.
Trending Multiple-Value Measurements
Some measurements generate multiple values, for example invasive pressure measurements can
provide systolic, diastolic, and mean values. These values are trended as separate measurements.
Screen Trends
Trends configured to display permanently on special monitor Screens are called Screen Trends. The
selection and number of measurement waves in the Screen Trend segment depends on your monitor
configuration. Screen Trends are color-coded to match the measurement wave and numerics, and they
can be viewed in graphical, tabular, histogram or horizon format.
If you do not see Screen Trends on the monitor Screen, select a different Screen, one that is configured
to show Screen Trends. Screen Trends are only available on specially designed Screens.
Screen Trend information is taken from the Trends database. If you do not see a Screen Trend for a
particular measurement on the Screen, check the trend priority list to ensure that this measurement is
being trended.
Setting the Screen Trend Time
To set the ScreenTrend Time for all graphical, histogram and horizon screen trends ("global" trend
time),
Select a screen trend then select Setup Trend, or select Main Setup then select Trends.
Select ScreenTrend Time and select the required time: 30 minutes, one, two, four, eight, or twelve
hours.
This is now the Global screen trend time and defines the period of trend information shown for
all screen trends.
To set a different ScreenTrend Time for a screen trend or a group of aligned screen trends,
Select a screen trend.
Select Change TrendTime.
Select the required trend time.
Selecting Global leaves the trend time set to the global screen trend time.
Changing the Selection of Screen Trends Displayed
228
Select the screen trend.
Select Change Trend and select the required trend from the list of available trends.
Select Blank to remove the selected trend from the Screen.
If you do not see Change Trend in the screen trend menu, the trend is aligned to display with the
measurement wave. Changing the wave automatically changes the trend.
17 Trends
To display two or more screen trends overlapping,
Select the screen trend to open the screen trend menu,
Select Change Trend followed by Add Trend and select a screen trend from the pop-up list.
Activating the Cursor for Screen Trends
To activate the cursor for Screen Trends:
Select the screen trend.
Select Activate Cursor.
You can now use the arrow keys to move the cursor across the time line. The values measured at the
cursor time are shown next to the cursor.
To de-activate the cursor,
•
Press the Main Screen key.
Changing the Screen Trend View
To switch between tabular, graphic, histogram and horizon views, select the screen trend then select
Change View and select the required view.
Tabular View
Aperiodic measurements such as NBP, can be viewed as a screen trend in tabular form. The measured
values and their timestamps are shown, with the measurement label.
Horizon View
The horizon view presents trend information superimposed over a defined baseline or base range. This
helps you visualize changes in your patient's condition since the baseline was set.
The horizon view is made up of:
•
a horizon, drawn in white, as a reference point or baseline to help you visualize changes in your
patient's condition. The horizon can be set to represent your patient's current condition, or a
target condition and can be a single value or a range.
•
a graphical trend, displaying patient data for the set TrendTime (1).
•
a trend indicator arrow, indicating how the patient trend has developed in the set time period
(10 minutes, 5 minutes or 2 minutes) (2).
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17 Trends
•
a deviation bar, showing how the currently measured value deviates from the set horizon (3). The
height of the deviation bar is an indication of the extent of the change in your patient's condition
relative to the (horizon) baseline.
Your monitor may not be configured to show all elements of the screen trend horizon view.
Setting the Horizon
The horizon is the reference value to which deviations in the measurements are compared.
To set the horizon:
Select the horizon trend.
Select
– Set High Horizon to select the upper horizon value. If the high and low horizon values are the
same, the horizon is a baseline - if the values are different the horizon is a range.
– Set Low Horizon to select the lower horizon value.
– Auto Horizon to set the horizon for the selected horizon trend to the currently-measured value.
– Auto All to reset the horizon for all horizon screen trends to the currently-measured values.
– Set Horizon to set the horizon to a specific value from a pop-up list.
Setting the Horizon Trend Scale
The horizon trend scale is defined with respect to the horizon. If your horizon is set to 100 and you
select 20 as the horizon scale delta, the upper limit of the horizon scale will be 120 and lower limit 80.
To set the horizon trend scale delta,
Select the horizon trend.
Select Set Scale Delta and select a value to define the distance between the horizon and the upper
and lower scale limits.
Be aware that changing the horizon trend scale can change the angle of the trend indicator, without the
patient's condition having changed.
If a measurement exceeds the outer limits of the scale, the wave will be clipped and you must either
reset the horizon or the horizon trend scale to display the values outside the scale limits.
Setting the Time Period for the Trend Indicator Arrow
The time period for which the trend indicator arrow is displayed can be set in the Trends window.
230
Select Main Setup then select Trends.
Select HorizonArrowTime.
Select 10, 5 or 2 minutes.
18
18
Recording
Central
Recording
For central recording from the bedside, your monitor must be connected via a network to an
Information Center. You can use either the M1116B/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 Recordings
The 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.
Delayed Recordng
RT A Recordng
RT B Recordng
Select Waves
Setup Recordng
Stop All Recordng
Recording Without a Template
To record without a preconfigured template, selecting the waves you require,
Select the Main Setup SmartKey, then select Recordings.
Select the pop-up key Select Waves.
Use the pop-up keys to choose up to three measurement waves to be printed on the recording. If
you want fewer than three waves on the recording, select the waves you want then select the
Continue pop-up key.
Select one of the recording speed pop-up keys to set the required recording speed.
Select the Start pop-up key to start the recording.
recordings use default values for any recorder settings not defined: runtime is continuous,
overlapping is set to non-overlapping.
Select Waves
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Overview of Recording Types
Delayed
Alarm
Realtime (RT)
manual
automatic, triggered by defined alarm
conditions
manual
Recording
Destination
central
central
printer
central
Information
recorded
from the start trigger
minus the delay time
from the start trigger
minus the delay time
n/a
from the start trigger
up to 2
n/a
up to 2
Type of recording
Number of waves up to 2
Speed
50, 25, 6.25 mm/sec
25 mm/sec
n/a
50, 25, 6.25 mm/sec
Runtime
n/a
n/a
n/a
continuously
Stops
automatically
automatically
n/a
manually
Delay Time
10, 15 seconds
10, 15 seconds
n/a
none
Off
Off
n/a
Off
On (up to 2 waves)
On (up to 2 waves)
Overlap
On (up to 2 waves)
n/a = not applicable
Creating and Changing Recordings Templates
To save you defining recording settings each time you start a recording, you can create templates for
commonly-used types of recordings in the Setup 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.
232
Select the Main Setup SmartKey to call up the Main Setup menu.
Select Recordings.
Select the Setup Recordng pop-up key to enter the Setup Recordings menu.
Select 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.
Design 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.
18 Recording
•
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 Strips
Recording ink sometimes fades when covered with transparent tape. Avoid covering any part of a
recording that is clinically relevant (annotation or waveforms) when taping a recording strip to a
patient record or other patient documentation.
Recorder Status Messages
CAUTION
If 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
 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.
233
18 Recording
234
19
19
Printing Patient Reports
Starting Report Printouts
Most patient reports can be printed by selecting Main Setup then Reports (or the Print Reports
SmartKey) and then selecting the report name in the top half of the Reports menu. Report names are
shown only for reports that have been correctly set up.
Data from the time of the print request is printed, even if the print job is delayed in the printer queue.
Your monitor can also be set up to automatically print all reports when a matching printer is available.
To set this up
Select Main Setup, then select Reports.
Select Auto Print Dbs.
– Always will print all reports when a matching printer is available.
– 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 Location
Depending 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.
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19 Printing Patient Reports
Starting the Different Types of Report
Report types
Report contents
How to start printing reports
Vital Signs Report
Depends on selected trend group, data resolution,
and period.
In the Vital Signs window, select Print/ Record,
then select Print.
In the Graphical Trends window, select Print.
Graphic Trends Report
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.
ECG Reports
Depends on format selected.
12-Lead Report
Captured ECG waves, measurement values, ST Map In an active 12-Lead application window, select the
(optional) and analysis results from the Information Print Report pop-up key.
Center (PIIC iX only)
ST Map Report
ST data in a transversal and/or horizontal multi-axis In the ST Map (Current) or ST Map (Trend)
diagram
window, select Print.
Alarm Limits Report
Graphic and numeric report of all current alarm
limits
In 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 waves
Select the Realtime Report SmartKey, if
configured.
Battery Report
Battery serial number, information on the currently- In the Battery Status window, select Print Status.
measured and potential charge status of the battery
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.
Stopping Reports Printouts
To stop Reports printing, in the Reports menu, select
to stop the current print job
•
Delete Report
•
Delete All Repts
to cancel all queued report printouts
•
Scheduled Rep.
to select Off and switch off scheduled reports.
Setting Up Reports
The content you define in the individual Setup Reports menus will be used in all reports of this type: for
example, if you set a print speed of 50 mm/sec in the ECG Reports menu, every ECG report will be
printed at this speed, irrespective of format.
ECG report layout and Auto Reports settings must be defined in Configuration Mode.
Setting Up ECG Reports
The settings you choose in the ECG Reports menu apply for all ECG-A and ECG-B reports printed. To
set up ECG Reports,
236
Select Main Setup, Reports, then ECG Reports. Note the report layout configured for your monitor,
either Internat or Cabrera. This setting is inactive ("grayed-out") in Monitoring Mode and can only
be changed in Configuration Mode.
19 Printing Patient Reports
Select ECG Gain and set the required ECG gain to define how ECG waves will appear on the ECG
report printouts.
Select Speed and select the report print speed.
Select Annotation and switch to On if the printed ECG wave should be annotated with beat labels.
See the “ECG, Arrhythmia, ST and QT Monitoring” chapter for a list of beat labels. Pace pulse
marks are automatically printed beside the wave for paced patients.
Setting Up Vital Signs and Graphic Trend Reports
The settings you choose in the Vital Signs Report and Graphical Trend Report menus apply for all Vital
Signs and Graphic Trend reports printed.
To set up Vital Signs and Graphic Trend reports,
Select Main Setup, Reports, then Vital Signs Rep. or Graph Trend Rep..
Select Trend Group and select the group you want to print on the report. The groups available
depend on your monitor's trend configuration.
Select Period and select the period of time for which trend data should be printed on the report. If
Automatic Period is configured to On, all trend data for the current patient will be printed,
irrespective which trend period is selected.
Select Interval (Vital Signs Reports only) and select the resolution of the trend data printed on the
report.
Setting Up Auto Reports
Auto Reports print automatically when a specified trigger occurs. There are two types of Auto Reports:
Scheduled Reports, which print at predefined intervals, and End Case Reports, which print when a
patient is discharged using the End Case function. An Auto Report can be both a Scheduled Report
and an End Case report.
To set up Auto Reports,
Select Main Setup, Reports, then Auto Reports and select the Auto Report you want to set up (A, B,
C, or D).
Select Report and assign a report type to the Auto Report.
Select End Case Report and switch to On if you want the selected report to print automatically when
you select End Case to discharge a patient.
Switch End Case Report to Off if the report is a Scheduled Report only.
Select Scheduled Rep. and toggle to On if you want the selected report to print at predefined
intervals, starting at a predefined time of day. The start time you set applies for every following day.
For example, if you set a start time of 07:00 and a repeat time of six hours, the first report will print
at 07:00 every day, the next at 13:00 and so on.
– To set the time of day at which you want the report to print every day: select Start Hour and
Start Minute and select the required time from the pop-up list
– To set the time interval in minutes between two scheduled reports: select Rep. Freq. (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.
Repeat the procedure for all Auto Reports you want to set up.
All Auto Reports or Scheduled Reports set to On print automatically at the predefined trigger.
237
19 Printing Patient Reports
Be 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 Jobs
To adjust the appearance of individual print jobs, in the Reports menu,
Select Main Setup, Reports, then Setup Reports to enter the Setup Reports menu.
Select Report and then select the report you want to set up.
Select Report Type and then select the reports template you want the report selected in Step 2 to
use. The selection of templates listed depends on the report type selected.
Each template includes patient demographic data, and each Realtime Report also includes alarm
and INOP information. In addition, the templates include:
VisibleWaves: all waves currently visible, in the order they appear on the screen.
All Waves: all measured waves.
RT Waves: all currently measured realtime waves, according to the monitor's priority list.
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.
Select Report Size to set the paper size to be used for the report: Unspecified to use the default size
for the template chosen, Universal, A4, Letter, LrgUniversal, A3, or Ledger. The list of available sizes
depends on the report type selected.
Select Orientation to set the orientation of the report printout: Unspecified to use the default size
for the template chosen, Landscape or Portrait.
Select Target Device and choose which printer the print job will be sent to: Unspecified to use the
default printer, or choose from the list of printer names defined at the Information Center or in
the monitor's Configuration Mode (for example, Remote 1 or Database).
Some settings may be inactive ("grayed-out") in this menu for reports that can only be started in a
special window.
Checking Printer Settings
The printer settings for your monitor are defined in Configuration Mode. The printer settings Paper
Size, Resolution, Color Support, and Duplex Option for the active printer are visible but inactive ("grayedout") 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
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.
Printers
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19 Printing Patient Reports
Printing a Test Report
A test report can be printed in Configuration mode, refer to the Service Guide for details.
Switching Printers On or Off for Reports
You can enable or disable printer status to switch individual printers on or off for report printouts.
In the Setup Printers menu, select Printer and then select the name of the device you want to switch
on or off for Reports printing from the pop-up list.
Select Printer Status to 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 Reports
If a section of a wave on a report is drawn with dashed lines, this tells you that a setting that affects the
appearance of the wave on the screen was changed while the report was printing.
For example, if you change the wave scale while a report is printing, the wave scale and wave size are
changed immediately on the monitor screen and on the report. To indicate that the scale information
printed at the beginning of the report no longer matches the currently used scale, the wave will be
printed using dashed lines, starting from the moment the change took place.
Some examples of settings that cause dashed lines in reports if changed during printing are: Filter
mode, ECG lead placement, wave scale, measurement unit, paced/non-paced setting, and
measurement mode. Note that as ECG waves are drawn with a fixed gain on reports (either 10 mm/
mV or 20 mm/mV), changing the ECG wave scale will not cause dashed-line reports.
To avoid dashed lines on reports, wait 15 seconds after changing a setting before you trigger a report.
Unavailable Printer: Re-routing Reports
If you send a report to be printed on a printer that is not available, for example, because it has run out
of paper, this print job is suspended and stored in the monitor's memory.
If the target device of this print job was set to Unspecified, the monitor will periodically try to resend
the print job to the first printer listed in the Setup Printers menu under Printer that is set to Enabled and
that has paper of the correct size.
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19 Printing Patient Reports
To allow the report to print, you must either solve the problem with the target printer, or re-route the
print job to another printer with paper of the correct size. To re-route a print job,
•
Enable the new target printer by selecting it in the Setup Printers menu and toggling to Enabled. As
the monitor tries to send the report to the printers in the order they are listed, you must make sure
that all the printers above the new target printer are disabled.
If the target device of the print job was set to a specific printer, re-routing is not possible.
Checking Report Status and Printing Manually
A list of all print requests which are waiting, printing or stored can be viewed in the 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.
CAUTION
The 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 Manually
Those jobs shown in black will be printed automatically when a matching printer is available. If the
Auto Print Dbs setting is Host Only or Never, some or all reports will not be printed automatically and
will be shown in gray. Any jobs shown in gray must be printed manually; to do this,
In the Report List, select the required report
Select Print Report.
Selecting Print All Reps will send all reports to the printer.
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19 Printing Patient Reports
Printer Status Messages
Printer Status Message
Possible causes and suggested action
Print job queued for 
The report has been placed in the queue for the named printer.
Print job can't queue;resources?
The printer queue is full and the monitor cannot accept another
report request. Wait until some more reports have been printed,
then try again, OR
Print job can't queue;queue full
Print job can't queue;no printer
Cancelling all print jobs
A report has been triggered that uses a paper size unavailable
with the target printer. Try another printer, if available, or change
the paper size of the print request.
Delete All Reps
has been selected in the Reports menu, OR
The Operating Mode has been changed from Monitoring Mode
to Demonstration or Service Mode.
Cancelling the active print job
The current report is being canceled as the result of a user
request.
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 ...
A report is in progress, or the monitor is waiting for the central
printer to accept the print job.
NoPrinter ;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  failed; no data
A report cannot be started on the requested printer.
One of three reasons is shown in the status message:
Job  fail;no printer
Job  fail;data error
Print job on  done
•
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.
The report has been printed.
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19 Printing Patient Reports
Sample Report Printouts
Each report header contains the patient's bed label, last name and first name, middle name (if there is
enough space) the patient ID, the date and time, and the name of the report. The report footer
contains the hospital label and page number, and the last page contains a note to mark the report end.
The monitor may be configured to leave a space on the top left or right of the report printout to enable
you to stick a patient address label on it. This setting is called the Addressograph and it can only be
changed in the monitor's Configuration Mode.
Alarm Limits Report
Measurement labels, with alarms off symbol where alarms are switched off
Graphic view of current alarm limits in relation to currently monitored measurement value
Realtime Report
242
Patient demographic information, time stamp
Active Alarms and INOPs, followed by vital signs
Measurement waves section
19 Printing Patient Reports
ECG Reports
Patient information
Numeric block
Wave area
Below the header on ECG Reports, the numeric block shows the current HR, PVC, and ST values.
The wave area shows the printed waves for all available ECG leads. A 1 mV calibration bar is printed
at the beginning of each wave. With the 3X4, 6X2, and 2X4 formats, a rhythm stripe prints a longer
section of the ECG wave from the primary ECG lead for ECG rhythm evaluation. The ECG signal
bandwidth, the patient's paced status, the ECG gain, and the print speed are printed at the bottom of
the wave area. Pace pulse marks are automatically printed beside the wave for paced patients. Beat
labels can be set to print on the rhythm stripe. The 12X1 (2P) format prints the report over two pages.
ECG Report type
Available Formats
Available Paper Sizes
12-Lead ECG
3X4 landscape
A4, letter, A3, ledger
6X2 landscape
A4, letter, A3, ledger
12X1 portrait
A4 and letter only
12X1 landscape
A4, letter, A3, ledger
12X1 (2P) landscape
A4, letter (2 pages)
2X4 landscape
A4, letter, A3, ledger
8X1 portrait
A4 and letter only
8X1 landscape
A4, letter, A3, ledger
Multi-lead ECG
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19 Printing Patient Reports
12-Lead ECG Report
Patient data
Analysis data from the Information Center (PIIC iX only)
12-Lead wave area
Data related to the wave presentation
ST Map with related ST numerics (optional)
Administrative data - including optional custom text fields
Hospital ID data - Institution, facility and department, if configured
Other Reports
See the sections on Trends for other example reports.
244
20
20
Care and Cleaning
Use only the Philips-approved substances and methods listed in this chapter to clean or disinfect your
equipment. Warranty does not cover damage caused by using unapproved substances or methods.
Philips makes no claims regarding the efficacy of the listed chemicals or methods as a means for
controlling infection. Consult your hospital's Infection Control Officer or Epidemiologist. For
comprehensive details on cleaning agents and their efficacy refer to "Guidelines for Prevention of
Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to Health Care and PublicSafety Workers" issued by the U.S. Department of Health and Human Services, Public Health Service,
Centers for Disease Control, Atlanta, Georgia, February 1989. See also any local policies that apply
within your hospital, and country.
General Points
Keep your monitor, 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.
WARNING
If you spill liquid on the equipment, battery, or accessories, or they are accidentally immersed in liquid,
contact your service personnel or Philips service engineer. Do not operate the equipment before it has
been tested and approved for further use.
245
20 Care and Cleaning
Cleaning the Monitor
Clean with a lint-free cloth, moistened with warm water (40°C/104°F maximum) and soap, a diluted
non-caustic detergent, tenside, ammonia- or alcohol-based cleaning agent. Do not use strong solvents
such as acetone or trichloroethylene.
Take extra care when cleaning the screen of the monitor because it is more sensitive to rough cleaning
methods than the housing. Do not permit any liquid to enter the monitor case and avoid pouring it on
the monitor while cleaning. Do not allow water or cleaning solution to enter the measurement
connectors. Wipe around, not over, connector sockets.
CAUTION
To clean the touch-enabled display, disable the touch operation by switching off the monitor during
the cleaning procedure, or by 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:
Tensides (dishwasher detergents)
Edisonite Schnellreiniger®, Alconox®
Ammonias
Dilution of Ammonia <3%, Window cleaner
Alcohol
Ethanol 70%, Isopropanol 70%, Window cleaner
Disinfecting the Equipment
CAUTION
Solutions: 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:
Product Name
Product Type
Ingredients
Isopropanol
liquid
Isopropanol 80%
Bacillol®
liquid, spray
100 g concentrate contains:
Propan-1-ol 45.0 g;
Propan-2-ol 25.0 g;
Ethanol 4.7 g
Bacillol® 25
liquid
Ethanol 100 mg/g
Propan-2-ol (= 2-Propanol) 90 mg/g;
Propan-1-ol (= 1-Propanol) 60 mg/g
Meliseptol®
spray
50% 1-Propanol
Accel TB RTU
liquid
0.5% accelerated hydrogen peroxide
Oxivir®
spray
0.5% accelerated hydrogen peroxide
wipes
0.5% accelerated hydrogen peroxide
AF
Tb Cleaner Disinfectant
Oxivir® Tb Wipes
246
20 Care and Cleaning
Product Name
Product Type
Ingredients
Carpe DiemTM/MC Tb
spray
0.5% accelerated hydrogen peroxide
Carpe DiemTM/MC Tb Wipes
wipes
0.5% accelerated hydrogen peroxide
Super Sani-Cloth
wipes
isopropanol 55%
quaternary ammonium chlorides 0.5%
wipes
isopropanol 15%
quaternary ammonium chlorides 0.25%
wipes
isopropanol < 0.15%
quaternary ammonium chlorides 0.14%
wipes
1 - 5% hydrogen peroxide
1 - 5% benzyl alcohol
Ready-to-Use General Virucide,
Bactericide, Tuberculocide,
Fungicide, Sanitizer
Germicidal Disposable Wipes
SANI-CLOTH® PLUS
Germicidal Disposable Wipes
SANI-CLOTH® HB Germicidal
Germicidal Disposable Wipes
Clorox ® Hydrogen Peroxide
Disinfecting Wipes 1
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 Equipment
Sterilization 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
Accessories
To 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 Compartment
Wipe 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.
247
20 Care and Cleaning
248
21
21
Using Batteries
The Lithium Ion batteries used in your monitor store a large amount of energy in a small package. This
allows reliable battery-operated monitoring but also requires care in use and handling of the batteries.
Follow the instructions in this chapter and 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.
Battery compartment
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).
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21 Using Batteries
Battery Power Indicators
The battery LED and battery status information on the Main Screen, in combination with INOP
messages and prompts, help you keep track of the battery power status. The indicators always show
the remaining capacity in relation to the battery's actual maximum capacity, which may lessen as the
battery ages. You can see the actual capacity in the Battery Status window.
Battery LED
The battery LED on the front panel of the monitor is indicated by a battery symbol.
Battery LED
The battery LED is off during regular monitoring, when none of the following situations is present:
Battery LED Colors
If the monitor is connected to
the external power supply
(M8023A), this means
Yellow
battery charging
less than 10 minutes power
remaining
Red, flashing
Red, flashes
intermittently
If the monitor is running on
battery power, this means
battery or charger malfunction
battery malfunction
Battery Status on the Main Screen
The 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.
250
21 Using Batteries
If 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).
Battery status indicator
Alternates with the battery gauge on
the Main Screen.
Check in the Battery Status window to
see which status symbol is displayed for
which battery to identify the cause.
Battery malfunction indicator
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.
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 Window
To access the Battery Status window and its associated pop-up keys, select the battery status
information on the Screen, or select Main Setup 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).
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.
TimeToFull
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.
251
21 Using Batteries
Symbols indicating critical situations are colored red.
Battery status symbols
Battery malfunction symbols
battery is empty
(red) incompatible battery
battery not charging as the temperature is
above or below the specified range
(red) battery malfunction
battery requires maintenance
(red) battery has no power left
charging stopped to protect the battery
(red) battery temperature too high
Printing Battery Reports
To print the information in the Battery Status window on a connected printer,
Select the battery status information on the Screen to open the Battery Status window
Select the Print Status pop-up key.
Checking Battery Charge
To check the charge status of a battery, refer to the battery power gauge on the screen, or open the
Battery Status window.
When Battery Lifetime is Expired
When the battery is aged, either after 3 years from manufacturing date or after 500 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.
WARNING
The 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.
252
21 Using Batteries
Replacing a Battery
To replace the battery,
Press 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.
Remove the battery from the compartment.
Slide the new battery into position with the contacts facing downwards. It should 'click' into
position when it is fully inserted.
WARNING
Do not insert your fingers or any objects into the open battery compartment.
253
21 Using Batteries
Replacing the Battery in the Battery Extension
To replace the battery,
Push the battery cover downwards, so that it opens.
Remove the battery from the compartment.
Slide the new battery firmly into position with the label facing downwards.
Close the battery cover and push it upwards, so that it remains closed.
Optimizing Battery Performance
The performance of rechargeable batteries may deteriorate over time. Battery maintenance as
recommended here can help to slow down this process.
254
21 Using Batteries
Display Brightness Setting
In the Main Setup menu, select User Interface, Brightness, then Optimum. This selects a level of
brightness suitable for most monitoring locations that uses less battery power than brighter
settings.
Ensure that the current level of brightness is suitable for your monitoring location.
Charging a Battery
A battery can be charged in a monitor during monitoring. You can also use the 865432 Smart Battery
Conditioner (previously M8043A) to charge batteries.
Insert the battery into a monitor connected to the external power supply (M8023A).
Charge 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 Battery
You 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.
CAUTION
Do 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,
Insert the battery into a monitor connected to the external power supply (M8023A) that is
connected to mains power.
Switch the monitor power off.
Charge the battery until it is completely full. Open the Battery Status window.
Check that the Batt fully charged message is displayed.
Disconnect the monitor from mains power and let the monitor run until there is no battery power
left and the monitor switches itself off.
Reconnect the monitor to mains power and charge the battery until it is full for use or charge to
50% for storage.
To condition the battery from a Battery Extension, use the 865432 Smart Battery Conditioner.
255
21 Using Batteries
Storing a Battery
A 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.
NOTE
The 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 Batteries
Dispose 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 Information
WARNING
256
•
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.
22
Maintenance and
Troubleshooting
22
WARNING
Schedule: Failure on the part of the responsible individual hospital or institution employing the use of
this equipment to implement a satisfactory maintenance schedule may cause undue equipment failure
and possible health hazards.
Contact: If you discover a problem with any of the equipment, contact your service personnel, Philips,
or your authorized supplier.
Inspecting the Equipment and Accessories
Perform a visual inspection before every use, and in accordance with your hospital's policy. With the
monitor switched off:
Examine unit exteriors for cleanliness and general physical condition. Make sure that the housings
are not cracked or broken, that everything is present, that there are no spilled liquids and that there
are no signs of abuse.
Inspect all accessories (cables, transducers, sensors and so forth). If any show signs of damage, or
the use-by date has been exceeded, do not use.
Switch the monitor on and make sure the backlight is bright enough. Check that screen is at its full
brightness. If the brightness is not adequate, contact your service personnel or your supplier.
WARNING
Electrical Shock Hazard: Do not open the monitor or measurement device. Contact with exposed
electrical components may cause electrical shock. Always turn off and remove power before cleaning
the sensor, monitor or measurement device. Do not use a damaged sensor or one with exposed
electrical contacts. Refer servicing to qualified service personnel.
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22 Maintenance and Troubleshooting
Inspecting the Cables and Cords
Examine all system cables, the power plug and cord for damage. Make sure that the prongs of the
plug do not move in the casing. If damaged, replace it with an appropriate Philips power cord.
Inspect the patient cables, leads and their strain reliefs for general condition. Make sure there are
no breaks in the insulation. Make sure that the connectors are properly engaged at each end to
prevent rotation or other strain.
Apply the transducer or electrodes to the patient, and with the monitor switched on, flex the
patient cables near each end to make sure that there are no intermittent faults.
Maintenance Task and Test Schedule
The following tasks are for Philips-qualified service professionals only. All maintenance tasks and
performance tests are documented in detail in the service documentation supplied on the monitor
documentation DVD.
Ensure that these tasks are carried out as indicated by the monitor's maintenance schedule, or as
specified by local laws. Contact a Philips-qualified service provider if your monitor needs a safety or
performance test. Clean and disinfect equipment to decontaminate it before testing or maintaining it.
Type
Maintenance and Test Activities
Frequency
Monitor Tests
Safety checks. Selected tests on the basis of
IEC 60601-1.
At least once every two years, or as needed, after
any repairs where the power supply is removed
or replaced, or if the monitor has been dropped.
Monitor
Maintenance
Check ECG synchronization of the monitor At least once every two years, or as needed.
and defibrillator (only if hospital protocol
requires use of monitor during defibrillation).
Measurement Tests
Performance assurance for all measurements At least once every two years, or if you suspect
not listed below.
the measurement values are incorrect.
Measurement
Maintenance
NBP calibration
At least once every two years, or as specified by
local laws.
Microstream CO2 calibration and
performance test
At least once a year or after 4000 operating
hours.
Mainstream and sidestream CO2 calibration
and sidestream flow check
At 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.
Troubleshooting
If you suspect a problem with an individual measurement, read the Instructions for Use and doublecheck that you have set up the measurement correctly.
If you suspect an intermittent, system-wide problem call your service personnel. You may be asked for
information from the status log. To view the status log,
In the Main Setup menu, select Revisions.
258
Select Status Log.
22 Maintenance and Troubleshooting
Disposing of the Monitor
WARNING
To avoid contaminating or infecting personnel, the environment or other equipment, make sure you
disinfect and decontaminate the monitor appropriately before disposing of it in accordance with your
country's laws for equipment containing electrical and electronic parts. For disposal of parts and
accessories such as thermometers, where not otherwise specified, follow local regulations regarding
disposal of hospital waste.
You can disassemble the monitor as described in the Service Guide.
You will find detailed disposal information on the following web page:
http://www.healthcare.philips.com/main/about/Sustainability/Recycling/pm.wpd
The Recycling Passports located there contain information on the material content of the equipment,
including potentially dangerous materials which must be removed before recycling (for example,
batteries and parts containing mercury or magnesium).
Do not dispose of electrical and electronic equipment as unsorted municipal waste. Collect it
separately, so that it can be safely and properly reused, treated, recycled, or recovered.
Disposing of Empty Calibration Gas Cylinders
Empty the cylinder completely by pushing in the pin of the regulator valve or by pulling out the
pin of the fill valve using a tire valve stem wrench or a pair of needle nose pliers.
When the cylinder is empty, either remove the valve stem from the fill (or regulator) hole, or drill a
hole in the cylinder.
Write "Empty" on the cylinder and dispose of it appropriately for scrap metal.
WARNING
Ensure that the cylinder is completely empty before trying to remove the valve stem or drill a hole in
the cylinder.
259
22 Maintenance and Troubleshooting
260
23
23
Accessories
This 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.
WARNING
Reuse: Never reuse disposable transducers, sensors, accessories and so forth that are intended for
single use, or single patient use only. Reuse may compromise device functionality and system
performance and cause a potential hazard.
Philips' approval: Use only Philips-approved accessories. Using non-Philips-approved accessories
may compromise device functionality and system performance and cause a potential hazard.
Packaging: Do not use a sterilized accessory if its packaging is damaged.
Correct Use: Always follow the instructions for use supplied with the accessories.
ECG/Resp Accessories
This symbol indicates that the cables and accessories are designed to have special protection
against electric shocks (particularly regarding allowable leakage currents), and are defibrillator proof.
The following cables may not all be available in all countries. Please check availability with your local
Philips supplier.
Trunk Cables
For use with:
Part No.
Length
3-Electrode Cable Set
M1669A
2.7 m
3-Electrode Cable Set, OR
989803170171
2.7 m
5-Electrode Cable Set
M1668A
2.7 m
5-Electrode Cable Set, OR
989803170181
2.7 m
261
23 Accessories
For use with:
Part No.
Length
6-Electrode Cable Set
M1667A
2.7 m
10-Electrode Cable set (5+5)
M1663A
2.7 m
10-Electrode Cable set (6+4)
M1665A
2.7 m
3-Electrode Cable Sets
Description
Length
AAMI Part No.
IEC Part No.
OR Grabber shielded
1.0 m
M1675A
M1678A
ICU Grabber shielded
1.0 m
M1671A
M1672A
ICU snap shielded
1.0 m
M1673A
M1674A
ICU Clip non-shielded
0.45 m
M1622A
--
ICU Clip non-shielded
0.7 m
M1624A
M1626A
Single Patient 3-Electrode Cable Sets
Description
Length
AAMI Part No.
IEC Part No.
ICU Grabber shielded
1.0 m
989803173121
989803174201
ICU Grabber shielded
0.84 m
989803173141
Description
Length
AAMI Part No.
IEC Part No.
OR Grabber shielded
1.0 m/1.6 m
M1973A
M1974A
ICU Grabber shielded
1.0 m/1.6 m
M1968A
M1971A
ICU Snap shielded
1.0 m/1.6 m
M1644A
M1645A
ICU Miniclip non-shielded
0.7 m/1.3 m
M1647A
M1648A
5-Electrode Cable Sets
Single Patient 5-Electrode Cable Sets
Description
Length
AAMI Part No.
IEC Part No.
ICU Grabber shielded
1.0 m
989803173131
989803174211
ICU Grabber shielded
0.85 m
989803173151
Description
Length
AAMI Part No.
IEC Part No.
OR Grabber
1.0 m/1.6 m
M1684A
M1685A
ICU Grabber
1.0 m/1.6 m
M1680A
M1681A
ICU Snap
1.0 m/1.6 m
M1682A
M1683A
6-Electrode Cable Sets
262
23 Accessories
10-Electrode (5+5) Cable Sets
Description
Length
AAMI Part No.
IEC Part No.
ICU Grabber, chest, shielded
1.0 m
M1976A
M1978A
ICU Snap, chest, shielded
1.0 m
M1602A
M1604A
OR Grabber, chest, shielded
1.0 m
M1979A
M1984A
For Limb Leads see 5-electrode cable sets
10-Electrode (6+4) Cable Sets
Description
Length
AAMI Part No.
IEC Part No.
ICU Grabber, chest, shielded
1.0 m
M1532A
M1533A
ICU Snap, chest, shielded
1.0 m
M1537A
M1538A
OR Grabber, chest, shielded
1.0 m
M1557A
M1558A
Description
Length
AAMI Part No.
IEC Part No.
3-lead Grabber, ICU
1.0 m
989803143181
989803143171
5-lead Grabber, ICU
1.0 m
989803143201
989803143191
For Limb Leads see 6-electrode cable sets
One-piece Cables
Radio-translucent Cables
Pack of five single wires, radio-translucent, 0.9 m, M1649A
Set Combiners and Organizers
Description
Set combiner
Set organizer for shielded leadsets - grabber and snap
Set organizer for non-shielded lead sets - miniclip
Part No.
3-electrode
M1501A
5-electrode
M1502A
3-electrode
M1503A
4-electrode
M1664A
5-electrode
M1504A
6-electrode
M1679A
3-electrode
M1636A
5-electrode
M1638A
Bedsheet clip
M1509A
Replacement red cover for trunk cable (for 5-electrode cable sets)
989808148861
263
23 Accessories
5-Electrode One Piece Cables
Description
Length
AAMI Part No.
IEC Part No.
OR Grabber
2.5 m
M1975A
M1985A
ICU Snap
2.5 m
M1977A
M1986A
Set Combiners and Organizers
Description
Part No.
Set combiner
3-electrode
M1501A
5-electrode
M1502A
Shielded 3-electrode
M1503A
Shielded 5-electrode
M1504A
Set organizer
Bedsheet clip
M1509A
NBP Accessories
These cuffs and tubings are designed to have special protection against electric shocks
(particularly regarding allowable leakage currents), and are defibrillator proof. You can use them during
electrosurgery.
Adult/Pediatric Reusable Comfort Care Cuffs
Patient Category
Limb Circumference
Part No.
Tubing
Adult (Thigh)
42 to 54 cm
M1576A
Large Adult
34 to 43 cm
M1575A
Large Adult XL
34 to 43 cm
M1575XL
M1598B (1.5 m)
or
M1599B (3 m)
Adult
27 to 35 cm
M1574A
Adult XL
27 to 35 cm
M1574XL
Small Adult
20.5 to 28 cm
M1573A
Small Adult XL
20.5 to 28 cm
M1573XL
Pediatric
14 to 21.5 cm
M1572A
Infant
10 to 15 cm
M1571A
Adult/Pediatric Reusable Comfort Care Cuff Kits
Cuff Kits
Part No.
Infant, pediatric, small adult, adult
M1577A
Small adult, adult, large adult, thigh
M1578A
Infant, pediatric, small adult, adult, large adult, thigh
M1579A
Small adult XL, adult XL, large adult XL
M1579XL
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23 Accessories
Adult/Pediatric Reusable Easy Care Cuffs
Patient Category
Limb Circumference Part No.
(Pack of five)
Tubing
Adult Thigh
44 - 56 cm
M4559B (M4559B5)
Large Adult X-Long
35 - 45 cm
M4558B (M4558B5)
Large Adult
35 - 45 cm
M4557B (M4557B5)
M1598B (1.5 m)
or
M1599B (3 m)
Adult X-Long
27.5 - 36 cm
M4556B (M4556B5)
Adult
27.5 - 36 cm
M4555B (M4555B5)
Small Adult
20.5 - 28.5 cm
M4554B (M4554B5)
Pediatric
14 - 21.5 cm
M4553B (M4553B5)
Infant
10 - 15 cm
M4552B (M4552B5)
Adult/Pediatric Reusable Easy Care Cuff Kits
Cuff Kits
Part No.
Assortment pack of one small adult, one adult, one large adult and one thigh cuff
864288
Assortment pack of one infant, one pediatric, one small adult and one adult cuff
864289
Assortment pack of one infant, one pediatric, one small adult, one adult, one large adult and 864290
one thigh cuff
Assortment pack of one small adult, one adult, one adult X-long, one large adult, one large
adult X-long and one thigh cuff
864291
Adult/Pediatric Multi Care Cuffs
Patient Category
Limb Circumference
Part No.
Tubing
Adult Thigh
42.0 - 54.0 cm
989803183371
Large Adult
34.0 - 43.0 cm
989803183361
Large Adult X-Long
27.0 - 35.0 cm
989803183351
M1598B (1.5 m)
or
M1599B (3 m)
Adult
27.0 - 35.0 cm
989803183341
Small Adult
20.5 - 28.0 cm
989803183331
Pediatric
14.0 - 21.5 cm
989803183321
Infant
10.0 - 15.0 cm
989803183311
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23 Accessories
Adult/Pediatric Single Patient, Gentle Care Cuffs
Patient Category
Limb Circumference
Part No.
Tubing
Adult (Thigh)
44 - 56 cm
M4579B
Large Adult X-Long
35 - 45 cm
M4578B
Large Adult
35 - 45 cm
M4577B
M1598B (1.5 m)
or
M1599B (3 m)
Adult X-Long
27.5 - 36 cm
M4576B
Adult
27.5 - 36 cm
M4575B
Small Adult
20.5 - 28.5 cm
M4574B
Pediatric
14.0 - 21.5 cm
M4573B
Infant
10 - 15 cm
M4572B
Adult/Pediatric Single Care Cuffs
Patient Category
Limb Circumference
Part No.
Tubing
Large Adult
35.0 - 45.0 cm
989803182321
Adult X-Long
27.5 - 36.0 cm
989803182311
Adult
27.5 - 36.0 cm
989803182301
M1598B (1.5 m)
or
M1599B (3 m)
Small Adult
20.5 - 28.5 cm
989803182291
Pediatric
14.0 - 21.5 cm
989803182281
Adult/Pediatric Value Care Cuffs
Patient Category
Limb Circumference
Part No.
Large Adult
34.0 - 43.0 cm
989803160861
Adult XL
27.0 - 35.0 cm
989803160851
Adult
27.0 - 35.0 cm
989803160841
Small Adult
20.5 - 28.0 cm
989803160831
Pediatric
14.0 - 21.5 cm
989803160821
Infant
10.0 - 15.0 cm
989803160811
266
Tubing
M1598B (1.5 m)
or
M1599B (3 m)
23 Accessories
Neonatal/Infant Single Patient Cuffs
Cuffs
Limb Circumference
Part No.
A - Luer connector
B - ISO 80369-1 compliant
connector
Tubing
Size 1
3.1 to 5.7 cm
M1866A/B
For A-version cuffs:
Size 2
4.3 to 8.0 cm
M1868A/B
Size 3
5.8 to 10.9 cm
M1870A/B
M1596B (1.5 m) or M1597B
(3 m)
Size 4
7.1 to 13.1 cm
M1872A/B
For B-version cuffs:
Size 5 (Infant)
10 to 15 cm
M1873B
M1596C (1.5 m) or M1597C
(3 m)
Neonatal/Infant Single Patient, Soft Cuffs
Cuffs
Limb Circumference
Part No.
Tubing
Size 1
3.1 to 5.7 cm
M1866S
Size 2
4.3 to 8.0 cm
M1868S
Size 3
5.8 to 10.9 cm
M1870S
M1596C (1.5 m)
or
M1597C (3 m)
Size 4
7.1 to 13.1 cm
M1872S
Size 5 (Infant)
10 to 15 cm
M1873S
Neonatal/Infant Cuff Kits
Cuff Kits
Part No.
Standard, Single Patient, Luer connector: 10 x M1866A, 10 x M1868A, 10 x M1872A,
and 20 x M1870A
M1820-60020
Standard, Single Patient, ISO 80369-1 compliant connector: 5 x M1866B, 10 x M1868B, 989803167541
20 x M1870B, 10 x M1872B, and 5 x M1873B
Soft, Single Patient, ISO 80369-1 compliant connector: 5 x M1866S, 10 x M1868S,
20 x M1870S, 10 x M1872S, 5 x M1873S
989803167551
IntelliVue CL NBP Pod Accessories
Mobile CL Cuffs and Accessories
Part Number
Description
Limb
Circumference
Range
Bladder Width
Contents
989803163171
Mobile CL Reusable Small
Adult Cuff
21 - 27 cm
10.5 cm
1 cuff
989803163191
Mobile CL Reusable Adult Cuff 26.0 - 34.5 cm
13.0 cm
1 cuff
989803163211
Mobile CL Reusable Large
Adult Cuff
16.0 cm
1 cuff
33.5 - 45.0 cm
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23 Accessories
Part Number
Description
989803163181
Limb
Circumference
Range
Bladder Width
Contents
Mobile CL Single-Patient Small 21 - 27 cm
Adult Cuff
10.5 cm
20 cuffs
989803163201
Mobile CL Single-Patient Adult 26.0 - 34.5 cm
Cuff
13.0 cm
20 cuffs
989803163221
Mobile CL Single-Patient Large 33.5 - 45.0 cm
Adult Cuff
16.0 cm
20 cuffs
989803163251
Mobile CL NBP Cradle Kit
20 cradles
989803163131
Mobile CL Extension Air Hose, 1.0 m
1 extension air
hose
989803187431
Mobile CL Air Hose - Bayonet
Connector
1 adapter air hose
989803163261
Mobile CL NBP Battery Kit
1 Battery
1 disassembly tool
1 front housing
989803137831
Telemetry Pouch with window
50 pouches
989803140371
Telemetry Pouch with window
4 boxes of
50 pouches
989803101971
(9300-0768-050)
White Telemetry Pouch with
Snaps; box of 50
50 pouches
989803101981
(9300-0768-200)
White Telemetry Pouch with
Snaps; 4 boxes of 50
4 boxes of
50 pouches
Comfort Reusable Cuffs
Part Number
Description
Limb Circumference Range
M1571A
Infant cuff
10.0 - 15.0 cm
M1572A
Pediatric cuff
14.0 - 21.5 cm
M1573A
Small adult cuff
20.5 - 28.0 cm
M1574A
Adult cuff
27.0 - 35.0 cm
M1575A
Large adult cuff
34.0 - 43.0 cm
M1576A
Thigh cuff
42.0 - 54.0 cm
M1577A
Kit of small cuffs (M1571A to M1574A)
M1578A
Kit of large cuffs (M1573A to M1576A)
M1579A
Kit of all cuffs (M1571A to M1576A)
Easy Care Reusable Cuffs
Part Number
Description
Limb Circumference Range
M4552B
Infant cuff
10.0 - 15.0 cm
M4552B5
Pack of 5 M4552B cuffs
268
23 Accessories
Part Number
Description
Limb Circumference Range
M4553B
Pediatric cuff
14.0 - 21.5 cm
M4553B5
Pack of 5 M4553B cuffs
M4554B
Small adult cuff
M4554B5
Pack of 5 M4554B cuffs
M4555B
Adult cuff
M4555B5
Pack of 5 M4555B cuffs
M4556B
Adult cuff, X-Long
M4556B5
Pack of 5 M4556B cuffs
M4557B
Large adult cuff
M4557B5
Pack of 5 M4557B cuffs
M4558B
Large adult cuff, X-Long
M4558B5
Pack of 5 M4558B cuffs
M4559B
Thigh cuff
M4559B5
Pack of 5 M4559B cuffs
864288
Assortment pack of one small adult, one adult, one large
adult and one thigh cuff
864289
Assortment pack of one infant, one pediatric, one small
adult and one adult cuff
864290
Assortment pack of one infant, one pediatric, one small
adult, one adult, one large adult and one thigh cuff
864291
Assortment pack of one small adult, one adult, one adult Xlong, one large adult, one large adult X-long and one thigh
cuff
20.5 - 28.5 cm
27.5 - 36.0 cm
27.5 - 36.0 cm
35.0 - 45.0 cm
35.0 - 45.0 cm
44.0 - 56.0 cm
Multi Care Cuffs
Part Number
Description
Limb Circumference Range
989803183311
Infant cuff
10.0 - 15.0 cm
989803183321
Pediatric cuff
14.0 - 21.5 cm
989803183331
Small adult cuff
20.5 - 28.0 cm
989803183341
Adult cuff
27.0 - 35.0 cm
989803183351
Adult cuff, X-Long
27.0 - 35.0 cm
989803183361
Large adult cuff
34.0 - 43.0 cm
989803183371
Thigh cuff
42.0 - 54.0 cm
Single Patient, Gentle Care Cuffs
Part Number
Description
Limb Circumference Range
M4572B
Infant cuff
10.0 - 15.0 cm
M4573B
Pediatric cuff
14.0 - 21.5 cm
269
23 Accessories
Part Number
Description
Limb Circumference Range
M4574B
Small adult cuff
20.5 - 28.5 cm
M4575B
Adult cuff
27.5 - 36.0 cm
M4576B
Adult cuff, X-Long
27.5 - 36.0 cm
M4577B
Large adult cuff
35.0 - 45.0 cm
M4578B
Large adult cuff, X-Long
35.0 - 45.0 cm
M4579B
Thigh cuff
44.0 - 56.0 cm
Single Care Cuffs
Part Number
Description
Limb Circumference Range
989803182281
Pediatric cuff
14.0 - 21.5 cm
989803182291
Small adult cuff
20.5 - 28.5 cm
989803182301
Adult cuff
27.5 - 36.0 cm
989803182311
Adult cuff, X-Long
27.5 - 36.0 cm
989803182321
Large adult cuff
35.0 - 45.0 cm
Invasive Pressure Accessories
These transducers and accessories are designed to have special protection against electric
shocks (particularly regarding allowable leakage currents), and are defibrillator proof.
If you are using the M3012A Hemodynamic MMS Extension, and you want to measure temperature
and invasive pressure at the same time, we recommend that you use the pressure transducer CPJ840J6,
with a round module connector piece, and not a transducer with a square connector. Pressure
transducers with square connectors may make it difficult to connect the adjacent Temperature
connector at the same time.
Pressure transducers and accessories
Part No.
Reusable pressure transducer 5 µV/V/mmHg sensitivity
CPJ840J6
Sterile disposable pressure domes for CPJ840J6 (pack of 50)
CPJ84022
Transducer holder for CPJ840J6 (pack of 4)
CPJ84046
IV pole mount for CPJ840J6
CPJ84447
Monitoring Line Set for CPJ840J6
CPJ84026
Single channel disposable sensor kit (20) (EU/EFTA only)
M1567A
Dual channel disposable sensor kit (20) (EU/EFTA only)
M1568A
Transducer holder for M1567/8A (EU/EFTA only)
M2271A
IV pole mount for M1567/8A (EU/EFTA only)
M2272C
Adapter cable for disposable sensor kit 3.0 m for M1567/8A
M1634A
270
23 Accessories
Pressure transducer kits
Part No.
PiCCO monitoring kit, 30 cm pressure line, includes PV4046 injectate temperature sensor
housing for M1646A
PV8103
PiCCO monitoring kit, 150 cm pressure line, includes PV4046 injectate temperature sensor
housing for M1646A
PV8115
PiCCO monitoring kit, 150 cm pressure line, includes PV4046 injectate temperature sensor
housing for M1646A and central venous pressure line
PV8115CVP
PULSION Pressure Interface Cable for disposable pressure transducer
PMK 206
Transpac 4 Disposable Pressure Transducer Pressure Monitoring
Kits
Transducer Pressure Monitoring Kits with SafeSet Blood Sampling/Conservation
System
Description
Length
Quantity
(per box)
Part No.
Single DPT TP4 with SafeSet, 2 Cannula Sampling Ports,
In-line Reservoir
213 cm (84 in)
20
989803179741
Single DPT TP4 with SafeSet, 2 Luer Sampling Ports, In-line
Reservoir
213 cm (84 in)
20
989803179751
Single DPT TP4 with SafeSet, 1 Cannula Sampling Port, In-line 152 cm (60 in)
Reservoir
20
989803179761
Single DPT TP4 with SafeSet, 2 Cannula Sampling Ports,
In-line Reservoir
152 cm (60 in)
20
989803179781
Single DPT TP4 with SafeSet, 2 Luer Sampling Ports, In-line
Reservoir
152 cm (60 in)
20
989803179791
Single DPT TP4 with SafeSet, Patient Mount, 1 Cannula
Sampling Port, In-line Reservoir
61 cm (24 in)
20
989803179861
Dual DPT TP4 with SafeSet, (Clear/Blue dash tubing) 2
Cannula Sampling Ports, In-line Reservoir
213 cm (84 in)
10
989803179801
Dual DPT TP4 with SafeSet, (Clear/Blue dash tubing) 2 Luer 213 cm (84 in)
Sampling Ports, In-line Reservoir
10
989803179811
Triple DPT TP4 with SafeSet, 2 Cannula Sampling Ports,
In-line Reservoir
213 cm (84 in)
10
989803179821
Triple DPT TP4 with SafeSet, 2 Luer Sampling Ports, In-line
Reservoir
213 cm (84 in)
10
989803179831
Transpac and SafeSet are trademarks of ICU Medical, Inc.
271
23 Accessories
Safeset Blood Sampling/Conservation System
Description
Length
Quantity
(per box)
Part No.
SafeSet Kit with tubing, 1 In-line Cannula Sampling Port and
10 ml In-line Reservoir
152 cm (60 in)
20
989803180851
SafeSet Kit with tubing, 2 In-line Cannula Sampling Ports and
10 ml In-line Reservoir
213 cm (84 in)
20
989803179891
(Transducer not contained in kit)
Transpac 4 Disposable Pressure Transducer Pressure Monitoring Kits
Primary
Stopcocks Tubing
Length
Extension
Tubing
length
Flush
Device
Drip
Chamber
Quantity
(per box)
Part No.
Single DPT TP4, (152 cm, Two 3-way 122 cm (48 in) 31 cm (12 in)
60 in) Red dash tubing
3 ml/hr,
Squeeze
Macrodrip
20
989803177901
Dual DPT TP4, (183 cm,
72 in) Red/Blue dash
tubing
Two 3 ml/hr, Macrodrip
Squeeze
10
989803177911
Single DPT TP4, (213 cm, Two 3-way 183 cm (72 in) 31 cm (12 in)
84 in) Red dash tubing
3 ml/hr,
Squeeze
Macrodrip
20
989803179721
Triple DPT TP4, (152 cm, Six 3-way
60 in)
122 cm (48 in) 31 cm (12 in)
3 ml/hr,
Squeeze
Macrodrip
10
989803179731
Single DPT TP4, (183 cm, Two 3-way 152 cm (60 in) 31 cm (12 in)
72 in) Red dash tubing
3 ml/hr,
Squeeze
Macrodrip
20
989803179771
Single DPT TP4, (23 cm,
9 in) Patient Mount
One 3-way 23 cm (9 in)
3 ml/hr,
Squeeze
Macrodrip
20
989803179871
Single DPT TP4, (61 cm,
24 in) Compartmental
Pressure
One 4-way 61 cm (24 in)
No flush
device
20
989803181141
Description
Four 3-way 152 cm (60 in) 31 cm (12 in)
One 3-way
Single DPT TP4, (152 cm, Two 3-way 122 cm (48 in) 31 cm (12 in)
60 in), Premium Stripe
3 ml/hr,
Squeeze
Macrodrip
20
989803181211
Single DPT TP4, (183 cm, Two 3-way 152 cm (60 in) 31 cm (12 in)
72 in), Premium Stripe
3 ml/hr,
Squeeze
Macrodrip
20
989803181221
Single DPT TP4, (213 cm, Two 3-way 183 cm (72 in) 31 cm (12 in)
84 in), Premium Stripe
3 ml/hr,
Squeeze
Macrodrip
20
989803181231
Dual DPT TP4, (183 cm,
72 in), Premium Stripe
3 ml/hr,
Squeeze
Macrodrip
10
989803181241
3 ml/hr,
Squeeze
Macrodrip
10
989803181251
Four 3-way 152 cm (60 in) 31 cm (12 in)
Triple DPT TP4, (152 cm, Six 3-way
60 in), Premium Stripe
122 cm (48 in) 31 cm (12 in)
Single Neonatal DPT
TP4 (61 cm, 24 in)
Two 3-way 61 cm (24 in)
30 ml/hr
Squeeze
20
989803179841
Single Neonatal DPT
TP4 (31 cm, 12 in)
Three 3way
31 cm (12 in)
30 ml/hr
Squeeze
20
989803179851
46 cm (18 in)
30 ml/hr
Squeeze
20
989803179881
Single Neonatal DPT
Three
TP4 (46 cm, 18 in) one in- 3-way
line Luer sampling port &
10 ml In-line reservoir
272
23 Accessories
Transpac 4 and Safeset Cables and Accessories
Description
Quantity (per box)
Part No.
Cable for Philips Monitors 3 m (10 ft)
989803177921
Cable for Philips Monitors 4.5 m (15 ft)
989803179941
Cable for Philips Monitors 4.5 m (15 ft)
20
989803179951
Trifurcated Cable for Philips Monitors 4.5 m (15 ft)
989803179961
3-Position Transducer Mount
28
989803177931
Transducer Holder for IV Pole
989803177941
Single Transducer Mount
30
989803179911
SafeSet Mounting Bracket
30
989803179901
Safeset Shielded Blunt Cannula
50
989803179921
SafeSet Shielded Blunt Cannula with Blood Tube Holder
25
989803179931
Extension tube, 30 cm
25
989803184971
Extension tube, 60 cm
25
989803184981
Extension tube, 90 cm
25
989803184991
SpO2 Accessories
Some 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).
273
23 Accessories
Philips Reusable Sensors
Product Number
Philips
Nellcor
Description
M1191A/B
Adult sensor (2 m cable), for patients over 50 kg. No adapter cable required.
Any finger, except thumb.
M1191AL/BL
M1191A/B with longer cable (3 m)
M1192A
Small adult, pediatric sensor (1.5 m cable) for
patients between 15 kg and 50 kg. Any finger
except thumb.
M1193A
Neonatal sensor (1.5 m cable) for patients
between 1 kg and 4 kg. Hand or foot.
M1194A
Ear sensor (1.5 m cable) for patients over 40 kg.
M1195A
Infant sensor (1.5 m cable) for patients between
4 kg and 15 kg. Any finger except thumb.
M1196A
Adult clip sensor (3 m cable) for patients over
40 kg. Any finger except thumb.
M1196S
Adult clip sensor (2 m cable) for patients over
40 kg. Any finger except thumb.
M1191T
Adult sensor (0.45 m cable), for patients over
50 kg. Any finger, except thumb.
M1192T
Small adult, pediatric sensor (0.45 m cable) for
patients between 15 kg and 50 kg. Any finger
except thumb.
M1193T
Neonatal sensor (0.9 m cable) for patients
between 1 kg and 4 kg. Hand or foot.
M1196T
Adult clip sensor (0.9 m cable) for patients over
40 kg. Any finger except thumb.
Comments
Requires M1943A (1 m) or
M1943AL (3 m) adapter
cable
Philips Disposable Sensors
Product Number
Philips
Nellcor
Description
Comments
M1901B1
P,N
Identical to OxiMax MAXN
P,N
Identical to OxiMax MAXI
M1903B1
P,N
Identical to OxiMax MAXP
M1904B1
P,N
Identical to OxiMax MAXA
For Philips FAST SpO2: use
M1943A (1 m) or M1943AL
(3 m) adapter cable.
For Nellcor OxiMax SpO2:
use M1943NL adapter cable.
M1131A
Adult/Pediatric finger sensor, 0.45 m cable
(patient size > 20 kg)
Use M1943A or M1943AL
adapter cable.
M1132A
Infant finger or toe sensor, 0.9 m cable
(patient size 3 - 10 kg)
Use M1943A or M1943AL
adapter cable.
M1133A
Adult/Infant/Neonatal, 0.9 m cable
Use M1943A or M1943AL
Foot or hand for neonates < 3 kg
adapter cable.
Big toe or thumb for patients between 10 kg
and 20 kg
Any finger except thumb for patients > 40 kg
M1902B
274
23 Accessories
Product Number
Philips
Nellcor
Description
M1134A
Adhesive-free, Adult/Infant/Neonatal, 0.9 m Use M1943A or M1943AL
cable
adapter cable.
Foot or hand for neonates < 3 kg
Big toe or thumb for patients between 10 kg
and 20 kg
Any finger except thumb for patients > 40 kg
Comments
Not available in the USA, Canada and Japan.
Nellcor Sensors
Nellcor sensors must be ordered from Nellcor/Covidien.
Product Number
Philips
Nellcor
Description
Comments
OxiMax MAX-A
P,N
Adult finger sensor (patient size > 30 kg)
OxiMax MAX-AL
P,N
OxiMax MAX-A with long cable
OxiMax MAX-P
P,N
Pediatric foot/hand sensor (patient size 10 - 50 kg)
For Philips FAST
SpO2: use M1943A or
M1943AL adapter
cable.
OxiMax MAX-I
P,N
Infant foot/hand sensor (patient size 3 - 20 kg)
OxiMax MAX-N
P,N
For Nellcor OxiMax
Adult finger or neonatal foot/hand sensor (patient size SpO2: use M1943NL
> 40 kg or < 3 kg)
adapter cable.
Oxisensor II D-25
Adult sensor (patient size > 30 kg)
Oxisensor II D-20
Pediatric sensor (patient size 10 - 50 kg)
Oxisensor II I-20
Infant sensor (patient size 3 - 20 kg)
Oxisensor II N-25
Neonatal sensor (patient size < 3 kg or > 40 kg)
Oxicliq A
P,N
See OxiMax MAXA
Oxicliq P
P,N
See OxiMax MAXP
Oxicliq I
P,N
See OxiMax MAXI
Oxicliq N
P,N
See OxiMax MAXN
Use M1943A or
M1943AL adapter
cable.
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.
MAX-R
Adult SpO2 Nasal Sensor
MAXFAST
Forehead SpO2 Sensor
Oxiband OXI-A/N
Adult/Neonatal SpO2 Sensor with Wraps
Oxiband OXI-P/I
Pediatric-Infant SpO2 Sensor with Wraps
SC-A
Adult SpO2 Sensor
SCNEO-I
Neonatal SpO2 Sensor
SC-PR-I
Preemie SpO2 Sensor
DS100A-I
Adult SpO2 Sensor
Dura-Y D-YS
SpO2 Sensor
Use M1943NL adapter
cable.
275
23 Accessories
Extension Cables and Adapter Cables for Philips and Nellcor
Sensors
Product Number
Philips
Nellcor
Description
Comments
M1941A
Extension cable (2 m)
For use with Philips reusable sensors
(with cable length ≤ 2 m) and
M1943A adapter cable.
M1943A
Adapter cable (1.1 m cable)
M1943AL
Adapter cable (3 m cable)
Adapter cable for Philips/Nellcor
disposable sensors.
M1943NL
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.
Masimo Sensors
The 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 Sensors
Product Number
Philips
Nellcor
Description
LNOP DCI
Adult Finger Sensor (> 30 kg)
LNOP DCIP
Pediatric Finger Sensor (10 - 50 kg)
LNOP YI
Multi-Site Sensor (> 1 kg)
LNOP TC-I
Ear Sensor (> 30 kg)
LNCS Reusable Sensors
Product Number
Philips
Nellcor
Description
LNCS DCI
Adult Finger Sensor (> 30 kg)
LNCS DCIP
Pediatric Finger Sensor (10 - 50 kg)
LNCS YI
Multi-Site Sensor (> 1kg)
LNCS TC-I
Ear Sensor (> 30 kg)
276
23 Accessories
LNOP Disposable Adhesive Sensors
Product Number
Philips
Nellcor
Description
LNOP Adt
Adult Sensor (> 30 kg)
LNOP Adtx
Adult Sensor (> 30 kg)
LNOP Pdt
Pediatric Sensor (10 - 50 kg)
LNOP Pdtx
Pediatric Sensor (10 - 50 kg)
LNOP Inf-L
Infant Toe Sensor (3 - 20 kg)
LNOP Neo-L
Neonatal Sensor (< 3 kg) or Adult adhesive Sensor (> 40 kg)
LNOP NeoPt-L
Neonatal Pre-Term Sensitive Skin Sensors (< 1 kg)
LNCS Disposable Adhesive Sensors
Product Number
Philips
Nellcor
Description
LNCS Adtx
Adult Finger Sensor, 18 inch/45 cm (> 30 kg)
LNCS Adtx-3
Adult Finger Sensor, 3 feet/90 cm (> 30 kg)
LNCS Pdtx
Pediatric Finger Sensor, 18 inch/45 cm (10 - 50 kg)
LNCS Pdtx-3
Pediatric Finger Sensor, 3 feet/90 cm (10 - 50 kg)
LNCS Inf
Infant Toe Sensor, 18 inch/45 cm (3 - 20 kg)
LNCS Inf-3
Infant Toe Sensor, 3 feet/90 cm (3 - 20 kg)
LNCS Neo
Neonatal Foot Sensor, 18 inch/45 cm (< 3 kg)
or Adult Finger Sensor 18 inch/45 cm (> 40 kg)
LNCS Neo-3
Neonatal Foot Sensor, 3 feet/90 cm (< 3 kg)
or Adult Finger Sensor, 3 feet/90 cm (> 40 kg)
LNCS NeoPt
Neonatal pre-term sensitive skin Sensor 18 inch/45 cm (< 1 kg)
LNCS NeoPt-3
Neonatal pre-term sensitive skin Sensor 3 feet/90 cm (< 1 kg)
Adapter Cables for Masimo Sensors
Product Number
Philips
Nellcor
Description
Philips Part Number
LNOP MP12
LNOP MP Series Patient Cable (3.6 m) Adapter
Cable for Masimo LNOP Sensors
451261000761
LNOP MP10
LNCS MP Series Patient Cable (3.0 m) Adapter
Cable for Masimo LNCS Sensors
989803148221
277
23 Accessories
IntelliVue CL SpO2 Pod Accessories
All listed sensors operate without risk of exceeding 41°C on the skin, if the initial skin temperature
does not exceed 35°C.
Make sure that you use only the accessories that are specified for use with this device, otherwise patient
injury can result.
Part Number
Description
Contents
989803165941
Mobile CL 20 single patient SpO2 Sensors
and Cradles for use on pediatric and adult
patients >10 kg
20 Single-Patient Mobile CL DSpO2-1A
Sensors
20 Single-Patient Wristbands
20 Single-Patient Cradles
pre-assembled
989803165921
Mobile CL 20 single patient SpO2 Sensors 20 Single-Patient Mobile CL DSpO2-1A
for use on pediatric and adult patients >10 kg Sensors
9898031659311
Mobile CL reusable SpO2 Sensor and
1 Reusable Mobile CL RSpO2-1A Sensor
Cradles for use on pediatric and adult patients 20 Single-Patient Cradles with pre-attached
> 15 kg
Wristbands
989803165951
Mobile CL 20 SpO2 Cradles (single patient) 20 Single-Patient Cradles with pre-attached
Wristbands
989803165961
Mobile CL 50 SpO2 Wristbands (single
patient)
50 Single-Patient Wristbands
989803168861
Mobile CL SpO2 Battery Kit
1 Battery
1 disassembly tool
1 front housing
May not be available in all geographies
Temperature Accessories
Reusable Temperature Probes
Part No.
Minimum measurement
time for accurate
readings
General purpose probe
21075A
90 sec
Small flexible vinyl probe (Infant/Pediatric)
21076A
60 sec
Attachable surface probe
21078A
60 sec
Disposable Temperature Probes
Part No.
Minimum measurement
time for accurate
readings
General purpose probe
M1837A
90 sec
Skin probe
21091A
60 sec
Esophageal/Stethoscope Probe (French 12)
21093A
180 sec
Esophageal/Stethoscope Probe (French 18)
21094A
210 sec
Esophageal/Stethoscope Probe (French 24)
21095A
310 sec
278
23 Accessories
Disposable Temperature Probes
Part No.
Minimum measurement
time for accurate
readings
Esophageal/Rectal Probe (French 12)
21090A
90 sec
Foley Catheter Probe (12 French)
M2255A
180 sec
Foley Catheter Probe (16 French)
21096A
180 sec
Foley Catheter Probe (18 French)
21097A
180 sec
Adapter cable 1.5 m
21082B
--
Adapter cable 3.0 m
21082A
--
Combined Temperature Probes/Feeding Tubes
Part No.
Response Time per ISO
80601-2-56
InnerSense Esophageal Temperature / Feeding Tube, purple (5
French)
989803183631
< 150 seconds
InnerSense Esophageal Temperature / Feeding Tube, purple (6.5
French)
989803183641
InnerSense Esophageal Temperature / Feeding Tube, purple (8
French)
989803183651
InnerSense Esophageal Temperature / Feeding Tube, orange (5
French)
989803183561
InnerSense Esophageal Temperature / Feeding Tube, orange (6.5
French)
989803183571
InnerSense Esophageal Temperature / Feeding Tube, orange (8
French)
989803183581
Mainstream CO2 Accessories
Description
Part No.
CO2 Sensor
M2501A
Adult/Pediatric Airway Adapter (reusable)
M2513A
Infant Airway Adapter (reusable)
M2516A
Adult Airway Adapter (single-patient use)
M2533A
Infant Airway Adapter (single-patient use)
M2536A
Sidestream CO2 Accessories
Description
Part No.
CO2 Sensor
M2741A
279
23 Accessories
Nasal and Oral-Nasal Cannulas
Part No.
CO2 Nasal Cannula, Adult
M2744A
CO2 Nasal Cannula, Pediatric
M2745A
CO2 Nasal Cannula, Infant
M2746A
CO2/O2 Nasal Cannula, Adult
M2750A
CO2/O2 Nasal Cannula, Pediatric
M2751A
CO2/O2 Nasal Cannula, Infant
989803144471
CO2 Oral-Nasal Cannula, Adult
M2756A
CO2 Oral-Nasal Cannula, Pediatric
M2757A
CO2/O2 Oral-Nasal Cannula, Adult
M2760A
CO2/O2 Oral-Nasal Cannula, Pediatric
M2761A
Airway Adapters
Part No.
Airway Adapter Set, ET > 4.0 mm
M2768A
Airway Adapter Set, ET ≤ 4.0 mm
989803144531
Airway Adapter Set H, ET > 4.0 mm
M2772A
Airway Adapter Set H, ET ≤ 4.0 mm
M2773A
Straight Sample Lines
Part No.
Straight Sample Line
M2776A
Straight Sample Line H
M2777A
Microstream CO2 Accessories
•
"FilterLine Set" is a combination of a FilterLine with an Airway Adapter.
•
"H" in the accessory name indicates suitability for humidified ventilation and longer usage due to
the active removal of humidity from the sample line.
•
"Smart CapnoLine" is a combined oral-nasal FilterLine.
•
"Smart CapnoLine O2" is a combined oral-nasal-O2-CO2 FilterLine.
•
"NIV Line" is a nasal FilterLine suitable for mask ventilation (for example, C-PAP).
The accessories are supplied in packs of 25.
NOTE
Not all accessories are available in all countries.
Accessories for Intubated Patients
Part Number
Part Number for
Long Version
FilterLine® SET Adult/Pediatric
M1920A
989803160241
FilterLine® H SET Adult/Pediatric
M1921A
989803160251
FilterLine® H SET Infant/Neonatal
M1923A
989803160261
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23 Accessories
Accessories for Intubated Patients
Part Number
Part Number for
Long Version
VitaLine™ H SET Adult/Pediatric
989803159571
VitaLine™ H SET Infant/Neonate
989803159581
Accessories for Non-Intubated Patients
Part Number
CapnoLine® H Adult
M4689A
CapnoLine® H Pediatric
M4690A
CapnoLine® H Infant/Neonatal
M4691A
CapnoLine® H O2 Adult
M4680A
CapnoLine® H O2 Pediatric
M4681A
CapnoLine® H O2 Infant/Neonatal
989803178001
NIV Line™ Adult
M4686A
NIV Line™ Pediatric
M4687A
Nasal FilterLine® Infant/Neonatal
989803178021
Nasal Filterline® O2 Adult
989803179101
Nasal Filterline® O2 Pediatric
989803179121
Smart CapnoLine® O2 Adult
M2522A
989803160281
Smart CapnoLine® H O2 Adult
989803177951
989803177961
Smart CapnoLine® O2 Pediatric
M2520A
989803160271
Smart CapnoLine® H O2 Pediatric
989803177971
989803177981
Smart CapnoLine® Adult
M2526A
989803160301
Smart CapnoLine® Pediatric
M2524A
Part Number for
Long Version
989803178011
989803179111
Accessories for Endoscopic Procedures
Smart CapnoLine® Guard
989803178031
Smart CapnoLine® Guard O2
989803178041
Hook and Loop Strap
989803178071
989803178051
Battery Accessories
Description
Part No.
Lithium Ion Smart Battery 1Ah (internal battery for X2/MP2)
M4607A
Lithium Ion Smart Battery 6Ah (for 865297 Battery Extension)
M4605A
Battery Charger and Conditioner (requires size adapter 4512 610 17451 to charge
M4607A battery)
865432
Size adapter for M4607A battery
4512 610 17451
281
23 Accessories
282
24
24
Specifications
The specifications in this section apply to the MP2 patient monitor.
Indications for Use
The 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 Environment
Hospital Environment
The 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 Environment
All 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.
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24 Specifications
WARNING
The monitor is not intended for use in an MRI environment or in an oxygen-enriched environment
(for example, hyperbaric chambers).
Restricted Availability
Following new features and functionality may not be available in all geographies:
•
Integrated Pulmonary Index for Microstream CO2
•
IntelliVue Information Center iX
•
Cableless Respiration Measurement
Manufacturer's Information
You can write to Philips at this address
Philips Medizin Systeme Boeblingen GmbH
Hewlett-Packard-Str. 2
71034 Boeblingen
Germany
Visit our website at: www.healthcare.philips.com.
© Copyright 2015. Koninklijke Philips N.V. All Rights Reserved.
Trademark Acknowledgement
Microstream®, 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.
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24 Specifications
Symbols
These symbols can appear on the monitor and its associated equipment and packaging (depending on
options).
Symbols
Caution, refer to accompanying documents
On/Off/Standby
Alternating current
Rechargeable battery symbol
DC power source
Battery Eject
ECG Sync Pulse Output indicator
Connection direction indicator
Pressure connector
Temperature connector
Connection direction indicator
Connector has special protection against
electric shocks and is defibrillator proof
NBP connector
SpO2 connector
Uses FAST SpO2 algorithm
LAN connection indicator for connection
to a wired network
Masimo SET technology
Nellcor OxiMax compatible
Silence Alarms
Alarms On/Off
Alarms Switched Off
Identifies year and month of manufacture
ECG connector
Error LED
IntelliVue Instrument Telemetry wireless
network
Always use separate collection for waste
electrical and electronic equipment
(WEEE)
285
24 Specifications
Symbols
Monitor supports 12-lead ECG
Indicates location of the date of
manufacture and/or name and address of
manufacturer
Built-in short range radio interface
Built-in wireless network
Indicates location of catalog number
Main Screen
Followed by two alphanumeric characters,
indicates ingress protection grade
Indicates location of serial number
Indicates location of service number
SmartKeys
Electrical 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 network
Start a measurement
Stop a measurement
Enter the measurement setup menu
Zero the invasive pressure transducer
Mass in kilogram (kg)
Indicates location of batch number
Indicates the location of the "use by" date
Not made with natural rubber latex
Prescription use only
Contents of the packaging are not sterile
Atmospheric pressure limitations for
storage
Humidity limitations for storage
Temperature limitations for storage
286
24 Specifications
Installation Safety Information
WARNING
If multiple instruments are connected to a patient, the sum of the leakage currents may exceed the
limits given in IEC/EN 60601-1, IEC 60601-1-1, UL 60601-1. Consult your service personnel.
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.
Connectors
The actual placement of boards and configuration of connections for your monitor depends on how
your hardware has been configured. See the symbols table 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 Precautions
Mount the monitor using either the Philips Quick Mount or Fix Mount solution or another approved
mounting solution. Select the mounting equipment and the mounting position so that no patient,
operator or other person can be harmed by a monitor removed intentionally or released accidentally
from the mount. When using the Quick Mount, be aware of the danger of accidental activation of the
Quick Mount release button when lifting or moving items located under the monitor, such as pole
mounts, etc. If in doubt, use the Philips Fix Mount solution to avoid such situations. Refer to the
respective IntelliVue Monitor Service Manual, Installation Instructions chapter, for more details.
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 Arm
Attempts 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.
287
24 Specifications
WARNING
Not 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 Setting
Altitude affects CO2 measurements. The monitor must be configured at installation to the correct
altitude.
Monitor Safety Specifications
The 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 + A2:1995
EN60601-1:1990 + A1:1993 + A2:1995
UL 60601-1:2003
CAN/CSA C22.2#601.1-M90 +Suppl. No. 1-94 + Am. 2
IEC 60601-1-1:2000
EN 60601-1-1:2001
IEC 60601-1-2:2001 + A1:2004
EN 60601-1-2:2001 + A1:2006.
The possibility of hazards arising from software errors was minimized in compliance with:
ISO 14971:2007
EN60601-1-4:1996 + A1:1999
IEC 60601-1-4:1996 + A1:1999.
Classification (according to IEC 60601-1): Class II, Type CF, Continuous Operation.
EMC and Radio Regulatory Compliance
This ISM device complies with Canadian ICES-001. Cet appareil ISM est conforme à la norme NMB001 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.
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24 Specifications
The 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 Adapter
FCC and Industry Canada Radio Compliance: This device complies with Part 15 of the FCC Rules and
RSS-210 of Industry Canada. Operation is subject to the following two conditions: (1) this device may
not cause harmful interference, and (2) this device must accept any interference received, including
interference that may cause undesired operation. Any changes or modifications to this equipment not
expressly approved by Philips Medical Systems may cause harmful 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.
CAUTION
High power radars are allocated as primary users (meaning they have priority) of 5250-5350 MHz and
5650-5850 MHz and these radars could cause interference and /or damage to LE-LAN devices.
IntelliVue 802.11 Wireless Network Adapter CE Compliance
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.
In addition the product complies with: ETSI EN 300 328; ETSI EN 301 893; AS/NZS 4771+A1;
ARIB STD-T66.
289
24 Specifications
Radiofrequency Radiation Exposure Information
For 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 Interface
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 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 Use
Out-Of-Hospital Transport - Standards Compliance
The 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 Battery
can 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:
290
•
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 Specifications
•
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 tests
The 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).
CAUTION
Temperature 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.
NOTE
There may be additional requirements for transport situations in air, on water or in difficult terrain in
certain countries, e.g. EU.
Physical Specifications
Product
Maximum Weight
Size (W x H x D)
Comments
MP2 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 options
M8023A 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)
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24 Specifications
Environmental Specifications
The 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.
Item
Condition
Range
Temperature Range
Operating
0 to 40°C (32 to 104°F)
Storage including transportation
-20 to 60°C (-4 to 140°F)
Temperature Range with
the Wireless IntelliVue
Adapter or IntelliVue
Instrument Telemetry
Wireless Network or when
charging the battery
Operating
0 to 35°C (32 to 95°F)
Humidity Range
Operating
15% to 95% Relative Humidity (RH)
Storage including transportation
5% to 95% Relative Humidity (RH)
Operating
-500 m to 3000 m (10000 ft)
Storage including transportation
-500 m to 4600 m (15000 ft)1
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.
Altitude Range
Ingress Protection
IP32 when mounted as described in the Service Guide.
Battery Extension (865297)
292
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.)
Sufficient for flight altitudes up to 12,000 m with pressurized cabins
24 Specifications
Monitor Performance Specifications
Performance Specifications
Power Specifications
Power consumption
<12 W average
<30 W while battery is loading
Battery Specifications
Operating Voltage
36 to 60 V DC floating
Operating Time (with new, fully charged
battery at 25°C)
Basic monitoring configuration: 2.5 hours
Charge Time
When monitor is off: 2 hours
(Brightness set to Optimum, ECG/Resp, SpO2 measurements
in use, NBP measurement every 15 minutes)
When monitor is in use, and connected to the external power
supply (M8023A), without MMS extensions: 12 hours approx.
Indicators
Sounds
Alarms Off
red or yellow LED with crossed out alarms symbol
Alarms
red/yellow/light blue (cyan) LED
On/Standby / Error
green / red LED
AC Power
green LED
Battery
yellow (charging)/red blinking (empty) LED
External Power
green LED
Audible feedback for user input
Prompt tone
QRS tone, or SpO2 modulation tone
4 different alarm sounds
Display Wave Speeds
6.25 mm/s, 12.5 mm/s, 25 mm/s, 50 mm/s
with ±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 delay
less than 4 seconds
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.
Delay for alarm availability on the network
less than 5 seconds
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.
Review Alarms
Pause duration
1,2,3 minutes or infinite, depending on configuration
Extended alarm pause
5 or 10 minutes
Sound pressure range
min. 0 dB(A)
max. 45-85 dB(A)
Information
all alarms / inops, main alarms on/off, alarm silence and time of
occurrence
Capacity
300 items
293
24 Specifications
Performance Specifications
Real Time Clock
Buffered Memory
Range
from: January 1, 1997, 00:00 to: December 31, 2080, 23:59
Accuracy
<4 seconds per day (typically)
Hold Time
infinite if powered by external power supply; otherwise at least
48 hours
Hold Time
if powered by external power supply: infinite
Contents
Active settings, trends, patient data, realtime reports, review
alarms
without power: at least 48 hours
M8023A External Power Supply Performance Specifications
Power Specifications
Power consumption
<12 W average
<30 W peak
Indicators
Line Voltage
100 to 240 V ~
Current
1.3 to 0.7 A
Frequency
50/60 Hz ~
AC Power
green LED
Display Specifications
Integrated QVGA
Display
Sweep Speeds
6.25, 12.5, 25 and 50 mm/s
Resolution
320 x 240
Refresh frequency
60 Hz
Useful screen
72 x 54 mm (2.8 x 2.1 in)
Pixel size
0.22 x 0.22 mm
Monitor Interface Specifications
Monitor Interface Specifications
Measurement Link
(MSL)
294
Connectors
Female ODU (Proprietary)
Power
30 V to 60 V input
Power Sync.
RS-422 compliant input 78.125kHz (typical)
LAN signals
IEEE 802.3 10-Base-T compliant
Serial signals
RS-422 compliant
Local signals
Provided for connecting measurement extensions
24 Specifications
Monitor Interface Specifications
ECG Sync Pulse
Output1
Cable detection
Yes
Marker In
No
Wave Output
No
Connector
Binder Series 709/719
Output levels
Output low <0.8 V @ I = -4 mA
Output high >2.4 V @ I = 4 mA
IntelliVue 802.11
Bedside Adapter
(Wireless Network
Adapter)
Isolation
None
Pulse Width
100 +/-10 ms (high)
Delay from R-wave peak to start
of pulse
20 ms maximum per AAMI EC13
Minimum required R-wave
amplitude
0.5 V
Type
Internal wireless adapter
Technology
IEEE 802.11a/b/g
Frequency Band
USA: 2.400 - 2.483GHz, 5.15 - 5.35GHz, 5.725 - 5.825GHz
Europe: 2.400 - 2.483GHz, 5.15 - 5.35GHz, 5.47 - 5.725GHz
Japan: 2.400 - 2.483GHz, 2.471 - 2.498GHz, 4.900 - 5.091GHz, 5.150 5.250GHz, 5.25 - 5.35GHz, 5.470 - 5.725GHz
China: 2.400 - 2.483GHz, 5.725 -5.85GHz
Modulation Technique
802.11b/g
DSSS (DBPSK, DQPSK, CCK)
OFDM (BPSK,QPSK, 16-QAM, 64-QAM)
802.11a
OFDM (BPSK,QPSK, 16-QAM, 64-QAM)
Short Range Radio
Interface2
Effective radiated power
max 18 dBm
Type
Internal SRR interface
Technology
IEEE 802.15.4
Frequency Band
2.4 GHz ISM (2.400 - 2.483 GHz)
Modulation Technique
DSSS (O -QPSK)
Effective radiated power
max. 0 dBm (1 mW)
IntelliVue Instrument Telemetry Wireless Network (USA only)
Internal WMTS
Adapter
Technology
compatible with Philips IntelliVue Telemetry System (ITS), cellular
infrastructure
Frequency Band
WMTS, 1395-1400 MHz and 1427-1432 MHz
IntelliVue Instrument Telemetry Wireless Network
Internal ISM Adapter Technology
Frequency Band
compatible with Philips IntelliVue Telemetry System (ITS), cellular
infrastructure
2.4 GHz ISM
See “Connectors” on page 287 for safety-related information)
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.
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24 Specifications
M8023A External Power Supply Interface Specifications
Measurement Link
(MSL)
Connectors
Male ODU (Proprietary)
Power
48 V output
Power Sync.
RS-422 compliant output 78.125 kHz (typical)
LAN signals
IEEE 802.3 10-Base-T compliant
Serial signals
RS-422 compliant output 78.125 kHz (typical)
Local signals
Not connected
865297 Battery Extension Interface Specifications
Measurement Link
(MSL)
Measurement Link
(MSL)
Connectors
Male ODU (Proprietary)
Power
36 -38 V output
Power Sync.
RS-422 compliant output 78.125 kHz (typical)
LAN signals
IEEE 802.3 10-Base-T compliant
Serial signals
RS-422 compliant
Local signals
Not connected
Connectors
Female ODU (Proprietary)
Power
30-60 V input
Power Sync.
RS-422 compliant input 78.125 kHz (typical)
LAN signals
IEEE 802.3 10-Base-T compliant
Serial signals
RS-422 compliant
Local signals
Not connected
865297 Battery Extension Specifications
865297 Battery Extension Battery Specifications
Battery Type
M4605A
Indicators
green power LED and green-yellow-red battery status LED
M4607A Battery Specifications
One battery is required for battery operation of the monitor.
The battery lifetime is 3 years from manufacturing date or 500 charge/discharge cycles.
M4607A Battery Specifications
Physical Specifications
WxDxH
66 mm (2.36 in) x 80 mm (3.15 in) x 20 mm (0.79 in)
Weight
160 g ±5%
Performance Specifications
Nominal Voltage
10.8 Volt
Rated Capacity at discharge C/5
1000 mAh (typical)
Environmental Specifications
296
24 Specifications
M4607A Battery Specifications
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 mAh
Safety
complies with UL 2054
Electromagnetic Compatibility (EMC)
complies with the requirements for FCC Type B computing Device, and EN
61000-4-2 and EN 61000-3-2
Communication Standard
complies with the SMBus specification v1.1
M4605A Battery Specifications
The battery lifetime is 3 years from manufacturing date or 500 charge/discharge cycles.
M4605A Battery Specifications
Physical Specifications
WxDxH
149 x 89 x 19.8 mm (5.866 x 3.504 x 0.78 in)
Weight
490 g (1.08 lb) per battery
Performance Specifications
Nominal Voltage
10.8 Volt
Rated Capacity at discharge C/5
6000 mAh
Continuous Discharge Capability
6.5 A
Environmental Specifications
Temperature 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 Ion
Safety
complies with UL 2054
Electromagnetic Compatibility (EMC)
complies with the requirements for FCC Type B computing Device, and
EN 61000-4-2 and EN 61000-3-2
Communication Standard
complies with the SMBus specification v 1.1
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24 Specifications
Measurement Specifications
See the “Default Settings Appendix” for a list of the settings the monitor is initially shipped with.
ECG/Arrhythmia/ST/QT
Complies with:
•
IEC 60601-2-25:1993 + A1:1999/EN60601-2-25:1995 + A1:1999
•
IEC 60601-2- 27:2005/EN60601-2-27:2006
•
IEC 60601-2-51:2003/EN 60601-2-51:2003
•
AAMI EC11/EC13:1991/2002
ECG/Arrhythmia/ST Performance Specifications
Cardiotach
PVC Rate
ST Numeric
QT Numeric
QTc Numeric
ΔQTc Numeric
QT-HR Numeric
Sinus and SV Rhythm Ranges
298
Range
Adult/pedi: 15 to 300 bpm
Neo range: 15 to 350 bpm
Note: for rates equal to or less than 15 bpm, the displayed heart
rate is 0.
Accuracy
±1% of range
Resolution
1 bpm
Sensitivity
≥200 µVpeak
Range
0 to 300 bpm
Resolution
1 bpm
Range
-20 to +20 mm
Accuracy
±0.5 mm or 15%, whichever is greater
Resolution
0.1 mm
Range
200 to 800 ms
Accuracy
±30 ms
Resolution
8 ms
Range
200 to 800 ms
Resolution
1 ms
Range
-600 to +600 ms
Resolution
1 ms
Range - adult
15 to 150 bpm
Range - pediatric and neonatal
15 to 180 bpm
Brady
Adult: 15 to 59 bpm
Pedi: 15 to 79 bpm
Neo: 15 to 89 bpm
Normal
Adult: 60 to 100 bpm
Pedi: 80 to 160 bpm
Neo: 90 to 180 bpm
Tachy
Adult: >100 bpm
Pedi: >160 bpm
Neo: >180 bpm
24 Specifications
ECG/Arrhythmia/ST Performance Specifications
Bandwidth
Bandwidth
Diagnostic Mode
Adult/neo/pedi: 0.05 to 150 Hz
Extended Monitoring Mode
Adult/neo/pedi: 0.5 to 150 Hz
Monitoring Mode
Adult: 0.5 to 40 Hz
Neo/pedi: 0.5 to 55 Hz
Filter Mode
Adult/neo/pedi: 0.5 to 20 Hz
Diagnostic Mode
Adult/neo/pedi: 0.05 to 40 Hz
when the ECG is transmitted from Extended Monitoring Mode
a telemetry device via short range Monitoring Mode
radio
Filter Mode
Adult/neo/pedi: 0.5 to 40 Hz
Adult: 0.5 to 40 Hz
Neo/pedi: 0.5 to 40 Hz
Adult/neo/pedi: 0.5 to 20 Hz
Differential 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 mV
Auxiliary Current
(Leads off Detection)
Active electrode: <100 nA
Reference electrode: <900 nA
Input Signal Range
±5 mV
ECG/Arrhythmia/ST/QT
Alarm Specifications
Range
Adjustment
HR
15 to 300 bpm
Adult:1 bpm steps (15 to 40 bpm)
5 bpm steps (40 to 300 bpm)
Pedi/Neo:1 bpm steps (15 to 50 bpm)
5 bpm steps (50 to 300 bpm)
maximum delay: 10 seconds
according to AAMI EC 13-1992
standard
Extreme Tachy
Difference to high limit 0 to
50 bpm
5 bpm steps
Clamping at 150 to 300 bpm
5 bpm steps
Difference to low limit 0 to
50 bpm
5 bpm steps
Clamping at 15 to 100 bpm
5 bpm steps
Run PVCs
None, fixed setting 2 PVCs
Not adjustable by user
PVCs Rate
1 to 99 PVCs/minute
1 PVC
Vent Tach HR
20 to 300 bpm
5 bpm
Vent Tach Run
3 to 99 PVCs/minute
1 PVC
Vent Rhythm Run
3 to 99 PVCs/minute
1 PVC
SVT HR
120 to 300 bpm
5 bpm
SVT Run
3 to 99 SV beats
1 SV beat
ST High
-19.8 to +20 mm
0.2 mm
ST Low
-20 to +19.8 mm
0.2 mm
STE Limit
-20 to +20 mm
0.2 mm
QTc High
200 ms to 800 ms
10 ms steps
ΔQTc High
30 ms to 200 ms
10 ms steps
Extreme Brady
299
24 Specifications
ECG/Arrhythmia/ST Supplemental Information as required by AAMI EC11/13, IEC 60601-2-27
Respiration Excitation Waveform
Sinusoidal signal, 260 μA, 40.5 kHz
Noise Suppression
RL drive gain 44 dB max., max. voltage 1.8 Vrms
Time to Alarm for Tachycardia Vent Tachycardia
1 mVpp,206 bpm
Gain 0.5, Range 6.5 to 8.4 seconds, Average 7.2 seconds
Gain 1.0 Range 6.1 to 6.9 seconds, Average 6.5 seconds
Gain 2.0, Range 5.9 to 6.7 seconds, Average 6.3 seconds
Vent Tachycardia
2 mVpp,195 bpm
Gain 0.5, Range 5.4 to 6.2 seconds, Average 5.8 seconds
Gain 1.0, Range 5.7 to 6.5 seconds, Average 6.1 seconds
Gain 2.0, Range 5.3 to 6.1 seconds, Average 5.7 seconds
Tall T-Wave Rejection Capability
Exceeds ANSI/AAMI EC 13 Sect. 3.1.2.1(c) minimum
recommended 1.2 mV T-Wave amplitude
Heart 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 seconds
HR change from 80 to 40 bpm:
Range: [5.6 to 6.4 sec] Average: 6.0 seconds
Heart Rate Meter Accuracy and Response to Irregular Rhythm
Ventricular bigeminy: 80 bpm
Slow alternating ventricular bigeminy: 60 bpm
Rapid alternating ventricular bigeminy: 120 bpm
Bidirectional systoles: 90 bpm
Accuracy of Input Signal Reproduction
Methods A and D were used to establish overall system error
and frequency response.
Pacemaker Pulse Rejection Performance
Rejection of pacemaker pulses with amplitudes from ±2 mV to
±700 mV and widths from 0.1 ms to 2.0 ms (Method A)
Pacemaker Pulse Rejection of fast ECG signals
2.2 V/s RTI (Paced Mode)
Minimum input slew rate
2.2 V/s RTI
Respiration
Respiration Performance Specifications
Respiration Rate
Range
Adult/pedi: 0 to 120 rpm
Neo: 0 to 170 rpm
Accuracy
at 0 to 120 rpm ±1 rpm
at 120 to 170 rpm ±2 rpm
Resolution
1 rpm
Bandwidth
0.3 to 2.5 Hz (-6 dB)
Noise
Less than 25 mΩ (rms) referred to the input
300
24 Specifications
Respiration Alarm
Specifications
Range
Adjustment
Delay
High
Adult/pedi: 10 to 100 rpm
Neo: 30 to 150 rpm
< 20 rpm: 1 rpm steps
≥ 20 rpm: 5 rpm steps
max. 14 seconds
Low
Adult/pedi: 0 to 95 rpm
Neo: 0 to 145 rpm
< 20 rpm: 1 rpm steps
≥ 20 rpm: 5 rpm steps
for limits from 0 to 20 rpm:
max. 4 seconds
for limits above 20 rpm: max.
14 seconds
Apnea Alarm
10 to 40 seconds
5 second steps
Respiration from the CL Respiration Pod
For 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.
cmResp Alarm Specifications
Range
Adjustment
Respiration Rate
5 to 60 rpm
<20 rpm: 1 rpm steps
>20 rpm: 5 rpm steps
Bradypnea
Difference to high limit 0 to 20 rpm
1 rpm steps
Clamping at 5 to 50 rpm
<20 rpm: 1 rpm steps
>20 rpm: 5 rpm steps
Pulse
30 to 220 bpm
30 to 40 bpm: 1 bpm steps
40 to 220 bpm: 5 bpm steps
Tachycardia
Difference to high limit 0 to 50 bpm
5 bpm steps
Clamping at 150 to 220 bpm
5 bpm steps
Difference to low limit 0 to 50 bpm
5 bpm steps
Clamping at 30 to 100 bpm
5 bpm steps
Bradycardia
SpO2
Complies with ISO 9919:2005 / EN ISO 9919:2009 (except alarm system; alarm system complies with
IEC 60601-2-49:2001).
Measurement Validation
The SpO2 accuracy has been validated in human studies against arterial blood sample reference
measured with a CO-oximeter. Pulse oximeter measurements are statistically distributed, only about
two-thirds of the measurements can be expected to fall within the specified accuracy compared to COoximeter measurements.
301
24 Specifications
Philips FAST SpO2 Performance Specifications
Philips FAST SpO2 Performance Specifications
SpO2
Range
The specified accuracy Accuracy
is the root-meansquare (RMS)
difference between the
measured values and
the reference values
0 to 100%
Philips Reusable Sensors:
M1191A, M1191AL, M1191B, M1191BL, M1192A, = 2% (70% to 100%)
M1193A, M1194A, M1195A, M1196A, 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%)
Pulse
Resolution
1%
Range
30 to 300 bpm
Accuracy
±2% or 1 bpm, whichever is greater
Resolution
1 bpm
Numeric Update Rate
Typical: 2 seconds, Maximum: 30 seconds. Maximum with NBP INOP suppression on: 60
seconds.
Sensors
Wavelength range: 500 to 1000 nm
Emitted Light Energy: ≤15 mW
Information about the wavelength range can be especially useful to clinicians (for instance,
when photodynamic therapy is performed)
Pulse Oximeter Calibration Range
302
70% to 100%
24 Specifications
Nellcor OxiMax Performance Specifications
Pulse Oximetry Performance Specifications
SpO2
Range
1 to 100%
The specified
accuracy is the rootmean-square (RMS)
difference between
the measured values
and the reference
values
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%)
Pulse
Low perfusion
accuracy5
2% (70 - 100%)
Resolution
1%
Range
25 to 300 bpm
Accuracy
+/- 3 bpm (25 to 250 bpm)
Low perfusion
accuracy5
+/- 3 bpm (25 to 250 bpm)
Resolution
1 bpm
Numeric update rate
typical 1 second, max ≤60 seconds
Sensors
Wavelength range: 500 to 1000 nm
Emitted Light Energy: ≤15 mW
Information about the wavelength range can be especially useful to clinicians (for instance,
when photodynamic therapy is performed)
1. 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.
303
24 Specifications
Nellcor 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 Specifications
SpO2 Alarm Specifications
Range
Adjustment
SpO2
Adult: 50 to 100%
Pedi/Neo: 30 to 100%
1% steps
Desat
Adult: 50% to Low alarm limit
Pedi/Neo: 30% to Low alarm limit
1% steps
Pulse
30 to 300 bpm
Adult:
1 bpm steps (30 to 40 bpm)
5 bpm steps (40 to 300 bpm)
Pedi/Neo:
1 bpm steps (30 to 50 bpm)
5 bpm steps (50 to 300 bpm)
Tachycardia
Difference to high limit 0 to 50 bpm
5 bpm steps
Clamping at 150 to 300 bpm
5 bpm steps
Difference to low limit 0 to 50 bpm
5 bpm steps
Clamping at 30 to 100 bpm
5 bpm steps
Bradycardia
SpO2 Alarm
Specifications (cont.)
Standard Delay
Smart Alarm Delay (alternative to standard alarm delay)
Short Mode
Medium mode
10 to 50 seconds
10 to 100 seconds +
+system alarm delay system alarm delay
SpO2 high and low limit
alarms
0 to 30 seconds (adjustable in
1 second steps) + system alarm
delay1
10 to 25 seconds +
system alarm delay
Desat
0 to 30 seconds (adjustable in
1 second steps) + system alarm
delay
not supported
Pulse
10 seconds + system alarm delay
Tachycardia
10 seconds + system alarm delay
Bradycardia
10 seconds + system alarm delay
Long Mode
1. Refer to “Monitor Performance Specifications” on page 293 for system alarm delay specification.
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SpO2 Smart Alarm Delay - Detailed Specifications
Deviation from violated
alarm limit
Resulting alarm delay according to selected mode
Short
Medium
Long
1%
25 seconds
(maximum delay)
50 seconds
(maximum delay)
100 seconds
(maximum delay)
2%
12 seconds
25 seconds
50 seconds
3%
10 seconds
16 seconds
33 seconds
4%
10 seconds
12 seconds
25 seconds
5%
10 seconds
10 seconds
20 seconds
6%
10 seconds
10 seconds
16 seconds
7%
10 seconds
10 seconds
14 seconds
8%
10 seconds
10 seconds
12 seconds
9%
10 seconds
10 seconds
11 seconds
>9%
10 seconds
10 seconds
10 seconds
NBP
Complies with IEC 60601-2-30:1999/EN60601-2-30:2000.
NBP Performance Specifications
Measurement Ranges
Systolic
Adult: 30 to 270 mmHg (4 to 36 kPa)
Pedi: 30 to 180 mmHg (4 to 24 kPa)
Neo: 30 to 130 mmHg (4 to 17 kPa)
Diastolic
Adult: 10 to 245 mmHg (1.5 to 32 kPa)
Pedi: 10 to 150 mmHg (1.5 to 20 kPa)
Neo: 10 to 100 mmHg (1.5 to 13 kPa)
Mean
Adult: 20 to 255 mmHg (2.5 to 34 kPa)
Pedi: 20 to 160 mmHg (2.5 to 21 kPa)
Neo: 20 to 120 mmHg (2.5 to 16 kPa)
Pulse Rate
Adult: 40 to 300 bpm
Pedi: 40 to 300 bpm
Neo: 40 to 300 bpm
Accuracy
Max. Std. Deviation: 8 mmHg (1.1 kPa)
Max. Mean Error: ±5 mmHg (±0.7 kPa)
Pulse Rate Measurement Accuracy
40 to 100 bpm: ±5 bpm
101 to 200 bpm: ±5% of reading
201 to 300 bpm: ±10% of reading
(average over NBP measurement cycle)
Pulse Rate Range
40 to 300 bpm
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24 Specifications
NBP Performance Specifications
Measurement Time
Typical at HR >60 bpm
Auto/manual/sequence:
Adult: 30 seconds
Neonatal: 25 seconds
Stat: 20 seconds
Maximum time:
Adult/pedi: 180 seconds
Neo: 90 seconds
Cuff Inflation Time
Typical for normal adult cuff: Less than 10 seconds
Typical for neonatal cuff: Less than 2 seconds
Initial Cuff Inflation Pressure
Adult: 165 ±15 mmHg
Pedi: 130 ±15 mmHg
Neo: 100 ±15 mmHg
Maximum Cuff Pressure
Adult/Pedi: 300 mmHg
Neo: 150 mmHg
Auto 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, 24h
STAT Mode Cycle Time
5 minutes
Venipuncture Mode Inflation
Inflation Pressure
Automatic deflation
after
Adult
20 to 120 mmHg (3 to 16 kPa)
Pediatric
20 to 80 mmHg (3 to 11 kPa)
Neonatal
20 to 50 mmHg (3 to 7 kPa)
Adult/pediatric
170 seconds
Neonatal
85 seconds
Measurement Validation: 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:
306
•
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.
24 Specifications
NBP Alarm Specifications
Range
Adjustment
Systolic
Adult: 30 to 270 mmHg (4 to 36 kPa)
10 to 30 mmHg: 2 mmHg (0.5 kPa)
>30 mmHg: 5 mmHg (1 kPa)
Pedi: 30 to 180 mmHg (4 to 24 kPa)
Neo: 30 to 130 mmHg (4 to 17 kPa)
Diastolic
Adult: 10 to 245 mmHg (1.5 to 32 kPa)
Pedi: 10 to 150 mmHg (1.5 to 20 kPa)
Neo: 10 to 100 mmHg (1.5 to 13 kPa)
Mean
Adult: 20 to 255 mmHg (2.5 to 34 kPa)
Pedi: 20 to 160 mmHg (2.5 to 21 kPa)
Neo: 20 to 120 mmHg (2.5 to 16 kPa)
NBP Overpressure Settings
Adult
>300 mmHg (40 kPa) >2 sec
Pediatric
>300 mmHg (40 kPa) >2 sec
Neonate
>150 mmHg (20 kPa) >2 sec
not user adjustable
Invasive Pressure and Pulse
Complies with IEC 60601-2-34:2000/EN60601-2-34:2000.
Invasive Pressure Performance Specifications
Measurement Range
Pulse Rate
-40 to 360 mmHg
Range
25 to 350 bpm
Accuracy
±1% Full Range
Resolution
1 bpm
Input Sensitivity
Sensitivity: 5 µV/V/mmHg (37.5 µV/V/kPa)
Adjustment range: ±10%
Transducer
Load Impedance: 200 to 2000 Ω (resistive)
Output Impedance: ≤3000 Ω (resistive)
Frequency Response
dc to 12 Hz or 40 Hz
Zero Adjustment
Gain Accuracy
Overall Accuracy
Range
±200 mmHg (±26 kPa)
Accuracy
±1 mmHg (±0.1 kPa)
Drift
Less than 0.1 mmHg/°C (0.013 kPa/°C)
Accuracy
±1%
Drift
Less than 0.05%/°C
Non linearity and
Hysteresis
Error of ≤0.4 %FS (@CAL 200 mmHg)
(including transducer)
±4% of reading or ±4 mmHg (±0.5 kPa), whichever is greater
Volume displacement of CPJ840J6
0.1 mm3 /100 mmHg
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24 Specifications
Invasive Pressure Alarm Specifications
Invasive Pressure Alarm
Range
Specifications
Pressure
-40 to 360 mmHg
(-5.0 to 48 kPa)
Adjustment
Delay
-40 to 50 mmHg
2 mmHg (0.5 kPa)
max. 12 seconds
>50 mmHg
5 mmHg (1 kPa)
Extreme High
Difference to high limit 0 to
25 mmHg
Extreme Low
Pulse
5 mmHg steps (0.5 kPa)
Clamping at -40 to 360 mmHg
5 mmHg steps (1.0 kPa)
Difference to low limit 0 to
25 mmHg
5 mmHg steps (0.5 kPa)
Clamping at -40 to 360 mmHg
5 mmHg steps (1.0 kPa)
25 to 300 bpm
Adult:
1 bpm steps (25 to 40 bpm)
5 bpm steps (40 to 300 bpm)
Pedi/Neo:
1 bpm steps (25 to 50 bpm)
5 bpm steps (50 to 300 bpm)
Tachycardia
Bradycardia
Difference to high limit 0 to
50 bpm
5 bpm steps
Clamping at 150 to 300 bpm
5 bpm steps
Difference to low limit 0 to
50 bpm
5 bpm steps
Clamping at 25 to 100 bpm
5 bpm steps
max. 14 seconds
max. 14 seconds
Temp
Complies with EN 12470-4:2000. Specified without transducer.
Temp Performance Specifications
Temp
Range
-1 to 45°C (30 to 113°F)
Resolution
0.1°C (0.2°F)
Accuracy
±0.1°C (±0.2°F)
Average Time Constant
Less than 10 seconds
Temp Alarm Specifications
Range
Adjustment
Temp 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) steps
30 to 45°C (86 to 113°F), 0.1°C (0.2°F) steps
308
24 Specifications
CO2
The 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 CO2
M3015A Microstream CO2 Performance Specifications
CO2
AwRR
IPI
Range
0 to 150 mmHg (0 to 20 kPa), or 20% CO2, whichever is lower
Accuracy
Up to 5 minutes during warmup: ±4 mmHg or 12%, whichever is greater
After 5 minutes warmup:
0 to 40 mmHg (0 to 5.3 kPa):±2.2 mmHg (±0.3 kPa)
Above 40 mmHg (5.3 kPa):±(5.5% + (0.08%/mmHg above 40 mmHg)) of
reading
These specifications are valid for 21% O2 and N2 balance, up to 35°C ambient
temperature, up to 60 rpm in adult mode and 100 rpm in neonatal mode.
Outside of these conditions the accuracy reaches at a minimum ±4 mmHg or
±12% of the reading, whichever is greater.
Resolution
Numeric: 1.0 mmHg (0.1 kPa)
Wave: 0.1 mmHg (0.01 kPa)
Stability
Included in Accuracy specifications
Range
0 to 150 rpm
Accuracy
0 to 40 rpm: ±1 rpm
41 to 70 rpm: ±2 rpm
71 to 100 rpm: ±3 rpm
>100 rpm: ±5% of reading
Range
1 to 10
Resolution
Warm-up Time
5 minutes for full accuracy specification
Rise Time
190 ms for neonatal mode
(measured with FilterLine H for neonatal)
240 ms for adult mode
(measured with FilterLine H for adult)
Sample Flow Rate
50 + 15/-7.5 ml/minute
Gas Sampling Delay
Time
Maximum:
3 seconds (2m sample lines)
6 seconds (4m sample lines)
Sound Pressure
Acoustic noise: <45 dBA
Total System Response
Time
The total system response time is the sum of the delay time and the rise time.
Microstream CO2 Humidity Correction Factor
Either BTPS or ATPD can be selected as the humidity correction factor for the Microstream CO2
readings. The formula for the correction calculation is:
where:
PBTPS = partial pressure at body temperature and pressure, saturated
309
24 Specifications
PATPD = partial pressure at ambient temperature and pressure, dry
M3014A Mainstream CO2
M3014A Mainstream CO2 Performance Specifications
CO2
awRR
Range
0 to 150 mmHg (0 to 20.0 kPa)
Accuracy
after 2 minutes warmup:
For values between 0 and 40 mmHg: ±2.0 mmHg (±0.29 kPa)
For values from 41 to 70 mmHg: ±5% of reading
For values from 71 to 100 mmHg: ±8% of reading
The specifications are valid for standard gas mixtures, balance air, fully hydrated at 35°C, Pabs =
760 mmHg, flow rate = 2 l/min.
Resolution
Numeric: 1.0 mmHg (0.1 kPa)
Wave: 0.1 mmHg (0.01 kPa)
Stability:
Short term drift
Long term drift
±0.8 mmHg over four hours
Accuracy specification will be maintained over a 120 hour period
Range
2 to 150 rpm
Accuracy
±1 rpm
Warm-up Time
2 minutes with CO2 transducer attached for full accuracy specification
Response Time
Less than 60 ms (with adult or infant reusable or disposable adapter)
M3014A Sidestream CO2
M3014A Sidestream CO2 Performance Specifications
CO2
awRR
Range
0 to 150 mmHg (0 to 20.0 kPa)
Accuracy
after 2 minutes warmup:
For values between 0 and 40 mmHg: ±2.0 mmHg (±0.29 kPa)
For values from 41 to 70 mmHg: ±5% of reading
For values from 71 to 100 mmHg: ±8% of reading
For values from 101 to 150 mmHg: ±10% of reading
At respiration rates above 80 rpm, all ranges are ±12% of actual. The specifications are valid for gas
mixtures of CO2, balance N2, dry gas at 760 mmHg within specified operating temperature range.
Resolution
Numeric: 1.0 mmHg (0.1 kPa)
Wave: 0.1 mmHg (0.01 kPa)
Stability:
Short term drift
Long term drift
±0.8 mmHg over four hours
Accuracy specification will be maintained over a 120 hour period
Range
2 to 150 rpm
Accuracy
±1 rpm
Warm-up Time
2 minutes with CO2 sensor attached for full accuracy specification
Sample Flow Rate
50 ±10 ml/minute
Total System Response Time
3 seconds
Operating Temperature
0 to 40°C (32 to 100°F)
310
24 Specifications
M8102A/M3014A Mainstream and Sidestream CO2 Humidity Correction Factor
Either BTPS or ATPD can be selected as the humidity correction factor for the CO2 readings. The
formula for the correction calculation is:
Where p = partial pressure, Pabs = absolute pressure, and PH2O = 42 mmHg @35°C and 100% RH.
CO2 Alarm Specifications
Alarm
Range
Adjustment
Delay
etCO2 High
20 to 95 mmHg (2 to 13 kPa)
1 mmHg (0.1 kPa)
etCO2 Low
10 to 90 mmHg (1 to 12 kPa)
M8102A/M3014A: less than 14 seconds
M3015A: less than 21 seconds.
imCO2 High
2 to 20 mmHg
(0.3 to 3.0 kPa)
steps of 1 mmHg (0.1 kPa)
M8102A/M3014A: less than 14 seconds
M3015A: less than 21 seconds.
awRR High
Adult/pedi: 10 to 100 rpm
Neo: 30 to 150 rpm
<20 rpm: 1 rpm steps
≥20 rpm:5 rpm steps
M8102A/M3014A/M3016A: less than 14 seconds
M3015A: less than 21 seconds.
awRR Low
Adult/pedi: 0 to 95 rpm
Neo: 0 to 145 rpm
M3015A:
settings ≤20 rpm: less than 8 seconds
>20 rpm: less than 21 seconds
M8102A/M3014A
settings ≤20 rpm: less than 4 seconds
>20 rpm: less than 14 seconds
IPI 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).
Interfering Gas and Vapor Effects On CO2 Measurement Values
The specified deviations for M8102A/M3014A are valid when the appropriate corrections are
switched on and set correctly.
M8102A/M3014A
M3015A
Gas or Vapor
Gas Level
(% volume fraction)
Nitrous Oxide
60%
±1 mmHg
±5%
Halothane
4%
±2 mmHg
±5%
Enflurane
5%
±2 mmHg
±5%
Additional deviation due to gas interference,
measured at 0 - 40 mmHg CO2
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
311
24 Specifications
Gas or Vapor
Gas Level
(% volume fraction)
Desflurane
15%
M8102A/M3014A
M3015A
Additional deviation due to gas interference,
measured at 0 - 40 mmHg CO2
+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%
Safety and Performance Tests
You must observe any national regulations on the qualification of the testing personnel and suitable
measuring and testing facilities. See the maintenance section for a list of required tests. Safety and
performance tests, and what to do if the instrument does not meet these specifications, are described
in the Service Guide.
Electromagnetic Compatibility (EMC) Specifications
Take special precautions regarding electromagnetic compatibility (EMC) when using medical electrical
equipment. You must operate your monitoring equipment according to the EMC information
provided in this book. Portable and mobile radiofrequency (RF) communications equipment can affect
medical electrical equipment.
Accessories Compliant with EMC Standards
All accessories listed in the accessories section comply, in combination with the monitor, with the
requirements of IEC 60601-1-2:2001 + A1:2004.
WARNING
Using accessories other than those specified may result in increased electromagnetic emission or
decreased electromagnetic immunity of the monitoring equipment.
Electromagnetic Emissions
The monitor is suitable for use in the electromagnetic environment specified in the table below. You
must ensure that it is used in such an environment.
Emissions test
Compliance
Avoiding Electromagnetic Interference
Radiofrequency (RF) emissions
Group 1
The monitor uses RF energy only for its internal function. Therefore, its RF
emissions are very low and are not likely to cause any interference in nearby
electronic equipment
RF emissions CISPR 11
Class A
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.
312
24 Specifications
Emissions test
Compliance
Avoiding Electromagnetic Interference
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), LAN
is 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.
1. excluding Nellcor OxiMax technology
Avoiding 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.
WARNING
The monitor should not be used next to or stacked with other equipment. If you must stack the
monitor, you must check that normal operation is possible in the necessary configuration before you
start monitoring patients.
Electromagnetic Immunity
The monitor is suitable for use in the specified electromagnetic environment. The user must ensure
that it is used in the appropriate environment as described below.
IEC 60601-1-2
test level
Compliance level
Electromagnetic environment guidance
Electrostatic discharge
(ESD)
IEC 61000-4-2
±6 kV contact
±8 kV air
±6 kV contact
±8 kV air
Floors should be wood, concrete, or
ceramic tile. If floors are covered with
synthetic material, the relative humidity
should be at least 30%.
Electrical fast transient/
burst
IEC 61000-4-4
±2 kV for power supply lines
±1 kV for input/output lines
±2 kV for power supply lines
±1 kV for input/output lines
Mains power quality should be that of a
typical commercial and/or hospital
environment
Surge
IEC 61000-4-5
±1 kV differential mode
±2 kV common mode
±1 kV differential mode
±2 kV common mode
Mains power quality should be that of a
typical commercial and/or hospital
environment
Voltage dips, short
interruptions and voltage
variations on power supply
input lines
IEC 61000-4-11
<5% UT (>95% dip in UT) for <5% UT (>95% dip in UT) for Mains power quality should be that of a
0.5 cycles
0.5 cycles
typical commercial and/or hospital
40% UT (60% dip in UT) for 40% UT (60% dip in UT) for environment. If the user of the monitor
requires continued operation during power
5 cycles
5 cycles
mains interruptions, it is recommended
70% UT (30% dip in UT) for 70% UT (30% dip in UT) for that the monitor is equipped with an
25 cycles
25 cycles
internal battery or is powered from an
<5% UT (>95% dip in UT) for <5% UT (>95% dip in UT) for uninterruptible power supply.
5 sec
5 sec
Immunity test
313
24 Specifications
Immunity test
Power frequency (50/
60 Hz) magnetic field
IEC 61000-4-8
IEC 60601-1-2
test level
Compliance level
Electromagnetic environment guidance
3 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
environment
In this table, UT is the a.c. mains voltage prior to application of the test level.
Recommended Separation Distance
WARNING
•
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:
Immunity test
IEC 60601-1-2
test level
Conducted RF
IEC 61000-4-6
3 Vrms
150 kHz to 80 MHz
Compliance level
Electromagnetic environment guidance
3 Vrms
Recommended separation distance:
(1 Vrms for respiration)
d = 1.2√P
for respiration:
d = 3.5√P
Radiated RF
IEC 61000-4-3
3 V/m
80 MHz to 2.5 GHz
3 V/m
Recommended separation distance:
(1 V/m for respiration)
80 MHz to 800 MHz: d = 1.2√P
For short range radio, see
note1.
80 MHz to 800 MHz for respiration: d = 3.5√P
800 MHz to 2,5 GHz: d = 2.3√P
800 MHz to 2,5 GHz for respiration: d = 7.0√P
2.0 to 2,3 GHz for short range radio: d = 7.0√P
314
24 Specifications
1. 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 equipment
The monitor is intended for use in an electromagnetic environment in which radiated RF disturbances
are controlled. The customer or user of the monitor can help prevent electromagnetic interference by
maintaining a minimum distance between portable and mobile RF communications equipment and the
monitor as recommended below, according to the maximum output power of the communications
equipment.
In the following table, P is the maximum output power rating of the transmitter in watts (W) according
to the transmitter manufacturer and d is the recommended separation distance in meters (m). The
values given in brackets are for respiration.
Frequency of
transmitter
150 kHz to 80 MHz
80 MHz to 800 MHz
800 MHz to 2,5 GHz
Equation
d = 1.2√P
d = 1.2√P
d = 2.3√P
for respiration:
for respiration:
for respiration:
d = 3.5√P
d = 3.5√P
d = 7.0√P
for short range radio in the range 2.0
to 2.3 GHz:
d = 7.0√P
Rated max. output
Separation distance
power of transmitter
Separation distance
Separation distance
0.01 W
0.1 (0.4) m
0.1 (0.4) m
0.2 (0.7) m
0.1 W
0.4 (1.1) m
0.4 (1.1) m
0.7 (2.2) m
1W
1.3 (3.5) m
1.3 (3.5) m
2.3 (7.0) m
10 W
3.8 (11.1) m
3.8 (11.1) m
7.3 (22.1) m
100 W
12.0 (35.0) m
12.0 (35.0) m
23.0 (70.0) m
Electrosurgery Interference/Defibrillation/Electrostatic Discharge
The equipment returns to the previous operating mode within 10 seconds without loss of any stored
data. Measurement accuracy may be temporarily decreased while performing electrosurgery or
defibrillation. This does not affect patient or equipment safety. Do not expose the equipment to x-ray
or strong magnetic fields (MRI).
315
24 Specifications
Fast Transients/Bursts
The 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 time
After a power interruption, an ECG wave will be shown on the display after 30 seconds maximum.
316
25
25
Default Settings Appendix
This appendix documents the most important default settings of your monitor as it is delivered from
the factory. For a comprehensive list and explanation of default settings, see the Configuration Guide
supplied with your monitor. The monitor's default settings can be permanently changed in
Configuration Mode.
NOTE
If your monitor has been ordered pre-configured to your requirements, the settings at delivery will be
different from those listed here.
Alarm and Measurement Default Settings
The default wave speed for all measurements except Respiration is 25 mm/sec. For Respiration the
default wave speed is 6.25 mm/sec.
In the following tables, settings may be entered only once per table row if they are the same for all
patient categories.
Alarm Default Settings
Alarm Settings
Factory Default H10/H20/H40
Alarm Volume
Alarms Off
2 min
Pause Al. 5min
Enabled
Pause Al. 10min
Enabled
Auto Alarms Off
Off
H30/H31 (deviations from H10/H20/
H40)
AlarmOffReminder
Off
Visual Latching
Red&Yellow
Red Only
Audible Latching
Red&Yellow
Off
Alarm Reminder
On
Reminder Time
3 min
Alarm Sounds
Traditional
RedAlarmInterval
10 sec
Yel.Al. Interval
20 sec
317
25 Default Settings Appendix
Alarm Settings
Factory Default H10/H20/H40
H30/H31 (deviations from H10/H20/
H40)
Alarm Low
Red Alarm Volume
AlarmVol. +2
Yell.AlarmVolume
AlarmVol. +0
INOP Volume
AlarmVol. +0
AutoIncrease Vol
2 Steps
IncreaseVolDelay
20 sec
Keep Blinking
No
Relay1 Sensitiv.
R&Y&C
Relay2 Sensitiv.
Red&Yellow
Relay3 Sensitiv.
Red
CyanRelayLatency
5 sec
Yel.RelayLatency
2 sec
Alarm Text
Standard
NoCentrMonMinVol
On
ECG, Arrhythmia, ST and QT Default Settings
ECG Settings
Factory Defaults
Adult
Pedi
Neo
High Limit
120 bpm
160 bpm
200 bpm
Low Limit
50 bpm
75 bpm
100 bpm
ECG/Arrhy Alarms
On
On
On
Alarm Source
Auto
Auto
Auto
ECG
On
On
On
QRS Volume
Primary Lead
II
II
II
Secondary Lead
Analysis Mode
Multi Lead
Multi Lead
Multi Lead
Lead Placement
Standard
Standard
Standard
Mod.LeadPlacment
Off
Off
Off
Filter
Monitor
Monitor
Monitor
AutoFilter
Off
Off
Off
Default ECG Size
Size x1
Size x1
Size x1
Color
Green
Green
Green
Asystole Thresh.
4.0 sec
4.0 sec
3.0 sec
Δ ExtrTachy
20 bpm
20 bpm
20 bpm
Tachy Clamp
200 bpm
220 bpm
240 bpm
Δ ExtrBrady
20 bpm
20 bpm
20 bpm
Brady Clamp
40 bpm
40 bpm
50 bpm
ECG Alm Off INOP
Cyan
Cyan
Cyan
318
25 Default Settings Appendix
ECG Settings
Factory Defaults
Adult
Pedi
Neo
Fallback
On
On
On
Alarms Off
Enabled
Enabled
Enabled
AlarmSource Sel.
Enabled
Enabled
Enabled
Va Lead
V2
V2
V2
Vb Lead
V5
V5
V5
SyncPulse Sensit
Medium
Medium
Medium
SyncPulse Marker
On
On
On
PulseAlarms Tele
Enabled
Enabled
Enabled
Arrhythmia Default Settings
Arrhythmia Settings
Factory Defaults
Adult
Pedi
Neo
Arrhythmia
On
On
Off
Pause Threshold
2.0 sec
2.0 sec
1.5 sec
VTach HR
100
120
150
VTach Run
Vent Rhythm
14
14
14
SVT HR
180
200
210
SVT Run
PVCs/min
10
Non-Sustain
On
On
On
Vent Rhythm
On
On
On
Run PVCs
On
On
On
Pair PVCs
On
On
On
R-on-T PVCs
On
On
On
V.Bigeminy
On
On
On
V.Trigeminy
On
On
On
PVCs/min
On
On
On
Multif.PVCs
On
On
On
Pacer n.Cap
On
On
On
Pacer n.Pac
On
On
On
Pause
On
On
On
Missed Beat
On
On
On
SVT
On
On
On
Afib
On
On
On
Irregular HR
On
On
On
HR Alarms
Short Yellow
Short Yellow
Short Yellow
TimeOut 1st
3 min
3 min
3 min
TimeOut 2nd
10 min
10 min
10 min
319
25 Default Settings Appendix
Arrhythmia Settings
Factory Defaults
Adult
Pedi
Neo
Cardiotach Msg
Yes
Yes
Yes
Some ECG Al INOP
On
On
On
ST and QT Default Settings
Lead-independent ST Settings
Factory Defaults
Adult
Pedi
Neo
ST Alarm Mode
Single ST
Single ST
Single ST
Alarms
On
On
On
ST Analysis
On
Off
Off
ST-Index
On
Off
Off
ISO Point
-80 ms
-80 ms
-80 ms
J Point
48 ms
48 ms
48 ms
ST Point
J+60
J+60
J+60
Lead I, II, III, V, aVR, aVL, V1-6, MCL
Settings
Factory Defaults
Adult
Pedi
Neo
On
Off
Off
ST (Label) High
+2.0 mm
+2.0 mm
+2.0 mm
ST (Label) Low
-2.0 mm
-2.0 mm
-2.0 mm
ST (Label) High
+1.0 mm
+1.0 mm
+1.0 mm
ST (Label) Low
+1.0 mm
+1.0 mm
+1.0 mm
Adult
Pedi
Neo
QT Lead
All
All
All
ST Analysis
For Alarm Mode = Single ST
For Alarm Mode = Multi ST
QT Settings
Factory Defaults
QTc High Limit
500 ms
480 ms
460 ms
ΔQTc High Limit
60 ms
60 ms
60 ms
QTc High Alarm
On
On
On
ΔQTc High Alarm
On
On
On
QT Analysis
Off
Off
Off
QTc Formula
Bazett
Bazett
Bazett
320
25 Default Settings Appendix
Pulse Default Settings
Factory Defaults
Pulse Settings
Adult
Pedi
Neo
Auto
Auto
Auto
Pulse (source label)
On
On
On
System Pulse
SpO₂
SpO₂
SpO₂
Alarms Off
Enabled
Enabled
Enabled
AlarmSource Sel.
Enabled
Enabled
Enabled
Alarm Source
Pulse Alarm Settings
Factory Defaults H10/H20/H40
Adult
Pedi
Neo
Pulse (SpO₂)
On
On
On
Pulse Alarms
Off
Off
Off
High Limit
120 bpm
160 bpm
200 bpm
Low Limit
50 bpm
75 bpm
100 bpm
Δ ExtrBrady
20 bpm
20 bpm
20 bpm
Brady Clamp
40 bpm
40 bpm
50 bpm
Δ ExtrTachy
20 bpm
20 bpm
20 bpm
Tachy Clamp
200 bpm
220 bpm
240 bpm
Pulse alarms use the settings of the currently selected Pulse alarm source.
Respiration Default Settings
Respiration Settings
Factory Defaults
Adult
Pedi
Neo
High Limit
30 rpm
30 rpm
100 rpm
Low Limit
8 rpm
8 rpm
30 rpm
Apnea Time
20 sec
20 sec
20 sec
Alarms
On
On
On
Resp
On
On
On
Auto
Auto
Auto
Yellow
Yellow
Yellow
Detection
Color
(Trigger Mode)
(Trigger Mode)
(Trigger Mode)
321
25 Default Settings Appendix
SpO2 Default Settings
SpO2 Settings
Factory Defaults
Adult
Pedi
Neo
Mode
Continuous
Continuous
Continuous
Repeat Time
15 min
15 min
15 min
Alarms
On
On
On
QRS Volume
Tone Modulation
Yes
Yes
Yes
Tone Mod. Type
Enhanced
Enhanced
Enhanced
Perfusion
On
On
On
Average
10 sec
10 sec
10 sec
NBP Alarm Suppr.
On
On
On
Extd. Auto OnOff
Disabled
Disabled
Disabled
Color
Cyan (light blue)
Cyan (light blue)
Cyan (light blue)
Average in Mon.
No
No
No
Signal Quality
On
On
On
Setting
Adult
Pedi
Neo
Desat Limit
80
80
80
Low Limit
90
90
85
High Limit
100
100
95
Desat Delay
20 sec
20 sec
20 sec
High Alarm Delay
10 sec
10 sec
10 sec
Low Alarm Delay
10 sec
10 sec
10 sec
SpO2 Alarm Default Settings
SmartAlarmDelay (SAD)
Off
Off
Off
High Alarm Delay (SAD)
Short
Short
Short
Low Alarm Delay (SAD)
Short
Short
Short
Label
SpO₂
SpO₂
SpO₂
On
On
On
Pulse settings
Pulse (SpO₂)
For all other Pulse default settings, refer to the Pulse Default Settings table.
NBP Default Settings
NBP Settings
Factory Defaults
Adult
Pedi
Neo
Mode
Auto
Auto
Manual
Alarms from
Sys.
Sys.
Sys.
High Limit
160/90 (110)
120/70 (90)
90/60 (70)
322
25 Default Settings Appendix
NBP Settings
Factory Defaults
Adult
Pedi
Neo
Low Limit
90/50 (60)
70/40 (50)
40/20 (24)
Alarms
On
On
On
NBP
On
On
On
Repeat Time
10 min
10 min
10 min
Pulse (NBP)
On
On
On
Unit
mmHg
mmHg
mmHg
Done Tone
Off
Off
Off
Start Time
Synchronized
Synchronized
Synchronized
VP Pressure
60 mmHg
40 mmHg
30 mmHg
Reference
Auscultatory
Auscultatory
Invasive
Color
Red
Red
Red
Adult
Pedi
Neo
Low Limit
36
36
36
High Limit
39
39
39
Alarms
On
On
On
Temperature Default Settings
Temp Settings
Factory Defaults
Unit
°C
°C
°C
Range
35...43
35...43
35...43
Color
Green
Green
Green
Invasive Pressure Default Settings
ABP, ART, Ao, BAP, FAPP,P P1, P2, P3, P4, UAP
Factory Defaults
Settings
Adult
Pedi
Neo
Alarms 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
On
Extreme Alarms
Disabled
Disabled
Disabled
Δ Extreme High
15
10
Δ Extreme Low
15
10
Sys. 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
100
Mean only
No
No
No
Filter
12 Hz
12 Hz
12 Hz
323
25 Default Settings Appendix
ABP, ART, Ao, BAP, FAPP,P P1, P2, P3, P4, UAP
Factory Defaults
Settings
Adult
Pedi
Neo
Mercury Cal
Yes
Yes
Yes
Artifact Suppr.
60 sec
60 sec
60 sec
Unit
mmHg
mmHg
mmHg
Color
Red
Red
Red
Adult
Pedi
Neo
Alarms from
Mean
Mean
Mean
High Limit
14/6 (10)
10/2 (4)
10/2 (4)
Low Limit
6/-4 (0)
2/-4 (0)
2/-4 (0)
Alarms
On
On
On
CVP, RAP, LAP, UVP Settings
Factory Defaults
Extreme Alarms
Enabled
Enabled
Enabled
Δ Extreme High
Δ Extreme Low
Mean 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
30
Mean only
Yes
Yes
Yes
Filter
12 Hz
12 Hz
12 Hz
Mercury Cal
Yes
Yes
Yes
Artifact Suppr.
60 sec
60 sec
60 sec
Unit
mmHg
mmHg
mmHg
Color
Cyan (light blue)
Cyan (light blue)
Cyan (light blue)
Adult
Pedi
Neo
Alarms from
Dia.
Dia.
Dia.
High Limit
34/16 (20)
60/4 (26)
60/4 (26)
Low Limit
10/0 (0)
24/-4 (12)
24/-4 (12)
Alarms
On
On
On
Extreme Alarms
Enabled
Enabled
Enabled
Δ Extreme High
Δ Extreme Low
Dia. 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
30
PAP Settings
Factory Defaults
Mean only
No
No
No
Filter
12 Hz
12 Hz
12 Hz
Mercury Cal
Yes
Yes
Yes
Artifact Suppr.
60 sec
60 sec
60 sec
324
25 Default Settings Appendix
PAP Settings
Factory Defaults
Adult
Pedi
Neo
Unit
mmHg
mmHg
mmHg
Color
Yellow
Yellow
Yellow
Adult
Pedi
Neo
Alarms from
Mean
Mean
Mean
High Limit
14/6 (10)
10/2 (4)
10/2 (4)
Low Limit
6/-4 (0)
2/-4 (0)
2/-4 (0)
Alarms
On
On
On
Extreme Alarms
Enabled
Enabled
Enabled
Δ Extreme High
10
10
10
Δ Extreme Low
10
10
10
Mean 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
30
Mean only
Yes
Yes
Yes
Filter
12 Hz
12 Hz
12 Hz
Mercury Cal
Yes
Yes
Yes
Artifact Suppr.
60 sec
60 sec
60 sec
ICP, IC1, IC2 Settings
Factory Defaults
Unit
mmHg
mmHg
mmHg
Color
Magenta
Magenta
Magenta
CO2 Default Settings
CO2 Settings
Factory Defaults
Adult
Pedi
Neo
etCO₂ Low
25
25
25
etCO₂ High
60
60
60
imCO₂ High
CO₂ Alarms
On
On
On
Unit
mmHg
mmHg
mmHg
Scale
50 mmHg
50 mmHg
50 mmHg
imCO₂
On
On
On
N₂O Corr. (only M3015A/M3016A)
Off
Off
Off
Oxygen Corr. (only M3014A)
20%
20%
20%
Gas Corr. (only M3014A)
Off
Off
Off
Humidity Corr.
BTPS
BTPS
BTPS
Max Hold
20 s
20 s
20 s
awRR
On
On
On
325
25 Default Settings Appendix
CO2 Settings
Factory Defaults
Adult
Pedi
Neo
awRR Alarms
On
On
On
High Limit (awRR)
30
30
60
Low Limit (awRR)
30
Apnea Time
20 sec
20 sec
20 sec
Color
Yellow
Yellow
Yellow
326
1
10-lead placement (ECG) 115
12-lead placement (ECG) 115
3-lead placement (ECG) 113
5-lead placement (ECG) 113
AAMI ECG lead labels 112
abdominal breathing 162
and Resp electrode placement 162
aberrantly conducted beats 130
accessories
10-electrode cable sets 263
3-electrode cable sets 262
5-electrode cable sets 262
5-electrode one piece cables 264
6-electrode cable sets 262
CO2 209
CO2 (mainstream) 279
ECG 105
NBP 183
adult cuffs 266
comfort cuffs 264
disposable cuffs 266
multi-patient comfort cuff kits 264
neonatal/infant cuffs (single
patient) 267
reusable cuffs 264
single patient, adult/pediatric soft
cuffs 266
Pulsion 270
resp 261
set combiners and organizers 263, 264
trunk cables 261
active alarms 47
address, Philips 284
addressograph (printer configuration
setting) 242
adjusting ST measurement points 143
adjusting wave scale (pressure) 199
adjusting wave size (CO2) 210
admitting a patient
quick admit 88
airway adapter 209
CO2, microstream accessory 209
alarm latching 58, 59, 135
alarm limits 54, 56
checking 54
narrow 56
report 221
ST 139
switching auto limits on/off 56
using automatic limits 56
wide 56
alarm source selection, disabled 159
alarms 47
active 47
alphabetical listing 61
apnea delay time (Resp) 164
arrhythmia 129
awrr limits 212
chaining 137
CO2, awRR 212
desat, SpO2 181
effect on pressure alarms during
zero 196
high priority 47
INOP 47
ISO/IEC standard 50
limit, SpO2 301
patient messages 61
physiological 61
recordings 60
red 47
selftest 59
SpO2 specific 176
ST 146
testing 59
tone configuration 49
traditional 50
yellow 47
alphabetical listing of alarms 61
analog output
ECG 105
apnea alarm delay
CO2 209
apnea alarm delay time (Resp) 164
apnea alarms 164
and Resp detection modes 163
arrhythmia 129
aberrantly conducted beats 130
analysis, how it works 129
atrial fibrillation and flutter 130
beat labels 131
initiating learning 134
intermittent bundle branch block 131
learning during ventricular rhythm 134
levels of analysis 123, 129
monitoring non-paced patients 129
Index
monitoring paced patients 129
options 129
relearning 134
relearning and lead fallback 134
status messages 132
switching on/off 56
understanding the display 131
arrhythmia alarms 47, 135, 137, 139, 298
adjusting alarm limits 136
all yellow on/off 136
chaining 137
latching 58, 59
multiple 137
PVC-related alarms 139
sinus and SV rhythm ranges 300, 301
switching on/off 56
timeout periods 136
arrhythmia monitoring 127
and defibrillation 127
arrhythmia options 123
arrhythmia relearning 122
with EASI INOP 122
arterial pressure source 201
artifact suppression (pressure) 199
atrial fibrillation and flutter 130
audible latching (arrhythmia alarms) 135
auto alarm limits 56
switching on/off 56
auto detection mode (Resp) 163
automatic arrhythmia relearn 134
automatic default setting 31
automatic NBP
repeat time 186
autosize 109
ECG wave 109
awRR alarm 212
limits 212
awRR alarms 212
CO2 209
baseline 150
ST map, updating 150
basic arrhythmia option 123, 129
battery 249, 252, 253, 255, 285
and display brightness 255
battery reports 252
charge status 252
conserving power 255
327
indicators 47
malfunction indicator 250
monitoring time 250
safety information 127, 164
status indicator 250
symbol 285
time to empty 251
time to full 251
battery eject symbol 285
battery performance 254
optimizing 254
beat labels 131
arrhythmia 129
blood pressure. See also NBP (noninvasive) or PRESS (invasive) 183
calculating cerebral perfusion 201
calculating temperature difference 192
calibrating 190
calibration 190, 197
NBP 183
pressure transducer 197
cardiac overlay 162, 163
and Resp detection modes 163
when measuring Resp 162
cardiotach alarms 123
cerebral perfusion 201
chaining 137
change screen window 29
changing ECG lead sets 112
changing Resp detection mode 163
changing Resp wave size 164
changing Resp wave speed 164
checking battery charge 252
cleaning 245
infection control 245
monitoring accessories 247
CO2 209
airway adapter 209
alarms, awRR 212
awRR alarm limits 212
correction, humidity 211
correction, N2O 211
corrections 211
FilterLine 209
measuring microstream 209
microstream accessories 209
microstream extension 209
removing exhaust gases 208, 210
wave scale, adjusting 210
CO2 (mainstream) 279
connecting temperature probe 191
connection direction symbol 285
328
connectors 287
conventional 12-lead ECG 116
correcting the NBP measurement 185
CPAP (RESP) 163
cuff 185, 186
pressure, NBP 186
selection, NBP 185
current view
ST map 147
DC power symbol 285
default profile 31
default settings 317
defibrillation 127
and arrhythmia monitoring 127
and ECG monitoring 127
defibrillator proof symbol 285
desat alarm, SpO2 181
detection modes (Resp) 163
disinfecting 245
infection control 245
display 131, 141, 162, 186
arrhythmia 129
ECG 105
NBP 183
Resp 162
ST 139
display brightness 255
display settings 30
dual Temp measurement 192
dyshemoglobins 173
intravascular (SpO2) 173
early systolic blood pressure, NBP 186
EASI 122
ECG monitoring 122
lead placement 161
EASI ECG lead labels 112
ECG 105
alarms off (Config Mode) 126
changing lead sets 112
choosing electrode sites 111
conventional 12-lead 116
external pacing electrodes 127
fusion beat pacemakers 127
intrinsic rhythm 127
modified 12-lead 116
New Lead Setup 112
pacemaker failure 127
rate adaptive pacemakers 127
wave size 109
ECG cable 127
for operating room 127
ECG cables, connecting 105
ECG connector 105
ECG electrode colors 112
ECG electrode placement 127
during electrosurgery 127
ECG gain 236
ECG lead labels 112
ECG leads monitored 112
ECG report 236, 243
lead layout 236
ECG safety information 127
ECG source tracking 101
ECG wave 109
autosize 109
calibration bar 109
ectopic status messages (arrhythmia
monitoring) 133
electrical output symbol 285
electrode placement (ECG) 105, 116
conventional 12-lead 116
modified 12-lead 116
electrode placement (Resp) 161, 162
with abdominal breathing 162
with lateral chest expansion 162
electrosurgery 127
and ECG 127
EMC interference 164
Resp 162
end case reports 237
enhanced arrhythmia option 123, 129
exclamation mark symbol 285
exhaust gases, removing 208, 210
external pacing electrodes 127
and ECG monitoring 127
extreme bradycardia alarm 125
extreme rate alarms 125
extreme tachycardia alarm 125
fallback (ECG) 112
FilterLine 209
CO2, microstream accessory 209
flushing invasive pressure accessories 193
fusion beat pacemakers 127
and ECG monitoring 127
gas cylinder
empty, disposing of 259
getting started 37
global trend time 228
H
horizon trend 228
trend time 228
HR = RR (Resp) 162
HR alarms 127
when arrhythmia off 127
HR alarms off (Config Mode) 126
HR and pulse alarm source selection 159
humidity correction 211
CO2 209
IEC ECG lead labels 112
IMV (Resp) 163
indicators 47
battery malfunction 250
infection control 245
disinfecting 245
Information Center 93
central recording 231
transferring patients 93
INOPs 47
indicators 47
installation
connectors 287
intermittent bundle branch block 131
intermittent mandatory ventilation
(Resp) 163
interruption symbol 285
intravascular dyshemoglobins (SpO2) 173
intrinsic rhythm 127
ISO point (ST) 144
J point (ST) 144
keyboard, on screen 27
keys 27
alarms 47
pop-up 27
latching 58, 59
alarms 47
alarms, behavior 59
latching arrhythmia alarms 135
lateral chest expansion (neonates) 162
monitoring Resp 162
lead fallback 134
and arrhythmia relearning 134
lead fallback (ECG) 112
lead labels (ECG) 112
lead placement 161
for Resp measurement 161
leads monitored (ECG) 112
Leads Off INOP (ECG) 112
levels of arrhythmia analysis 129
main setup 25
maintenance 257
schedule 257
malfunction symbols
battery 252, 255
manual detection mode (Resp) 163, 164
and apnea alarms 164
manufacture date symbol 285
manufacturer's information 284
map 147
ST 139
Mason-Likar lead system 116
measurement points, ST 143
measurement server
ECG connector 105
measurement settings 30
measurement setup menu 24
measurements 32, 38
menu 24, 25
main setup 25
measurement setup 24
messages
INOP 47
methemoglobin (SpO2) 173
microstream CO2 209
modified 12-lead ECG 116
monitor defaults 317
monitor revision 37
how to find 37
monitoring
starting 37
N2O correction 211
CO2 209
narrow alarm limits 56
NBP 183
adult cuffs 266
ANSI/AAMI SP10-1992 183
calibrating 190
comfort cuff kits 264
comfort cuffs 264
cuff pressure 186
cuff, applying 185
cuff, selecting 185
cuff, tightness 185
disposable cuffs 266
how the measurement works 183
measurement correction 185
measurement limitations 184
measurement methods, auto 184
measurement methods, manual 184
measurement methods, sequence 184
measurement methods, stat 184
neonatal cuffs (disposable) 267
numerics 186
oscillometric method 183
pediatric cuffs 266
preparing to measure 185
repeat time 186
reusable cuffs 264
single patient, adult/pediatric soft
cuffs 266
site inspection 173
time of last measurement 186
units 186
venous puncture 190
neonates 162
Resp electrode placement 162
new features 41
non-invasive blood pressure. See NBP 183
non-paced patients 129
arrhythmia monitoring 127
numerics 186
explanation of NBP display 186
on-screen keyboard 27
operating room ECG cable 127
orange ECG cable 127
organizers 263, 264
oscillometric NBP measurement
method 183
overlapping screen trends 228
pace pulse rejection (ECG) 106, 108
about 31
switching on/off 56
paced patients 109, 127, 129
arrhythmia monitoring 127
repolarization tails 109
safety information 127, 164
setting status 127
paced status
checking 54
pacemaker failure 127
parameter scales 226
patient 183
category, NBP 183
329
patient alarm messages 61
patient reports 242
contents 242
performance specifications 298
performance test 312
perfusion indicator 173, 181
Philips contact information 284
physiological alarms 47
pleth wave 181
pop-up keys 27
preparing skin 105
for ECG 105
pressure
alarms during zero 196
arterial source 201
calibration pressure 197
cerebral perfusion, calculating 201
performance specifications 298
wave scale 199
wave size 109
pressure accessories 270
pressure artifact suppression 199
pressure of NBP cuff 186
pressure transducer 197
calibration 190, 197
print job 239
suspended 239
printer 238, 239, 241
settings 31, 101, 317
status messages 132
unavailable 239
printing 235
ST map reports 150
probes 191
disposable temperature 191
profiles 30, 31
default profile 31
patient category 30
swapping a complete profile 31
pulse 157, 158
alarms 47
system pulse source 157
pulse numerics for SpO2 173
PVC-related alarms 139
QRS volume, changing 110
QT alarms 155
QT baseline 155
QT measurement algorithm 152
QT monitoring 153
limitations 153
QT/QTc monitoring 152
330
quick admit 88
radiated field immunity 164
Resp 162
rate adaptive pacemakers 127
and ECG monitoring 127
recording
preventing fading ink 233
recording alarms 60
relearning arrhythmia 134
repolarization tails 109
reports 235
alarm limits 54, 56
battery reports 252
contents 242
ECG 105
re-routing 239
scheduled 237
ST map 147
stopping printouts 236
re-routing reports 239
resp accessories 261
Resp alarms 164
apnea alarm delay time 164
Resp detection level 164
and apnea detection 164
Resp detection modes 163
and cardiac overlay 162
Resp display 162
Resp monitoring 162
and cardiac overlay 162
Resp safety information 164
Resp wave 164
changing size 164
rhythm status messages (arrhythmia
monitoring) 132
safety information 127, 164
batteries 256
ECG 105
Resp 162
safety test 312
safety tests
visual inspection 257
scale 109, 164
ECG wave 109
Resp wave 164
scales 226
for trends waveforms 226
scheduled reports 237
screen trend 228
trend time 228
selftest 59
alarms 47
sequence mode 189
set combiners 263, 264
setting up the sequence 189
settings 31, 101, 317
about 31
default 317
screen settings 31
synchronized telemetry and
monitor 101
settings blocks 30
short yellow alarms on/off 136
signal quality of SpO2 175
sinus and SV rhythm ranges 300, 301
skin preparation 105
ECG 105
SmartKeys symbol 285
source tracking 101
ECG 105
specifications 298
arrhythmia 129
SpO2
alarms specific to SpO2 176
assessing suspicious reading 175
perfusion indicator 173, 181
pleth wave 181
pulse numerics 173
signal quality 175
site inspection 173
site selection 172
SpO2 desat alarm 181
ST 139
adjusting alarm limits 136
alarms 47
ensuring diagnostic quality 139
filtering 139
measurement points, adjusting 143
snippets 141
ST display 141
ST map 147
report, printing
printing 235
ST map report 150
scale, changing 150
scale 109, 164
ST map 147
task window 150
trending interval, changing 150
trending priority 150
ST maps 147
ST point 144
standard 10-lead placement 115
standard 3-lead placement 113
standard 5-lead placement (ECG) 113
standby symbol 285
status log
printing 235
status messages 132
printer 238, 239, 241
status messages (arrhythmia) 132, 133
ectopic 133
rhythm 132
sterilizing 245
infection control 245
stopping reports printouts 236
surgical ECG cable 127
suspicious SpO2 reading 175
symbols 285
battery 252, 255
system pulse 157
systolic blood pressure, NBP, early 186
Tamb 192
task window for ST map 150
Tcereb 192
telemetry alarms 101
suspending at bedside 101
telemetry device
unpairing 218
temperature
alarm settings 191
connecting probe to monitor 191
difference, calculating 192
dual Temp measurement 192
extended label set 192
first 192
making a measurement 191
probe, disposable 191
probe, selecting 191
second 192
temperature probe 191
testing alarms 59
tone configuration, alarm 49
transferring centrally-monitored
patients 93
transport brightness setting 255
trend time 228
global 228
trend view
ST map 147
trending interval 150
ST map 147
trends
setting parameter scales 226
trends pop-up keys 221
trends priority list
ST map 147
troubleshooting
CO2 209
trunk cables 261
Ttymp 192
Tvesic 192
unpairing 218
V electrode placement (ECG) 115
venous puncture 190
visual latching (arrhythmia alarms) 135
wave 199, 210
scale (CO2) 210
scale (pressure) 199
size (CO2) 210
size (pressure) 199
wave size 109
Resp 162
wave size (ECG) 109
wave speed (Resp) 164
what's new 41
wide alarms limits 56
wired network connection symbol 285
zero 196
effect on pressure alarms 196
zeroing
pressure transducer 197
331
332
Part Number 453564547171
Published in Germany 04/2015
*453564547171*

---

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